Structure and carbohydrate histochemistry of the stomach in eight species of teleosts. The histology and carbohydrate histochemistry of eight teleostean stomachs are compared. Three gross anatomical types of stomachs are described and their shapes appear to correlate somewhat with feeding habits. Each type can be divided histologically into a corpus and pylorus. Gastric glands, containing only one cell type, occur in the copora of all species, but are present in the pylori of esocids only. As a single cell can produce both enzymes and hydrochloric acid such cells may be comparable to those of amphibians but not mammals. Lamina propria and submucosa are indistinctly separated in corpora but better defined in pylori by an intervening muscularis mucosa. The arrangement of the muscularis into inner circular and outer longitudinal layers is the opposite of that seen in the esophagus. Gastric mucous cells show species variations in localization of epithelial mucosubstances, which in broad terms are recognized as sulfomucins, sialomucins and neutral mucosubstances. A piscivorous diet does not appear to demand any particular type of carbohydrate. Within the Centrarchidae, gastric pit cells vary in carbohydrate content from only neutral mucosubstance to only weakly acidic sulfomucin; two species contain both types. A positive PAS reaction on the surface of gastric epithelial cells is suggestive of a striated border and thus possibly absorptive function. The absence of stomachs in some teleosts and the evolutionary and dietary significances are discussed.


The pineal-paraphyseal complex of sea turtles. I. Light microscopic description. The pineal-paraphyseal complex of sea turtles is an impressively large structure which projects dorsally and anteriorly above the prosencephalon. The complex was examined by light microscopy in several age classes of green sea turtles (Chelonia mydas) and from juvenile loggerhead turtles (Caretta caretta). The paraphysis is extensively fused to the distal portion of the pineal body, suggesting an interrelated function for these two tissues. No duct or canal was observed connecting the pineal lumen to the third ventricle. Two pineal cell types are described which appear to correspond to the neuroglial supportive cells and the secretory rudimentary photoreceptor cells of other amniotic vertebrates. A possible luminal secretion in the form of apical protrusions is produced by the latter cell type. No typical photoreceptive outer segments were observed.


Ultrastructural features of neuromuscular junctions in the stapedius muscle of gallus gallus. The ultrastructure of neuromuscular junctions in the twitch fibers of the stapedius muscle of Gallus gallus (domesticus) was investigated as part of a series of neurophysiological studies. Among the morphological features observed were elongated end-plates with numerous large and clear synaptic vesicles mixed with larger dense core vesicles and irregular or aperiodic "active sites" in the presynaptic membrane where synaptic vesicles were focused. The most remarkable features of these junctions were large synaptic clefts (50-80 nm) and the absence of junctional folds in the sarcolemmal surface. Unlike the large periodic junctional folds seen in the neuromuscular junctions of frogs and in the fast twitch fibers of the mammalian stapedius, the preparations studied only show small aperiodic invaginations (primitive folds) in the postsynaptic membranes. This morphological feature remains essentially constant from newly hatched to adult chickens. While these smooth junctions are consistent with earlier findings of inconspicuous junctional folds in the twitch fibers of the chicken posterior latissimus dorsi they are unlike those seen in the fast twitch fibers of the mammalian stapedius muscle, or other twitch fibers in general. The morphological findings of the present study may also suggest that the simple, unmodified neuromuscular junctions in the stapedius of Gallus may be a useful preparation for studies of synaptic membrane structures that employ the freeze-fracture technique.


Application of the 'profiles of relationship' method to distantly related proteins. An analysis is made of the applicability of the recently published 'profiles of relationship' method for establishing evolutionary relatedness among proteins by using the distantly related proinsulin and neurotoxin protein sequences as a test object. The method is based on a simultaneous group analysis of both the frequency of acceptance of mutations and their genetic code interchangeability. Regularities in the patterns of the profiles, which reflect decreased similarity with the passage of time, are established for typical cases of closely related, distantly related and unrelated proteins. This makes it possible to distinguish distantly related from unrelated proteins without extensive statistical randomization procedures. New evidence is stated in favour of a previously suggested definition of interchangeability which does not consider the third base in the codon. The applicability of the profiles of relationship method is examined on the distant relationship between proinsulin and the snake and scorpion neurotoxins which has been established previously by means of conventional approaches.


Evolution of the 5 S RNA genes in vertebrates. We have built the phylogenetic tree of Vertebrate 5S RNA using the sequence data of thirteen species belonging to six groups. Evolution of the 5S genes has been very slow in Vertebrates since 90 residues are identical in all 5S RNAs which are presently sequenced. In Amphibians and Teleosts different 5S genes are active in oocytes and in somatic cells. This dual gene system has probably been acquired independently by Amphibians and Teleosts. In Amphibians, the oocyte-type 5S genes have evolved much faster than the somatic-type genes. This is not true in all species since the oocyte-type genes of one Teleost (Tinca tinca) have evolved more slowly than the somatic-type genes. There are in all Vertebrate 5S RNAs five complementary regions which can be base-paired. The sequence data are compatible with the three secondary-structure models that have been proposed for 5S RNA.


Evolution of isozyme loci and their differential tissue expression. Creatine kinase as a model system. The phylogeny of the creatine kinase (CK, EC 2.7.3.2) isozyme loci and their differential tissue expressions were determined for representatives of 65 families of vertebrates, with emphasis on the fishes. The transition from the single creatine kinase locus, characteristic of certain echinoderms, to the two creatine kinase loci which are orthologous to those present in all vertebrates, occurred early in the chordate line. The majority of pre-teleostean fishes possesses only these two CK loci (A and C). These loci are relatively generalized in their tissue expressions which are variable among species of primitive fishes. The third and fourth creatine kinase loci (B and D) arose separately in the ancestors of the bony fishes and appear to be the result of regional genome duplications. Concomitant with the increase in the number of isozyme loci has been an increase in the specificity of their tissue expression. In the advanced teleost fishes the four CK loci are differentially expressed in a characteristic manner. The A2 isozyme predominates in skeletal muscle, the B2 isozyme in eye and brain, the C2 isozyme in stomach muscle, and the D2 isozyme is found exclusively in testis. We propose a phylogeny of the creatine kinase genes in the lower chordates based on the time of appearance of new CK loci, the sequence in which the loci achieve a tissue restricted expression, and the immunochemical relatedness of the orthologous and paralogous gene products.


The effectiveness of sex therapy for chronic secondary psychological impotence. This paper describes the treatment results of sexual therapy with 16 couples. The men had chronic secondary psychological impotence. They were evaluated, treated, and followed up by the same sex therapist. Another psychiatrist evaluated each couple after therpay. Pre- and posttherapy Sexual Interaction inventories were administered as numberical measures of therapeutic effectiveness. By the end of treatment 6 men of the 16 were consistently potent and 4 were potent at least half of the time. Of the 11 men who had improved, 10 demonstrated considerable instability in erectile functioning over 1-year follow-up. Sex therapy can improve sexual functioning. However, it does not restore complete sexual health to couples with this complicated disorder.


Sexual behavior and guilt among women: a cross-generational comparison. This paper reports the results of a study of the relationship between guilt and sexual behavior among 45 married women. The age breakdown of the subjects included 60 and above, 40 to 50, and 20 to 30, with 15 women included in each age category. A negative relationship was found between the age of subjects and the extent of sexual behavior while a positive relationship existed between age and sexual guilt. The younger women's sexual behavior scores were higher than both the middle and older (statistically significant) women. Scores indicated less guilt associated with sexual behavior for the younger women than for the middle-aged and older (statistically significant) women.


Extramarital sexuality: implications for marital therapists. Although large numbers of clients approach marital therapists with concerns about extramarital behavior (ES), little has been written specifically about the implications of ES for practitioners. This paper uses a script theory framework to suggest why there are important attitude-behavior discrepancies concerning ES and how these differences may affect therapy. The authors also examine research findings concerning ES which do not support some widely held beliefs. This discussion includes a list of seven factors which therapist may utilize to differentiate diverse ES experiences and help couples clarify their values and intentions. Several case examples illustrate this process. Attention is also paid to the therapist's own values about ES and how they may affect therapy. ES emerges as a very complex phenomenon which requires a high degree of knowledge, sensitivity, and recognition of individual differences on the part of therapists.


The care and feeding of small-group leaders of sex discussion groups. This paper will focus on the selection, training, and monitoring of the small-group leaders in an extensive program of sex education. While not explicitly therapeutic, the leadership role in the six small-group sessions held during a 2-day period, covering highly emotional material, demands the skills and sensitivities of the traditional group therapist. In addition, group leaders must be aware of the limits of this experience and the subtle effect of a leader's role modeling during group discussion. The paper will discuss the SAR model, its academic history, and our experience with over 200 leaders drawn from both professional and paraprofessional ranks. We have data on participant evaluation of leaders and have developed a series of concepts regarding group process which is fed into our training program. Qualitative assessment of characteristics of the effective sex group leader is now possible as are basic group and member issues that most leaders must handle. The paper will discuss leadership screening, early orientation, small-group training sessions, practice leadership, supervision, evaluation, and problem solution in this highly sensitive area of sexuality, which while educational in purpose, is therapeutic in process.


The impact of a marriage enrichment program on relationship factors. This study represented a continuing effort to assess the effects of a marriage enrichment program previously used by Kilmann, Moreault, and Robinson. Eleven couples who responded to newspaper and radio announcements received fair-fight training followed by sexual enhancement. Six couples recruited in the same manner received no treatment but responded to the measures at the same time intervals as the experimental couples. In comparison with the control couples the experimental couples reported a significant increase in marital adjustment and significantly greater actualized relationship. From a videotaped problem-solving task the experimental couples were rated as exhibiting significantly more positive communication patterns than the control couples. The findings offer support for the marriage enrichment program, although larger samples are needed to determine which treatment components are most beneficial for defined couples.


Thyroid carcinoma in black patients.

Thyroid carcinoma in black patients. From 680 surgical specimens of thyroid disease, 31 cases of thyroid carcinoma found at Howard University Hospital, from January 1950 to December 1975, are reviewed. Eighteen (58 percent) were females and 13 (42 percent) were males. Of the 31 patients, there were 11 patients with follicular carcinoma, 11 with papillary carcinoma, seven with mixed papillary and follicular carcinoma, one with Hurthle cell carcinoma, and one with medullary carcinoma. Thyroid carcinoma accounts for only .001 percent of all admissions during the period of study, and is indeed a rare cause of disease among blacks at this institution. Recommendations for surgery and follow-up data are presented.


