Typing of fluorescent phytopathogenic pseudomonads by bacteriocin production. Several phytopathogenic fluorescent Pseudomonas species, primarily P. syringae, could be grouped into 16 bacteriocin producer groups, including new and previously described groups. At least 86% of the P. syringae strains could be typed by bacteriocin production. There was poor correlation between bacteriocin type and host plant origin. No correlation was detected between syringomycin (a phytotoxin) production and bacteriocin type.


Morphogenetic expression of Arthrobacter globiformis 425 in continuous culture with carbon or biotin limitation. When deprived of biotin, Arthrobacter globiformis 425 exhibits abnormal morphology (large, branched forms of variable size) and a retardation of its normal growth rate. In chemostat cultures, when cells were grown under glucose limitation, the morphology was normal (coccoids or rods) at specific growth rates between 0.05 and 0.125 h-1 (doubling times between 14 and 5.5 h, respectively) at 25 degrees C. The coccoid-to-rod morphogenesis occurs at a specific growth rate of 0.11 h-1. At the same specific growth rates and temperature, but under biotin limitation, abnormal morphology was observed.


Role of oxygen in the induction of fermentation in the obligately psychrophilic yeast Leucosporidium stokesii. Leucosporidium stokesii, an obligately psychrophilic yeast, metabolizes glucose during the initial stages of aerobic growth by aerobic respiration. During later stages of growth and in the presence of excess glucose and limiting oxygen the organism develops a fermentative-type metabolism. Rates of respiration on the other hand remain relatively constant. The change in metabolism occurs only at temperatures which support growth of the organism and does not occur at 25 degrees C. Resting cells prepared from young glucose-grown cultures can be induced to ferment glucose. The induction process occurs only in the presence of glucose and is inhibited by actidione.


Some effects of arsenic on the rumen microflora; an in vitro study. The rate of fermentation of the rumen microflora was inhibited almost 30% by 5 micrograms/ml of arsenic added in the form of arsenite, although 304 micrograms/ml was required to cause 50% inhibition. Arsenate was less inhibitory. The rate of fermentation of a separated bacterial fraction was inhibited 37% by 1 microgram of arsenite per millilitre, whereas 100 micrograms/ml had little effect on the fermentation of a separated protozoal fraction. Similar results were obtained for arsenate. Both fractions had the capacity to take up arsenate, but the protozoa took it up more readily to a higher intracellular concentration. Both arsenate and arsenite inhibited the growth of a number of rumen bacteria in pure culture at concentrations as low as 5 micrograms of arsenic per millilitre. The greater resistance of Megasphaera elsdenii to arsenate as compared with that of Bacteroides succinogenes was not related to the inability to take up the element. In conclusion, the concentrations of arsenic causing a significant inhibitory effect on the fermentative activity and growth of some rumen bacteria are less than that reported to be toxic to ruminant animals.


Transfer, maintenance, and expression of bacterial Ti-plasmid DNA in plant cells transformed with A. tumefaciens. The mechanism of induction of the plant cancer crown gall by Agrobacterium tumefaciens has been briefly described. The salient points are as follows. 1. Large plasmids of molecular weight (100 to 150) S 10(6), called Ti-plasmids, are essential to the transformation process. 2. Ti-plasmids carry a DNA segment that can be transferred to, and maintained and expressed in, transformed plant cells. 3. This DNA segment has been identified both by direct hybridization experiments between Ti DNA fragments and crown gall DNA and by the study of a deletion mutant of a Ti-plasmid. 4. Indirect evidence suggests that genes involved in the synthesis of abnormal amino acids (such as octopine and nopaline) by crown gall cells, and known to be carried on the Ti-plasmids, are in fact located on the DNA segment that is transferred to the plant cells. 5. Ti-plasmids are efficient conjugative plasmids, since they can promote their own transfer by conjugation to various plasmid-free bacterial strains. Their conjugative properties may be involved also in the Ti DNA transfer from Agrobacterium to plant cells. 6. Preliminary evidence indicates that the transferable segment of the Ti-plasmid has the structure of a transposon, since it appears to be flanked by a sequence exhibiting most of the properties of the sequences that border the known bacterial drug-resistance gene transposons.


[Denitrification by Bacillus licheniformis]. The denitrifying capacity of 15 strains of Bacillus licheniformis was evaluated. In general, N2 production by the cultures on complex media containing NO3- is irregular and quite slow and three of the strains never produce gas. Bacillus licheniformis grows rapidly in anaerobiosis on peptone medium containing NO3- which is reduced to NO2-. None of the strains grow in peptone medium with NO2- or N2O as the respiratory substrate, nor do they grow under an atmosphere of 10% NO-90% N2. Denitrification was studied in cell suspensions using gas chromatography. N2O production from NO3- or NO2- is always weak at best; nitric oxide is reduced to N2O at an appreciable rate. All the strains synthesize nitrate reductase A in anaerobiosis when NO3- is present. In cell extracts, nitrite reductase activity is always negligible or nil with tetramethyl-p-phenylenediamine as an electron donor.


Survival and reversion of a stable L form in soil. The stable L form of Agromyces ramosus reverted to a bacterial form when incubated in sterilized soil. The cellular and colonial morphology of this bacterial form resembled that of the original parent bacterial form. The two forms differed, however, in that the revertant maintained its bacterial form when transferred onto a low-salt (NaCl) medium but was virtually completely induced into the L-form state on a high-salt medium. The original parent bacterial form was not sensitive to salt. The possibility is discussed that an L-form interchanging with a bacterial-form cycle for this bacterium might occur naturally in soil. This cycle would be mediated by fluctuations in local salt concentrations in the soil.


Lipid body content and persistence of chlamydospores of Fusarium solani in soil. Chlamydospores of Fusarium solani f. sp. pisi. low or high in lipid content, were produced in soil from "low and high reserve" macroconidia, respectively. The development of "low and high reserve" populations of macroconidia and chlamydospores in soil was studied. The rate of conversion of macroconidia into chlamydospores is influenced by the lipid content of the macroconidia. The long-term persistence of chlamydospores in soil seems to be independent of the lipid content of the chlamydospore cells.


Teratocarcinoma cells as vehicles for mutant and foreign genes. Mouse malignant teratocarcinoma cells, upon injection into early embryos at the blastocyst stage, become integrated into the developing embryo and stably normalized. In the mosaic mice that are formed, tumor-derived cells can give rise to the full range of normal, functional somatic tissues, and also to germ cells from which progeny are obtained. Totipotent mouse teratocarcinoma cells thus provide a new and essentially parasexual means of generating entire animals. The advantages of in vitro and in vivo technologies can now therefore be combined to synthesize mice with experimentally useful mutations. After mutagenization of the teratocarcinoma cells in culture, and selection or screening for the desired mutant phenotype, cells of mutant clones are microinjected into genetically marked blastocysts for further differentiation and full gene expression within the framework of the organism. An example is the isolation, by 6-thioguanine resistance, of cells deficient in hypoxanthine-guanine phosphoribosyl transferase -- the same deficiency that characterizes human patients with the X-linked Lesch-Nyhan disease. In work in progress, these cells have been cycled into genetically marked blastocysts, where the tumor lineage has successfully given rise to fully differentiated tissue contributions in which the enzyme defect persists. Such experiments present numerous possibilities for introducing specific mutations into mice, toward the ends of studying gene mechanisms responsible for differentiation and of producing animal models of human genetic diseases. Teratocarcinoma cells may also serve as vehicles for introducing foreign genetic material into mice in order to facilitate analyses of gene control mechanisms in development and disease.


Evidence for the cotransfer of genetic markers in Pseudomonas solanacearum strain K60. A procedure in which transfer of genetic information between genetically distinct derivatives of strain K60 of Pseudomonas solanacearum occurred is described. Genetical analysis of recombinants demonstrated the transfer of an unselected marker, and the linkage of genes determining resistance to streptomycin and rifampicin.


An examination of enzyme production of Phytophthora spp. on solid and liquid media. Solid media were used to determine which extracellular hydrolytic enzymes are produced by Phytophthora parasitica; P. parasitica var. nicotianae, races 0, 1, and 3; and several other Phytophthora spp. Most isolates produced RNase, DNase, phosphatase, lipase, and cellulase uniformly. All race 3 isolates of P. parasitica var. nicotianae exhibited protease activity on a medium containing gelatin, while only 33 and 60% of the race 0 and 1 isolates, respectively, and 14% of the P. parasitica isolates did so. Addition of sorbose to this medium enabled the detection of protease activity by most of the isolates. Amylase activity, measured in the culture fluid, was higher in race 3 than in races 0 or 1 of P. parasitica var. nicotianae and P. parasitica.


[Inventory of serotypes of Salmonella found in Iraq]. This list of the Salmonella found in Bagdad demonstrates their considerable frequency. The frequency of salmonelloses in Irak is very significant, because not only of their incidence on human health, but also on economy: price of salaries, animal death, abortion in the veterinary field, tourism and food exportation handicap.


[Clinical forms of secondary syphilis in Cameroun]. Clinical lesions of Secondary Syphilis in Negroes are similar to classical descriptions which confirm what Montel postulated (1972) according to which "Syphilis is almost the same all over"; the essential difference we discovered lies in the frequencies of clinical forms met.


[Therapeutic trials of a new anti-helminthic in Colombian Amazonia: flubendazole]. After a coprologic survey made at Araracuara, a village in colombian Amazonia showing high prevalences of nematodosis, 83 villages (including 55 children below twelve) were given Flubendazole during three consecutive days. The total dose was 600 mg. for children below 12, and 900 mg. for adults. The product efficiency was 88% for Trichuris, 82% for Hookworm, 77% for Ascaris and 43% for Strongyloïdes. The tolerance was excellent in all cases, in spite of heavy parasital infection. The Flubendazole's effect seems to be particularly interesting by its polyvalency.


[Inventory of the Culcinae in Balagne (Corsica)]. We have drawn up the faunistic inventory of Culicinae in Balagne (Corsica) in late summer. The list shows the following species (in order of frequency): Culex hortensis, Culex pipiens, Culex impudicus, Culex territans (?), Culiseta longiareolata, Culiseta annulata, Culiseta subochrea, Aedes mariae, Aedes caspius, Aedes vexans, Anopheles claviger, Anopheles maculipennis. We have observed the important recession of the maculipennis complex (only one female catched indoor) and the abundance of Anopheles claviger founded in underground resting places from the sea level up to the mountains.


