[Transport of D-xylose in isolated frog sartorius muscle in the presence of actinomycin D]. The action of actinomycin D on the basal and insulin stimulated D-xylose uptake has been studied on isolated frog sartorius muscles. Actinomycin D at concentrations of 10 mg/ml or 100 mg/ml exerts no effect on the basal transport of sugar and causes no alteration in the response to insulin. The distribution coefficient of actinomycin D in muscle tissue is equal 0,9--1. It is supposed that the inhibition of RNA synthesis by antibiotics does not influence sugar transport.


[Rare causes of acute gastric hemorrhage]. According to the author's findings rare causes of acute gastric hemorrhages (the Mallory-Weiss syndrome, cancerous lesions of the gastrointestinal organs, excluding the stomach, esophageal and duodenal diverticulum, prolapse of gastric mucosa into the duodenum, necrosis of the gastric wall, its traumatic rupture, the Rendu-Osler disease, rupture of the renal artery aneurysm) made 3.2% of other causes. Profuse hemorrhage was noted in 12 of 32 patients under consideration. In 8 of 32 patients (25%) the diagnosis was established only at autopsy. In other more frequent causes of acute gastric hemorrhage the diagnosis proved to be feasible in 90-95% of cases.


[Changes in the level of electrolytes in the blood of patients with acute gastro-intestinal hemorrhages]. The authors have studied kinetically the content of potassium, sodium, calcium and chlorides in blood plasma, potassium and sodium in erythrocytes and diurnal urine in 27 practically healthy subjects and in 100 patients with acute gastrointestinal hemorrhages of various etiology. Variations in the level of electrolytes are described.


[Emergency esophagogastroduodenoscopy in the diagnosis of acute gastrointestinal hemorrhage]. It is reported that among 1383 endoscopies, performed in the clinic, 618--were defined as urgent ones for acute gastrointestinal hemorrhages. There were 470 male and 148 female patients, their age ranging from 14 to 93 years. 408 endoscopies were performed during the first 6 hours since patients' admission to the clinic, and 210--during the following 48 hours. Contraindications to an urgent exploration of patients in hemorrhage from upper portions of the digestive tract are determined.


Hypertensive optic neuropathy.

Hypertensive optic neuropathy. In 1970 a 62-year-old physician with hypertensive vascular disease suffered a small infarction in the left optic disc, which left him with a subtle paracentral temporal visual field defect in that eye. In 1973 he had another separate and distinct episode in the same eye, which produced a dense lower nasal field defect. Careful Hruby lens examination of the disc under high magnification revealed focal arteriolar disease in the optic nerve head corresponding to the field defects, and fluorescein angiography confirmed these findings. The importance of differentiating ischemic optic neuropathy, hypertensive optic neuropathy, and temporal arteritis with optic nerve involvement is emphasized, and the therapy of each is discussed.


Metabolism of 1-(3-trifluoromethylphenyl)-3-(2-hydroxyethyl) quinazoline-2,4(1H,3H)-dione (H-88). I. Species differences in metabolism. 1. Following oral administration of [14C] H-88 to rat, mouse, quinea-pig and hamster, 40-65% and 5-15% of radioactivity was excreted in urine and faeces respectively during 3 or 4 days. In rabbit, monkey and man, more than 80% of radioactivity was excreted in urine during 2 or 3 days, and faecal excretion was negligible. 2. Rabbit, rat or guinea-pig excreted non-labelled H-88 in urine as unchanged H-88 (M-I), 1-(3-trifluoromethylphenyl) quinazoline-2,4(1H,3H)-dione-3-acetic acid (M-II), H-88 glucuronide (M-III) and 1-(3-trifluoromethylphenyl)-3-(2-hydroxyethyl)-6-hydroxyguinazoline-2,4(1H,3H)-dione (M-IV). 3. The carboxylic acid (M-II) was the major metabolite of H-88 in rat, mouse, guinea-pig and hamster urine and faeces, while the major metabolite in urine of rabbit, monkey and man was H-88 glucuronide (M-III). The 6-hydroxy compound (M-IV) was a major metabolite only in guinea-pig.


[Condition of lymphoid tissue and characteristics of development of antitoxin immunity during an experimental course of methotrexate treatment]. Methotrexate administered to albino mice in a dose of 0.5 mg/kg for a period of 10 days caused significant (two period) changes in the central and peripheral immunocompetent tissue. During the first--destructive--period there occurred a marked reduction in the weight of the spleen and the thymus, a cut in the count of the nuclear cells in them, and also a significant depletion of the cellular composition of the lymphoid organs. Suspension of the cytostatic was followed by a gradual restoration of all the indices under study, slower in the thymus than in the spleen. In the animals immunized with the tetanus toxoid against the background of the methotrexate administration all the changes in the lymphoid organs developed under a preponderant influence of the cytostatic agent; the action of the antigen was depressed during the whole experiment. Specific antibodies appeared in the blood of these animals later and their titres were lower than in control; experimental mice were also less resistant to tetanus toxin.


Fatal haemorrhage following atraumatic liver rupture secondary to post-operative perforation of the gall-bladder. A case report. A case of post-operative perforation of the gallbladder with massive intraperitoneal haemorrhage is presented. The clinical picture was complicated by urinary infection and bleeding from an acute gastric erosion. It is suggested that the antibiotic treatment given for his urinary infection may have altered the clinical course of his cholecystitis, allowing a silent perforation to take place and present in the form of an atraumatic liver rupture.


[Cellular organization of the vestibular nucleus of the frog medulla oblongata]. Ventral vestibular nucleus of frogs is composed by multipolar cells of isodendritic type. Three basic kinds of cells are found in the nucleus-large, medium and small ones which differ mainly by the number of synaptic contacts on their perikaryon. The neuropile of the vestibular nucleus contains a large number of unmyelinated nervous fibers and exhibits numerous contacts formed along each of the fibers. Similar features in the organization of ventral vestibular nucleus in frogs and Deuters nucleus in rats and cats are noted. Functional role of cellular elements composing the nucleus is discussed.


The distribution of polymorphic traits in atopic asthmatic patients. The phenotypic distribution and gene frequencies of haptoglobin (Hp), transferrin (Tf), group specific component (Gc), cholinesterase (Cho E2), and alpha1-antitrypsin (Pi) in plasma proteins, and phosphoglucomutase (PGM), 6-phosphogluconate dehydrogenase ((6-PGD), esterase D (Es D), phosphohexose isomerase (PHI), adenosine deaminase (ADA) and acid phosphatase (AcP) in red cells were studied in 127 atopic, asthmatic patients. The gene frequencies were compared with normal groups. The phenotypic distribution of the Pi system in atopic patients was somewhat different from the normal. No significant differences were found between the two groups in protein systems or in enzyme systems, except Pi systems. In conclusion, except for the Pi system, no definite association between polymorphic traits and atopic asthma was found in this study.


The fine structure of the lymphocyte nucleus under conditions of phytohaemagglutinin stimulation. The nucleus of PHA (phytohaemagglutinin) cultured lymphocytes is studied by EDTA, Thalium-Schiff and uranyl-lead techniques. Scattering of the dense chromatin, increase in the number of NB (nuclear bodies) and nucleolar modifications are established. Transportation is seen of granules similar to perichromatin ones from the nucleus into the cytoplasm. Morphometric investigation reveals a decrease between 7,7 and 26,3% of the dense chromatin and also that the number of PCG (perichromatin granules) to be the greatest in the untransformed PHA lymphocytes, e.g. B lymphocytes. It is established in new born chickens that the lymphocytes of the bourse of Fabricius are richer in PCG than these of the thymus.


Observation of Kolmer's crystalloid outside the retina. Presence in the corneal endothelium in various conditions. A structure similar to Kolmer's crystalloid, an organelle found in the horizontal cells of the retina, was observed in endothelial cells of the cornea from four patients (one case of hyperparathyroidism and three cases of corneal dystrophy). Based on a morphological analysis it is concluded that the structures in the present cases are identical with the cytoplasmic structure of the horizontal cell, and that the membranous tubes probably constitute a special form of rough surfaced endoplasmic reticulum, eventually involved in transport and/or a specialized protein synthesis.


Complement fixing and lymphocytotoxic antibodies in serum of pregnant women at delivery. III. Clinical observations. The investigation comprised 2,008 pregnancies. Sera fnd lymphocytotoxic antibodies (LCTAb). 14 women had only CFPAb, 44 had CFPAb and LCTAb, 224 had only LCTAb. In 3 of 481 cord blood serum samples LCTAb were demonstrated. No cases of neutropenia or thrombocytopenia was observed. No association was found between CFPAb or LCTAb and stillbirth, birth defects, degree of bilirubinaemia, diseases of the newborn, or placental weight. It was suggested that the applied lymphocytotoxicity test detects both in vivo cytolytic antibodies and enhancing antibodies, which may explain the results.


Electron microscopy of Trichomonas vaginalis Donné: interaction with vaginal epithelium in human trichomoniasis. Light and electron microscopic examination of portio biopsies from eleven patients with trichomoniasis vaginalis revealed in four patients clusters of cells of T. vaginalis (T. vag.) which were attached to the vaginal mucosa. The minimum gap between adjacent trichomonad cells was the size of gap junctions (2 nm). Cells of T. vag. invaded superficially located epithelial cells but did not penetrate to the deeper cell layers of the epithelium. The latter, however, were frequently infiltrated with neutrophilic granulocytes. Contact between cells of T. vag. and neutrophils was not observed. Trichomonads which were attached to epithelial cells contained a dense network of cytoplasmic microfilaments in the part of the cell which came into contact with the epithelium. The remaining part contained the organelles normally seen in T. vag.. Endocytotic cell activity of amoeboid T. vag. occurred from the free cell surface only. A cell coat on the cell membrane--formed by bristles--was confined mainly to pinocytotic invaginations. Glycogen granules which were absent from the larger part of the epithelium were densely packed in the trichomonad cells. The findings in this study indicate that the interaction between the cells of T. vag. and the vaginal epithelium takes place primarily at a distance probably by means of substances released into the vaginal fluid, and secondly by a direct cell contact mechanism.


Stimulation of the vestibular receptor by means of step temperature changes during continuous aural irrigation. A technique for rapid, balanced hot/cold stimulation of the vestibular receptor is presented. During continuous aural irrigation the temperature of the irrigation fluid is switched between hot and cold values at times computed according to a mathematical model of heat conduction in the labyrinth area. As a result, the induced temperature difference across the lateral semicircular canal describes an approximately sinusoidal time course, reaching peak values of equal magnitude but opposite sign. Application of the test to 32 clinical subjects demonstrated that the heat conduction model and the analysis used in timing the sequence of thermal pulses was accurate. We expect that, with further refinements, the new technique will prove superior to conventional caloric test methods in the detection and measurement of subtle as well as gross abnormalities of the vestibular system.


