Independence of brain and body temperatures in flying American kestrels, Falco sparverius. Brain and body temperatures were measured via small thermocouples implanted in the anterior hypothalami and colons, respectively, of five adult American kestrels (F. sparverius, mean mass 119 g) during descending flights in a wind tunnel at angles of 4 and 6 degrees below horizontal, at 10 m.s-1 air speed, and at 23 degrees C air temperature. For comparison, temperatures were recorded from resting birds at 22.5-36.1 degrees C air temperatures. Colonic (Tc) and hypothalamic (Th) temperatures both increased after the onset of flight; steady-state levels were attained after 1 min in the hypothalamus and after 5 or more min in the colon. The steady-state difference (delta T = Tc - Th) averaged 1.2 degrees C, higher by 0.5 degrees C than delta T in resting kestrels. The establishment of delta T during flight may be correlated with increased respiratory and corneal evaporation. The response apparently confines most stored body heat to noncranial regions, thus protecting brain tissue from thermal extremes.


Effects of carotid occlusion and left atrial stretch on supraoptic neurosecretory cells. Acute experiments were performed on pentobarbital-anesthetized cats to determine whether atrial and carotid baroreceptors affected the same neurosecretory neurons in the supraoptic nucleus (SON) of the hypothalamus. The osmosensitivity of these neurons was also determined. Eighty-two SON neurons were antidromically identified and 63 of these increased their firing rates during complete occlusion of the right carotid artery. Further testing of these 63 neurons demonstrated that 56 were inhibited by directly stretching the left atrium and 61 were excited by intracarotid injection of hypertonic saline. Left atrial stretch greatly reduced the neuronal response to carotid occlusion. These results show that the activity of the majority of the antidromically identified SON neurons is altered by left atrial and carotid artery receptors as well as changes in plasma osmolality. Results are consistent with the known influence of these receptors on plasma vasopressin.


Body weight and body composition of male rats following hypothalamic lesions. Carcass analyses were performed on 160 male rats maintaining reduced, normal, or elevated levels of body weight following lateral hypothalamic (LH), sham (control), or ventromedial hypothalamic (VMH) lesions, respectively. Extracted body lipid (ranging from 26 to 738% of the control mean) correlated highly (r = +0.95) with the level of maintained body weight (which ranged from 67 to 191% of control). Neither the nonfat solids (which ranged from 60 to 123% of control) contributed significantly to the variance in body weight (r = +0.01 and +0.06, respectively). Fat thus accounted for approximately 90% of the overall variance in body weight among LH, control, and VMH animals. Consideration of only the LH data, however, revealed a breakdown of this close covariance of body fat and weight. Fat mass correlated significantly with body weight in LH rats maintaining weight 0-12% below normal; but, at maintained body weights below 88%, the correlation between weight and fat in LH rats was only +0.07. Variation in lean body mass then better accounted for differences in body weight. The implications of these observations for existing lipostatic theories of weight regulation are discussed.


Influence of dietary magnesium in experimental phosphate depletion: bone and soft tissue mineral changes. We studied weanling rats fed 0.06% (group 1) and 0.10% (group II) magnesium (Mg) during phosphate depletion (PD) in order to evaluate the role of Mg in the bone, soft tissue, and serum changes of PD. The following results were obtained: 1) serum Mg remained stable in the face of a negative Mg balance; 2) the hypercalcemic and hypercalciuric response to PD was the same in both groups; 3) bone Mg content was decreased with PD in both groups and was associated with a significant decrease in bone calcium and phosphorus. We conclude that: 1) the hypomagnesemia of PD is dependent mainly on the dietary intake of Mg; 2) the hypercalcemia and hypercalciuria of PD are not caused by primary changes in Mg homeostasis; 3) low-dietary Mg during PD may cause a defect in soft tissue utilization of P in the growing rat.


Electrical responses in cat adrenal cortex: possible relation to aldosterone secretion. The effects of secretagogues for aldosterone release were studied on the membrane potential of cells in the adrenal cortex of the cat. Adrenal glands were excised, sliced, and continuously superfused. Membrane potentials were recorded from both zona glomerulosa and zona fasciculata-reticularis. Secretagogues, angiotensin II (1 microgram/ml) and 20 mM KCl, were found to depolarize cells rapidly. Ouabain (10(-5) M) also depolarized the membrane potential although the response was sluggish. Samples of the superfusate were collected and analyzed by radioimmunoassay for their aldosterone and cortisol content. Depolarizing concentrations of angiotensin II, KCl, and ouabain seemed to increase aldosterone release. Cortisol output was more variable. Saralasin blocked the effects of angiotensin II on the membrane potential. These experiments suggest that membrane depolarization plays a role in the stimulus-secretion coupling of mineral corticoids.


Role of Ca2+ in genesis of lower esophageal sphincter tone and other active contractions. The effects of absent or low Ca2+ (0.5 mM), verapamil, nifedipine, Na nitroprusside, theophylline, La2+, and ethanol on basal active tension (tone), "off" contractions, and carbachol contractions were studied in opossum lower esophageal sphincter strips. Incubation in Ca2+-free Ringer (0.1 mM EGTA) abolished tone and contractions. Low Ca2+, verapamil, nifedipine, and theophylline depressed tone more rapidly than "off" contractions. Only verapamil and nifedipine depressed carbachol contractions. Na nitroprusside rapidly depressed tone but left contractions unchanged. La3+ at 1 X 10(-3) M behaved like Ca2+-free incubation but produced sustained contractions with muscle stimulation. Ethanol depressed "off" contractions more than tone and did not affect carbachol-induced contractions. These results suggest that tone probably results from inward leak of Ca2+, whereas "off" contractions depend on release of Ca2+ sequestered in the cell by a mechanism not immediately dependent on increased Ca2+ influx. Carbachol may increase Ca2+ influx as well as utilize sequestered Ca2+. Nifedipine and verapamil may act to block both resting and stimulated Ca2+ influx. Na nitroprusside may act by increasing Ca2+ efflux. Ethanol may act by decreasing the availability of sequestered Ca2+ or by inhibiting the function of a mediator responsible for "off" contractions.


Does 5-hydroxytryptamine influence "purinergic" inhibitory neurons in the intestine? Intrinsic inhibitory neurons to guinea pig taenia coli and small bowel circular muscle were activated by transmural electrical stimulation, and the postinhibitory contractile response of the muscle was utilized to evaluate whether or not the neuronal action of 5-hydroxytryptamine (5HT) was associated with the inhibitory neurons. The postinhibitory contractile responses of the small intestinal circular muscle were unaffected by 5HT. The 5HT antagonist methysergide also did not affect the poststimulus contractile response of the circular muscle. The amplitude and area under the contractile curve of the poststimulus contractile response of the taenia coli were reduced and the amplitude of the relaxation response to electrical stimulation was increased in one-half of the preparations after application of 5HT. Methysergide did not alter the poststimulus contractile response of the taenia coli. 5HT is implicated as a neurotransmitter substance for slow synaptic excitation within the enteric nervous system of the guinea pig small intestine; however, the 5HT synapses do not appear to be present on the "purinergic" inhibitory neurons nor on neurons that synaptically influence the inhibitory neurons.


Urinary concentrating ability during dehydration in the absence of vasopressin. Despite the apparent absence of vasopressin (ADH), Brattleboro homozygotes [diabetes insipidus (DI) rats] can concentrate their urine when deprived of drinking water. Since other investigators have shown that reducing glomerular filtration rate (GFR) improves the concentrating ability of water-loaded dogs, the present studies were undertaken to quantify the magnitude and time course of changes in GFR during dehydration. Clearance experiments were performed in 10 conscious DI rats before and following 3, 6, 9, 12, 15, and 24 h of dehydration. Urine osmolality increased from 155.0 +/- 12.6 (SE) to 696.7 +/- 8.4 mosmol/kg H2O after 24 h. GFR averaged 984.3 +/- 79.6 microliters . min-1 . 100 g body wt-1 in the control phase, fell to about 80% of this value over the first 12 h of dehydration, and then declined to 27% at 24 h. The rats lost 20% of their body weight over the 24 h. The osmolality of the papillary tip averaged 896 +/- 44 mosmol/kg H2O at 24 h compared to a control value of 493 +/- 28. The lack of osmotic equilibration between urine and papillary interstitium suggests that dehydration did not appreciably increase the water permeability of the distal nephron. These experiments clearly show a progressive decline in GFR as urine becomes concentrated during dehydration in the absence of ADH; these events may or may not be causally related.


Renal vascular resistance and reactivity in the spontaneously hypertensive rat. Renal vascular resistance is elevated in spontaneously hypertensive rats (SHR) when compared to normotensive control Wistar-Kyoto rats (WKY). The present study examined possible determinants of this raised vascular resistance in in situ autoperfused kidneys of pentobarbital-anesthetized, 12- to 16-wk-old SHR and WKY. Over a wide range of arterial pressures (30--100 mmHg) renal blood flow was consistently higher in WKY than in SHR. This relative flow difference was unchanged by acute renal denervation, with renal vascular resistance decreasing approximately 20% in both strains. Changes in renal vascular resistance to renal nerve stimulation and the administration of intra-arterial vasoactive hormones also were assessed. Vascular responses to renal nerve stimulation, tyramine, angiotensin II, and acetylcholine were similar in kidneys of the two strains, but reactivity to norepinephrine was significantly less in kidneys of SHR. It was concluded that elevated renal vascular resistance in the SHR does not result from an excessive neurogenic influence on the renal vasculature or from vascular hyperreactivity to norepinephrine or angiotensin II.