Computerized tomography in the assessment of diseases of the thorax: a critical review. Many diseases of the chest wall, heart, mediastinum, pleura, and lungs can be successfully imaged by CT. Radiotherapy ports can be calculated and transcutaneous biopsies can be monitored. In future, it is conceivable that by studying the numerical data within these areas of diseased and healthy lung it may be possible to more closely correlate pulmonary function with radiographic images. It is hoped that lung volumes extravascular lung water, blood flow patterns, and many more physiological parameters may become open to elucidation by CT.


[Medical practice in Indians of the Colombian Amazon. Epidemiology of intestinal parasitoses]. In spite of the presence of a physician, the real pathology of an indian population of Colombie is not very well known. Some of ill people are probably entrusted to the traditional "chaman". The western medicine is symptomatic, curative and not preventive. Intestinal nematodiasis and amoebiasis are the major problem. Prevalences are: ascaris 46%, trichuris 30%, ankylostoma 39%, strongyloides 40%, Entamoeba histolytica 30%. Among this slowly evoluting population parasitism is related with cultural factors.


[Hemoglobin abnormalities and glucose 6 phosphate dehydrogenase deficiency (G6PD) in 101 refugees from southeast Asia]. Hematological studies were performed systematically in 101 refugees from South-Eastern Asia living in the Grenoble area at the present time. We found: --4 haemoglobin E homozygosity, --29 haemoglobin E heterozygosity, --2 beta-thalassemia heterozygosity, --4 alpha-thalassemia heterozygosity, --14 glucose 6 phosphate dehydrogenase deficiencies.


[Dermatologic aspects of arsenic poisoning caused by drinking water]. The dermal aspects of an accumulated familiar arsenical late-intoxication -- caused by drinking-water -- are described. We have to expect similar cases to this one even today. At the appearance of multiple M. Bowencentres we have to consider in addition to inner-organic carcinoma, the possibility of an arsenical intoxication as well.


Contact sensitivity to trivalent chromium compounds. The investigations confirmed the known fact that for skin tests larger amounts of trivalent chromium compounds are necessary than those of potassium dichromate. It was also observed that some patients react to relatively higher Cr VI and lower Cr III concentrations and others vice versa. Chromium nitrate and chloride release and that of potassium dichromate was determined and converted to the chromium content in the concentrations used for skin tests. It was found that Cr III compounds cannot be used for skin tests in a 0,5% concentration if only because they are released in undeterminable amounts. Release of Cr III and potassium dichromate from bases containing the same amount of substance when converted to chromium demonstrated that the different release of Cr III is not an additional cause of the fact that much higher concentrations of Cr III compounds have to be used for patch tests than those of Cr VI compounds.


[Contact urticaria caused by Peru balsam]. By tests on six patients with recurrent urticaria it could be demonstrated that it was caused by an allergy against Peru balsam. Different reaction types seem to have been responsible for the occurrence of the urticaria. Cross reactions with different other substances, mainly luxury food and stimulants, play a particular part.


In vitro studies of the metabolic pathway from 8-COOH porphyrins to 4-COOH porphyrins. The authors report the experiments about incubation of uroporphyrinogen with sonified fibroblasts of normal individuals and prophyrics and present the hypothesis of the absence of deficiency in the activity of uroporphyrinogendecarboxylase.


Influence of a systemically administered aromatic retinoid (Ro 10-9359) on the light sensitivity. The light sensitivity was determined on 14 psoriasis patients using two different light sources before, and after a three week period of systemic administration of 75 to 100 mg daily of the aromatic retinoid (ethyl ester of all-trans-9-(4-methoxy-2,3,6-trimethylphenyl)-3,7-dimethyl-2,4,6,8-nonatetraenoic acid, Ro 10-9359 [1]). The results indicate that with this therapy, the light sensitivity remains unchanged or even decreases; there is thus no contraindication to the simultaneous application of phototherapy and the systemic administration of this retinoic acid derivative.


[Physician's duty to secrecy in social legislation]. It is reported on the physicians duty of secrecy in social legislation for the protection of individuals claiming or receiving social security, on the penalty regulations of unauthorized revelation of the medical secret, on the authorized revelation of the secret, on the duty of secrecy by the medical expert, on the right of the physician to refuse insurance institutions (AOK,LVA,BfA,BG etc.), and on official help among the social insurance institutions.


Functional classification of undernourished populations in the Republic of El Salvador. Methodological development. Typical government nutrition programmes usually lack precise information on the size of groups that could benefit from interventions, on the different types of potential beneficiaries and their location, and on socio-economic and cultural characteristics through which they could readily be identified. In the functional classification approach to the definition of nutritional problems, detailed information on human behaviour and social constraints is collected at family and community levels. The data are then interpreted in general terms in order to understand how these factors contribute to inadequate levels of nutrition within larger groups. This new approach should enable more effective measures for reducing the numbers of those living under conditions of deprivation to be presented to planners and decision makers.


[Permanent cardiac pacing in Italy to-day (author's transl)]. The current status of cardiac pacing in Italy is outlined by the following figures: 121 hospitals implant over 10,000 pacemakers each year. Of this number 69% are new implants which raises the incidence of new treated cases to 111 per million population, with the highest peach (197) in Tuscany. This figure was only 61 in 1973. At elsewhere, the dominant age group is the 7th decade; the prime indication for pacing is the symptomatic patient with a-v block (62% of all cases), the next most common one being chronic fascicular block (11%) and sick sinus syndrome (10%). The transvenous route is utilized in 98.3% of cases. The pacemaker of choice is the R-inhibited units; fixed rate units are used in only 4% of cases and units with conventional mercury battery cells in  66%, in favour of pacers with longer energy sources (e.g. lithium). Fifteen companies are supplying pacemakers in Italy and four of them are local manufacturers. An estimate 18,000 patients are being paced throughout the country to-day. Their density is highest in the region Friuli-Venezia Giulia (948 per million population). Follow-up of patients as a whole is not satisfactory being adequate only in about 50% of hospitals; telephone monitoring is available but in a few locations. The average cost of permanent pacing in Italy is the equivalent of 2.50 U.S. dollars per day.


[Old and new methods for control of pacemakers (author's transl)]. First there is a description of present methods available for controlling the functioning of pacemakers, most of which are already being used in traditional clinic-electronic control. There follows a presentation of telephone monitoring (ECG + Pacing Rate) and its limits so far as photoanalysis is concerned. Mention is made of the new italian system of telephone monitoring which also includes measurement of amplitude and width of the pulse. Personal experience of the diagnostic value of photoanalysis is given. This concords with others as to its necessity to detect any failure from circuitry defects or from breakage or insulation of electrode. In conclusion the hope is expressed of actuating a completely trustworthy control system which includes a high degree of foreseeing failure (telephone monitoring) and diagnostic value (Rx + photoanalysis). At last the advantages of an automatic follow-up system in a pacemaker patient clinic are discussed.


[Permanent endocardial pacing. Experience on 1678 patients. (De Gasperis Cardiology Center--Ente Ospedaliero Niguarda--Milano) (author's transl)]. The Authors report on eleven years and six months experience with permanent endocardial pacing in the treatment of various conduction disturbances. This experience relates to 1678 patients, 3617 pacers were used. The age of the patients ranges from 60 to 80 (70%), 30% referring to the remaining decades, minimum 14--maximum 94. Fixed rate pacers were used in 31% of cases, QRS synchronous or QRS inhibited pacers were used in 69%. Average life of the pacers varies from 25 to 29 months; the average life of fixed rate pacer is higher. Complications and causes of failures, among which electrode dislodgement is the most relevant and frequent, as well as the relative therapeutical treatments, are described. Early mortality is about 1% and late mortality 20%; the survival rate calculated altogether after 11 years and 6 months treatment with implantable pervenous pacing is about 16%.


[The experience with permanent cardiac pacing at the Surgical Clinic of the University of Padua Medical School (author's transl)]. A computer analysis is reported of the most significant data concerning 1624 pacemaker implantations and 1386 battery replacements. The patients were treated by endocardial stimulation with transvenous electrodes in 91% of the cases; the remainder: 9% received epicardial electrodes. The mode of stimulation was 2189 times "demand", 138 "synchronized" and 683 "asyncronous". Pacers of 13 different brands were used. At the beginning of our experience, the catheter was introduced through the superficial or profunda giugular vein: since 1969 the cephalic vein has been preferred. Epicardial electrodes were implanted via a left thoracotomy but in the most recent years the extrapleural phrenico-pericardial approach has been adopted. In a number of cases external pacemakers have been employed for permanent stimulation. The most common post-operative complications were infection (3.9%), skin erosion (2.2%), catheter rupture (3.5%), electrode dislodgement (1.7%). Such complications are becoming less frequent since 1969, due to technical improvements.


[Clinical experience with permanent cardiac stimulation in the Department of Medical Pathology of Pisa University (author's transl)]. Experience with about 1500 electrostimulated patients is reported. Rather than give statistical data we have preferred to go briefly through the problems encountered in the course of our experience and suggest possible solutions. We have emphasized the following aspects: ventricular-triggered pacemaker, stimulation threshold, haemodynamic behaviour of the paced patient, problems concerning implanted pacemakers follow-up. Our 13 years experience has opened new prospects which deserve further study, such as programmable pacemakers, optimal generator life and a few important aspects in follow-up techniques.