Ionic requirements for rapid axonal transport in vitro in frog sciatic nerves. The effects of K+, Na+, hypo- and hypertonicity on the synthesis and fast axonal transport of 3H-leucine-labelled protein were studied in vitro in the frog sciatic system. The methodology used made it possible to discriminate between effects on synthesis and transport of protein. The preparation which consisted of the dorsal ganglia, the sciatic nerve and the gastrocnemius muscle was placed in an incubation chamber. The ganglia were incubated in standard Ringer containing 3H-leucine and the nerve was prefused with modified Ringer. Perfusion of the nerve for 17 h with K+-free Ringer of Na+-free Ringer did not affect the rapid axonal transport of 3H-leucine-labelled material from the ganglia along the nerve towards a ligature in front of which it accumulated. Not was the transport influenced by concentrations of K+ up to 68.8 mM. In contrast concentrations exceeding 100 mM K+ partially inhibited the transport. Inhibition by ouabain (0.1 mM) was not prevented by elevating K+ to 30 mM, Deviation from isotonicity, towards a hypo- or a hypertonic medium, partially inhibited axonal transport. The transport inhibitory effects showed reversibility. Expermintal conditions, which arrested the transport, were tested in spearate experiments for effects on uptake of 3H-leucine into TCA-soluble and insoluble ganglionic components. K+ substituted for Na+, ouabain (0.1 mM) and hypotonic Ringer partially inhibited the amino acid uptake but also subsequent steps in the incorporation process, whereas only the latter was inhibited by hypertonic Ringer. The results are discussed in relation to possible changes in energy metabolism.


Conductance recording of ionic outflow from frog skin glands during nerve stimulation. A method for continuous recording of the ionic efflux from frog skin glands has been developed which under given experimental conditions provides a convenient index on glandular secretion. A nerve skin preparation from the calf is mounted so that the outside of the skin forms the bottom of a small test compartment with distilled water while the corium side is bathing in Ringer's solution. After determination of the adequate nerve stimulus parameters for discernible gland secretion to occur, the skin nerve was stimulated at 10 Hz during varying periods and chemical control analyses performed of the changes in ionic content of the test compartment solution. The main ionic outflow consisted of Na+ and Cl- in equal amounts, the outflow of other ions during stimulation being negligible. The concomitant conductance changes were measured as variations of absorption in a high-frequency field applied to a conductance probe placed in the test chamber. Determinations of the NaCl outflow based on the conductance changes were in good agreement with the values obtained by chemical analysis. The continuous conductance recordings proved to give approximative information of the quantities and time relations of the glandular secretion, allowing a direct comparison with, e.g., skin potential changes.


Host specificity of DNA in Haemophilus influenzae: the in vivo action of the restriction endonucleases on phage and bacterial DNA. In Haemophilus influenzae strains only the type 1 of the restriction endonucleases have an in vivo effect on phage and bacterial transforming DNA. The type 2 of restriction endonucleases which act very efficiently in vitro are completely inactive in vivo. The reasons for this inactivity is unknown.


Value of internal mammary artery bypass. Coronary artery bypass in 150 patients with angina has been accomplished with 225 IMA grafts and 85 saphenous vein grafts. There were 7 (4.7%) hospital deaths. Posterative catheterization in 85% of patients revealed that 9 (4.7%) IMA grafts and 11 (15%) vein graft had thrombosed. One-year catheterization in 32 patients (38 IMA grafts and 13 vein grafts) revealed no additional graft failures. The better patency of the IMA grafts appears to be related to their smaller size and therfore greater velocity of blood flow and freedom from intimal proliferation.


Objective elaluation of bypass surgery in patients with acute coronary artery disease. 80 patients with acute coronary artery disease, including 70 patients with PIA, 8 patients with acute myocardial infarction, and 2 patients with cardiogenic shock, underwent bypass surgery. The surgical mortality rate was 1.4% in patients with PIA and during an average follow-up period of 15 months none of the patients died of cardiac disease. Ventricular function, as indicated by systolic ejection fraction and segmental wall motion, was noted to improve in many patients. Postoperative studies showed the internal mammary artery to be superior to the saphenous vein graft for left coronary bypass procedures. This was demonstrated by 100% patency of internal mammary artery grafts to the left anterior descending coronary artery. We believe that when a patient presents with one of the syndromes of acute coronary artery disease such as unstable angina, severe chest pain suggestive of infarction without infarction, status anginosis, recurrent ventricular tachycardia or acute myocardial infarction complicated by evidence of potential extension, cardiogenic shock, heart block or rupture, these patients deserve at least coronary and left ventricular  cineangiographic studies with hemodynamic evaluation. Our experience to date suggests that myocardial revascularization and catheterization carry a lesser risk than that of medical treatment.


Early and late effects of the coronary bypass operation on cardiac contractility and coordination. In 100 cases of coronary heart disease, cardiac contractility was studied before and after coronary bypass by a flow method, the force ballistocardiogram, and by a pressure method, the carotid pulse derivative. The two methods gave very similar results in most cases, and the agreement of their averages was impressive. A marked increase in cardiac strength, reaching its maximum a month or two after operation, followed the procedure in most cases. Cardiac coordination was also improved at this time in many subjects, but complete cardiac normality was very rarely attained. This early postoperative improvement was greater in hearts judged to be weak before operation than in those judged to be normal in strength. The early cardiac improvement was seldom held in its entirety, but usually declined at a rate, which, if continued, would abolish the postoperative improvement in about three years. This rate of cardiac decline was many times faster than that found in healthy persons or in unoperated cases of mild angina as age advanced. Nevertheless, in over 1/3 of our cases followed for a year and a half or longer, their hearts were still stronger or better coordinated, or both, than they had been before operation, and there is reason to believe that the decline was leveling. At their last test, the great majority of patients still reported that subjective improvement in their angina continued. This subjective improvement was significantly related to objective improvement of cardiac contractility in our date, but there was one striking exception to this rule. Previous studies of results following internal mammary artery ligation anf the Vineberg procedure afford an important control to the present work.


Variant angina pectoris: Clinical and anatomic spectrum and results of coronary bypass surgery. Twenty patients are described with the variant angina syndrome (recurrent angina at rest with S-T segment elevations occurring only during pain and no evolution of infarction). In contrast to patients previously reported on, all but one had progressive unstable angina before hospitalization. Angina was frequently associated with arrhythmias, including ventricular fibrillation (2 instances), ventricular tachycardia (4), frequent ventricular premature beats (5), atrioventricular block (4), sinus bradycardia (2), sinoatrial exit block (1) and supraventricular tachycardia (1). Seventeen patients had significant proximal stenosis of one or more coronary arteries with good distal vessels. Bypass surgery in 15 of these patients resulted in one noncardiac postoperative death, one perioperative infarction and relief of pain in all 14 survivors. After a 17 month mean follow-up period (range 4 to 38 months), all survivors are pain-free. Three patients had no significant coronary disease; one of these became asymptomatic with medical therapy, one continues to have angina and one died suddenly. Patients with normal coronary arteries could not be distinguished clinically or by electrocardiogram from those with severe obstructive lesions. This experience suggests that all patients with the variant angina syndrome should be studied by coronary angiography, and that most patients with significant fixed coronary lesions will do well after coronary bypass surgery.


Reappearance of anterior QRS forces after coronary bypass surgery. An electrovectorcardiographic study. This report describes the reappearance of anterior QRS electrical forces in six patients after direct coronary arterial bypass surgery. Each patient had severe coronary artery disease including a segmental stenosis of the left anterior descending artery. Revascularization was performed by direct  anastomosis of the left mammary artery to the left anterior descending coronary artery and saphenous vein bypass of other stenotic coronary arteries. Preoperative electrocardiograms and vectorcardiograms showed patterns of anterior wall myocardial infarction with absent or diminutive anterior QRS forces. In each case, postoperative studies demonstrated the regeneration of anterior QRS forces within 10 days of operation. Although these patients represent a small percent of those with a preoperative pattern of infarction who undergo coronary revascularization, the findings demonstrate that electrically silent areas of myocardium may be altered and are not always synonymous with myocardial cell death. Chronic myocardial ischemia may in certain instances produce electrocardiographic and vectorcardiographic patterns of myocardial infarction that may be reversible upon reestablishment of perfusion to ischemic areas.


Experimental coronary arterial occlusion and release. Effects on enzymes, electrocardiograms, myocardial contractility and reactive hyperemia. After less than 1 hour of coronary arterial occlusion, the myocardium suffers irreversible changes as revealed by electron microscopy. Yet, the earliest clinical laboratory indexes of myocardial infarction--elevated serum enzyme levels and significant Q waves on the electrocardiogram--are not detected until at least 6 hours after coronary occlusion. To study the early period after coronary occlusion in the dog, occlusion of the left anterior descending coronary artery for 1 to 3 hours was followed by release, and coronary sinus and venous enzyme levels, the electrocardiogram and myocardial contractility from the infarcted area, and reactive hyperemia were monitored. Coronary sinus enzyme levels rose within 15 minutes after release of occlusion in half of the experiments with 1 to 1 1/2 hours and in all of those with 2 to 3 hours of occlusion, and this rise preceded the rise in venous levels by only 10 to 20 minutes. Significant Q waves appeared 15 to 30 minutes after release of occlusion as the serum enzymes were increasing. Thus, clinically, the delayed appearance of increased serum enzymes and significant electrocardiographic Q waves is probably largely due to a lack of circulation in the infarcted area rather than to prolonged survival time. Also, the venous enzyme level reflects the coronary sinus level minutes later. The presence of viable myocardium in the infarcted area was suggested by elevation of the S-T segment upon reclamping, and by residual myocardial contractility and retained capacity for reactive hyperemia. These findings occurred in some experiments even in the presence of a significant Q wave.


