Ouabain on active transepithelial sodium transport in frog skin: studies with microelectrodes. Studies were done with isolated frog skin to determine the effects of 10(-4) M ouabain on the electrophysiological parameters of outer and inner barriers of the Na-transporting cells. Microelectrodes were used to impale the skins from the outer surface to determine the intracellular voltages (Vsco) under conditions of short-circuiting and under conditions where a voltage clamp was used to vary the transepithelial voltage, VT. From this, the electrical resistances of outer (Rfo) and inner (RI) barriers were estimated. In addition, the driving force for active transepithelial Na transport (ENa = E'1) was estimated from the values of VT when the Vo = 0 mV (Helman and Fisher. 1977. J. Gen. Physiol. 69: 571-604). Studies were done with skins bathed with the usual 2.4 meq/liter [K]i in the inner solution as well as with reduced [K]i of 0.5 and 0 meq/liter. Characteristically, the responses to ouabain could be described by an initial rapid phase (5-10 min) during which time the Ri was increased markedly and the E'1 was decreased from control values. Thereafter, during the slow phases of the response, the resistances of both outer and inner barriers increased continuously and markedly with time leading ultimately to essentially complete inhibition of the short-circuit current. Similar studies were done with skins exposed to 10(-4) M amiloride in the outer solution. Although estimates of Ri could not be obtained under these conditions, the effects on the Vsco and E'1 were similar to those observed for the Na-transporting skins. However, the magnitudes of the effects were less and relatively slower than observed for the Na-transporting skins. The results of these studies were analyzed within the context of a proposed electrical model that takes into account the observation that the magnitude of the voltage at the inner barrier appears to exceed the equilibrium potential for K especially when transepithelial Na transport is inhibited at the apical barrier of the cells.


Cytotoxic T-cell and antibody responses to influenza infection of mice. The immune response to influenza infection was evaluated in mice using recently developed techniques to measure the induction of cytotoxic thymus-derived (T) lymphocytes and complement-dependent cytolytic antibody, locally and systemically, during primary and secondary immunization. Cytolytic antibody responses were compared to antibody titres measured by haemagglutination-inhibition (HI) and neutralization in the same samples. The development of these responses was also correlated with the titres of virus in the lung, in an attempt to further define the role of these host immune responses which can kill virus infected cells during recovery from influenza infection in vivo.


The spectrum of clinical manifestation of anomalous origin of the left coronary artery and surgical management. Intercoronary collaterals play a major role in determining whether patients with the symptoms of anomalous left coronary artery will suffer infarction early in life with resultant complications or will survive to an older age before becoming symptomatic with angina. We believe that the definitive surgical treatment should be performed at the earliest age possible to avoid further damage to myocardial muscle.


Arteriographic embolization for control of recurrent severe gastric hemorrhage in a 10-yr-old boy. Severe stress ulceration or stress gastritis may occasionally produce uncontrollable gastric hemorrhage in the pediatric age group. Modern arteriographic techniques utilizing selective embolization to occlude demonstrated bleeding arteries can successfully control such hemorrhage and avoid emergency destructive surgical resection. A 10-yr-old boy, in whom a previous 80% gastric resection failed to control life threatening hemorrhage, is presented, with roentgenographic demonstration of the procedure and the successful control of his gastric bleeding.


Nuclear-substituted styryl ketone analogs: effects on neoplasms, microorganisms, and mitochondrial respiration of tumorous and normal cells. Analogs of some antineoplastic and cytotoxic Mannich bases derived from conjugated styryl ketones were prepared and evaluated for activity in the P-388 lymphocytic leukemia screen. Most of the new compounds had lower antineoplastic and murine toxicity than the parent compounds. Antimicrobial evaluation of some oximes and alcohols related to the Mannich bases revealed activity against certain Gram-positive bacteria and fungi. Primary pharmacological evaluation showed that some compounds containing a dimethylaminomethyl group displayed analgesic and antihistaminic properties. Five of the Mannich bases were evaluated as respiratory inhibitors in mitochondria derived from hepatic tumors, liver tissue from tumor-bearing animals, and normal rat liver. No statistical difference between the sensitivity of the three tissues to the compounds was obtained.


The velocity of unloaded shortening and its relation to sarcomere length and isometric force in vertebrate muscle fibres. 1. The velocity of shortening at zero load was studied during fused tetanic contractions and single twitches in isolated skeletal muscle fibres of Rana temporaria. 2. The technique used for determination of the speed of unloaded shortening consisted of a series of quick releases of different amplitudes applied at a given instant during activity. The time, delta t, needed for the fibre to take up the slack was plotted against the amplitude of release, delta L. The slope of the straight line relating delta t-delta L provided a measure of the velocity of shortening at zero load, V0. 3. V0 was compared with force-velocity data obtained at finite loads (load-clamp recordings). The predicted velocity of shortening at zero load, derived by hyperbolic extrapolation from velocities at low and intermediate loads, was not significantly different from V0. 4. The temperature dependence of isometric force and of shortening velocity was investigated between 2 and 12 degrees C in the same fibres. Q10 was 2.67 +/- 0.07 (S.E. of mean, n = 6) for V0 and 1.24 +/- 0.01 for tetanic force. 5. The velocity of unloaded shortening was determined at different sarcomere lengths in the range 1.4--3.1 microns. V0 was constant between 1.65 microns and approximately 2.7 microns. It decreased below 1.65 microns and increased above 2.7 microns. 6. The decrease in velocity at short sarcomere lengths probably reflects an increase of the passive resistance to shortening. The increase in velocity at long sarcomere lengths can be accounted for by the passive compressive force that is produced by the parallel elastic elements of the prestretched fibre. 7. V0 was determined at the peak of the twitch and during the plateau of the fused tetanus in the same fibre. Whereas the peak twitch force varied between 38 and 85% of the tetanic tension in the different fibres (mean: 71 +/- 5%, n = 8), V0 during the twitch was 99 +/- 2% of the value recorded during the tetanus. Depression of the isometric twitch amplitude to 10% of the control value by dantrolene did not cause any significant reduction of V0.


Effects of temperature on tension, tension-dependent heat, and activation heat in twitches of frog skeletal muscle. 1. The effects of temperature on muscle energy liberation (heat plus work production) and isometric twitch force production were measured at rest length (l o) and at long muscle lengths (approx. 1.35 l o) where twitch force was greatly depressed. 2. Force production and energy liberation at l o declined progressively as muscle temperature was elevated from 0 to 20 degrees C. Force production decreased to a greater extent than did energy liberation. A plot of energy liberation vs. twitch force suggested that a fraction of the l o energy liberation was produced independent of temperature. 3. The energy liberated at long muscle lengths, the activation heat, was independent of muscle temperature. The activation heat is interpreted as reflecting the energy dissipated during Ca2+ cycling and thus suggests that, under the conditions of these experiments, the amount of Ca2+ released with stimulation is independent of muscle temperature and subsequent muscle force production. 4. Analysis of the results also supports the conclusions that skeletal muscle energy liberation is dependent on muscle force production and that the energy liberation associated with Ca2+ cycling is essentially independent of muscle length in the range of l o--1.35 l o.


Neural connexions between the medial forebrain bundle, the preoptic area and the basal hypothalamus in the rat: an electrophysiological study. 1. Electrophysiological experiments have been performed on intact cycling female rats to investigate the neural connexions that exist between the medial forebrain bundle, the anterior hypothalamic region, which included the preoptic area, and the basal hypothalamus. Recordings have been made from a total of 351 neurones in the anterior hypothalamus of which 216 were responsive to stimulation of either or both the medial forebrain bundle and basal hypothalamus (arcuate and ventromedial nuclei).2. Forty-six of these cells were responsive to a stimulus applied both to the medial forebrain bundle and the basal hypothalamus with a variety of response combinations. The majority of neurones were orthodromically activated by stimulation in both sites. Inhibition by stimulation of the medial forebrain bundle coupled with orthodromic excitation from the basal hypothalamus, or the reverse situation, was also encountered frequently.3. A few cells were antidromically invaded by the stimulation of the medial forebrain bundle and these received orthodromic or inhibitory inputs from the basal hypothalamus, although one unit outside the anterior hypothalamus was antidromically activated by both stimuli.4. Ninety per cent of all the doubly responsive units that could be antidromically activated by stimulation of the basal hypothalamus received an orthodromic input from the medial forebrain bundle, and no cells in the anterior hypothalamus that projected to the basal hypothalamus were found to receive an inhibitory input from the medial forebrain bundle.5. These results provide electrophysiological evidence for inhibitory and excitatory inputs from the medial forebrain bundle to the preoptic and anterior hypothalamic cells that either project to, or receive connexions from, the basal hypothalamus. Neurones in the preoptic area which project to the basal hypothalamus are implicated in the control of anterior pituitary function, particularly gonadotrophin secretion. These experiments, coupled with functional studies, suggest that there is an excitatory input from the medial forebrain bundle to these preoptic and anterior hypothalamic cells which may modulate adenohypophyseal secretions.


Structure of trichomonads as revealed by scanning electron microscopy. A scanning electron microscope (SEM) study of Hypotrichomonas acosta (Moskowitz), Trichomonas vaginalis Donné, Pentatrichomonas hominis (Davaine), and Tritrichomonas foetus (Riedmüller) provided new information about the structure of the periflagellar canal; emergence of the flagella from the cell body; structure of the undulating membrane; and position, shape, and size of the pelta. Of special interest were the spatial relationships of the attached part of the recurrent flagellum and the accessory filament in Hypotrichomonas and in the members of Trichomonadinae, i.e. Trichomonas and Pentatrichomonas.