[The experience in cardiac pacing at the Cardiology Department of St. Camillo Hospital (Rome) (author's transl)]. The experience of the Cardiac Electrostimulation Center of S. Camillo Hospital in Rome on 1503 patients treated with permanent pacemakers for an 11 year period is referred. The Authors analyze the increase of the activity of the Center during these years and some events that caused it. 94.5% of the patients were more than 50 years old; the dominant pathology has been ischemic and idiopathic cardiopathy, which together include 94.7% of the totality. The indication to the implant has been A-V block in 70% of the patients; intraventricular block in 20%; sick sinus syndrome in 10%. In the last years the prophylactic indication has increased (from 0.4% to 4.4%). 2459 pacemakers have been used, of which 79.5% was QRS-inhibit. The mercury prosthesis have been progressively substituted with the lithium ones. 1642 catheters (implant and reimplant) have been used; principally endocardic (95%) and monopolar (85%). The substitution of the catheter has been necessary in 9% of the totality; in 2.6% of the endocardic and in 15.9% of the epimyocardic. Among 50 electrodes, after a period of observation of about 7.7 years, 36 are still in function. The percentage of the complications has been 17.1%; the most important complications have been: dislocation (6%), microdislocation (1.5%), late high threshold (2.1%), failure of catheter (1.2%), generator malfunction (2.3%). The total mortality has been 15.4%; 0.2% caused by deficit of the implant; 2% sudden deaths and 13.2% not depending from the implant; 243 patients (16%) are not to be found. The frequency of out-patients controls has decreased in the last 2 years (from 3.8 controls per years to 1.8).


[Cardiac pacing in Sicily (author's transl)]. We report the experience in Sicily, where more than 3000 pacemakers have been implanted in different Schools of Medicine and Hospitals (Agrigento, Catania, Messina, Palermo and Ragusa). Our personal experience (Cardiology Division--Catania) is 846 cases up to June 1977. We would like to stress that today the sick sinus syndrome and other pathological conditions not due to complete AV block are of increasing incidence as an indication to definitive electrostimulation. In addition, the average age of patients is getting lower, and more PM-demand and lithium powered PM are implanted. The most used implant technique has been through the cephalic vein. Today it is possible to have more distant controls mainly because of the oscilloscopic evaluation technique. Mortality during surgery and immediately post-surgery is very low, and the bioelectric complications are very rare. In conclusion, we would suggest: 1) a strict cooperation with a Cardio-surgery Division; 2) the utilization of more sophisticated techniques to make controls less frequent and more rapid and easy (e.g. telephone controls); 3) a more modern and correct law on this issue and a better information of the public, involving educational, social and medical structures so that the patient with a pacemaker can live in his family with a recovery for work and society.


[A regional experience with permanent cardiac pacing: in Friuli-Venezia Giulia the highest density of pacemaker patients in Italy, to-day (author's transl)]. In Friuli-Venezia Giulia, a region of 1,243,463 inhabitants, a total of 1,629 first implants have been carried out since the first patient was treated with permanent cardiac pacing (P.C.P.) early in 1692. This patient is still alive. In the last four years, the annual rate of implants was 185 per million inhabitants. The average age of patients is 72.9. The most frequent indication for pacing is the a-v block (64.5%), followed by the fascicular blocks (10.8%) and the sick sinus syndrome. No asinchronous fixed rate generators are implanted at present; lithium batteries are the power source of choice to-day. There have been 1,120 replacements in the Region, mainly due to battery depletion (89.9% of cases). A total of 442 patient deaths have occurred in 10 years due to neoplasms (17%), cerebrovascular accidents (15.6%), respiratory infections (15%), myocardial infarction (8%) and other causes. In 8.8% of cases the death was sudden. There are 1,179 patients in follow-up in the Region (948 per million inhabitants). A computer system, described elsewhere in these proceedings, allows a close follow-up of these patients along with the evaluation of long term pacing on a reliable statistical basis.


[The Italian experience with lithium pacemaker (author's transl)]. After explaining the concept and evolution of lithium-anode batteries, and the various types in use at present as power sources for pulse generators, the Authors examine the Italian studies, including pacemaker's clinical follow-up, technical trials and productions. In fact the first pulse-generators, powered by the best known battery prototypes, i.e. old Lithium-Iodine cell 702 C,P, and E, and Lithium-Silver Chromate cell Li 210 and Li 355, were implanted respectively in 1972, 1973 and 1974, at the Cardiology Department, Ferrara, Italy. The detailed account and analysis of the data supplied by both Italian and Foreign manufacturers, together with the observations furnished by 24 Pacing-Centres--2845 pacemakers implanted for a total amount of 31,794 months/pacemaker out of 8,475 pacemakers supplied for 77,606 months/pacemaker up to June, 30, 1977-indicate a promising future for the development of such pulse-generators. Indeed the latest improved power sources associated with the best and most reliable electronic and electrode pacing systems, already allow the manufactures to produce small, comfortable and long-term pacemakers. Furthermore the significant reduction in periodic controls and replacements, if actually needed, seems sufficient in itself to counterbalance the initial high cost. Thus, medical staff and equipment can be utilized for other purposes.


[The Italian experience in permanent pacing. A casuistry for more of 10 years: a policentric study (author's transl)]. According to a recent national survey, 387 patients were treated by permanent pacing in 10 Italian centers, between 1961 and 1966. Of these patients 205 have died; 131 (77 males and 54 females) are still alive and no informations could be obtained for the remaining 51 (13%). The overall survival of patients treated during this period of time is therefore not less than 34% which is comparable to that of general population of the same age group. The 131 patients still alive have totaled 1,486 years of pacing and have used up to 784 pacers. Comparing the incidence of the most common causes for replacement during the periods 1961-66 and 1973-77, electrode failures dropped from 21 to 0.9%; circuitry malfunctions occurred in 10.5 and 7.8%; battery depletion rose from 36.8 to 69% of the cases. According to their clinical conditions, the 131 patients on long-term follow-up can be grouped as follows: 62% are in class 1 or 2 of NYHA; 26.7% are in class 3, and 3.8% in class 4. Moreover, 53.4% of patients are living an active life, having some sort of occupation and 29% are holding a driving license.


[Prospectives for rehabilitation of subject with pacemakers (author's transl)]. The research performed in the last ten years has allowed important knowledge related to cardiocirculatory physiopathology concerning subjects treated with artificial pacemakers. Relying upon available data, one may today state with certainty that subjects treated with artificial pacemakers may afford an activity very often quite near to the physiologic one: it ensues that every attempt must be made (particularly referring to subjects under 50 years) in order to resume work adaptation correlated with similar efficient possibilities about peripheral circulation. A rehabilitation treatment, on a valid functional evaluation ground, is today possible and desirable, as is demonstrated by some patients who have again resumed their activity.


[Cardiac pacing in sinus node disease (author's transl)]. In sinus node disease, cardiac pacing is used as a diagnostic and therapeutic tool. The assessment of sinus node recovery time by means of rapid atrial pacing and sino-atrial conduction time by means of premature atrial stimulation, are the methods usually utilized in the diagnosis of sino-atrial dysfunctions. Theoretical and practical limitations however induce to careful evaluation of the results. Heart pacing is also useful for the treatment of sino-atrial dysfunctions. However, criteria for pacemaker implantation in these conditions are still lacking and the type of pacemaker indicated is not defined yet. At present, the accurate clinical investigation of the patient still remains the best guide to therapeutical approach.


[Psychological problems of pacemaker carriers (author's transl)]. The Authors examine the peculiar psychological problems of pacemaker carriers. According to the degree of adjustment to the new clinical condition, it is possible to distinguish patients who react developing an anxious-depressive status (10-20%), those who realistically adjust to the new functional condition allowed by the pacemaker (70-80%) and those who, denying their disease, tend to overdo in their physical performance (10-20%). These characteristic psychological behaviors are examined with their family social, and physical implications. On the basis of these observations the importance of psychological support of nurses and physicians is emphasized.


[The pacemaker and the general practitioner (author's transl)]. The Authors promoted an inquiry, to all the General Practitioners in the Province of Verona about the problems the patient with a pacemaker implanted bears to his attending physician. The results of this inquiry have shown uncertainties or faulty beliefs about the follow-up and medical treatment of the patients with pacemaker. Therefore the work has shown the necessity of a closer connection between hospitals and general practitioners in order to provide continuous medical education on this problem.


[The "ideal" pacemaker (author's transl)]. The therapeutic role of chronic cardiac pacing in cardiology has significantly altered for two fundamental reasons: a) on the one hand, there has been a widespread increase in the indications for cardiac stimulation, and consequently, today, approximately 50% of the patients with pacing do not suffer from advanced atrioventricular (A-V) block or syncopal attacks, but are frequently suffering from other pathological conditions: episodes of paroxysmal arrhythmia, atrial disease, depression of the habitual pacemaker by drugs or in the course of cardiomyopathy; b) on the other hand, through technological progress the life of the generator has been lengthened (lithium, plutonium), more variable frequencies within relatively high limits are available, electrodes, wiring, circuits etc. have improved. This extended use of the pacemaker, however, creates in itself a series of problems: it is now possible to envisage the characteristics of the "ideal" pacemaker, in other words, a stimulation unit endowed with resistance, modulation, self-control, innocuosness.


The European Working Group on Cardiac Pacing. A brief review of the activities of the European Working Group on Cardiac Pacing, is given. This Group, together with other 18 study groups, has been created by the European Society of Cardiology which is now renewing its basic organization. The main goals of the Pacing Group are illustrated. They are: patient registration; pacemakerclinic registration; early failure reporting; registration of pacemakermeetings; development of research projects throughout Europe.


[Clinical and electrophysiological indications for permanent electrostimulation in sick sinus syndrome (author's transl)]. In 49 patients with sick sinus syndrome the following electrophysiological parameters were studied: sinus node recovery time and conduction time, atrial and AV nodal refractory periods, atrioventricular and intraventricular conduction. Moreover, pharmacological, vagal and sympathicomimetic stimulation were performed. These data were related to the clinical picture to establish any possible correlation leading to a more specific therapeutical choice. Patients were divided in two groups: group 1, with a prevalence of tachyarrhythmic symptoms and a lesser incidence of syncope, in which cases the sinus node function appeared to be only slightly affected. In group 2 small incidence of tachyarrhythmias and a clear prevalence of syncope with severe impairment of sinusal automaticity and/or sinoatrial conduction were present; AV and IV conduction disturbances were equally distributed in both groups. In more than 1/3 of the cases of the group I arrhythmias were succesfully treated with pharmacological therapy only, with Group 1 A antiarrhythmic agents in most cases. In the other cases of this Group and in all cases of Group II permanent electrical stimulation alone or together with drug therapy was necessary. Long term results with different therapeutical choices and, specifically, with the type of stimulation chosen in individual cases (sequential, rate-programmable ventricular, demand ventricular) are presented.


