Effects of D 600 and papaverine on the inotropic response to isoprenaline on left guinea-pig atria under the graded influence of changes of frequency and temperature. Isolated left guinea-pig atria were used to examine the influence of D 600 and papaverine on baseline contractile function and inotropic response to isoprenaline, under variable conditions of temperature (27 degrees to 42 degrees C) and rate of beat (0.125 to 4 Hz). The inotropic stimuli, caused by increasing the frequency of stimulation and decreasing the temperature, could not overcome the depressive action of D 600 on basal systolic tension. In addition the inotropic effects evoked by papaverine at low rates of beat and high temperatures were converted into cardiodepressive effects at high stimulation rates and low temperatures. The inotropic response to isoprenaline appeared to be by far more resistant to the depressive actions of D 600 and papaverine than the baseline contractile function. Only at a stimulation frequency of 2 Hz, high concentrations of D 600 (3 X 10(-7)M) and papaverine(3 X 10(-5)M) reduced the response caused by isoprenaline. At a stimulation frequency of 0.5 Hz, however, D 600 left the inotropic responses to isoprenaline unchanged, whereas papaverine potentiated these responses. It appears from the present results that the frequency of stimulation and the temperature greatly modify the cardiodepressive actions evoked by D 600 and papaverine.


Effects of angiotensins and catecholamines on the transmembrane potential and isometric force of rattib isolated atria. The action of angiotensin II (ATII), 1-des-Asp-ATII (Hepta-2-8), angiotensin I (ATI), 1-Sar,8-Gly-ATII and catecholamines on isometric force and transmembrane potential were studied in rabbit isolated atria, driven electrically. In some experiments two microelectrodes were implated to record simultaneously cjamges of intracellular electrical events in the left and in the right atrium: changes of tension were recorded isometrically. In other experiments changes of transmembrane potential were measured with floating microelectrodes. Norepinephrine and epinephrine increased tension, prolonged the plateau phase of the action potential (A.P.) in both atria, while facilitating conduction. ATII and 1-des-Asp-ATII showed similar effects on tension and greater changes on the electrical events of the left than on the right atrium, while ATI was more effective on the right than on the left atrium. 1-Sar, 8-Gly-ATII had no direct effect but prevented or reduced the action of ATII, 1-des-Asp-ATII and ATI, without influencing norepinephrine and epinephrine. All angiotensions except 1-Sar,8-Gly-ATII slightly prolonged the time of conduction. The results indicate that: a)angiotensins and catecholamines prolong the duration of the action potential and induce minor changes of potential overshoot in atrial fibers; b) ATII and 1-des-Asp-ATII act preferentially on the left and ATI on the right atrium; c) 1-Sar,8Gly-ATII inhibits secifically the effects of ATII and ATI in this preparation.


Effect of aminophylline on coronary circulation and cardiac metabolism. Doses of aminophylline commensurate with human doses, administered intravenously to dogs under chloralose anesthesia cause an increase in heart rate, a decrease in mean systemic arterial blood pressure, a rise in cardiac output, coronary blood flow and myocardial oxygen consumption and an increase in the oxygen content of the coronary sinus blood which resulted in a decrease in the coronary oxygen arteriovenous difference as the oxygen content of the arterial blood remained essentially unchanged. This increase in coronary blood flow in the presence of a decrease in arterial blood pressure is obviously due to a decrease in the resistance of the coronary bed, which is probably due, at least partially, to dilatation of the coronary bed. Furthermore, since aminophylline decreases the coronary oxygen arteriovenous difference although it raises the myocardial oxygen consumption, it is concluded that aminophylline increases the coronary blood flow more than the myocardial oxygen consumption.


Sudden death in the late hospital phase of acute myocardial infarction. Forty-seven patients died suddenly during the late hospital phase of acute myocardial infarction. Risk factors associated with late in-hospital sudden death included prior cardiovascular disease, circulatory failure while in the coronary care unit, and certain arrhythmias and conduction disturbances while in the coronary care unit. These were associated with a twofold to sixfold increase in late in-hospital phase sudden death. The most prevalent risk factor occured in 62% of the sudden-death patients; the highest incidence of sudden death with a single risk factor was 2.6%, and the greatest relative risk was 6.0. Relative risks were uniformly greater for males than females. Multiple factors were associated with a greater risk than single factors. These risk factors characterize the group of sudden-death patients as a whole but do not allow precise identification of individual patients at high risk.


Life adjustment postmyocardial infarction: determining predictive variables. Sixty-eight patients with diagnosed myocardial infarctions were followed up for one year postinfarct onset to determine psychosocial adjustment. A previous pilot had differentiated between two groups of patients--depressive and deniers-who had poor vs good rehabilitation results, respectively. Results from this study substantiated previous findings in that 70% of those who were depressed postinfarct remained so throughout follow-up. These patients failed to remain at work and/or to function sexually and had a higher hospital readmission rate. The denial group, although still functioning with minimal psychosocial distress, was not distinguished from the remainder of the study population who generally also  functioned well. Women postinfarct seemed to have the most difficult time, accounting for 80% of the deaths and 50% of the depressed group. Their noticeable type A behavior may account for this finding.


Lymphographic and echographic findings in angioimmunoblastic lymphadenopathy. Four patients with angioimmunoblastic lymphadenopathy with dysproteinemia (AILD) had lymphograms that did not show a consistent radiographic pattern. Instead, a spectrum of radiologic changes ranging from a moderate increase in lymph node size with slight "foaminess" to total nonopacification was observed. One patient with this disorder had gray-scale echograms that showed enlarged anechoic lymph nodes. The findings in this small group of patients with AILD are indistinguishable from the radiologic and echographic changes seen in malignant lymphoma.


Bacteremia in a community hospital: spectrum and mortality. The problem of bacteremia was studied at our 500-bed community hospital during 1974-1975. All patients with positive blood cultures for clinically significant organisms were analyzed with respect to age, sex, host factors, type, dose, and time of institution of therapy with antibiotics, and mortality. Of 142 episodes of bacteremia, outcome according to underlying host factors showed that 12/15 died in the rapidly, fatal group, 12/24 died in the ultimately fatal group, and in the nonfatal group 25/103 died. Mortality for Gram-positive bacteremia was 37% (7/54) for Gram-negative bacteremia in the nonfatal group. In addition to underlying host factors, inappropriate antibiotic therapy also contributed to higher mortality in patients with gram-negative bacteremia.


Treatment of hypertension at the university medical clinic. The treatment of high blood pressure at the general medical clinic of a traditionally oriented university hospital was found to be unsatisfactory for most patients. Charts of all hypertensive patients (diastolic blood pressure, greater than or equal to 105 mm Hg) who made their first clinic visit in 1964 or 1971 were reviewed. Half of all patients were lost to follow-up within the first year, and blood pressure control was achieved by only one third of the patients. New information contained in the Veterans Administration study reports (1967 and 1970) had no effect on workup, compliance, or blood pressure decline. Furthermore, no significant relationship was found between blood pressure reduction and medical process, therapeutic regimens, or patient compliance. These data suggest that, in contrast to experience obtained in programs specifically designed for long-term management of this chronic disease, the present-day general medical clinic cannot satisfy the needs of most hypertensive patients.


Gastric bezoar formation secondary to gastroparesis diabeticorum. Diabetic autonomic neuropathy may result in delayed gastric emptying and gastric retention. A case of gastric phytobezoar formation that was secondary to diabetic autonomic neuropathy is reported. Greatly impaired gastric emptying was documented in this case by administration of a radiolabelled meal. Parenteral metoclopramide hydrochloride completely corrected the patient's gastric motility disturbance.


Severe sodium depletion syndrome during lithium carbonate therapy. Lithium carbonate, useful in the treatment of manic-depressive disorders, can produce nephrogenic diabetes insipidus. The drug, therefore, has been used to facilitate renal waster excretion when severe hyponatremia occurs in the syndrome of inappropriate antidiuretic hormone secretion. Symptomatic dilutional hyponatremia developed in a patient with pulmonary carcinoma whom we treated. Lithium carbonate was administered and renal sodium wasting, hypovolemia, and hypotension occurred. Hyperkalemia was also observed, and since adrenal steroid levels were not decreased, impairment of distal tubular function was suggested. Lithium carbonate blocks antidiuretic hormone effect by decreasing collecting duct cyclic adenosine monophosphate generation. These observations suggest that more generalized inhibitory effects on renal tubular function may also result from its use. An alternative drug, demeclocycline, may be preferable.


Prevention of vitamin A deficiency by fortification of sugar. A field study. The small amount of vitamin A in the diet of people living in some regions of Chile can be increased by adding this vitamin to sugar. In order to evaluate the effectiveness of a sugar fortification program, vitamin A fortified sugar was distributed to four indian villages in the mountainous region of Africa, whose inhabitants showed a severe vitamin A deficiency. The results of this study demonstrate that sugar fortification program is able to correct vitamin A deficiency by elevating the vitamin intake and consequently improve the circulating retinol, without substantially increasing the cost or modigying the organoleptic characteristics of sugar.


[Soluble iron and iron available in vegetable foods]. The relation ship between the quantities of soluble iron and iron available for humans reported by other authors in seven different vegetable foods was investigated. Total iron content, soluble iron, and in some cases also phytic acid were determined. The recovery in soluble form of iron added as iron sulphate to some foods was also studied. The results were compared with those reported in the literature for the amount of iron absorbed in humans from these same foods. In some cases the quantities of soluble iron and available iron were very similar but in some others the values differed considerably. There was a marked variation in the amount of soluble iron in different samples of the some vegetable product and also the iron absorption reported from a single food in different persons. These facts may explain, at least in part, the lack of coincidence mentioned.


Influence of some processing methods on the quality of apple slices: II-Cultivar Melrose. The influence of three browning treatments (blanching, SO2 and ascorbic acid) and three processing methods (canning, freezing and freeze-drying) on the quality of apple slices of the cultivar Melrose was studied. Immediately upon arrival at the pilot plant, half of the fruits was processed and the remainder was held in storage for six weeks at 4.4 degrees C to be processed later. The results showed that the best treatment was the blanching-freezing combination for all attributes of quality, except for color, in which the SO2-freezing combination was superior. Storage appeared to have some influence on the quality of apple slices, so that the zero week storage samples were judged superior for all attributes of quality. Blanching was the best browning treatment for freezing, but for freeze-drying the samples treated with SO2 was superior to the blanched ones.


