Preferential distribution of inhbititory cardiac receptors in left ventricle of the dog. The purpose of this study was to determine the relative magnitudes of the reflex effects mediated by sensory endings in the left ventricle activated by intracoronary injection of nicotine or veratridine into left anterior descending (LAD) or circumflex (Cx) coronary arteries in the dog. Injection of nicotine or veratridine into the Cx consistently resulted in larger decreases in heart rate, arterial pressure, and in gracilis perfusion pressure than were observed following injection of the same dose into the LAD. Vagotomy abolished the cardioinhibitory and vasodepressor responses to intracoronary nicotine or veratridine. The weight of left ventricle perfused by LAD or Cx was not different (43.5 +/- 1.65 and 44.5 +/- 2.2 g, respectively. These data indicate that chemical activation of sensory endings with vagal afferents in the inferoposterior left ventricle of the dog results in larger cardionhibitor and vasodepressor responses than result from activation of respects in the anterior left ventricle. Further, these data provide strong evidence that these sensory endings which are chemically activated are preferentially distributed to the inferoposterior left ventricle.


Transplacental gradients in the guinea pig. We measured plasma concentrations of Na+, K+, Mg2+, Cl-, Ca2+, HCO3-, phosphate, lactate, glucose, total amino acids, and total protein, and also the total (freezing point depression) osmolality and the colloid osmotic pressures. Conversion of chemically measured concentrations to osmolalities showed that unrecognized solute (s) were present in maternal (7 mM) and fetal (12 mM) plasma. Statistically reliable transplacental gradients existed only for calcium ion, phosphate, and amino acids, Ionic Na, K Mg, Cl, Ca, HCO3 and lactate were in electrochemical equilibrium at potential differences of -4.2 to +1.3 mV. Total plasma osmolalities were not significantly different in maternal and fetal plasmas in preparations in good condition, but fetal plasma osmolalities rose due to lactate secretion in asphyxiated fetuses. Colloid osmotic pressures were about 5 cmH2O higher in maternal plasmas before 45 days gestation and about 6 cmH2O higher in fetal plasmas after 60 days gestation. In the guinea pig, colloid osmotic pressures are at least as important as intravascular pressures in the regulation of transplacental water flow.


Influence of tris on contracile responses of isolated rat aorta and portal vein. The influence of tris(hydroxymethyl)-aminomethane (Tris) on the spontaneous mechanical activity (SMA) and agonist-induced contractile responses of rat portal vein and aorta was investigated. Tris, in a concentration-dependent manner (5, 10, and 30 mM), significantly increased frequency and attenuated amplitude of SMA in portal vein. Tris, in all concentrations, abolished spontaneous activity of aorta. Tris (5 mM) attenuated epinephrine-, angiotensin-, and potassium-induced contractile responses in portal vein and in aorta: the vein responses exhibited the greater sensitivity to Tris inhibition. In the presence of Tris, agonist dose-response curves were shifted to the right, concomitant with a reduction in maximum tension in portal vein. In contrast, in aorta, only a rightward shift of the dose-response curves was observed, withour any change in maximum tensions in the presence of Tri. Tris (5 mM) depressed contractions induced by calcium in potassium-depolarized aortic and venous smooth muscle. These results suggest that Tris may interfere with the binding, translocation, and utilization of calcium ions at or beyond the membrane in venous smooth muscle and at the membrane in aortic smooth muscle.


Response of cultured myocardial cells to countershock-type electric field stimulation. Myocardial cells isolated from 8-day chick embryos were grown in monolayer culture under conditions that produce "standard embryonic" and "adult-type" cells. These cells were subjected to electric field stimulation that had a waveshape and intensities similar to those used in clinical electric countershock procedures. Photocell mechanograms obtained before, during, and after stimulation were correlated with simultaneously measured transmembrane potentials to determine the relationship between membrane polarization and arrhythmia production that occured after the stimulus. The results of these experiments demonstrate that a predictable sequence of mechanical responses occurs after stimuli ranging in intensity from 6 to 200 V/cm. This sequence, which closely resembles that observed in vivo after similar stimulation intensities, consists of a single response (activation), tachyarrhythmia, relaxed arrest followed by transient tachyarrhythmia, arrest with contracture, and cellular fibrillation. This diverse pattern of arrhythmias is associated with a prolonged depolarization of the cell membrane which increases with the intensity of the applied stimulus. It is probable that this depolarization is caused by a transient electromechanical deformation of the cell membrane during the shock. These findings contribute to a better understanding of the causes of the arrhythmias that appear after clinical and experimental electric countershock procedures.


Left and right ventricular dimensions during ventricular fibrillation in the dog. Ventricular dimensions by surface echocardiography and intraventricular pressures were monitored in 27 dogs before and during ventricular fibrillation (VF) induced by coronary embolization (nine dogs), potassium infusion (nine dogs) and calcium infusion (nine dogs). Left ventricular diameter (LVD) fell by an average of 10.3 mm during the first 30 s after the onset of VF induced by ischemia or potassium and remained smaller than the prefibrillation end-diastolic LVD during the ensuing 10 min. LVD fell during calcium infusion, and after the onset of VF it remained only slightly larger than the preinfusion end-systolic LVD. Right ventricular (RV) diameter increased progressively for the first 2 min during VF an average of 15.9 mm. The failure of LV size to increase during VF was explained by a pressure gradient inhibiting LV filling during the early phase of VF. Despite progressive RV filling, pressure in the more compliant RV remained lower than in the LV, which exhibited reduced compliance during VF. Therefore, cardiac dilation during VF appears to be confined to the RV, and inhibition to LV filling is an important feature of the syndrome.


Androgen-mediated sex differences of cardiovascular responses in rats. Sex differences in the systemic depressor response to arachidonic acid (50 or 150 microgram/kg iv) were observed in intact and castrated anesthetized Sprague-Dawley rats. The rank order of responsiveness was: castrate males, castrate females, females, males; all four groups were significantly different (P less than 0.05) at the higher dose. Castrated males pretreated with testosterone (1 mg/kg sc) 5 or 7 days previously gave a response at the higher arachidonate dose levels that was of the same order as that obtained with intact males. Similar treatment of castrate males with androgen potentiated (P less than 0.05) the vasopressor action of norepinephrine (0.25 microgram/kg) on day 7 after the testosterone pretreatment. In contrast, treatment with depot estradiol (100 microgram/kg sc) in castrate males produced no significant change in the response to either of the vasoactive compounds on both days 5 and 7 after pretreatment. These data suggest that testosterone may be a significant factor in the development of sex differences in the cardiovascular systems of rats.


Regional variations in calculated diastolic wall stress in rat left ventricle. Principal radii of curvature and wall thickness were measured at the apex and three other loci on the free wall of the left ventricle in 16 rat hearts that had been fixed at end-diastolic pressure. The law of Laplace was applied to calculate the mean tensile stress at each locus. No significant variation was found among the nonapical loci, but apical stress was approximately twice the stress calculated for any nonapical locus. The higher stresses that must be borne by the apex may be a predisposing factor for apical aneurysm in certain cardiomyopathies such as Chagas' disease. These higher stresses may also help to promote apical aneurysms in patients with ischemic heart disease.


Effect of velocity of distribution on red cell distribution in capillary blood vessels. Through the use of simulated model experiments, data on blood cell distribution into a bifurcating capillary blood vessel are obtained. The results show that the movement of red blood cells at a bifurcation point is influenced by the difference in velocities of flow in the daughter branches. If the velocity of flow in one branch is slower than that in the other, the hematocrit decreases in the slower branch and increases in the faster branch. For velocity ratios sufficiently smaller than a certain critical value, the hematocrit ratio can be expressed by a linear relationship, (H1/H2) - 1 = a[v1/v2) - 1], in which v1,  v2 and H1 H2 denote the particle velocities and tube hematocritis in the branches 1 and 2, respectively, and a is a dimensionless contant dependent upon a number of factors, the most important of which are the ratio of cell diameter to tube diameter, the shape and rigidity of the pellets, and the hematocrit in the feeding tube. For velocity ratios beyond a critical value, nearly all the cells flow into the faster branch. The smaller the feeding-tube hematocrit is, the smaller is the critical velocity ratio at which this phenomenon occurs.


Physician importation--a solution to developing countries' rural health care problems? Developing countries almost universally suffer from severe health service shortages, particularly in rural areas. Manpower problems are the most critical aspect of the shortages. Iran has recently begun a massive program to increase physician supply in its rural areas by importation of physicians from India, Pakistan, and the Philippines. The present study investigated two questions: What  are physicians' reasons for accepting a post in a rural area of another country, and what are the attitudes of residents in such rural areas toward foreign physicians? Results of a questionnaire survey of foreign physicians indicate that the most common reasons for physician acceptance of the posts were higher salaries and the desire to go eventually to a Western country. Results of an interview survey of Iranian consumers indicate that residents of rural areas were far more likely to prefer Iranian auxiliaries than non-Iranian physicians.


A longitudinal study of military performance subsequent to civilian drug use. This study evaluates the military performance of soldiers who were identified by the Army's urine screening program as having used drugs at the time they reported for active duty. The study used prospectively defined cohorts of large size (over 1,600 urinalysis positive and over 2,400 urinalysis negative entering males) and used longitudinal outcome measures drawn from existing medical and personnel files. The major findings are that the urinalysis positive individuals were significantly more likely not to complete their tour of duty, were more likely to be hospitalized, and had more bed-days per hospitalization than their urinalysis negative fellow soldiers. In terms of cohorts entering the Army, however, minimal improvement in outcome was found by considering an entirely drug-free cohort (obtained by omitting the urinalysis positive individuals) compared to a random cohort which contained positives at the then current prevalence of 2 per cent.


Planning a food and nutrition surveillance system: the example of Honduras. A description of the preliminary steps in establishing a food and nutrition surveillance system in a country of Central America is presented in outline. The system will provide the basis for policy formulation, program planning, and evaluation. It is organized on the basis of the participation and resources of seven national agencies and will operate at the local, regional, and central level.