On the cross-reactivity of amiloride and 2,4,6 triaminopyrimidine (TAP) for the cellular entry and tight junctional cation permeation pathways in epithelia. 2,4,6 Triaminopyrimidine (TAP) has been previously shown to inhibit the passive tight junctional cation permeation pathway in various "leaky" epithelia. Amiloride has been shown to be an effective inhibitor of the cation cellular entry pathway in "tight" epithelia. In this paper we demonstrate that TAP and amiloride at appropriate concentrations are able to block either of these epithelial cation permeation pathways. TAP was found to block the Na entry pathway in frog skin with the following characteristics: it (1) inhibits from the external solution only, (2) is completely reversible, (3) increases the transepithelial resistance, (4) is active in the monoprotonated form, (5) is noncompetitive with Na, (6) displays saturation kinetics which obey a simple kinetic model (KI = 1 X 10(-3) M), (7) is independent of external calcium, (8) is dependent on external buffering capacity, and (9) is competitive with amiloride. Amiloride inhibition of the junctional permeation in gallbladder had the following characteristics: it (1) increases the transepithelial resistance, (2) decreases cation conductance without affecting the anion conductance, (3) displays saturation kinetics which obey a simple kinetic model (KI = 1 X 10(-3) M), and (4) possesses inhibitory activity in both its protonated and unprotonated form. These results not only indicate that a similar inhibitory site may exist in both of these cation permeation pathways, but also provide information on the chemical nature and possible location of these inhibitory sites.


Uropod-bearing lymphocytes (hand mirror cells) in a virus-induced murine lymphoma. A Moloney murine leukemia virus-induced T-cell preleukemic thymic lymphoma tissue culture from an inbred C3H/HeJ mouse contained numerous hand mirror cells (HMC). The cells were studied by light and phase-contrast microscopy, special stains, indirect immunofluorescence for terminal deoxynucleotidyl transferase, and scanning and transmission electron microscopy. The uropods of the mouse and human HMC were similar. In contrast, viruses were noted on the tip of the mouse HMC uropod by transmission electron microscopy. These observations, reported for the first time in an animal model, will enable investigators to study the HMC under controlled conditions.


The treatment of detrusor incontinence by electrical stimulation. Cystometrograms were done on 20 patients before and during transrectal stimulation to determine if electrical stimulation increased the detrusor reflex threshold. In 4 patients the detrusor reflex threshold was increased during stimulation and urinary continence was restored. However, each patient became incontinent when transrectal stimulation was discontinued for 1 to 5 days. Thus, cyclic periods of stimulation were necessary to maintain the beneficial effects of electrical stimulation and a permanent pelvic floor stimulator was implanted since chronic transrectal stimulation was inconvenient.


T and B lymphocytes and blastogenesis in leprosy. T and B cell percentages and their blastogenic response to PPD and lepromin have been studied in 107 patients of various types of leprosy. T cell counts and their blastogenic response were found to be considerably lower in all types of leprosy as compared to the normal. The counts and stimulation were the lowest for lepromatous leprosy. B cell counts were unaltered in all types of leprosy.


Successful use of a left ventricular assist device in cardiogenic shock from massive postoperative myocardial infarction. A 41-year-old man underwent an uneventful aorta-coronary bypass for unstable angina pectoris. Four hours later, a massive anterior wall myocardial infarction resulted in cardiac arrest. Conventional resuscitative means were not effective. A left ventricular assist device (LVAD) was successfully employed for 94 hours. The patient is alive and well 8 months postoperatively.


Electrophrenic respiration: report of six cases. The development of electrophrenic respiration has permitted freedom from mechanical ventilation for patients who have irreversible respiratory failure in association with high-cervical spinal cord or brainstem lesions. There are three basic criteria for successful diaphragm pacing: (1) the need for long-term mechanical ventilatory assistance, (2) a functionally intact phrenic nerve-diaphragm axis, and (3) chest wall stability. Inability to achieve satisfactory pacing can be due to malfunction of equipment, instability of the chest wall, or inadequate neuromuscular responsiveness. These features of diaphragm pacing are exemplified in a series of six patients. Three achieved independence from mechanical ventilatory assistance with full-time phrenic pacing. In one patient, only limited electrophrenic respiration was achieved, and in another the method was entirely unsuccessful. Although functioning well, pacing systems were removed from the sixth patient because of infection. Diaphragm pacing can be a valuable form of respiratory support for carefully selected patients.


[Laboratory procedures in the detection of deficiencies and the determination of alpha 1-antitrypsin phenotypes in the blood serum]. Eriksson's method was analysed and an attempt was made to determine the probability of the occurrence of phenotypes predisposing to emphysema and obstructive catarrhs, when low alpha-1-AT values were found using gelatinous film or immunochemical methods. The authoresses propose a three-stage system for the detection of all those susceptible to emphysema.


Association of prealbumin deficiency with alpha-1-antitrypsin deficiency. Prealbumin (PA) measurements were made by electrophoretic and radial immunodiffusion techniques in three alpha-1-antitrypsin deficient Pi-D) serum samples. The deficiency was characterized as phenotype ZZ (homozygous). In two out of three serums PA was undetectable, as revealed by the absence of radiothyroxine distribution in the PA area, whereas quantitative estimates of PA by radial immunodiffusion showed very low levels (2--7 mg/100 ml) thus corroborating electrophoretic observations; low PA binding of T4 tracer was noted in another Pi-D serum. The total protein and laboratory thyroid function (thyroxine, triiodothyronine, and free thyroxine index concentration) measurements were normal, and the decrease in PA could not be explained on the basis of surgery, protein malnutrition, or cirrhosis. These and other observations described in this preliminary communication have served to raise the possibility of severe prealbumin deficiency being associated with alpha-1-antitrypsin deficiency, while the presence of low-but-not-absent PA in another Pi-D case might also suggest subgroup classification of the phenotype ZZ based on degrees of PA deficiency.


Problem orientated medical records--all or none? Junior hospital doctors from different medical schools were asked about their experience of the Problem Orientated Medical Record. Few had been introduced to this method of writing notes by their teachers when they were undergraduates, though more had learned about it from other sources. The majority of those with experience of the method found it preferable to the more conventional one. The advantages and disadvantages of the method are discussed and it is suggested that a less rigid format might make it more acceptable. This can be achieved by writing follow-up notes in the usual way and using the problem orientated approach only when the patient is assessed for the first time or when information is passed from one team of doctors to another.


Macrophage-T cell interaction mediated by immunogenic and non-immunogenic forms of a monofunctional antigen. As an approach to the elucidation of the essential steps in the immune pathway, the uptake and retention of immunogenic and non-immunogenic analogs of a monofunctional antigen by guinea pig macrophages and the efficiency of macrophages pulsed with the compounds to present antigen to sensitized T lymphocytes were compared. L-Tyrosine-azobenzene-p-arsonate (RAT) and its non-immunogenic analog, 4-hydroxyphenyl-n-propane-3-azobenzene-p-arsonate (RAN), react similarly with antiarsonate antibody, but RAN, unlike RAT, is unable to induce cellular immunity in guinea pigs. The uptake and retention patterns of the two compounds by macrophages differed in that, at a given time, more RAN than RAT was retained and detectable on cell surfaces by anti-arsonate antibody. Equivalent numbers of T lymphocytes from guinea pigs sensitized to RAT formed antigen-dependent clusters with macrophages pulsed with either RAT or RAN after 24 hr in culture, but not with macrophages pulsed with an azobenzenoid compound of unrelated specificity. On the other hand, T lymphocytes from guinea pigs immunized with RAN showed no significant capacity to bind to macrophages which had been pulsed with any of the compounds. The number of lymphocytes from RAT-sensitized animals which bound to RAT-pulsed macrophages remained relatively stable over a 48 hr period, whereas clusters of the same lymphocytes with RAN-pulsed macrophages dissocitated to background levels within that time. Early cluster formation mediated by RAN, as well as its ability to induce transient specific T cell unresponsiveness to RAT in vivo, indicate that T cells are capable of recognizing (binding) the non-immunogen. However, such early, and perhaps weak, interaction with RAN-pulsed macrophages did not induce DNA synthesis by T cells. Anti-Ia serum completely blocked cluster formation mediated by either RAT or RAN. Thus, the only significant distinction disclosed by these studies between the immunogenic and non-immunogenic compounds was the stability of macrophage-T cell interaction as determined by the persistence of antigen mediated cell clusters in culture, suggesting that this may be a factor in immunogenic discrimination.


Nitrous acid mutagenesis of duplex DNA as a three-component system. Purified native Hemophilus influenzae DNA is relatively insusceptible to nitrous acid (NA) mutagenesis in vitro, but is readily mutated following denaturation. NA mutagenicity for duplex DNA is significantly increased in the presence of various alcohols, glycols, phenols or primary amines. Phenol-extracted DNA contains dissociable contaminants of low molecular weight that enhance NA mutagenesis. Enhancement of NA mutagenesis by phenol and by spermine is due to the formation of unstable molecular species. We propose that reactive organic nitroso compounds are formed which then serve as delivery vehicles to promote mutagenicity of native DNA, perhaps via transnitrosation reactions. Similar reactions probably occur in vivo to promote NA-induced base substitution (but not frameshift) mutations in Salmonella typhimurium and in Escherichia coli. The possible significance of these observations to carcinogenesis is discussed.


Familial abnormalities of suppressor-cell function in systemic lupus erythematosus. We tested the hypothesis that abnormalities of central immune function are genetically controlled in patients with systemic lupus erythematosus. We used an in vitro suppressor-cell assay to evaluate central immunoregulation in 15 patients, 50 of their clinically healthy family members and 41 normal persons. Impaired suppressor-cell function was found in 11 patients; there was no correlation between disease activity and test results. Abnormal suppressor-cell activity was also found in 13 first-degree relatives, 12 of whom were women. We found no correlation between results of the suppressor-cell assay and the presence or absence of lymphocytotoxic antibodies in the relatives. Impaired suppressor-cell function cannot by itself explain the pathogenesis of systemic lupus erythematosus. Our results support the hypothesis that certain abnormalities of suppressor cells are genetic markers. We propose that the development of systemic lupus erythematosus requires the participation of at least two functionally distinct classes of genes.


Autonomic hyper-reflexia modulated by percutaneous epidural neurostimulation: a preliminary report. Our clinical experience in the management of five paraplegic or quadriplegic patients with subjective complaints and objective findings of autonomic hyper-reflexia is presented. These five patients had epidural neurostimulation systems implanted percutaneously to regulate intractable spasticity. During a follow-up period varying from 2 months to almost 2 years, four of the five patients experienced no episodes of autonomic dysfunction with the use of a low frequency, low voltage, square wave pulse output. From their responses and from recent neurophysiological evidence, the potential benefit of percutaneous epidural neurostimulation in the modulation of autonomic hyper-reflexia without antihypertensive medication is suggested. Further follow-up of these patients and additional clinical research should be performed to confirm our initial clinical impressions.