[Selenium content in the blood cattle from Venezuela. I. Central and Portugueste zones]. Whole blood concentrations of selenium were determined in 776 dairy cows and calves from 28 farms located in three States (Aragua, Carabobo and Guárico) of the central zone of Venezuela and in Portuguesa State. Selenium levels largely varied according to both the geographic distribution and animals breed. Cattle from Guárico State showed the lowest average concentration (0.21 ppm) and those from Portuguesa the highest one (0.67 ppm). A group of animals from Turén (a District of Portuguesa State) showed the highest average concentration (1.64 ppm, range 1.02 +/- to 3.24 ppm). Concentrations of this magnitude in animals under grazing conditions could be related to high levels of selenium either in the soil or in the pasture. It is concluded that such animals are localized inaseleniferous zone (Turén). It must be noted that Jaffé et al. (op. cit.) found high levels of selenium in sesame seeds (Sesamum indicum) from this area and in blood and urine samples of children from Villa Bruzual, a little town of Turén. The results of this wok significantly differ from those obtained in other countries (of Europe and North America), where animals are managed under conditions very different from those of the tropical areas like Venezuela. The role this factor is discussed. This is the first report on blood levels in large animals of economical importance in Venezuela.


Regulation of symbiotic nitrogen fixation in root nodules of alfalfa (Medicago sativa) infected with Rhizobium meliloti. Symbiotic nitrogen fixation of Rhizobium meliloti bacteroids in Medicago sativa root nodules was suppressed by several inorganic nitrogen sources. Amino acids like glutamine, glutamic acid and aspartic acid, which can serve as sole nitrogen sources for the unnodulated plant did not influence nitrogenase activity of effective nodules, even at high concetrations. Ammonia and nitrate suppressed symbiotic nitrogen fixation in vivo only at concentrations much higher than those needed for suppression of nitrogenase activity in free living nitrogen fixing bacteria. The kinetics of suppression were slow compared with that of free living nitrogen fixing bacteria. On the other hand, nitrite, which acts as a direct inhibitor of nitrogenase, suppressed very quickly and at low concentrations. Glutamic acid and glutamine enhanced the effect of ammonia dramatically, while the suppression by nitrate was enhanced only slightly.


The demonstration of the existence of an interlayer between the cytoplasmic membrane and the cell wall proper of staphylococci. By disintegration of the cell wall of staphylococci a definite interlayer located between the cytoplasmic membrane and the cell wall proper could be demonstrated for the first time (MW-interlayer). This MW-interlayer contains a sort of "cloddy" material in which clusters of embedded ring-like disks are hexagonally arranged in a crystal-like manner. The ring-like disks, approximately 40 A in diameter and with center-to-center spacings of approximately 75 A, -lie in direct contact either with a rhombically arranged fibrillar network of the outer parts of the cytoplasmic membrane or they themselves are part of (or interconnected by) such an apparently rhombical network. The crystal-like arranged ring-like disks of the interlayer between the cytoplasmic membrane and the cell wall shall be called MW-particles in order to differentiate them from intramembrane particles and particles on the outer surface of the cell wall. At present, nothing more than speculation on the function of the MW-particles located within the space where final processes of the cell wall polymerization are taking place is possible.


Enzymatic studies on autotrophically, mixotrophically and heterotrophically grown Nitrobacter agilis with special reference to nitrite oxidase. Nitrobacter agilis was grown autotrophically on nitrite, mixotrophically on nitrite together with either acetate or pyruvate and heterotrophically on acetate and casamino acids, pyruvate and casamino acids or pyruvate and nitrate. The enzymatic activities differed most in the key enzymes of lithotrophic metabolism. Nitrite oxidase was repressed 90% in 10 days after transition to heterotrophic growth and was no longer detectable after several transfers. The induction of nitrite oxidase began after a lag of 2 days and reached the autotrophic level after 7 days when pyruvate was the carbon and energy source and after 9 days using acetate.


Metabolic regulation of pyruvate kinase isolated from autotrophically and heterotrophically grown Paracoccus denitrificans. Pyruvate kinase (ATP: pyruvate phosphotransferase (EC 2.7.1.40) was partially purified from both autotrophically and heterotrophically grown Paracoccus denitrificans. The organism grown under heterotrophic conditions contains four times more pyruvate kinase than under autotrophic conditions. The enzyme isolated from both sources exhibited sigmoidal kinetics for both phosphoenolpyruvate (PEP) and ADP. The apparent Km for ADP and PEP in the "autotrophic" enzyme were 0.63 mM ADP and 0.25 mM PEP. The effect of several low molecular weight metabolites on the pyruvate kinase activity was investigated. Ribose-5-phosphate, glucose-6-phosphate and AMP stimulated the reaction at low ADP levels; this stimulation was brought about by an alteration in the apparent Km for ADP. The pyruvate kinases differ in their response to adenine nucleotides, but both preparations seem to be under adenylate control. The results are discussed in relation to the role of pyruvate kinase as a regulatory enzyme in P. denitrificans grown under both autotrophic and heterotrophic conditions.


On the specificity of the uridine diphospho-N-acetylmuramyl-alanyl-D-glutamic acid: diamino acid ligase of Bifidobacterium globosum. The peptidoglycan of Bifidobacterium globosum contains ornithine and lysine alternately in the same position of the peptide subunit. The uridine diphospho-N-acetylmuramyl-alanyl-D-glutamic acid: diamino acid ligase of this organism was purified 700-fold. Since the activities for the incorporation of ornithine and lysine into uridine diphospho-N-acetylmuramyl-tripeptide did not separate during purification and since the incorporation of ornithine is competitively inhibited by lysine and vice versa, both ornithine and lysine are assumed to be incorporated by one single enzyme. Studies on the specificity of the ligase toward analogs of ornithine have shown that the enzyme requires a diamino, monocarboxylic acid with 4-6 carbon atoms. Methylation of the epsilon-amino group or hydroxylation of the delta-carbon atom of lysine decreases the competitive properties of the analog, whereas the substitution of the gamma-methylen group by sulfur (S-2-aminoethyl cysteine) results in a highly competitive compound.


[Thyroid dysgenesis in mother and daughter]. A case of congenital hypothyroidism with lingual thyroid in a woman and her daughter is presented. The scarcity of familial cases of thyroid malformations leads to discuss the genetic factors involved.


[Colonic stenosis following necrotizing enterocolitis in newborn infants. Apropos of 3 cases]. Three cases of double left colic stenosis revealed at one month of age by subobstruction are reported. Recovery was obtained by surgery. The evolution of radiological data in one case, and of histological changes observed on the resected sigmoid colon in the two other cases favor the assumption that cicatricial stenosis occurred likewise. These cases also confirm the existence of a benign expression of necrotising enterocolitis, most common with a colonic localization. Such stenosis due to submucous connective sclerosis strengthens the hypothesis that a transitory mesenteric ischemia is responsible for the necrotizing enterocolitis in newborns.


[Transitory hepatic peliosis in a child]. A case of hepatic peliosis in a 4 year old child is reported. The exceptional character of such a presentation in a child, along with its reversibility, are emphasized. The hepatogram performed during splenoportography showed numerous little granular pictures, which probably corresponded to the opacification of "peliotic" cavities. The mechanism of hepatic peliosis remains unknown in this case, except that it occurred in a child with poor general condition.


[Agranulocytosis in visceral leishmaniasis treated with glucantime]. Report of one case of agranulocytosis occurring in a 23 months old child, during treatment of visceral leishmaniasis by antimony.


[Statistical analysis of clinical, biological and histologic data in 288 cases of neonatal cholestasis]. The retrospective analysis of 288 cases of neonatal cholestasis showed that 4 clinical data allowed to separate extra- and intra-hepatic cholestasis in 82% of cases. These results should facilitate the diagnosis and lead to early surgery, when required.


[Study of weight deficiency in a representative sample of newborns]. A study of a representative sample of 11,330 newborns allowed to establish the distribution of birth weights in terms of gestation-age. The comparison with Lubchenco's curves shows important differences since the 10th percentile of the American curve is below the 3rd percentile of the French sample for prematures. The use of a technique of multivariant analysis distinguishes groups with low and high risks of prematurity and hypotrophy. The distinction is more obvious for the first group than for the second. The study of the rate of early neonatal mortality in terms of weight and gestation-age, led to individualize the risk related to hypotrophy from that related to prematurity.


[Immunity in cystic fibrosis. A comparative study of chronic bronchorrhea of different etiology]. Various aspects of immunity in cystic fibrosis were studied in 24 children and compared with the results in 13 children with other types of chronic bronchial infection. The complement was not significantly altered: number of lymphocytes, delayed hypersensitivity skin reactions, number of T (an B) cells, phytohaemagglutinin lymphocyte stimulation were virtually normal. Only the phagocytic activities (chemotaxis, phagocytosis, bacteridal activity) were altered in 20 out of 24 patients with cystic fibrosis and in a comparable percentage of patients with other types of chronic bronchial infection. No serum inhibitory factor was found and leukocyte enzyme activities were normal. This deficiency of phagocytic functions seems to be, at least in part, secondary to infection.


[Convulsions in the fifth day of life: a new syndrome?]. Among a series of 98 newborns who experienced neonatal seizures, 20 of them were individualized for they illustrated a "new syndrome": "the seizures of the fifth day of life". These patients were born at term, their maternal and natal history was unremarkable. Seizures always began around the fifth day and most often constituted a real electro-clinical état de mal. EEG reveals alternating sharpened theta waves, a pattern which seems to be characteristic. Some 6 days later, children recovered completely. Further evolution appeared to be always favorable. Although etiological enquiry remained negative, many facts suggested a viral etiology. This syndrome is probably frequent as it was also observed in other neonatal units.