School achievement: risk factor in teenage pregnancies? A review of live births, spontaneous fetal deaths, and induced abortions in residents of Upstate New York ages 12--17 shows that pregnancy rates increased during the period 1971 through 1974. This increase was attributable to pregnancies ending in induced abortion while live births remained relatively stable. White teenagers had a higher frequency of induced abortions than non-white teenagers, but induced abortions increased more rapidly among non-whites over the four-year period. School achievement as reflected by highest grade completed at the end of pregnancy was related to risk of pregnancy as well as to election of induced abortions. The distribution of pregnancies by age and school grade suggests that an increased risk of pregnancy is associated with below average but also, and unexpectedly, with above average grade attainment. Incongruity of age and school achievement may identify groups of teenage schoolgirls with special needs for preventive programs.


The energy cost of overweight in the United States. We have calculated the total fossil energy equivalent of the food calories saved by reducing the present degree of overweight (2.3 billion pounds for the adult United States population) to optimum body weight and the annual fossil energy reduction once all Americans reached their optimum weight. The energy saved by dieting to reach optimal weight is equivalent to 1.3 billion gallons of gasoline and the annual energy savings would more than supply the annual residential electrical demands of Boston, Chicago, San Francisco, and Washington, DC.


An evaluation of the utility of high blood pressure detection fairs. Our data indicate that voluntary casual screenings in essentially middle class locations may be of limited value in attracting the young, the black, and the male relative to the target population. Our screens attracted a large proportion of individuals who where already aware of their high blood pressure. Nevertheless, these screens can be useful in getting and keeping individuals under medical care: newly detected hypertensives, those who knew they have it and even some of those under treatment for it.


Parent-inclusive pediatric units: a survey of policies and practices. A nation-wide survey of Parent-Inclusive Pediatric Units identified innovations and restrictions in policies and practices. Questionnaires mailed to Directors of Nursing Service at 84 general hospitals which encourage parental "living-in" indicated that parents are provided with a place to sleep but infrequently are offered additional facilities, services, and guidance necessary to optimize their presence on the Parent-Inclusive Pediatric Unit. Restrictions on parents remaining with their children are common during highly stressful procedures. Results indicate a gap between research on the importance of parental presence and current hospital practice.


Welfare status, illness and subjective health definition. The self-defined health status of welfare recipients hospitalized for illness during the preceding year was compared to that of persons not on welfare but hospitalized for illness during the same period. Data were derived from a systematic probability sample of household residents of the Harlem Hospital inpatient district population surveyed July 1967-June 1970. Welfare recipient respondents were more likely to perceive their health as fair/poor than were persons not on welfare. This difference persisted when the data were analyzed by sex, age, reported levels and type of illness, hospital days and number of stays, and current usual activity; usual activity was a major explanatory variable but only partially accounted for the relationship. It has been hypothesized that in achievement-oriented societies, illness may be used as justification for a culturally-induced sense of personal failure to fulfill socially prescribed role obligations. The data are consistent with this hypothesis.


Elective induction and stimulation of labor and the health of the infant. This study examines a large heterogeneous sample to determine whether elective induction and stimulation of labor have a beneficial or deleterious effect on the health of the infant. Previous studies have reached contradictory results, partly because of the small sample sizes employed. This study uses a multiple regression analysis of New York City birth certificate data from 1968. We find a small, but significant, negative effect on the newborn of both elective induction of labor and elective stimulation of labor. When hospital care context is allowed to vary, much larger negative effects were found within municipal hospitals and to a lesser extent on service wards of voluntary hospitals. Although 1968 findings cannot be applied to 1978, the implications are clear.


The prevalence of clinically treated diabetes among Zuni reservation residents. At least one-fourth of the over 45 aged population of the Zuni Indian reservation have diabetes. The true prevalence may be higher since an unknown number of Zunis had no blood sugar measurements during 1975-76 and therefore no opportunity for diagnosis. The high prevalence of diabetes among the Zunis has not been previously documented. It is similar to that found in the well-studied Pima Indians and much higher than that in a carefully examined large white population.


Monitoring consumer satisfaction with the clinical services provided to 'exceptional' children. Given recent federal and state legislation mandating all necessary services for children with handicapping conditions, it is incumbent upon the providers of health care services to demonstrate accountability for their services to children with special needs. A procedure to assess the satisfaction of parents and community-based case coordinators with clinical services provided to such children has been demonstrated. By focusing on specific service elements, it is possible to align optimum versus actual consumer satisfaction. Through an analysis of observed variance, the modification of documented weaknesses can decrease the difference between optimum and actual consumer satisfaction levels. This procedure will be continued on a bi-annual, longitudinal follow-up basis to monitor progress. The concept of consumer input into the provision of clinical services is relevant to other developments in the field of health care which place importance on administration accountability. Those health care providers who recognize the value of consumer input and allow for its incorporation into their service programs will be better able to adapt their systems to the emerging trend towards medical accountability. Self-ordered accountability is more meaningful, is easier to understand than government imposed regulations, and can be smoothly blended into an organization's goals and objectives.


Ewing's sarcoma. A light- and electron-microscopic study of 21 cases. Twenty-one cases of Ewing's sarcoma were analyzed by light- and electron-microscopy and the fine structure compared to that described in previous publications. In the predominant "primary" tumor cells, glycogen was abundant in 53% of cases, infrequent in 33%, and rare in 14%. In three cases, microtubules, in association with glycogen, were demonstrated. The so-called differentiated "secondary" reticular tumor cells were sparsely populated in eight cases. Evidence is presented to suggest that these so-called "secondary" reticular cells are merely "primary" tumor cells in a state of regression. Secondary cells and cells with nuclear identations or convolutions were of no discernible prognostic significance. The histogenesis of Ewing's sarcoma remains an enigma but present findings support a primitive mesenchymal origin.


Effect of preseason conditioning on the incidence and severity of high school football knee injuries. An 8-year study comparing two groups of high school varsity football players has shown that the number of knee injuries, and the severity of knee injuries that do occur may be significantly reduced by total body preseason conditioning.


Leiomyosarcoma of male breast originating in the nipple. A case of leiomyosarcoma of the breast in a 53-year-old man originating in the erectile musculature of the nipple is presented. The tumor assumed roughly the conical configuration of the nipple musculature and was limited to the mammary gland. Ultrastructural study of the tumor revealed neoplastic smooth muscle cells with typical myofilaments.


Sebaceous carcinoma of the eyelid following radiation therapy. This paper reports a case of a 12-year-old boy with fatal sebaceous carcinoma originating from the eyelid. The carcinoma developed 11 years after curative radiation therapy for bilateral retinoblastoma. Sebaceous carcinomas associated with previous irradiation are uncommon, and only five such cases have been published. Three of the patients were treated for benign disorders and the two other cases followed radiation therapy for bilateral retinoblastoma. Second malignant neoplasms in patients with bilateral retinoblastoma are thought to be related to a genetically inherited predisposition to the development of second malignant tumors. Radiation therapy is claimed to be an inducing factor in many cases but malignant neoplasms are also found in areas distant from the portals of irradiation as well as in patients not irradiated. Most of the secondary tumors were sarcomas, and usually osteogenic sarcomas.


Tibiofibular synostosis and recurrent ankle sprains in high performance athletes. Recent evidence points toward a weight bearing and dynamic stabilizing function of the distal fibula in ankle joint mechanics. When fibular rotation and translation are restricted, ankle pain during weight bearing and push off often (but not always) results. The case histories of six professional athletes with distal tibial synostosis resulting from internal rotation-inversion injury confirm recent reports of ankle disability resulting from restriction of fibular motion, but suggest that there may be many patients with this lesion who are not disabled. Two patients with incomplete synostosis were asymptomatic, and one with complete synostosis had only occasional pain after vigorous exercise.


Osteoid osteoma as a cause of knee pain in the young athlete: a case study. Knee problems are frequently seen in young athletes. It is important for the examining physician to be mindful of the complex differential diagnosis of knee pain in the adolescent, and not presume a traumatic origin of this pain. A case of osteoid osteoma of the distal medial condylar epiphysis of the femur in a 15-year-old athletic male, who presented with limitation of extension of the knee and medial joint pain and swelling, which could easily be misinterpreted as internal derangement, is discussed as an example of this problem.


What can and cannot be achieved with conventional anti-malaria measures. Malaria eradication has been based on interception of the vectors through the spraying of houses with DDT. With proper strategy and adequate execution this goal should be achieved in the extensive areas where the vector is responsive to the insecticide, but in large regions where it is refractory other conventional measures against the vectors are more costly and cannot produce eradication. In such cases new ways should be sought to tackle the other primary epidemiological factors--the parasite and the susceptible human being. There is so far no drug which can eliminate the parasites from man with one or two doses and that has a long-lasting protective effect against new infections, the two conditions required for effectiveness in the field. The development of a vaccine to protect susceptible human beings is the other possibility being explored at the present time. Let us hope that such a vaccine may become available.


Hemoglobin A2 levels in malaria patients. The influence of malaria on the hemoglobin A2 (Hb A2) level in humans was studied in a series of 94 imported cases in Belgium. Sixty-nine of the patients were natives of Western European countries, their results are reported separately since their origin and the results of their hematological examination made it unlikely that they carried the beta-thalassemia trait. The Hb A2 level of the 94 malaria patients (mean 2.76%; S.D. 0.51%) was not statistically different from that found in 60 healthy controls (mean 2.70%; S.D. 0.38%; P greater than 40). Likewise the level of the 65 Western European patients was not statistically different from that of the same controls (mean 2.81%; S.D. 0.42%; P greater than 0.10). There was also no significant difference between the level in patients infected with a particular species of Plasmodium and that of the controls. No correlation was found between the Hb A2 level and the intensity of the parasitemia or the concentration of total hemoglobin in the blood. These results are discussed in comparison with the divergent ones obtained by others and it is suggested that malaria has no significant influence on the results of surveys for the prevalence of beta-thalassemia in regions of malaria endemicity.


The antileishmanial activity of lepidines. A series of lepidines (6-methoxy-4-methyl-8-aminoquinoline derivatives) was studied in a hamster-Leishmania donovani model. Members of this class were found to have activity many-fold that of the standard, meglumine antimoniate (Glucantime). One of them, 8-(6-diethylamino-hexylamino)-6-methoxy-4-methylquinoline, designated WR 6026, when given orally was over 700 times as effective as the standard antimonial drug.