Cerebellar stimulation in the management of cerebral palsy: clinical and physiological studies. Cerebellar stimulators were inserted into seven children who had cerebral palsy and in whom extensive investigation, including computerized tomography, had revealed no structural brain abnormality. A team including physiotherapists, occupational therapists, speech pathologists, and respiratory physiologists assessed the children pre- and postoperatively; their somatosensory evoked potentials were also measured. The mean age at implantation was 8.6 yearsl follow-up has ranged from 8 to 23 months (mean, 17.3 months). No adverse effects of the cerebellar stimulation have been noted. Detailed case histories obtained from the parents, together with formal assessment scores, indicate good improvement in six patients and mild but significant improvement in the seventh. Clinically, there has been gradual improvement in all seven patients. The charge density range associated with clinical improvement was 0.8 to 2.1 muCi/cm2/phase. The stimulation equipment must be monitored very carefully to ensure that any variation from the desired output is acceptably small because it is probable that sizable deviation is a determining factor in lack of response to this therapy.


[Cell-mediated immunity after head injuries]. In 20 patients with head trauma associated with loss of consciousness without massive damage to the tissues total count of lymphocytes T in the peripheral blood was determined, and test of lymphocyte blastic transformation and leucocyte migration inhibition were done. The investigations were done one time only, usually 5 days after trauma. In the patients the total count of lymphocytes and T-cells was decreased in the peripheral blood and production of the factor inhibiting leucocyte migration was reduced. The immune disturbances observed in these patients were due probably to the action of stress triggered by trauma.


Dorsal spinal cord stimulation in the treatment of multiple sclerosis. Previously published work indicated significant improvement in the symptoms of multiple sclerosis with dorsal spinal cord stimulation. In this study 23 patients with multiple sclerosis documented by history, examination, laboratory studies, and clinical course were treated with dorsal spinal cord stimulation and followed for 19 to 45 months (mean, 32 months). Pre- and postoperative clinical assessment was carried out using the Kurtzke Scale. Walking velocity, upper limb coordination, sphincter function, and sensory function were also evaluated quantitatively. No statistically significant objective improvement in any of these measures was demonstrated. Fifty per cent of the patients initially reported subjective symptomatic improvement, but this declined to 30% at last follow-up. Fifteen of 23 patients experienced complications related mainly to the hardware used and required a total of 21 subsequent operative procedures for correction of these complications. These results do not support the continued clinical use of dorsal spinal cord stimulation in the symptomatic treatment of multiple sclerosis.


Measurement of the normal ventricular system and supratentorial subarachnoid space in children with computed tomography. The normal ventricular system and subarachnoid space were evaluated on the CT scans of 155 children chosen from 1,400 pediatric CT examinations, and linear measurements were made. The left septum-caudate distance was greater than the right, and the width of the left anterior horn and size of the skull were larger in boys. The interhemispheric and sylvian fissures, the third ventricle and Evans' ratio were larger in the younger group (less than 3 years) than in the older (greater than or equal to 3 years), while the opposite was found for the cella media index and size of the skull. The size of the lateral ventricles (expressed by anterior horn width, septum-caudate distance and width of cella media) was not different in the two age groups of children. Normal limits for the linear measurements and indices are given in Table 2.


Computed tomographic evaluation of the early phase of adrenoleukodystrophy. Analysis of computed tomograms of patients with adrenoleukodystrophy in the early disease phase reveals a dinstinct CT apperance. It is suggested that brain or adrenal biopsy may not be necessary for diagnosis of adrenoleukodystrophy when these particular CT features are correlated with the clinical course and other laboratory parameters.


[Postoperative complications in the Billroth I gastrectomy]. A series of 234 patients who underwent Billroth I gastric resection for gastric and duodenal ulcerous lesions is reported. Special attention is paid to the immediate postoperative complications whose incidence was 5.5%. Particularly serious is the dehiscence of gastroduodenal anastomosis which requires emergency reconversion intervention, namely gastrojejunostomy with sinking of the duodenal stump.


Increased colony-stimulating activity in the plasma of a patient with lymphoepithelioma metastatic to the liver. Leukocytosis with predominance of poly morphonuclear leukocytes is not unusual in a variety of primary or metastatic hepatic tumors. However, to date no apparent explanation for this event is available. This paper describes extreme leukocytosis in a 17-year-old black male with lymphoepithelioma after development of metastases to the liver. In order to identify the source of leukocytosis, studies of granulocytic colony-stimulating activity (CSA) of the patient's plasma and leukocyte-conditioned media (LCM) were carried out and compared with normal controls. The assay system consisted of nonadherent marrow cells of hematologically normal individuals and normal mice cultured in semi-solid culture media. In this system, the number of granulocytic colony-forming units (CFU-C) is proportional to the amount of stimulating activity present, and therefore allows for quantitative comparison. The number of colonies produced under the influence of patient's plasma was significantly higher (p less than 0.001) than those obtained from the patient's LCM or from control plasma or LCM. This pattern is the reverse of that seen in normal individuals in whom the major sources of CSA are macrophages and monocytes. It is conceivable that malignant cells are the source of additional CSA.


[Interaction of T- and B-cells in the secondary response to ram erythrocytes in mice of different ages]. The spleen cells from old primed donors were found to produce lesser secondary response, as compared with the cells of young animals, in the system of adaptive transfer on the CBA mice. In the experiments with extermination of T-or B-cell population in the cell suspension by means of theta-or anti-b-sera it was established that the memory to the antigen used (ram ethyrocytes) was carried by both T- and B-cells but the T-cell component played the leading role in this system. The primed cells from old animals proved to be more sensitive to defects of cellular interactions.


Amphotericin B methyl ester: evaluation for intravitreous use in experimental fungal endophthalmitis. Amphotericin B methyl ester, a water-soluble derivative of amphotericin B, is an experimental antifungal agent. Intravitreous injection of 5 and 10 micrograms of amphotericin B methyl ester in the normal rabbit eye does not cause toxic changes that can be detected clinically, microscopically, or by electroretinography. A single intravitreous injection of 5 micrograms was effective in reversing the course of exogenous Candida fungal endophthalmitis when administered within five days after inoculation of the infecting organism.


On the interaction of vestibular and optokinetic nystagmus in man. The interaction of vestibular and optokinetic nystagmus (OKN) was investigated by applying periods of ipsi- and contradirectional optokinetic stimulation during perand postrotatory vestibular nystagmus in healthy humans. Slow phase velocity and cumulative eye displacement of OKN was enhanced by vestibular nystagmus beating in the same direction of decreased by contradirectional vestibular nystagmus. A distinct correlation between the intensity of vestibular stimulation and the modification of OKN could be demonstrated by averaging the responses obtained in different subjects. On the other hand there was also a modification (enhancement or decrease) of vestibular nystagmus slow phase velocity by preceding OKN. Considering the intensity of these modifications, large interindividual differences were observed.


Vestibular decruitment. A study of the phenomenon in a normal population. Vestibular decruitment is a phenomenon characterized by the presence of less intense responses following stronger vestibular stimulation, and its presence has been considered as indicative of central vestibular pathology. In this study conducted in 24 normal individuals, with normal caloric responses, decruitment was observed in 58.3% of the cases. These decruitments were of types I and II as defined by Torok. Type III decruitment was not seen in these patients. In view of the present findings the actual meaning of the phenomenon must be investigated in larger numbers of patients with peripheral or central vestibular disorders.


Pitfalls in detecting vestibular decruitment with air calorics. Vestibular decruitment is a pathological finding which indicates retrolabyrinthine disease. In the overwhelming majority of cases, it is consistent with posterior fossa pathology. Weak and strong caloric stimulations must be applied with precision for detecting decruitment. Air-caloric stimulation has inherent limitation in regards to reproducing the strength of the stimulus. Thus, it is inadequate for decruitment detection. It is, therefore, advisable to use water-caloric testing to assess vestibular decruitment or recruitment as one of the most revealing diagnostic clues in our neurotologic armamentarium.


Evidence for selective proliferation and histological localisation of B lymphocytes in the human tonsil. Tonsil lymphocytes are labeled in vitro by 14C-thymidine and, respectively, 14C-uridine. The cells are separated by E-rosetting technique, and the fractions are characterised as B and T lymphocytes. Specific radioactivity was highest in the B lymphocytes, and large Lymphocytes are enriched in this fraction. The B lymphocytes are located in the germinal centres, the perinodular tissue contains T lymphocytes. The results indicate a selective proliferation of B lymphocytes in the germinal centres.


An ultraviolet light induced bacteriophage in Beneckea gazogenes. An ultraviolet light induced prophage has been discovered in the red pigmented marine vibrio Beneckea gazogenes. Two spontaneously derived pigment mutants, one forming pink colonies and one lacking pigment and forming white colonies, were also irradiated. The presence of pigment was not related to phage induction; uv-induced cell lysis occurred in wildtype and mutant strains at the same dosages. Lysis was not prevented or retarded by exposure after irradiation to visible light indicating the phenomenon was not photoreactivable. Electron micrographs of the 'T-like' B. gazogenes phage are shown. A second beneckea was isolated form the anaerobic zone of cyanobacterial mats growing in the hypersaline environment of Laguna Mormona, Baja California. The Baja beneckea does not harbor a uv inducible prophage and is resistant to the B. gazogenes phage under all conditions tested.


Immunologic and clinical investigation on a bovine thymic extract. Therapeutic applications in primary immunoedificiencies. Thirteen patients with primary immunodeficiencies (eight with T-cell deficiency, one with Wiskott-Aldrich (W-A) syndrome, two with common variable agammaglobulinemia (CVA), and two with severe combined immunodeficiency (SCID) were treated with a calf thymus extract, called thymostimulin (TS). It has been shown that this extract causes in vitro differentiation of T-cell precursors in patients with T-cell defect. Five of eight patients with pure T-cell defect showed immunologic recovery and clinical remission lasting for several months after interruption of the therapy; one had only transient reconstitution, one had slight increase in T-cells (clinical conditions not yet estimated), and two patients soon died from severe infections after showing a slight increase of T-cells. Immune recovery was assess by an increase of the absolute number of E-rosettes forming cells, of human T-lymphocyte antigen positive cells and of PHA responsiveness in the peripheral blood, and by a positive delayed hypersensitivity reaction to antigens. In five patients, there was also B-cell increase after TS treatment. Clinical remission consisted of disappearance of infections, weight gain, and in improvement in general conditions. No effect was observed in one patient with W-A syndrome, in two with CVA, and in two with SCID. Several hypotheses on the mechanisms involved in immune reconstitution are discussed. It seems likely that TS acts on prethymic cells or on the epithelial cells of hypoplastic thymuses. TS was not effective, either in vitro or in vivo, in patients with SCID probably because of a defect in stem cells.