[Long term electrophysiological study on patients with acute myocardial infarction and complete heart block. Is cardiac pacing always necessary? (author's transl)]. Of 335 consecutive patients (pts) admitted to the coronary care unit (CCU) for acute myocardial infarction (AMI), 34 (10%) evidenced complete heart block (HB). The overall inhospital mortality was 14% (47 pts) versus 39% of the HB group (13 pts). No previous conduction disturbances were documented in 58% of pts before appearance of complete HB. Complete HB was preceded in 52% of pts by first or second degree HB or bundle branch block. Of 21 pts with HB discharged from the hospital, 5 (23%) died between 5 and 24 months (mean 12): no patients had sudden death; 16 pts (76%) are still alive after 13 to 45 months (mean 30). His bundle electrophysiologic (HBE) study was performed in 10 pts of the HB group after 4 to 40 months: 4 pts with anterior versus 6 with inferior AMI. Conduction disturbances were no longer present in all but one pt who had H-V 60 msec. Ajmaline (50 + 50 mg iv) prolonged A-H over 130 msec in 4 pts; H-V was not significantly increased in 8 of the 10 pts, while in two pts was 100 msec. One pt in the acute phase and one pt 12 months later, required pacemaker (PM) implant (both had inferior MI). no sudden death was documented during the follow-up period. The late HBE study, before and after ajmaline, did not allow to recognize critical conduction abnormalities suggessting prophylactic PM implantation.


[Programmed electrical stimulation in the treatment of reciprocating arrhythmias. Use of radiofrequency as a stimulating and synchronising means (author's transl)]. A new model of radiofrequency stimulator is presented, which can be programmed for the transmission of one or two impulses synchronised and delayed on the endocardial electrogram. This pacemaker was successfully used in jounctional reciprocating tachycardias and in a case of recurrent ventricular tachycardia. The implanted device, connected to the electrode catheter in right ventricle, does not contain energy sources. This lets a little size and allows having outside the body all the program controls, which in the time can have to change, due to variations of the parameters of tachycardias interruption. The implanted receiver is designed to induce in the resonant coil of external transmitter a frequency modulation proportional to the endocavitary signal. A slope detector receives this signal and programs on them the stimulating impulses, transmitted to stop the tachycardia. It is possible to manufacture such a simple device that the same patient can use it. Of course, periodic controls on the patient must be made to assess the cause of the tachycardia.


[Permanent pacemaker implantation in children after open heart cardiac surgery (author's transl)]. Between 1972 and 1977, a permanent pacemaker has been implanted in 9 children for complete heart block, after repair of a congenital heart disease. Children's age ranged between 2 1/2 years and 13 years (mean age 8 years). The block had been caused by the operation in 8 children and was pre-existent in the last one. A permanent pacemaker was not implanted in another four children with postoperative complete heart block. In seven cases the pacemaker was implanted in the subclavear zone and connected to a transvenous electrode; in the remaining two cases the pacemaker was positioned subcutaneously in the abdomen and connected to an epicardial electrode. VVI-type pacemaker have always been used. Three children died after implantation because of chronic cardiac failure complicated, in one case, by surrhenalic insufficiency. In two cases the pacemaker was replaced because of battery exhaustion, as suggested by routine controls; in five cases, wire breakage occurred and it was replaced together with the pacemaker. In another case transvenous electrode displacement occurred; skin infection at pacemaker site occurred only once. No skin breakdown at pacemaker site has ever occurred, or any problem due to excessive pacemaker dimensions. Reappearance of normal synus rhythm was noted in one patient. No complication has been reported so far for the cases with postoperative complete heart block not treated with cardiac pacing.


[Temporary artificial pacing after open-heart surgery (author's transl)]. A three-year experiences with the treatment by artificial pacing of the cardiac rhythm anomalies after open-heart surgery, at the Institute of Surgery of the Heart and Great Vessels, Ist School of Medicine, University of Naples, are reported. The most frequent arrhythmias occurring during or soon after open-heart surgery and the main aetiologic factors are examined. The surgical techniques for pacing and their indications are considered. Thereafter some particularly interesting cases are reported.


[Biocompatibility and quality control of pacemaker (author's transl)]. The Authors examine the functional, toxicological and pharmacological controls routinely performed on materials and on the finished products. They propose a biocompatibility protocol for screening materials, and they compare Italian regulations on quality control and good manufacturing practice of medical devices with foreign regulations.


[Technology and real performances of a new circuit for new pacemaker (author's transl)]. Continuing evolution in cardiac stimulation today imposes on PM manufacturers the need to submit their products under new criteria, such as: contained dimensions, functional complexity and longer periods of patient care. PM electronic circuity plays a determinant role in meeting the best solution of these problems. Thick film hybrid technology has been chosen by the Authors because it is deemed to be the best compromise for the present goals, such as: low power consumption, low weight and small size, electrical parameters stability, functional complexity and high circuitry density, Hi-Rel performance for longer working life. A little space has been reserved for schematic diagrams of the manufacturing cycle and the applied technology; particular evidence has been shown concerning selection criteria for circuitry component selection and Hi-Rel tests for the end product. Hi-Rel and qualification standards have been selected by the Authors from MIL-STD 883 methods and AAMI-FDA pacemakers standards. Practical results of the application of this methodology can be summarised as follows: only 44-50% of the total circuits pass the complete cycle of tests and thus are used for PM manufacture; electronic failure rate in the implanted units is 0.024% failure per month.


[The acupuncture in 20 patients submitted to placement of endocardial permanent pacemakers (author's transl)]. The Authors report on 20 patients who underwent definitive surgery for placement of artificial pacemaker with utilisation of acupuncture for analgesic purposes. The report in detail on the results obtained with even, in the light of a limited experience, can be considered positive.


[Measurement of the myocardial stimulation threshold in chronic and acute patients with pacemaker implanted (author's transl)]. Eighty-two patients, with electrodes implanted for varying periods of time, have been divided into three groups: acute (at implantation); intermediate (3 to 36 months) and chronic (37 to 124 months). In these groups, respectively 28, 26 and 28 myocardial stimulation threshold measurements have been performed. Measurements have been performed with MEEMR (Myocardial Excitation Energy Meter), an instrument deviced and built by the Institute of Elaboration of Information, CNR and University of Pisa. Microjoule has been chosen as unit of measure. More commonly used units of measure, such as threshold current in milliamp, have been calculated from values in microjoules. Mean values was 0.6 muJ in the first group, 6.9 muJ in the second one and 8.3 in the third one. Student test has been performed on such measurements, divided into groups, with the following results: p less than 0.01 between 1st and 2nd group, non significant difference between 2nd and 3rd group, p less than 0.01 between 1st and 3rd group. Such results suggest a trend toward myocardial threshold stabilization over a long period of time, as had already been hypothized by others Authors. Further useful information may be drawn from these data if they are evaluated in relation to a life-time pacemaker, as is nowadays desirable in view of recent progress in circuit technology and energy sources.


[Complications observed in 800 cases with implanted permanent endocardial pacemakers (author's transl)]. The Authors discuss their research on 800 endocardial permanent pacemakers (ventricular, atrial, and bifocal) implanted during six years. In the light of the examination of the literature, the AA. report the complications registered, in particular: lead's displacing 6.2%, run away 0.7%, marked hyperthermya 0.0%, haemorrage 0.4%, wound dehiscence 0.3%, asectic necrosis by decubitus 5%, septic necrosis 0.3%, perforation of the heart 0.2%, pulmonary embolism 0.1%. Both the most common causes of complications and the technical expedients employed to minimize the complication rates are being discussed.


[Syncopal attacks due to ventricular tachyarrhythmias ("torsade de pointe type") in a patient with a PM of hysteresis type (author's transl)]. The authors report on a patient with artificial ventricular pacemaker with hysteresis, who suffered from ventricular fibrillation known as "torsade de pointe" and ventricular flutter, often accompanied by lipothymias, with hypokalemia. The following points are considered: the pacemaker responsibility to produce arrhythmia; the pacemaker behaviour during ventricular tachyarrhythmias; the modifications of stimulation threshold and R-wave sensitivity after PM removal and the following hours.


[Behaviour of some serum enzymes after permanent pacemaker implantation (author's transl)]. The behaviour of some serum enzymes (CPK, LDH, alpha HBDH, SGOT) in 50 patients after permanent pacemaker implantation is outlined. Changes of each enzyme were analyzed statistically by applying Student's t test. Most significant changes are represented by the increase in CPK serum concentrations (19 cases). In 14 of them LDH isoenzymes were evaluated and in 4 patients alteration of LDH1/LDH2 ratio suggestive of cardiac "injury" were observed.


[The diagnosis of myocardial infarction in the presence of disorders of ventricular activation for right endoventricular pacing and left bundle branch block (author's transl)]. The Authors have studied the vectocardiogram in left bundle branch block, right endoventricular pacing, myocardial infarction and right endoventricular pacing, myocardial infarction and left bundle branch block. Vectocardiographic loop analysis allows the diagnosis of myocardial infarction both in the presence of endoventricular pacing and in the presence of left bundle branch block.


[Pathological observations on patients carrying pacemakers and clinical consequences. Reports of 105 observed cases (author's transl)]. In subjects carrying pacemakers, the catheter-electrode can induce, over a period of time, specific modifications at the level of the veins and the heart. The organism reacts to extraneous bodies with adhesive and sometimes thrombotic phenomena. The latter can occasionally be the cause of a pulmonary embolism (8 cases out of 105) or more rarely, the seat of a mycotic infection (one case). In the casuistry are included two cases of the complete perforation of the right ventricle (one of which was fatal) and four cases of partial perforation; in another subject a papillary muscle was perforated. Finally, one case of endocarditis was noted, the so called traumatic type, of the tricuspid valve.


[Proposal for a national system of pacemaker patient registration. Goals, technical aspects and cost analysis (author's transl)]. Based on a personal experience with computer logging of pacemaker data, the Authors describe a system for a nation-wide registration of pacemaker patients. The advantages of such registration are stressed. The way of collecting and storing data, the interactions between pacemaker centers and the central registration system, the registration card, the estimated costs are discussed in detail.