Comparative evaluation of two dosages of tinidazole in the treatment of giardiasis. Forty-five patients with parasitologically confirmed symtomatic giardiasis were treated with tinidazole. A course of 150 mg twice daily for 7 days cured 14 of 19 patients (74%), and a single dose of 2,000 mg cured 24 of 26 (92%). After the single dose, mild side effects were common including maltase, lassitude, and dizziness. Three probable cases of the so-called "postgiardiac syndrome" were seen. Either dosage of tinidazole initially cleared all stool samples of Giardia lamblia, and most clinical and parasitological failures were first detected a few weeks after the treatment. This emphazises the significance of long follow-up periods.


Serum sickness with furazolidone.

Serum sickness with furazolidone. Two cases of serum sickness from furazolidone (Furoxona), prescribed for giardiasis in Latin America, are described. No previous case of serum sickness related to this drug has been reported in the United States. Tartrazine (yellow dye number 5), a component of furazolidone tablets (Furoxona) manufactured in Latin America countries but no longer included in the drug (Furoxone) in the United States is suggested as a possible cause of serum sickness.


Extensive cutaneous burn complicated by severe necrotizing amebic enterocolitis. Pathogenic factors resulting in severe amebic disease. A 59-yr-old Mexican-American man developed fatal necrotizing amebic enterocolitis following an extensive cutaneous thermal injury. Those factors in the severely burned patient which predispose to amebic disease are discussed.


Cystoscopic picture of Schistosoma haematobium in Egyptian children correlated to intensity of infection and morbidity. Cystoscopy was done on 45 children, 5--12 yr old, infected with Schistosoma haematobium. On the basis of urinary egg output, the children were classifed as having mild, moderate, or heavy infection and the cystoscopic picture was correlated with their egg output and with their signs and symptoms. Lesions reported, in descending order of frequency, were: hyperemia, sandy patches, tubercles, ulcers, nodules, and polyps. Multiple schistosomal lesions were present in some patients and the frequency and severity of lesions correlated with the heaviness of infection. Individual variation in the severety of response to S. haematobium was observed.


Susceptibility of Bahian population of Biomphalaria glabrata to an allopatric strain of Schistosoma mansoni. Seventeen populations of snails (Biomphalaria glabrata) from the state of Bahia, Brazil were studied with respect to their susceptibility to infection with an allopatric strain of Schistosoma mansoni. Two of the populations were from the city of Salvador, 3 from other sites in Bahia, and 12 from habitats in the municipio Castro Alves. Our data show that the Bahian snail populations are extremely variable in their susceptibility to an allopatric strain of S. mansoni and that the phenomenon is not associated solely with distantly separated strains, but is present, as well, in adjacent populations situated in a restricted geographic region. Of the 6 populations found to be completely refractory to infection when exposed at a size of 5--7 mm, only 2 were refractory when exposed at 5--12 days of age. It is suggested that the variability to infection displayed by populations in a restricted geographic area may be explained by assuming that the Founder Principle was operative.


Liver changes in hamsters infected with a liver fluke of man, Opisthorchis viverrini. Thirty male Syrian golden hamsters were each infected with 100 metacercariae of Opisthorchis viverrini. The hamsters were killed at 3, 7, 15, 30, 154 days of infection. The early pathological changes consisted of an acute inflammatory reaction involving the bile ducts of the second order and the portal connective tissue, especially the large veins, as well as focal coagulation necrosis of the liver lobules. As the flukes developed into adults they induced hyperplasia and adenomatous formations of the bile duct epithelium. There was also a granulomatous response to the adult flukes and eggs. Resolution of the granulomas led to periductal and portal scarring. These findings suggest that immunopathologic mechanisms may be important in the pathogenesis of liver fluke disease.


Diagnostic value of the Widal test in areas endemic for typhoid fever. The usefulness of a single Widal test to diagnose typhoid fever in endemic areas was investigated. Reciprocal Salmonella typhi O and H titers greater than or equal to 40 and greater than or equal to 80, respectively, occurred in approximately 90% of 42 Mexican patients with bacteriologically-confirmed typhoid fever at the time of presentation to hospital and, by day 4 to 5 of clinical illness, in 70% of U.S. adult volunteers who developed typhoid fever in the course of vaccine efficacy trials but in only 0.7% (O) to 3% (H) of 275 healthy individuals from a non-endemic area. Healthy Peruvians from areas endemic for typhoid fever commonly had antibody which was age-related. Peak prevalence was found in 15- to 19-yr-olds in whom 29% had O titers greater than or equal to 40 and 76% had H titers greater than or equal to 80. A single Widal test in an unvaccinated individual showing elevated O and H titers is strongly suggestive of typhoid fever if the person comes from a non-endemic area or is a child less than 10 yr of age in an endemic area. Because of the high prevalence of antibody amongst healthy invididuals over 10 yr of age in endemic, areas, a single Widal test offers virtually no diagnostic assistance in adolescents and adults.


Paracoccidioidomycosis (South American blastomycosis): treatment with miconazole. Six patients with multisystem paracoccidioidomycosis proven by serology and culture or smear were treated with relatively brief courses of intravenous miconazole. Two had relapsed following prior therapy; 6 had active pulmonary, 4 laryngeal, 2 oropharyngeal, 2 lymphoid, and 1 abdominal disease. Paracoccidioides brasiliensis was highly susceptible to miconazole in vitro; minimal inhibitory concentration was less than or equal to 0.001 microgram/ml. Clinical examination showed a prompt and objective response in all patients, confirmed by smear or culture and X-rays; in 4/6 serological response was shown. Side effects were minor. Two patients relapsed 3--5 mo after therapy; another had a rise in antibody 6 mo after therapy and was given maintenance oral sulfa. One remains in remission 7 mo after treatment; two given oral sulfa after response to miconazole remain in remission 4--6 mo after treatment. Paracoccidioidomycosis responds well to miconazole, but longer courses may be needed to prevent relapse.


Paracoccidioidin and histoplasmin sensitivity in Coari (state of Amazonas), Brazil. A skin test survey with paracoccidioidin and histoplasmin was conducted on 495 residents of Coari in the Brazilian state of Amazonas. Positive dermal reactions to paracoccidioidin and histoplasmin were seen, respectively, in 13.9% and 50.1% of the study subjects. Specific reaction to paracoccidioidin was observed in 1.6% of the individuals, and to histoplasmin in 37.8%. Cross-reactivity between the two antigens in persons who reacted positively to both skin tests was not totally reciprocal. There were no significant differences in dermal reactivity to either of the two antigens in either sex, or among different occupational groups. No precipitating antibody to paracoccidioidin or histoplasmin was detected in the sera of the skin test-positive individuals by the immunodiffusion test. Skin test positivity in the general population of Coari reaffirmed the concept of benign, self-limited infection in paracoccidioidomycosis and histoplasmosis. It also identified the equatorial forests of the Upper Amazon Basin as endemic zones of these two mycoses.


Humoral and cell-mediated immunity to Histoplasma capsulatum during experimental infection in neotropical bats (Artibeus lituratus). The humoral and cell-mediated immune responses of the large, frugivorus bat, Artibeus lituratus, were studied following intraperitoneal injection of 10 or 10(4) viable mycelial particles of Histoplasma capsulatum. Most bats had both cultural and histologic evidence of disease at autopsy. Utilizing a technique designed to measure the volume of footpad swelling in hypersensitive bats a significant degree of delayed hypersensitivity to histoplasmin was evident in both groups 4 to 6 wk after infection. Precipitating antibodies first appeared in the serum 3 wk after infection, but only in the animals infected with 10(4) viable organisms. Both the double diffusion and counterimmunoelectrophoresis techniques for antibody gave identical results. These findings suggest that A. lituratus is very susceptible to infection with H. capsulatum, and that a mild infection will stimulate delayed hypersensitivity to the organism but only low levels of antibody. The footpad test utilized in this study may be a sensitive and practical method for detecting natural infection in bats.


Blood meal size as a factor affecting continued host-seeking by Aedes aegypti (L.). The effect of ingested blood on the host-seeking response of two strains of Aedes aegypti was examined. Using an olfactometer, females fed partial blood meals were scored for host-seeking behavior within 1 h, and their blood meal sizes were measured chemically immediately afterwards. The suppression of host-seeking within 1 h after a blood meal appears to be caused by abdominal distention from ingested blood. Mosquitoes of either strain were attracted to a host when the blood meal size was less than 2.5 microliter; above this threshold there was a sharp decline in the tendency to respond. Small mosquitoes resulting from a low larval diet had a lower threshold, and were more likely to cease host-seeking after a small blood meal. Multiple feeding within a single gonotrophic cycle may result if mosquitoes take small blood meals which are insufficient to terminate host-seeking. Partial meals and reduced feeding success of mosquitoes can result from defensive host behavior, which in the laboratory rat was shown to increase at high mosquito densities.


"Ghost" forms of Giardia lamblia cysts initially misdiagnosed as Isospora. Because of their distinctive morphology the cysts of Giardia lamblia usually are not mistaken for cysts or eggs of other intestinal parasites. At a hospital laboratory in Kentucky a case of giardiasis was encountered in which the initial fecal examination revealed only degenerated cysts of Giardia which were mistaken for the oocysts of Isospora at the one-sporoblast stage.


Oxolinic acid for the treatment of chronic gastrointestinal Shigella carriers. Two patients were long-term gastrointestinal carriers of Shigella flexneri for 23 mo and 6 mo, respectively. Neither patient responded to oral antibiotics, despite in vitro sensitivity of the bacteria to the antibiotics administered. Oral oxolinic acid produced immediate cessation of the carrier state in both patients, with resolution of minor but persistent physical complaints.


Antibodies to snowshoe hare virus of the California group in the snowshoe hare (Lepus americanus) population of Nova Scotia. Serological study showed the presence of antibodies to snowshoe hare virus in 6--14% of snowshoe hares (Lepus americanus) samples in Nova Scotia. This report extends the known range of this virus in North America.


David M. Hume memorial lecture. In situ vein bypass in the treatment of femoropopliteal atherosclerotic disease: a ten year study. The in situ vein bypass technic for femoropopliteal atherosclerotic disease is described. Several factors influence the long-term results, the most important being a history of myocardial disease, the size of the vein graft, and sufficient runoff.