Alterations in energy metabolism and ultrastructure upon reperfusion of the ischemic myocardium after coronary occlusion. The effects on myocardial function, metabolism and ultrastructure of 60 minutes of reperfusion, instituted after 30, 60 and 90 minutes of occlusion of the left anterior descending coronary artery, were studied in 48 dogs. Twelve sham-operated dogs served as controls. Coronary occlusion for 60 or 90 minutes caused significant depression in the first derivative of left ventricular pressure (dP/dt) (P less than 0.05) that could not be reversed by reperfusion. Upon reperfusion, creatine phosphate stores in myocardium made ischemic for 30 and 60 minutes, but not for 90 minutes, returned toward control levels, but stores of adenosine triphosphate (ATP) and total nucleotides and the ATP/adenosine diphosphate ratio of myocardium subjected to 60 and 90 minutes of ischemia were further decreased. After 60 and 90 minutes of ischemia, swelling of the sarcoplasmic reticulum and mitochondrial damage (swelling, decreased matrix density and partial loss of cristae) were seen. Myofibrils were relaxed in all these groups. Reperfusion produced gross contraction of myofibrils and aggravated these changes in mitochondria and sarcoplasmic reticulum. In the hearts subjected to 90 minutes of ischemia these changes were gross. The levels of creatine phosphokinase, glutamic oxaloacetic transaminase and lactic dehydrogenase in the coronary sinus blood increased dramatically (P less than 0.05) upon reperfusion after 60 or 90 minutes of occlusion, indicating severe impairment of cell membranes. This secondary rise in serum enzyme activity during reperfusion should be taken into consideration when estimating the size of a myocardial infarct from enzyme changes alone. It appears that 60 and 90 minutes of ischemia cause severe myocardial damage that is not reversed by reperfusion maintained for 1 hour although longer periods of reperfusion may be beneficial.


The bleeding time as a test of hemostatic function. The vascular component of hemostatis is determined by the bleeding time as designed by Duke or by the Ivy modification, which is a combined bleeding time-tourniquet test. A prolonged bleeding time is observed: (1) in thrombopathic thrombocytopenia, which may be (a) hereditary or (b) acquired, as in the immune types or from depression of bone marrow, and (2) athrombocytopenically, as in von Willebrand's disease, Glanzmann's thrombasthenia, or from aspirin intolerance. The role of a specific bleeding time determinant in the plasma (labile bleeding time factor of Perkins) is discussed and its possible relation to platelets suggested.


Infectious arthritis in the neonate caused by Haemophilus influenzae. Two newborns had hematogenous pyarthrosis due to Haemophilus influenzae. One infant had signs of sepsis and dactylitis involving several fingers and toes. She also developed a soft tissue abscess, meningitis, and a septic hip, and was found to be infected with a nontypable organism. In the second infant, a shoulder traumatized at birth became infected with a type b strain. In both cases, the patients were successfully treated, but delays occurred in selecting the optimal therapeutic agent because of failure to appreciate that Haemophilus may cause systemic infection in the newborn. In the first infant the source of the infection was identified as the mother's endocervical canal. This patient is also of interest because in contrast to previous reports of Haemophilus infection in the newborn, bactericidal activity was present in the maternal serum.


Prothrombin complex concentrate: use in controlling the hemorrhagic diathesis of chronic liver disease. A prothrombin complex concentrate was used in attempts to control life-threatening hemorrhage in 4 patients with chronic liver disease. The population manifested profuse bleeding from varices and/or hemorrhagic gastritis; 3 had Laennec's cirrhosis and 1 had postnecrotic cirrhosis from childhood hepatitis. In all patients the complex was given in amounts needed to raise the prothrombin (factor II) level to approximately 100% of normal. In all 4 cases the prothrombin time and prothrombin complex factors approached normal within 1-2 hr after beginning the infusion. In all patients bleeding ceased with correction of the clotting status. One patient rebled several hours after completing the infusion. In several patients, increases in factors V and VIII were noted following infusion of the concentrate. A further unexpected finding was a spontaneous increase in factors II and IX at 3 days postinfusion. Prothrombin complex concentrate appears to be useful in controlling the hemorrhage of chronic liver disease when used alone or in combination with other modalities to correct specific hemostatic defects; however, patients may be expected to rebleed when the effect of the concentrate wears off. Its use, therefore, should probably be restricted to those patients who are to undergo corrective surgery of the bleeding point once hemostasis is achieved.


The effect of menopause on serum cholesterol in American (Pima) Indian women. Serum cholesterol levels in Pima Indian women were investigated to determine if menopause caused these levels to rise. The mean cholesterol values of 148 pre-menopausal women aged 34-54 when age-matched with 75 post-menopausal women were not significantly different. Sixty-five women passed through menopause while under observation and were examined sequentially for an average of 6.1 years. Their mean pre- and post-menopausal cholesterol levels of 182 +/- 5 mg/100 ml and 180 +/- 5 mg/100 ml were similar. Nor did menopause alter cholesterol levels in the subgroups of these patients with diabetes mellitus. Cholesterol levels in both Pima males and females showed no age-related rise, and were 20-30% lower than white populations. This study provides additional evidence against the postulated relationship between menopause and serum cholesterol.


Topical treatment of the burn patient.

Topical treatment of the burn patient. The pathophysiology, classification and bacteriology of burns are discussed, as well as treatment of burns with silver nitrate, silver sulfadizine, silver allantoinate, mafenide acetate, furazolium chloride, povidone-iodine complex, antibiotics, antiproteolytics, fibrinolytics, Pseudomonas vaccine and antiglobulins.


Inhibitors of leukocyte chemotaxis in alcoholic liver disease. Twenty-one of 42 patients (50 per cent) with alcoholic liver disease showed serum chemotactic inhibitory activity (CIA). CIA was not related to any single biochemical or histologic feature in the patients studied. The frequency of CIA was greatest in those with active infection. Serial studies demonstrated that CIA may be a transient phenomenon, associated with active alcoholic liver disease or appearance of infection. Nine of 15 patients showed skin test anergy; CIA was present in 8 of these 9 patients. Serum immunoglobulin A (IgA) and G (IgG) concentrations were significantly higher in patients with CIA when compared to those without CIA. Sucrose density gradient centrifugation of serums showing CIA yielded three peaks of inhibitory activity. Two had sedimentation coefficients of 10.7S and 6.8S, and the third was approximately 3S. The two higher molecular weight inhibitors were predominant in the 50 per cent ammonium sulfate precipitate. Immunoabsorption by anti-IgA but not by anti-IgG or IgM columns removed the ammonium sulfate precipitable chemotactic inhibitors. The appearance of chemotactic inhibitors in patients with alcoholic liver disease may have relevance to their apparent susceptibility to serious infections.


Computer analysis of defined populations of lymphocytes irradiated in vitro. II. Analysis of thymus-dependent versus bone marrow-dependent cells. Three uniform populations of T and B cells exposed to varying amounts of x-irradiation are examined utilizing computer-assisted morphometric analysis. These populations are: thoracic duct lymphocytes (TDL) from congenitally athymic (nude) mice (B cells); TDL from CBA mice treated with anti-Ig plus complement (T cells); and computer-selected untreated T cells from CBA TDL. Irradiated B cells show a more even dispersion of the nuclear chromatin and a dose-dependent increase in relative nuclear area beginning with the lowest dose evaluated (50 rads); no significan change in total optical density (OD) is demonstrable over the dose range evaluated (0 to 2000 rads). Anti-Ig-treated irradiated T cells demonstrate an initial shift toward lower OD values as a function of dose followed by a marked rise of OD values at 2000 rads, where numerous densely staining Feulgen-positive aggregates are identified. The relative nuclear area of this cell population also shows a biphasic response to radiation injury with an initial increase at the lower dose levels followed by a progressive decline to approximate control levels at 2000 rads. This effect is mirrored by the alteration in total OD which, after a decrease at low dose levels, approximates control values at 2000 rads. The computer-selected T cells show little change in OD values at the low-dose levels but show a marked increase in the more densely staining Feulgen-positive material following 2000 rads. This population reveals no apparent change in either relative nuclear area or total OD as a function of dose. Thus, untreated computer-selected T cells exhibit remarkably little evidence, morphologically, of radiation injury of doses associated with pronounced alterations on the part of B cells. In addition, treatment of a mixed cell population (CBA TDL) with anti-Ig plus complement to remove the B cells appears to alter the response of the residual T cells to radiation injury. These results, in conjunction with recent evidence to support the concept that T cells possess surface Ig, suggest that an Ig-anti-Ig interaction may alter the radiosensitivity of T cells.


The development of anti-immunoglobulin antibodies in rhesus monkeys repeatedly exposed to Schistosoma japonicum. The development of anti-immunoglobulin (Ig) antibodies in rhesus monkeys repeatedly exposed to Schistosoma japonicum cercariae was studied. Anti-Ig developed in all 8 monkeys exposed 5 times to cercariae of the Formosan strain, while none of 4 monkeys exposed once to the Philippine strain developed such antibodies in the same period. All monkeys developing anti-Ig had specificities for IgA, 6 of 8 for IgM and IgG, and 7 of 8 for rabbit Ig. The persistence of anti-Ig was greatly extended in the monkeys exposed initially to the Formosan strain and then challenged with the Philippine strain. A single monkey exposed once to  the Philippine strain developed anti-IgA and anti-rabbit Ig 85 weeks postinfection. No relationship between host reaction to trapped eggs and the development of anti-Ig was discerned. The results suggest that immunization protocols designed for humans be carefully examined for their potential immunopathological side effects.


Role of splenectomy in Felty's syndrome. To evaluate the effectiveness of splenectomy in the treatment of Felty's syndrome (association of rheumatoid arthritis, leukopenia, and splenomegaly), such experience from 1968 to 1972 at the University of Alabama Medical Center in Birmingham was analyzed. There were five patients with Felty's syndrome who underwent splenectomy. In all five patients, there was no operative morbidity, no blood transfusions were required, and leukopenia and susceptibility to infection were greatly improved; neutropenia disappeared in all but one patient. Splenectomy appears to benefit most patients with Felty's syndrome.


Technic of chronic thoracic duct "side fistula" for immunologic evaluation of patients with cancer. A technic suitable for long-term study of the human thoracic duct circulation under physiological conditions is described. The results and observations obtained in ten patients studied for three to twenty-one days are presented.