Report of 65 cases of Haemophilus influenzae b pneumonia. During a 14-year period there were 65 cases of pneumonia caused by Haemophilus influenzae b; 83% were children less than 2 years of age and 80% of illness occurred in winter and spring. The roentgenographic picture was consolidative pneumonia in 75% and pleural effusions were present in 75% of all cases. Ten patients had associated meningitis and three had purulent pericarditis. Otitis media was diagnosed in 43% and H influenzae b was isolated from eight middle ear aspirates. Three patients (5%) died. Recommendations for diagnosis and treatment are made.


Nasopharyngeal carriage of antibiotic-resistant Haemophilus influenzae in healthy children. We selected 16 schools representing a broad socioeconomic cross-section of metropolitan Omaha and obtained nasopharyngeal cultures for Haemophilus influenzae from 1,084 healthy 4- to 7-year-old children. We found that 34.2% of the children carried nontypable strains and 2.0% carried type b strains. Carriage rates were not influenced by recent illness, family size, or number of people sharing a bedroom. The prevalence of ampicillin-resistant H influenzae in the sample population was 0.9% for nontypable strains and 0.4% for type b strains; it was not significantly different in the group of children who had recently used beta-lactam antibiotics. One child carried a nontypable strain which was resistant to both chloramphenicol and tetracycline, the first chloramphenicol-resistant H influenzae detected in Omaha. A survey of healthy children may be a useful method for projecting a community's risk of disease caused by ampicillin-resistant H influenzae. Among the nasopharyngeal isolates from healthy children, 2.7% of nontypable strains and 18.2% of type b strains were resistant to ampicillin (P less than .01). During the same five-month period in Omaha, clinical failure in the treatment of otitis media with ampicillin was uncommon and four (20.0%) of 20 cases of H influenzae type b bacteremia and meningitis were caused by ampicillin-resistant organisms.


The interaction of ruthenium red with surface charges controlling excitation-contraction coupling in frog sartorius. Frog sartorii were incubated in choline Ringer solution containing different amounts of the cationic dye ruthenium red, and were subsequently superfused with ruthenium red-free solution. The contraction threshold was measured during and after the incubation at different calcium and magnesium concentrations. During incubation in ruthenium red the threshold potential is slowly shifted to more positive values depending on time of incubation and the ruthenium red concentration (10--300 microns). After ca. 40 min of incubation a saturation potential is reached. The threshold shift is already maximal (-38mV threshold potential) at 30 microns of ruthenium ret regardless of the calcium concentration up to 5 mM. Omitting calcium from the incubation solution or adding 0.5 mM magnesium instead of calcium resulted in a more negative saturation potential (-48 mV). Washing the muscle in ruthenium red-free solution for 60 min after the incubation fails to reverse the threshold shift completely. The irreversible component of the threshold shift does not depend on the divalent cation concentration during incubation as long as the saturation value during incubation is more positive than -50 mV. The contraction threshold achieved after incubation with ruthenium red is dependent on the divalent cation concentration with calcium being twice as effective as magnesium. The effect of ruthenium red is greatest at small divalent cation concentrations and not significant at 50 mM. Incubating muscles with 5 units of neuraminidase shifted the concentration threshold to more positive potentials to the same extent as incubation with ruthenium red. Subsequent treatment of the neuraminidase-treated muscles with 30 microns of ruthenium red has no further effect on contraction threshold. The alternative experiment, first incubation with ruthenium red and then treatment with neuraminidase, gives the same results. The results are explained by the interaction of ruthenium red with membrane-bound sialic acid. This interaction is thought to result in a decrease in negative charges which results in a shift of the surface potential and hence of the contraction threshold to more positive potentials.


Development of activation and rise of tension in an isometric tetanus. The force-velocity relation was determined at preset times after the beginning of the stimulus volley, either at low isometric tensions, during the raising phase of tetanus and the recovery after a quick release imposed at the plateau, or at the steady state. It is concluded that the characteristics of the force-velocity relation may be used to express the actual level of activation at any time during the contractile process and that the mechanical output of frog twitch muscle fibres implies two distinct steps: (i) activation of the contractile machinery; (ii) production of force.


[Acute leukaemias after treatment using cytotoxic agents for rheumatological purpose. 19 cases among 2006 patients(author's transl)]. The authors undertook a retrospective study to determine the number of acute leukaemias developing amongst 2006 patients suffering from chronic inflammatory rheumatic conditions and connective tissue disorders, treated with cytotoxic agents. The follow-up period ranged from 1 to 13 years. Nineteen leukaemias were found, essentially granulocytic, with a latent period of 5.7 +/- 2, 8 years after the beginning of treatment. This incidence of almost 1% of leukaemias is probably less than the actual percentage since a number of patients were lost on follow up and since the period of observation is as yet too short. The majority of patients has been treated for more than one year. No cases were seen amongst patients treated for less than six months, or with less than 1g of chlorambucil or 50 g of cyclophosphamide. The risk would seem to be the same for both alkylating agents. No patients treated with azathioprine developed leukaemia, but few patients received this drug. Amongst 35 patients treated for severe psoriatic arthropathy with chlorambucil, 4 developed leukaemia. This particularly high percentage is such that all trials of alkylating agent in this condition should be stopped. The prevalence of leukaemia seen in the series as a whole is comparable to that found in mass studies carried out in various malignant diseases treated by cytotoxics. Awareness of this risk should, lead to even stricter limitations before the use of cytotoxic drugs in rheumatological conditions.


Specific modulation of brain stimulation reward by haloperidol. Low doses of haloperidol (3--18 micrograms/kg) caused dose related increases in reinforcing thresholds for self-stimulation to the medial forebrain bundle in rats. These effects, which were demonstrated completely independent of performance variables, indicate a direct modulation of central reinforcement processes by this drug, at doses which have highly selective action on dopaminergic neurotransmission.


Central antiserotonin action of amitriptyline. Amitriptyline (AMI) was studied in rats snd mice in order to find out whether it had a central antiserotonin activity, previously demonstrated for doxepin - a compound chemically related to AMI. It was observed that AMI at low doses antagonized the head twitch response to L-5-hydroxytryptophan or 5-methoxytryptamine, as well as tryptamine-induced convulsions. In the hind limb flexor reflex preparation of the spinal rat AMI acted as a serotonin antagonist: when administered alone, it did not change the flexor reflex but prevented its stimulation induced by serotoninmimetics (LSD, quipazine, fenfluramine) not affecting that one evoked by noradrenalinemimetics (clinidine). At higher doses, AMI revealed a noradrenolytic activity. The results indicate that AMI, similarly as doxepin, has a central antiserotonin activity.


The prevalence of psychiatric illness among patients on home haemodialysis. An entire population of 32 patients on regular dialysis treatment (RDT) in their own homes were ranked according to their present mental state as assessed by a standardized semi-structured interview. The point-prevalence of psychiatric morbidity was 31% which compares closely with that of patients attending a general practitioner's surgery who were assessed by the same method. The 10 patients who were psychiatrically ill had more organic symptoms and their spouses were less able to tolerate RDT in the home.


[Strain-specific antigens detected on murine tumour cells by means of rabbit heteroantisera (author's transl)]. The rabbit heteroantisera anti-Meth A sarcoma (H-2d) (RAMA) and rabbit anti-RBL-5 leukemia (H-2b) (RAR-5) have been used to study the presence of normal strain antigens on the surface of different murine tumour cells. RAR-5 detected H-2-like structures on TLX9 (H-bb) lymphoma, however RAMA did not on LSTRA leukemia (H-2d) mastocytoma. Neither RAR-5 nor RAMA contained antibodies against non-H-2 and differentiation antigens.


The absence of benefit of proteinase inhibition with aprotinin in severe shock in dogs. A standard canine shock model has been used to assess the role of proteinase inhibition in the treatment of severe shock. Conventional therapy, i.e adequate volume replacement, was ensured in all experiments, while in the treated groups aprotinin (Trasylol) was administered at different stages of the haemorrhage. Despite other reports to the contrary, no benefit was demonstrated in the period of established refractory shock even when proteinase inhibition was commenced at an early stage of haemorrhage. It is concluded that proteinase inhibition cannot be recommended for shock resuscitation.


[Positive ventriculography and computer assisted tomography of the skull in the evaluation of megalocephaly in newborns and infants (author's transl)]. To clarify indications and limits of computer assisted tomography and positive ventriculography the results of both methods were compared with each other retrospectively in 55 macrocephalic newborns and infants. It could be shown that positive ventriculography, even if combined with coronal views, was superseded by computer assisted tomography to only a certain extent. To complete the appropriate diagnosis preoperatively positive ventriculography was necessary most often in patients with paranatal disturbances who had undergone intensive care treatment. The non-invasive method of computer assisted tomography often yielded sufficient information on localisation, size, and nature of the underlying pathologic process. Both methods turned out to be complementary when topographical and functional interrelations of cranial cysts had to be demonstrated, especially structures of the midline and of the posterior fossa, which could not be visualized by computer assisted tomography alone.


Acute gastrointestinal bleeding detected with abdominal scintigraphy using technetium-99m-labeled albumin. In 24 patients admitted with gastrointestinal bleeding 36 scintigraphic studies of the abdomen were performed after intravenous injection of technetium-99m-labeled albumin. In 12 patients bleeding from the esophagus, stomach, duodenum, biliary tract, or colon was visualized. In the other 12 patients, in whom the bleeding seemed to have subsided, the investigation showed no scintigraphic signs of hemorrhage. Scintigraphy was also negative in five controls who had no bleeding. The method is non-invasive and easy to perform. Our study suggests that it is reliable, but a controlled trial is necessary to evaluate the diagnostic value of the method.