[Blood xylose as a screening test for malabsorption in jejunal mucosa abnormalities; importance of diet in interpretation]. Blood xylose level 60 min. after an oral dose of 10 g/m2 xylose was compared with the histology of the jejunal mucosa in 56 children. Ninety-two percent of children with blood xylose below 20 mg/100 ml had an abnormal jejunal mucosa; 98% of children with a normal mucosa had a blood xylose above 20 mg/100 ml. In children with coeliac disease the following observations were made: 1) blood xylose was above 20 mg/100 ml in 50% of children with flat mucosa; all were given a diet excluding gluten; 2) blood xylose levels which were initially below 20 mg/100 ml were found above this level 3 to 12 days after the onset of the diet; 3) all the histological relapses following re-introduction of gluten in the diet were not associated with a decrease of blood xylose level below 20 mg/100 ml.


[The measurement of total blood cell volume in newborns with respiratory distress]. The total blood cell volume was measured with 51Cr labelled red blood cells in 52 premature newborns, divided into 3 groups, with similar gestational ages and birth weigths: 15 controls, 11 children with transitory respiratory distress and 26 with hyaline membrane disease. The total red blood cell volumes were significantly different (p less than 0.001) in newborns with hyaline membrane disease (32.12 ml/kg +/- 8.75). No hypothesis explaining these results was satisfactory. However, early blood transfusion in children with hyaline membrane disease may be proposed as a practical application.


[Hyperphenylalaninaemia with normal phenylalanine-hydroxylase activity and a deficiency of tetrahydrobiopterin and dihydropteridine reductase]. Two cases of hyperphenylalaninemia with a normal activity of phenylalanine hydroxylase are described. No activity of DHP reductase was found in the first case, having very high biopterin levels in basal conditions and after intravenous perfusion of phenylalanine. In the other case, the DHP reductase activity is normal but plasma and urinary levels of the reduced forms of biopterin are largely lowered and do not increase during the phenylalanine load. Early substitutive treatment with L-dopa and 5-HTP in one of the cases avoided the development of the "progressive neurological illness unresponsive to dietary treatment" characterizing two variants. This raises the question of a liver biopsy in order to assay the hydroxylation enzyme activities when screening hyperphenylalaninemia whatever the type.


[Ano-rectal abnormalities and esophageal atresia; familial and epidemiological studies]. The authors estimate the frequency of anorectal malformations (0.30 p. 1,000) and oesophageal atresia (0.20 p. 1,000) and record an increase in the sex-ratio along with a high percentage of associated malformations. From the available data and a family study on 366 anorectal malformations and 327 oesophageal atresia, they suggest the possibility of a dominant autosomal inheritance with weak penetrance, in certain cases of anorectal malformations and of a polygenic heredity in oesophageal atresia. The findings do not allow to reassure the parents completely of the sporadic cases, since the recurrence risk is 1-2 p. 100.


[Insulin-dependent diabetes associated with celisc disease in two families]. Two families in which insulin-dependent diabetes was associated with coeliac disease were studied. All patients had the HLA B 8 antigens. In one case there was an association of HLA B 8 with BW 15. The HLA B 8 determinant was found in that of the parents with a familial diabetic trait. These findings contribute to replace the association diabetes-coeliac disease in the larger frame of auto-immune diseases.


[Partial lipodystrophy, hypocomplementemia and glomerulonephritis]. Renal involvement is found in 20 to 50% of cases of Partial lipodystrophy (PLD). We report 8 cases of PLD of which 6 had a glomerular nephropathy and 2 had no renal disease but all had persistent hypocomplementemia and 5 had circulating nephritic factor (C3NeF). The analysis of these cases and of all the cases reported in the literature shows the specificity of the glomerular involvement. Membranoproliferative glomerulonephritis (MPGN) with dense intramembranous deposits is a constant finding in PLD with renal involvement. This variety of MPGN is well known for being associated with persistent hypocomplementemia. However, the presence of hypocomplementemia and C3NeF in patients with PLD but without nephritis raises the question of the interrelationship between alternative pathway complement activation and the development of MPGN with or without lipodystrophy. There is no valid explanation in the present state of knowledge for the association of partial lipodystrophy hypocomplementemia, and MPGN. From the answer to this problem should emerge a better understanding of the role of complement in renal disease and in particular in the unusual form of glomerular injury seen in MPGN.


[Use of the computer for management of a vaccination program]. The surveillance of vaccine acceptance was carried out in 3 French towns. The cost was minimal as the necessary equipment and personnel were available in the town-halls. This arrangement was utilized to monitor the increasing percentage of children vaccinated in the 3 towns. The increase was particularly significant for diphteria, tetanus and poliomyelitis.


[A rare form of total abnormal pulmonary stenosis return: atresia of the common pulmonary vein]. One case of atresia of the common pulmonary vein is discussed at the light of the few reports found in the literature. The presence of criteria distinguishing this type of obstacle to pulmonary venous return from the other cases, is of practical diagnostic interest; indeed, its diagnosis leads to surgical intervention, theoretically curative.


[Solitary hemangioma of the liver manifested by neonatal heart failure]. A new case of solitary angioma of the liver, complicated with heart failure, is reported in a newborn. The rarity of this anatomo-clinical form is emphasized, and the interest of venous catheterization, which permitted an angiogram of good quality, is underlined. Radiotherapy was so rapidly efficient that one is incited to promote this treatment before any other, especially in cases where surgery involves major risks.


[Clinical significance of plasma renin, testosterone, 17-alpha-hydroxyprogesterone and ACTH activities in the treatment of congenital adrenal hyperplasia due to 21-hydroxylase deficiency. A review of 31 cases]. Measurements of urinary steroids do not allow a precise supervision of the evolution and treatment of congenital adrenal hyperplasia due to 21-hydroxylase deficiency. Thirty-one cases with a 2 year follow-up allowed a trial of estimation of the progress that could be obtained with plasmatic dosages of renine, testosterone, A.C.T.H. and 17-hydroxyprogesterone (17-O.H.P.) activities. The best way for reaching diagnosis is presently 17-O.H.P. However, the amplitude and variability of nyctemeral changes of 17-O.H.P. as well as A.C.T.H. activities do not allow to use these two dosages for a precise supervision of therapeutic effects. On the contrary, the dosage of testosterone allows the appreciation of the risk of virilization and its reliability gives a precise control of the effects of steroid therapy. The dosage of the renine activity disclosed unknown or not well controlled sodium-losses, and allowed to adjust the dosage of 9-alpha-fluorohydro-cortisone, while limiting glucocorticosteroids. It gave also evidence of the usefulness of prolonged steroid therapy until the end of the growth period.


[Cryotherapy in basalioma].

[Cryotherapy in basalioma]. The biological basis of cryotherapy of tumours is explained. The enveloped cryosurgical instruments in Dresden were presented. Oculists and dermatologist have treated 200 basal cell epitheliomas by cryotherapy. Good functional and cosmetical results were seen. The time of control completes up to 5 years.


[The prevalence of single and synchronous multiple tumours in autopsy series and its dependence on age (author's transl)]. The present study reports the age specific prevalence rate of tumors in autopsies of the years 1958--1969, registered in the Medical Academy "Carl Gustav Carus" Dresden. The results refer to the total of all malignant tumors, to several tumor sites as well as to multiple simultaneous tumors. In many neoplasms highest prevalence occurs in presenile age (malignancies of lung, uterus, ovar, brain, and bone marrow). On the other side prevalence of carcinoma of breast, urinary bladder, kidney, prostate, and large intestine increases up to the oldest age-groups. With respect to the population the prevalence of cancer increases permanently up to the age of eighty and decreases only in the following age-groups. The age-specific prevalence of simultaneous multiple tumors referred to cases of single tumors in the post-mortem findings reveals an analogous age distribution curve. The prevalence of simultaneous cancer is discussed concerning the influence of age and duration of the malignancy.


Cervical canal aspiration smears in hormonal cytodiagnosis. On the basis of 200 women with functional ovarian disturbances analysed, it has been found that though cervical canal aspiration smears along cannot serve in hormonal diagnosis they can be valuable when estimated together with vaginal smears, particularly in the cases with the Intermediate Cell Complex. In oestrogen deficiency cytologic indices of CCAS are close to those of VS, cervical mucus is opaque, gray, homogenous and abundant in leukocytes and histiocytes; and glandular cells, both endometrial and endocervical, are hypothrophic. In oestrogen and androgen stimulation, high M.V., S.C.I., and E.I. and low N.I., C.I., F.I. and C., abundant, transparent, polychromatic and membranaceous cervical mucus scant in leukocytes and histiocytes; and typical oestrogenic appearance of the endometrial and endocervical cells are observed in CCAS, as compared to VS, where high C. and leukopenia are typical. In dried smears, arborization of the cervical mucus is usually seen in these cases. In luteal stimulation, M.V., S.C.I. K.I., and E.I. are slightly elevated, N.I., C.I., F.I., and C. are lower, cervical mucus is opaque, gray, and homogenous, abundant in leukocytes and scant in histiocytes, endometrial glandular cells are secretory, and endocervical cells are of luteal type in CCAS in comparison to VS. Some residual arborization phenomenon is frequenyc present in dried mucus. These preliminary results require further studies.


[Cytologic examination during operation of endometrial cancer (author's transl)]. In order to prevent vaginal recurrences after hysterectomy for endometrial cancer, a operation method is described which permits sampling of endometrial cells and enables cytologic examination, evaluation of sensitation response and radiation response and search for vital cancer cells after preoperative irradiation. In 84 endomentrial carcinomas operated upon using this procedure no vaginal reccurences have been met.


The value of fine needle biopsy in the diagnosis of ovarian tumours in women. The diagnostic value of fine needle biopsy was assayed in the diagnosis of ovarian tumours in women. Our material comprised malignant tumours with different histological structures, benign tumours such as different kinds of cysts, teratomata and myomas. In the investigated cases of ovarian cancer the cytologic examination was in accord with the following histopathologic results. The cytologic findings failed to determine the microscopic pattern of the cancer. Teratomata were diagnosed cytologically in all cases under consideration. In the remaining tumours the results of cytologic evaluation were in accordance with the histologic examinations in the view of dismissing of tumour under study. The method seems to be very helpful in early diagnosis of malignant ovarian tumours as well as in the evaluation of the character of some tumours. The latter might be particularly important in cases presenting counterindication to laparotomy.