Unusual manifestations of pancreatic pseudocysts and their surgical management. Six cases representing selected complications of pancreatic pseudocyst are reported and their surgical management is discussed. Patients with mediastinal extension of a pseudocyst frequently present with symptoms in the chest rather than in the abdomen. Chronic recurrent pleural effusion, rich in protein and amylase, often accompanies mediastinal extension of a pancreatic pseudocyst. It is important to recognize that such an effusion almost certainly represents disruption of the pancreatic duct with formation of a pancreatic pseudocyst or a pancreaticopleural fistula. Internal drainage from below the diaphragm is the treatment of choice for pancreatic pseudocysts extending into the mediastinum. To be certain that obstructive jaundice is due to a pancreatic pseudocyst, there must be operative demonstration of compression of the common bile duct by the pseudocyst, relief of the obstruction by surgical drainage of the cyst, and subsequent disappearance of jaundice. Cysts that cause jaundice are located in the head of the pancreas, and cystoduodenostomy is the treatment of choice. Intraperitoneal rupture has been associated with a high mortality, but with adequate fluid replacement, prompt evacuation of the cyst contents from the peritoneal cavity, and adequate drainage, mortality can be lowered. Pancreatic ascites is much more common than is generally supposed and may result from a leaking pancreatic pseudocyst. In contrast to cirrhotic ascites, pancreatic ascites produces elevation of both the serum amylase level and protein concentration. Massive hemorrhage from pancreatic pseudocysts is usually due to the development of a false aneurysm in a branch of the celiac axis in the wall of the pseudocyst, with subsequent rupture of the aneurysm into the gut or peritoneal cavity. Any patient with a pancreatic pseudocyst who shows signs of bleeding should have prompt arteriography for determination of the bleeding site and appropriate surgical control. Pancreaticobronchial fistula is a rare complication. Treatment should be directed toward adequate drainage of the pseudocyst in the abdomen.


Heparinless left heart bypass for resection of thoracic aortic aneurysms. Our clinical experience employing heparinless left heart bypass for the resection of twenty-three thoracic aneurysms is presented. In our current technic of heparinless left heart bypass, plastic tubing coated with nonthrombogenic polyurethane-polyvinyl-graphite material and a conventional roller pump are employed. The reduced size of the aneurysm below the aortic clamp during bypass facilitates careful dissection of the aneurysm and the aorta. Twenty-two of twenty-three patients underwent successful thoracic aneurysmectomy with this technic. None had subsequent paraplegia and the postoperative blood loss was minimal. Heparinless left heart bypass is a simple and safe procedure to facilitate thoracic aneurysm resection.


[The course of zonular fibers in the area of pars plicata corporis cilaris pars plana, ora serrata and retina. Eectron microsocpic study]. The course of zonular fibers in the area of pars plicata corporis ciliaris could be shown down to the pigmented epithelial layer and its basement membrane. S ingle fibrils enter in a connection with the plasma membrane in allinvestigated parts. Fibrils could  be observed in the cytoplasm of the ora serrata. For the other areas (pars plicata corporis ciliaris, parsplana) this can be suggested too.


The clinical picture of Eales' disease.

The clinical picture of Eales' disease. The clinical findings in 316 eyes with Eales' disease and 41 eyes true idiopathic periphlebitis were analyzed. Eales' disease differed clearly from idiopathic periphlebitis in a predominance of male patients, a marked tendency toward bilateral disease in males, the aspect of vascular sheathing and the absence of inflammatory signs from the vitreous body. The clinical picture of Eales' disease was characterized by avascular areas in the retinal periphery, followed posteriorly by microaneurysms, rope-ladder-like dilations of capillary channels, tortousity of neighbouring vessels and spontaneous choriortinal scars. The more pronounced finds were neovascularizations (84%) hemorrhages (58%), obliterated vessels (39%) and vascular sheathing (34%). In contrast to idiopathic periphlebitis, Eales' disease is considered a primary, non-inflammatory disorder of the walls of the peripheral retinal vessels, namely the shunt vessels.


Ultrastructure of the microvessels of the iris in mammals with special reference to their permeability. The ultrastructure of the microvessels of the guinea pig, rat, rabbit and cat was studied in an effort to discover the morphological basis of the permeability of the iris vessels. The microvessels of the iris revealed a non-fenestrated endothelium. A relatively wide intercellular space and macula occludens were seen at the intercellular junctions of the endothelial cells in the capillaries and postcapillary venules. It is concluded that these intercellular spaces may form the small pore system which makes the diffusion through the iris vessels possible. Transcapillary exchange of high molecular substances is made possible by the vesicular transport system of the micropinocytosis vesicles.


[Fixation disparity in peripheral and central binocular vision under conditions of prismatic heterophoria (author's transl)]. A critical review of the literature shows that there are controversal interpretations of thephenomenon fixation disparity. The former findings of Ogle and coworkers are ascertained byinvertigator to close the central gap in the fusional patter. Formerly the gap was essentialdue to polarisation techiques. 1. Without central gap fixation disparity decreases, but remainssignificantly different from zero. 2. Diminution or closing of the gap leads to more preciseresults, since the position of the eyes is better controlled. 3. Straining the binocular vision with high prism power cortical tolerances increase when fusion was aided by central stimuli. Fixation disparity could be extended up to 20' (minutes of are) which is three times the well accepted size of the Panum area.


[Experimental Research on the O2 supply of the eye author's transl]. To investigate the O2 supply conditions of the corneal endothelium and the lens by the aqueous hymor, O2 solubility coefficients of aqueous humor as well as in the lens had to be determined. The current assumption that the vitreous body is a possible O2 pool had to be examined. The following conclusions are drawn from the measured values of Bunsel O2 solubility coefficients (ml O2ml atm) of bovine aqueous humor, lens homogenates, vitreous bodys as well as of solutions of hyaluronic acid at temperatures from 10 to 40 degrees C: 1. The physiological rate of oxygen transport by the aqueous suffices to supply the corneal endothelium and the lens with oxygen, the temperature gradients within the anterior chamber favour the O2 supply of the corneal endothelium compared to other ocular tissues. 2. The O2 content of the aqueous can maintain O2 consumption of corneal endothelium for about 20 min theoretically or for about 5 min the lens ones. 3. The vitreous body can act as a possibel O2 pool only with regard to the O2 supply of the lens. In this case the pool can maintain O2 consumption of the shole lens for about 20 min. 4. During physiological growth of the lens the central part expands, which is characterized by an O2 concentration near zero. Therefore, the O2 supply of the lens is maintained for only less than one minute by the content of the lens itself.


Optically induced eye torsion. I. Fusion cyclovergence. Fusional cyclovergence was demonstrated for the first time, using ab objective photographic method. It was discovered that the results of subjective and objective measurements of cyclovergence agreed exactly. The largest fusional cyclovergence observed was 8 degrees. The cyclovergence partly cancels out the cyclodisparity presented. The greater part of the cyclodisparity usually remains. The maximum aplitude of the sensory cyclofusion is of the order of 8 degrees. The cyclovergence response is greatest when large fusion images with numerous horizontal contours are presented. The motor mechanism of cyclofusion presupposes the existence of recently demonstrated cyclodisparity detectors. The amplitude of sensory fusion is determined by the vertical diameter of the peripheral Panum areas.


Coat's disease. An epidemiologic and Fluorescein angiographic study. Coats' disease represents a disorder of the retinal vascular walls. In a series of 112 consecutive eyes with Coats' disease the involvement was unilateral in 90.2%. The majority (72%) of patients were male. 57.8% were under 20 years of age. There was, however, a second peak of the disease (30.4%) between the age of 41 and 60. Severe cases were found mainly among juvenile patients, whereas in the senile group milder cases prevailed. Fluorescein angiographic findings comprised vascular aneurysms in almost all cases, rarefaction and coarsening of the capillary bed in 71%, capillary occlusions in 70%, occlusions of arterioles or arteries in 27%, shunt formations in 27%, extensive widening of arteries or veins in 27% and leakage of dye mainly in advanced cases. The participation of the central retina in the disease process was variable. Evidence is presented that Leber's military aneurysm retinitis is not a separate entity but a special form of Coats' disease.


[The effect of human leukocyte interteron (HIF) on experimental viral keratitis in monkeys (author's transl)]. 12 african green monkeys were inoculated in both eyes with herpes simplex virus typ 1 and 16 rhesus monkeys with vaccinia virus. The right eyes were treated with human leukocyte interferon (HIF) while the left eyes served as controls and showed the typical keratitis, 7 out of 8 herpes eyes and all 9 vaccinia eyes which were treated prophylactically or simultaneiously with HIF showed no signs of disease. When HIF was given later in the course of the infection the keratitis was either little influenced or not modified at all. The reasons are discussed.


[On scanning electron microscpy to the anterior part of the eye with special regard to the coruse of zonula Zinnii (author's transl)]. Three areas in which zonular fibers of Zinn enter were demonstrated with the aid of scanning electron microscopy. 1. The area, which applied to the edge of the lens. 2. The area of Pars plicata corporis ciliaris. 3. The area of Pars plana. The connection of zonuar fibers with limited membran of vitreous body was presented too.


[Electronmicroscopic investigation about the course of zonular fiber in the area of ora serrata and the peripheral retina (author's transl)]. Single zonular fibers could be shown in the area of ora serrata and the peripheral parts of retina between the basement membrane of pigmented epithelium and the elastic tissue of Bruchsmembran. The occurrence of fibroblasts in the proximity of zonular fibers was noticeable.


Alpha-antitrypsin Pi types in postmortem blood. It is possible to determine alpha1-antitrypsin Pi types from serum obtained at necropsy.  The Pi types were identical in 37 paired antemortem and postmortem samples.  Blood transfusion in the 72 hours preceeding death may produce serum that cannot be typed.  The frequency of the Pis allele was high in this study (0.074) and may reflect terminal alterations in alpha1-antitrypsin mobility and thus Pi typing, or a higher frequency in the population studied.  The Pis allele was particularly frequent among Canadians with French names and Canadians born in Italy, Greece, and Portugal.  The prevalence and severity of emphysema were not increased in PiA and Pis heterozygotes, but the groups studied were small and the variable, smoking, could not be adequately controlled.  Studies of larger groups are recommended.


Effect of indomethacin and phenylbutazone-prednisone combination of gastric mucosa: gastroscopic and histological study. The effect of a phenylbutazone-prednisone combination and indomethacin on the anatomical state of the gastric mucosa were studied by gastroscopy, gastrophotography, and gastrobiopsy. All four patients examined had redness of the antral mucosa after administration of either drug. Intramucosal gastric haemorrhage was present in two patients after both phenylbutazone-prednisone combination and indomethacin. Mucosal erosions occurred in three cases after the phenylbutazone-prednisone combination, one of them slight, and in two cases after indomethacin. On histological examination, increased intramucosal haemorrhage could be seen in the specimens from all four patients after indomethacin, and in the specimens from three patients after the phenylbutazone-prednisone combination. There was considerable mucosal vasodilatation in one patient on the phenylbutazone-prednisone combination and in two patients on indomethacin. The effects of both drugs on the gastric mucosa were similar. None of the subjects suffered from abdominal symptoms during the drug administration.