Subtypes of schizophrenia: descriptive models. Descriptive approaches to subtyping schizophrenia use symptoms, signs, and functioning characteristics as diagnostic criteria. Such approaches often appear superficially to be obvious, simple, and atheoretical; in reality, however, there are many ways in which descriptive data can be selected and organized to subtype patients. This report describes these various approaches. Selection of diagnostic criteria can focus primarily either on cross-sectional or longitudinal characteristics of patients. Alternative ways of organizing descriptive data include typological and dimensional approaches and two increasingly common complex models, multiaxial and hierarchical subtyping. Examples and implications of these alternative approaches are described, and methods for choosing among them are suggested.


Mortality among bricklayers and carpenters/cabinet makers. Mortality among members of two medium-sized trade unions, the union of carpenters/cabinet makers and the union of bricklayers, has been studied during the period 1.1.71-31.12.75, primarily to investigate if the greater exposure to dust and organic solvents of the carpenters/cabinet makers caused any increase in the mortality from lung diseases. The study did not reveal any significant differences in mortality regarding any category of diagnoses except suicide, when the analysis was based on the main diagnosis recorded on the death certificate. However, when including underlying causes of death too, statistically significant increased death rates from larynx cancer, asthma, bronchitis and emphysema were found among the bricklayers, as compared with the carpenters/cabinet makers. No explanation can be given for these observations. They may be a result of an unequal distribution of confounding variables in the two groups, or they may reflect various grades and forms of "Healthy Worker" selection. This study is a cross-section study and such studies and longitudinal studies over a period of a few years of occupational mortality are very sensitive to the selection of the occupational groupings. The analysis is based on deaths among life-insured members under the age of 67 years, in the two trade unions. Copies of the death certificates were obtained from the National Health Service and then coded by us along the lines indicated by the NHS.


[Lymph node lesions simulating a malignant lymphoma]. Examples are reported of lymph node lesions simulating histologically and/or clinically malignant lymphomas. Two main categories of alterations have been distinguished: A. hyperplastic lymph node alterations associated with systemic disease and/or viral or drug-induced lymphadenitis; B. anatomo-clinical entities such as giant lymph node hyperplasia, massive lymphadenopathy with sinus histiocytosis, and angio-immunoblastic lymphadenopathy. It is suggested that in some situations such as angio-immunoblastic lymphadenopathy the borderline between reactive and enoplastic alterations is not clear cut. To evaluate such changes, close collaboration between the clinician, the hematologist and the patholigist is necessary.


[The effect of 1-deamino-8-D-arginine vasopressin (DDAVP) on blood coagulation in patients with hemophilia A and in healthy men]. DDAVP, a synthetic vasopressin analogue, causes a sustained increase of factor VIII in blood. The drug (0.4 micrograms/kg) was repeatedly infused into 13 hemophilics and 5 healthy men in order to study the kinetics of the elicited antihemophilic factor (AHF). The AHF increase and disappearance were found to be strictly related to the severity of the coagulation defect. Thus, data were obtained which will form a basis for rational therapeutic use of DDAVP in hemophilia. The DDAVP effect was completely independent of the presence of AHF in the circulation and was not associated with activation of clotting or platelets.


[Is there a correlation between sugar content, thrombocyte aggregating activity and molecular size of factor VIII?]. Human and bovine factor VIII, isolated from cryoprecipitates of fresh plasma by gel filtration on Sepharose CL-2B, gave similar elution patterns and showed comparable distribution of oligomers on SDS agarose electrophoretic gels. The carbohydrate content of individual factor VIII bands, measured by reaction with dansyl hydrazine or binding of glucose/mannose specific concanavalin A, was not directly related to the size or von Willebrand activity of factor VIII oligomers. Staining of disulfide-reduced factor VIII subunits, in polyacrylamide gels, with galactose-specific fluorescein-labelled Ricinus communis lectins, showed an increased binding affinity with increasing size and von Willebrand activity of the parent factor VIII. The von Willebrand activity was strongly inhibited by reaction with Ricinus RCAI lectin, whereas concanavalin A inhibited platelet aggregation only at concentrations above 1 mg/ml. These results suggest that galactose residues are involved in the aggregation of platelets by factor VIII.


[Granulocyte dysfunction in transcobalamin II deficiency]. Granulocytes from a boy with congenital transcobalamin II (TC II) deficiency were found to have abnormally low antibacterial activity against Staphylococcus aureus. Transfusion of normal plasma supplemented with hydroxocobalamin temporarily restored granulocyte bactericidal activity to normal. Granulocyte function was also temporarily restored by oral leucovorin. The defect appears to be causally related to the patient's TC II deficiency and indirectly to an intracellular deficiency of cobalamin and folate coenzymes [1].


[The prognostic value of immunologic markers in juvenile acute lymphatic leukemias and non-Hodgkin lymphomas]. Prognostic factors such as T-cell markers, peripheral WBC and age at diagnosis in ALL, or B-cell markers and site of primary tumor in NHL, are used today for important therapeutic decisions. Immunologic markers are said to be the most important. A survey of 7 ALL patients diagnosed in the period 1977 to 1978 shows that 4 are in continuous remission, including 3 for more than 3 years to date (2 despite a high initial WBC). These 3 had received only standard ALL treatment. Of 7 NHL cases diagnosed in 1977/1978, 4 had abdominal primaries (3 of the B-cell type). Of 2 children with mediastinal tumors, one (with a T-cell tumor) has been disease-free for 16 months, as also the patient with a cervical reticulum cell sarcoma. These 3 patients are under intensive high dose chemotherapy. These few cases show that prognostic factors are only of relative importance and need not involve a pessimistic attitude towards treatment.


[Acquired von Willebrand's syndrome associated with malignant lymphoma]. The sudden development of multiple bleeding episodes in a 63-year-old patient with malignant lymphoma was shown to be due to the presence of an acquired von Willebrand syndrome, characterized by a prolonged bleeding time and low levels of the factors VIII: C, VIIR:Ag and VIII:Rcof. Crossed immunoelectrophoresis demonstrated diminution of the factor VIII portion with least anodic mobility. Mixing experiments of the patient's and normal plasma revealed a weak (T/2: 4.5 hours) inhibitory activity against the factors VIII:C, VIIIR:Ag and VIII:Rcof. After infusion of 800 units of cryoprecipitate there was rapid destruction (T/2: less than 1 hour) of infused factors VIII: C and VIIIR:Ag and no correction of the bleeding time. Chemotherapy resulted in disappearance of the lymphoma and the hemostatic defect, and its discontinuation in their reappearance. The weak inhibitory activity of the patient's plasma does not fully account for the factor VIII levels observed and other pathophysiological mechanisms, such as adsorption of factor VIII to the malignant lymphocytes, must be considered.


[Selective aplasia of neutrophils: auto-immune origin]. Autoimmunity is a recognized factor in pure red cell aplasia and in some cases of aplastic anemia, but not in agranulocytosis. The case reported here demonstrated that pure neutrophilic aplasia of autoimmune origin may exist in man. A 75-year-old male is described who presented with complete agranulocytosis and absence of neutrophilic precursors in the bone marrow without thrombocytopenia or anemia. After 6 weeks, remission was induced by immunosuppressive treatment and 22 months later the patient is doing well without therapy. The absence of known cases of agranulocytosis, a good response to immunosuppressive therapy, and the demonstrated fact that the patient's peripheral blood mononuclear cells inhibit the growth of granulocytic colonies of normal human marrow in vitro allow the conclusion that this patient had pure neutropenic aplasia, probably due to autoimmune phenomena.


Heavy metals affect rod, but not cone, photoreceptors. Low concentrations of lead, mercury, or cadmium depress the amplitude of the rod receptor potential in the perfused bullfrog retina. Responses from the cones were not affected. The data implicate the rods as a lesion site in animals exhibiting scotopic vision deficits as a result of heavy metal poisoning.


Monoclonal antibodies defining distinctive human T cell surface antigens. Three novel nonoclonal antibodies (designed OKT1, OKT3, and OKT4) were generated against surface determinants of human peripheral T cells. Both OKT1 and OKT3 reacted with all human peripheral T cells and 5 to 10 percent of thymocytes but differed in their reactivities with T cel- lines. By contrast, OKT4 reacted with 55 percent of human peripheral T cells and 80 percent of thymocyted in that they did not react with normal B cells, null cells, monocytes, or granulocytes.


Efferent system in the retina of the frog, Rana catesbiana. Single units were recorded through glass microelectrodes placed on the optic disk or on the retina of the opened eye of the frog (Rana catesbiana). Units were classified as A-, B-, and C-fibers according to conduction velocities. By the method of collision between naturally elicited and electrically elicited impulses, many of the B-fibers and some A- and C-fibers, which showed unusual behavior to photic stimulation, were found to be efferent fibers. Retinal effects of the efferent nerves were studied by repetitive stimulation and cooling of the optic nerve. The effects were found to be both inhibitory and excitatory.


Mallory-Weiss syndrome: retrospective review of eight years' experience. Retrospective review of eight years' experience with the Mallory-Weiss syndrome emphatically supports the need for accurate, early localization of the site of upper gastrointestinal hemorrhage. Pertinent aspects of the history and physical and laboratory evaluation of this group of patients were analyzed to determine the relative merits of each in diagnosis and treatment. Angiography was helpful as a diagnostic aid in a small group of patients. Endoscopy, the cornerstone of diagnosis, is essential in the choice of the management program. Data from this study support the following conclusions: (1) patients not bleeding at the time of endoscopy rarely require surgical intervention; and (2) patients bleeding at the time of endoscopy vary as to their need for operative treatment and deserve a trial of preliminary medical therapy.


A study on the diagnostic methods for Trichomonas vaginalis infection. A comparison of the sensitivity of the wet smear, Papanicolaou's stained smear, and culture in Cystein-Peptone-Liver-Maltose (CPLM) medium for the diagnosis of T. vaginalis infection was undertaken in 1, 197 female subjects, both with and without gynaecological disorders. The wet smear method gave 15.5% positives, culture method, 16.5% positives and Papanicolaou's stained smear 6.7% positives. All positive cases by Papanicolaou's method or wet smear method were positive by the culture method. These findings indicate that the wet smear and culture in CPLM medium were better than the Papanicolaou's method.


[A practical clinical record system for the general practitioner]. Owing to the multidisciplinary character of general practice, there is a great need for an effective and practical clinical record system for the family physician. The recording of clinical data of home visits and other visits places an extra burden on his record system. A practical system which tries to solve these and other problems is presented. A simplified form of Weed's Problem Orientated Medical Records (POMR) is incorporated in this system. The different components as well as the practical functioning of the system are described.