Management of ruptured thoracic aortic aneurysms. Nine cases of emergency resection of the thoracic aorta without temporary shunt or cardiopulmonary bypass are presented. Five were acute traumatic transections of the descending thoracic aorta secondary to blunt trauma. All five patients survived without sequelae. Four of the patients had ruptured arteriosclerotic aneurysms, including one aortobronchial fistula and one aortobronchial esophageal fistula. Two of these four patients survived without sequelae and two died in the postoperative period. One of the two latter patients had paraplegia. A review of the different methods of prevention of ischemic damage to the spinal cord and abdominal viscera is presented. Use of simple aortic cross clamping in the emergency situation for both acute traumatic transections of the aorta and ruptured arteriosclerotic aneurysms of the thoracic aorta is justified.


Arteriovenous fistula secondary to rupture of atherosclerotic abdominal aortic aneurysm. Report of five cases. Five patients with an acute spontaneous arteriovenous fistula as a result of rupture of abdominal aortic aneurysms into the inferior vena cava of iliac vein are presented. A high mortality usually accompanies this rather infrequent complication of abdominal aortic aneurysms. The pathologic and physiologic aspects of this catastrophic event are discussed with emphasis on the variation of operative management necessary for a successful outcome.


Position artifacts in occlusive impedance phlebography (plethysmography). The accuracy of occlusive impedance phlebography (IPG) depends on recognition of the artifacts that produce false-positive results. Fifty per cent of a series of studies of patients with normal legs showed abnormal results when the recording was made with the leg held straight. We therefore recommend that the patient's leg position be carefully monitored when an IPG test is being administered.


Femorofemoral grafting: indications and late results. Experience with fifty-three femorofemoral grafts performed as the initial operation for iliac occlusive disease over a ten year period is reviewed. There was one operative death (2 per cent). There were two early and three late graft failures, for a five year cumulative graft patency rate of 80 per cent. Of the twenty-eight patients in whom the femorofemoral graft was performed for limb salvage, the five year cumulative limb salvage rate was 91 per cent. During the follow-up period, two grafts were converted to axillobilateral femoral grafts because of recurrent symptoms of claudication caused by progression of disease in the iliac system from which the femorofemoral graft originated. All other patients with patent grafts have had satisfactory relief of symptoms throughout the follow-up period.


Initial experience with the polytetrafluoroethylene graft for limb salvage. A report on twenty patients. The early results of the bypass procedures for limb salvage using the new polytetrafluoroethylene (PTFE) graft are analyzed. Of twenty patients presenting with either severe rest pain or gangrene, patency has been maintained in fourteen for a mean period of thirteen months to date. Particularly satisfying results have been achieved when bypassing into single dominant arteries below the knee where limb salvage and graft patency was obtained in all cases.


New Doppler pressure indexes plotted as curves. Curve configuration used to determine sites of arterial obstruction. Brachial, femoral (in the groin), popliteal, and tibial systolic blood pressures were determined with the Doppler technic. New indexes were developed: femoral/brachial (B/B), popliteal/femoral (P/F), ankle/femoral (A/F), and ankle/popliteal (A/P). Curves were plotted using these indexes and compared with established configurations. As a result the site or sites of obstruction were rapidly determined.


The posterior stocking seam approach to radical subfascial clipping of perforating veins. The posterior stocking seam approach to radical subfascial ligation of perforating veins has been advocated for the patient with postphlebitic syndrome presenting with severe stasis dermatitis, leg edema, and recurrent ulceration. Our indications for this procedure have been extended to include signs and symptoms of advanced venous insufficiency which persist after multiple operative procedures for recurrent varicose veins in the absence of deep venous thrombosis. In this series of twenty-five operations there was one instance of recurrent stasis ulceration after the procedure, and reversal of the pigmentation of stasis dermatitis was dramatic in the majority of cases. All limbs have completely healed, and there has been no significant swelling. The long-term results of this surgical procedure have been excellent, and short-term complications have been minimal.


Evaluation of extracranial cerebrovascular disease with ocular pneumoplethysmography. The results of OPG studies performed on 121 patients between 1974 and 1977 are compared with the results of biplane angiograms. By adding criteria based on the ratio of AOP:BAP, the overall accuracy was increased from 76.9 to 91.7 per cent. This improvement was obtained by establishing criteria that identified bilateral significant lesions. The results have confirmed the value of OPG in noninvasive assessment of carotid artery disease.


Upper extremity complications of axillofemoral grafts. Four patients sustained five upper extremity complications after axillobifemoral grafting including brachial plexus injuries, axillary artery thrombosis, and arterial steal. To avoid these problems, the following precautions are recommended: (1) proper positioning of the patient to prevent hyperabduction of the shoulder; (2) adequate exposure of the axillary artery during dissection and gentle handling of the nerve trunks; (3) meticulous technic during construction of the proximal anastomosis and avoidance of undue tension on the graft; and (4) careful preoperative assessment of the axillary-subclavian artery as a potential donor vessel.


Extraperitoneal aortoiliac disobliteration with plaque cracker. Disobliteration of the aorta and iliac arteries through an extraperitoneal approach is described. An intimal guillotine (plaque cracker) is used to transect the intima of the unopened vessel. The intima is then milked down to a transverse arteriotomy in the left common iliac artery, through which all of the discarded intima is removed. Since the intima is dissected free before opening the vessels, blood loss is minimal. The procedure is rapid and requires only an average of 19 minutes of aortic cross clamping. Our operative mortality was 4.2 per cent and the long-term patency rate 75 per cent.


Retroperitoneal aortofemoral bypass using a reversed L-shaped prosthesis. An extraperitoneal approach for aortofemoral bypass has proven superior to the transperitoneal approach. The incision starts at the tip of the eleventh rib and extends obliquely downward to 2 inches above the femoral point, where it turns further downward over the femoral artery. This approach is especially suitable for a reversed L-shaped prosthesis which extends from the aorta directly to the left femoral artery and crosses the abdomen subcutaneously to the right groin, where an anastomosis is made with the right femoral artery. The operation is simple and rapid. Morbidity is reduced and recovery is accelerated. The same incision is used to perform aortoiliac endarterectomy. Fifteen patients with occlusive disease and twenty-one with aneurysms received reversed L-shaped prosthesis through an extraperitoneal approach. The procedure was superior to that involving a transperitoneal approach to the aorta and the reversed L-shaped graft was superior to the Y graft for replacement fo the iliac arteries.


The effects of ischemia on the electrical and contractile activities of the canine small intestine. The effects of ischemia on the electrical and contractile activites of the small bowel were studied in dogs. Ischemia due to arterial occlusion abolished the contractile activity and made the regular rhythm of the pacesetter potential (PP) irregular. Revascularization within 3 hours restored the contractile activity and the PP rhythm. With longer periods of ischemia, revascularization did not restore contractile activity, and the PP pattern remained irregular or slow.


A thirty year study of breast cancer in a consecutive series of private patients. Is axillary nodal study a valuable index in prognosis? A consecutive series of 435 patients with breast cancer followed from six to thirty years is presented. Radical mastectomy was the surgical procedure of choice and our experience indicated that the degree of axillary nodal involvement is a most important guide in establishing prognosis in this disease. The majority of recurrences became evident within the first five postoperative years, the next most hazardous period for the patient being the half decade between the fifth and tenth years after initial therapy. A second independent malignancy developed in 37 of the 275 pateints who died, and it was the cause of death in 7.6 per cent of this group. Among the 160 patients still living to date a second independent malignancy has already developed in 10. Bilateral breast cancer was observed thirty-eight times in this entire series of 435 patients, an incidence of 8.7 per cent.


The role of Doppler ultrasound in acute deep vein thrombosis. Doppler ultrasound in the range of 5 mHz is a simple, portable, inexpensive, and accurate technic for the diagnosis of acute deep vein thrombosis. One hundred sixty patients underwent bilateral Doppler examinations and ascending contrast venography. The overall accuracy was 94 per cent.


The posterior approach for villous tumors of the rectum. Report of eleven cases. Use of the posterior surgical approach for the management of villous adenoma of the rectum below the peritoneal reflection has been evaluated in eleven patients. There has been no mortality and no recurrence. The Kraske approach was also suitable in four patients with noninvasive adenocarcinoma arising within villous adenomas, although there is no place for this procedure in the treatment of invasive carcinoma.


Acute anal fissure: treatment by lateral subcutaneous internal anal sphincterotomy. Lateral subcutaneous internal anal sphincterotomy in the management of chronic anal fissures is well established. Its role in the management of the acute severely painful fissure is reported and the technic described.


Custom-fitted appliances for intestinal fistulas. A method for containing troublesome intestinal stomas or fistulas in open wounds is described. Custom-fitted faceplates are made using alginate materials and vulcanizing silicone rubber at room temperature. Three patients have been presented illustrating the rehabilitation and palliation that can be achieved by collaborative interaction between surgeons, enterostomal therapists, and prosthetic technicians.


Cell-mediated immunity of Yersinia enterocolitica serotype 3 in patients with thyroid diseases. The cellular immunity to Yersinia enterocolitica serotype 3 and crude human thyroid extract in 64 patients with thyroid diseases and 25 controls was studied by the leucocyte migration test. In the patient group as a whole and in patients with Graves' disease and nontoxic diffuse goitre a significantly reduced leucocyte migration towards Yersinia was found when compared with the controls. In controls the migration index was not related to the presence or titre of circulating yersinia antibodies, whereas the migration index of patients with yersinia antibodies was lower than the migration index of patients without yersinia antibodies as well as that of the controls. The leucocyte migration inhibition in two patients with recent yersinosis was normal during the recovery phase. In the presence of thyroid extract leucocyte migration inhibition differed only significantly in Graves' disease. However, a significantly positive correlation between inhibition of migration by thyroid extract and by Yersinia was found, while no correlation could be demonstrated in the controls. The cell-mediated immunity towards Yersinia in thyroid diseases thus demonstrated adds further evidence to the association between Yersinia and thyroid disease.