Pituitary function and growth hormone dynamics in acromegaloidism. Acromegaloidism is a condition which resembles acromegaly by its clinical manifestations but is not due to pituitary or hypothalamic dysfunction. Twenty patients were diagnosed as having this disorder and the results from studying growth hormone (GH) responses in 15 patients (11 women and four men) were included in this report. Clinical manifestations closely resembled those of acromegalics, including history of progressive changes, acral enlargement, visual disturbances, abnormal visual fields in four patients, and sella turcica enlargement in two patients. The glucose tolerance test (GTT) was abnormal in 12/15 patients, 13/15 were > 10 percent obese, 8/15 had hypertension, 7/15 had large-statured relatives, but lactorrhea was absent in all patients. The mean serum GH concentration was 2.2 ng/ml, which suppressed to 0.6 ng/ml during the GTT; increased to 24 ng/ml during hypoglycemia; and increased to 10.3 ng/ml after L-dopa ingestion. Other pituitary hormones (LH, FSH, TSH, prolactin), the metyrapone test, 24-hour random and nocturnal sleeping GH concentrations were normal. These GH values and responses helped to differentiate acromegaloidism from treated and untreated acromegaly. The pathogenesis of acromegaloidism was not determined, but somatomedin studies may prove helpful in further defining this disorder.


Cytologic problems in diagnosis of endocervical atypia in young females with and without maternal history of diethylstilbestrol exposure. Sixteen cytologic endocervical atypias are reported with corroborative tissue analysis. Maternal diethylstilbestrol (DES) history was positive in three patients, one with clear cell adenocarcinoma, one with colposcopy and biopsy proven benign vaginal adenosis, and one with squamous carcinoma in situ of the cervix. Colposcopy was performed in two cases, one with adenosis and one with clear cell adenocarcinoma.In three patients, aged 19, 17, and 25, respectively, clear cell adenocarcinomas were found with unknown DES history and positive cytology. In five other cytologically positive cases, endocervicitis was found in three, atypical endocervical hyperplasia in one, and severe squamous dysplasia in one. This represents a cytologic false positive or specificity reading error of 37 percent in this type of material. One case of clear cell adenocarcinoma was linked with DES exposure.In the six suspicious and borderline cytologic reports, one vaginal adenosis, one condyloma acuminata, and one squamous carcinoma in situ were found. This represents a false positive or specificity reading error rate of 43 percent.Cytology is clinically valuable in Proven cases of vaginal adenosis or adenocarcinoma. It is not a diagnostic modality, with a high sensitivity error (false-negative rates) of 50 percent and higher, as reported in the literature and high specificity error (false-positive rates) as herein reported.


The role of psychiatric emergency services in aiding community alternatives to hospitalization in an inner-city population. In the proper political/economic environment, Crisis Intervention Programs can reduce the recidivism rate of patients who suffer from recurrent intermittent acute psychotic episodes. The author seeks to outline such a program and demonstrate its effectiveness in providing an alternative to brief hospitalization. It is believed that this form of management of the psychiatric emergency aids the practice of community psychiatry and supports the use of day treatment facilities, outpatient clinics, emergency housing, family therapy, and other community support systems.


Toxins and carcinogens in the environment: an observation in the tropics. The incidence of primary liver cancer in the countries of tropical Africa is the highest in the world. There is a growing belief that the relatively high prevalence of hepatocellular carcinoma in Nigeria may have a multiple chemical factor etiology in such forms as food contaminants, herbal teas, and environmental chemicals. Major chemical toxins and carcinogens that have been identified so far in the tropical environment include sapotoxin, cycasin, mushroom toxin, capsaicin, oxalic acid, prussic acid, fluorooleic acid, N-nitroso compounds, aflatoxin, palmotoxin, pyrrolizidine alkaloids, quinine, DDT, and cyclamate.


Effect of subacute manganese feeding on serotonin metabolism in the rat. To clarify the effect of subacute manganese feeding on serotonin and mineral metabolism, Wistar rats were separated into two groups and fed two different diets, on a normal diet and another a manganese-supplemented diet. After 3 wk on these dietary regimens, the rats on the manganese-supplemented diet manifested the following abnormalities: blood pressure was decreased, brain serotonin was decreased, aromatic L-amino-acid decarboxylase activity in the brain was decreased, and manganese levels in heart, lung, and kidney were increased, whereas sodium, potassium, magnesium, and calcium levels in the brainstem were decreased.


Dose-dependent fate of 1,4-dioxane in rats. A pharmacokinetic study was conducted to determine the fate of dioxane in rats at doses equivalent to those given in toxicological studies conducted previously. The results show that the fate of dioxane in rats is markedly dose-dependent because of a limited capacity to metabolize dioxane to beta-hydroxyethoxyacetic acid (HEAA). The pharmacokinetic data collected in support of these conclusions include plasma concentration-time curves for dioxane given to rats iv at dose levels of 3-1000 mg/kg and for an inhalation study of 50 ppm dioxane vapors for 6 h. The plasma curves at low doses by each route were linear with half-life values of about 1 h. As the dose was increased above 10 mg/kg the plasma clearance rate decreased, the fraction of the dose excreted as HEAA decreased, and the fraction of the dose excreted as dioxane per se in the urine and expired in the breath increased. These data could be described by a one-compartment open system model with parallel first-order (urinary and pulmonary excretion) and Michaelis-Menten (metabolism) elimination kinetics. At saturation, the maximum velocity of metabolism of dioxane to HEAA was about 18 mg/kg . h. Multiple daily oral doses of 1000 mg/kg, but not 10 mg/kg, were excreted more rapidly than equivalent single doses, indicating that at high daily doses dioxane induced its own metabolism. The correlation of the dose-dependent fate of dioxane with the results of toxicological studies in rats supports the conclusion that there is an apparent threshold for the toxic effects of dioxane that coincides with saturation of the metabolic pathway for its detoxification.


Pharmacokinetic and toxicological evaluation of dogs fed 1,2,4,5-tetrachlorobenzene in the diet for two years. 1,2,4,5-Tetrachlorobenzene (TCB), an intermediate in several industrial processes, was administered in the diet to dogs at 5 mg/kg . d for 2 yr, followed by a 20-mo recovery phase. The animals were examined periodically for toxicity; the concentration of TCB in the plasma and fat was measured during the 2 yr of exposure and 20 mo of recovery. After 18 mo of exposure, all clinical chemistry parameters were normal; however, after 24 mo, serum alkaline phosphatase activity and total bilirubin levels were slightly elevated in the dogs dosed with TCB. Both clinical chemistry parameters returned to normal levels within 3 mo of the cessation of exposure. After the 20-mo recovery, gross and histopathologic examination of tissues revealed no morphological changes considered related to the ingestion of TCB. At the end of 2 yr of exposure, TCB had reached 98 and 97% of the calculated steady-state concentrations in fat and plasma, respectively. TCB was eliminated from the fat and plasma with half-life values of 111 and 104 d, respectively. Although there were only small differences in the approach to steady state, differences in the rate of elimination of TCB from fat and plasma resulted in dramatic changes in the fat/plasma ratio of TCB throughout the entire study.


Effect of linamarin on thiocyanate production and thyroid activity in rats. The principal cyanogenic glucoside in cassava is linamarin (2-hydroxyisobutyronitrile-beta-D-glucoside). Addition of pure linamarin to a diet based on 10% vitamin-free casein did not affect the weight gain of rats. However, as expected, the animals that received the casein diet supplemented with methionine gained more weight than those that received the unsupplemented diet. The amount of thiocyanate ion excreted in the urine by the animals that received linamarin was higher than that excreted by the animals that did not receive linamarin at both levels of dietary methionine. The plasma thiocyanate concentration was also higher for linamarin-fed animals than for animals that did not receive linamarin. Higher plasma thiocyanate levels were associated with a lower percentage uptake of radioiodine by the thyroid.


Stimulation of DNA synthesis in lungs of hamsters tolerant to nitrogen dioxide. Nitrogen dioxide (NO2) is both edematogenic and cytotoxic to the lung. Preexposure to NO2 protects against mortality from formation of excessive pulmonary edema (tolerance) and, depending on the preexposure schedule, may or may not protect against the cytotoxic effects of NO2 in the lung. Measurement of DNA synthesis in hamster lung was used to study the question of whether the more subtle cytological injury induced by NO2 is mediated by a system that also exhibits tolerance. It was found that when hamsters are preexposed daily to 10 ppm NO2, they develop tolerance for normally lethal concentrations of NO2, are protected against cytological injury from 10 ppm NO2, but are not protected from the cytotoxic effects of NO2 at concentrations greater than 10 ppm. Animals exposed weekly to 10 ppm NO2 are not protected from further cytological injury induced by weekly exposures to 10 ppm NO2, but do develop tolerance for lethal concentrations of NO2. Thus, the data indicate that induction of tolerance to NO2 does not necessarily protect the cell populations of the lung from the cytotoxic effects of NO2.


Combined effects in toxicology--a rapid systematic testing procedure: cadmium, mercury, and lead. A testing procedure is described for the assessment of the toxicological response (e.g., acute toxicity or mutagenicity) of any combination and number of chemical, physical, and biological agents, with no more effort for a particular combination than for a single agent. The method provides a simple, sensitive, and quantitative index of synergism, antagonism, and additivity, and it has been demonstrated experimentally in rats by determining the acute lethality of combinations of cadmium, mercury, and lead salts. In a combination of two metal salts, the dose of one metal of the pair was fixed at or near the no-effect level while the dose of the second metal was increased until the entire dose-response curve was obtained. To evaluate interactions of the three metals, the previous pair of metals were kept fixed at their combined extrapolated LD1 level, and the third metal was increased. The statistical treatment of the data employed a computer program that did not involve probit transformations, but rather the approximate linear relationship between the fractional response and the logarithm of the dose. A particular combination could be synergistic, antagonistic, or additive, depending on the relative doses employed. Generally, a combination was synergistic when the most toxic member was present at or near its LD1 dose in the presence of the much less toxic member; the same combination was protective when the least toxic member was present at or near its LD1 dose. The results clarify apparently contradictory reports regarding the biological effects of metal combinations. The application of the testing procedure to combinations of mutagens is described, and an example is cited involving, for a particular bacterial mutagen, a combination of N-methyl-N'-nitro-N-nitrosoguanidine with ethylmethanesulfonate.