Corticoid effects on angiotensin- and norepinephrine-induced proteinuria in rats. Adrenalectomy is known to prevent the proteinuria induced by renin or angiotensin, but it is not clear whether the loss of glucocorticoids or mineralocorticoids is responsible. The problem was reinvestigated using dexamethasone and aldosterone, essentially pure glucocorticoid and mineralocorticoid, respectively. Dexamethasone treatment for 2--5 days completely restored the protein-uric response to angiotensin II or norepinephrine, but aldosterone did not, even though the dose and treatment were sufficient to induce changes in electrolyte excretion. Fractional sodium excretion was also increased by angiotensin II and norepinephrine in the dexamethasone-treated rats, but not in the aldosterone-treated rats. Both dexamethasone and aldosterone treatments restored the increase in filtration fraction, but the increase was not associated with proteinuria in some groups, and it is concluded that there is no causal relationship between increased filtration fraction and proteinuria. Reasons for considering binding of norepinephrine and angiotensin to the glomerular basement membrane as causal for the proteinuria and the hormonal requirements for such binding are discussed.


Effect of arsenite on renal tissue slice metabolism in chronic metabolic acidosis and alkalosis. Tissue slices prepared from renal cortex of littermate dogs with chronic metabolic acidosis or alkalosis were incubated in media with or without arsenite and containing 1 mM L-[14C]glutamine or [1,5-14C]citrate. The presence of arsenite increased the concentration of alpha-ketoglutarate in slices by 5--20 times the values found without this inhibitor. alpha-Ketoglutarate concentrations in acidotic slices were 40% or more greater than those in alkalotic ones when arsenited was present. 14C incorporation into alpha-ketoglutarate was also increased manyfold by arsenite with either labeled glutamine or citrate as substrate. 14CO2 production from labeled glutamine by over 90% and from labeled citrate by over 75%; the difference between 14CO2 production by acidotic and alkalotic slices was greatly reduced or eliminated by arsenite. These results suggest that in chronic metabolic acidosis metabolism of both glutamine and citrate is stimulated at a site or sites preceding formation of alpha-ketoglutarate.


Renin response to hemorrhage and hypotension in the aglomerular toadfish Opsanus tau. Renal renin and the juxtaglomerular cells evolved in primitive bony fishes, whereas the macula densa emerged later in vertebrate phylogeny. We attempted to determine whether a renal arteriolar baroreceptor exists in the toadfish Opsanus tau, which possess renin and granulated cells in the kidneys, but lack glomeruli and macula densa. Cumulative hemorrhage of 1.5, 3, 6, 12, and 18 ml/kg, or a single massive bleeding from unanesthetized toadfish, kept in 50% seawater, caused an immediate and significant decrease in mean aortic pressure and stepwise increases (5-20 times) of plasma renin activity (PRA). Papaverine (10 mg/kg) caused hypotension and increased PRA. Minoxidil (6-12 mg/kg) neither decreased blood pressure nor increased PRA. The results suggest that toadfish respond to hemorrhage and acute hypotension with renin release despite the absence of a macula densa. It remains to be determined whether decreased renal perfusion pressure due to decreased dorsal aortic pressure stimulated the receptor in the granulated cells or whether the renal nerves may be involved.


Noncholinergic vasodilator innervation in the feet of ducks. Vasomotor responses to nerve stimulation were studied in the feet of Pekin ducks (Anas platyrhynchos) and domestic chickens (Gallus domesticus). The birds were killed and the feet isolated and perfused with a Krebs solution. Electrical stimulation of pedal nerves gave vasoconstrictor responses that were abolished by injecting guanethidine and by treating birds with reserpine. After guanethidine or reserpine, nerve stimulation resulted only in vasodilatation, which was unaffected by hexamethonium. Vasodilator responses to nerve stimulation were not blocked by hyoscine or atropine, which blocked responses to acetylcholine, nor by metiamide, which blocked vasodilatation in response to histamine. Responses to nerve stimulation were blocked by tetrodotoxin. Isoprenaline produced vasoconstriction that was blocked by phentolamine and also weak vasodilator responses that were antagonized by propranolol. It is concluded that the vasoconstrictor innervation is adrenergic. The identy of the vasodilator neurotransmitter is unknown; it is apparently not acetylcholine, a catecholamine, or histamine.


Coronary dynamics and myocardial metabolism in the diabetic newborn lamb. Diabetes mellitus (DM) was produced in 17 neonatal lambs by a single intravenous injection of alloxan monohydrate (150 mg/kg). All developed hyperglycemia (greater than 300 mg/100 ml) and glycosuria after 24 h, but none exhibited ketonuria or acidosis. Plasma insulin levels were reduced to about 20% of those appropriate for the plasma glucose levels. Glucose tolerance tests (intravenous) were also consistent with reduced insulin reserve. Measurements of left ventricular performance were obtained under constant hemodynamic conditions in 16 diabetics and did not differ from those in 10 normal lambs. However, myocardial uptake of glucose was sharply reduced and fatty acid uptake was less. Myocardial O2 consumption (MVO2) was unchanged. Coronary flow (CF) was significantly lower in the diabetics (P less than 0.001). Pressure-flow studies were also done and demonstrated a consistent reduction in CF at a given aortic pressure in DM compared with controls. These findings indicate that coronary vascular resistance is elevated in the lamb with DM, and this is not explained by a change in MVO2. Oxygen requirements of the diabetic hearts were satisfied by increased extraction.


Flow and power output of right ventricle facing load with variable input impedance. The output from the right ventricle (RV) was studied at different load impedances. Isolated cat hearts were perfused with Tyrode solution with erythrocytes. Coronary perfusion pressure and RV end-diastolic pressure were kept constant. The RV pumped into an artificial hydraulic load with independently variable resistance (R) and compliance (C). Mean RV flow (RVO) decreased after R increase or C reduction. For each heart, RVO and mean RV pressure were linearly related. The slope of the regression line is interpreted as an "apparent source resistance" (Rs). Rs was on average 3.4 X 10(3) (dyn.s.cm-5). The static hydraulic power output was maximum at a certain load R (Rm). Rm was C dependent at an average high C of 5 X 10(-5) dyn-1.cm5, Rm was 9.4 X 10(3) dyn.s.cm-5 on average and shifted to 5.4 X 10(3) at low C (avg 0.8 X 10(-5). Theoretical considerations show that Rm/Rs will be equal to total heart period divided by ejection period in the extreme case C leads to infinity, and Rm/Rs leads to 1 when C leads to 0. Experimentally, Rm/Rs was 2.4 (avg) for high C, and approached 1 for low C, which fits the theoretical predictions. The results indicate that high C facilitates the matching between the right heart and the vascular resistance in the lung.


Hemodynamics of central infusion of angiotensin II in normal and sodium-depleted dogs. The intraventricular (IVT) administration of angiotensin II (AII) (100 ng.kg-1.min-1) produced significant elevations of arterial blood pressure in pentobarbital-anesthetized dogs on either normal or sodium-deficient diets. In both groups of dogs the intraventricular administration of AII caused comparable and significant elevations in blood pressure averaging 15 +/- 2 and 17 +/- 4 mmHg, respectively, within 10 min after onset of the infusion. The rises in blood pressure were due to increased peripheral resistance (2.87 +/- 1.20 vs. 1.67 +/- 0.43 units). At the peak of the pressor response bradycardia was a constant feature in sodium-depleted animals, but was not present in the normal ones. In both groups of dogs regional cerebral blood flow (rCBF), determined by the xenon-133 washout method, remained unchanged during the development of the pressor response, and peripheral plasma renin activity failed to increase in response to the central infusion of AII. In conclusion, sodium deprivation appears not to influence the sensitivity of the central AII receptor because comparable pressor responses and hemodynamic changes were obtained following the intraventricular administration of AII in both normal and sodium-depleted dogs.


Vagal and sinoaortic reflexes in postural control of circulation and renin release. Anesthetized cats were subjected to two 10-min trials of head-up tilting spaced 60 min apart. Bilateral cervical vagotomy, performed after the first tilting episode, did not affect the hemodynamic response to the change in posture, but significantyly and markedly reduced the increase in renin release from the innervated kidney. After sinoaortic denervation a marked and sustained arterial hypotension occurred during tilting, and the postural increase in renin release, though still limited to the innervated kidney, was even greater. When pressure homeostasis to tilting was disturbed, the renin release response was seen to be independent of the vagi, as it occurred after combined vagotomy and sinoaortic denervation. Maintenance of arterial pressure during tilting is mainly due to sinoaortic reflexes, whereas vagal reflexes are mostly responsible for the postural increase in renin release. The vagally independent release of renin observed when the cardiovascular response to tilting is impaired, is probably due to a direct action of arterial hypotension on intrarenal receptors, an action occurring only in innervated kidneys.


Comparison of arterial wall mechanics in normotensive and spontaneously hypertensive rats. Segments of carotid artery from Wistar (NW), Kyoto Wistar (WKY), and spontaneously hypertensive rats (SHR) were used to compare mechanical properties and connective tissue composition. Pressure-diameter measurements were made under conditions of active (5 microgram/ml norepinephrine) and passive (0 mM Ca2+ and 2 mM EGTA) smooth muscle. Systolic blood pressures averaged NW, 121 +/- 3; WKY, 124 +/- 4; and SHR, 187 +/- 5 MMHg. Passive mechanics were stiffest in SHR and most compliant in NW arteries. No differences in collagen-elastin ratio were found but collagen + elastin was lowest in SHR and highest in NW carotids. These results are not consistent with current concepts of the contribution of connective tissue elements to passive mechanics. Maximum stress development was NW, 561 +/- 49; WKY, 735 +/- 50; and SHR, 944 +/- 79 X 10(3) dyn/cm2. Diameter reductions to NE at 100 mmHg were NW, 17.6 +/- 2.4%; WKY, 16.7 +/- 2.0%; and SHR, 24.8 +/- 2.4%. The former suggests different contractile protein contents or more efficient intercellular force coupling in SHR. The latter suggests a more effective contractile apparatus as a result of stiffer passive muscle elements and/or a relatively larger wall thickness.