Attempts to attenuate the cardiostimulatory effects of ketamine. In an attempt to attenuate the cardiostimulatory effects of ketamine, a number of drugs were given individually, or in combination, to fit adults undergoing body surface operations, either before or aftera ketamine induction of 1 mg kg-1 followed by an infusion of 1 mg ml-1. Of these, practolol, phentolamine, practolol-phentolamine, phentolamine-practolol, promethazine, hexamethonium, procainamide and verapamil were unacceptable. Labetalol, in doses of 0.5 mg kg-1 and 1.0 mg kg-1, proved to be the most promising drug and is worthy of further study.


Attempted reduction of the cardiostimulatory effects of ketamine by labetalol. Labetalol, a new antihypertensive agent with alpha and beta-adrenoceptor blocking properties was given to five series of patients anaesthetised with a ketamine infusion. in an attempt to reduce the cardiostimulatory effects of ketamine. It proved very effective in controlling the chronotrophic action of ketamine but was unreliable in controlling the rise in blood pressure. In doses of 1.0 mg kg-1 given with tubocurarine, it was not without side effects.


Pulmonary shunts in the prone position.

Pulmonary shunts in the prone position. Pulmonary shunting (Qs/Qt with the FIO2 = 1) was determined in ten young healthy non-obese patients prior to anaesthesia, 30 min after induction in the supine position and 1 h later during surgery in the prone position. Respiration was spontaneous in awake patients and was controlled following the induction of anaesthesia. Halothane was the primary anaesthetic and tubocurarine provided muscle relaxation. Mean PaCO2 was 40.7, 29.5 and 27.9 mmHg respectively in the three study periods. The shunt remained unchanged at 5.7 +/- 0.8% in the awake patients, and 6.0 +/- 1.1% during anaesthesia in the supine position, and 5.2 +/- 1.2% during anesthesia and surgery in the prone position. It is concluded that in this population the prone position does not alter the magnitude of the pulmonary shunt even in those patients who develop shunts of over 10% after the induction of anaesthesia.


Intraocular pressure after suxamethonium and endotracheal intubation. The effect of pre-treatment with tubocurarine or gallamine. Intraocular pressures were recorded in two series of fifteen patients after the administration of suxamethonium and endotracheal intubation. One series received tubocurarine 0.05 mg/kg and the other gallamine 0.3 mg/kg 4 min before the suxamethonium. The pressures were compared with those in a control group of fifteen patients who received normal saline before the suxamethonium. An increase in intraocular pressure occurred in 80% of patients and was similar in all three groups.


Heart disease in pregnancy. The anaesthetic management of a patient with prosthetic heart valves. The management of pregnant woman with a double heart valve replacement is described. The aspects of particular relevance to the anaesthetist are discussed.


Temperature alarm for heated humidifiers. In order to ensure a water content of between 30 and 40 mg/l in the inspiratory gases using a heated humidifier, the temperature in the delivery tube, near to the patient, must be between 30 and 37 degrees C. A low cost thermistor temperature alarm is described which indicates by means of different coloured lights if the temperature falls below 30 degrees C, lies between 30 and 37 degrees C, or if the temperature exceeds 37 degrees C. An alarm also sounds if temperatures above 37 degrees C occur. This device has been in use since 1974 and has proved reliable and time saving.


Psychotropic drugs in the treatment of chronic pain. The psychotropic drugs in the treatment of chronic pain have value in several areas. They not only influence the mood of the patient but also provide hypnosis, augment the activity of the analgesics and exhibit analgesic potency in their own right. They may be used alone, or in combination with analgesic agents or with each other. The three most valuable groups are the antidepressants, tranquillizers and anticonvulsants, all of which exert their effect by influencing the intracerebral levels of various neurotransmitter amines.


Propranolol in thyrotoxicosis. Cardiovascular changes during thyroidectomy in patients pre-treated with propranolol. The cardiovascular changes during anaesthesia and thyroidectomy have been studied in seven thyrotoxic patients prepared with propranolol. The heart rate and cardiac rhythm remained very stable throughout surgery. A 20% increase in mean arterial pressure occurred during surgical stimulation. A decrease in cardiac output, due to decreased stroke volume, occurred during surgical stimulation. A decrease in cardiac output, due to decreased stroke volume, occurred during surgery, reaching a maximum of 21% during ligation of the thyroid vessels and returning to pre-operative values by the end of surgery. The fall in cardiac output was accompanied by raised central venous pressure and raised total peripheral resistance.


Recovery from neuromuscular blockade. a comparison between old and young patients. Thirteen young and thirteen elderly patients undergoing elective surgery were given an anaesthetic using tubocurarine as the sole muscle relaxant. Following reversal with neostigmine, the time taken to recover from neuromuscular blockade was measured. No significant difference was found between the two groups of patients.


Entonox analgesia in labour. A pilot study to reduce the delay between demand and supply. In a pilot study in six mothers using 50% nitrous oxide and 50% oxygen (Entonox) as an intermittent self-administered analgesic during labour, a significant reduction in the mean times to attain specified end-tidal nitrous oxide concentrations was obtained by a continuous nasal supplement of Entonox. The method proved acceptable in this small number of patients and there were no demonstrable effects upon fetal heart rate.


Physostigmine in open-heart surgery. Reversal of hyoscine supplementation of morphine-oxygen-air-relaxant anaesthesia. The use of physostigmine salicylate to reverse hyoscine supplementation of morphine-oxygen-air relaxant anaesthesia has been studied in twenty open-heart surgery patients and found to be both reliable and innocuous.


Cardiovascular effects of tubocurarine in man. The cardiovascular effects of tubocurarine in patients anaesthetised with thiopentone or ketamine have been compared, using volume-pulse finger plethysmography, electrocardiography, sphygmomanometry and impedance cardiography for the clinical assessments. Tubocurarine potentiates the arterial hypotensive effect of thiopentone and reverses the hypertensive action of ketamine. It also prevents the dysrhythmic (adrenergic) reaction of the heart to orotracheal intubation and has less effect on the positive chronotropic and inotropic reactions thereto. Hypotensive doses of tubocurarine in patients anaesthetised with thiopentone do not prevent reflex constriction of the finger blood vessels in response to surgical stimuli (orotracheal intubation) which means that the drug is not a sympathetic ganglion blocker in man. It is concluded that tubocurarine is a myocardial depressant which acts, like verapamil, as a calcium ion antagonist.


Carbon dioxide output in anaesthetised children. Carbon dioxide output was measured in 278 children aged between 1 day and 16 years, who were anaesthetised with thiopentone and nitrous oxide and ventilated mechanically following the injection of a non-depolarising neuro-muscular blocking agent. It is suggested that the results obtained form a clinically useful guide to the carbon dioxide output of anaesthetised children.


Hypophosphataemia and its consequences in patients following open heart surgery. Plasma phosphate concentration (Pi), red cell 2,3-diphosphoglycerate (2,3-DPG) and adenosine triphosphate (ATP) concentrations were measured pre-operatively and at intervals after operation for 30 h in twelve patients (nine males and three females, 44--61 years of age), who underwent open heart surgery. All patients received intravenous injections of glucose, insulin and potassium at regular intervals. In all patients studied Pi decreased within hours following operation, remained low for about 6 h and pre-operative values were reached by 18 h. Pi decreased from 1.04 +/- 0.6 mmol/litre (mean +/- s.e. mean) to 0.32 +/- 0.06 mmol/litre. This fall in Pi was accompanied by a small but significant fall in 2,3-DPG (from 14.8 +/- 0.60 mumol/g Hb to 11.2 +/- 0.60 mumol/g Hb). ATP concentration did not change significantly. The calculated P50 (partial pressure of oxygen at which there was 50% saturation of haemoglobin) decreased by 1.2 mmHg. The regular fall in Pi which is probably due to the glucose-insulin-potassium injections was of short duration and had very little effect on red cell 2,3-DPG and ATP.


Malignant hyperpyrexia. A case report of successful treatment and subsequent uneventful general anaesthesia. A case of successfully treated fulminant malignant hyperpyrexia induced by halothane is reported. The patient underwent uneventful general anaesthesia with Althesin, nitrous oxide, fentanyl and pancuronium 1 week later. The treatment of the established MH-syndrome and its prevention in MH-susceptible patients are discussed.


The problem of aerophagy. Postoperative gastric dilatation as a remote complication of total laryngectomy. A case of acute gastric dilatation due to massive aerophagy in a patient who had previously had a laryngectomy is reported. Excitement during regional analgesia was responsible. The pathophysiology of this mechanism is discussed and suggestions are made about its prevention.


Unilateral pulmonary oedema after bilateral pneumothorax. A case history of unilateral pulmonary oedema which occurred in a patient who had recently re-expanded bilateral pneumothoraces is presented.


Suxamethonium apnoea masked by tetrahydroaminacrine. A case is reported of a patient who was given THA with suxamethonium and who demonstrated a prolonged apnoea. This patient was later shown to have a variant cholinesterase enzyme. The different techniques of THA and suxamethonium administration are discussed and it is suggested that an initial dose of suxamethonium should precede a THA-suxamethonium combination in order to try and avoid a prolonged apnoea.


A workable literature index.

A workable literature index. A literature index is presented based on edge notched cards. A key word vocabulary is included with suitable binary coding. A simple system for coding and searching is explained.


[Changes in intraocular pressure with various concentrations of enflurane during constant conditions of ventilation (author's transl)]. A variety of factors influence intraocular pressure. An increase for example, can be found under conditions of hypoventilation, prohibited ventilation and too light anaesthesia. Some pressure decreasing factors are barbiturates, various inhalation anaesthetics, neuroleptics, and also hyperventilation. In 10 gynaecological patients with normal ophthalmological status, IOP was measured under enflurane anaesthesia by means of a Draeger hand-held applanation tonometer. The neuroleptanaesthesia served as a basis. After anaesthetic conditions were stabilized, concentrations of enflurane ranging from 0.5 to 2.0 vol.% were administered. Under constant ventilation (PECO2) the following parameters were measured: pH, PCO2cap,PO2cap,base excess, minute ventilation, respiratory rate, blood pressure and pulse rate. The concentration of enflurane was measured by gas-chromatography. The IOP was decreased by using enflurane in various concentrations. This decrease is caused by enflurane/itself and is independent of blood pressure changes.