Degradation of cadmium-thionein in rat liver and kidney. [3 H] Cystine and 115mCd were incorporated into hepatic and renal Cd-thionein in response to sc administration of 4.4 mumol of Cd2+ containing 115mCd. Cd-thionein-bound 115mCd reached a plateau by 24 and 72 h after the Cd2+ injection in liver and kidney, respectively. The half-life (t1/2) of 3 H-labeled hepatic Cd-thionein was 3.5 d, whereas the average t1/2 of the soluble proteins was 3.7 d. The t1/2 of 3 H-labeled renal Cd-thionein was 3.7 d, whereas the average t1/2 of the soluble renal proteins was 3.8 d. In marked contrast, the 115mCd content of both hepatic and renal Cd-thionein was virtually unchanged, even 9 d after administration of this radionuclide. These data indicate that the protein moiety of metallothionein is degraded, although there appears to be a concomitant rebinding of Cd2+ to nascent thionein polypeptide chains. Thus the lack of metallothionein degradation per se does not account for the long-term retention of Cd2+ in liver and kidney during chronic exposure.


Use of the Wagner apparatus in complicated fractures of the distal femur. Five case histories are presented involving management of complicated fractures of the distal femur with the Wagner apparatus used for external fixation. The advantages of this method are that it involves less metal and less extensive surgical exposure than internal fixation devices. There is ample wound access, more rigid fixation, earlier ambulation, and increased patient comfort. Use of the device as an available alternative, especially in cases complicated by vascular or neurologic injury, soft-tissue, or bilateral injury, is advocated, based on this preliminary experience.


Effects in rats and guinea pigs of six-month exposures to sulfuric acid mist, ozone, and their combination. Rats and guinea pigs were exposed to 0.5 ppm O3, 10 mg/m3 sulfuric acid (H2SO4) mist, or their combination for 6 h/d, 5 d/wk for 6 mo. Microscopic alterations were seen in the lungs of guinea pigs exposed to O3 alone or in combination with H2SO4 mist. No other microscopic lesions were present in either rats or guinea pigs. No biologically meaningful synergistic effects were noted in animals exposed to the combination of O3 and H2SO4 mist.


Effect of glucose infusion on glucose and lactate metabolism in normal and burned guinea pigs. We have used the simultaneous primed-constant infusion of 6-3H-glucose and U-14C-lactate to investigate the effect of an exogenous glucose infusion (55 mumole/kg.min) on glucose and lactate metabolism in normal and burned guinea pigs. Before the unlabeled glucose infusion, glucose turnover was higher in the burned animals than in the controls, but lactate turnover was similar. During the unlabeled glucose infusion, lactate production increased in both control (73%) and burned animals (104%), yet arterial lactate concentration did not rise in either group. The ability of tissue uptake of lactate to keep pace with increased lactate production appeared to be related to an enhancement of lactate oxidation. When a two-pool model was used to calculate glucose-lactate interrelationships, it was concluded that during the glucose infusion Cori cycle flux (glucose to lactate to glucose) was higher in burned animals than in controls. Also, the primary route of oxidation of infused glucose in controls and particularly in burned animals appeared to be through conversion to lactate and subsequent oxidation of lactate.


Asbestos fibers in wines: relation to filtration process. Asbestos fibers were counted by using the transmission electron microscope in 42 wines from France and abroad. Fifteen samples were found to be significantly positive for chrysotile asbestos. Concentrations were in the range of 2--64 X 10(6) fibers per liter. Technical investigations showed that the abestos content of the wines was related to the process by which they were filtered. On the other hand, we found that abandoning the use of asbestos for filtering wines would not alter the wine from the enological point of view.


Vertebral column injuries associated with tobogganing. Twenty-four cases of vertebral column injuries associated with tobogganing accidents are presented. The position assumed by the participants increased flexion of the vertebral column, therefore enhancing the possibility of injury to the spine, especially at the mobile thoracolumbar junction. The importance of a thorough examination in evaluating these patients is emphasized as not all injuries are benign. We urge safer and better organization of tobogganing facilities. Two case reports, one a burst fracture of L1 with neurologic involvement and the second, a traumatic spondylolisthesis of L1, are presented in detail.


Spinal injuries in child abuse: case report. Injuries of the spine have been seen in cases of child abuse. These injuries can be identified by careful skeletal survey. In the case described, a young boy was originally diagnosed as having dorsolumbar kyphus with no previous trauma, but the injury was later found to be related to parental abuse. The most important condition to rule out is spinal infection. The parental behavioral history is important, and social work consultation is recommended.


Respiratory tract lesions in guinea pigs exposed to sulfuric acid mist. Guinea pigs were exposed inhalation chambers to 25 mg/m3 sulfuric acid mist 6 h/d for 2 d, and the acute respiratory effects were correlated by light and electron microscopy. This concentration of acid was selected since lower concentrations result in only slight effects while higher concentrations result in death. By light microscopy, the most prominent pulmonary lesion at 48 h was segmental alveolar hemorrhage and edema accompanied by proliferation of alveolar macrophages and type 2 pneumocytes. The segmental distribution of the pulmonary lesion was reaffirmed by scanning electron microscopy, while transmission electron microscopy showed injury to the distal airways and changes in the vascular endothelium.


Occult infected fracture of the femur: report of two cases with long-term followup. The unusual occurrence of secondary infection of a closed fracture in two patients is described. The various possible etiologies of this syndrome and alternatives for treatment are discussed. Recognition of this entity and initiation of early definitive care, usually including open packing of the fracture wound, are emphasized.


Interactions of methoxychlor, methoxychlor base-soluble contaminant, and 2,2-bis(p-hydroxyphenyl)-1,1,1-trichloroethane with rat uterine estrogen receptor. Laboratory grade methoxychlor (99% pure), base-washed methoxychlor, and a metabolite of methoxychlor, 2,2-bis(p-hydroxyphenyl)-1,1,1-trichloroethane (HPTE), were tested for their ability to compete with [3 H] estradiol-17 beta ([3 H]E2) for specific binding to the estrogen receptor from immature rat uterine cytosol. The binding was determined on 10--30% sucrose gradients and by a dextran-coated charcoal assay and subsequent Scatchard plot analysis. On gradients, laboratory grade methoxychlor, but not base-washed methoxychlor, suppressed [3 H]E2 binding to the 8S estrogen receptor. However, the base-soluble fraction from washing of laboratory grade methoxychlor caused suppression o[3 H]E2 binding on sucrose gradients at a concentration as low as 3.6 ppm. Scatchard plot analysis indicated that the inhibition of binding observed with laboratory grade methoxychlor was competitive in nature and not caused by receptor destruction. It was concluded that laboratory grade methoxychlor contained a contaminant that was potentially estrogenic. HPTE, an in vivo metabolite of methoxychlor, caused a marked suppression of [3 H]E2 binding in the 85 region of the gradients. Analysis by Scatchard plot indicated that the effect of HPTE was not to decrease the number of E2 binding sites but merely to alter the affinity of binding to the receptor, presumably in a competitive manner. The low K1 value for HPTE suggested an extremely high affinity for uterine cytosolic E2 receptors.


Case report: an unusual stress fracture in a jogger. Stress fractures of the proximal fibula are uncommon, but do occur in the distal fibula in long-distance runners. A case is presented of a 71-year-old jogger who presented with a 2-month history of left knee pain. Radiographs showed an apparent destructive lesion of the proximal fibula which resembled a malignant bone lesion. Excision revealed a healing fracture.


Lethal complication from insertion of nasogastric tube after severe basilar skull fracture. An unusual complication is presented arising from the use of a nasogastric tube in a patient with a massive basilar skull fracture. Intracranial passage of the NG tube resulted. Therefore, in the presence of a severe basilar fracture and/or significant maxillofacial trauma where the integrity of the base of the skull may be in question, one should be very hesitant to insert tubes into the nasopharynx.


Gastrointestinal absorption and organ distribution of oral cadmium chloride and cadmium-metallothionein in mice. Body retention and tissue distribution of Cd from oral 109CdCl2 and 109Cd-metallothionein were studied in C57BL/6J mice given identical doses (60 microgram Cd and 2 muCi 109Cd). Measurement of 109Cd radioactivity in mice showed identical absorption but differences in tissue distribution of Cd from the two forms. A significantly greater deposition of Cd was observed in the kidney of mice fed Cd-metallothionein than in the CdCl2 group where a major portion of Cd was deposited in the liver. Most of the radioactive Cd in the renal and hepatic tissue and in the duodenum was bound to metallothionein 24 h after oral Cd-metallothionein, whereas only 30 and 38% of the cadmium in liver and kidney supernatants, respectively, were bound to metallothionein after oral CdCl2. These results suggest that the dietary form of Cd may influence the renal deposition of Cd.


A complication of nasogastric intubation: intracranial penetration. A patient with severe maxillofacial trauma had a nasogastric tube inserted into the intracranial cavity. Two such case reports were found in the literature and in both instances the patients expired. The present patient is believed to be the first who survived intracranial passage of a nasogastric tube.


Cardiovascular stabilization after hemorrhage depends upon restitution of blood volume. The role of late restitution of blood volume after hemorrhage in cardiovascular stabilization was examined in awake, splenectomized dogs. Cardiovascular variables were measured: at 2 hours after hemorrhage, changes were noted in cardiac output, mean arterial pressure, heart rate, stroke volume, arterial pressure, and CVP in three hemorrhage groups (p less than 0.05), and in total peripheral resistance for 15 ml/kg and 22.5 ml/kg hemorrhage groups (p less than 0.05). At 24 hours after hemorrhage, the degree of restitution of blood volume was correlated with cardiac output (p less than 0.01), stroke volume (p less than 0.02), and total peripheral resistance (p less than 0.01). No correlation was noted with heart rate, CVP, or mean arterial pressure. Blood volume restitution was correlated with degree of hemorrhage throughout the 24-hour period of investigation. Plasma protein content restitution and blood volume restitution were correlated with changes in osmolality. The results suggest thatcardiovascular stabilization after hemorrhage is a function of the degree of restitution of blood volume mediated through a shift of fluids to the interstitutium, mediated in turn by extracellular hyperosmolality.