Diagnosis and control of diverticular bleeding by arteriography and vasopressin infusion. A report of 2 cases. Large-bowel bleeding usually arises from either angiodysplasia or colonic diverticula. Diverticular bleeding is more common in the right or the transverse colon, even though diverticula are more common on the left. Arteriography in these patients may identify the bleeding site, and in some cases vasopressin infusion controls the bleeding. Embolization of the large bowel is not recommended because of the danger of necrosis.


Postoperative anorectal bleeding.

Postoperative anorectal bleeding. Forty-three postoperative anorectal bleeding episodes were encountered in the treatment of 4,059 anorectal operations, an incidence of 1.06 per cent. One-third of the postoperative bleeding occurred within the first 48 hours and reflects technical errors; nearly half of the bleeding occurred from the seventh to the 11th postoperative days; the cause of this delayed bleeding remains obscure.


Ten years' experience with mesocaval grafts. A ten years' experience with this particular shunt has demonstrated that the patency rate, incidence of encephalopathy and of rebleeding and perioperative mortality have remained quite favorable when compared with other shunting procedures. Based upon a ten years' experience, we have no reservations in recommending it as the procedure of choice for patients with alcoholic or posthepatitic cirrhosis who are classified as A, B or C, according to Child's criteria.


What is the probability that coronary artery surgery prolongs life? Two-hundred and nine male patients who had coronary artery surgery from 1972 to 1974 at the Marshfield Clinic (MC) were compared with Veterans Administration (VA) coronary patients to determine the probability of coronary surgery prolonging life. The survival data includes operative and late cardiac and noncardiac deaths. Including the MC operative mortality rates but considering late noncardiac deaths withdrawn as alive at the time of death, the MC cumulative 5-year surgical survival rate is 93%. This is identical to predicted 93% 5-year survival rate for any man of 54.5 years, the average age of MC patients living in this geographic locale in 1973. Annual attrition rates, including the noncardiac deaths, are 1.4% for any man 1.5% per year for MC patients, based on MC 5-year survival data. It is probable that coronary surgery prolongs life by sharply reducing late cardiac deaths.


Alpha 1-antitrypsin screening of 18-year-old men. In 11 128 apparently healthy 18-year-old men screened for alpha 1-antitrypsin deficiency (AATD) 44 had an alpha 1-antitrypsin (AAT) level of 50% or less of the transferrin reference. In 42 of the 44 the Pi types were: five Pi Z, 10 Pi SZ, three Pi MZ, one presumptive Pi M-, one Pi FM, and 22 Pi M. Probably all Pi Z and most of the Pi SZ subjects were identified. The transferrin reference, however, is probably less reliable for the study of this age group, and alpha 1-antichymotrypsin may provide a more valid reference for the AAT screening procedure. In the clinical investigation the additive risk factor of smoking was discovered in eight of 15 individuals with AATD Pi Z or Pi SZ. We believe screening for Pi Z and probably also Pi SZ AATD should be done before young people start smoking or train for jobs in polluted environments.


Kinetics of acetylsalicylate and D-lactate transport across isolated frog gastric mucosa. Luminal to submucosal migration of 14C-acetylsalicylate and D-lactate and some electrical properties were studied in isolated frog gastric mucosae. With both compounds, the unionized acids permeated much more rapidly than the ionized conjugate bases. The permeability coefficient for unionized acetylsalicylic acid increased from 0.27 to 0.43 mumoles, h-1, cm-2, mM-1 when its luminal concentration was increased above 3 mM. Simultaneously there was an increase in mucosal ion conductance. Acetylsalicylic acid has been shown previously to increase gastric mucosal permeation of ions and uncharged larger molecules. The present results indicate that above a threshold concentration the unionized form also enhances absorption of this drug per se. Unionized D-lactic acid had no effect of mucosal ion conductance and the permeability coefficient (0.07 mumoles, h-1, cm-2, mM-1) was independent of its luminal concentration.


Genetic aspects of lens luxation in the Tibetan terrier. Analyses were undertaken of 20 cases of lens luxation in British-bred Tibetan terriers, together with a further seven from Sweden. General proband segregation tests showed that the data were consistent with a simple autosomal recessive hypothesis (P = 0.152 +/- 0.0563). This was supported by high levels of inbreeding ranging from 0 to 24.3 per cent, with a mean of 14.3 per cent (SD 5.32 per cent). All affected cases traced back to one or more of three animals (born mid 1950s) on both sides of their pedigrees, all three being breed champions. Inclusion of data from repeat litters between presumed heterozygous animals gave a ratio of 25 lens luxation cases in 121 progeny, which again supported the same genetic theory. The age at onset (three to five years) mitigates against test mating of animals within the breed.


[Acute pancreatitis].

[Acute pancreatitis]. The acute pancreatitis is a disease which is unchangedly characterized by a high lethality. The actual frequency of this disease is difficult to be established, but its increase is probable particularly in the countries with high living standard. Factors of nutrition play an important role in the etiology and in the actual development, and the consumption of alcoholic beverages gains increasingly significance. Despite modern apparative possibilities for making the diagnosis the clinical picture and proved laboratory findings--fermentative lapses, disturbances of the carbohydrate metabolism--are in the first place. At first a conservative treatment is demanded with the preceding aim to prevent shock as well as renal and pulmonary insufficiency. None of the substances, which were experimentally introduced into treatment during recent years, could clearly prove a superiority in contrast to conventional therapeutic principles. Single cases may be saved by timely operation, the problem is here the certain recognition of the borderline to the surgical treatment.


[Modern pancreatic function tests].

[Modern pancreatic function tests]. The functional diagnostics is a corner-pillar of the difficult diagnostics of pancreas. Despite new tests many wishes remain open. The secretine-pancreozymine test and the Lundh-test give good informations, but they are expensive and for the patients considerably stressing. They certainly are not regarded as screening tests. The suitable and justifiable tests for epidemiologic examinations (estimations of stool enzymes and of serum isoamylase) are less specific and sensitive. A differentiation between chronic pancreatitis and neoplasm of the pancreas is not possible with the help of the functional diagnostics. The results of functional examinations may be correctly evaluated only within all informations which concentrate at the patient's bed.


[Clinical aspects and therapy of chronic pancreatitis]. Not infrequently exact diagnosis of chronic pancreatitis is possible only after step by step observation. The results of examination, analyses and treatment should be communicated from a general practitioner to a specialist, further to a specialized centre and vice versa. Screening tests and special examinations should be conducted in definite order. A surgical treatment is desirable in approximately 40% of clinically pronounced chronic pancreatitis. The best results are obtained by close cooperation between different specialists and the patient himself.


[Atypical courses of rheumatoid arthritis]. For the investigation of the question of atypical forms of course selected findings of a multicentric electronic data processing investigation carried out on 1,000 patients with manifest rheumatoid arthritis were attracted. In these cases differences of the clinical symptomatology in the sexes were the result, at a different moment of the beginning and concerning serological findings. The latter was concerned clearly by the titres of rheumatoid factors, only suggestively cases with antinuclear factors. These differences, however, were not regarded as special forms in the sense of separated disease units. They rather represent only statistically provable deviations, the borderlines of which are by far transgressed by individual characteristics.


[Fiberendoscopic injection therapy of bleeding gastrointestinal lesions (author's transl)]. In 28 patients with acute gastrointestinal bleeding emergency fiberendoscopy was combined with aethoxysclerole (1%) injection of the bleeding lesion with purpose to controll haemorrhage. In 61% of 31 proceudres done in patients with oesophageal varices (n = 19) haemorrhage was controlled, and in further 16% deminuation of bleeding intensity was noted. In the remaining cases (n = 7) the procedure was ineffective. Only patients with Child C liver cirrhosis having oesophageal varices stages III and IV finally died because of uncontrolled haemorrhage. In 9 patients with bleeding from other lesions (gastric erosions and ulcers, Mallory-Weiss-Syndrome, erosio simplex Dieulafoy) haemorrhage was controlled in 8 patients. The method is practicable and efficient, but does not determine better the final outcome of patients with livercirrhosis Child C having oesophageal varices stages III and IV. In other cases tube treatment was avoided. The operation lethality within the series was 1,5%.


[Bone marrow plasma cell reaction in alcoholic patients]. A study of plasmocellular reactions of the bone marrow in alcoholism and alcoholic psychoses demonstrated an increase in the amount of plasmatic cells, a prevalence of mature plasmatic elements with distinctly marked basophilia and a reaction of clasmatosis. These facts indicate the functional preservation in alcoholism of the system of B cells, the derivatives of which are plasmatical elements; of an increase in the protein synthesis (including antibodies) as well as a prevalence of the so-called productive phase of immunogenesis over the adaptive.


Analgesic anesthesia with fentanyl (F) and sufentanil (SF) in coronary surgery. A double blind study. The study includes 54 unselected coronary patients. Fifty underwent one or several aortocoronary bypass associated with left ventricular resection (3 times), mitral valve replacement (twice), aortic valve replacement (twice). Four patients underwent left ventricular resection alone. The operations were performed under analgesic anesthesia with sufentanil (SF) or fentanyl (F) with a double blind protocol. The ratio of concentrations of the two analgesics was SF/F = 1/10. Flunitrazepam induced and maintained sleep. After having reached by increments the total dose of 1.5 mg F/M2 or 0.15 mg SF/M2, droperidol was then added in small amounts of 3.75 mg/M2, alternating with the analgesic both being given as needed to maintain blood pressure between 100 and 120 mm Hg, in order to potentiate the level of analgesia reached and prevent vasoconstriction. Under this setting tachycardia (heart rate greater than 100 beats/min. and less than 120 beaths/min.) was observed before ECC in only 7.4% of cases with both analgesics and brief episodes of hypertension (mean maximum systolic blood pressure 140.7 +/- 20.3 mm Hg seen with SF exclusively). There was neither postoperative hypertension (except with 6 out of the 7 known hypertensive patients) nor low cardiac output, nor arbythmia. No patients remained in intensive care unit more than 24 hour. No difference attribuable to the used analgesic was detectable in the early and late follow-up in both series. On an average, the patients were discharged on postoperative day 10 in a valid condition.