[Peripheral arteriographies under intraarterial analgesia (author's transl)]. 45% contrast medium, to which lignocaine had been added in a concentration of 0.1%, was injected for 44 translumbar aortograms, 26 femoral arteriograms and 4 brachial arteriograms under premedication with pethidine-promethazine. Few patients described their sensations spontaneously; most patients graded their pain as minimal and described only the sensation of heat. When the contrast medium was injected, first without and then with lignocaine, the pain was markedly reduced by lignocaine. No patient showed signs of CNS-toxicity. After the injection of the mixture of contrast medium and lignocaine, the heart rate rose slightly, the arterial blood pressure fell slightly, both not more than after injection of the contrast medium only. The ECG showed no anomalies. The addition of lignocaine to a contrast medium in low concentration represents a simple and, for the patient, acceptable method of analgesia as well as a safe alternative to general, spinal or epidural anesthesia.


[Streptokinase in pulmonary embolisation with cardiac arrest (author's transl)]. A 51 year old hypertensive female was successfully resuscitated from two episodes of cardiac arrest due to massive pulmonary embolisation, by injection of 750,000 units of streptokinase into a central venous catheter on the first postoperative day. Two severe complications showed the limits of this agressive form of intensive therapy.


[Changes in the internal cuff pressure in intubated patients (author's transl)]. In 50 intubated patients the changes of pressure in the interior of the cuff were recorded during various methods of narcosis for 30 min. The results were evaluated statistically and interpreted with respect to the difference in the gas mixture and time. A linear increase of inner pressure in the cuff was established. Further modified experimental series are proposed.


[The use of spinal anaesthesia for cesarean section (author's transl)]. In analysing our own material of 139 cases of cesarean section a clinical report is given concerning the method of anaesthesia, the maternal haemodynamics during anaesthesia and the Apgar score of the newborn. Primarily hyperbaric spinal anaesthesia was always chosen, only 28.3% of the cases were performed under general anaesthesia because of missing maternal consent or general objection of the obstetrician. The rationale for choosing spinal anaesthesia was the safe prevention of acid aspiration of the mother and in the minimal fetal depression. The only disadvantage of spinal anaesthesia, namely a marked blood pressure fall leading to placental hypoperfusion, can be safely prevented by counteracting the sympathetic blockade by volume therapy in time. The two groups of newborns should no show significant differences in Apgar scores. 10 lively babies in a group of 12 cases of severe haemolytic disease of the newborn (Rh) however, all delivered under spinal anaesthesia, confirm our ideas about spinal anaesthesia being less depressant to the fetus than general anaesthesia. Regional anaesthesia therefore is stated as the method of choice especially for the fetus at risk. Differences in favour of spinal anaesthesia in our series were not statistically relevant in the normal case; studies of neurobehavioral function, however, are not included.


[Metabolism and distribution of bupivacaine-experiments in rats I. Methods and metabolism (author's transl)]. A method is described enabling blood concentrations and urinary and biliary excretion of bupivacaine to be estimated in unanaesthetized rats. After enteral application of bupivacaine, the urine volumes of 40 rats are collected, cleared off and analysed by gas chromatography. 5 fractions are obtained, of which the structures are identified by mass spectrometry and nuclear magnetic resonance. The following five metabolites could be identified: (1) Desbutyl-bupivacaine, (2) 3'-Hydroxy-bupivacaine, (3) N-Butylpipecolyl-2-amide, (4, 5) mono-hydroxylated isomeres on the piperidine ring.


[Comparative studies of the local anaesthetic action of carticaine 1% and mepivacaine 1% (author's transl)]. The actions of carticaine 1% and mepivacaine 1% in peripheral nerve block were investigated in double-blind study. Bilateral ulnar nerve blocks were performed in 14 healthy subjects (age range 20-30 years), and latency, duration, and intensity of anaesthesia were quantitatively determined. There were no differences in latency of nerve block, but a significant difference in the duration of effect: Mepivacaine acted for nearly twice as long as Carticaine. In addition, several incomplete blocks were noted with Carticaine. On the basis of these results mepivacaine is preferred in peripheral nerve block because of its longer and more reliable action.


[The anatomical and histological investigation of the pancreas in the 19th century and till the discovery of insulin (1921). 2. The pancreas research from the discovery of islets (1869) till the discovery of pancreas-diabetes (1889) (author's transl)]. In this study is the period of the morphological exploration of the pancreas from the discovery of islets of LANGERHANS (1869) to the discovery of pancreas-diabetes through von MERING and MINKOWSKI (1889) investigated. In his thesis has PAUL LANGERHANS the islets of pancreas and the centro-acinar cells described. In the period from 1869 to 1889 has the majority of investigators the opinion that the islets are parts of the lymphatic system. In the other hand investigators have the opinion that islets are parts of pancreatic ducts or residues of the embryonic period. RENAUT (1879) makes it possible that islets are derivatives of epithelial tissues. KUHNE (1875) gives the description of vessels in the islets of Langerhans. KUHNE and LEA (1882) have found that islets are independent of acini. This hypothesis has RUDOLPH HEIDENHAIN (1875) supposed.


[Endometrial granular cells in fetal membranes (author's transl)]. The authors' aim was to obtain a survey of endometrial granular cells in fetal membranes. In all 30 cases the existance of granular cells was confirmed. The functional significance of these cells for the delivery and for separating of the fetal membranes from the uterus wall was discussed.


A note on the effect of different methods of emasculation on gain in body weight in Indian buffalo (Bubalus bubalis) calves. The effect of Burdizzo, Russian and vasectomy methods of castration on the gain in body weight was studied over a period of 2 1/2 months in the buffalo calves of two age groups (1--1 1/2 years and 2 1/2--3 years). The gain in body weight (1--1 1/2 years age group) has been significantly greater (P less than 0.05) in the control animals (30.3 +/- 3.38 kg) as well as those emasculated by the vasectomy (31.3 +/- 1.4 kg) method in comparison to the other two methods.


Structural changes in the thyroid gland of buffalo following administration of thiouracil. The effects of a goitrogen (thiouracil) on the structural variations of the thyroid gland were studied in male buffalo calves. Following the treatment, the thyroid became enlarged and both the weight and the size of the gland were significantly increased (P less than 0.01). Hyperplasia and hypertrophy of the gland were correlated with a significant increase of thyroidal uptake of 131I. The height and number of the follicular cells were significantly increased (P less than 0.01). The follicles were small and had vacuolations in the colloid. The colloid content of the follicles became reduced. The vascularity of the gland was appreciably increased.


[Ultrastructural and histochemical aspects of the rodlet cells from the bulbus arteriosus of Cyprinus carpio L. (Pisces: Cyprinidae) (author's transl)]. Morphological details of the "Stäbchendrüsenzellen" (PLEHN), rodlet cells syn. pear-shaped cells of the endothel from the Bulbus arterious of carps were studied in the electron microscope. From morphological characteristics, especially from the development of desmosomes with adjacent endothelial cells, it becomes evident, that the cells in question, which are very common in Teleostei, are not of parasitic nature. Specific protrusions of the apical cell poles towards the arterial lumen are indicative of a holocrine type of secretion.


An experimental study on the role of the reciprocal tendinous apparatus of the horse at walk. The locomotor pattern of the hind limb of seven horses has been studied in intact animals and after transection of the following structures: the peroneus tertius tendon, the cranial tibial muscle, both cranial tibial muscle and peroneus tertius tendon, and the superficial digital flexor tendon. The investigation was carried out by high speed cinematography and electromyography. It is concluded that (1) the muscles and tendons over the cranial aspect of the tibia play an important role during the support phase; (2) the movements of the hind limb may be performed without the action of the cranial tibial and gastrocnemius muslces; (3) the tendons in the shank store elastic energy during the support phase; (4) the gastrocnemius and cranial tibial muscles may centre the force of the load through the long axis of the tibia.


Remodeling of the avian fracture callus by estrone treatment and exposure to a 2 g environment. Rhode Island Red female chicks were subjected to complete closed fracture of the right radius at two weeks post hatching. The animals were allowed to heal for 2 weeks at either earth gravity (1 g) or a 2 g environment with saline injected controls and estrone injected experimentals. Total fractured bone weight was decreased by exposure to the 2 g environment regardless of whether the animal received saline or estrone treatment. The mean weight of fracture callus was significantly decreased when the hypergravity exposed animals received low hormonal levels of 0.2 mg estrone. The average mid-cross sectional diameter of fracture callus was significantly decreased when the centrifuged chicks received saline or 0.2 mg estrone and it was increased with the administration of high hormonal levels of 0.4 mg to the 2 g animal. The mean thickness of the subperiosteal trabeculae of the bridging callus was decreased by exposure to hypergravity either with or without estrone treatment.


Ultrastructural study of the adenohypophysis of the male Chinese quail. The ultrastructural analysis of the adenohypophysis in the male Chinese quail reveals seven different types of granular cells, and agranular folliculo-stellate cells. The cell types are assumed to be endocrine cells and are classified as: Type I cells (presumptive LH-gonadotrophs), with dilated endoplasmic reticulum, perinuclear spaces, and granules of 150--260 nm; Type II cells (presumptive FSH-gonadotrophs), with regularly-shaped cytoplasmic cisterns and small granules (80--150 nm); Type III cells (presumptive thyrotrophs), very close in appearance to the type II cells of normal birds; Type IV cells (presumptive prolactin cells), with very large secretory granules (up to 400 nm), Type V cells (presumptive corticotrophs), with abundant and electron-dense granules (160--300 nm); Type VI cells, with irregularly-shaped granules;  Type VII cells (presumptive somatotrophs), with abundant granules (130--220 nm) and less cytoplasmic structures. Cytological characteristics of the nucleus, and more particularly the presence of a Feulgen-postive nucleolus with a very particular ultrastructure are here reported. It is proposed that heterospecific associations of Chinese quail cells with chick cells can be used in embryological work for the study of cellular interactions.