[The value of vaginal cytology after total hysterectomy for benign or malignant lesions (author's transl)]. The necessity of vaginal stump smears is demonstrated by way of 1773 smears taken from 846 hysterectomized patients. In 1,18 per cent of cases operated for benign indications there are found pathological changes on the vaginal end; 7,5 percent pathological neoplastic deformations are found following hysterectomy for carcinoma in situ; recurrences of cervical, corpus- and ovarial carcinomata are detected by vaginal stump smears at an early data. The leaving of a vaginal cuff is discussed as being responsible for the increased occurrence of new malignant growth following carcinoma in stu-operations. The other results are compared with those stated in literature.


[Comparison of vaginal cytologic effects and blood elimination curves of different oestrogen drugs (author's transl)]. With different oral oestrogens it was studied, if relations are existing between pharmacokinetic and vaginal effect. By means of Karyopycnotic Index and Dynamic Oestrogenicity Index the cytological effect was quantified from a single dose of oestradiol valerianate, mestranol, ethinyloestradiol and 3 depot oestrogens proved on postmenopause women and compared with adequate pharmacocinetical investigations. The courses of oestrogen levels did not correlate with indices. Both methods of investigation do not compensate, but complete one another. Depotoestrogens and short acting oestrogens are distinguishable with regard to proliferation maxium and steepness of index decline.


An attempt to determine the relation between levels of IgG, IgA and IgM immunoglobulins and titers of antibodies against RS virus. In a group of 126 children aged 5-24 months with respiratory infections, the relation between levels of IgA, IgG and IgM immunoglobulins and titers of antibodies against the RS virus were studied. In children aged 5-12 months with high titers of antivirus antibodies, elevated levels of IgG were more frequent, but high antibody titers were not related to IgA and IgM immunoglobulins.


HLA antigens in asbestosis.

HLA antigens in asbestosis. One hundred thirty-four workers in an asbestos factory who had been in contact with asbestos for about 20 years, were typed for 22 HLA antigens of the A and B loci. In this group, 22 workers were diagnosed as asbestosis patients on the basis of chest radiography and clinical findings; the remaining 112 were without signs of asbestosis. In the group of asbestosis patients an increase of B27 antigen was observed in comparison with the group without asbestosis (27-27% and 9-82% respectively). The relative risk = 3-44 is significant at the level of p less than 0-05. These results may indicate that a genetic factor, connected with HLA locus has influence on the development of asbestosis under conditions of contact with asbestos.


HLA antigens and rheumatoid arthritis.

HLA antigens and rheumatoid arthritis. One hundred twenty-five patients with rheumatoid arthritis were typed for 21 HLA antigens from A and B loci. The antigen frequencies found in patients were compared with the frequencies in a control population of 300 healthy individuals. No statistically significant differences were observed between patients and the control group.


Transplantation of Peyer's patches under the kidney capsule of syngeneic mice. The host origin of repopulating cells. Peyer's patches were transplanted under the kidney capsule of syngeneic mice. After initial decrease in cellularity, the grafts were repopulated by lymphoid cells. Chromosomal marker analysis revealed that the host cells contribute mainly to the transplant repopulation.


Production of antibodies against ML antigen in the xenogeneic host. By using various protocols of immunization in the xenogeneic system, a serum was produced which contained antibodies against normal as well as leukemic lymphocytes in DBA/2 mice. To obtain specific antibodies capable of recognizing the ML tumor antigen, the best protocol proved to be the one used in group 2, in which immunization with leukemic cells was preceded by immunization of newborn mice with normal lymphoid cells from mice of the DBA/2 f BALB/c/MTV-s-negative strain. The sera contained antibodies capable of identifying the ML antigen in leukemia cells as well as in isolated form.


Rat interferons. Homologous and heterologus rat serum activity. Serum proteins from normal rat serum and induced with Sindbis virus were separated on Sephadex G-100. Interferon activity was studied in a system of homologous REC and heterologous LG cells. Proteins of normal serum as well as induced serum emerged in two peaks separated by a deep saddle. Four hours after induction, the serum gave two peaks with similar interferon activity in both cell systems. After 8-hour induction, two interferons were also obtained, but activity in the heterologous system was much lower than in the homologous system. Electrophoresis in polyacrylamide gel and on paper showed that interferon activity is connected mainly with the alpha1-globulin fraction.


Estimation of ABO system antibodies by an automatic technique. Detection of ABO system antibodies of IgG class in human sera is of importance both for diagnosis of feto-maternal incompatibility and for transfusiology. Inactivation of IgM and IgA class antibodies by 2-mercaptoethanol with subsequent estimation of IgG class antibodies, insensitive to 2-mercaptoethanol, serves as one of the approaches to the problem. In serological studies, IgG class antibody level is usually determined by the indirect antiglobulin test. Since the automatic technique is regarded as more accurate, we have attempted to adapt it to estimation of the ABO system antibody level.


The rare PGM1 7-1 phenotype in a Polish family. The phenotype PGM1 7-1 is described in eight members of a Polish family. Analysis of the findings confirmed the hereditary character of this phenotype, dependent on presence of the PGM71 gene in conjunction with the PGM11 gene in all the subjects examined.


Significance of the "acute phase" factors during delivery. In the intrauterine, peripheral and umbilical cord blood oj parturients the levels of the following glycoproteid "acute phase" factors--sialic acid, seromucoid, and haptoglobin were determined. It was found that the levels of these factors, determined in peripheral and intrauterine blood samples, were approximate. The determinations made in the umbilical cord blood showed regularly significantly lower levels. The differences found in contents of the substances studied between maternal and newborn blood were statistically significant. The possible causes of these differences were discussed considering both the placental barrier and developmental factors. It was found that the "acute phase" factors might be of importance in obstetrical practice.


Studies on the lysosomal enzymes activity during delivery. The activities of lysosomal enzymes: acid phosphatase, beta-glucuronidase, proteolytic (caseinolytic) activity and lysozymic activity were studied in intrauterine, peripheral and umblical cord blood. It was found that the highest activity of enzymes was in the blood taken from the cavity of the uterus, somewhat lower enzymatic activity was found in peripheral venous blood. The lowest activity of enzymes was regularly observed in the umbilical cord (neonatal) blood. The possible causes of these differences were discussed. The phenomenon described may be brought about by the delivery trauma of uterus and the regressive alterations occurring there. The abnormal enzyme activity in umbilical cord blood may, on the other hand, be explained by incomplete enzymatic maturity of the newborn. Although the parameters studied can present the intensity of the regressive alterations occurring  in the cavity of uterus, the determinations of enzymatic activities in the peripheral blood of the paturients do not seem to be of a significant diagnostic or prognostic value.


Social adaptation patterns among cancer patients with facial disfigurements resulting from surgery. An assessment of adaptation patterns among cancer patients with facial disfigurements was made by interviewing 152 patients in two head and neck clinics at Roswell Park Memorial Institute, Buffalo. It was found that 86.2% had adapted to their disfigurement. More specifically, disfigurement seldom was mentioned as a reason for not returning to work and for not participating in social activities with work mates, friends, relatives, and society in general. Disfigurement also seemed to have little effect on involvement in formal groups. Reactions from society toward disfigurement were perceived as being mostly positive (although staring was commonly reported). Reasons for this high level of adaptation are suggested. These include the need to maintain stability of self-concept, age as a stabilizing factor, the positive reaction from society, the nature of the disease itself (so that disfigurement may be seen as being more acceptable (positive) than the alternative of threat of death), the hospitalization experience as it prepares the patient for society's response, and the fact that this is an acquired disfigurement in a patient from a relatively normal population.


Visual scanning training effect on reading-related tasks in acquired right brain damage. This study presents a method for analyzing and remediating the visual perceptual deficits often found in persons with acquired right brain injury due to stroke. A total of 57 patients were randomly assigned to experimental (N=25) or control (N=32) groups. All patients were administered the same test battery prior to assignment. Experimentals received the specific training program and the controls received standard rehabilitation. Both groups were retested after a period of one month. Analysis revealed the superior performance of the experimental group. The results suggest that the academic disorders found in right brain damage can be treated as secondary to a primary disturbance in visual scanning behavior.


Carotid bruits: their significance in the cervical radicular syndrome. Routine physical examination of 600 patients referred with complaints of neck or shoulder pain included auscultation of both carotid and subclavian arteries. A treatment regimen including consideration of therapeutic cervical traction was precluded in 11 patients when unilateral carotid bruits were heard. Subsequent testing including radioisotopic carotid blood flow studies, and arteriography demonstrated 1 thoracic outlet syndrome, 1 arteriovenous malformation, 1 scarring secondary to radical neck dissection, 1 extrinsic pressure from an epidermoid carcinoma, 5 partial carotid occlusions secondary to intra-arterial plaque formation, and 2 normal carotid contrast studies. Successful surgery in all five of the stenotic patients and in the case of arteriovenous malformation aborted what might have otherwise been a less satisfactory outcome.


Polyarticular disability: a functional assessment. The purpose of this study was to design and evaluate a system for the functional evaluation of patients with polyarticular disease. A single assessment can be done in approximately 15 minutes. Extensive prior preparation is not required. The evaluation is reproducible and the numerical characterization agrees well with a physician's overall assessment of functional impairment. The subscores can be used independently of the total score to focus on specific areas of disability. Use of the evaluation in other institutions has produced a high degree of reliability. Statistical evaluation has demonstrated areas of weakness that have been eliminated or modified to increase reliability of the system.


Spastic constriction of cerebral vessels after electric convulsive treatment. The brains of nine cats were subjected to bitemporal electric convulsive treatment. The current (AC, 220 V, 50 Hz, ca. 500 mA, 500 ms) was applied two to five times. Pial vessels were observed through a skull window. Immediately after current application, some pial arteries exhibited segmental spastic constriction which usually did not disappear until the animals were killed. Before sacrificing the animals, 20 min after convulsive treatment they were perfused with a carbon suspension. In some cortical areas blackening was impaired indicating that perfusion was not complete. Electron-microscopic investigation revealed that spasm also occurred in arterioles of the brain parenchyma. Many arterial vessels, some of them possessing only one muscular cell sheat, had collapsed so that the lumen was merely a small cleft. The spasms were irregularly distributed and confined to small segments of the vessel. Small arteriolar vessels were more affected than large pial arteries. Arterial spasms continued for 20 min. In a total of 39 control animals spastic constriction was observed only once; this animal had been subjected to prolonged hypocapnia.