[The pacemaker and the practitioner (author's transl)]. Considering the increasing importance of cardiac pacing (800-1000 pacemaker patients per million population according to most recent evaluations), the Authors made an investigation on a sample of 100 general practitioners, to evaluate their knowledge on pacemakers. These physicians have been questioned following a form, which resumed the most important problems that can arise in patients with cardiac pacemakers. The conclusion is that the practitioner has little knowledge on cardiac pacing and that he is not able to handle this sort of patient.


[Our experience in treatment of the inhibition of demand pacemaker by muscle potentials (author's transl)]. The inhibition of demand pacemakers by muscular potentials is rarely described in the literature. The Authors have found an interference of the pectoralis muscle's electric activity with pacemakers in 4 patients suffering from occasional faints. Extending this study to a group of 10 asymptomatic electrostimulated patients, pacemaker's inhibition by sub-maximal contraction of pectoralis major muscle has been found in 9 of them. The 4 symptomatic patients have been operated displacing the battery near the sternum. The poor thickness of the pectoralis muscle's fibres suggested the treatment. The controls performed from 2 to 8 months respectively have shown disappearance of the symptoms.


[On 1800 patients with implanted definitive pacemaker (author's transl)]. The Authors outline their clinical experience with 1800 patients, 1190 of which underwent definitive pacemaker implantation and 610 replacement of the impulse generator. They examine some parametres in detail, reporting on the results obtained.


[Experience in prophylactic peroperative cardiac electrostimulation (author's transl)]. The Authors refer on about 35 cases of prophylactic peroperative cardiac electrostimulation on about 50,500 cases undergoing surgical procedures during seven years. The indications were: bifascicular block, complete left bundle branch block, primitive sinusal bradycardia, surgical correction of carotid synus syndrome, atrial fibrillation with spontaneous low ventricular rate, neurosurgical treatment of cranial trauma by suspected MAS syndrome, surgical implantation of epicardial electrodes. It is enphasized the necessity to continue with prophylactic peroperative cardiac stimulation in all these cases, except for bifascicular blocks for which one has to decide case by case according to the clinical history and ECG findings.


[Surgical complications of pacemaker implantation (author's transl)]. During the period 1966-1977, 705 pacemaker implantations with transvenous endocardial electrode and 369 substitutions of generators were carried out, besides 275 operations treating some complications after implantation were required. The most frequent complications were: endocardial electrode dislocation (9.4%), lesion caused by decubitus (7.5%) and infection of subcutaneous pocket (5%), decubitus lesion and infection of the skin caused by the electrode (1.7%), electrode and generator breaking (1.3%), right ventricle perforation caused by the electrode (0.37%). Surgical mortality-rate was 0.18%.


[The computer assisted pacemaker clinic at the regional hospital of Udine (author's transl)]. For a close follow-up of large groups of pacemaker patients and for evaluation of long term pacing on a reliable statistical basis, many pacemaker centers in the world are now using computer systems. A patient data system with structured display records, designed to give complete, comprehensive and surveyable information and which are immediately retrievable 24 hours a day, on display or printed sets, seems to offer an ideal solution. The pacemaker clinic at the Regional Hospital of Udine has adopted this type of system. The clinic in linked to a live, on-line patient data system (G/3, Informatica Friuli-Venezia Giulia). The input and retrieval of information are made through a conventional keyboard. The input formats have fixed headings with coded alternatives and a limited space for comments in free text. The computer edits the coded information to surveyable reviews. Searches can be made on coded information and data of interest.


[Experience with lithium pacemaker in the University of Genova (Italy) (author's transl)]. The Authors report on their own experience of 77 lithium pacemaker implanted between 1974 and September 1977 in the Centre of Cardiac Surgery of the University of Genova (Italy). Only one generator has been replaced till now because of liquid infiltration. Rate variations in pacemaker marketed by Sorin were studied, considering the test-stand rate the first control and the following rate controls; the reliability of this parameter was confirmed.


[Stenosis of superior vena cava at the crossing site of two catheters (author's transl)]. A case of superior vena cava syndrome is described in a patient with two endocardial pacing electrodes. At autopsy a severe stenosis of the venous lumen was found at the crossing site of the two catheters. There was no evidence of thrombus formation. Venous wall stenosis is an unusual complication of transvenous pacing and is probably favoured by the presence of two electrodes.


[Cardiac electrostimulation in childhood (author's transl)]. The AA. relate on two cases of pacemaker implantation in childhood, and they outline the causes that make necessary a cardiac pacemaker in such an age and the troubles can possibly occur.


[Demand pace-maker for the treatment of carotid sinus syndrome (author's transl)]. This is a report of a case of carotid sinus hypersensitivity treated with an endocardial demand ventricular inhibited pacemaker. With this modern form of therapy of carotid sinus hypersensitivity we have obtained in the case presented a complete resolution of lipothymic attacks due to complete atrioventricular (A-V) block secondary to carotid sinus stimulation. The patient discharged from the hospital after seven days from the implantation of the pacemaker has been symptom free at a control after eight months.


[Cardiac pacing as prophylaxis in surgical operations (author's transl)]. During a 24-month period, 37 patients with fascicular blocks (RBB-LAH, alternating bundle-branch block, bundle-branch block with PR prolongation, RBBB-LAH with PR prolongation) were sheduled for operation. The study was undertaken to determine what effect the stress of anesthesia and operation might have on these patients, and to attempt to answer the question whether all patients with fascicular block should have demand pacemakers implanted. All these patients were in stable condition and had no history of transient complete heart block. Patients were monitored continuously intraoperatively and were followed by serial electrocardiograms to the third postoperative day. No instance of complete heart block was found. No significant problem arose both intra- and postoperatively. According to these findings, routine, prophylactic, temporary cardiac pacing in patients with fascicular blocks, before anesthesia and during operation, seems to be not necessary in the absence of cardiac symptoms.


[Cardiac pacing during open heart surgery (author's transl)]. Cardiac pacing by means of temporary wires inserted during open heart surgery is an established useful adjunct to post-operative care. Optimal rate can be imposed to the heart with transiently depressed function, arrhythmias can be suppressed by overdriving and atrioventricular synchronization sometimes can be reestablished, with a resulting improvement of cardiac output. We routinely insert wires on the right ventricle, and on the right atrium wherever excitable. Wires have been inserted in 383 consecutive patients, significantly contributing to the control of bradiarrhythmias, the suppression of PVCs, and the improvement of low cardiac output states.


[Recent progress in energy sources and in technology of electronic circuits (author's transl)]. Since 1957, when the first implantable pacemaker was developed, the performances of cardiac pacemakers have enormously improved. The paper describes the recent progress in the field of energy sources, technology and circuit solutions. The improvements achieved up to now have extended the mean life-time of an implantable pacemaker from about 30 months up to more than 6 years, while some pacemakers with programming capabilities are available and pacemakers with self-adapting capabilities to the individual hemodynamic needs are in the stage of advanced development.


[The criteria for the choice of a cardiac pacemaker (author's transl)]. The criteria commonly followed for the choice of a cardiac pacemaker to be used in the treatment of AV blocks and sick sinus syndrome are described. In case of AV block, the AA, believe that at first implant a ventricular inhibited pacemaker is to be preferred, while for the replacements the choice will be based on clinical grounds (mainly from the data obtained during the periodic controls, such as persistence of spontaneous activity, failure of sensing, etc.). In case of sick sinus syndrome, ventricular inhibited pacemakers are generally to be preferred firstly to secure stimulation even in case of AV block, secondly for the advantage of a greater stability of the endoventricular catheter. Atrial pacemakers (asynchronous, on demand, or bifocal) will be preferred when the atrial contribution is believed to be important from an haemodynamic point of view. Lastly, in single cases, its is possible to implant radiofrequency devices connected with the electrocatheter for the control of the tachyarrhythmic phases.


The choice of the pacemaker-electrode combination. The advantages of the endocardial electrode over the transthoracic electrode are illustrated by the fact that the Vth International Symposium on Cardiac Pacing in March 1976 in Tokyo a world wide survey of 15000 electrodes implanted in 1975 showed that 93.4% were of the tarnsvenous type. These advantages will be discussed. An important electrode choice that has to be made next is the selection between the monopolar and the bipolar electrode. Mechanical (electro), physiological and clinical aspects have pushed this choice towards the monopolar electrodes. The monopolar transvenous electrode is known in various types. The selection of the electrode can be determined by the incidence of electrode dislocation that has resulted in electrode tips with fixation principles like hooks, barbs and balloon or screw mechanism. For the longevity of a pacemaker system the efficiency of the electrode system is important, that means the energy needed for cardiac stimulation. This stimulation threshold is determined by the myocardial tissue, the stimulation impulse and the electrode, especially the electrode surface. Decrease of the surface area from 50 mm2 about 8-10 years ago to 5-10 mm2 raises the question if there exists an optimal surface area and optimal electrode shape. The electrode area can also influence the R-wave amplitude as detected by the pacemaker and therefore the electrode-pacemaker interface has to be discussed. The solution of some of the electrode problems, that has resulted in more sophisticated electrodes and improved electrode pacemaker systems, will be illustrated.


[Damages of malfunction of the electrostimulating system (author's transl)]. In this study we describe the damages, or the ill-functioning of the electrostimulating system due to failure or bad functioning of the catheter electrode, of the electronic circuits and of the energy sources. Complications due to iatrogen causes or to clinical pathology have not been dealt with. Defects of electrostimulation are described in their clinical, electrocardiographic, oscilloscopic and electrophysiologic aspects, and in the operative report, through the study of 1455 cases. In the differential diagnosis of the defects of electrostimulation we point out their biological causes. The sheath interruption, observed in 31 cases, causes defects in electrostimulation, depending on the extension and on the position of the unsheathing. The circuit variations can be compared with the effect produced by a shunt capacitor. The sheath interruption causes a current reduction which reaches stimulating surface and the differential diagnosis concerns the electronic failure of the generator, the battery discharge, the organic liquid infiltration in the insertion point, the position of the catheter, and the tip perforation of it. The breaking of the spiral (in 6 cases) can be partial or total, and may be compared to the forming of a series capacitor between the electrodes which may sham the increase of the myocardic threshold. The stimulating surface, too wide respecting the intensity supplied by the electrostimulator, brings about a low current density and failures in electrostimulation; the difference between such condition and the one caused by a high myocardiac threshold is shown by determining the safety factor. A very small stimulating surface increases the electrode impedance and may cause a defect of the perception function, if the generator input impedance (4 cases) is reduced. The fall of the output voltage may be caused by a battery discharge, and is the most frequent cause of electrostimulation disturbances; it has been observed in 432 cases. Other causes of the fall of the output voltage (30 cases) are the outflow of mercury from the cells, or mycotic formations. The ill-functionning or the loss of perception (9 cases) caused by defects of the electrostimulator must be distinguished from the ones caused by the endocavitarian potential reduction (myocardiac infarction, conduction disturbances: 2 cases). Variations of the stimulating cycle can be caused by ageing, humidity on resistances and on oscillator condensers (9 cases). Accelerated stimulating was observed in 1 case, plate corrosion in 3 cases, high density of anodic current in 9 cases, generator turnover in 3 cases. Finally we give the chief points of electrical stimulating disturbances due to interferences of electromagnetic radiation.