Viet Nam wound analysis.

Viet Nam wound analysis. A statistical study is reported of 17,726 wounded American soldiers in Viet Nam over 15 months from March 1966 to July 1967. Causes, location, treatment, and results were analyzed for various regions, organs, and tissues. Results of treatment were remarkably good, the best in the history of military surgery. Major problems of resuscitation and treatment of local tissue injury which had not before been treated on a large scale were treated with excellent results.


Gastric mucosal lesions after burn injury: relationship to H+ back-diffusion and the microcirculation. Rats were subjected to a 30% body surface area full-thickness burn. Two hours after injury, 93% of animals had gastric mucosal erosions. At 5 hours this increased to 100%, but at 24 and 72 hours, lesions were fewer and less severe. Histologic study suggested that lesions noted at 24 and 72 hours represented erosions formed earlier. No mucosal abnormalities were noted in control rats. A causal relationship between mucosal ischemia and the development of erosions is suggested by the presence of A-V shunts at 2 and 5 hours only. Significant increases in H+ back-diffusion and protein leakage into the gastric lumen at 2 and 5 hours also implicated changed mucosal permeability in the etiology of erosions. The return of H+ back-diffusion to control values at 24 and 72 hours, when lesions were still present, appears to contradict the theory that permeability changes are secondary to erosion formation.


The mental health team on a burn unit: a multidisciplinary approach. The usual methods of psychiatric consultation in a medical-surgical ICU setting were found to be inadequate to deal with the complexly interrelated issues of patients' emotional reactions to severe injury and the simultaneous stresses on the staff who care for such critically ill patients. A new approach to consultation/liaison in this setting, a multidisciplinary mental health team, is described and illustrated to demonstrate a more effective model for dealing with a patient-staff system under chronic high stress.


Endocarditis with the indwelling balloon-tipped pulmonary artery catheter in burn patients. The postmortem finding of acute right-sided bacterial endocarditis in a burn patient monitored with an indwelling pulmonary artery (Swan-Ganz) catheter for 14 days prompted a review of burn autopsies in which the catheter had been used. Autopsies of six consecutive burn patients monitored with a pulmonary artery catheter and who then died showed septic or aseptic endocarditis. In two of the six patients, right-sided staphylococcal endocarditis was the anatomic cause of death. In the remaining four, the lesions were aseptic thrombotic vegetations involving primarily the right atrium, tricuspid valve, right ventricle, and pulmonic valve. Several factors in the severely burned patient would favor endocarditis where a foreign object impacts on the heart valves. These include intermittent bacteremia, hypercoagulability, hyperdynamic cardiovascular function, and the use of antibiotics resulting in resistant strains. While an indwelling pulmonary artery catheter can provide useful monitoring information, it is sometimes responsible for serious complications in burned or septic patients.


Bilateral dorsal dislocation of the distal radio-ulnar joint. A case of bilateral distal radio-ulnar dislocation following a forced extension-pronation injury of both wrists with bilateral fractures of the ulnar styloid is presented. The diagnosis was not made at the initial evaluation; and closed reduction under general anesthesia was performed 11 days after injury. A review of the literature, problems in diagnosis, and methods of treatment are discussed.


Triceps tendon avulsion with or without fracture of the radial head--a rare injury? The rarity of triceps tendon avulsion is called into question by our series of 6 cases collected over a 5-year period in a small, isolated Israeli community. The even rarer occurrence of triceps avulsion accompanying fractures of the radial head is more obviously contradicted by the 3 or 4 instances of such combined injuries in our series. Awareness that a fall on the outstretched arm, with or without fracture of the radial head, is sufficient cause of the triceps avulsion or tear ought to increase the frequency of the diagnosis. Just as fractures of the proximal ulna oblige the clinician to look for dislocations of the radial head (Monteggia or Hume fractures) (6), so must falls on the outstretched arm bring to mind the possibility of triceps tendon tears. Seemingly trivial findings then become significant, and the clinical entity thus crystallizes into the diagnostic syndrome.


Transcorpus impalement: occurrence in an unusual manner. An unusual case of abdominal impalement is presented. In such patients intra-abdominal injury must be suspected, and the impaling object must not be manipulated until the proper moment in the operating room. An approach involving various subspecialties, such as urology, neuro-, and vascular surgery, is often required.


Primary repair for closed lobar bronchus injury. Primary repair in a 19-year-old male who sustained a closed injury to the right bronchus in an auto accident was performed successfully. A 1.5-cm tear was found at operation extending from the right lower lobe bronchus into its distal portion. Nine months later, the patient showed a patent airway with minimal granulation around one suture.


Clinical trial of levamisole in the treatment of ascariasis in Khorasan, Iran. This paper identifies the parasitic infections and their incidence in 246 people aged between 10--20 years living in a semi-rural Iranian village. 64 patients with ascariasis were treated with levamisole ('Ketrax' ICI) in accordance with the manufacturer's instructions. Most were followed up 1 and 2 weeks after treatment, with cure rate of 97.7% and 98.4% respectively, as assessed by negative egg findings in faeces. No side effects were reported. Levamisole meets the requirements of individual and mass treatment of ascariasis.


Chromomycosis caused by Philaphora pedrosoi in eastern Nigeria. Three cases of chromomycosis from Eastern Nigeria are described. The aetiological agent was identified as Phialophora pedrosoi. Amphotericin B cleared most of the lesions in one case while 5-fluorocytosine gave a complete cure in another case.


Levamisole therapy of chronic Leishmania tropica. Cutaneous leishmaniasis is endemic in parts of Saudi Arabia. Levamisole used as a stimulant of cell mediated immunity has been shown in this study to produce good therapeutic response in clinical trials in the chronic form of this disease. Levamisole may prove to be the treatment of choice in the chronic form of Leishmania tropica.


African histoplasmosis in Eastern Nigeria: report of two culturally proven cases treated with septrin and amphotericin B. Two cases of African histoplasmosis culturally proven to be caused by Histoplasma duboisii are reported from Eastern Nigeria. One case had cutaneous papules and subcutaneous nodules all over his body while the other patient had cutaneous papules, an abscess over the right scapula, enlarged cervical, axillary and inguinal lymph nodes, and possible lung involvement. None of the 35 soil samples collected from the environment of the two patients were found positive for H. duboisii. In the first case, most of the lesions cleared with Septrin given orally. The 2nd case responded very well to treatment with intravenous Amphotericin B except for persistance of swellings in the inguinal lymph nodes. The effect of intralesional injection of Amphotericin B on this residual lymph node infection is now being assessed.


Pig-bel--a zoonosis?

Pig-bel--a zoonosis? It is postulated that the combination of a very low protein diet, with low pancreatic tryptic activity, plus the continual consumption of sweet potato trypsin inhibitors leads to inadequate proteolysis when a meal containing meat contaminated with C. perfringens type C and its beta toxin is consumed. The necrotizing pathogenic process concluding as segmental gangrene is set in motion by toxin produced under altered dietary conditions first by motor paralysis via beta toxin, followed by villous attachment and colonisation by ingested or resident C. perfringens type C in the gut. Necrobiosis is maintained by further toxin production which may be blocked in immune individuals. The endemicity of the disease is governed by the amount of C. perfringens type C in both the general and gut environments, the latter determined by dietary influences and the protein nutrition of the host. A hypothesis put forward is that the organism is carried and dispersed by the domestic pig and man becomes an incidental host. Infectivity only occurs when critical ecological factors exist in the small gut of humans. Prevention in the short term is possible with a toxoided vaccine using three injections given at one month and twelve month intervals.


Serum uric acid in Jordanian Arabs.

Serum uric acid in Jordanian Arabs. Serum uric acid was measured in 96 male and 140 female healthy Jordanian Arabs. Values obtained for serum uric acid were slightly higher than those previously reported by workers from other parts of Arabia, but comparable to those reported from the United States and United Kingdom. The frequency histograms for serum uric acid in both males and females do not appear to be normally distributed. A hint of bimodality is evident in both sets of data, being more evident in males than in females. A significant positive correlation was seen when, uric acid was compared with ponderal index (P less than 0.05) and total body surface area in both males and females (P less than 0.001). No significant correlation was observed when, uric acid was compared with either age, height or body weight in both sexes.


Patients admitted to the new central hospital in Bhutan. A new 100-bedded hospital was opened in Thimphu, the capital of Bhutan, in 1974. The hospital serves a large district, and also acts as a referral hospital for the rest of the country. This study analyses the first complete year of running the hospital with a full medical staff.


Aplastic anaemia and optic fundus haemorrhages due to traditional herbal remedies. Aplastic anaemia as a consequence of use of traditional African herbal remedies in Zambia is reported in 5 cases. Three patients died. A feature of the haemorrhagic tendency from severe thrombocytopenia was optic fundus and vitreous haemorrhage.


Catering personnel and environmental health activities in Malumfashi and Samaru-Zaria Northern Nigeria. A three month part-time training course in the basic principles of environmental health programmes with specific emphasis on practical food sanitation and control measures for food borne diseases, was organised for 79 members of the catering staff, of the Ahmadu Bello University (ABU) in Samaru-Zaria and Malumfashi, Northern Nigeria. The aims of the course were to instil in the participants, a new approach to food hygiene with a view to promoting proper catering qualities and also preventing or minimising the problems of the diarrhoeal diseases. The results, of the evaluation of the course contents and laboratory exercises are analysed and discussed. With the shortage and uneven distribution of medical and health manpower in Nigeria, all available staff in health and allied fields must be properly trained and utilised maximally in our fight against diseases and ignorance, whether such staff are hospital or community based.


D-xylose absorption in B-thalassaemia major. The cause of growth retardation seen in children with B-thalassaemia major is not fully understood. Neither the one-hour D-xylose absorption test nor jejunal biopsy support the suggestion of small bowel malabsorption as a contributory cause.