[Contribution to facial spasm (author's transl)]. Clinical, electromyographic, neurographic, and nystagmographic results of 20 cases of facial spasm are reported. The syndrome is discussed with reference to parabiosis of the facial nerve and the "ephapse" theory, the localization of facial nerve lesions, and possible etiologic factors of parabiotic changes. For the pathogenesis chronic and subclinical preimpairments of facial nerve axons are postulated as causing, after subsequent additional affections, an "ephaptic" transfer to neighboring fibers. Therapeutic possibilities are discussed.


[Dates of birth of persons committing suicide (author's transl)]. Of 5469 persons who committed suicide in Nordrhein-Westfalen in 1971 and 1972, there was found to be no connection between their dates of birth and their later suicide. The ratio between the distribution of births obtained and the mathematical probability ranged from 50% to 75%. Consequently no geophysical or cosmic factor exists which could connect the dates of these persons and their later suicide.


[Hydranencephaly versus spelencephaly--a report of two cases (author's transl)]. Two cases are presented, one of hydranencephaly and one of spelencephaly. Spelencephaly represents an intermediate form between multicystic encephalopathy and hydranencephaly and is characterized by preservation of the ventricular walls. There is no clinical distinction between spelencephaly and hydranencephaly. Diagnosis can be made by pneumencephalography, as described in this paper, if the gas is applied via both lumbar and ventricular puncture. Autopsy findings of both cases are presented and the possible vascular etiology of the condition is discussed.


[The endocrine psychosyndrome in the long term. I. A cantamnestic reexamination of patients suffering from panhypopituitarism (author's transl)]. Twelve patients (8 females, 4 males) with panhypopituitarism who had been thoroughly examined psychiatrically in 1957 and 1958 were reexamined in 1974 for psychopathologic alterations in the course of their endocrine disease. Eleven patients had been receiving an adequate hormonal treatment during the intervening years or (four patients) until the time of their death. Seven patients showed a good or excellent result of hormonal therapy, in respect of the psychic symptoms: the endocrine psychosyndrome which had been observed prior to treatment had improved considerably. Signs of organic brain syndrome were judged to be caused by age and not by the endocrinopathy. The factors influencing prognosis of psychic symptoms are: alteration in mental activity, in the sense of apathy and lack of drive, and the extent of social distegration caused by these alterations; the age of the patient at the onset of symptoms and the lapse of time prior to the beginning of adequate therapy; finally the personality structure and the social situation of the patient.


[The endocrine psychosyndrome in the long term. II. A catamnestic reexamination after treatment of patients suffering from Cushing's syndrome (author's transl)]. Twelve patients with Cushing's syndrome (11 females, 1 male) who were examined for psychopathologic alterations in the course of the endocrine disease during the years 1960-61, were reexamined in 1976 regarding psychiatric sequelae after treatment. Ten patients had been treated by adrenalectomy, one patient by radiotherapy of the hypophysis, and one patient had refused any treatment. The average lapse of time from operation to reexamination or death (five patients) was 15 2/3 years. In seven patients it had been possible to stop completely the excessive production of adrenal hormones. Corresponding the long-term result was favorable, with complete recovery of the ability to work. The previous symptoms of the endocrine psychosyndrome disappeared almost completely. There was no permanent alteration of personality and the vital dependence on hormonal substitution was well tolerated. In four of the five patients with an unfavorable course of the disease it had not been possible to stop the excessive production of adrenal hormones. These patients became increasingly invalid and had to be cared for. Symptoms of chronic organic brain syndrome developed. In contrast to the course of panhypopituitarism where nonspecific personality factors are of considerable importance, in Cushing's syndrome the long-term prognosis depends entirely on the successful stoppage of the overproduction of adrenal hormones. The artificial subsitution is not necessarily a disadvantage for the psychic functioning of the patient.


The prognosis of psychiatric treatment in military service. The author discusses the outcome of psychiatric treament in the Military. He served as a military psychiatrist in Norway for one year. During this time he personally examined and treated 215 soldiers with psychiatric disorders. The diagnostic composition of the patient group and the treatment given are described. The patient material was again examined at the end of the military service period, when one-third of the patients had been found unfit for service. The remainder were still fit for service. The patients did not differ from soldiers in general from a disciplinary point of view. However, they did not achieve as good grades in personal conduct and military efficiency as the other soldiers. The patient's clinical picture at the follow-up examination had improved when compared to the initial psychiatric examination. The author concludes that psychiatric treatment in the Military is both possible and desirable.


[Disturbances of word finding of compound nouns (nomina composita) in aphasics (author's transl)]. The faulty use of compound nouns by aphasics is of practical and theoretical significance. Defects in the finding and using of compound nouns were investigated with respect to the following parameters: the importance of the frequency with which compounds and compound parts are used in normal speech, the influence of grammatical and psycholinguistic peculiarities on aphasic dysfunction, and the handling of compounds in individual aphasic syndromes. The distinctly poorer recall of compound nouns compared with simple nouns was found to be due mainly to their less frequent use in normal speech. In word-finding the grammatical unit of the compound noun was not very stable patholinguistically. If one part of the compound noun was commoner and more usual in normal speech than the other it was usually better recalled. However, some remarkable deviations from this were due to semantic functional value, vividness, morphologic peculiarities, and linguistic form. The wider meaning-range of the second part of the compound noun had no positive mnemonic effect, despite the propensity of the aphasic for the general. In naming tests the first part of the compound noun was preferred on average. Certain differences in the defective use of compound nouns were observed between the individual aphasic syndromes.


Manifest sadomasochism of males: results of an empirical study. Two hundred forty-five manifestly sadomasochistic West German completed an anonymous questionnaires concerning their sexual behavior and psychosocial problems. They were reached as placers of sadomasochistic contact advertisements or as members of sadomasochistic clubs. Thirty percent were exclusively heterosexually oriented, 31% bisexually oriented, and 38% homosexually oriented. Results are described with respect to the invisibility of deviant behavior, seeking of partners, participation in the subculture, realization of the deviant desires, self-acceptance, preferences for sadomasochistic roles and practices, masturbation, and coming out. The possibilities for realization of the deviance are poorer for heterosexual sadomasochists than for the other groups. However, subcultural groups exist among heterosexual sadomasochists.


Plasma testosterone values in transsexual women. Plasma testosterone was determined by radioimmunoassay in 50 transsexual and 50 normal women. The testosterone levels in transsexuals were significantly higher (nearly double) than in normal women. In transsexuals, minor changes in the pattern of the menstrual cycle were also found.


The discrete syndromes of transvestism and transsexualism. The literature concerning the relationship between transvestism and transsexualism is briefly reviewed. Some workers consider the two conditions to be on a continuum, whereas others feel that they are independent clinical entities. To clarify the relationship between the two syndromes, biographical data were collected and penile volume changes recorded in 29 subjects who identified themselves as transsexuals and 35 who identified themselves as transvestites. In comparison to the transvestite subjects, significantly more transsexuals were younger, were single, cross-dressed fully, and reported homosexual interest, a feminine gender identity, and a desire for a sex-change surgery. In comparison to the transsexual subjects, significantly more transvestites reported heterosexual interest, cross-dressed partially, and had shown fetishistic arousal. It is concluded that transvestism and transsexualism are separate clinical entities.


Sexual daydreams and quantitative aspects of sexual activity: some relations for males across adulthood. Sexual daydreams were measured using the Imaginal Processes Inventory, while retrospective data on number of coital partners, frequency of intercourse in early marriage, and quantity of sexual activity experienced between 20 and 40 years of age were obtained by interview. The 277 men studied ranged from 24 to 91 years. The frequency and intensity of sexual daydreams declined with increasing age, and after age 65 virtually disappeared. The occurrence of sexual daydreams varied directly with each of the three behavioral indicators of sexual vigor for all age groups through age 64. The results are seen as supportive of the "current concerns" explanation of daydreaming production.


Extension of the Gender Identity Scale for Males. Our earlier Femine Gender Identity Scale for males appear to measure a strong single factor which was reliable and displayed substantial discriminant validity. However, the number of items was small and there was substantial overlap between items with respect to their meaning. In an attempt to overcome these limitations, in the present study the scale was extended and validated. Each item of the new scale differentiated among the groups in an experimental sample and, subsequently, in a cross-validation sample. A secondary finding was the significantly higher femine gender identity scores of homosexual patients over homosexual nonpatients.


Patrons of massage parlors: some facts and figures. A survey of 183 patrons of a massage parlor in Illinois indicated that the typical customer is a 35-year-old married white male from out of town with 13 years of education who is employed in a lower- or middle-class job and goes to church on Sunday. He reports having had a variety of heterosexual experiences in the past, has come to the parlor because of lack of sexual partner at this particular time or because of curiosity, will come to orgasm during the genital massage, and will find it sexually satisfying. He is likely to have high self-esteem, consider himself personally and sexually adjusted, consider his value system liberal, and to be somewhat sympathetic to the goals of the women's rights movement.


Staged intracranial and extracranial revascularization. Twenty patients with a combination of intracranial and extracranial cerebrovascular lesions were identified in a series comprised of 118 candidates for superficial temporal artery to middle cerebral artery (STA-MCA) bypass. Ten patients had internal carotid (ICA) occlusion and contralateral ICA stenosis, seven patients had combinations of ipsilateral lesions, usually ICA occlusion and external carotid (ECA) stenosis, and three patients had multiple lesions. Eighteen patients had a STA-MCA bypass performed; 11 of these had contralateral reconstruction for ICA stenosis, and seven had ECA stenosis corrected. Two additional patients became asymptomatic after ECA endarterectomy only and their proposed STA-MCA bypass has been postponed. There were two deaths, one early and one late. Eleven patients are asymptomatic, five are improved, one is unchanged, and one is neurologically worse.