Autoregulation of superior mesenteric flow in fasted and fed dogs. Pressure-flow relations in the intestinal vasculature were obtained by producing stepwise reductions of intestinal perfusion pressure with an adjustable metal clamp placed upon the descending thoracic aorta. To eliminate intervention of the baroreceptor reflex, systemic arterial pressure was maintained constant by a pressure compensation system connected to the two carotid arteries. In the fed dogs, autoregulatory vasodilatory responses to reduced perfusion pressure maintained flow within 5% of control in the 85-125 mmHg range. In 30% of the fed dogs, superior mesenteric flow actually increased as perfusion pressure was reduced in the pressure range 85-125 mmHg, indicating superregulation of flow in the intestinal vasculature. The degree of flow autoregulation in the fasted dog was less than in the fed dog. Moreover, superregulation of intestinal flow was not observed in any of the fasted animals. These data suggest an intimate link between parenchymal activity and local flow control in the small intestine.


Effect of sympathetic nerves on cerebral vessels during seizures. The purpose of this study was to determine the effect of activation of sympathetic pathways during seizures on cerebral blood flow and integrity of the blood-brain barrier. We measured cerebral blood flow with microspheres and disruption of the blood-brain barrier with labeled albumin in cats. One cerebral hemisphere was denervated by cutting the superior cervical sympathetic trunk on one side. During bicuculline-induced seizures, superior cervical sympathetic nerve activity increased about threefold. Blood flow to the innervated hemibrain was significantly lower than flow to denervated hemibrain. However, in relation to the total increase in flow, this effect of nerves was minor. Blood-brain barrier permeability increased about sixfold during seizures, but there was no difference between the innervated and denervated sides of the brain. We conclude that sympathetic nerves attenuate the increase in cerebral blood flow during seizures, despite the increase in metabolism, but this effect is small. Activation of sympathetic nerves does not reduce disruption of the blood-brain barrier during seizures.


Myocardial relaxation. I. Effect of nitroprusside on the tension prolongation phenomenon. The effects of nitroprusside and cyanide on myocardial relaxation were studied during hypoxia and reoxygenation of isolated rat papillary muscle, and during segmental ischemia and reperfusion in the intact dog heart. Nitroprusside did not affect isolated muscle performance before or during hypoxia. During reoxygenation of hypoxic muscles, the tension prolongation phenomenon (which characterizes abnormal or prolonged relaxation) was only slightly attenuated by the addition of nitroprusside to the muscle bath; in contrast, cyanide (at concentrations that did not prevent the return of tension) abolished tension prolongation during reoxygenation. During reperfusion of ischemic segments in intact hearts, the prolongation of segment tension was not affected by systemic administration of nitroprusside, but was abolished by intracoronary cyanide. Attenuation of the tension prolongation phenomenon by nitroprusside in the isolated muscle may be due to the liberation of cyanide. Inasmuch as nitroprusside did not affect the tension prolongation phenomenon in the intact heart, it is unlikely that the influence of this drug on left ventricular diastolic compliance is mediated through an alteration in the tension prolongation phenomenon.


Quantitative study of intramyocardial compression in the fibrillating heart. Extravascular compression inhibits coronary blood flow in fibrillating hearts. Pressure-flow curves from spontaneously fibrillating hearts whose coronary arteries were maximally dilated were examined to see whether this inhibition involves a vascular waterfall mechanism as has been found in the beating heart. Waterfall behavior is indicated when pressure-flow curves are linear and experience a zero-flow intercept at pressures greater than venous pressure. Regional pressure-flow curves revealed a zero flow intercept of 28.4 mmHg for the inner quarter of the left ventricle, indicating that compression is quite high in that region. A zero-pressure intercept of only 15.1 was found at the outer quarter, which was not significantly different from venous pressure. We conclude that the spontaneously fibrillating heart experiences a gradient of compression falling from 28 mmHg at the subendocardium to near zero at the subepicardium.


In vitro effects of desoxycorticosterone on vascular smooth muscle. We present evidence in accord with the observations of S. Kalsner (Br. J. Pharmacol. 36: 582-593, 1969) that in the rabbit aorta, desoxycorticosterone (DOC) potentiates the contractile response to certain catecholamines by inhibiting their degradation by catechol-O-methyltransferase. In contrast, DOC depresses the contractile responses in rat aorta and tail arteries. To elucidate the mechanism of this depression the effect of DOC was evaluated under various conditions. DOC depressed the contractile response to epinephrine, phenylephrine, KCl, and angiotensin II. The depression was unaltered by ouabain or by a potassium-free solution, indicating that DOC did not produce its depression by altering Na-K-ATPase activity. The depression is unaltered in a chloride-free solution, demonstrating that the DOC effect is not caused by a change in membrane permeability to chloride. Radioisotope studies demonstrate that DOC does not alter membrane permeability to potassium. Removal of extracellular calcium with EGTA (ethylene glycol-bis (beta-aminoethyl ether) N, N'-tetraacetic acid) significantly reduced the magnitude of the DOC depression. Indirect evidence is presented suggesting that DOC might increase calcium binding to the plasma membrane, resulting in its stabilization and hence in a depression of the contractile response.


Participation of slow inward current in the Purkinje fiber action potential overshoot. We used microelectrode techniques to study the relationship of canine Purkinje fiber membrane potential and the action potential (AP) overshoot. At the maximum diastolic potential, -93.0 +/- 0.5 (SE) mV, AP overshoot was +37.7 +/- 0.4 mV. There was a range of membrane potentials (MP) less negative than the maximum diastolic potential from which action potentials were elicited with an overshoot greater than the control. Starting at an MP of less than -78.7 +/- 0.4 mV, AP overshoot was less than control. A maximum overshoot of +40.2 +/- 0.4 mV occurred at an MP of -85.4 +/- 0.4 mV. The relationship of the maximum upstroke velocity (Vmax) of phase 0 depolarization to MP was sigmoidal. Peak Vmax, 497 +/- 13 V/s, occurred at MP greater than or equal to -89.3 +/- 0.5 mV. The increase in overshoot was enhanced as perfusate [Ca2+] increased and decreased as [Ca2+] decreased. Slow-channel blocking agents and tetrodotoxin (TTX) depressed the peak of the curve relating overshoot to MP. TTX also decreased Vmax. The effect of TTX on overshoot but not on Vmax was reversed with Ca2+, 8.1 mM. The increase in overshoot for action potentials initiated during the terminal part of phase 3 was due to a slow, delayed component of the upstroke and appears to result from the slow inward current.


Cardiovascular changes during spontaneous micturition in conscious cats. The hemodynamic changes occurring during spontaneous micturition were recorded in conscious cats. Arterial blood pressure was continuously measured by chronically implanted arterial catheter, heart rate (HR) by a cardiotachometer, and cardiac output (CO), superior mesenteric (MF), renal (RF), and external iliac blood flows (IF) by chronically implanted electromagnetic flow probes. Spontaneous micturition was accompanied by little change in mean arterial pressure (-9.7 +/- 0.7%), but by a marked decrease in HR (-49.0 +/- 1.2%) and CO (-28.6 +/- 2.5%), and therefore by a marked decrease in total peripheral conductance (-21.0 +/- 3.5%). Visceral and hindlimb blood flows were markedly reduced during micturition (MF, -34.7 +/- 2.1%; RF, -22.6 +/- 1.5%; and IF, -48.7 +/- 1.5%, respectively) due to a marked reduction in regional conductances in both these areas. The vasomotor changes in the regional circulations were prevented by local sympathectomy. Thus spontaneous micturition is associated with marked changes in cardiac function and systemic circulation. Cardiac output is decreased, but diffuse nervous systemic vasoconstriction compensates for this and provides maintenance of arterial blood pressure level.


Formation of angiotensin III from [des-Asp1]angiotensin I in the mesentric vasculature. The effects of [des-Asp1]angiotensin I and angiotensin III on mesenteric blood flow were compared in 15 pentobarbital-anesthetized dogs. These agonists were administered as bolus injections directly into the vasculature supplied by the superior mesenteric artery. Both [des-Asp1]angiotensin I and angiotensin III produced dose-dependent decreases in mesenteric blood flow, with angiotensin III being more potent than [des-Asp1]angiotensin I at all doses tested. The constrictor responses to [des-Asp1]angiotensin I were markedly attenuated in the presence of an angiotensin-converting enzyme inhibitor (SQ20881); SQ20881 did not alter responses to angiotensin III or norepinephrine. The administration of [Ile7]angiotensin III (an angiotensin III antagonist) attenuated the responses to both [des-Asp1]angiotensin I and angiotensin III, without altering the responses to norepinephrine. These results suggest that the decrease in mesenteric blood flow produced by [des-Asp1]angiotensin I is largely caused by its local enzymatic conversion to angiotensin III. This conversion in one transit through the mesenteric vasculature is approximately 24%.