Consequences of congenital hearing loss - a longterm view. Responsibility for detection of hearing loss at the earliest possible age rests on the shoulders of the medical profession. Early detection and presentation of language through all available sensory channels, most notably the visual, are essential since deaf children of hearing parents, the vast majority of the deaf, characteristically remain grossly deficient linguistically despite years of special schooling. The deaf children of deaf parents, who are not as deprived linguistically since they learn a manual language at the normal age of language acquisition, tend to be less severely handicapped than the deaf children of hearing parents. Deafness is a hidden handicap in infancy although lack of vestibular function may delay motor milestones like sitting and walking but does not constitute a serious problem after they are achieved. The average 18 year old deaf student achieves a reading level comparable to that of a hearing fourth grader and the mathematical skills of a sixth grader. He is also deficient in science, social studies, and general information despite his average scores on nonverbal intelligence tests. Although many deaf students drop out of school before graduation and few go on to higher education, congenitally deaf adults are usually self-supporting and independent. Eighty per cent of the deaf marry hearing impaired persons. The deaf are greatly assisted by the cohesive deaf community existing in every sizable city which provides a social, recreational, and economic framework to their lives. As a result, delinquency and psychiatric illness are not higher among the deaf than the hearing, despite the difficulties they have dealing with the complexities of the hearing society.


Identifying deafness in the newborn.

Identifying deafness in the newborn. The necessity of early identification of hearing loss has long been urged by otolaryngologists, pediatricians, audiologists, and others working with the deaf. Yet there have been difficulties in implementing accurate and cost-effective newborn hearing screening programs. This article reviews some of the history of infant screening programs, discusses various areas of research related to stimulus and response parameters, and outlines a screening program, designed to fit new recommended procedures, currently under way in Halifax.


Families of young, hearing-impaired children: the impact of diagnosis. In 1976--77 there were 15 families with young hearing-impaired children, living in Kingston or within a radius of 50 miles, who participated in a study, funded by the Atkinson Charitable Foundation, to evaluate the impact which the diagnosis of deafness made upon them and their families. The sample was too small for sophisticated statistical analysis, but certain indications are provided by the research. The age at which the children were diagnosed was remarkably late and physicians and other involved professionals were felt to be uncomfortable in facing the parents whose children had hearing losses. Parents willingly admitted their need for more guidance at the time of diagnosis but had, in many cases, become somewhat complacent in their responses to their children and their needs. A strong source of support at the preschool stage was felt to be the home-visiting teacher service provided by the Ministry of Education. A need for more in-home guidance was felt by most parents when their children reached school age. Similarly, a need was expressed for a locally based correspondence course.


Support services in schools for the hearing- impaired in Canada. A questionnaire was sent to the principals of 20 schools for the hearing-impaired across Canada seeking data on the types and numbers of professional support staff utilized by them. In addition the schools were asked to express opinions regarding the additional number of professionals in various disciplines that should be employed. The most commonly employed professionals were audiologists and the least common otolaryngologists. The greatest need was said to be for a vast increase in the number of speech therapists available, although among them the schools employed less than the equivalent of one such full-time person.


Diagnostic delay in deafness - the effect of active case finding. Impaired hearing, sensorineural or conductive, was detected in 464 (25 per cent) of the 1,876 children tested during visits with a mobile hearing clinic in rural northern Ontario. Seven severe to profoundly deaf preschool children were identified; expected prevalence in this population is 5--10 preschoolers. Three older children (7--15 years of age), also, were found to have severe to profound deafness that previously had been undetected. Previously, initial identification of severe sensorineural hearing loss in this age group in these areas was at an average age of 30 months. Since visits by the clinic this is 18 months. Conductive hearing losses that had inhibited learning were identified earlier than the reported average (6.4 years vs 5.3--9.0 years of age). Follow-up has shown more effective management of conductive hearing loss since visits by the clinic. Few rural Ontario communities with populations under 10,000 have adequate surveillance for hearing problems. The goal of The Hospital for Sick Children's Mobile Hearing Clinic is to identify early all children with hearing problems and to speed the introduction of a better program for the recommendation and fitting of hearing aids, including proper counselling in the use of amplification.


Granular cell tumor of the floor of the mouth - a case report. The granular cell tumor is an uncommon lesion and, when arising in the head and neck, principally involves the tongue and larynx. A patient with a granular cell tumor of the floor of the mouth is reported. Management is usually accomplished by complete local excision, but longterm follow-up is mandatory. Distinguishing the epithelial (pseudo-epitheliomatous) hyperplasia from a well differentiated squamous cell carcinoma is critical to avoid unnecessary radical surgery. At present the lesion is considered to be a true neoplasm, likely of Schwann cell origin, and clinically benign.


Silastic implant in atrophic rhinitis - a review of 10 cases. Ten patients with atrophic rhinitis were treated surgically with silastic implants. The details and principles of the surgical technique are emphasized. These patients have been observed for up to nine years. They all improved, with 70 per cent of them showing a "marked improvement" and the remaining 30 per cent showing a satisfactory one.


Epistaxis.

Epistaxis. Epistaxis is discussed. Three unusual cases are reported. The first was a patient with a basal skull fracture due to a motor vehicle accident. He developed a carotid-cavernous fistula causing epistaxis severe enough to cause a cardiac arrest on one of his bouts of severe bleeding. The second was an unusual complication of a rhinoplasty due to damage to the anterior ethmoidal artery from the medial osteotomy. The third was due to psychopathology causing an adult female to traumatize her nose as an attention-getting or defence mechanism causing epistaxis with anemia requiring bi-annual blood transfusions of more than 175 units of blood over a 20 year period. Management is described.


Transcription of the transforming region of adenovirus type 5 in a rat cell line transformed by a small restriction fragment. The fraction of the adenovirus type 5 genome expressed as mRNA in a rat cell line, 5RK, transformed by the HsuI-G restriction fragment was analyzed by saturation hybridization using separated strands of 32P-labeled HindIII-G fragment. It was found that 45 to 50% of G fragment (about 8 X 10(5) daltons) is expressed as mRNA. The size of polyadenylic acid-terminated virus-specific cytoplasmic and nuclear RNA was determined by electrophoresis on polyacrylamide gels containing 98% formamide, followed by hybridization of gel slices with viral DNA. The major virus-specific RNA species present in the cytoplasm is about 14S, whereas the major virus-specific RNA present in the nucleus is 30 to 32S. The large size of nuclear virus-specific RNA suggests that host sequences are covalently linked to the viral transcript.


Genetic analysis of adenovirus type 2. VIII. Physical locations of temperature-sensitive mutations. Temperature-sensitive mutations of human adenoviruses can be physically located on the viral genome by determining the DNA structures of recombinants formed in genetic crosses between different members of the same subgroup. We have analyzed the DNA structures of many interserotypic recombinants formed in crosses between temperature-sensitive (ts) mutants of adenovirus type 2 and adenovirus type 5 with the restriction endonucleases BamHI, EcoRI, HindIII, and and Sma I. In this way, we have mapped the physical coordinates of adenovirus type 2 (Ad2) ts1, Ad2 ts3, Ad2 ts4, and Ad2 ts48, and refined the mapping of Ad5 ts1.


Susceptibility of influenza A viruses to amantadine is influenced by the gene coding for M protein. Influenza A virus recombinants derived from "resistant" and "sensitive" parental viruses were examined for susceptibility to inhibition by amantadine. Correlation of gene constellation and amantadine susceptibility revealed that the gene coding for M protein influences sensitivity or resistance to amantadine. All recombinants which derived an M protein from an amantadine-resistant parent were found to be resistant to amantadine. All amantadine-sensitive recombinants derived an M gene from the amantadine-sensitive parent. However, a few amantadine-resistant recombinants which derived an M gene from the sensitive parent were also isolated, suggesting that the expression of amantadine sensitivity in these recombinants may be influenced by other genes.


Low-multiplicity infection of Moloney murine leukemia virus in mouse cells: effect on number of viral DNA copies and virus production in producer cells. Mouse cells infected with Moloney murine leukemia virus (M-MuLV) were prepared by two methods, and the number of M-MuLV-specific DNA copies in the infected cells was measured. The number of M-MuLV-specific DNA copies detected varied from one to eight per infected cell in different cell lines. Cells in which multiple rounds of viral infection occurred during establishment had on the average more viral DNA copies than cells in which infection at low multiplicity was performed, followed by cloning of the cells. However, even in cells derived by the low multiplicity of infection method, most cell lines carried more than one copy of M-MuLV-specific DNA. Virus production per cell was also measured, and no strict correlation was observed between the number of M-MuLV DNA copies present and the amount of virus produced.


Specific secretion of polypeptides from cells infected with vaccinia virus. The pattern of polypeptides specifically secreted by cells after infection with vaccinia virus has been analyzed. A complex pattern of apparently virus-specified polypeptides exhibiting temporal control of the type seen with intracellular polypeptides after virus infection was observed. Some of the specifically secreted polypeptides were shown to be modified by glycosylation and sulfation. The possible significance of these results is discussed.


Transcription of bacteriophage M13 DNA: existence of promoters directly preceding genes III, VI, and I. In vitro transcription and coupled transcription-translation studies have been performed with restriction fragments of bacteriophage M13 replicative-form DNA which contain either gene III, gene VI, or gene I. It could be demonstrated that DNA fragments which contain gene III were able to direct the synthesis of gene III protein. Fragments which encompassed genes VI and I gave rise to the synthesis of gene I protein only, whereas gene I-containing fragments were able to direct the synthesis of gene I protein. None of the fragments studied gave rise to a detectable level of gene VI protein, although an RNA transcript of gene VI could readily be obtained during in vitro transcription of the relevant gene VI-containing DNA fragments. From these results we have concluded that the promoters A0.44 and A0.49 are located in front of genes VI and I, respectively, and that gene III is also equipped with a promoter (X0.25). Introduction of a single cleavage within the gene III region does not abolish the expression of genes VI and I in vitro. Hence, the expression of these genes is not solely dependent on the initiation of RNA synthesis at the gene III promoter or on leakage of transcription through the central termination site (T0.25), but is also determined by the initiation frequency of RNA synthesis at their individual promoters.