The artificial heart. Progress and promise. A multidisciplinary group has designed, fabricated, and evaluated an artificial heart. The heart consists of two smooth-surfaced sac-type pumps, two pneumatic power units, and an electronic control system. The artificial heart has been employed in 22 calves. A variety of problems have been encountered and overcome and a significant improvement in pump design has been made. As a result, a gradual increase in survival times has occurred. The last two calves in which the heart was tested lived for 60 and 42 days respectively. These animals ate well and gained weight. The ability of the control system to balance the output of the two pumps over long periods of time and to automatically increase cardiac output with treadmill exercise has been confirmed. No insurmountable problems in the development of the artificial heart have been identified. The date that an artificial heart will be available for clinical use depends on the availability of funds and on the tenacity of the investigators.


An intracorporeal (abdominal) left ventricular assist device. Initial clinical trials. We have initiated clinical trials with an intracorporeal (abdominal) partial artificial heart and ten preterminal postcardiotomy patients have been studied. During profound left ventricular failure, the device captures the entire cardiac output from the apex of the left ventricle at low pressures (20 to 40 mm Hg) and ejects (at 80 to 150 mm Hg) into the infrarenal abdominal aorta; the biological aortic valve opens only intermittently and the entire systemic circulation is pump generated. The device is six to ten times more effective than intra-aortic balloon pumping in man and has maintained systemic perfusion during clinical asystole and ventricular fibrillation. We have documented that the profoundly depressed postcardiotomy left ventricle, initially incapable of ejection, can recover during total left ventricular unloading with the abdominal left ventricular assist device support over a seven-day period.


Pulmonary artery banding for ventricular septal defect with pulmonary hypertension. Sixty children in this series underwent pulmonary artery banding (PAB); isolated ventricular septal defect (VSD) was present in 24, and 20 were corrected seven months to ten years and eight months after PAB. Other anomalies were present in 37, and 15 were eventually totally corrected. Survival after PAB was 90% (95.8% with isolated VSD), and 94.3% (95% with isolated VSD) after total correction. Mean age at banding was 12.9 months, and 52.6 months at debanding. All patients underwent catheterization before PAB; 39 underwent catheterization after PAB, and ten after total correction. Pulmonary artery blood pressure was reduced from 53.5 mm Hg to 25.3 mm Hg by banding. Most patients had only moderately increased pulmonary blood flow. Banding at the altitude of Denver (1,600 m) appears to be an effective means to convert high-risk infants into lower-risk children for total correction. The cumulative mortality for two-stage treatment of VSD was 8.3%.


Carpentier ring annuloplasty in severe noncalcific mitral insufficiency. Sixteen patients have undergone Carpentier ring annuloplasty for severe mitral insufficiency (MI) since 1974. Our criteria were clinical and angiographic evidence of severe noncalcific MI, a dilated mitral anulus, absence of severe subvalvular chordal thickening, and no major loss of leaflet substance. Carpentier annuloplasty has been successful in eliminating MI in every patient except one. There have been no embolic problems and no early or late deaths. From 1971 to 1974, a similar group of 20 patients with the same diagnosis underwent prosthetic valve replacement. Even though all patients were receiving anticoagulant drugs, three had emboli and there were one early and three late deaths. In patients with severe noncalcific MI who meet our criteria, Carpentier ring annuloplasty is preferable to valve replacement, thus eliminating the hazards of a prosthesis and of long-term anticoagulant therapy.


Aortic valve replacement in the elderly. Encouraging postoperative clinical and hemodynamic results. Seventy-three patients aged 60 and over and 277 patients under 60 years of age underwent isolated aortic valve replacement (AVR) for aortic stenosis, regurgitation, and mixed disease from 1966 through 1975. Cardiac catheterization was performed five to nine months following operation in 77% of these patients. Follow-up averaged 55 months per patient. The hospital mortality in the elderly group was 2.7%, compared to 5.8% in the younger group. The late cardiac mortality was 21% and 19%, respectively. There was significant improvement (P less than .001) in the left ventricular end-diastolic pressure, cardiac index, and functional class in each of the three disease groups in the younger as well as the elderly patients. More important, the magnitude of improvement in each of these variables in patients over and under 60 years of age was not significantly different. Increasing longevity will make cardiac operations more common in the older population. These findings indicate that AVR carries the same low risk and brings about a similar improvement in left ventricular pump function in patients older and younger than 60.


Heparin-coated shunts for lesions of the descending thoracic aorta. Experimental and clinical observations. Heparin sodium-coated shunts are employed frequently to maintain trunk and lower extremity perfusion during temporary occlusion of the descending thoracic aorta. In the past five years, this shunt has been used in a series of 39 patients ranging in age from 19 to 72 years old, with 34 survivors (87%). The proximal end of the shunt was placed in the subclavian artery in 17 patients, the left ventricle in ten, and in the ascending or transverse aortic arch in 12. The distal end of the shunt was placed either in the lower thoracic aorta or in the femoral artery. For further evaluation of effectiveness, paired observations were made in dogs to determine the physiological consequences with the proximal end of the shunt inserted at two different sites. Although neither shunt decompressed the left ventricle fully, the subclavian-femoral shunt was significantly more effective than was the left ventricle-femoral artery bypass. If a choice exists for sites of insertion of the shunt, it appears that it should be placed distal to the aortic valve, since this position provides the least increase in systolic blood pressure and is associated with a lower demand for myocardial blood flow.


Assessment of cardiac risk in surgical patients. Fifty patients admitted to the hospital for elective noncardiac surgery were carefully assessed for cardiac risk by exercise stress testing. Twenty-five of 38 (66%) patients with adequate testing had abnormal stress test results. Patients with symptoms of angina had a high incidence of abnormal stress test results (15 of 20). In the majority of these patients, the exercise stress test was true-positive, so that on angiography, severe coronary artery disease was present. In patients with no cardiac symptoms, 33% (ten of 30) had abnormal stress test results and seven patients had significant coronary artery disease. Our preliminary data indicate that exercise stress testing is a good noninvasive screening test to detect asymptomatic coronary artery disease. Those patients who have an abnormal stress test or an abnormal ECG or angina should undergo coronary angiography to determine extent of coronary disease.


Etiology of catheter-associated sepsis. Correlation with thrombogenicity. A series of 94 central venous catheters was observed at removal for gross evidence of intraluminal or surface thrombus deposition. All those that were later found to have positive cultures had been noted to display thrombus formation, while catheters having negative cultures were usually free of thrombus. Devices made of a relatively nonthrombogenic material (ethylene acrylic acid) were also relatively free of bacterial contamination.


Spontaneous mediastinal hemorrhage associated with renovascular hypertension. We report on a patient with severe renovascular hypertension associated with massive spontaneous mediastinal hemorrhage. Differentiation of this entity from aortic dissection, as well as establishing the cause of the severe hypertension, was possible only through the aid of angiography. Following exploratory thoracotomy, renal artery revascularization was carried out, with resolution of the hypertension. To our knowledge, this complication of renovascular hypertension has not been reported. Prompt recognition and appropriate therapy were possible only after angiographic evaluation.


[Effect of polypeptides isolated from the anterior hypothalamus and epiphysia on cells of the hypothalamo-hypophyseal neurosecretory system]. A comparative study on the influence of physiologically active substances, extracted from the epiphysis and the anterior hypophalamus, on the morpho-functional status of the cells of the hypophalamo hypophysial neurosecretory system was carried out. The substances in question were extracted from the cattie epiphysis and anterior hypothalamus by means of acetic acid extraction from acetone-dehydrated tissue and the following sedimentation of the substances by means of cooled acetone and lyophilization. The investigation of the substances demonstrated them to be polypeptides with an average molecular weights from 2.000 to 10.000. The experiment was done in male rats Wistar strain Morphofunctional status of the hypothalamo-hypophysial neurosecretory system was estimated in paraffin sections, stained with paraldehyde-fuchsine after Gomori- Gabe and additional staining with azan after Heidenhain. The data obtained demonstrated that injection of the substances excreted by the anterior hypothalamus and epiphysis produced opposite changes in the functional status of the cells of the hypothalamo-hypophysial neurosecretory system: the substances from the epiphysis increased, while the substances from the hypothalamus, on the contrary, decreased their activity.


[Histomorphology of the suslik ovary during postnatal development and hibernation]. Morphogenetic and histogenetic changes in the ovaries of Citellus citellus during the postnatal period and hibernation (September- March) at the age of 10, 25, 45 days and 2 to 12 months after birth were studied. Significant cellular and tissue-organoid differentiation processes were established. After birth oogonia enter the prophase I of meiotic division. At the end of the first month, oocytes with enlarged cytoplasm and single layer of satellite cells form the primary follicles. The growing follicles with organizing antrum are formed in the third postnatal month. During the same time, theca foliculi is observed. Between the 3d and the 6th months after birth the authors demonstrate a "stage ox isofolliculia" when the follicles stop undergoing further development. During the winter hibernation, the ovarian follicles continue to grow slowly and at the end of this period, preovulatory follicles are formed. The results reported demonstrate Citellus citellus ovary to be an organ of intensive cell-tissue reconstruction during the postnatal development and hibernation period determined by the ovarian histophysiology, the ovarian steroid hormones production and the hormonal activity of other glands and organs of the endocrine system.


[Use of the straightened diagram method in morphologic studies]. A possibility is demonstrated to use a technical method of strahtened diagrams in order to check hypotheses of normal distribution for treating experimental morphological data. The method is a graphic interpretation of experimental values in the coordinate system: measured values (abscissa) and accumulated frequences (ordinate). In the case of the law on normal distribution, the experimental dots are distributed closely enough to the straight line drawn along the average arithmetic parameters of observation and their mean square deflection. Confidence intervals plotted on the diagram accurately enough serv as a criterion for the experimental dots proximity to the straight line. The order of calculation to build the straightened diagram for a large (several hundreds) number of values is represented. An example is given when the method is not applied.