Myocardial adenosine salvage rates and restoration of ATP content following ischemia. The isolated perfused rat heart was utilized to determine the maximum rate of adenosine incorporation into adenine nucleotides and the effect of ischemia on this rate. In aerobic hearts, the rates of [8-14C]adenosine incorporation into nucleotides in nanomoles/minute per gram dry tissue were ATP 34 +/- 2, ADP 6 +/- 0.4, AMP 3 +/- 0.3, and IMP, 1 +/- 0.2. Following ischemia these values were not significantly different except for the rate of incorporation into IMP, which doubled. The extent of adenosine deamination with one pass through the coronary vasculature was the same in aerobic and postischemic hearts: 2% and 7% of the perfusate adenosine was converted to hypoxanthine and inosine, respectively. These percentages were similar at 50, 100, and 200 micron adenosine. Perfusion of aerobic hearts for 5 h with adenosine did not change ATP concentrations. Therefore, [8-14C]adenosine incorporation into ATP in these hearts appeared to represent ATP turnover. In contrast, 5 h perfusion of postischemic hearts with adenosine restored ATP concentrations to control values. The synthesis rate calculated from the increase in ATP concentration was comparable to the synthesis rate calculated from [8-14C]adenosine incorporation. Thus, incorporation of [8-14C]adenosine into ATP in postischemic hearts represented net ATP synthesis.


Intramural PCO2: a reliable index of the severity of myocardial ischemic injury. The present study was performed to evaluate the usefulness of changes in intramural oxygen (PmO2) and carbon dioxide (PmCO2) tensions shortly after coronary artery occlusion as indices of the severity of myocardial ischemic injury. In 14 open-chest, anesthetized dogs, a 60-min coronary artery occlusion was performed, during which PmO2 and PMCO2 were measured continuously with a mass spectrometer. Regional myocardial blood flow (RMBF) adjacent to the mass spectrometer probes was measured by the xenon-127 washout technique both before and 30 min after coronary artery occlusion. At the end of 60 min of occlusion, the dogs were killed, and biopsies for histological examination of 1-micron-thick sections were obtained from the tissue surrounding each mass spectometer probe. The decline in PmO2 during the 60-min occlusion bore no relationship either to the severity of ischemic injury as assessed by histological examination, or to the reduction of RMBF. In contrast, the magnitude of rise in PmCO2 during the 60 min of occlusion corresponded closely to both the severity of injury assessed histologically and the reduction of RMBF.


Laser scanner measurement of central segment performance in isolated cardiac muscle preparations. A laser scanning system has been developed to facilitate the study of isolated cardiac muscle by excluding the possibly damaged tissue at the ends of the preparation. The laser scanner monitors the length of a central segment of the muscle that has been delineated by markers consisting of single loops of 8-0 silk suture. Focused laser light traverses the length of the muscle at 150 Hz. Scattered light is detected by a photodiode and the length of the central segment is calculated electronically. This system provides an accurate measure of central segment length in both resting and active muscle with no apparent damage to the preparation.


In vivo measurement of blood vessel wall thickness. To understand the mechanical properties of arteries and vascular grafts, it is crucial that the wall thickness in these vessels be known. Unfortunately, all availble methods for measuring this parameter require the removal of the vessel, which precludes the study of such vessels as a function of time. A new radiographic technique for measuring the wall thickness of arteries and vascular grafts in vivo, utilizing contrast materials injected into the vessel lumen and applied to the outer surface of the vessel, is described. Radiographs are obtained with a portable X-ray machine and analyzed using a calibrated microscope. The technique has been successfully applied to the in vivo measurement of wall thickness in canine arteries, veins, and experimental vascular grafts. It is concluded that the method provides better than 95% accuracy in a variety of vessels and that it can be used to study changes in vascular grafts after their implantation into the arterial circulation.


Evaluation of a screen oxygenator suitable for small animal organ perfusion. A small vertical screen oxygenator was built using a stainless steel screen enclosed in a Plexiglas box as the oxygenating surface. The unit was primed with 35 ml dextran-diluted blood (Hct 25.1 +/- 0.6%. mean +/- SE) and tested in cats with a partial cardiopulmonary bypass circuit. An oxygen saturation of more than 95% was always obtained, even when the incoming venous saturation was as low as 15%. The O2 exchange capacity was minimally affected by changes in blood flow (1.5 to 70 ml/min) through the unit. CO2 extraction was not flow limited over the range tested. Output PCO2 was 33.3 +/- 0.6 mmHg and pH was 7.29 +/- 0.02. These results were obtained when 3% CO2 in O2 was passed through the oxygenator chamber at 1.0 to 5.0 l/min. The performance of the unit was stable for periods up to 4 h. The small priming volume and reliable performance make this oxygenator suitable for organ perfusion in small experimental animals.


Nonpressor mechanisms in CNS-induced natriuresis. Ventriculocisternal perfusion was performed in pentobarbital-anesthetized dogs. Perfusion of high Na (300 mM NaCl) artificial cerebrospinal fluid (CSF) (E) for 2 h was preceded by 2 h of control (C) and was followed by 2 h of recovery (R) during which normal (150 mM NaCl) artificial CSF was perfused. A time-control group was perfused with normal artificial CSF throughout C, E, and R. High sodium perfusion resulted in a marked natriuresis in each of nine animals and suppression of plasma renin activity. Theere were no simultaneous changes in mean arterial pressure, glomerular filtration rate, or renal plasma flow. Sodium excretion and plasma renin activity showed a slight gradual rise in the time-control group, but no significant differences were observed between the C and E periods; sodium excretion and plasma renin activity were similar in the high Na and time-control groups during C and R, but significantly different during E. It is concluded that when CSF sodium is elevated by perfusing artificial CSF, the resulting natriuresis and suppression of plasma renin activity are not caused by hemodynamic changes.


Denial and affirmation in illness and health. Recent research has shown that patients with life-threatening illnesses have improved chances of survival if, rather than recognizing the serious consequences of their illness, they employ the psychological defense mechanism of denial. Reexamination of these data suggests that unexamined psychological factors which promote a positive view of health are of equal or greater importance in explaining those results. Health care professionals, concerned with diagnosis and treatment, primarily focus attention on illness and its denial or recognition. To expand this perspective to include factors for health, the author presents a four-cell paradigm of illness, health, denial, and affirmation. The paradigm is illustrated with examples of common problems in medical care.


Administrative relationships between community mental health centers and academic psychiatry departments. The authors reviewed the administrative relationships between academic departments of psychiatry and community mental health centers (CMHCs). By telephone, they surveyed the chairpersons of 110 departments of psychiatry with approved psychiatric residency programs and found that 87 (79%) had some type of administrative relationship with a comprehensive CMHC. Almost two-thirds of the chairpersons of these departments considered the CMHC to be of major importance to their educational programs. Only 8 (7%) of the 110 departments had discontinued their relationship with a CMHC. Most of the chairpersons whose departments were involved with a center were optimistic about the future of their programs in CMHCs.


Impact of restrictive civil commitment procedures on a prison psychiatric service. To assess the impact of restrictive civil commitment procedures, the authors studied the population of a prison psychiatric unit before and after the procedures were implemented. Their findings suggest that when the community finds it difficult to use the alternative of involuntary hospitalization, arrest and imprisonment are used to remove mentally ill people from the community.


Judging emotions of normal and schizophrenic subjects. Thirty-two nursing students were shown silent films in which 10 normal and 10 schizophrenic women described a happy, sad, and an angry personal experience. Accuracy in judging the content of films of normal subjects was associated with social detachment and mechanical interests, whereas accuracy in judging the emotions of the schizophrenic subjects was associated with social involvement and nursing interests. Further, the students nurses' ability to relate to patients, as judged by their nursing supervisors, was associated with their ability to accurately identify the nonverbal emotional communications of the schizophrenic patients but not of the normal persons.


Decreased 24-hour urinary MHPG in childhood autism. The authors compared a group of boys with childhood autism and a group of normal boys of similar age and found a decrease in urinary 3-methoxy-4-hydroxyphenethylene glycol (MHPG) in the autistic group. They hypothesize that autistic children might have an alteration in central and peripheral noradrenergic function, which might be related to impaired regulation of attention, arousal, and anxiety.


A language-cultural course for foreign psychiatric residents. Foreign medical graduates are an important component of the health care system in the United States. All foreign medical graduates have acculturation problems, but they are especially aggravating among foreign psychiatric residents. These difficulties affect the personal lives of the foreign residents as well as crucial teacher-student and doctor-patient relationships. The authors report on an effort to further define these problems in a residency program and their systematic attempts to solve them by offering a special course. The program they describe benefitted not only the foreign residents but their families and the residency program itself.


Amyl nitrite use among homosexual men.

Amyl nitrite use among homosexual men. The authors interviewed 150 homosexual men to determine the relationship between use of amyl nitrite and certain aspects of homosexuality. They found that the use of amyl nitrite is strongly related to a number of unconventional, deviant sexual practices and to certain medically related problems.


Three cases of manic-depressive illness in mentally retarded adults. The authors point out that manic-depressive illness is often not diagnosed in mentally retarded patients because they are already regarded as "different." They discuss the use of lithium carbonate as a prophylactic agent in the treatment of manic-depressive illness in mentally retarded patients and present three case histories illustrating some of the difficulties encountered in diagnosing mania or hypomania in such patients. They provide a number of suggestions to help physicians recognize and treat these disorders.


Psychoanalytic teaching in medical education. The author sent a questionnaire to directors of medical student education in psychiatry to determine the role of psychoanalytic concepts in medical education. Practically all of the 66 respondents indicated that psychodynamic theory had been incorporated into major required courses. More than half considered the concepts of defense mechanism countertransference, transference, and dynamic unconscious necessary to general education. The author concludes that psychoanalytic principles will continue to provide a unique view into illness behavior and the doctor-patient relationship.