Temporal bone histopathological findings in trisomy 13 syndrome. This study reports the histopathological findings of 14 temporal bones from infants with trisomy 13 syndrome. The most primitive anomalies in the structures of the inner and middle ears in the present series are those of the semicircular canals, particularly of the horizontal canals: flattened horizontal canal cristae, absence or opening of the utricular endolymphatic valve, small facial nerve, and obtuse angle of the geniculate area of the facial nerve. Each ear demonstrated more than one of those anomalies. The anomalies present features similar to those found in the structures of the normal six to ten-week fetus. Many other mild anomalies observed appear to demonstrate features similar to those seen in the same structures in later fetal life. Reviewing these findings, most of the anomalies that were found in the inner and middle ears appear to be the result of poor development of the structures for reasons which are now unclear. In addition, middle ear infection was found in all cases.


Some characteristics of Anaerovibrio lipolytica a rumen lipolytic organism. Strains of Anaerovibrio lipolytica isolated from sheep- and cow-rumen contents on a linseed oil -- rumen fluid -- agar medium fermented ribose, glycerol and DL-lactate. Fermentation products from glycerol were propionate and succinate, while ribose, fructose and DL-lactate were fermented mainly to acetate, propionate and carbon dioxide. Propionate is formed in this organism by the dicarboxylic acid pathway similarly as in propionibacteria. Measurements of the rate of lipolysis by pure cultures suggest that the organism may play an important role in the lipolytic activity of rumen contents of sheep. The demonstrated fact that the cell-free lipase excreted in the culture medium can easily be adsorbed on particulate matter in autoclaved rumen fluid may explain the absence of free lipase in clarified rumen liquor.


Isolation and characterization of some new oxalate-decomposing bacteria. Forty-one cultures degrading and assimilating oxalate were isolated from chicken dung. Characterizarion indicated six different types. One of these belonged to thhe genus Alcaligenes hitherto never reported to degrade oxalte. Three groups of Pseudomonas strains differed physiologically from strains already known.


Hansenula lynferdii sp.nov.

Hansenula lynferdii sp.nov. A single strain of an undescribed Hansenula species was recovered from soil. A description of the new species is given and its possible relationship to the other species of the genus is discussed.


Ultrastructural aspects of wall regeneration by Pythium protoplasts. Electron microscope studies were made of wall regeneration by Pythium protoplasts. Wall regeneration began with the formation of a loose network of fibrils on the surface of the protoplast followed by increase in density of the fibrillar mesh and deposition of granular mitrix material. The majority of the protoplasts did not develop beyond the loose fibrillar network stage, however a small percentage were able to complete wall formation and to form hyphal tubes. A clear zone of demarcation was  visible between the fibrillar surface of the protoplast and the smooth surface at the base of the developing hyphal tube.


Paget's disease of the temporal bone.

Paget's disease of the temporal bone. Osteitis deformans Paget is a fairly common, heritable, sometimes progressive disease of bone which affects primarily the axial skeleton and may lead to deformity and weakness. It affects 3% of the population over forty years of age and males more frequently than females. The skull and temporal bones become involved in about two-thirds of the patients. Progressive involvement of the temporal bones may lead to alteration of position, increase in size and change of architecture of the petrous pyramid, external canal, middle ear and inner ear capsule. These changes in turn may produce impairment of hearing (about 30-50% of cases) and vestibular function (20-25%). The clinical, radiological, and pathological manifestations of Paget's disease of the temporal bone are discussed in detail and explained with photomicrographs. Examples of tumor formations and vascular changes are presented.


Polysaccharide production and the possible occurrence of GDP-D-mannose dehydrogenase in Azotobacter vinelandii. During the growth of Azotobacter vinelandii in batch culture in Burk's 2% glucose medium supplemented with 50 mg EDTA per litre, water-insoluble capsular polysaccaride material accumulated in cultures prior to the appearance of water-soluble polysaccharide in the culture medium. On isolation, hydrolysis and chromatography, both these polysaccharides were observed to be composed of carbohydrate monomers having the same chromatographic mobilities as glucose, rhamnos, guluronic acid and mannuronic acid. The activity of GDP-D-mannose dehydrogenase recorded in crude cell-free extracts from Azotobacter vinelandii, when these polysaccharides were produced, may indicate a close similarity between the biosynthetic pathway of alginate synthesis in marine Phaeophyceae and this soil microorganism.


Scanning isoelectric focusing of cholera enterotoxin in polyacrylamide gels. Scanning isoelectric focusing has been employed for continuous monitoring of the isoelectric spectrum of highly purified cholera enterotoxin in 4% polyacrylamide gels containing 2% ampholytes pH 3-10. The resolution obtained by this technique is of high order because at no instance during focusing interruption of current occurs and thus diffusion of the isolated protein moieties is suppressed. An added aspect of scanning isoelectric focusing was that it allowed estimation of the minimal focusing time of cholera enterotoxin. Thus under the standard assay procedure, the main basic component of cholera enterotoxin was focused in 5800 sec, while the other at least 3 minor acidic and anodic components were focused in approximately 19000 sec. Focusing of cholera enterotoxin in the presence of 6 mu urea allowed the visualization of 5 well defined and about equal components. The proteinaceous nature of the observed peaks was verified by scanning at wavelenghts other than 280 nm, staining of gels for protein, and varying the concentration of the enterotoxin. The design of scanning isoelectric focusing equipment is presented. Reproducibility, economy of sample, and ampholytes and simplicity of experimental technique were some of the features of this apparatus. The resolution of scanning isoelectric focusing was found to be superior to that of ordinary disc and SDS gel electrophoresis.


DNA base composition of species of the genus Saccharomyces. DNA base compositions (GC content) of Saccharomyces species are reported and discussed. Several amendments of the four groups given by van der Walt are suggested, viz. the transfer of S. kluyveri to group 1, and of S. eupagycus, S. cidri, S. montanus, S. microellipsodes and S. florentinus to group 2. The synonomy of S. amurcae and S. cidri is suggested. The DNA base compositions revealed two possible pairs of sibling species: S. elegans and S. bailii, with a difference in GC content of 4.1%; S. dairensis and S. servazzii with a difference in GC content of ca. 3%. S. mrakii had a GC content of 47.3-48.5% the highest encountered in this genus and similar to that of Kluyveromyces thermotolerans.


Bacteriocin typing of Pseudomonas putrefaciens from food, human clinical specimens, and other sources. With the use of 4 bacteriocin donor strains of Pseudomonas putrefaciens most low G+C strins were readily distinguished from high G+C strains. Two bacteriocin donor strains exhibited autoinhibition when subjected to bacteriocin typing.


Substrate inhibition in Pseudomonas oxalaticus OX1:  a kinetic study of growth inhibition by oxalate and formate using extended cultures. Pseudomonas oxalaticus OX1 has been grown in a mineral salts medium with oxalate or formate as the sole source of carbon and energy. At concentrations of these substrates above 50 mM inhibition of growth was indicated by a long and variable lag phase in batch culture. This inhibition was further studied by estimating maximum specific growth rates at different substrate concentrations using the extended culture technique for control of the substrate concentration. With formate, inhibition became apparent at substrate concentrations above 20 mM, whereas oxalate inhibited growth at concentrations above 15 mM. Complete inhibition was not observed even at concentrations of 100 mM. A number of inhibition functions were fitted with the experimental data using computer analysis. The results indicated that the Haldane equation was the simplest function to describe quantitatively the kinetics of the observed substrate inhibition. Studies on the rate of oxygen uptake at different concentrations of oxalate indicated that respiration was much more sensitive to inhibition than growth. However with formate, inhibition of respiration was not observed up to concentrations of 50 mM, indicating that different mechanisms may underlie the observed growth inhibition by the two substrates.


L-Phase variants of Agromyces ramosus.

L-Phase variants of Agromyces ramosus. Agromyces ramosus, which is a numerically prevalent bacterium in soil, was easily induced into the L-phase by growing it on agar media containing low levels of penicillin or glycine. The L-forms were stable after initial contact with the inducing agent and could not be reverted to the bacterial form by any of the procedures tried. These results are discussed in relation to a possible natural occurrence of L-forms of this bacterium in soil.


Pichia philogaea sp. nov.

Pichia philogaea sp. nov. Two strains of an undescribed Pichia species were recovered from soil. A description of the new species is given and its possible relationship with the other species of the genus is discussed.


Two undescribed hyphomycetes from Malaysia. Raffaelea variabilis is described as a new species in culture from Lannea grandis. It is distinguished by turbinate to cuneiform conidia measuring 4-16 times 2.5-7.5 mum, and compared and contrasted with established species. Trichocladium lobatum is described as a new species in culture with 1-2 euseptate spherical conidia, 19-22 mum diam., ornamented with flabelliform, spathulate or petaloid lobes 7 mum long. It is compared and contrasted with established Trichocladium species and representatives of Chlamydomyces, Histoplasma, Mycogone, Sepedonium and Thermomyces.


Lipomyces anomalus sp. nov.

Lipomyces anomalus sp. nov. A description of a new yeast species from soil - Lipomyces anomalus - is given. It differs from all the accepted Lipomyces spp. by the formation of abundant pseudomycelium, absence of capsules, the assimilation properties, and its habitat: the north taiga subzone.


Two new species of the genus Sterigmatomyces. The descriptions of two new species of the genus Sterigmatomyces, St. nectairii and St. penicillatus are given. The diagnosis of the genus is extended to starch production, positive or absent. An earlier described species, St. acheniorum Buhagiar et Barnett, is transferred to the genus Rhodotorula.


Three new asporogenous yeasts found in industrial waste water. Representatives of three new asporogenous species, Candida flavificans, Candida inositophila, and Torulopsis sorbophila were isolated from washings of ion-exchange resin in a guanosine monophosphate manufacturing plant. The DNA base composition, proton-magnetic-resonance spectrum of extracted polysaccharides, and serological characteristics of the yeasts were investigated in addition to the characteristics commonly employed. Descriptions of the new species are given.


Smoking and disease: effect on serum antitrypsin in hospitalized patients. The mean serum antitrypsin (AT) activity for 1,829 patients hospitalized with medical problems exceeded the mean for a group of blood bank donors by 51%. Analysis of data from individual patients in terms of the general category (there were 16) of their disease and smoking status (smoker, nonsmoker, former smoker) indicated significant differences due to disease status and smoking status. The highest mean AT levels were associated with infectious, respiratory, and neoplastic diseases. Smokers had significantly higher mean levels than nonsmokers, and lung cancer patients had significantly higher mean levels than those with other malignant neoplasms. Among smokers (as a group) mean AT levels. through elevated relative to nonsmokers were not significantly related to duration or intensity of smoking; but former smokers showed a decline (with time following cessation of smoking) in their mean AT level to the mean level for nonsmokers. These findings provide further evidence of the sensitivity of serum antitrypsin activity to environmental influences.