Evaluation of proteohormon concentrations in serum and seminal fluid and its relationship with sperm count. The measurement of FSH, LH, and PRL in serum and seminal fluid of 105 men attending a male infertility clinic and 21 men of proven fertility (controls) did not reveal an interrelationship between the spermatozoal count and the level of the proteo-hormones in both biological fluid except for FSH, which was significantly higher in the serum of men with low as compared to normal sperm count (p less than 0.01). FSH in seminal fluid was significantly lower (p less than 0.01), and LH-like activity significantly higher (p less than 0.01) than in serum, while there was no difference between the respective levels of PRL. These results could be confirmed in 4 patients with azoospermia due to occlusive disease, and in 1 out of 2 vasectomized men. It was demonstrated for the first time that the higher concentration of "LH" in seminal fluid as compared to serum was due to the presence of HCG-beta or a HCG-like material cross-reacting with the antiserum against LH.


[L-fucose content in human semen].

[L-fucose content in human semen]. Human semen contains beside the major carbohydrate fructose: galactose, glucose, sorbitol and inositol. By means of gas-liquid chromatography it is possible to identify also L-fucose. Our method requires the removal of hexosamines, amines and amino acids after hydrolysis. The gas-chromatographic separation of the carbohydrates is achieved in form of their trimethylsilyl derivatives. By this method the fucose content of several freeze dried human semen samples of different diagnosis could be determined.


The total Leydig cell volume of the testis in some common mammals. Total Leydig cell volume has been quantitatively determined by a histometric point-counting method in six common mammals, including man. Although the size of the testis has increased from 1.3 +/- 0.1 ml in the rat to 19.8 +/- 6.9 ml in the buffalo, the composition has remained fairly constant with the Leydig cells making up 9--16% of the testicular volume. In absolute terms, the Total Leydig Volume has increased progressively with body size, from 0.11 +/- 0.02 ml/testis in rat to 2.44 +/- 0.64 ml/testis in buffalo, the value for man being 2.21 +/- 0.40 ml/testis. The significance of these findings, from the point of view of the comparative physiology of male reproduction, has been discussed.


Carnitine in seminal fluid as parameter for the epididymal function. Carnitine represents the secretion which is added to human seminal fluid by the epididymis. More than 94% of the free carnitine originates from the epididymis. The frequency distribution of carnitine concentration is investigated with patients showing a normal spermiogram and with those suffering from azoospermia. Correlations with conventional spermiogram parameters are discussed. The clinical significance of the carnitine determination is shown in various andrological clinical pictures, with special consideration given to postvasectomy semen and Klinefelter's Syndrome. Two case reports of high blockages in the male reproductive tract demonstrates the diagnosis of such a blockage with the simultaneous determination of fructose, citrate and carnitine. The evaluation of split ejaculates confirms that free carnitine does not originate from seminal vesicles, but rather flows into the seminal fluid via the ductus deferens.


The influence of human menopausal gonadotropin, natrium fluoride and cyproterone acetate on the spermatogenesis in immature rats. Human menopausal gonadotropin (HMG), natrium fluoride (NaF) and cyproterone acetate (CYA) were applied to immature male rats between the 26th and 32nd day of life and histological examination was performed in testes of 33rd-day-old rats. HMG treatment alone slightly influenced the spermatid completion process, while NaF evidently increased frequency of occurrence of various seminiferous tubules containing spermatids. CYA alone damaged the spermatid completion process (especially the cap-phase of spermiogenesis), produced a degeneration of meiotic spermatocytes, and decreased the tubular diameter. Those changes were prevented by addition of HMG to the CYA treated animals. The results suggest a possible regulatory role of FSH at the end of the first meiosis, and, also, in the progression of spermiogenesis. The mechanism of action of NaF may be hypothetical, but it probably consists of direct action on the seminiferous epithelium level.


[Absolute teratozoospermia in a family. Irregular microcephalic spermatozoa without acrosome]. Two brothers have spermiograms with a similar pattern: absolute teratozoospermia with round-headed spermatozoa. The familial trait only has been previously one time in the literature. The spermatozoa show several abnormalities in the head. They lack acrosome and postacrosomal sheath. The nuclei are small and the chromatin is distributed in small groups. The nuclear envelope has abundant pores and is loosely attached to the chromatin. All the nuclei have brown inclusions, refringent when they are observed under the light microscope, vesicular and laminar under the electron microscope. Other abnormalities less frequently observed are: irregularities in the mitochondrial sheath, loss of parallelism of the dense fibres and duplication and angulation of the sperm tail. The hormonal assays and the biochemical tests are normal in both patients.


Tracheal constriction by morphine and by fentanyl in man. The effects of morphine and fentanyl on tracheal smooth muscle tone were studied in 38 patients during induction of anesthesia. Endotracheal tube cuff pressure was used to measure tracheal tone. Anesthesia was maintained with nitrous oxide, 70 per cent in oxygen, and pancuronium and ventilation was controlled with a respirator. Morphine, 0.5 mg/kg, produced a biphasic response, initially causing tracheal dilatation and then tracheal constriction. Ten minutes after morphine injection, cuff pressure increased to significantly (21 +/- 8 per cent) above control. Morphine-induced tracheal constriction could be completely blocked by the prior administration of atropine, 0.5 mg. Fentanyl, 0.006 mg/kg, also produced significant tracheal constriction, cuff pressures increasing to 44 +/- 11 per cent above control at 10 min. Fentanyl-induced tracheal constriction could be blocked by pretreatment with droperidol, 0.25 mg/kg. At equianalgesic doses, morphine and fentanyl produced similar tracheal constriction.


Objective evaluation of sperm motility and values of velocity. Differences between the sperm velocity values of normozoospermic men and of those with proved fertility, above all in younger age groups, are quoted. There is a reference to the possibility of the diagnostic and prognostic importance of following the sperm velocity in various time intervals, at a minimum rate within 1 and 5 hours after ejaculation.


Autoimmunity to sperm.

Autoimmunity to sperm. 1. Sperm-specific antigens behave immunologically more like foreign than self antigens. 2. Consequences of autoimmune response to testicular and/or sperm antigens can result in allergic orchitis, postvasoligation orchitis, and infertility. In these conditions, multiple pathogenetic mechanisms, including immune complexes and T-cell-mediated immune reaction, have been shown to be important. 3. Normally, factors that circumvent sperm autoimmune disease are likely to be multiple. Besides the mechanism of sperm-antigen sequestration, other controlling mechanisms also should be considered.


Echocardiographic assessment of ventricular performance following induction with two anesthetics. Echocardiographic studies were made of 20 healthy patients scheduled for minor surgical procedures to determine whether this technique could be used routinely in the operating room and to evaluate the effects of halothane and enflurane on left ventricular performance. Thirteen minutes following induction of anesthesia with halothane in ten patients (mean end-tidal halothane concentration 0.93 per cent), mean arterial blood pressure, left ventricular (LV) diastolic dimension, LV fractional shortening, mean velocity of circumferential fiber shortening and systolic thickening of the posterior LV wall were significantly decreased. LV systolic dimension was increased significantly. These data indicate that halothane caused decreased contractility in the presence of a decreased afterload. Twelve minutes following induction of anesthesia with enflurane in ten patients (mean delivered enflurane concentration 2.4 per cent), mean arterial blood pressure and LV systolic and diastolic dimensions were decreased, while heart rate was increased significantly, indicating that enflurane caused vasodilatation and may have had some depressant effect on contractility. Echocardiography is a non-invasive, safe and relatively rapid method that can be used in the perioperative period to assess cardiac function and to evaluate the effects of pharmacologic agents on the heart.


Physiologic saline solution, Normosol R pH 7.4, and Plasmanate as reconstituents of packed human erythrocytes. The authors compared the effects of three reconstituent solutions (Normosol R pH 7.4, physiologic saline solution, and Plasmanate) on hemolysis and cellular morphology of young (8-10 days' storage) and old (22-26 days' storage) packed human erythrocytes (PE). These variables were tested at 22 and 37 C and at two dilutions )1 part PE:1 part reconstituent and 2 parts PE:1 part reconstituent). Plasmanate produced unacceptably high levels of hemolysis, particularly of older PE, and should not be used as a reconstituent. Normosol R pH 7.4 and physiologic saline solution were compatible with both young and old PE, producing similar changes in hemolysis and erythrocytic morphology, Therefore, Normosol R pH 7.4 may be used as a diluent for PE when rapid and massive infusions are needed.


Cerebral hypometabolism obtained with deep pentobarbital anesthesia and hypothermia (30 C). Cerebral metabolic and vascular effects of hypothermia (30 C) and deep pentobarbital anesthesia, separately and combined, were evaluated in 15 mongrel dogs. External cardiovascular support was not used, and mean arterial blood pressures remained greater than 60 torr. Normothermic deep pentobarbital anesthesia, characterized by an electroencephalographic (EEG) frequency of less than 1 Hz, was associated with 30% decreases in cerebral metabolic rates for oxygen (CMRO2) and glucose (CMRG) from lightly anesthetized control values. Hypothermia (30 C) alone caused similar decreases in CMRO2 and CMRG in the presence of an active EEG. The use of pentobarbital anesthesia and hypothermia combined achieved significantly greater (P less than 0.05) decreases in CMRO2 (70%) and CMRG (72%) from the control state. Cerebral vascular resistance (CVR) increased by 70% (P less than 0.05) during hypothermia and about 20% when pentobarbital was administered to normothermic dogs. In hypothermic animals the addition of pentobarbital had a minimal effect on CVR. No alteration in the oxygen-glucose or lactate-glucose index indicative of cerebral hypoxia occurred in any experimental group. This study indicates that barbiturates combined with hypothermia decrease cerebral metabolism to a greater extent than hypothermia or barbiturate alone. When cerebral hypometabolism is therapeutically necessary, barbiturates may be indicated as an adjunct to moderate hypothermia.


Glucose transport across the rat blood-brain barrier during anesthesia. The authors studied blood-brain barrier (BBB) glucose transport kinetics in awake rats and in pentobarbital- and halothane-anesthetized rats, using a 3H2O/14C-D-glucose double-indicator method corrected for cerebral blood flow at glucose concentrations from 1 to 80 mM. At normal glucose concentrations (5 mM), total brain glucose influx was unaltered by pentobarbital. In contrast, halothane attenuated glucose transport capacity from 1.9 to 0.4 mumol/g-min-1 and increased diffusional transport, Km (Michaelis constant) was decreased sixfold, from 12 to 2 mM. Halothane appears to inhibit BBB glucose transport by competing for the glucose carrier and by altering the affinity of the carrier for glucose, perhaps by altering the environment of the carrier or the carrier itself. The finding of halothane-induced increased diffusional transport of glucose across the BBB corroborates earlier reports and more recent evidence that halothane increases the permeability of the BBB to diffusional processes.