Effect of released lymphocyte proteins on human lymphocytes in vitro. II. Protein synthesis of nylon-wool separated cells in the presence of proteins derived from lymphocytes. Protein synthesis of nylon-wool adherent (B) and non-adherent (T) human tonsillar lymphocytes was examined in the presence of three protein fractions precipitated with ammonium sulfate from the medium of the above lymphocytes incubated in vitro for 4 hours. One fraction precipitated with ammonium sulfate at 0--30% saturation was found to inhibit amino acid incorporation into proteins mainly in unseparated cells while the fraction precipitated at 30--70% saturation decreased the rate of protein synthesis in B cells. The fraction precipitated at 70--100% saturation inhibited protein synthesis slightly in T lymphocytes. Protein synthesis in B and T as well as in unseparated cells was also examined in the presence of proteins obtained from the medium of B and T lymphocytes. It is assumed that proteins released by lymphocytes without mitogenic activation in vitro are involved in the mediation of lymphocyte interactions and may be related to lymphokines synthesized and released by activated cells.


Temperature dependence of conduction velocity in myelinated frog nerve. The temperature dependence of the conduction velocity of excitation was investigated in frog sciatic nerve trunk. A specific electronic circuitry was used to measure the time of conduction between two electrodes with an accuracy of +/- microseconds in the temperature range of 5--30 degrees C. Our experiments have proved that the conduction velocity depended linearly on temperature. The slope of the curve was similar at both increasing and decreasing temperature, and "hysteresis" occurred only if irreversible changes occurred in the preparation during the experimental procedure.


K+-loss of frog nerves during electric stimulation. Proximal section of nervus ischiadicus of frog was directly stimulated, and distal section of the same length was stimulated indirectly. Indirect stimulation resulted in a 2 per cent loss of K+ content, direct stimulation caused a loss of 31 per cent of the K+ content. Indirect stimulation does not cause a significant K+ efflux; direct stimulation results in a significant decrease in K+ content even at a probability level of p=0.001. A correlation was found between the changes in the K+ content of frog nerve and the intensity of the applied electric impulses. The decrease of K+ content of frog nerves is in ratio with the logarithm of stimulation voltage.


The rationale and technique of head exercises in the treatment of vertigo. The central compensation mechanisms for vertigo resulting from vestibular lesions are described together with the scientific basis for head exercises in vestibular rehabilitation. The indications and contra-indications for head exercises are discussed and the Cawthorne-Cooksey regime of exercises illustrated.


Lymphocytes from adenoid vegetations: proliferative responses in vitro as compared to blood lymphocytes. Thymidine incorporation by lymphocytes obtained from adenoids (AVL) and blood (PBL) were compared in 27 children undergoing adenoidectomy. Optimal conditions as regards cell number and duration of culture were worked out. The spontaneous thymidine incorporation was higher in PBL than in AVL. In cultures stimulated by polyclonal activators or by PPD, the responses of PBL were higher. The dose-response curves for PBL and AVL after stimulation with killed H. influenzae were different: PBL showed a higher response, the optimal antigen concentration was lower for PBL, and the responsiveness to suboptimal antigen concentrations wash higher in PBL than in AVL.


Work status after coronary bypass surgery. A prospective randomized study with ergometric and angiographic correlations. The rate of return to work was assessed in a series of patients with coronary heart disease randomly allocated to medical and surgical treatment groups of 50 patients each. Sixteen of the medical and 19 of the surgical patients were already retired at entry and did not resume work later. Only 9 patients (26%) on medical therapy were working at 2-year follow-up in contrast to 18 (60%) working after bypass surgery (p less than 0.05). Functional classification of angina pectoris and exercise tolerance on ergometry were significantly better in the surgical group, especially in the surgical subgroup at work. Repeated postoperative anigographies of the inserted grafts and native vessels disclossed that completeness of revascularization was related to work status after bypass surgery. The data suggest that a combination of coronary bypass surgery and medical therapy, when indicated, is superior to medical therapy alone in influencing the rate of working in coronary heart disease.


Gastrointestinal bleeding in cases of ruptured cerebral aneurysms. Among 1,000 cases of patients undergoing direct surgery on cerebral aneurysms, two, showed clear signs of preoperative, and 19 cases showed postoperative gastrointestinal bleeding. We have made a clinical analysis of various aspects of the 19 cases in which the bleeding developed postoperatively. 1. Gastrointestinal bleeding was most frequent postoperatively in cases of AComA aneurysms (4.3%) and ICA aneurysms (2.0%), and less common in MCA and ACA aneurysm cases. 2. Gastrointestinal bleeding was most frequently seen in those cases operated on between the third and seventh days after the last subarachnoid haemorrhage (8.9%) and was more common in cases with a relatively poor preoperative grade. 3. The development of such bleeding in cases with a good preoperative grade was due to problems with the surgical operation in most cases, although the influence of vasospasm must not be ignored. The development of bleeding in cases with a poor preoperative grade is thought to be due primarily to vasospasm and transitory brain damage to the hypothalamus and the orbital portion of the anterior lobe due to a haematoma caused by aneurysm rupture. 4. First, the location of gastrointestinal bleeding should be determined endoscopically and, if haemostasis is not achieved by coagulation, then the desirability of surgery should be considered early. Abdominal surgery may be performed.


Selective trigeminal root section via an endoscopic transpyramidal retrolabyrinthine approach. Present experience supports the view that endoscopic access to the cerebellopontine angle has proved an easy and safe therapeutic (selective trigeminal root section in cases of Vth nerve neuralgia) and diagnostic (inspection in cases of otherwise  undetectable tumours) method, offering the advantages of little surgical risk and high effectiveness.


Psychosocial aspects of truancy in early adolescence. The authors studied truancy in junior high school students, largely by structured interviews of 33 truants. Truancy at this age was commonly associated with significant difficulties at home, at school and with peers. Two modal types of truants were delineated: "authority defying" and "peer phobic." The school environment, including the response to truancy and the transition to the junior high, was found to play a critical role in creating and aggravating truancy. The authors discuss the findings with respect to strategies for prevention and remediation.


The labyrinth of the American bullfrog.

The labyrinth of the American bullfrog. The labyrinth of the American bullfrog (Rana catesbiana) has been studied by aid of light and electron microscopy. Cell counts and sensory area mapping has been made and it has been shown that scanning electron microscopy is the most appropriate technique at present for cell counts.


Neurotological studies on Meniere's disease and sudden deafness. During the period from January 1973 to June 1975, 60 cases with definite Meniere's disease and 30 cases with sudden deafness were listed according to such criteria for the diagnosis of both diseases as determined by the Research Committee of Japan. A neurootological assessment for both diseases were performed in our series. In patients with definite Meniere's disease, hearing impairment was characterized by deficiency in detecting low- and middle-pitched tones and fluctuation of auditory threshold in low frequency range. In sudden deafness, highly impaired hearing loss, i.e., total deafness, was frequently observed (45%). However, recruitment occurred at the same incidence (80%) in both diseases tested. The incidence of spontaneous nystagmus was almost the same regardless of associated vertigo and the course of both diseases. Moreover, it was also recognized that a reduction of caloric responses was a better indication for assessment of the affected ear in both diseases.


Characteristics of body sway in patients with peripheral vestibular disorders. Measuring the movement of the body's center of gravity during standing with the eyes open and with the eyes closed, proved to be a useful test in vestibular investigation. 30 patients with peripheral vestibular disorders were tested using a static sensonograph and a digital computer. Three types of locus patterns, the lateral deviation of the averaged position and two types of frequency spectral patterns obtained from the movement of the center of gravity were the characteristics of the body sway in the patients with peripheral vestibular disorders.


Peripheral vestibular disorder of cervical origin. The provoking mechanism of peripheral vestibular disorder in the cervicovestibular syndrome is discussed on the basis of the results of perivascular sympathectomy of the vertebral artery. The peripheral type of this syndrome can be differentiated from the central type in that it shows fatigue due to positioning nystagmus and the reversion phenomenon in the self-recording cupulogram. 42 cases of the peripheral type could be completely cured of episodes of vertigo by the unilateral operation, but the other 6 cases required bilateral operations to prevent such episodes.


The mechanism of benign paroxysmal positional nystagmus. A characteristic nystagmus profile of benign paroxysmal positional nystagmus (BPPN) was determined from analyses of horizontal and vertical electro-oculographic recordings in 8 patients. The vertical component was upbeat in both eyes (fast phase toward the ground in the head-hanging position) while the horizontal component was dissociated with the ipsilateral eye beating away from the down ear and the contralateral eye beating toward the down ear. The amplitude of the vertical component was larger in the contralateral eye while that of the horizontal component was larger in the ipsilateral eye. This dissociated nystagmus profile is consistent with a burst of excitatory activity originating in the posterior canal of the ear that is undermost at the end of the positioning maneuver.


On the mechanism of vestibular disturbances caused by industrial solvents. The industrial solvents xylene, styrene, trichloroethylene and methylchloroform administered to rabbits caused a positional nystagmus and disturbances in the nystagmus response to rotatory acceleration. The positional nystagmus had a beat direction the opposite to positional alcohol nystagmus, which was in similar experiments elicited by methanol, ethanol and propanol. The three alcohols needed a ten times higher blood concentration to cause a nystagmus than the solvents did.


The effects of some drugs on the caloric induced nystagmus. A striking difference between the two anticholinergic drugs was observed. Atropine only modified the eye speed of the slow phase (mes), whereas scopolamine modified both parameters measured, mes and duration. Amphetamine and caffeine prolonged the duration, leaving the mes unchanged. All antiemetic drugs inhibited both parameters. It is concluded that the effect of a drug on the caloric reaction gives insufficient information in the preclinical evaluation of vestibulo-suppressive drugs.


Effect of ethacrynic acid upon the peripheral vestibular nystagmus. The effect of ethacrynic acid (ETA) upon pendular rotation nystagmus and paralytic nystagmus was examined using 61 guinea pigs. 100 mg/kg ETA reduced these nystagmus but 30 mg/kg ETA had on effect. Galvanic nystagmus, Bechterew's compensatory nystagmus, OKN and EEG were not affected by 100 ng/kg ETA. These results are highly suggestive that the inhibition of the peripheral vestibular nystagmus by ETA is mainly due to the reduction of the ampullar endolymphatic potential.