Proteinase inhibitors in rheumatoid arthritis. The concentrations of five normally occurring protease inhibitors in serum and synovial fluid were compared in patients with rheumatoid arthritis, osteoarthrosis, and normal controls. The patients with rheumatoid arthritis showed a significant rise in alpha1-antitrypsin, alpha1-antichymotrypsin, and inter-alpha-trypsin inhibitor (in decreasing order) in serum as well as in synovial fluid. In synovial fluid the inhibitors were present in their native form and bound to hyaluronate. A large molecular protein with immunological specificity of alpha1-antitrypsin, presumably a complex of alpha1-antitrypsin and a protease, could be shown in synovial fluid of all patients with classical and probable rheumatoid arthritis and not in that of the other subjects studied.23Author


Cross-sectional studies on Schistosoma mansoni infection in northeast Brazil. Studies on the prevalence and morbidity of Schistosoma mansoni infection were carried out in selected areas of northeastern Brazil. The study revealed that both prevalence and morbidity rates were significantly higher in rural than in urban areas. No statistically significant differences in prevalence and morbidity were found in relation to sex. The age-specific prevalence curve was found to be of the usual shape found in highly endemic areas of the country: it reaches its peak in the 10-14 group, and slightly decreases in the older groups. Although it is generally admitted that hepatosplenic forms of the disease occur more frequently between 10 and 40 years of age, the present study has shown that the proportion of these severe cases increases with increase of age.


Mesencephalic porjections of the rectus lateralis muscle afferents in the cat. Responses to passive stretch applied to the rectus lateralis muscle (RL) were recorded with a microelectrode from the mesencephalic nucleus of the fifth nerve (Mes V) in cat encéphale isolé preparation. The necessary conditions to attribute the unit response to an eye muscle stretch are the followings: i) respond neither to jaw movements nor to pressure applied to the eye ball: ii) be activated with a short latency, following stretch of the eye muscles; iii) be excited by a light touch applied to a small area of one eye with a glass rod. The characteristics of the Mes V responses following stretch of the eye muscle are similar to those obtained in a primary afferent fibre from a skeletal muscle. Horseradish peroxidase was injected in the RL muscle of young and adult cats. As a consequence of fast retrograde axonal transport, the tracer was found to accumulate in the corresponding motoneurones of the VI nucleus. In addition, the enzymes accumulation was also found in cells of Mes V corresponding to the somata of RL sensory terminals. Units responding to RL stretchs, and primary sensory neurons labelled by the tracer, were found in the same area of Mes V.


The problem-oriented record. Problem definition. A problem is defined when the clinician judges a dysfunction is apparent or highly probable for the patient in one or more of three areas: physiological, psychological, or social functioning. In defining specific problems, data assessments are often confounded with the data themselves. To "lump" or "split" problems in psychiatry should be by theoretical and practical considerations. Problem indicators should be "split" when the clinician believes they are not different indicators of the same problem or treatments for the problem indicators will be different. They can be "lumped" when the clinician believes they are different indicators of the same problem, or when the treatment will be the same. Criteria supporting the belief of a single problem construct are met when indicators co-vary, are functionally equivalent, or respond similarly to the same treatment variable.


Current surgical management of left ventricular aneurysm. One hundred thirty-two patients with ventricular aneurysm had cardiac catheterization, coronary anglography, and ventriculography. More than 50 percent of the patients, in addition to aneurysmectomy, had other procedures consisting of revascularization, mitral valve replacement, and closure of ventricular septal performation. The overall mortality was 10 percent. Aneurysmectomy alone had a higher mortality (9 percent) when compared with combined resection of the aneurysm and coronary bypass (5.4 percent). During a six-month to 4-1/2-year follow-up (mean, 21 months), seven patients died, representing a late mortality of 6 percent. This study confirms the importance of complete cardiac evaluation in patients with ventricular aneurysm and shows that, in spite of extensive combined operative procedures required in more than 50 percent of the patients, the results are favorable.


Electrocoagulation of bleeding in the upper part of the gastrointestinal tract: a preliminary experimental clinical report. Electrocoagulation of gastric or esophageal bleeding sites was evaluated in dogs using a flexible suction coagulator electrode passed through the endoscope using an electrocautery unit (Cameron-Miller model 80-7910). Acute and chronic coagulation studies in 25 dogs showed that electrocoagulation of both the esophageal and gastric mucosa was safe at an electrocautery unit setting of 5 for three to five seconds. This level of coagulation was successful in stopping bleeding created from actively bleeding esophageal and gastric mucosal defects by taking multiple large biopsy specimens. Based on these data, six patients with active bleeding gastric lesions have undergone mucosal coagulation. This successfully stopped the bleeding initially in all six patients; two patients rebled and required operative intervention within 48 hours. Further clinical evaluation is being implemented to determine its clinical role in the treatment of bleeding in the upper part of the gastrointestinal tract.


[Recent views on the functional histological classification of malignant lymphomas]. The recent immunological classification of malignant lymphoma (ML) proposed by Lukes and Collins is examined. It is based on morphological changes linked to the dynamics of the reactive or secondary follicular clear centres. B-cells (follicular centre) are small or large and may cleft or not; they may proceed to macrophage or plasma cell types. T cells (around the follicles) are small and round, and have a convolute nucleus. ML types are distinguished by the predominance of one cell element, or by a mixture of cells from the maturative line of the follicular centre, i.e. T-cell (or convolute) lymphomas and B-cell (or follicular centre) lymphomas. Stem cells have none of these features. The classification was applied in a series of 32 non-Hodgkin and 24 Hodgkin ML's. Of the former, 23 were classed as B-cell types: 8 small and 5 large cleft cells; 7 small and 3 large non-cleft cells. The remainder were: 2 B-cell immunoblastic sarcomas, 3 histiocyte ML, 2 small lymphocyte ML, 1 ML with convolute lymphocytes, and 1 case with indeterminate cells ("stem cell lymphoma"). The 24 Hodgkin cases were classified in accordance with Rye's pattern (based on the work of Lukes et al.). It was noted that the numerical prevalence of convolute cells gradually fell, passing from lymphocyte dominance to lymphocyte depletion. At the same time, there was an increase in follicular centre cells and a diminution of plasma cell tending lymphocytes. The problems raised by this new immunological and morphogical classification of ML are discussed.


General surgery problems in patients with spinal cord injuries. Twenty-four patients with spinal cord injuries were studied to correlate their responses to intra-abdominal disease with the level and completeness of the cord lesion. Patients with complete cervical lesions and lesions of the upper part of the thoracic region (C-4 to T-6) usually responded by early noniocalized abdominal pain associated with signs of autonomic dysreflexia. As the disease progressed to involve the parietal peritoneum, these patients were more capable of localizing pain to the corresponding dermatome, whereas patients with incomplete lesions were able to localize their pain earlier. Patients with lumbar lesions and lesions of the lower part of the thoracic region (T-7 to L-3) were able to localize their pain earlier than those with lesions located higher in the thoracic region. All patients had delayed diagnoses except those with hemorrhage of the upper part of the gastrointestinal tract. Irrespective of level of cord lesion, increased pulse rate was themost prominent objective acute intra-abdominal pathologic finding. Shoulder pain in the quadriplegic is a most helpful sign.


Diagnostic sonography in general surgery. Eighty-seven patients who had sonographic examinations at the Orange County Medical Center were studied retrospectively to evaluate the usefulness and reliability of this noninvasive technique, and sonographic results were compared with findings at operation or findings made using other diagnostic methods. With a variety of lesions, the overall accuracy of diagnosis by sonography was 85%. In the remaining 15% of studies, false-positive or false-negative results were observed. The accuracy varied with the organ involved, the greatest being renal and hepatic masses. Ultrasound, when used in addition to careful surgical assessment of the patient, was found to be most useful in the diagnosis and follow-up of abdominal problems in surgical patients.


[Morphology of the synaptic apparatus of the motor neurons of the frog's spinal cord]. The method of light microscopy was used in order to study the synapses of motor neurons of the thoracic and lumbar parts of the spinal cord of intact frogs. Under study were the shape of the synapses, their size, as well as the quantitative distribution on the bodies and dendrites of neurons. It was established that the distribution density of active synaptic terminations on the motor neurons of the lumbar part was higher than the density of active synapses in the thoracic part, and the amount of synaptic terminations on dendrites was greater than on the neuron bodies; the snyaptic terminations of different shape were different in size; the occurrence of certain shapes of synaptic terminations in the thoracic and lumbar parts was almost the same.


[Linear measurements of the rhomboid fossa (the fourth ventricle in man]. The linear sizes of the rhombiod fossa of the human brain were studied with the help of the M. M. Sauliak-Savitskaja's device. Under study were 72 objects of the brain of humans from 20 to 78 years of age. The obtained data were statistically treated. No relationship between the sizes of the rhombiod fossa, sex and age was revealed, no statistically significant distinctions between the sizes of the right and left parts of the rhombiod fossa were revealed either. Between the length and width of the rhomboid fossa there exits a direct correlative relationship, the width of the rhomboid fossa having more close correlative relationships with the length of the superior part of the fossa rombiodea that the length of its inferior part.


Pancreatic cyst complicated by major arterial erosion and gastrointestinal haemorrhage. Uncommonly, pancreatic cysts are complicated by the erosion of certain adjacent arteries and serious gastrointestinal haemorrhage. This diagnosis should be entertained in any patient with chronic pancreatitis who presents with unexplained gastrointestinal blood loss, whether acute or chronic, a pulsatile mass in the epigastrium, and an associated bruit. Selective caeliac axis angiography may not only confirm the diagnosis, but provide precise anatomical information as a guide to the surgeon in planning treatment. The surgical treatment of choice is transcystic ligation of the bleeding vessel, followed by internal cyst drainage.


Attempted suicide: an operant formulation. An alternative formulation of attempted suicide is offered, in which the phenomenon is considered within the context of social learning theory. The suicidal behaviour is viewed as an operant which is reinforced and maintained by the consequent interpersonal contingencies. The modification of the suicidal behaviour then involves alteration of the contingent consequences. This theoretical formulation is elaborated and the treatment principles and practice are outlined.