Cardiovascular effects of plasma levels of thiopental necessary for anesthesia. The cardiovascular effects of plasma levels of thiopental necessary for anesthesia were studied using systolic time intervals (STI). In ten healthy patients anesthesia was induced with thiopental, 2-2.5 mg/kg, intravenously, and maintained with an infusion of 1-1.5 mg/kg/min. STI and thiopental plasma levels were measured before induction and when corneal reflex and trapezius muscle response, indicators of anesthetic depth equivalent to response to surgical stimulation, were lost. Significant changes included: an increase in heart rate with induction of anesthesia; a decrease in 1/pre-ejection period2--indexed for heart rate (1/PEP2-I) at loss of corneal reflex; a decrease in systolic blood pressure and 1/PEP2-I at loss of trapezius muscle response. No other variable was significantly different from control. Control values for STI were in the high-normal range, indicating some sympathetic stimulation. With induction of anesthesia these values decreased to a normal range. Free and total plasma levels were 5.4 and 37.6 microgram/ml at loss of corneal reflex; 6.1 and 41.6 microgram/ml at loss of trapezius muscle response. In comparison with other studies, thiopental causes less cardiac depression than inhalational agents at approximately the same anesthetic depth. It is concluded from this study in healthy patients that plasma levels of thiopental producing surgical anesthesia result in minimal cardiac depression as determined by systolic time intervals.


A high-humidity circle system for infants and children. A scaled-down version of a modified adult circle system capable of increasing normal humidity output 300% was constructed for pediatric use. The moisture content of the gases leaving the system was tested and found to be superior to that of any pediatric circle system commercially available that does not incorporate an electrically heated water vaporizer.


Long injection time and biplane oblique patient positioning in femoral arteriography. We have made several important changes in femoral arteriography, including a slower rate, longer injection time, and the use of biplane oblique views. The long injection time has resulted in fewer repeat examinations. Biplane oblique filming of the pelvis has increased our ability to demonstrate stenoses and abnormalities, although it has not significantly increased the information content of the studies.


Acute effects of furosemide on blood electrolytes and hemodynamics in dogs. The effects of furosemide on the hemodynamics, blood electrolytes, and urinary output in 5 anesthetized dogs were studied. There were no significant changes in blood Na+ or Ca++ levels, but K+ decreased significantly after 15 minutes of furosemide treatment. There were no significant changes in the blood pressure, heart rate, left ventricular systolic pressure, index of left ventricular contractility [(dp/dt)/IIP], or systemic vascular resistance. Left ventricular dp/dt decreased for 30 to 60 minutes. Later the dp/dt and (dp/dt)/IIP of left ventricular pressure exceeded control values, although increases were not significant. Left ventricular work index and stroke volume decreased significantly between 30 and 90 minutes. The cardiac output and cardiac index also decreased. Left ventricular end-diastolic pressure decreased significantly only at 30 minutes. Cardiac function remained unchanged and consistent with the electrolytes changes. Although there was a marked diuresis, which normally must have significantly decreased the effective blood volume and hence the myocardial contractility, the cardiac function remained unchanged. These results suggests that furosemide might have a direct effect on the myocardium. Clinical improvement in patients might be the result of a direct effect on the myocardium aside from its effect due to diuresis.


Tetralogy of Fallot associated with uncommon lesions. A patient presented with a a unique combination of cardiovascular abnormalities: tetralogy of Fallot, absent pulmonary valve, stenosis of peripheral pulmonary arteries, and partial anomalous pulmonary venous connection to the azygos vein. The salient aspects and associated lesion of each of these abnormalities are described.


Angiographic and pathologic correlations in Prinzmetal variants angina. The coronary-arteriographic and pathologic findings in a case of Prinzmetal's angina are reported. Right coronary arteriograms performed in the absence of pain showed only minor stenotic changes, whereas those performed during an anginal attack revealed a spastic occlusion involving almost the entire vessel. Anatomic examination revealed obstructive lesions of the right coronary artery, more pronounced at the site where spasm had started, due to concentric atherosclerotic thickening of the inner wall, whereas the elastic fibers and the muscular ring of the tunica media were preserved. These findings suggest (1) the need for great caution before assuming on purely angiographic bases that spasm may affect a normal coronary artery and (2) the possibility that spasm occurs in a markedly diseased and stenotic segment of a coronary artery as long as the contractile tissue of the tunica media is preserved.


An unusual coronary abnormality.

An unusual coronary abnormality. An unusual case of an aberrant coronary artery is described. The aberrant artery arose from the L.A.D. branch and ended in the aorta. It had two aneurysmal dilatations.


Peripheral vascular dynamics studied by calcium ion inhibition. The study of peripheral vasomotility through inhibition of parietal smooth muscle cells is of great clinical interest for both diagnostic and therapeutic reasons. It permits the differentiation of the functional clinical forms from the organic. And in organic forms, once any spastic component is eliminated, it determines the site and severity. On the basis of these premises we have developed a test for the study of vascular dynamics based on the use of nifedipine as antagonist of calcium ions.


Gaisböck's syndrome: its hematologic, biochemical and hormonal parameters. The syndrome of plethora without splenomegaly, leukocytosis, or thrombocytosis was described by Gaisböck in 1905. It was reevaluated in 25 patients through the study of numerous hematologic and biochemical parameters. Statistically significant findings included mild obesity; elevation of blood pressure (especially diastolic); decrease in plasma volume with relative increase in red cell count, hemoglobin, hematocrit, viscosity of blood, elevation of plasma proteins, serum cholesterol, triglycerides, uric acid, and plasma renin; and increased excretion of urinary sodium. The reduction in plasma volume seemed related to the elevation of the diastolic blood pressure, and favorable through temporary therapeutic results were produced by some antihypertensive agents. The elevation of serum cholesterol, triglycerides, and uric acid, the increased blood viscosity, and the elevated plasma renin were reminescent of the biochemical changes observed in some instances of hypertension and atherosclerotic disease. They may explain why patients with the Gaisböck's syndrome belong to the high risk group of hypertensive individuals who often develop cardiovascular complications. While its long-term effects remain to be evaluated, treatment with nondiuretic antihypertensive drugs may help reduce the incidence of these complications.


Combined study of hyperemia after arterial occlusion and exercise by an isotopical test and a Doppler-ultrasonic method. Postischemic hyperemia was studied in normal and pathologic limbs by an isotopical method, which measures the delay and the rate of appearance of tagged serum-albumin in the foot after release of an arterial femoral occlusion (T in seconds). The postexercise hyperemia was assessed by the follow-up of the ankle arterial pressure drop (deltaP). deltaP was positively correlated to the logarithm of T in the absence of proximal arterial lesions. The correlation vanished in the presence of an aortoiliac occlusive disease. Therefore we conclude that the isotopical test can be used to assess selectively the capacity of hyperemia of the arterial network below the inguinal ligament.


Circulatory effect of respiratory maneuvers. The circulatory effects of three kinds of respiratory maneuvers--maximum breathing, voluntary hyperventilation, and the Valsalva maneuver--on cerebral blood flow, brachial blood flow, heart rate, and systolic blood pressure were investigated by means of the on-line Doppler ultrasonic technique in 20 men. Arterial gas contents (PO2, PCO2, pH) were also examined. Cerebral blood flow was increased or showed the biphasic response (increase in the former and decrease in the latter part of the maneuver) with maximum breathing. Cerebral blood flow was decreased with voluntary hyperventilation. The cerebral blood flow was maintained at a same level during the maneuver or tended to return to the control level. Cerebral blood flow was decreased in the Valsalva maneuver. There was a transient but conspicious increase of the cerebral blood flow immediately after the maneuver.


Prognosis of patients with diabetes mellitus after endarterectomy of the femoral artery. The perioperative prognosis of 81 diabetic patients after endarterectomy of the femoral artery was analyzed by a computer program and compared to the prognosis of a control group of 83 nondiabetic patients. The percentage of female patients in the group with diabetes mellitus was 22% in comparison with 8% of the control group. Most of the diabetic patients in clinical degree II/III were approximately 10 years younger at the time of operation than the patients of the control group. Cardiac complications occurred in 16% of the diabetic patients and in 1% of the nondiabetic patients. The hospital mortality in the group with diabetes mellitus was 14%, significantly higher than the 6% mortality among patients of the control group (x2 = 4.26). Clinical evaluation of the patients in both groups showed that the patency rate of the reconstructed vessels was 80%.


Echocardiographic demonstration of tricuspid valvulitis and right atrial thrombus complicating an infected artificial pacemaker:a case report. A right ventricular artificial demand pacemaker was implanted into a 59-year-old man with supra-Hisian complete heart block. His postoperative course was complicated by Staphylococcal aureus septicemia, which was controlled with antibiotics. A year later, S. aureus was again isolated from the blood. Echocardiography showed thickening of the tricuspid valve leaflet and multiple echoes in the right atrium. Autopsy findings included tricuspid leaflet thickening and an overlying right atrial thrombus. The echocardiogram is thus useful in localizing an infected valve in bacterial endocarditis and in demonstrating the presence of the thrombus.


Cardiovascular function in dogs with acute hypokalemia. The effects of acute hypokalemia on plasma electrolytes, cardiovascular function, osmolality, and hematocrit were investigated in anesthetized dogs for 2 hours. There was progressive increase in the total systemic vascular resistance, but no change in the osmolality and blood hematocrit. All of the hemodynamic parameters decreased except the preferred index of myocardial contractility, [dp/dt]/IIP, which increased during hypokalemia. The changes in this index of myocardial contractility were associated with changes in the plasma potassium but not the plasma sodium. The results suggest that hypokalemia-induced increases in myocardial contractility might be associated with an increased influx of Ca++ as a result of hypokalemia-induced inhibition of sarcolemmal Mg++ -dependent, Na+-K+-ATPase.