Head-eye coordination in normals and in patients with vestibular disorders. Oculomotor response in the absence of vision was examined in 8 normal subjects, 11 unilaterally labyrinthectomised patients and 2 patients with suspected bilateral canal paresis. The experiments involved (a) voluntary oscillation of the head, (b) whole body oscillation on a turntable and (c) stimulation of neck afferents by oscillation of the body with the head fixed. In the patients with unilateral lesions there was a directional preponderance of the slow phase eye velocity towards the side of the lesion which differed significantly from that of the normal population. In the patients with bilateral paresis the oculomotor response to whole body oscillation was negligible, whereas the response to voluntary head movement had a mean gain of 0.45 and at high frequency could not be suppressed when viewing a head-fixed image. The saccadic activity during voluntary head movement was similar in all subjects and was correlated with slow phase velocity.


Anatomy of the para-vestibular canaliculus. A histologic study of the para-vestibular canaliculus (PVC), its contents, and its relationship to the vestibular aqueduct (VA), is presented. 20 normal human temporal bones were fixed in 10% formalin solution, embedded in celloidin, and sectioned horizontally at intervals of 20 micrometers. Every tenth section was stained with hematoxylin and eosin (HE) and studied under a light microscope. Three significant observations were made. First, in 80% of the specimens, two rather than one PVC were found in the area of the vestibular orifice of the VA. Second, in 70% of the specimens, the PVC was found to merge with the VA rather than to enter the posterior cranial fossa (PCF) separately. Third, in all the specimens examined, a vein was seen to traverse the entire length of the PVC. However, in 17 specimens, no artery could be identified within the PVC. In the 13 (65%) specimens in which arteries could be identified in the PVC, the arteries extended only half the length of the PVC, from the PCF to the VA. In no specimen examined could arteries be seen extending the full length of the PVC from the PCF to the vestibule.


Sensory integration in the rehabilitation of blind adults. Learning difficulties displayed by the blind adult prompted an investigation of a link with sensory integrative dysfunction. A review of the literature provided evidence that tactile and vestibular deficiencies were prevalent within this population. Through observational assessment, sensory integrative dysfunction was identified in a number of clients and individual sensory integrative treatment programs were initiated. In the three case studies presented, improvements were noted in mobility, activities of daily living, handwriting, and behaviour after six months of treatment. A discussion is provided on those deficit areas responding to sensory integrative treatment.


Effects of coronary bypass grafting on resting left ventricular contraction in patients studied 1 to 2 years after operation. Left ventricular contraction was evaluated with angiography in 51 patients 1 to 2 years after coronary arterial bypass surgery. The left ventricle was classified into five segments, and segmental ventricular wall motion was analyzed with subjective and objective methods. With subjective analysis, 25 percent of asynergic segments showed improvement, 72 percent no change and 3 percent deterioration in contraction. There was a 5 percent incidence rate of new wall motion abnormalities in segments that were judged normal from the preoperative ventriculogram. Objective analysis revealed significant improvement in contraction of asynergic segments in each of the five left ventricular segments analyzed. Thus, 1 to 2 years after coronary bypass surgery, there was a significant reduction in left ventricular segmental wall motion abnormalities, and the incidence of deterioration in contraction was small.


Reversal of exertional hypotension after coronary bypass grafting. A decrease in systolic blood pressure that occurs with treadmill exercise testing may be a sign of reversible ischemic left ventricular dysfunction. To test this hypothesis, we examined retrospectively the postoperative treadmill responses of 37 patients who had exertional hypotension (end exercise systolic blood pressure less than or equal to initial preexercise levels) before coronary arterial bypass grafting. This group of 37 patients was characterized preoperatively by an abnormal exercise electrocardiogram (36 patients), multiple vessel occlusive disease (36 patients) and a normal ejection fraction at rest (32 patients). Postoperative exercise tests showed improvement in hemodynamic and electrocardiographic changes with reversal of exertional hypotension (33 patients), and conversion to a normal exercise electrocardiogram (29 patients). Coronary bypass surgery can be expected to reverse exertional hypotension in patients with symptomatic angina pectoris and evidence of ischemia in the exercise electrocardiogram.


Epicardial activation in human left anterior fascicular block. Four patients with coronary artery disease and chronic marked left axis deviation, defined as a frontal QRS axis more negative than -45 degrees, were studied with epicardial mapping during coronary bypass surgery. All patients had normal right ventricular and inferior left ventricular epicardial breakthrough sites and activation sequence. Normal breakthrough in the basal anterolateral left ventricular epicardium was absent in all four patients. Two patients had breakthrough in the apical region of the anterolateral left ventricle. In the other two this region was activated from wave fronts emerging in the right ventricle and inferior left ventricle. The latest site of left ventricular activation was the basal segment of the anterolateral wall, a site never found to be the latest activated in our previously studied patients without conduction defects. This site was activated during or slightly after the terminal portion of the QRS complex. It is concluded that marked left axis deviation in patients with coronary artery disease reflects delayed activation of the basal anterolateral left ventricle, and is consistent with the presence of block or delay in the anterior "fascicle" of the left bundle branch.


Chromosomes and causation of human cancer and leukemia. XXXIII. 5q-- in a case of acute lymphoblastic leukemia (ALL). The case of a 4-year-old boy with ALL, possibly developing subsequent to a lymphoma involving the thoracic cavity, which was shown to be of the T-cell type, is presented. The leukemic cells had a 5q-- anomaly, which had previously been described only in cases of refractory anemia and/or AML. The 5q-- abnormality was invariably accompanied by a 9p-- chromosome in the leukemic cells. The interstitial deletion leading to the 5q-- chromosome was shown with banding techniques to be similar to that described previously in myeloproliferative disorders. Some aspects of the 5q-- anomaly in ALL and its relation to previous experience with this karyotypic change are discussed.


Segregation distortion of the alpha 1-antitrypsin Pi Z allele. alpha 1-antitrypsin (alpha 1AT) of the Pi type Z is associated with two diseases: pulmonary emphysema and cirrhosis of the liver. We report 23 families with both parents heterozygous for the PiZ allele, characterized from our own analysis and from world literature sources. All families were identified through members expressing disease. From the extended pedigrees, 18 backcross families (parents with Pi types MM and MZ) were identified. Analysis of the backcross families reveals a significant increase in Pi MZ offspring (.73) among families where the male is heterozygous. The distortion is not detected among families where the female is heterozygous. Among the matings where both parents are heterozygous, we found 0.43 Pi ZZ from families where one or more members expressed hepatic cirrhosis, and 0.40 Pi ZZ for total families studied. This contrasts to the 0.25 Pi ZZ expected, but is consistent with the distortion observed in backcross matings. The implications of various statistical approaches are discussed, and we point out why our findings differ from previous reports. We suggest a possible biological explanation residing in the fertilization process.


Ectopia lentis et pupillae.

Ectopia lentis et pupillae. Two brothers whose parents were second cousins had ectopia lentis et pupillae. This autosomal recessive disorder is distinguished from other disorders with ectopia lentis by the limitation of abnormalities to the bilateral displacement of lens and pupil.


Prevalence of sleep disorders in the Los Angeles metropolitan area. The authors determined the prevalence of sleep disorders in a general population through a survey of 1,006 representative households in the Los Angeles metropolitan area. They found an overall prevalence of current or previous sleep disorders in adults of 52.1%. Specifically, they found a 42.5% prevalence of insomnia, 11.2% of nightmares, 7.1% of excessive sleep, 5.3% of sleeptalking, and 2.5% of sleepwalking. These conditions were often chronic and usually started early in life. Insomnia was more frequent in older people, particularly older women, and in people of lower educational socioeconomic status. Insomnia, nightmares, and hypersomnia were correlated with more frequent general physical and mental health problems.


The pattern and nature of the lymphocyte population response in dengue hemorrhagic fever. Eighty-eight specimens consisting of lymphocytes separated from peripheral blood samples from 76 patients with dengue hemorrhagic fever (DHF) were studied. The results revealed a significant increase in numbers of atypical lymphocytes and B lymphocytes, and a decrease in T lymphocytes by comparison with normal controls. Anti-T lymphocyte antibody was also detected in the serum of all patients with DHF. The greatest increments and decrements of the above were noted on the day of shock of subsidence of fever.


[Haemodynamic and vascular effects of dobutamine during and after open heart operations (author's transl)]. In cardiosurgical patients the haemodynamic effects of dobutamine 2.5 microgram/kg . min and 5 microgram/kg . min dobutamine were investigated during neuroleptanalgesia, intra- and immediately postoperatively. Intraoperative measurements were performed in 8 coronary surgical patients each after sternotomy and pericardiotomy, but before the aortocoronary venous bypass operation. The following haemodynamic parameters increased significantly: cardiac index (2.5 microgram/kg . min: 2.6 leads to 2.1 1/min . m2; 6 microgram/kg . min: 1.5 leads to 2.24 1/min . m2), heart rate (80 leads to 91 min-1; 86 leads to 107 min-1), stroke index (16%, 27%), mean arterial pressure (70 leads to 90 mm Hg; 70 leads to 93 mm Hg), mean pulmonary arterial pressure (8%; 14%), LV dp/dtmax (72%; 121%) and calculated myocardial oxygen consumption Eg (35%; 52%). Changes in right (PRA) and left ventricular filling pressure (PLVED), in total systemic resistance and total pulmonary vascular resistance were not significant. Postoperative measurement immediately after open heart operations (ASD-correction n = 5, aortocoronary venous bypass (n = 3) in neuroleptanalgesia too, showed the same haemodynamic results as intraoperatively before correction of coronary stenosis. Only a few premature ventricular beats were observed in 3 patients and there were no changes in S-T segments during dobutamine infusion. In another group of 15 patients selective vascular responses to an infusion of 10 microgram/kg . min dobutamine were examined during steady state cardiopulmonary bypass excluding heart and lungs from the circulation. No relevant direct influence on the arteriolar resistance vessels and the venous capacitance vessels were found. In a dose range of 2.5--5.0 microgram/kg . min dobutamine proved to be a potent inotropic agent causing almost no peripheral and relatively little positive chronotropic effects. But the increase in heart rate was more pronounced than in other clinical investigations in conscious patients, which might be due to an attenuation of vagal reflex by anaesthesia. The results indicate, that dobutamine may be a valuable drug in the treatment of intra- and postoperative low output syndromes especially in patients with coronary heart disease.