Sexual function, pregnancy and delivery in spinal cord injured women. Complete spinal cord injury results in abolition of motor, sensory and autonomic functions. Among the autonomic functions, the sexual system is seriously disturbed. The spinal cord injury with its many complications offers a challenge to the rehabilitation team, and the sexual problem is one of its most important aspects. For the female paraplegic, rehabilitation of sexual functions is an essential part in the building of a positive new self-image. In this review, we try to summarize the gynecological and obstetrical aspects of spinal cord injured women. Although the innervation of the reproductive system is damaged, this system continues to function and the menstrual cycle resumes its normal course after a while. Ovulation takes place regularly and pregnancy is possible. Today the general opinion is that the pregnant paralyzed woman can deliver vaginally and not by cesarean section as was believed before. We emphasize the importance of special medical care before, during and after delivery. The cooperation between physiatrist and gynecologist is mandatory.


Vacuum aspiration at therapeutic abortion: blood loss at operation in multigravid women. Therapeutic abortion by vacuum aspiration in the first trimester was carried out on 129 healthy multigravid women. The loss of haemoglobin at operation was estimated and the volume of blood calculated. The figures were compared to those in a group of primigravid women earlier reported. Blood loss increases with gestational length. Blood loss at first trimester abortion is smaller in multigravid than in primigravid women. In multigravid women blood loss is not significantly influenced by the woman's age and the number of pregnancies.


Vacuum aspiration at therapeutic abortion: influence of two different negative pressures on blood loss during and after operation. In 167 women blood loss was measured during and after vacuum aspiration for therapeutic abortion in the first trimester of pregnancy. Two different negative pressures were used -49.1 kPa (-0.5 kp/cm2) and -78.5 kPa (-0.8 kp/cm2) in a randomized series. It was found that for the whole first trimester (8--13 weeks) blood loss during and after operation was relatively small and not influenced by the pressure used. In no case blood loss exceeded 500 ml at operation or 60 ml during the first post-operative week. In 6 women post-operative infections were diagnosed.


Serum levels of FSH, LH, estradiol-17 beta and progesterone following the administration of a combined oral contraceptive containing 20 micrograms ethinylestradiol. An oral contraceptive containing 20 micrograms of ethinylestradiol and 250 micrograms of levonorgestrel was given to 5 normally menstruating women for two consecutive cycles. Peripheral serum levels of FSH, LH, estradiol-17 beta and progesterone were determined during the treatment period and during two control cycles, one immediately before, and one immediately after treatment. In all 5 women studied there were no LH peaks and no luteal phase levels of progesterone during the treatment cycles indicating complete inhibition of ovulation. 4 of the 5 women showed no biphasic estradiol pattern. Posttreatment control cycles showed reestablished ovulatory pattern in 4 of the 5 subjects.


Effect on blood coagulation and fibrinolysis in women using norethisterone or a combination of ethinyloestradiol and quingestianol. Oral contraceptives of the combined type and contraceptives containing only progestagen were studied for their effect on blood coagulation and fibrinolysis. Several blood parameters were determined in 13 women before and during the 3rd month of use of either 0.3 mg norethisterone alone or 0.05 mg ethinyloestradiol combined with 0.5 mg quingestianol. Blood samples were obtained on days 2--4, 9--11, 16--18 and 23--25 of the menstrual cycle. Except on days 16--18, a significantly increased fibrinolytic activity and a significantly increased variation in plasminogen were observed in women using the combined type of contraceptives, but not in the women using contraceptives containing only norethisterone. The other variables studied were not significantly changed, which might be due to the doses and types of progestagens used in the present series.


Study to confirm the lack of severe cardiac side-effects following treatment with the beta-adrenergic drug fenoterol. 100 patients with premature contractions were treated with the beta-adrenergic agent fenoterol for up to 9 weeks. To rule out a detrimental effect on the myocardium, the creatine kinase isoenzyme MB, which is specific to the myocardium, was determined regularly in addition to electrocardiographic monitoring. No pathological enzyme activity was detected even in long-term tocolytic therapy with the maximum dose.


Role of fetal adrenal glands. A contribution to the etiology and mechanism of fetal pulmonary maturation. The role of fetal adrenals in the maturation of fetal lungs is not clear as yet. The anencephalic baby, with rudimentary adrenal glands, may be considered an excellent model for the study of this subject. The maturation of fetal lungs was determined in 3 anencephalic monsters and in 2 microencephalic babies. As a measure of fetal pulmonary maturation the foam test and lecithin/sphingomyelin ratio (L/S) were used, as determined in the amniotic fluid. In the anencephalic babies, fetal pulmonary maturation was lacking, while in the microencephalic infants there were definite signs of lung maturation.


Psychological distress among the community elderly: prevalence, characteristics and implications for service. This paper reports the results of a survey of elderly persons living in a predominantly blue collar, New England town. Data about psychological distress and its relationship to demographic and social interaction characteristics are explored. Vulnerability to the stresses of aging increases where there is a habitual pattern of dependency, poor interpersonal skills and lack of social initiatives. Mental health services were not reaching the elderly in need and there was minimal utilization of other helping services. Some possible preventive interventions are discussed.


Generation and ethnic identity: a typological analysis. Data bearing on cognitive acculturation, ethnic behavior, and values were gathered from three generations of Mexican and Japanese Americans. Two dimensions of ethnic behavior were identified and named: Anglo Face and Traditional Orientation. Although subcultures and generations differed in value orientation, the values data did not contribute to the identification of ethnic identity types. Typological analysis using Anglo Face, Traditional Orientation, and Acculturative Balance Scale scores identified six types of ethnic identity, two for each generation. Immigrants differ mainly on whether or not they retain Traditional Orientation; later generations differ mainly on Anglo Face. Although there are large differences between generations in Acculturative Balance, the two types within each generation do not differ.


Life satisfaction and occupational retirement: beyond the impact year. This article examines three theoretical perspectives relative to the prediction of life satisfaction following retirement. Hypotheses derived from crisis, continuity, and consistency theories were systematically examined with regard to the pre- and post-retirement satisfaction scores of 114 male respondents (mean age 69 years). The data confirm one of four crisis hypotheses. Specifically, individuals underwent a decline in satisfaction with retirement. Similarly, only one of three continuity hypotheses was partially confirmed. A positive association obtained between safisfaction and orientational change in the voluntary association area. Contrary to the theory, however, respondents underwent a significant decline in satisfaction. Finally, only one of the consistency hypotheses was substantiated. In general, expectational disconfirmations relative to retirement did not result in lowered satisfaction.


Career set: a resource through transitions and crises. Following Foote the life histories of twenty-seven white, middle-aged, middle class, American mothers were analyzed for career-like components [4]. Motherhood dominates the lives of these women but is only one of several careers which ebb and flow throughout their lives. Treating careers as developmental subdivisions in the life course, we understand how women can progress through life transitions and crises. Properties of careers, such as the emergent symbols of success, the clockwork which sets the time limits for career objectives, and the bargaining which these women undertake to work out career conflicts, all contribute to the understanding of how career is placed beside career to create each woman's career set. The career set acts as a social and personal resource, providing consistent and continuous meaning throughout major periods of time even in the face of major career stress or loss.


Perceptions of ideal and typical middle and old age. An investigation of attitudes toward typical and ideal old age was carried out with seventy-eight undergraduate students. Half of the participants responded to semantic differential scales for typical and ideal old age and half to middle age stimulus objects. The scales were analyzed in terms of three dimensions produced in previous research. No difference was found between the middle and old age conditions for the personal acceptability dimension but differences were found for both the autonomous-dependent and instrumental-ineffective dimensions. The old and middle age objects were rated alike at ideal but the old age objects was rated less autonomous and less instrumental at typical.


Effects of the living environment on activity and use of time. Exposure to an environment with increased opportunities resulted in increased activity among a group of elderly persons, compared to similar people in unenriched environments. Findings support the hypothesis that unmet need for activity existed among the group, all of whom had been matched to the enriched environment by staff and self-selection, and the hypothesis that environmental intervention is potent in influencing behavior, even in old age. Persistence of the relative elevation in activity over eight years and concomitance with other indexes of well-being suggest that appropriate environment intervention which expands activity opportunities is beneficial. Congruity between the person's needs and the environment's resources is central. Individual differences in need for activity interacted with opportunity in accounting for outcomes.


Incest: some neuropsychiatric findings.

Incest: some neuropsychiatric findings. A review of the medical records of twenty-two patients who were the child or younger member of an incestuous relationship revealed a higher than expected incidence of abnormal neuropsychiatric findings. Seventeen patients had abnormal EEG's; six had clinical seizures; and eight of thirteen patients tested gave evidence of a low IQ or organicity. In addition, indications of impulsivity and depersonalization were frequently found in this group. It could be speculated that these neuropsychiatric handicaps create a vulnerability that enhances inappropriate relationships within a family and makes it more difficult for the person to resist an incestuous relationship.