Community mental health centers: returning to basics. Community mental health centers (CMHCs) have made a significant contribution to making mental health services available to many Americans; in 1977 they served almost two million people. External fiscal constraints and internal service and accountability requirements now test the viability of CMHCs, but the most recent extension of the law allows increased flexibility on implementation, and the President's Commission on Mental Health has reinforced the original purpose of CMHCs by calling for an initiative to give special attention to the needs of children and youth, the elderly, minorities, the chronically mentally ill, and other underserved populations and areas.


Piaget's stages of cognitive development and adult character structure. Psychonalytic and Piagetian findings are bridged by understanding character structure. Social cognition of the three character types corresponds to three phase of cognitive development: Symbolic, Intuitive, and (Concrete) Operational. A child constructs his supergo by coordinating his perceptions of his caretaking as he coordinates other perceptions in the Operational Period.


Critique on primal therapy.

Critique on primal therapy. This paper attempts to indicate some of the strengths and weakenesses of primal therapy, some of the ways it is changing and how it can be incorporated within more traditional psychodynamic frames of reference.


The "Newsletter": a catalyst for learning in group psychotherapy. This article reports on an experiment in which members of a therapy group were invited to take turns doing process recordings of meetings, which were then circulated weekly to all members. The history of this "Newsletter," its benefits, the therapeutic goals, and the resistance it encountered are described. The method is seen as a potentially enriching tool for group psychotherapy.


Alexithymia and psychotherapy.

Alexithymia and psychotherapy. Alexithymia represents a disturbance in affective and cognitive function which overlaps diagnostic categories. Emotions are not differential, and are poor verbalized. Imagination related to drive fulfillment is limited. These and other problems seriously interfere with the patients' capacity to benefit from dynamic, uncovering or "anxiety-producing" psychotherapy. In order to consider possible remediation of the problem, we must explore the nature and causes of this disturbance.


Psychotherapy of the obsessional.

Psychotherapy of the obsessional. Obsessional defenses require a confronting, active therapist in order to break through the intellectualized, ritualized, and highly distracting productions of the patients. The tendency to obfuscate through details and rigid adherence to the instructions demands a loose, flexible, and direct interaction from a therapist who is not too obessional and willing to forego his own perfectionistic expectations from therapy.


Behavioral problems masking depression--cultural and clinical survey. In different cultures depressions are masked by different acting-out behaviors; they vary as to type and frequency and are colored by local customs and social determinants. In Western societies hypochondriasis and psychosomatic disorders are the more common masking processes. The broad spectrum of acting-out behavioral patterns pose diagnostic and therapeutic challenges.


Heredity and character disorders.

Heredity and character disorders. The role of heredity in personality development and character disorder has been studied by a variety of means. These include investigation of twins and/or families, using clinical ratings, personality scales, or psychological tests; observation of neonates and infants; and longitudinal description of discordant pairs of twins. Attention to the interaction of heredity and environment provides new strategies for prevention and treatment.


Group therapy with gender-dysphoric patients. A two-year study utilizing expressive dynamic group psychotherapy with gender-dysphoric patients is described. Two distinct stages in the emergent therapeutic relationship are labeled and clinically evaluated. Specific strategies and goals and the problems and processes of running such a therapy group are discussed at length.


New views on the psychodynamics of phobias. After having differentiated phobias from pseudophobias, the author describes the three stages in the psychodynamics of this psychoneurotic condition. A case is reported in detail and interpretations offered. The new hypothesis is advanced that the unconscious motivation and the defenses go beyond the individual protection of the patient. Psychotherapy is discussed.


Lateral capsualr ligament complex: anatomical and surgical considerations. Acute avulsion of the bony attachment of the lateral capsular ligament was observed on x-ray films in September 1975. Seven instances were confirmed at surgery during the following 29-month period. The avulsion was reproduced in six amputation specimens which were dissected to identify the components of the lateral capsular complex. Dynamic studies were performed on a set of amputation specimens to determine the role of the various structures contributing to lateral rotary instability. The dissection revealed that the lateral capsular ligament complex has vertical and horizontal components. The dynamic studies showed that lateral pivot shift was produced by a lateral capsular release, a complete section of the anterior cruciate ligament, and a partial tibial collateral ligament release. Based on these observations, 30 patients have subsequently had reconstructive surgery to eliminate their lateral rotational instability. In the reconstruct procedure, both the bony attachment of the lateral capsular ligament and the iliotibial tract with Gerdy's tubercle have been moved anteriorly and inferiorly without separating their interconnections or any attachments. Clinical experience in these 30 patients supports the evidence obtained in the dynamic studies. Restoration of stability is secure when both the lateral capsular ligament and the iliotibial tract are advance with their anatomical connections intact.


Strains of the posterior calf musculature ("tennis leg"). Strains of the posterior calf musculature frequently relate to overuse of the gastrocnemius muscle. The principal sports involved are the slower side-to-side sports. Treatment routine is composed of pain relief, passive stretching, exercises for the antagonists and later the agonists, and quadriceps exercises. In a series of 720 patients, over a 12-year period, this routine has been effective as evidenced by a recurrence of the condition in only 0.7% of the patients. Prevention of the injury is best obtained by regular stretching and strength development routines.


Primary internal fixation of carpal navicular fractures in the athlete. Primary open reduction and internal fixation is an established procedure for treatment of carpal navicular fractures. With the use of an alignment device, the surgery can be performed on outpatients, under local anesthesia, in 30 to 45 min. The wrist is splinted in a protective device for approximately 6 weeks but no cast is necessary. Four of 13 patients in this series have been athletes. The procedure has allowed them to participate in sports during the healing period and to return to contact sports 6 to 8 weeks postoperatively without joint protection. These athletes have regained full range of motion in the wrist joint. Although the procedure is not recommended for hairline fractures which usually heal quickly or comminuted fractures of the navicular, it appears to be the treatment of choice for fractures of the carpal navicular bone at the level of the middle and proximal third of the bone or any displaced fragment with malposition in the axial or rotary plane.


Exposure to injury in major college football. A preliminary report of data collection to determine injury exposure rates and activity risk factors. Five football teams from major colleges in the nation were surveyed during practices and games in the 1976 season. Data were collected on three packages of information designed as a computer program for tabulation, analysis, and storage of data. Investigators, with a thorough knowledge of football and trained in the use of the program, obtained the data from a given team during every drill, practice, and game of the season. Injury exposure rate was calculated as a ratio of injuries to minutes of exposure in 14 categories (12 specific drills, practice games, and other activities). Agility drills produced the fewest number of injuries for the amount of exposure time (exposure rate, 47,138; risk ractor, 1) and, therefore, it served as a base from which risk factors for all other categories would be calculated. No injuries were recorded in calisthenics. Practice games had the lowest injury exposure rate (1,009) and the highest risk factor (47). Analysis of data is incomplete at this time. The ultimate intent of the study is to help identify and eliminate harmful factors, establish norms, and provide a service to other schools that may desire exposure rate/risk factor data analyzed at a reasonable cost.


Recommendations for the screening of military personnel over 35 years of age for physical training programs. Persons over 35 years old have an increased prevalence of risk factors. Careful medical examinations, even in a fit military population, are needed before initiating intensive physical training regimens. Risk factor profiling, which synthesizes major risk factors into a composite score, is a beneficial procedure by which to evaluate individuals. Training programs should be based on several considerations: (1) the individual's age and physical condition; (2) his body composition; (3) his risk factor profile; (4) his preference and physical ability for activity; and (5) the available facilities and climatic conditions. Exercise should enhance work capacity and serve as a preventive measure for coronary heart disease. The most efficient types of exercise to meet these ends are activities that involve the large muscles in continuous activity for 20 to 30 min daily, including warm-up and cool-down periods.


Management of hand injuries in a professional football team. Review of 15 years of experience with one team. Thirty-eight players from one professional football team suffered 46 major hand and wrist injuries during a 15-year period. Twenty-one of the injuries occurred in offensive players and 25 occurred in defensive players. The injuries included fractures, dislocations, fracture dislocations, and soft tissue injuries of the phalanges, metacarpals, carpals (particularly the navicular), and distal radius/ulna, including intra-articular injuries. Twelve surgical procedures were performed. Open reduction, internal fixation, and Lightcast immobilization devices (3M Company, Atlanta, Georgia) allowed the players to return to active participation with a minimum loss of practice time and virtually no loss of Sunday game availability. Early aggressive surgery for intra-articular and certain metacarpal fractures is the correct course of treatment, according to our analysis, in order to achieve the best possible functional results.


Orthopaedic injuries in athletes (ages 6 to 17). Comparison of injuries occurring in six sports. A prospective study of orthopaedic injuries to children (ages 6 to 17) was conducted for a calendar year in the controlled environment of a military post. Data were collected on the number of participants, the hours of participation, and the number of injuries for six supervised sports (football, soccer, basketball, baseball, swimming, and gymnastics). An injury index factor was derived by a formula: (number of injuries x 10(4)) divided by [(number of participants) x (average number of hours of participation) x (number of weeks in the season of the sport)]. When the injury index factors were compared, the risk a participant has for sustaining an injury in football was twice as high (1.72) as its nearest competitors, basketball (0.88) and gymnastics (0.85). Soccer had an index factor of 0.29; baseball, 0.14; and swimming had a factor of zero. Eighty percent of all sports-related orthopaedic injuries involved the upper extremities. Lower extremity orthopaedic injuries occurred only in football and gymnastics. The evidence suggests that those persons concerned with reducing the number of injuries to the growing athlete in supervised sports should focus their attention on reducing the risk of injury to the upper extremities.