Bacteriophage lambda mutants (lambdatp) that overproduce repressor. Lambda tp mutants, selected for their ability to form turbid plaques on lon hosts, overproduce repressor. The tp1 and tp2 mutations have been located within (or adjacent to) the cIII gene. The tp1 mutation reduced late gene expression, as measured by endolysin synthesis (in the absence of functional cI repressor) and progeny phage yield. The tp4 mutation was mapped in the cY-cII region, and complementation tests indicated that tp4 affects the diffusible product of the cII gene. The tp4 mutation also reduced progeny production, but did not markedly affect endolysin synthesis.


Bacteriophage phi29 terminal protein: its association with the 5' termini of the phi29 genome. The location of the protein bound to bacteriophage phi29 DNA has been studied with restriction endonucleases, exonucleases, and polynucleotide kinase. The protein is invariably associated with the two terminal DNA fragments generated by restriction endonucleases. The phi29 DNA prepared with or without proteinase K treatment is resistant to the action of the 5'-terminal-specific exonucleases, lambda-exonuclease and T7 exonuclease. The phi29 DNA is also inaccessible to phosphorylation by polynucleotide kinase even after treatment with alkaline phosphatase. On the other hand, phi29 DNA is sensitive to exonuclease III, and the 3' termini of the DNA can be labeled by incubating with alpha-[32P]ATP and terminal deoxynucleotidyl transferase. The protein remains associated with the phi29 DNA after treatment with various chaotropic agents, including 8 M urea, 6 M guanidine-hydrochloride, 4 M sodium perchlorate, 2 M sodium thiocyanate, and 2 M LiCl. These results are consistent with the notion that the protein is linked covalently to the 5' termini of the phi29 DNA.


Electrophoresis of bacteriophage T7 and T7 capsids in agarose gels. Agarose gel electrophoresis of the following was performed in 0.05 M sodium phosphate-0.001 M MgCl2 (pH 7.4): (i) bacteriophage T7; (ii) a T7 precursor capsid (capsid I), isolated from T7-infected Escherichia coli, which has a thicker and less angular envelope than bacteriophage T7; (iii) a second capsid (capsid II), isolated from T7-infected E. coli, which has a bacteriophage-like envelope; and (iv) capsids (capsid IV) produced by temperature shock of bacteriophage T7. Bacteriophage T7 and all of the above capsids migrated towards the anode. In a 0.9% agarose gel, capsid I had an electrophoretic mobility of 9.1 +/- 0.4 X 10(-5) cm2/V.s; bacteriophage T7 migrated 0.31 +/- 0.02 times as fast as capsid I. The mobilities of different preparations of capsid II varied in such gels: the fastest-migrating capsid II preparation was 0.51 +/- 0.03 times as fast as capsid I and the slowest was 0.37 +/- 0.02 times as fast as capsid I. Capsid IV with and without the phage tail migrated 0.29 +/- 0.02 and 0.42 +/- 0.02 times as fast as capsid I. The results of the extrapolation of bacteriophage and capsid mobilities to 0% agarose concentration indicated that the above differences in mobility are caused by differences in average surface charge density. To increase the accuracy of mobility comparisons and to increase the number of samples that could be simultaneously analyzed, multisample horizontal slab gels were used. Treatment with the ionic detergent sodium dodecyl sulfate converted capsid I to a capsid that migated in the capsid II region during electrophoresis through agarose gels. In the electron microscope, most of the envelopes of these latter capsids resembled the capsid II envelope, but some envelope regions were thicker than the capsid II envelope.


Tryptic peptide analyses of polypeptides generated by premature termination of cell-free protein synthesis allow a determination of the Rauscher leukemia virus gag gene order. Translation of Rauscher murine leukemia virus (R-MuLV) 35S RNA in an mRNA-dependent cell-free protein-synthesizing system yields polypeptides identical to authentic Pr65gag, the R-MuLV gag precursor, and Pr200gag-pol, the precursor to the R-MuLV reverse transcriptase. In addition to these polypeptides, the cell-free product contains a family of polypeptides of less than 65,000 molecular weight which appear to be generated by premature termination of protein synthesis within the viral gag gene. We compared the tryptic maps of several of these less than 65,000-molecular-weight premature termination polypeptides with that of full-size Pr65gag and found a progressive loss of tryptic peptides which could be assigned to known R-MuLV gag proteins. A 40,000-molecular-weight fragment, P40gag, lacked p10 and part of p30, placing p10 at the C terminus pf Pr65gag and p30 ajacent to it. Fragments of 33,000 (P33gag) and 27,000 to 28,000 (P27/28gag) molecular weight showed a successive loss of additional p30 tryptic peptides, but no loss of either p15 or p12. An 18,000-molecular-weight fragment lost p12 but retained p15. These data suggest an R-MuLV gag gene order of NH2-p15-p12-p30-p10-COOH.


Adrenal cortical carcinoma.

Adrenal cortical carcinoma. A review of 28 cases of adrenal cortical carcinoma provides some insights into the natural history of this disease and suggests modifications in current techniques of diagnosis and management. Our patients ranged in age from 1 to 69 years but it is notable that all of our male patients were more than 39 years old. In addition the men tended to have high stage tumors that were nonfunctional. Female patients, on the other hand, were more evenly distributed in terms of stage, function and age at diagnosis. Staging was extremely important and is discussed in some detail. A dismayingly large number of patients were found to have stage 3 or 4 tumor at initial diagnosis, suggesting that aggressive and rapid evaluation and a high index of suspicion are important to optimize survival. Function is helpful but non-function is common and should not dissuade one from the diagnosis. Excretory urography with tomography followed by angiography frequently will provide the diagnosis. Endocrinologic evaluation should be done with alacrity. Survival with high stages of disease is poor and lengthy evaluation should not be allowed to delay prompt and, hopefully, curative surgery. Surgical resection is the key to cure; chemotherapy and radiotherapy provided relatively poor results in our hands although mitotane has shown a 34 to 54 per cent response rate.


Descent of the right renal vein.

Descent of the right renal vein. A new operation is described, in which the right renal vein outlet is moved to a lower level on the vena cava, helping to decrease the distance between the kidney and the bladder. This procedure permits treatment of extensive obstructive wounds of the pyeloureteral junction or lumbar ureteral junction, caused by lithiasis and ureteral and renal operations, that cannot be treated with conventional operations. Renal circulation is not altered with this procedure. The operation is simple, does not cause complications and provides excellent results.


The association of significant renal anomalies with Turner's syndrome. The incidence of significant renal anomalies in 38 patients with Turner's syndrome was 26 per cent (10 of 38 cases). An additional 11 per cent of the patients have insignificant renal abnormalities and 63 per cent apparently have normal excretory urograms. In this series there seemed to be no correlation of the incidence of abnormalities with either the phenotypic or karyotypic expression of Turner's syndrome, that is the 45/XO pattern of the mosaic variants. Therefore, clinicians should be aware that any patient with Turner's syndrome must receive a thorough clinical and radiologic evaluation of the urogenital tract.


Experience with new double J ureteral catheter stent. Experience with a newly designed self-retaining silicone ureteral stent is presented. The stent is supplied in various lengths, has a J or hook molded into each end to prevent migration and has been designed specifically to be passed during an open operation as well as endoscopically. The device is used to provide free drainage to the bladder, reduce or eliminate urine leakage, provide stenting of the ureter and allow for earlier discharge from the hospital of patients without external catheters. In some cases the stent may be used instead of a nephrostomy tube to provide prolonged drainage with less chance of infection. It is removed easily in the outpatient facility by cystoscopy.


Permanent cutaneous ureterostomy: 18 years of experience. We have reviewed 84 patients managed with cutaneous ureterostomy during the last 18 years. If at least 1 hypertrophied and dilated ureter is available cutaneous ureterostomy is a safe and effective diversion, with satisfactory late functional results. Stomal stenosis remains a continuing problem but usually is managed easily if present. Cutaneous ureterostomy should be used in selected patients until the ideal form of vesical substitution is achieved.


Preoperative evaluation of patients with bladder outlet obstruction with particular regard to excretory urography. During the last 15 years excretory urography has been a routine preoperative diagnostic procedure for patients with bladder outlet obstruction in our department and, perhaps, for many more years in other urological centers. There are 2 reasons that this investigation should be done: 1) to detect abnormalities of the upper urinary tract that can be important indicators to operate or for the postoperative course and 2) to detect abnormalities in the bladder that should be corrected simultaneously with the prostatectomy or that can interfere with the procedure.


Relationship of varicocele to sperm output and fertility of male partners in infertile couples. Both partners of 455 infertile couples seen consecutively were evaluated. When indicated the female partners were treated. Six semen specimens from each male subject were analyzed. A varicocele was diagnosed in 23.7 per cent of the men. More than 60 per cent of the men with a varicocele had sperm counts less than 40 million per ml., while 67 per cent without a varicocele had sperm counts more than 40 million per ml. The mean and total sperm counts of men with a varicocele were significantly lower than those without a varicocele. However, the pregnancy rates were not significantly different. The pregnancy rate was 46 per cent in couples whose male partners underwent a varicocelectomy, not significantly different from the pregnancy rate achieved in couples when the varicoceles were not corrected surgically (51 per cent). Varicocelectomy resulted in improvement in sperm count only when preoperative counts were more than 10 million per ml. Pregnancy rates for couples in which a varicocelectomy did or did not result in improvement in sperm count or motility were identical (45.1 and 45.5 per cent, respectively). These findings suggest that in male partners of infertile couples the presence of a varicocele is associated with compromised semen quality but not with diminished fertility when the female partners are treated. This observation emphasizes the importance of considering infertility as a problem of a couple, rather than a specific disorder of one of the partners.


Vesical neck closure versus balloon catheter in suprapubic prostatectomy: a controlled clinical trial. In a randomized trial comprising 102 cases of suprapubic prostatectomy a modified Hryntschak technique of vesical neck closure was compared to the balloon compression method. There were no statistically significant differences between the 2 groups in operative and postoperative blood loss, duration of operation or postoperative hospital stay. In the vesical neck closure group compared to the balloon catheter group more patients experienced catheters falling out prematurely, as well as more postoperative strictures and more cases of incontinence at followup 1 year later. Our data do not justify the adoption of the vesical neck closure technique in suprapubic prostatectomy.