Evaluation of medical-psychiatric consultation. This report describes four approaches to the evaluation of hospital psychiatric consultation. These are: 1) a survey of actual consultation use; 2) a house staff attitudinal survey; 3) a patient chart review; and 4) a patient questionnaire. The findings of this project and those previously reported are: 1) The psychiatric consultation is under-utilized and a large number of house staff find it not useful. 2) The psychiatric and non-psychiatric house staff view the functions of consultation in markedly different ways. 3) A high percentage of written consultation reports are too vague to determine if the needs of the referring physician were met. 4) Patients usually respond positively to psychiatric consultation. The implications of these findings are discussed in this report.


A typology of responses to illness in survivors of myocardial infarction. One hundred and eighteen survivors of myocardial infarction were assigned scores on eight dimensions of illness behaviour recently described as arising in response to myocardial infarction. These data were subjected to a cluster analysis to produce an optimal solution of four homogeneous clusters of patients. The first contained patients who, on clinical grounds, appeared to be claiming illness as a highly significant and consequential occurrence in their lives; the second accepted illness but experienced a marked affective response to it; the third appeared to adopt a realistic approach to illness and be coping adequately; and the fourth seemed to be denying (or at least minimizing) both the presence of serious illness and its possible consequences. These findings were discussed in terms of their bearing on prognosis, within the context of abnormal illness behaviour.


Psychosocial factors related to the incidence of cancer. The recent data concerning the relationship between psychosocial factors and the incidence of cancer have been reviewed covering life events, personality factors, psychiatric diagnoses, and loss-separation-hopelessness. The multiple methodological and design problems in this area of investigation are the factors that stand out and make interpretation difficult. Nevertheless, an association between oncogenesis and a number of factors such as extraversion, neuroticism, and lack of closeness to family is suggested. Many studies raise additional questions without providing definitive answers. A long term prospective study which has been designed to look at cancer outcome and multiple psychosocial factors is needed to determine if such factors add to the risk of oncogenesis.


Are psychiatric consultants' recommendations followed? The extent of adherence to psychiatric consultants' recommendations was calculated through a review of charts. All charts of patients seen in Psychiatric consultation from May 1976 to April 1977 were reviewed and a total of 273 charts contained scoreable consultant recommendations. Recommendations were scored as either actively followed, passively followed or not followed. Results are reported for the extent of adherence 1) between different types of recommendations (medications, disposition, etc.), 2) between medical, surgical and obstetrical-gynecological services and 3) between consultants, two psychiatrists and one psychologist. The results suggest that recommendations more likely to be followed are those easily performed by a consultee and leading to direct, tangible results. Adherence to consultants' recommendations is discussed in the context of resistance to psychiatric consultation.


Noninvasive measurement of cardiac pressures by induced ventricular wall resonance: preliminary results in the dog. Experiments in the excised dog heart and in live dogs are presented wherein a method of induced right ventricular wall resonance has been utlized to estimate the pressure in the right ventricle of the heart. Externally induced cardiac wall vibrations produced low frequency signals which, when subjected to spectrum analysis and coherent signal processing, permitted close approximation of static pressures and wave forms in the right ventricle at normal and hypertensive levels.


Serotonin irritation syndrome: an hypothesis. Two patients were seen with multisystememic complaints and anxious feelings. Their history was similar for chronic exposure to potentially ionized atmospheric environments--a waterfall and high-voltage equipment. Physical examination showed various signs sometimes associated with hyperserotonergic states. Laboratory testing showed increased levels of serum serotonin and decreased levels of its metabolite, urinary 5-hydroxyindoleacetic acid (5-HIAA). Removal of the patients from these environments or the use of a serotonin-blocker ameliorated all symptoms and reestablished normal serotonin and 5-HIAA levels. A literature-review disclosed a similar symptom-complex reported with air-ionization during the sweep of hot winds across desert lands. Animal studies are cited in which cation aerosols are used to block serotonin metabolism, producing clinical and laboratory results some of which are similar to those seen in the patients described. It is suggested that a "serotonin irritation syndrome" might be related to cation-induced serotonin metabolic dysfunctions.


Non-occlusive ischemic colitis: angiographic aspects in a canine model. A model of non-occlusive colonic ischemia (NCI) was produced in the dog, incorporating both moderately decreases systemic pressure and increased intralumenal colonic pressure. These factors may play an etiologic role in human NCL. When differences between mean systemic and mean distention pressures were 30 mmHg or less, severe mucosal injury occured. In no case was the muscularis injured. Moderate systemic hypotension alone, or moderate colonic distention alone, did not produce significant colonic ischemic injury. Colonic distention with pressures of 60 mmHg alone resulted in colonic mucosal necrosis, but these pressures are beyond those ordinarily encountered clinically, even in large bowel obstruction. Angiography may be useful in demonstrating reduced flow to the colon during development of colonic ischemic injury. However, angiography is not a sensitive method in the diagnosis of nonocclusive colonic ischemic injury, once that injury has been established and inciting factors have subsided.


The effect of contrast media on the isolated perfused canine heart. The intravascular injection of contrast medium produces a rise of ventricular filling pressure which may reflect blood volume expansion, a negative inotropic effect on the myocardium, and/or a decrease in ventricular diastolic compliance. This phenomenon was studied by randomly infusing three substances, Renografin-76, 1% saline and 38% sucrose, into the aortic root of the isolated perfused canine heart. The preparation was modified by having an inflated ballon within the left ventricular cavity so that the end diastolic ventricular volume and afterload were fixed. A dose-related depression of left ventricular systolic pressure and peak dP/dt due to contrast media occurred, without a significant change in the left ventricular diastolic pressure. This decrease in ventricular contractility due to Renografin-76 could not be attributed entirely to either a saline or an osmotic effect. No significant changes were observed in left ventricular diastolic compliance. Sucrose was found to exhibit a marked positive inotropic effect.


Assessment of a non-ionic contrast medium (Amipaque) in the gastrointestinal tract. Gastrografin and Amipaque with identical iodine content and flavoring were orally administered in 100 ml doses to 10 healthy volunteers in a double-blind crossover study. The nonionic Amipaque has only about one third of the osmolality of Gastrografin, and draws less fluid into the bowel lumen. Consequently there is less dilution with Amipaque, and a higher contrast density in the ileocecal region can be observed. Unlike the highly hypertonic Gastrografin, Amipaque causes less changes in hematocrit, and has only a very mild cathartic effect. No more than 0.4% of the iodine in Amipaque was excreted in the urine during one day, and no more than 0.8% during three days. This was less than the excretion found after ingestion of Gastrografin. Non-ionic media are recommended when there is an indication for use of water-soluble contrast media in the gastrointestinal tract.


The diagnostic potential of contrast enhancement pharmacokinetics. Diastizoate concentrations in the blood and twelve tissues and organs of 20 rats were measured at 40 seconds, and 2, 5, 15 and 60 minutes after bolus intravenous administration of 125 I-labeled diatrizoate and 131 I-labeled albumin. Contrast enhancement (HU) and distribution volumes(%) were calculated from this data, and the results are presented graphically. The tissues can be separated into two groups according to the rapidity of extravascular contrast medium uptake. The liver appeared to concentrate the contrast medium. Curves of local contrast enhancement with time could be constructed by a CT scanner from the data of several consecutive scans and are of potential importance in the differential diagnosis of lesions detected on CT. Repeat postcontrast CT scans could be used to detect and characterize lesions which raise a diagnostic problem. The potential diagnostic advantages of calculating percent distribution volumes from CT scans are demonstrated and discussed.


Splanchnic extraction and conversion of testosterone and dihydrotestosterone in man. The splanchnic extraction and interconversion of testosterone and dihydrotestosterone (DHT) were studied in 7 healthy men (ages 29-46 years) undergoing cardiac catheterization. During a constant infusion of [1,2-3H]testosterone and [4-14C]DHT, the arterial and hepatic vein blood samples were taken and radioactive and non-radioactive testosterone and DHT were determined. Metabolic clearance rate (MCR), splanchnic extraction (SE), splanchnic clearance (SC), extrasplanchnic clearance (ESC), transfer constant in blood (T-DHT rhoBB) and transfer constant across the liver (T-DHT rhoSB) were calculated. The MCRT was 952 +- 172 (mean +- SD) 1/day and MCRDHT was 764 +/- 67 1/day in agreement with data from non-catheterized subjects. SET was 68.8 +/- 7.1% (mean +/- SD) and SEDHT was 37.6 +/- 5.9%. SET was significantly greater than SEDHT (P less than 0.001). The calculated SCT and ESCT were 638 +/- 112 (mean +/- SD) 1/day and 314 +/- 190 1/day, respectively. SCDHT and ESCDHT were 343 +/- 95 (mean +/-SD) 1/day and 421 +/-105 1/day, suggesting that a major fraction of testosterone is metabolized in the splanchnic organs and a higher fraction of DHT is metabolized in extrasplanchnic organs. In the interconversion study, overall conversion of testosterone to DHT in blood (T-DHT rhoBB) was 4.0 +/- 0.6% (mean +/- SD). No evidence for a net appearance of DHT by either mass or specific activity analysis in hepatic vein blood was observed in any infusion leading to the conclusion that the overall contribution of testosterone to circulating DHT from the liver (T-DHTrhoSB) was undetectable. This work indicates that conversion of testosterone to DHT occurs entirely in extrasplanchnic tissue in man.


Safety of percutaneous fine-needle pancreatic biopsy: a porcine model. Percutaneous fine-needle aspiration biopsy was performed on pigs with no complications. Pancreatic cells were retrieved in 73% of the biopsies. Thus, percutaneous biopsy with cytologic examination for pancreatic carcinoma can be performed in order to plan for appropriate therapy.


Failure of nocturnal prolactin suppression by methysergide to entrain changes in testosterone in normal men. In order to investigate further the postulated relationship between the secretion of PRL and testosterone, 10 normal young men were studied during polygraphically recorded sleep. Concentrations of LH and testosterone were measured in plasma every 20 min, and the results were analyzed in relation to sleep parameters and previously reported (J Clin Invest 56: 690, 1975) concentrations of PRL. All subjects were studied on a control night after placebo administration and on an experimental night after ingestion of the serotonin receptor blocker, methysergide. Analysis of variance revealed that concentrations of testosterone rose gradually during sleep on both nights, as has been noted in previous studies. Highest LH values occurred during stage 1 sleep, but were only 25% higher than the lowest values, which were seen in stage 4. As shown previously, PRL concentrations were markedly suppressed by methysergide treatment. However, no significant change in testosterone values were observed on the methysergide nights as compared to the control nights. When the data were analyzed by a correlational approach, again, no significant relation between concentrations of PRL and testosterone was found. Although these data do not support the concept that PRL-stimulated testosterone secretion occurs during the night in normal men, this study does not rule out the possibility that such a mechanism may be operative during daytime hours, or under conditions of PRL stimulation rather than PRL suppression.