Immunoassay of serum polypeptide hormones by using 125I-labelled anti(-immunoglobulin G) antibodies. 1. A technique for indirectly labelling antibodies to polypeptide hormones, by combining them with radioactively labelled anti-(immunoglobulin G) is described. (a) 125I-labelled  anti-(rabbit immunoglobulin G) and anti-(guinea-pig immunoglobulin G) antibodies with high specific radioactivity were prepared after purification of the antibodies on immunoadsorbents containing the respective antigens. (b) Rabbit immunoglobulin G antibodies to human growth hormone, porcine glucagon and guinea-pig immunoglobulin G antibodies to bovine insulin and bovine parathyroid hormone were combined with immunoadsorbents containing the respective polypeptide hormone antigen. (c) The immunoglobulin G antibodies to the polypeptide hormones were reacted with 125-I-labelled anti-(immunoglobulin G) antibodies directed against the appropriate species of immunoglobulin G,and the anti-hormone antibodies were combined with the hormone-containing immunoadsorbent. (d) 125I-labelled anti-(immunoglobulin G) antibodies and anti-hormone antibodies were simultaneously eluted from the hormone-containing immunoadsorbent by dilute HCl, pH 2.0. After elution the anti-(immunoglobulin G) antibodies and antihormone antibodies were allowed to recombine at pH 8.0 and 4 degrees C. 2. The resultant immunoglobulin G-anti-immunoglobulin G complex was used in immunoradiometric (labelled antibody) and two-site assays of the respective polypeptide hormone. 3. By using these immunoassays, concentrations down to 90pg of human growth hormone/ml, 100 pg of bovine insulin/ml, 80 pg of bovine parathyroid hormone/ml and 150 pg of glucagon/ml were readily detected. Assays of human plasma for growth hormone and insulin by these methods showed good agreement with results obtained by using a directly 125I-labelled anti-hormone antibody in an immunoradiometric assay of human growth hormone or by radioimmunoassay of human insulin. 4. The method described allows immunoradiometric or two-site assays to be performed starting with as little as 450 ng of polypeptide hormone-antibody protein. An additional advantage of the method is that a single iodination of the readily available antibodies to immunoglobulin G allows the establishemnt of several polypeptide hormone assays


Iron removal from transferrin by a cell-free amphibian system. 1. Transferrin-bound iron was released by a cell-free solution prepared from Rana catesbeiana immature erythrocytes, showing that cellular integrity is not necessarily a requirement for this process as previously thought. 2. The biological molecule(s) involved in the removal of iron from transferrin is relatively small.


Effect of cytostatic drugs on nucleic acid synthesis in mouse thymocytes and chick embryo cells. Cell suspensions of either mouse thymocytes or chick embryo cells were incubated with labelled precursors after preincubation with different cytostatic drugs. The total time of in vitro incubation was four hours. The ratio between the amount of incorporated labelled precursors and the total amount of DNA was determined and used to measure the cytostatic effect. All drugs used caused a marked depression of this ratio. The cytostatic drugs had no effect on the phosphorylation of thymidine.


The effect of sex hormones on the growth of HeLa tumour nodules in male and female mice. The effect of exogenous sex hormones on the cell mediated response in male and female mice has been studied by measuring the subcutaneous growth of HeLa tumour nodules and the variation in the total lymphocyte count. It was found that oestrogen treated male and female mice experienced a profound lymphopenia which was vary rapid in onset. Concurrent with the lymphopenia there was prolongation of HeLa tumour nodule growth in female mice, but not in males. A lymphopenia occurred in androgen treated male mice with subsequent prolongation of HeLa tumour nodule growth, and a lymphocytosis in female mice, with reduction of HeLa tumour nodule growth.


T and B cell populations in blood and lymph node in lymphoproliferative disease. Lymph node and peripheral blood lymphocytes were studied simultaneously for surface markers of T and B cells in 22 patients with lymphoproliferative diseases and 8 patients with non-neoplastic lymphadenopathy. This resulted in the classification of the malignancy from involved lymph nodes into 4 groups. Six patients had B cell lymphomata with normal or strong immunofluorescent staining for surface membrane immunoglobulin; 8 patients had B cell chronic lymphocytic leukaemia with pale staining for surface membrane immunoglobulin; 5 patients had T cell lymphomata and 3 patients were not definitely classifiable. In 6 out of 8 patients with B cell CLL, histopathology of lymph nodes showed infiltration with well differentiated lymphocytes and in all T cell lymphomata, the infiltrating cells were poorly differentiated. By the use of these markers, malignant lymphocytes were identified in the circulation in only 3 out of 6 patients with B cell lymphoma, in all patients with B cell CLL but in none of those with T cell lymphoma or unclassifiable lymphoma. Therefore a more conclusive characterization of the malignant lymphocyte in lymphoproliferative diseases must include an examination of involved lymph nodes.


Detection of two further beta-type cytochromes in Rhodopseudomonas spheroides. The photosynthetically-incompetent mutant V-2 of Rhodopseudomonas spheroides which is incapable of synthesising bacteriochlorophyll was grown aerobically under conditions of both high and low aeration. Potentiometric titration a at 560 nm minus 570 nm revealed the presence of several different components tentatively identified as b-type cytochromes. Two such components of oxidation-reduction midpoint potentials of +390 mV +/- 10 mV and +255 mV +/- 7mV have not previously been detected in membranes of Rps. spheroides. These components have also been resolved by difference spectra at controlled oxidation-reduction potentials and fourth derivative spectra. Neither component appeared to react with CO. With increasing aeration of the culture medium the relative concentration of these two b-type cytochromes diminished, whilst that of the a-type oxidase increased.


Immunologic characterization of the mononuclear cell infiltrates in rheumatoid synovia, in rheumatoid nodules, and in lip biopsies from patients with Sjögren's syndrome. Two subcutaneous rheumatoid nodules and 8 rheumatoid synovia from patients with rheumatoid arthritis (RA); and 2 parotid glands, 1 "pseudolymphoma," and 6 lip biopsies from patients with Sjogren's syndrome (SS) were studied to identify mononuclear cells. The palisading mononuclear cells in subcutaneous nodules had a surface membrane receptor for complement. B lymphocytes surrounded by larger numbers of non-B lymphocytes were found in RA synovium and between salivary ducts of SS lip biopsies. A "pseudolymphoma" obtained from a patient with SS consisted primarily of B lymphocytes. The predominant mononuclear cell in rheumatoid synovia and salivary glands in patients with RA and SS do not have surface membrane receptors from complement and are thus probably T lymphocytes or null cells.


Experimental murine amyloidosis: a model system for studying amyloid formation. Myeloma-associated and casein-induced murine amyloidosis were used as models to study the role of lymphocytes and macrophages in amyloid formation. Amyloidosis occurred rarely and in small amounts in Balb/C mice with immunoglobulin (Ig)-producing myeloma tumours but large amounts could be induced by injections of casein. Fluorescent staining of both forms of amyloid deposits by means of anti-casein- and anti-myeloma-amyloid antibodies indicated that they either crossreacted or coexisted. Nor abnormality of Ig biosynthesis was detected in amyloidosis, suggesting that abnormal degradation was responsible for production of the Ig form of amyloid. Although spleen lymphocytes of casein-injected mice with amyloidosis demonstrated diminished cellular immunologic responses, this did not indicate generalized immunologic incompetence. The non-Ig form of amyloid in casein-injected mice was shown to be produced by macrophages, and a technique was developed for increasing the yield of amyloid-containing cells.


Acute lymphocytic leukemia in children.

Acute lymphocytic leukemia in children. An overview is presented of the improvements in the prognosis of acute lymphocytic leukemia due to combined modality therapy. With the best available regimens, approximately 50% of these children have remained leukemia-free for 5 years or more. Because of these results, there is growing concern for the quality of survival and for the side effects of therapy. A case in point is a completely unexpected side effect in a current study. Nonleukemic leukoencephalopathy has developed in 8 of 20 children given intravenous methotrexate, 50-80 mg/m2 per week, as the sole agent following remission induction and CNS therapy. Thus, with longer remissions and survivals now commonly observed, a concerted effort is needed to minimize side effects while trying to improve further the efficacy of therapy.


Chemical synthesis of a peptide fragment of thymopoietin II that induces selective T cell differentiation. Thymopoietin is a polypeptide hormone of the thymus that consists of a 49 amino acid polypeptide chain of 5562 daltons. A peptide corresponding to positions 29-41 of bovine thymopoietin II was synthesized by the Merrifield solid-phase technique. This peptide was shown to have a purity (correct sequence) of 96% by amino acid and C terminal analyses and by a complete determination of the amino acid sequence by manual Edman degradations. It displayed a selectivity of action similar to that of thymopoietin itself, inducing the differentiation of T lymphocytes but not of complement receptor (CR+) B lymphocytes. Although a number of substances induce the differentiation of both T cells and CR+B cells under the conditions of assay in vitro, only thymopoietin and the synthetic peptide described in this report have been shown to induce the differentiation of T cells selectively. Our data establish that the key residues involved in the active site of thymopoietin are present within a synthetic polypeptide which constitutes a minor portion of the amino acid sequence of thymopoietin. Since this peptide had 3% activity by comparison with thymopoietin, the tertiary structure of thymopoietin may be required for optimal configuration of the active site to produce full biological activity.


Left main coronary artery obstruction. Follow-up of thirty patients with and without surgery. Thirty patients, 20 males and 10 females, having a 50% or greater obstruction of the left main coronary artery, were evaluated. Their ages ranged from 40 to 71 years (mean 53.8 years). All patients had angina pectoris, the duration of which varied from 2 months to 20 years (mean 5.4 years). Twenty-four patients (80%) had accelerated angina pectoris; 17 (56.7%) had prior myocardial infarction, and 27 (90%) were found to have coexisting three-vessel disease and abnormal left ventricular contraction. There were no deaths or serious arrhythmias related to cardiac catheterization procedures. In the 11 unoperated patients 5 (45%) died within the first year of follow-up; however, all except one death occurred in patients with diffuse distal coronary artery disease technically unsuitable for surgery. Among the six survivors four were considered surgical candidates. These four patients have continued to have symptoms of angina pectoris with a mean follow-up period of 17.5 months (16 to 20 months). In the 19 patients who underwent aortocoronary saphenous vein bypass grafting, there was one immediate postoperative death (surgical mortality 5.3%) and one late death. The 17 survivors in the surgical group have a mean follow-up period of 17.3 months (8 to 31 months); 13 of them have clinically improved with 6 being totally free of angina pectoris. Thus, mortality is extremely high in those with poor distal vasculature technically unsuitable for surgery, but mortality is relatively low in patients who have technically bypassable lesions whether treated surgically or medically. Although saphenous vein bypass grafting appears to be more effective in providing clinical improvement, asymptomatic left main coronary obstruction may not justify surgical therapy.