Suprapubic prostatectomy. The removable purse string: a continuing comparative analysis of 300 consecutive cases. Mortality rates, length of hospitalization, transfusion requirements, weights of excised tissue, complications and operating time are analyzed in this series of 300 patients who underwent suprapubic prostatectomies in which a removable purse-string closure of the bladder neck was used. The results are compared to those in other studies. The mortality rate in our study is the lowest reported to date for a large series. We believe that this technically simple operation, which has the most adaptability for combination with conjunctive operations, low transfusion requirements, few long-term complications and which can be done rapidly, is the most desirable method to remove benign prostates of 40 gm. or larger. We believe that there should be acceptance of broader indications for its use and that greater emphasis should be placed on teaching this procedure in urological training programs.


Clinical experimental randomized study of 2.6-cis-diphenylhexamethylcyclotetrasiloxane and estramustine-17-phosphate in the treatment of prostatic carcinoma. Patients with poorly differentiated prostatic carcinoma and skeletal metastases were randomized to treatment with 2.6-cis-diphenylhexamethylcyclotetrasiloxane (2.6-cis) and estramustine-17-phosphate (estramustine). Parallel with the clinical study a group of non-randomized patients were treated with 2.6-cis. Cytological regression of the tumor could be registered in half of the estramustine group but not in the 2.6-cis group. There were no drug-related changes in blood chemistry, kidney function tests, hematology or liver enzymes. There was in increase in acid and alkaline phosphatase in both groups but more pronounced in the 2.6-cis group. In both groups follicle-stimulating and luteinizing hormone values were depressed. Testicular and penis atrophy was observed in the 2.6-cis group. Relief of pain and marked improvement of conditions occurred in the majority of the cases in both groups. In general, no tumor regression was observed during administration of 300 mg. 2.6-cis daily for at least 3 months. Some tumor regression was noted during 600 mg. estramustine therapy daily.


Novel bacterial structures in human blood. II. Bacterial variants as etiologic agents in idiopathic hematuria. Novel bacterial structures have been demonstrated in lysed blood filtrates placed in special culture media from patients with idiopathic hematuria. These structures converted rapidly to gram-positive coccal (streptococcal and staphylococcal-like), coccobacillary and filamentous, bacterial forms in vitro from 96 per cent of the patients studied. Blood cultured conventionally yielded negative findings. Although structures (dense bodies) were demonstrated in normal control blood specimens (albeit in lesser numbers) few converted to classical bacteria in vitro (7 per cent). Erythromycin therapy appeared to correlate with disappearance of hematuria and inability to revert rapidly the variant forms to classical bacteria in vitro. It is suggested that continual bombardment of the blood by bacteria entering from the mouth or other sites may lead to the development of variant bacterial parasitism. In an effort to survive the deleterious host effects the organisms may convert to persisting osmotically stable variant bacterial forms (dense bodies). Development of a disease state may be conditioned by some existing or developing abnormality in the host (immunologic, physiologic and/or biochemical). Furthermore, changes (genetic?) that might take place in the organisms per se during their transition to variant forms and adaptation to life in vivo may not allow certain host environments to adapt to these new forms, possibly leading to a pathogenetic role in renal diseases whose etiologies have long been enigmas.


Calcium oxalate stone disease: effects and side effects of cellulose phosphate and succinate in long-term treatment of absorptive hypercalciuria or hyperoxaluria. Absorptive hypercalciuria was treated in 27 patients with cellulose phosphate. In all patients urinary calcium decreased and stone formation virtually ceased. The most striking side effect was an excessive hyperoxaluria, necessitating withdrawal of the drug in 8 patients. Succinate decreased the hyperoxaluria in 14 of 19 patients. All patients had mild hypercalciuria and hypermagnesiuria. This study was done to determine the therapeutic value and the side effects in the treatment of absorptive hypercalciuria with sodium cellulose phosphate and of hyperoxaluria with succinate.


Cis-diamminedichloroplatinum II in advanced urothelial cancer. Thirteen patients with advanced urothelial cancer received a minimum of 2 courses of cis-diamminedichloroplatinum II. Of these patients 6 (46 per cent) achieved a partial response with an average duration of more than 6 months. One patient has received cis-diamminedichloroplatinum for more than 1 year and has no clinical evidence of tumor (complete response in lung metastasis plus excision of local recurrence). The routine administration of intravenous fluids and mannitol immediately before cis-diamminedichloroplatinum prevented the nephrotoxicity associated with this drug. An outpatient setting was well tolerated in most instances. This report confirms the activity of cis-diamminedichloroplatinum in urothelial cancer and suggests its use as an adjuvant to operation and/or radiotherapy in selected cases.


Early and late management of the neuropathic bladder in spinal cord injury patients. Early and late management of neuropathic bladders in 562 consecutive patients with spinal cord injuries is described. Indications for an operation to relieve outlet obstruction by transurethral resection and external sphincterotomy are outlined, and the management of urinary infection and incontinence is discussed. Approximately 30 per cent of all spinal cord injury patients had outlet obstruction for which either external sphincterotomy, transurethral resection or both procedures were necessary. Operations appeared to be required more frequently in patients with complete and thoracic lesions, and more than 1 operation may be necessary to achieve satisfactory bladder emptying.


Modern urodynamic evaluations in the urologist's office. Patients with voiding disturbances comprise 20 per cent of the yearly outpatient visits to urologists. Of this number 25 per cent have significant neurogenic bladder dysfunction. The theoretical basis and experimental demonstration of urodynamics have been established and reported by multiple investigators during the last 15 years. Recent advances in clinical applications of fast-flow gas cystometry have led to the development of complete, portable urodynamic units that can be used conveniently in the urologist's office and are capable of simultaneously recording parameters of detrusor, urethral and skeletal muscle phincter function. This equipment is simple, efficient, economical and can be operated by well trained paramedical personnel, with minimal immediate direction required by a physician. With recent recognition by many third party carriers this equipment may amortize itself rapidly but, more importantly, it may serve to identify neurological diseases of the bladder that are undetected by other conventional methods of investigation. During the last 9 months 213 patients have undergone urodynamic evaluation at our outpatient urology clinic. These patients were categorized according to type and incidence of voiding disturbance and the number of neurogenic bladders diagnosed within each group was compiled and discussed. Several of the more interesting and unusual clinical examples are presented to familiarize the urologist with the interpretative aspects of this study.


Exstrophic anomalies: followup of 36 cases. Since 1950, 36 patients with exstrophic anomalies were seen at the Medical College of Virginia Hospitals. There were several modalities of treatment used, including primary reconstructive procedures in 11 patients, 6 of whom continue to have a functional bladder closure. Our results and current management are discussed.


The role of vaginal immunoglobulin A in girls with recurrent urinary tract infections. Vaginal immunoglobulin A in girls with recurrent urinary tract infections was significantly lower when compared to an age-matched group of controls who had never experienced bacteriuria. The possible role of deficiencies in vaginal secretory immunoglobulin A leading to recurrent urinary tract infection in this age group is discussed.


Gray scale ultrasonography in the diagnosis of pseudocysts of the pancreas simulating renal pathology. Ultrasonography has proved to be a reliable tool in the diagnosis of pseudocysts. A case is reported of a patient with a pseudocyst in the transverse mesocolon adjacent to the left kidney and spleen. Initial examination by computerized tomography and angiography failed to visualize the mass, while a renal cyst was simulated on nephrotomography. Repeat ultrasound examinations showed progressive increases in the size of the pseudocyst. This diagnosis was confirmed at operation. We believe that ultrasound is the modality of choice in patients with clinical suspicion of a pseudocyst.


Hydronephrosis with ureteral valve: diagnosis by ultrasonography and antegrade pyelography. A case of massive hydronephrosis secondary to a ureteral valve was discovered upon evaluation of mild trauma. The orderly diagnostic studies, including ultrasonography and antegrade pyelography, led to the correct diagnosis and appropriate therapy. Ultrasonography as a diagnostic tool in urology is discussed and characteristics of the 18 cases of ureteral valves reported to date are reviewed.


Bilateral localized amyloidosis of the ureter presenting with anuria. A patient with bilateral localized amyloidosis of the ureters is described. This is the first case to be reported in which anuria was the presenting symptom, the second case with bilateral involvement and the thirteenth case of amyloidosis localized to the ureter. Careful urologic and hematologic followup is indicated.


Bladder injuries associated with cesarean section. Bladder injury during cesarean section is unusual and may occur by failure to empty the bladder preoperatively, inadequate bladder flap reflection or incision into the vagina rather than the lower uterine segment. Three bladder injuries during cesarean section are reported. Although 2 women recovered normally 1 has persistent vesicoureteral reflux. With liberalization of indications for cesarean section bladder injuries may be seen more frequently.


Genetic and environmental modification of spontaneous hypertension. The further selection of stroke-prone spontaneously rats (SHR) by the grade of hypertension resulted in the separation of substrains with more and less severe hypertension, respectively. Their average tail blood pressures at the age of 100 days were 240 and 200 mmHg. The ratios of cerebral hemorrhage to infarction were markedly decreased from 1/2 in the former into less than 1/30 in the latter. Also a similar attempt separated stroke-resistant SHR into substrains with moderate and mild hypertension; blood pressures at the age of 100 days were 200 and 180 mmHg, respectively. On the other hand, development of severe hypertension was attenuated and the incidence of stroke was significantly reduced in stroke-prone SHR when they were fed on a high-fat-cholesterol diet or a high fish protein diet. The selection of substrains with different grades of hypertension in stroke-prone and stroke-resistant SHR indicates the additional involvement of some hypertension genes, and the alteration of the course and the level of hypertension by nutritional factors substantiates the importance of gene-environment interaction in spontaneous hypertension.


The mode of inheritance in idiopathic cardiomyopathy, preliminary report. Genetic analyses of 565 first-degree relatives of 99 patients with ICM suggests that ICM has both simple dominant and recessive modes of inheritance. There was no clinical form of ICM specific to the mode of inheritance, both hypertrophic and congestive types almost equally observed both modes of inheritance. Two pairs of identical twins who suggested the simple recessive mode were reported.