Aspirin effect on canine iopanoate transport maximun. Iopanoate saturation kinetics were measured in four dogs both drug free and following six days of low dose aspirin ingestion. Each animal acted as its own control. In post aspirin ingestion studies there was s significant (P less than .001) decrease in the apparent Vmax of iopanoate. The volume of distribution showed no significant change, and gallbladder visualization showed no significant change despite the decrease in Vmax. Although aspirin pretreatment decreases the control Vmax by 50%, its mechanism and significance in the clinical setting will require further study.


Normal iodide efflux from nonfunctioning nodules of human thyroid glands. The kinetics of iodide efflux were studied in four benign thyroid nodules and one carcinoma by observing the fractional rate of radioiodide release from slices prelabeled in vitro. The thyroid:medium ratio for iodide (T:M) of the benign nodular tissue was 1.9 +/- 0.3 (mean +/- SE) with a value of 9.1 +/- 3.3 obtained from adjacent normal tissue. Despite the reduction in iodide concentrating activity, the rate constant for iodide efflux (ko) from the nonfunctioning, benign thyroid nodular tissue (0.112 +/- 0.044 min-1) was not significantly different as compared to normal tissue (0.102 +/- 0.033 min-1). In a papillary carcinoma, the efflux of radioactive iodide appeared markedly enhanced. These studies indicate that in non-functioning, benign thyroid adenomas, the reduction in iodide concentrating activity is not the consequence of an increased iodide efflux.


Localization of parathyroid adenomas by cervical esophagram. By using a standardized method of cervical esophagraphy, parathyroid adenomas were successfully localized preoperatively in 19 of 20 consecutive patients with hyperparathyrodism. Two of the 19 patients had a second adenoma which was not demonstrated. The esophagrams were performed in the frontal projection with a 105-mm camera by utilizing rapid sequential filming. Film exposure was synchronized so that roentgenograms were obtained with the esophagus maximally distended. A persistent indentation of the esophagus present on multiple films was compatible with parathyroid enlargement. Our results suggest that cervical esophagrams are useful in the preoperative localization of parathyroid adenomas.


Familial male pseudohermaphroditism with normal Leydig cell function at puberty. Four male pseudohermaphrodites from two families have been described. Although reared as females, at puberty, the timing, pattern, and degree of masculinization was similar to that of a normal male. No feminization occurred. They had normal testicular testosterone synthesis as judged by plasma testosterone, LH and FSH concentrations, as well as incubations of testicular minces with labeled precursors. Studies on cultured skin fibroblasts indicated adequate peripheral 5 alpha-reductase and normal receptor affinity and capacity for dihydrotestosterone. The histology of the testis was suggestive of a primary testicular defect. A mosaic pattern was seen: some areas contained tubules with active spermiogenesis; other areas, only Sertoli cells. These male pseudohermaphrodites appear to have a defect in fetal testicular maturation in which inadequate fetal testosterone synthesis and defective differentiation of germinal elements occurred.


Carboxyl-terminal fragments of human parathyroid hormone in parathyroid tumors: unique new source of immunogens for the production of antisera potentially useful in the radioimmunoassay of parathyroid hormone in human serum. We have found large quantities of immunoreactive carboxyl-terminal fragments of human parathyroid hormone )hPTH) in a previously discarded fraction [the 7.5% trichloroacetic acid (TCA)supernate] generated during extraction of intact hPTH from hyperfunctioning parathyroid tissue by the urea-TCA procedure. It is well established that serum RIAs directed toward the carboxyl-terminal region of hPTH are superior to those directed toward the amino-terminal region in the differential diagnosis of patients with suspected chronic parathyroid dysfunction. However, antisera that react with the carboxyl-terminal region of hPTH are not yet available for general use for these assays because of a lack of suitable hPTH immunogens. We immunized seven guinea pigs and two goats with the desalted 7.5% TCA supernate (containing about 2% carboxyl-terminal hPTH fragments); three of the guinea pigs and one goat produced high affinity antisera with predominant specificity for the carboxyl-terminal region of PTH. One of the guinea pig antisera had affinity for hPTH equal to that of our laboratory's best antiserum (GP1M) used in diagnostic RIAs for serum PTH. The use of this byproduct fraction as an immunogen should permit a large scale immunization program in large animals to provide standardized, species-and sequence-specific antisera potentially useful in RIAs for diagnosis of parathyroid disease.


17 beta-Estradiol and progesterone concentrations in myometrium of pregnancy and their relationships to concentrations in peripheral plasma. 17 beta-Estradiol (E2) and progesterone (P) concentrations in blood and in the myometrium of human pregnancy at term (n=33) and in a few samples (n=5) around midterm of pregnancy were determined. E2 concentration in the myometrium (per g wet wt) at midterm was lower than the concentration in the plasma (per ml) so that the myometrium to plasma (My:Pl) ratio was 0.7. Relative to plasma concentration, the myometrial E2 increased little from midterm to term so that My:Pl was only 0.2 at term. Although P concentration in the myometrium was much greater than that in the plasma at midterm, My:Pl ratio being 2.2, it was lower than that in plasma at term so that My:Pl ratio was only 0.6. A fairly good correlation between plasma steroids and the myometrial steroids was observed at midterm but was distorted at term, probably due to saturation of the tissue-binding capacity. Steroid concentrations determined on the basis of protein showed a good correlation to the values expressed on the basis of wet weight. Whereas myometrial E2 concentration was significantly influenced by the distance from placenta, P concentration was not.


Prepubertal diagnosis of steroid 5 alpha-reductase deficiency. The diagnosis of 5 alpha-reductase deficiency was proven in two prepubertal patients with male pseudohermaphroditism (MPH). Both had a 46-XY karyotype and were reared as females; one child had been castrated in infancy. Clitoromegaly, urogenital sinus, and short vaginal pouch were present in both; inguinal gonads were palpable in one. The diagnosis was made biochemically by observing characteristic changes in five parameters: 1) abnormally high testosterone to dihydrotestosterone (T:DHT) ratio after hCG stimulation (35 and 53 vs. normal, 11 +/- 3), 2) abnormally high 5 beta-T metabolites in urine (8.1 and 6.0 vs. normal, less than 1),3) deficient conversion of T to DHT during [3H] T infusion (0.3 and 0.4% vs. normal, 5.3 +/- 3), 4) deficient conversion of [14 C] T to 5 alpha-reduced metabolites by nongenital skin fibroblasts (2.2 and 1.9 pmol/microgram DNA/nmol substrate vs. 68.4+/- 7.8 Pmol/microgram DNA/nmol substrate in normal controls), and 5) deficient conversion of [14C]T to DHT in genital skin slices. The fact that this syndrome represents a defect in T metabolism rather in in T binding is demonstrated by the observation that binding of [3H]DHT to cytosol of skin fibroblasts was normal (4.2 dpm/micrograms DNA vs. normal male values of 3.7 +/- 0.64). Thus, the present report suggests that 5 alpha-reductase deficiency can be diagnosed during childhood and even after castration by metabolic studies of nongenital skin fibroblasts and determination of the conversion ratio of [3H]T to [3H]DHT in plasma.


Cytoplasmic and nuclear estradiol and progesterone receptors in human endometrium. Estradiol and progesterone receptors have been characterized in normal human endometrial biopsy samples. The cytosol and nuclei were prepared from 150-250-mg samples, either processed immediately or kept in liquid nitrogen. The total concentration of estradiol-and progesterone-binding sites (available or occupied with endogenous hormone) were measured in both fractions. Results were best expressed in femto-moles per mg DNA, or in sites per cell, assuming an even distribution of receptor throughout the endometrial samples. The contribution to total binding of non-saturable binding components and of plasma proteins (transcortin or sex steroid-binding protein) was taken into account. Measurements were obtained in more than 300 patients, among whom 54 had completely normal menstrual cycles on the basis of clinical, hormonal, and histological features. Total estradiol and progesterone receptors were highest in the late proliferative phase (about 8,000 and 12,000 sites/cell, respectively) and were very significantly lower in the late secretory phase. During the proliferative phase, estradiol receptors were increased only in the nuclear fraction, whereas progesterone receptors were increased mainly in the cytoplasm. In the early luteal phase, estradiol and progesterone receptors decreased in the cytosol, whereas they remained high in the nuclei. Both receptors were at their lowest level in cytosol and nuclei in the late secretory phase. The changes of total estradiol and progesterone receptor sites and of their respective subcellular distributions seem to depend upon the plasma levels of both hormones and to follow the same cause and effect relationships as those demonstrated experimentally in laboratory animals.


Somatomedin bioactivity in serum and amniotic fluid during pregnancy. Somatomedin bioactivity (SMA) in maternal serum, as measured by hypophysectomized rat cartilage assays, was low during early and late pregnancy but was similar to normal nonpregnant control levels near 28 weeks and at term pregnancy. At term, the mean level of SMA in cord serum was significantly less than in maternal serum, and greater than in amniotic fluid. The mean level of SMA in amniotic fluid was higher at term than in early pregnancy. No significant correlation was noted between SMA levels in amniotic fluid, maternal serum or cord serum, or between the SMA levels in these samples and the usual amniotic fluid parameters used as indices of fetal maturity.


Increased serum thyroglobulin levels in patients with nontoxic goiter. Thyroglobulin (Tg) levels were found to be elevated in 30 to 35 patients with euthyroid sporadic goiter and in 15 of 37 patients with euthyroid endemic goiter. The elevated Tg levels in the goitrous patients did not correlate with either goiter size, TSH levels, or urinary iodine excretion, but did correlate with the triiodothyronine to thyroxine ratio. It was concluded, therefore, that in both sporadic and endemic euthyroid goiters, factors other than goiter size and TSH, such as hypoiodination of Tg may be responsible for the elevated Tg secretion.