Myocardial damage in combined valvular and coronary bypass surgery. The incidence of perioperative myocardial infarction (MI) and acute ischemic injury was determined in 44 patients having aortic valve replacement plus aortocoronary vein grafts (AVR + CABG) and in 22 patients having mitral valve repair or replacement plus aortocoronary vein grafts (MVR + CABG). These data were correlated with aortic cross-clamp time, fibrillation time, presence of left ventricular hypertrophy, and, in selected cases, left ventricular biopsy. Perioperative MI occurred in 21% (9/44) of the AVR + CABG patients and 5% (1/22) of MVR + CABG patients. In contrast, the MI rate for isolated valve replacement was 7% (15/213), and for isolated CABG 14% (16/112). In the AVR + CABG group, 100% (5/5) of patients with combined cross-clamp and fibrillation times greater than 120 minutes suffered MI. These results indicate that patients with combined AVR + CABG are subject to substantially greater risk of perioperative myocardial damage than the other groups. Excessive aortic cross-clamp times and fibrillation plus aortic cross-clamp times should be avoided in AVR + CABG patients.


Prospective randomized study of coronary bypass surgery in stable angina. The first 100 patients. In a prospective study to evaluate surgery for angina pectoris, 50 patients randomized to surgery and 50 treated medically have completed 8 to 34 months' follow-up (median, 24 months). Anginal symptoms improved in both groups (88%, 72%), but more operated patients are currently asymptomatic (70%, 8%) and using fewer medications (nitrates, 18%, 96%; propranolol, 8%, 72% of patients). Exercise tests with treadmill revealed increased exercise tolerance time in both groups, more so in the operated group (+ 89%, + 42%), and angina could not be provoked in 70% and 20% of patients, respectively. During the follow-up, fewer cardiac complications developed in the operated group (19 vs. 44; P = less than 0.02); there was no difference in mortality. Repeat catheterization in 83 of 84 survivors at 1 year did not reveal any significant differences in the progression of disease. Atrial pacing studies revealed improvement in anginal threshold in 70% of operated and 48% of nonoperated patients. The study suggests that although subjective and objective improvement occurs with surgical as well as nonsurgical treatment, the frequency and magnitude are higher with surgery. The quality of life appears to be better in the operated patients during the first 24 months. Further follow-up is necessary to determine the duration of such improvement and to assess the influence of surgery on the natural life history of this disease.


Long-term survival following coronary bypass surgery in patients with significant impairment of left ventricular function. To assess the influence of coronary revascularization on the long-term survival of patients with debilitating angina and significant impairment of left ventricular function, analysis was done of 62 consecutive patients with severe angina and hypokinetic left ventricles (LVED larger than or equal to 20) undergoing coronary bypass at N.Y.U. Medical Center between January, 1971 and May 1974. Follow-up was 98% complete, range 4 to 41 months with a mean of 23 months. Multiple bypasses were done in 94% of the group; a left-ventricular scar was excised in 16%. There were six operative deaths (mortality 9.7%) and three late deaths, all within eight months after operation. Angina was either absent or substantially improved in 90% of surviving patients. Life-table analysis shows a two-year survival of 85%, very similar to the survival rate for patients with good ventricular function. Hence, with current techniques impaired ventricular function is not a major contraindication to bypass grafting.


Effects of partial obstruction on phasic flow in aortocoronary grafts. Phasic blood flow recorded in five unobstructed dog aortocoronary bypass grafts to the left coronary artery was similar to that of normal coronary arteries, with a high diastolic-to-systolic flow ratio which averaged 2.7 +/- 0.4. With an average of 52 +/- 7% and 72 +/- 6% stenosis in the coronary artery distal to the graft, the phasic graft-flow pattern was altered, with a decrease in the diastolic-to-systolic flow ratio to 1.9 +/- 0.4 and 1.2 +/- 0.4, respectively. Phasic patterns recorded in 42 human saphenous vein grafts to branches of the left coronary artery subsequently shown to be patent by postoperative coronary arteriography were similar to those of a normal coronary artery, with an average diastolic-to-systolic flow ratio of 2.3 +/- 0.83 and an average flow of 76 +/- 48 ml/min. Phasic flow measured in 20 grafts shown to be occulded at restudy had an average diastolic-to-systolic flow of 1.3 +/- 0.45, with an average flow of 72 +/- 33 ml/min and a phasic graft flow which was similar to that obtained from partially obstructed coronary arteries. We conclude that partial obstruction of the graft or the distal coronary artery alters the flow pattern, and this partial obstruction may lead to closure of the graft.


Coronary bypass surgery. Value of maximal exercise testing in assessment of results. To evaluate the relationship of results of maximal treadmill testing and results of saphenous vein bypass surgery (SVG), 30 patients underwent a maximal treadmill test before and after SVG; an additional 39 had results of postoperative exercise testing available. These patients were part of a group of 91 patients (95% of 96 survivors) who had complete right- and left-heart catheterizations and coronary angiography before and after operation. Twenty-one per cent had improved ejection fractions postoperatively; in 32% ejection fractions were worse. Duration of maximal treadmill exercise correlated poorly with ejection fraction changes or graft patency. Rate-pressure product (RPP) was usually lower postoperatively in patients with worse ejection fractions, primarily because of a low systolic blood pressure at maximum exercise. RPP postoperatively of less than 25,000 almost always meant poor surgical results, either graft occlusion or poor left ventricular function, while RPP of more than 30,000 meant that left ventricular function was preserved and all grafts or the graft to the anterior descending were patent. Thus, success or failure of SVG in these groups may be predicted without postoperative catheterization. An open graft to the anterior descending coronary generally insured a high RPP with exercise, even if other grafts were closed, as long as ventricular function remained good.


Combined gas endarterectomy and coronary artery bypass graft. A follow-up study. One hundred and four patients who underwent combined gas endarterectomy and bypass grafting were followed for periods up to 4 1/2 years (mean, 15 months). The early mortality was 2.9% and the late mortality 3.8%; all of these deaths occurred in patients operated on for heart failure. The survival rate, presented in an actuarial manner, was 91% for the whole group at 3 years. Perioperative infarction occurred in 5.8%, was usually accompanied by patent grafts, and produced left ventricular dysfunction in only 1 of 5 patients investigated. Symptomatic improvement was observed in 96% of the patients. There was fairly good correlation between symptomatic improvement and graft patency. Repeat graft and coronary angiography showed that of 65 grafts to endartectomized arteries, 56 were patent (a patency rate of 87%); there was no evidence of decrease of patency rate with time, and no significant difference between patency rates of grafts to different arteries. The runoff of patent grafts was judged to be good in 75% of patients, moderate in 15% and poor in 10%.


Myocardial infarction in coronary artery surgery. Myocardial infarction has been noted as a frequent complication of coronary artery surgery in many review series, although its causes are uncertain. Follow-up of 100 patients at 19.7 months (mean) after coronary bypass surgery identified 15 patients with perioperative myocardial infarction as judged by new, significant Q waves after surgery. There were no significnat differences in age, preoperative anginal class, previous infarction, presence of hypertension, hyperlipidemia, or frank glucose intolerance compared with the 85 patients without infarction. Nor was there a significnat difference in coronary artery score, left ventricular end-diastolic pressure, cardiac index, or presence of collaterals. Cardiopulmonary bypass time, duration of anoxic arrest, and number of vessels grafted did not differ. Perioperative infarction always occurred in the territory of a grafted vessel and not in comparably compromised, nongrafted areas. In 13 cases new Q waves appeared in the first 24 hours, and myocardial infarction was not clinically suspected. Eight of the 15 grafts at risk were patent at late follow-up. Mean ejection fraction was not significantly changed postoperatively, but affected segmental wall motion declined in most cases. Five patients with perioperative infarction but no patent grafts improved by only 1 NYHA class (mean), but ten patients with infarction and one or more grafts patent improved by 2.9 NYHA classes (mean). Perioperative infarction could not be correlated with currently recognized patient and operative risk factors. The consistent anatomical relationship suggested that the grafting procedure itself was critical to the occurrence of distal segmental infarction.


Myocardial blood flow following saphenous vein bypass surgery. Myocardial blood flow was measured by the 133Xe clearance technique in 21 patients 6 to 31 months after saphenous vein grafting for coronary arterial disease. Preoperative measurements were made in 16. All patients had improved symptomatically, and 20 had returned to work. Thirty of 39 grafts were entered and selective injections of 133Xe performed. Flow in the left coronary artery (LCA) was unchanged postoperatively in 9, increased in 5, and decreased in 1 (preoperative mean = 54 ml/100 g/min, SD +/- 16; postoperative mean = 65 ml/100 g/min, SD +/- 20). Flow in the right coronary artery (RCA) was unchanged postoperatively in 3, decreased in 9, and increased in 2 (preoperative mean = 46 ml/100 g/min, SD +/- 18; postoperative mean = 33 ml/100 g/min, SD +/- 12). Nine of 14 grafts to the left anterior descending coronary artery showed flow rates significantly greater than those in the corresponding LCA. Two of the 3 circumflex grafts showed flow rates significantly lower than those in the LCA. Four of 8 right grafts showed significantly higher flow rates than those in the corresponding RCA. These findings correlated well with the angiographic appearances. We conclude that saphenous vein grafting increases total myocardial blood flow. The data suggest that the coronary arteries and the grafts are supplying different regions of the myocardium, and that the graft regions were previously underperfused. There would appear to be little mixing of blood between artery and graft regions.


Saphenous vein bypass grafting. Changes in native circulation and collaterals. One hundred patients were evaluated 12 to 43 months after saphenous vein bypass surgery. The rate of progression of obstructive disease in the native vessels and changes in collateral circulation were analyzed in detail. Fifty-five per cent of preoperatively patent vessels showed progression proximal to the site of graft insertion, 40% proximal to patent grafts; there was distal progression in only 7% of grafted vessels. The progression rate for nongrafted vessels was 14%. Patent grafts were associated with a high rate of disappearance of collaterals to the grafted vessels, while occluded grafts were associated with preservation of collaterals or appearance of new collaterals. Progression of obstructive disease in the native circulation and changes in collaterals did not prevent symptomatic improvement (93% of patients were symptomatically improved).