Circulatory effect of jet noise, with special reference to cerebral circulation. The circulatory effect of jet noise on heart rate, systolic blood pressure and cerebral blood flow was investigated by means of the on-line Doppler ultrasonic technique devised by the author in 20 normal young males, normal elderly males and elderly patients with cerebral vascular disease. The jet noise ranged from 60 dBA to 110 dBA. Heart rate and systolic blood pressure showed slight and transient increase at the level of over 90 dBA. Although the cerebral blood flow was increased at the level of 90--110 dBA, conspicuous dissociation was observed between the vertebral artery and internal carotid artery. The vertebral artery dominant type was more frequent than the internal carotid artery dominant type. Headache and discomfort due to the noise were observed in all the subjects. The above facts suggest that the jet noise induces dysfunction of the autonomic nervous system and various kinds of psychosomatic diseases.


Coronary atherosclerosis in Aligarh district, Uttar Pradesh. A morphological study. The present communication deals with the observations of the type and extent of atherosclerotic lesions in coronary arteries obtained from 108 heart specimens. In 81.4% cases the lesions were present. The earliest lesion of fatty streak was noticed in 2nd decade whereas all the cases above 4th decade had atherosclerotic lesion. Fatty streaks involved 4.5% of the intimal surface in 2nd decade, reaching a maximum to 26% in 6th decade and later on receding to 12% in 7th decade. Fibrous plaques were seen in later period of 2nd decade involving 2% of the surface area. There was a slow and tardy progression of the lesion with the maximum involvement of 32% in 7th decade. Complicated lesions were seen in 3rd decade but involved only 7% of the surface in 7th decade. Left coronary artery was involved in 79.62% cases and the right in 78 (72.22%). Salient histomorphological changes as well as degenerative changes occurring in the development of the disease process have been discussed. Main differences in the natural history of the disease in Indians were the slow progression of fibrous plaque and a very low incidence of grade IV lesions (complicated lesions). Marked disparity between the lesions observed in coronary arteries and root of aorta was noticed.


Spread of the epicardial excitation in right bundle branch block pattern. Electrophysiologic mapping was performed on 29 dogs and 35 patients to investigate the ventricular excitation sequence of normal hearts and various cardiac lesions exhibiting the electrocardiographic pattern of right bundle branch block (RBBB). The activation times of epicardial surface were referenced to the onset of left ventricular cavity potential or QRS wave of lead II ECG. Epicardial activation sequence was represented by isochrones. 1. In normal hearts, the earliest epicardial breakthrough occurred at the mid-anterior paraseptal area in the right ventricle and the activation spread in a circular fashion. In the left ventricle, the epicardial activation occurred at three areas and then spread to the posterobasal area. The epicardial activation sequence was a good representation of the ventricular excitation. 2. In RBBB due to trauma to the main right bundle branch, the right ventricular activation showed marked delay and the characteristic V-shaped pattern. 3. Following vertical ventriculotomy, the right ventricular epicardial activation showed marked delay at sites distal to the incision but no significant delay proximal to it. Regarding postoperative RBBB, central right bundle branch injury was able to be differentiated from distal Purkinje injury due to right ventriculotomy by means of epicardial mapping. 4. In left ventricular pacing, the activation spread in a circular fashion with the prolonged right ventricular activation. 5. In ostium secundum defect, the right ventricular epicardial activation sequence showed various patterns of activation delay resulting from right ventricular hypertrophy. In ostium primum defect, the earliest epicardial activation was found in the left posterior paraseptal area, and the right ventricular activation showed a normal pattern with some delay. Epicardial mapping has been the precise representation of ventricular excitation by direct measurement of cardiac potentials. Cardiac lesions exhibiting the electrocardiographic RBBB pattern provided various patterns of the right ventricular activation delay according to the geneses of RBBB.


Studies on heart failure in old age (Part II). Hemodynamic effects of propranolol and isoproterenol in elderly patients with heart failure. Hemodynamic responses to propranolol and isoproterenol were examined in elderly patients with heart failure. The results obtained are as follows: 1. Patients with mild heart failure showed greater reduction than control group in heart rate and cardiac output after intravenous propranolol. These enhanced hemodynamic responses to propranolol would be the evidence of increased adrenergic activity even in mild heart failure. 2. Intravenous propranolol in the small dosage of 0.03 mg/kg showed only a negligible hemodynamic deterioration even in patients with heart failure. 3. Hemodynamic responses to beta-adrenergic stimulator, isoproterenol, were depressed in severe heart failure.


[Clinical experience with ceftezole (author's transl)]. Ten patients with acute urinary tract infection or acute epididymitis were treated with ceftezole (CTZ) twice daily at a dose of 1 approximately 3 by intravenous injection. The effective ratio obtained was nearly 90%. As a side effect, exanthem was observed in one patient.


A study on the effects of nifedipine in hypertensive crises and severe hypertension. Ten mg of Nifedipine, a Ca++ antagonist, was administered orally in 2 groups of patients; Group 1: 6 patients in hypertensive emergency and Group II: 12 patients with intractable, severe hypertension. Following results were obtained. 1) A marked hypotensive effect was observed in all patients of Group I. The maximum effect was observed within 30 to 60 min and lasted for approximately 180 min. Clinical symptoms also improved remarkably with the fall in blood pressure. Any side effect was not observed. 2) A marked hypotensive effect was observed in all cases of Group II. The blood pressure fell by 21.4% systolic (p less than 0.01) and 19.4% diastolic (p less than 0.02). The peripheral vascular resistance also showed the decrease by 26.2% (p less than 0.01). The heart rate and cardiac index increased slightly. It was suggested that the hypotensive mechanism of this preparation is due primarily to the peripheral vasodilation.


Urinary excretion of catecholamines and their metabolites in patients with renovascular hypertension. Urinary excretion of catecholamines, vanillylmandelic acid, and methoxycatecholamines was studied in 50 patients with renovascular hypertension. The urinary excretion of noradrenaline was increased in patients with elevated peripheral plasma renin activity and in those with elevated renal vein renin ratio in comparison with the patients with normal plasma renin activity. The urinary excretion of dopamine was diminished and vanillylmandelic acid increased in the entire group of patients with renovascular hypertension. In the investigated group, following sodium restriction, the mean urinary excretion of noradrenaline increased while dopamine excretion decreased. These results suggest that the increased sympathetic activity may play a role in the pathogenesis of renovascular hypertension.


Two varieties of the onset of atrial fibrillation studied by monophasic action potential recording. Two types of the initiation of atrial fibrillation are demonstrated in the continuous recordings of right atrial monophasic action potentials. In the first way, more common, atrial fibrillation takes place suddenly after an an extrasystolic atrial beat, in the second one it develops gradually after atrial tachycardia. In the first type the micro reentry starts from the beginning, in the second type only after sustained focal atrial tachycardia.


Apex-carotis diagram as related to systolic and diastolic time intervals in mitral valve prolapse syndrome. The electrocardiogram, phonocardiogram, carotid pulse tracing and apexcardiogram were simultaneously obtained in 25 patients with mitral valve prolapse syndrome and in 62 normal subjects. This allowed us to measure systolic and diastolic time intervals and to construct the apexcarotis diagram (ACD), a new mechanocardiographic method which integrated the catotid pulse tracing and the apexcardiogram in an orthogonal coordinate system. In mitral valve prolapse syndrome, the ACD showed curve of the segment of slow ventricular ejection (S-AC) to the right, and a decrease of the field of ventricular ejection. The measurement of time intervals gave statistically significant information on Q-I and A2-OS intervals.


Electrographic changes associated with cyclical reduction of coronary blood flow. Electrographic changes associated with cyclical reduction of blood flow in partially constricted one or two coronary arteries of anesthetized dogs were examined. In the preparations with single vessel constriction, cyclical ST elevation occurred along with cyclical reduction of coronary blood flow below 25% of the control value. The ST elevation was associated with reciprocal ST depression in the contralateral ventricular surface. In the preparations with double vessel constriction, cyclical reduction of flow frequently occurred in both vessels. The reduction of flow in one vessel occurred not synchronously with that in another vessel in the majority of preparations. The reduction of flow in both vessels was associated with ST elevation in the corresponding areas of the left ventricle. Premature ventricular contractions frequently occurred at the beginning of or immediately after disappearance of ST elevation, or when ST elevation persisted for more than 10 min. Ventricular fibrillation frequently occurred in the preparations with double vessel constriction.


The effect of alcohol on active and passive stiffness, and on isometric contractions of glycerinated heart muscle in rats. The response of the contractile and the series elastic elements to ethanol was studied isometric contraction and quick release methods after measuring the passive length-tension relationship in glycerinated heart muscle fibers of rats at resting state. In rats consuming 30% ethanol for an average of 5 weeks, maximal developed tension (P0), the maximal rate of tension development (dp/dtmax) and Vmax were significantly depressed, the time to peak tension (t0) was not changed. As in fresh papillary muscle the modulus of elasticity of active glycerinated muscle increased in proportion to load. The stiffness of the series elastic element showed significant elevation in rats receiving ethanol. The passive stiffness in resting state revealed no significant difference between control and alcohol exposed rats. Therefore, increased stiffness of the series elastic element and diminished contractility are present following chronic alcohol consumption.


Tissue edema and arterial lesions produced by pure submaxillary gland renin of mouse. In order to identify the nature of the substance(s) that causes pancreatic edema, pleural effusion, hematolcrit increase, and vascular lesion upon administration of renal extracts, effects of a pure preparation of submaxillary gland renin of mouse on blood vessels were studied. This enzyme was administered intraperitoneally to conscious anehpric rats. Blood pressure elevation recorded under unrestricted conditions was proportional to pancreatic edema, pleural effusion, hematocrit increase, and vascular lesions in small arteries and arterioles. Since the renin administered does not contain any substances and since the function of this enzyme is quite analogous to renal renin, these results have been interpreted to indicate that renin possesses both pressor and permeability activities and that the action of renin alone can account for the vascular lesions and the increased vascular permeability.


Constrictive pericarditis with atrial septal defect in children. Two cases of (1-year-old and 13-year-old) of constrictive pericarditis (CP) associated with atrial septal defect (ASD) are presented. The correct diagnosis was made preoperatively in both cases. Both patients underwent surgery (pericardiectomy and ASD closure). One patient died soon after the surgery because of low cardiac output. The other patient was associated with protein-losing enteropathy and it improved dramatically after the operation. Cardiac catheterization is necessary for the diagnosis of this unusual combination. The cause of this unusual combination is obscure.