Psychologic factors in competitive failures in athletes. To compete successfully, one must be able to act aggressively in controlled, nondestructive, goal-oriented ways. Conflicts affecting aggressive behavior tend to interfere with competitive success. Depression, fear of success/competitive inhibition, and guilt are among the psychopathologic entities that affect the athlete's performance, whether he be a professional athlete or an amateur to whom athletic competition is a source of recreation and pleasure. It is important that all of those involved in the training and care of athletes be aware of emotional conditions that lead to injuries, both physical and psychologic, as well as those conditions that interfere with performance and effectiveness.


Malaria and erythrocyte glucose-6-phosphate dehydrogenase variants in West Africa. In a clinical study, 702 Nigerian children aged 1-6 years were examined for malaria. Comparison of morbidity rates and parasitemia of patients with different glucose-6-phosphate dehydrogenase (G6PD) status provided evidence that in heterozygous females the gene for G6PD deficiency (GdA-/GdB) confers an advantage against malaria.


Ovaries and adrenals in murine Schistosomiasis mansoni. I. Histopathological changes of the ovaries in acute and chronic infection. Acute and chronic infections with schistosomiasis mansoni in mice were found to cause a reduction of the ovarian weight and atrophy of the corpus luteum cells, followed by lymphocytic and stroma cell infiltration. Finally, the corpora lutea disappeared completely. Acute schistosomiasis caused arrested development of the corpora lutea. Both acute and chronic schistosomiasis led to the formation of "wheel cells" in the interstitial tissue of the ovaries. A threshold level of intensity of disease was found to be necessary for these pathological changes. With less severe schistosomiasis, the morphology of the corpora lutea remained normal. The more intensive and long-lasting the infection, the greater became the atrophy of corpora lutea. The various factors which could have caused these pathological alterations are discussed in the light of available literature, and it is suggested that a pituitary hypofunction, and particularly a lack of luteinizing hormone effect, may play a role in the pathological transformation of the ovarian tissue.


Physiologic performance of women compared to men. Observations of cadets at the United States Military Academy. Observations about the physiologic factors which affected performance were made on the first women (total 119) admitted to the United States Military Academy, West Point, during their first 8-week training period. The physical requirements during 16 1/2-hr (average) days were essentially the same as required of the men (total 1,366). Results obtained from observations of the women compared to the men were tabulated in the following categories: hospital admissions (3.6 to 2.5%, injuries; 21 to 7.7%, medical conditions); stress fractures (10 to 1%); and loss of duty time (26 to 5% not capable of full duty at end of the 8 weeks). Also measurements were compared for hematocrits, body composition, major muscle groups of the upper and lower extremities, and maximum oxygen consumption. These short-term observations on women and men in an environment of equal physical training show there is a measureable difference in physical performance and that men have the advantage in accomplishing the tasks with fewer injuries or diseases and less apparent stress. Women may be capable of equal efficiency in aerobic metabolism.


Cholera in the Gilbert Island. I. Epidemiological features. An explosive epidemic of cholera due to Vibrio cholerae, biotype El Tor, serotype Inaba, was centered on the coral atoll of Tarawa, Gilbert Islands. This outbreak was a unique experience in the South and Central Pacific region. The principal mode of spread during the peak of the outbreak was probably through contamination of the main water supply. Tarawa lagoon water and shellfish were found to be contaminated with V. cholerae and ingestion of raw fish and shellfish from the lagoon also served as a source of transmission. This outbreak raises the concern of Rother outbreaks of cholera occuring on remote and poorly equipped Pacific islands where the environmental circumstances are conducive to cholera spread.


Cholera in the Gilbert Islands. II. Clinical and laboratory findings. An epidemic of cholera due to Vibrio cholerae biotype El Tor occurred in 1977 on Tarawa in the Gilbert Islands. No cholera epidemic had occurred there previously and special problems were encountered in both the diagnosis and clinical management. The clinical features of the 585 hospital admissions on Tarawa during the first 64 days of the epidemic were recorded. Eight hospital deaths occurred in this period. A marked increase in cholera among malnourished Gilbertese children was noted. Simplified regimes for management were devised for the circumstances including schemes for oral and intravenous rehydration. Coconut water was used extensively in oral rehydration. Paramedical personnel were used effectively during the epidemic. Prophylactic tetracycline was used in household contacts of patients and was effective in reducing subsequent illness.


Acremonium recifei as an agent of mycetoma in India. Acremonium recifei was identified as the causal agent in a case of white grain eumycotic mycetoma of the hand which occurred in South India. The identification was based on the structure of the granules in tissue and on the morphological characteristics of the culture obtained from the granules. This case represents the first documented instance in which A. recifei has been found outside of Latin America.


Additional isolations of Blastomyces dermatitidis from natural sites. The ecological niche of Blastomyces dermatitidis has not been established. This paper describes the repeat isolation of this pathogenic fungus from organic debris collected at a natural site and another, previously not reported, isolation. Although the precise environmental source of this pathogen still cannot be defined, each isolation of this fungus from a natural site adds to the understanding of the ecology of this organism.


Epidemic dengue hemorrhagic fever in rural Indonesia. I. Virological and epidemiological studies. Virological studies were carried out during an epidemic of dengue hemorrhagic fever in Central Java, Indonesia in 1976. Dengue virus was isolated from the acute sera of 45 of 69 patients (65%). The isolation rate was higher in primary than secondary cases. Dengue 3 was the predominant serotype being transmitted (27 isolates), but both dengue 1 (8 isolates) and dengue 4 (10 isolates) were also being transmitted. A composite picture of magnitude and duration of viremia showed that many patients were circulating over 10(8) MID50 per milliliter dengue 3 virus for the first 3 days of illness and that viremia persisted for 5-6 days in some persons. If all shock cases were considered, there was no relationship between dengue serotype and severity of disease. All three confirmed fatal cases, however, were associated with dengue type 3 infections.


Epidemic dengue hemorrhagic fever in rural Indonesia. II. Clinical studies. Clinical observations were made on 95 serologically or virologically confirmed dengue fever cases during an epidemic in a rural area of Indonesia in December 1976. The age distribution was similar to that observed in patients with dengue hemorrhagic fever in Jakarta, a highly endemic urban area. The observed disease ranged in severity from undifferentiated fever to shock and death. The majority of patients had acute onset of fever with nausea, vomiting, headache, and abdominal pain. Hepatomegaly was observed in only 19% of the patients. A positive tourniquet test was the most frequently observed hemorrhagic manifestation, but epistaxis was observed in 20% and hematemesis in 6% of the patients. Dengue shock syndrome was observed in 37% of the patients. There were four deaths, three of which were confirmed as due to dengue infection by virus isolation. The data suggest that one, and possibly two, of the fatal cases with virus isolation were primary infections, based on the results of hemagglutination-inhibition test using all four dengue antigens.


Epidemic dengue hemorrhagic fever in rural Indonesia. III. Entomological studies. Entomological studies were carried out during a dengue hemorrhagic fever epidemic in Central Java in December 1976. Both Aedes aegypti and Aedes albopictus were widely distributed in Bantul, but the latter species was more abundant. Comparative studies on the vector competence of the two species showed that Ae. albopictus had a higher susceptibility than Ae. aegypti to oral infection with all four dengue serotypes. The two species were equally compentent in transmitting the Bantul strain of dengue 3 virus after parenteral infection. The data suggest that Ae. albopictus could have been an important vector in this epidemic, but no direct observations were obtained to define the respective contribution of either Ae. albopictus or Ae. aegypti.


Further observations on infections of guinea pigs with Venezuelan encephalitis virus strains. Guinea pigs from a Guatemalan colony died after subcutaneous inoculating of moderately small doses of equine-benign strains of Venezuelan encephalitis (VE) virus of hemagglutination-inhibition subtype I-E from enzootic habitats in Mexico and Guatemala. Thus these guinea pigs were unlike English short hair and inbred 13 guinea pigs, which usually survive infections with equine-benign VE strains of subtype I-E. We therefore caution others that not all strains of guinea pigs can be used to evaluate the potential equine virulence of VE viruses.


Relationships of bunyamwera group viruses by neutralization. A standardized serum dilution plaque reduction neutralization test was used for cross-neutralization studies of 23 strains of Bunyamwera serogroup viruses. Antigenic relationships were determined by inspection of the neutralization tests results as well as by numerical taxonomic analysis. Based on these analyses five complexes, containing 1-11 viruses, were distinguished. Little or no cross-reactivity was observed between viruses of different complexes. Three of the viruses tested were indistinguishable from prototypes and probably represent strains or varieties of those prototypes. A tentative classification scheme for the Bunyamwera group is presented.


Inactivation of complement by Loxosceles reclusa spider venom. Zymosan depletion of serum complement in guinea pigs rendered them highly resistant to lesion by Loxosceles reclusa spider venom. Guinea pigs deficient in C4 of the complement system are as sensitive to the venom as normal guinea pigs. The injection of 35 micrograms of whole recluse venom intradermally into guinea pigs lowered their complement level by 35.7%. Brown recluse spider venom in concentrations as slight as 0.02 micrograms protein/ml can totally inactivate one CH50 of guinea pig complement in vitro. Bee, scorpion, and other spider venoms had no influence on the hemolytic titer of complement. Fractionation of recluse spider venom by Sephadex G-200 filtration separated the complement-inactivating property of the venom into three major regions which could be distinguished on the basis of heat stability as well as size. None was neutralized by antivenom. Polyacrylamide gel electrophoresis of venom resolved the complement inactivators into five fractions. Complement inactivated by whole venom or the Sephadex fractions could be restored to hemolytic activity by supplements of fresh serum but not by heat-inactivated serum, pure C3, pure C5, or C3 and C5 in combination.