[Dynamics of lipid concentration changes in the livers of rats on biosatellites "Cosmos-605" and "Cosmos-782"]. Histological and histochemical investigation was carried out with rat liver specimens taken 9-11 h (from 6 rats), 24 (from 7 rats), 48 h (from 8 rats), and 25 (from 5 rats) and 27 days (from 7 rats) after the completion of 19.5- and 22.5-day of space bioflights in "Cosmos-605" and "Cosmos-782". The same number of specimens was investigated from corresponding models of the experiments carried out in the laboratory and from the control rats. The investigations demonstrated that in the rats sacrificed during the first two days, and in 25 and 27 days after the completion of the flight, no morphological changes developed in comparison with the control and with the animals from the laboratory experiments. Only some fluctuations in lipid content could be noticed in connection with the time of samples taking after the completion of the experiments. The greatest amount of lipids in the liver was observed in the rats sacrified 9-11 h after the completion of the flight, in 24 h the lipid level was still rather high, and in 48 h there was a tendency to their decrease. In 25 and 27 days the livers of the animals from the experimental group did not differ in their lipid content from those of the control animals. The changes in the lipid content observed in the liver during 8-48 h after the flight completion and during the period of afteraction indicate the reversibility of the adipose infiltration process, connected with lipid mobilization, dependent on stress-reaction.


[Condition of the microcirculatory bed of cat ventricular myocardium following exposure to gravitational stress]. The status of microcirculatory bed in the cat ventricular myocardium was studied after a single (10 units for 3 min) and repeated effect (6 units for 3 min every other day for a month) of overloading in the cranio-caudal direction (+Qz). The material to examine was taken in 20 min, 1, 3, 7 and 30 days after the completion of the experiment. The myocardial vessels were injected with water emulsion of Indian ink and studied by routine histological methods, amino nitrogen silver impregnation and electron microscopy. A single overloading was stated to result in changes of capillary permiability which was evident in the increasing amount of pinocyte vesicles, polysoma and endothelial plasmic processes. The effect of repeated overloadings produces more severe disorders in the walls of different components of the myocardial microcirculatory bed.


Effect of hypokinesia on the telencephalic blood vessels of rabbits. Experiments were carried out in 37 animals (33 test animals and 4 controls). Hypokinesia was produced by keeping the animals in small cages. After 1, 2, 3, 4, 5, 6, 8, 12, 16 weeks of restricted mobility the animals were killed. The brain blood vessels were injected with dye-stuffs and examined in cleared sections. In 9 animals (2 controls and 7 test animals) the brain blood vessels were studied histochemically. Hypokinesia was stated to change significantly the angio-architectonics of the telencephalon. During first three weeks of restricted mobility, the blood vessels change but a little. By that time, together with unchanged arteries and veins, narrow arteries and a great number of dilated veins are encountered. The density of the blood vessel network is altered. Later on, after 4 weeks, more profound changes in the blood vessels occur: they become tortuous, deformed with disturbance of their usual orientation of course. These changes are specific for all the parts of the telencephalon. They increase with the time of hypokinesia.


[Distribution of the intrahemispheric and interhemispheric afferent connections of the visual and parietal regions of the cat cerebral cortex]. Distributional peculiarities of the associative and callosal connections of the visual area and parietal region in the cat cortex have been studied by Nauta-Guigax and Fink-Heimer's methods. Their horizontal and transversal distribution in the parietal and occipital areas are described. The afferents of the visual projection area are rare in both hemispheres, but spread in all visual areas and middle suprasilvian girus. The connections of the parietal associative area are expressed better and seen in all areas of parietal and occipital regions of the ipsilateral hemisphere, in the contralateral hemisphere, however, they are found in its homotopic area. Both afferent, independently of their origin are characterized by the identical distribution along the transverse of the different zones of the neocortex. For example, in field 17 the oblique and radially oriented degenerating fibres are represented equally and are limited by inner layers, as to the parietal associative region, predominatingly radial parallel fibres are seen along the whole cortex, they terminate mainly in the upper layers.


Retrograde degeneration of autonomic neurons and other cell groups of the spinal cord following extirpation the thoracic sympathetic ganglia. Examination of vegetative, as well as sensitive and motor spinal neurons after surgery performed on the peripheral part of the vegetative nervous system in the thoracic cavity of 34 dogs reveals reactive and degenerative changes in the nerve cells. Alterations in the neuronal structure are already observed on the 7th day after the operation and they reach thir maximum on the 60th day. During the time mentioned, most of the nervous cells undergo a complete pyknosis; among them, however, there are neurons restoring their normal structure. Therefore, it is possible to believe that after operations on the thoracic cavity, certain morphological disturbances occur in the corresponding vegetative centers, which are followed by disorders in the nervous regulation of the internal organs after the operation.


[Electron microscopic study of intestinal auto-, allo- and xenotransplants in the 1st hours following extracorporeal perfusion]. Mucous membrane ultrastructure was studied after extracorporeal perfusion of the small intestine under auto- (12 experiments), allo- (10 experiments) and xenotransplantations (4 experiments). In all mucosal structures the lesions are demonstrated to depend on nonspecific factors on the one hand, and on genetically foreigh tissue, on the other hand. In every experimental group, the earliest changes occur in microcirculatory bed. Disorders in vessel and blood flow tone lymphotasis and interstitial edema result in disturbances of capillary-epithelial interrelations and metabolic processes. Destructive changes are followed by tissue neutrophilosis, activation of macrophages and plasmocytic cells, degranulation of eosinophil, enterochromaffin and mast cells, profound mucin excretion. Unlike autoperfusion, alloperfusion is characterized by massive neutrophillic degranulation and more severe lesions of mucosal structures. At allotransplantation, neutrophil cell reaction (nonspecific by its nature) is supposed to be the earliest and primary in the course of establishing transplantation immunity. At xenotransplantation, intestinal destruction, developing and rapidly progressing, is connected with the influence of natural antibodies.


[Role of exogenous thyrocalcitonin in post-traumatic skin regeneration]. The character and completeness of posttraumatic skin regeneration, as well as the role of fibroblastic cells were studied under the effect of thyrocalcitonine (TCT). By means of cytological, morphological, histochemical autoradiographic, electron microscopic and some biochemical methods, stimulating effect of TCT on the cell proliferation and differentiation in the host regeneration was demonstrated. Application of TCT enhanced the main stages of collagenogenesis that, in its turn, promoted earlier transformation of granulous tissue into connective tissue and stimulated healing of experimental wounds.


[Relationship between the time of day of trauma infliction and the dynamics of endothelial mitotic activity]. Endothelial mitotic activity of the rabbit jugular veins depending on the daytime of trauma infliction was studied. In the first series of experiments (I), the operations were performed from 8 to 10 a. m., and in the second (II)-- from 8 to 10 P. M. After the operation one animal was killed every 3 hour, for 5 days. Mitotic activity (MK %) was studied continuously 8 mm from the wound edge in flat film preparations. The data obtained were statistically treated using approximation of the process course by the method of weighed sliding averages. Independently of the time of trauma infliction, the first mitoses in the endothelium appear after 21 h. Further, mitotic proliferation has a wavy character of different intensity in different tissue areas. Lack of similarity in the organism circadiam phase at the time of operation, produces distinct differences in the course of the process which are seen in asynchronity of the daytimes when the rise and recession of mitotic activity occur and in different length of these waves. In I series the length of these waves equals to 36, and in II series-- to 48 h. After the evening operation, 24-hour rhythm superimposed on its aliquat 48-hour activity is slearly seen. After the morning operation, daily rhythm is not observed. After the evening operation the process is more intense and has a greater length along the endothelial layer.


[Ultrastructure of the blood supplying capillaries of the sciatic nerve in rats]. Electron microscopic studies of the capillaries in the epi-, peri- and endoneurium of the rat sciatic nerve revealed that the capillaries in question possess the features common to the construction of this category of vessels in other organs. In epineurium and perineurium there are capilaries with somatic and visceral types of endothelium. Endoneural capillaries have endothelium of somatic type with ultrastructural features demonstrating its barrier properties. This specificity of endoneural capillaries endotheilum is connected with peculiarities of hemato-neuronal barrier of the peripheral nerves, to which endothelium is an integrated part.


Fibrinopeptides. IV. Synthesis of human fibrinopeptide A. Human fibrinopeptide A, a hexadecapeptide, released by the action of thrombin on fibrinogen during clotting of blood, has been synthesized by conventional methods. The synthetic peptide as well as some of the intermediates in the synthesis have been examined for anticoagulant activity. Though all of them were found to be active, the terminal carboxyl protected peptides are more potent inhibitors of clotting than the carboxyl free peptides.


External buckling without drainage.

External buckling without drainage. Scleral buckling without drainage of subretinal fluid is a technique suitable to a broad range of detachment problems including aphakia, vitreous traction, multiple tears, high myopia, and large breaks, as well as old or extensive detachment. Retinal detachments operated on by modification to the Custodis procedure reattach in a spontaneous and predictable manner determined by the patient's  age, the duration of the detachment, and its extent. Ninety percent of cases are completely reattached four days following surgery. Clues to successful surgery when subretinal fluid persists are retinal tear closure, documented daily fluid loss, macular reattachment, and dependent shifting of subretinal fluid. When uncertainty still exists, the final objective evaluation is the observation that fluid fails to accumulate beneath the retina when the patient is unpatched and mobilized. The operation is extraocular and avoids the problems of drainage-choroidal hemorrhage, retinal incarceration, vitreous loss, and restoration of hypotony. The technique offers the modern surgeon a simple, direct, and rational approach applicable to 75 percent of retinal detachments, and it also assures a smooth, uncomplicated recovery.


Radial buckling in the repair of retinal detachment. Experience with external sponge buckles for the treatment of retinal detachment has led to a preference for radial placement of the sponge. More retinal holes, particularly large horseshoe breaks, can be closed effectively with radially oriented buckles than with limbus parallel ones; limbus parallel buckles often were complicated by "fish-mouthing" of the breaks and leaking radial folds. A radial orientation of the buckle averts this complication. The geometry of retinal detachment and scleral buckling reveals the origin of "fish-mouthing" and radial folds and why radially oriented buckles prevent this complication.