Failure of metronidazole in a patient with hepatic amebic abscess. The therapeutic problems of multiple amebic liver abscesses in a patient who failed to respond to metronidazole are described, and the importance of an early change to an alternative therapy is emphasized.


Is trichuriasis associated with iron deficiency anemia? We performed quantitative fecal examinations, hemograms, and serum iron determinations on 103 first-grade children from Vieques Island, Puerto Rico, to determine whether trichuriasis was associated with iron deficiency and anemia. Although hemoglobin values tended to be slightly lower in Trichuris-infected children, there was no association between trichuriasis and serum iron or transferrin saturation values. These data demonstrate that in lightly infected children such as the population studied trichuriasis is not associated with iron deficiency anemia.


Renal cortical necrosis following exposure to sap of the marking-nut tree (Semecarpus anacardium). An 18-year-old man developed skin lesions and anuria following exposure to sap of the marking-nut tree (Semecarpus anacardium). Renal biopsy showed diffuse cortical necrosis. The mechanism of nephrotoxicity of the sap is unknown but may be due to its phenolic constituents.


Low anterior resection with anastomosis by endorectal pull-through. Another look at Black's operation. The type of endorectal pull-through described by Black was evaluated as an alternative method of anastomosis in 11 anterior resections in which anastomosis from above was impossible. The method is attractive from the standpoint of function because it preserves the distal rectum and leaves the anus intact. Technical points important to success are complete mobilization of the descending colon to allow the distal descending colon to be used for the pull-through and prophylactic dilatation of the early stenosis, which is characteristic of this type of anastomosis.


Complications of continent ileostomy.

Complications of continent ileostomy. Immediate postoperative complications occurred in 15 per cent of 39 patients undergoing continent ileostomy, and late complications developed in 46 per cent of these patients. Age over 40 years, obesity, and Crohn's disease were related to the morbidity rate, but corticosteroid therapy was not a factor. Results of primary operations were superior to those of secondary continent ileostomies. With careful selection of patients and attention to technical detail, success in 90 per cent of initial continent ileostomy operations is a realistic goal.


Human hyperthermic therapy: relation between tumor type and capacity to induce hyperthermia by radiofrequency. There is mounting evidence that hyperthermia of 42 degrees C or greater is tumoricidal to cell cultures and to animal and human tumors. However, temperatures of 45 degrees C or greater may have greater potential therapeutic benefit. The ability to selectively achieve such highintratratumor temperatures without injury to normal tissue may be due to the relatively poor blood flow in tumors compared with that in normal tissues. While vascularity and blood flow are known to vary significantly among tumors, we found that of 52 tumors evaluated, temperatures of 42 degrees C or greater in 42 tumors (81 per cent) and of 45 degrees C or greater in 23 tumors (44 per cent) appeared to be independent of the histologic type of tumor. Therefore, therapeutic hyperthermia may be possible for most varieties of human solid cancer.


Thoracic outlet syndrome.

Thoracic outlet syndrome. Eleven patients with vascular sequelae of thoracic outlet syndrome were operated on at the University of California, SanFrancisco, during the past 17 years. Five patients presented with episodes of ischemia of the arm and hand secondary to microemboli released from subclavian arterial lesions produced by chronic compression at the thoracic outlet. Treatment consisted of arterial reconstruction, removal of the compressive structure, and cervical sympathectomy to relieve or lessen distal ischemia. Four of the five patients had good or excellent results; one patient required amputation of the forearm. The results were inversely proportional to the extent of distal arterial embolic occlusions present at the time of surgical treatment. Six patients presented with symptoms of chronic venous hypertension. Four of the six had subclavian venous thrombosis and were treated by transaxillary resection of the first rib to decompress the collateral veins within the costoclavicular space. All four were symptomatically improved. Two patients had venous hypertension due to extrinsic compression of the subclavian vein. One patient became asymptomatic and the other was markedly improved after resection for external compression. In this small series transaxillary resection of the first rib has resulted in symptomatic improvement in chronic venous hypertension of the arm.


Reduction of infection rates in abdominal incisions by delayed wound closure techniques. A low incidence of infection in abdominal wounds after contaminated, infected, and selected clean-contaminated operations was achieved after delayed wound closure of the skin and subcutaneous tissue. An effective method of delayed primary closure is described. Four days of open wound management with Xeroform gauze between the skin and subcutaneous tissue is followed on the 5th day be removal of the Xerform and skin approximation with Steri-Strips. Proper use of this technique is based upon appropriate assessment of wound contamination and infection risk factors. All contaminated and infected wounds are best managed with delayed primary closure and, when not possible, with healing by secondary intention. Delayed primary closure should be applied to clean-contaminated wounds if the patients are older than 60 years or have associated diabetes mellitus, malnutrition, or obesity.


Cardial myxomas: a clinical diagnostic challenge. Our experience consists of seven intracardiac myxomas in five patients seen over an 8 year period. It includes one patient who had three primary tumors, each anatomically distinct, occurring at 4 year intervals. The initial clinical presentation included embolic phenomena, unexplained neurologic symptoms, hemodynamic obstruction, and vague systemic illness. Preoperative diagnosis was confirmed by echocardiography or angiocardiography in all cases. At operation, only two of seven tumors were found to arise from the vicinity of the fossa ovalis; the other five arose from the atrial wall or ventricular septum. Wide resection of the tumors constituted the key to successful treatment. All patients have done well for periods of follow-up ranging from 6 months to 8 years. Awareness of cardiac myxoma is the key to diagnosis; treatment should be uniformly successful in all instances once the proper diagnosis has been made. Although recurrences are rare, all patients must be followed up closely for the development of new tumors, and a thorough investigation of all chambers must be conducted in patients with suspected recurrence.


Effect of micropore filtration on pulmonary function after massive transfusion. 1. This study demonstrates a positive correlation between the number and size of infused microaggregates and the subsequent abnormality in pulmonary function as measured by oxygenation and dead space. 2. No such correlation between the severity of injury and the altered pulmonary function or transfusion volume was demonstrated. 3. We were unable to demonstrate an advantage to the use of a 40 mu micropore filter in preventing the adult respiratory distress syndrome (ARDS) or in improving pulmonary function in our patients. 4. One explanation for the failure to demonstrate such an advantage is the low efficiency of the filter used.


Surgical management of extensive tracheal lesions. Resection and end-to-end anastomosis has been effective in correcting localized tracheal obstruction. This procedure can be utilized in the definitive management of extensive tracheal lesions requiring the resection of at least eight tracheal rings. Important clinical considerations are the precise preoperative assessment of the lesion, careful planning of anesthetic management, choice of the appropriate incision, avoidance of circumferential dissection, and the construction of an anastomosis free of disruptive tension.


Septic phlebitis: a neglected disease.

Septic phlebitis: a neglected disease. A review of 100 patients with peripheral septic phlebitis revealed that 54 per cent of the cases were due to intravenous catheters and 46 per cent were secondary to drug abuse. Eighty per cent of the involved veins were in the arm or neck. Pain was the most common symptom (83 per cent), with erythema and edema the most common physical signs (63 per cent). Eighty per cent of the causative organisms were gram-positive bacteria, usually Staphylococcus aureus (41 per cent) or Group A streptococcus (20 per cent). Complications were more common if septic phlebitis was due to intravenous therapy than drug abuse. No deaths were directly attributed to septic phlebitis. However, hospital stay after development of septic phlebitis was 14 days with a 56 per cent complication rate. The initial treatment of septic phlebitis should include prompt removal of the intravenous device, antibiotics, heat, and elevation. Because serious complications occur in a significant number of patients, operative excision of the involved vein should be performed if clinical deterioration occurs or if septicemia persists after 24 hours despite conservative therapy.


Reliability of Doppler ultrasound in the diagnosis of acute venous thrombosis both above and below the knee. We have found the Doppler examination to be accurate in 92% of limbs with suspected iliofemoral thrombosis and in 86% of limbs with suspected calf vein thrombosis. Above the knee, the sensitivity was 94% and the specificity, 90%. Below the knee, the sensitivity was 91% and the specificity, 84%. In the hands of a skilled examiner, Doppler ultrasound is a reliable noninvasive technique for evaluating patients with suspected deep venous thrombosis and one on which therapy can safely be based.


Asymptomatic carotid stenosis. Immediate and long-term results after prophylactic endarterectomy. 1. A review of the immediate and long-term results of prophylactic carotid endarterectomy for asymptomatic lesions of 78 carotid arteries in 72 patients between 1961 and 1976 is presented. 2. The inhospital operative mortality was zero. Two patients experienced postoperative transient neurologic deficit with complete recovery (2.6 per cent). There were no postoperative strokes. 3. Late follow-up data demonstrated that in only one patient did a stroke subsequently develop appropriate to the operative side, and it occurred 4 years after operation. Life table analysis for neurologic events carried out for up to 15 years indicated a 96 per cent stroke-free status of the surviving patients. 4. A 42 month survival rate of 83 per cent in patients treated by prophylactic carotid endarterectomy represented a statistically significant improvement over the 67 per cent survival of a comparable group of patients reported on in the literature. 5. Prophylactic carotid endarterectomy in the experience of vascular surgeons who can offer a low operative morbidity and mortality appears to be reasonable therapy in preventing stroke and prolonging survival until a randomized controlled study comparing surgery with the natural history of untreated patients shows evidence to the contrary.