Fluorescein angiography of degenerative lesions of the peripheral fundus and rhegmatogenous retinal detachment. Since the number of cases for each of the conditions in our study was small, only preliminary conclusions can be made; in order to establish the fluorescein pattern of each of these peripheral retinal lesions, additional studies will be required. The following summarizes our preliminary observations. 1. Areas of retinal white-with-pressure or without and peripheral retinal cystoid degeneration did not reveal remarkable fluorescein angiographic findings. One exception was in an area of pigment epithelial disturbance characterized by atrophy and proliferation, which showed a "window and masking" effect of choroidal fluorescence. 2. Fluorescein angiography of areas of the fundus with lattice retinal degeneration showed little or no findings in early or mild cases. In severe or advanced cases, the affected retina revealed poor or absent perfusion caused by vascular occlusion. The retinal and choroidal circulation was devoid of fluorescein leakage. Advanced lesions displayed choroidal hypofluorescence in areas of pigment proliferation and hyperfluorescence in areas of pigment atrophy. 3. In advanced cases, occlusive vascular changes over areas of acquired retinoschisis were observed. There was intraretinal leakage of the dye from deep capillaries and pooling of the dye in cystic cavities near the margin of the retinoschisis. 4. There was no perfusion of the choroid and retina in the area of the hole and in the retina surrounding it. This finding suggests choroidal and retinal ischemia in the pathogenesis of a retinal hole. 5. Fluorescein angiography of retinal tears revealed fluorescein leakage along the edge of the tear and absent perfusion of the retinal flap. The retinal and choroidal circulation-around the tear was otherwise unremarkable. The choroidal fluorescein underlying the retinal flap was not visible, perhaps because it was masked by the retinal flap. 6. Our fluorescein angiographic findings in cases of rhegmatogenous retinal detachment confirmed those of others [7, 8, 10]. Transit of fluorescein through the retinal circulation was sluggish. The retinal capillaries were dilated. 7. In cases of rhegmatogenous retinal detachment which had become reattached surgically, areas treated with diathermy or cryoapplications showed absent or diminished choroidal and retinal perfusion. Leakage of the fluorescein from capillaries in the optic disc and retina in the posterior pole was sometimes persistent several months postoperatively.


Massive vitreous retraction.

Massive vitreous retraction. More than half of previously hopeless cases of MVR can be anatomically reattached by tight elastic equatorial compression with a circling silicone sponge. Visual results range from light perception to 20/30, with most retinas being so severely damaged by the MVR that they regain 20/200 or less vision. Because of the possible serious complications of this operation, it is indicated only for otherwise incurable cases of retinal detachment. In properly selected patients, the benefit of limited vision may clearly justify this admittedly difficult and unpleasant procedure.


Vitreous surgery and retinal detachment. Vitrectomy has proved to be extremely useful in facilitating reattachment of the retina in a variety of complicated detachments. The author's experience has been exclusively with the vitreous infusion suction cutter. Several other, similar, instruments are now available, and they are described in a recent review article on vitreous surgery [8]. The techniques required for successful surgery are not easily mastered, and it is the author's practice to have a trainee assist on about 50 operations before assuming major responsibility for a difficult microdissection.


B-scan ultrasonography of the retina and vitreous. We feel that ultrasonography performed prior to vitreous surgery should be performed or at least observed by the operating surgeon or the assistant. The actual dynamic scanning process allows much more information about the status of the eye than looking at static pictures. Although vitreous surgery can be performed without preoperative ultrasonographic examination, we feel that ultrasonography can provide the surgeon with valuable, accurate information about the status of the vitreous humor and the retina.


Coordinated surgical and drug treatment of cancer. Normal cells can proliferate to heal wounds while cancer cells die from chemotherapy with selected sulfhydryl (SH) inhibitors. Choice of the drugs is directed by sensitivity tests run immediately after surgery on each patient's own cancer. The SH-bearing nonhistone chromosomal proteins were predicted to play a major role in regulating genes. Much recent work now suggests that these proteins may play a key role in controlling gene expression.


Free perforation of the gallbladder with special reference to diagnostic paracentesis. We report two cases of free perforation of the gallbladder in young women and emphasize the role of diagnostic abdominal paracentesis in making the correct preoperative diagnosis.


Acute regional enteritis.

Acute regional enteritis. Severe melena is a rare complication of acute regional enteritis. The hemorrhage is more severe when the large intestine is also involved. The difference betwee "real" acute regional enteritis and exacerbations of regional enteritis lies in their pathological appearance, development and complications.


The phacoemulsification procedure. I. The effect of intraocular irrigating solutions on the corneal endothelium. Irrigating solutions for intraocular purposes were evaluated for their possible damaging effects on the corneal endothelial cell structure and function. Rabbit corneal endothelium was perfused in vitro with Tis-u-Sol, Travenol Ringer's Solution, or Travenol Sodium Chloride. The irrigating solutions caused an immediate corneal swelling of 67 mum per hour +/- 5 (mean +/- standard error), which was not modified by a previous stabilization perfusion with glutathione-bicarbonate Ringer's (GBR). In contrast, the Plasma-lyte-148 solution which is used in the phacoemulsification procedure, did not cause corneal swelling for more than twenty minutes, and for more than sixty minutes if the cornea was perfused after a GBR stabilization. After more than sixty minutes of corneal swelling, endothelial intercellular junction separations appeared. This breakdown was present with the tested irrigating solutions except for Travenol Ringer's Solution, which contained calcium. Plasma-lyte was also evaluated in conjunction with the surgical phacoemulsification procedure. The complete procedure or just irrigation with ultrasound did not cause endothelial cell damage similar to a prolonged in vitro irrigation. Instead, endothelial cells were traumatically damaged in varying degrees by the surgical manipulations.


The phacoemulsification procedure. II. Corneal endothelial changes. The effect of phacoemulsification, with the Cavitron-Kelman instrument, on the corneal endothelium of rabbit and cats was studied by scanning electron microscopy and nitroblue tetrazolium staining. The various steps of the procedure were examined separately. Irrigation of the anterior chamber of the eye with balanced salt solution (Plasma-Lyte) for ten minutes caused no cell damage. Ultrasound and irrigation alone for four to six minutes caused increased permeability to NBT. Edema of endothelial cells and cell junction disruption occurred after eight minutes of anterior chamber irrigation with Plasma-Lyte. Uncomplicated phacoemulsification produced moderate cellular edema with scattered loss of endothelial cells. Destruction of endothelial cells was frequent after phacoemulsification, it appeared to be due to lens nucleus manipulation in the anterior chamber, instrumentation, and needle contact. From two to five days postoperatively, intercellular edema, altered cell morphology, and mosaic pattern were seen. However, it gradually recovered and seven to ten days later the endothelium appeared normal.


Successful therapy of herpes hominis keratitis in rabbits by 5-iodo-5'-amino-2'5'-dideoxyuridine (AIU): a novel analog of thymidine. The efficiency of 5-iodo-5'-amino-2'5'-dideoxyuridine (AIU) in the therapy of experimental herpes keratitis in rabbits has been examined. Virus infections were established bilaterally in 40 animals using herpes simplex, type 1 (NIH strain 11124). Twenty-four hours after infection the rabbits were divided into five matched groups of eight and each group was treated, double-blind, with topical drugs at four-hour intervals for a total of 72 hours. The solutions instilled were: (1) saline; (2) IdUrd, 1 mg. per milliliter; (3) AIU, 1 mg. per milliliter; (4) AIU, 4 mg. per milliter; and (5) AIU, 8 mg. per milliliter. Each eye was examined daily for 12 days and graded independently by two ophthalmologists. Although IdUrd and AIU (8 mg. per milliliter) were effective therapeutically, IdUrd had a greater effect. The AIU at 1 and 4 mg. per milliliter were less active, but showed more rapid healing than the saline control. Viral recovery studies are consistent with the clinical observations. A second independent experiment, similar to that described above, gave essentially identical results. Although less potent than IdUrd, AIU does provide effective therapy for herpes keratitis.


Sialic acid in rabbit lacrimal gland fluid. To date, there has been no attempt to determine which of the orbital glands contribute the sialic acid, which has been found in tears and tear mucoids. In the present study, sialic acid was found in the fluid collected directly from the lacrimal gland excretory duct, uncontaminated by the secretions of the other orbital glands (Nictitans, Harderian, conjunctival) as well as in the fluid secreted into the conjunctival sac by the other orbital glands, uncontaminated by lacrimal gland fluid. At all flow rates, the rate of secretion of sialic acid increased as flow rate increased in both fluids and the rate of secretion of sialic acid by the lacrimal gland was three times that by the other orbital glands. This is the first demonstration that a substance, which can be derived from either nonserum glycoproteins, such as the tear mucoids, or alpha-globulins, is a component of the secretions of the lacrimal gland, as well as of the secretion of the other orbital glands.


Stromal sodium binding after glycosaminoglycan digestion. The glycosaminoglycans of isolated rabbit corneal stroma, clamped between two lucite plates at near normal hydration, were digested with testicular hyaluronidase in saline solution. After equilibration with 0.9 per cent saline solution alone the sodium and chloride content of the stroma was determined. Chloride was in equilibrium with both normal and hyaluronidase-treated stroma, allowing use of the Donnan calculation for excess or bound sodium to be made. Normal stromas contained 200 mEq. bound sodium per kilogram of dry weight calculated from the Donnan calculation; hyaluronidase-treated stromas contained 110 mEq. bound sodium per kilogram of dry weight. The data show that about half of the bound sodium in the corneal stroma is on nonsaccharide binding sites. Quantitative verification of the loss of glycosaminoglycans was performed.


Effects of isoproterenol and norepinephrine on regional ocular blood flows. The effects of norepinephrine and isoproterenol on regional ocular blood flows were studied by the labeled microspheres using the reference sample method in pigs. Total and regional ocular flows increased in response to norepinephrine and isoproterenol infusions. Increase in flows during norepinephrine infusion may be due to increased ocular perfusion pressure induced by the drug, thereby masking its reported direct vasoconstrictor effect in isolated perfused ocular vessels. Increase in flows during isoproterenol infusion occurred despite a decrease in arterial pressure suggesting the existence of vasodilatory beta-adrenergic receptors in the ocular circulation of the pig.


Centrioles and cilia in the mesothelial cells of the pericanalicular region. An evaluation of 70 trabecular meshwork biopsies obtained at the time of therapeutic surgery in glaucomatous and cataractous eyes revealed that the mesothelial cells in the iridocorneal angle had a marked abundance of cilia and centrioles. The distribution of cells showing cilia and/or centrioles is positively correlated with the apparent aqueous humor outflow pathway. The morphology and arrangement of the cilia-centriole complexes in the angle are highly variable and show many forms not previously reported in a single tissue. There were no obvious correlations between organelle abundance and the identifiable factors affecting the patients involved in this study.