Human umbilical cord vein allograft arteriovenous fistula for chemotherapy access. Seven patients who received chronic chemotherapy and required vascular access underwent construction of an arteriovenous fistula of the leg using gluteraldehyde-tanned human umbilical cord vein allografts. No wound or graft complications have occurred and patient tolerance of the operative procedure and subsequent use of the fisulas for chemotherapy has been excellent. Our preliminary results suggest that the use of umbilical vein allograft arteriovenous fistulas is quite satisfactory for long-term chemotherapy access.


Division of the left renal vein. Guidelines and consequences. Ligation and division of the left renal vein is a reasonable safe procedure in selected patients when exposure of the perirenal aorta is crucial. This manipulation is possible because of extensive venous collateralization from the left kidney in man. Measurement of the venous stump pressure before ligation is recommended to assess the degree of collateralization, and the upper limit within which the vein may be divided safely is probably in the neighborhood of 60 cm of water. Reanastomosis of the vein is not necessary for preservation of renal function, although transient left renal dysfunction may occur. Examination of the urine and careful monitoring of renal function should be routine in the postoperative period. Intravenous urography and left spermatic venography later in the postoperative course can indicate the ultimate degree of function of the left kidney and the pathways of venous collateralization. Preservation of normal function and venous architecture at the renal hilum should be the rule.


Surgical treatment of chronic visceral ischemia. Our experience with the operative repair for chronic visceral ischemia in eight patients, including two patients without visceral ischemic symptoms, is described. We prefer revascularization of as many vessels as possible and have used a small diameter Dacron bifurcation graft directed cephalad from the infrarenal aorta to the superior mesenteric artery and hepatic or splenic artery in four patients. One patient died postoperatively of an arrhythmia. Three patients died of unrelated causes 7 to 36 months after surgery. Four patients are alive 8 to 48 months after surgery. All patients were relieved of the intestinal ischemic symptoms by surgery.


Vertebral artery trauma.

Vertebral artery trauma. Injury to the vertebral artery is infrequent and poses special problems in exposure if it occurs above the entrance to the transverse foramen. The patients may present with neurologic symptoms. Pulsatile tinnitus and a bruit in the cervical-paravertebral region are constant findings. Permanent occlusion by a balloon catheter offers an unhurried and facile means of control after otherwise life-threatening lesions are stabilized.


Traumatic injuries of the abdominal aorta. Despite immediate operation, patients with abdominal aortic injuries and profound hypovolemic shock do not respond to the usual methods of resuscitation and die soon after celiotomy, prior to control and repair of the aortic injury. The rate of aortic hemorrhage exceeds the ability to restore blood volume. Shock becomes "irreversible." In such patients tamponade of the aortic injury may be effected by the use of an external counterpressure device such as a G-suit or MAST suit. These devices, used in conjunction with transthoracic aortic occlusion, may raise blood pressure sufficiently to perfuse the sritical coronary and cerebral circulation, allowing time to correct acidosis and locate, control, and repair the aortic injury. Early aggressive therapy should result in increased survival.


Role of the vascular diagnostic laboratory in the evaluation of male impotence. Penile systolic pressures, penile volume waveforms, and postischemic reactive hyperemia were measured in 106 patients (38 potent and 68 impotent). With such testing the vascular laboratory can clearly identify those impotent patients in whom penile blood flow is normal and who would not benefit from direct arterial surgery. Unfortunately, abnormal results give no assurance that ischemia is responsible for a given patient's impotence and a multimodal approach is necessary to further evaluate such patients.


A new method of preclotting fabric prostheses. A preliminary report. A new method of preclotting arterial fabric prostheses is described. The preclotting process depends on infusion of blood into a polyethylene bag containing the prosthesis. Massage of the bag aids permeation of the graft, and a second infusion of blood over a 1 minute period seals the fraft completely. Rapid preclotting and asepsis are the unique features of this method.


Management of acute aortic occlusion.

Management of acute aortic occlusion. Acute aortic occlusion is most often seen in elderly patients with advanced cardiac disease. The management of these patients has been facilitated by the use of extraanatomic bypass. Over the past 2 years, six patients aged 55 to 87 years presented to our medical center with acute aortic occlusion, three after major operative procedures. One patient had a thrombosed abdominal aortic aneurysm; in the other five patients differentiation between saddle embolus and thrombosis of the distal aorta was impossible. There was one operative death. Four of the other five patients underwent axillobifemoral bypass and one underwent aortofemoral thrombectomy. All survived, and none required amputation. Two of the three patients who underwent preoperative aortography developed transient renal failure postoperatively. Aortography is of little value in diagnosis and is probably contraindicated in acute aortic occlusion. Our recommendation for operative management includes (1) preparation of the patient for possible axillobifemoral bypass, (2) angiography of distal runoff via both femoral arteries, (3) attempt at bilateral aortofemoral embolectomy with Fogarty catheters, and (4) axillobifemoral bypass if embolectomy fails to restore normal pulsatile flow.


Incidental splenectomy: early and late postoperative complications. Of 542 splenectomies performed from 1964 to 1977, 242 were incidental to gastrointestinal surgery. The highest rate of complications was observed in these patients as opposed to those who underwent splenectomy for trauma or Hodgkin's disease. Eighteen laboratory studies did not show significant changes 1.5 to 10 years postoperatively in 96 patients. Ninety-three patients questioned because of late symptoms had the highest rate of complaints after incidental splenectomy.


Biliary enteric fistulas. Management of 47 cases in native Americans. The management of 47 patients with spontaneous biliary fistulas is reported. Thirteen did not have surgery, and another 8, although operated on, did not have the fistulas closed. In none of these patients have recurrent biliary symptoms developed. The 26 patients who did have surgical closure of the fistula were operated on, in nearly every instance, for symptoms of residual cholelithiasis or choledocholithiasis, and in only 4 of these patients was the fistula known to exist preoperatively.


Clinical significance of umbilicoportal manometry. Ninety-six adult patients had measurements of portal pressur over 1 to 5 days via indwelling extraperitoneal umbilicoportal catheters. Liver biopsy specimens obtained during catheterization showed 50 patients to have a normal liver; the remainder had liver disease. Portal pressure averaged 16.08 +/- 2.87 (SED) cm of saline in normal patients. Ten patients, 6 with cirrhotic and 4 with normal livers, were recatheterized 1.5 days to 7 months later when they came to laparotomy. In all but one, portal pressures were decreased during anesthesia and laparotomy. Twenty additional patients undergoing cholecystectomy had portal pressures measured before and after laparotomy, and after recovery from anesthesia for 1 to 3 postoperative days. Laparotomy caused a decrease in portal pressure of 2.7 +/- 1.3 (SED) cm of saline; after recovery from anesthesia portal pressure was higher by 2.5 +/- 1.7 (SED) cm of saline. Umbilicoportal catheterization is a safe and accurate technique for studying the portal system. In the intact unanesthetized state, we consider 22 cm of saline to be the upper limit of normal for portal pressure.


Evaluation and management of penetrating wounds of the neck: the role of emergency angiography. With the use of emergency angiography, careful observation, and monitoring, 40 consecutive patients with penetrating wounds were selectively managed. Eleven patients were operated on with one negative exploration and one death. Twenty-nine patients were observed after negative angiography without operation on the neck and were subsequently discharged without' overlooking a significant vascular or visceral injury or amy complication. We believe this policy to be safe and effective. It should reduce the number, the morbidity, and the cost of needless mandatory surgical explorations and should guard against clinically undetected serious injuries. Operations should be reserved for those patients with clinically obvious servere vascular or visceral injury and for those with radiographically demonstrated significant lesions.


Selective management of gunshot wounds to the neck. Report of a series and review of the literature. Thirty-two patients with gunshot wounds to the neck, 13 with multiple pellet injuries and 19 with single missile injuries, were managed selectively. Although 3 of the 32 patients died in the hospital, no death was attributable to the neck injury. This experience and a review of the literature support the concept of selective management of penetrating neck injuries with intervention based on specific indications.


Postlactational tumoral granulomatous mastitis: a localized immune phenomenon. Recurrent, nodular necrotizing granulomatous mastitis in two patients is reported in detail. Pathologic, immunologic, and bacteriologic studies in one patient indicate that this entity is different from plasmas cell mastitis, fat necrosis, mammary ductal ectasia, and the usual infectious and puerperal mastitis. Systemic antibreast autoimmune mastitis and vasculitis are also ruled out. Its pathogenesis, differential diagnosis, surgical treatment, and prognosis are discussed.


Technique for thrombectomy of reversed saphenous vein arterial bypass grafts. A technique for thrombectomy of saphenous vein arterial bypass grafts is described. The technique includes visual inspection of both anastomoses and avoids unnecessary trauma to the graft secondary to repeated attempts at passing a balloon catheter against the direction of the venous valves.


A simple method for atraumatic control of small vessels. The use of a surgical clip to maintain tension on an elastic band provides gentle temporary occlusion without special instruments or equipment.


[The therapeutic use of streptokinase in the treatment of shock lung (author's transl)]. After protracted haemorrhagic or traumatic shock, the danger of severe respiratory insufficiency is often very imminent. This serious complication is frequently acutely progressive. Even the early use of adaequate artificial respiration cannot always prevent the developement of shock lung. The significance of the different pathogenic factors is still not definitely clear. The main changes that are most imminent during shock are the organisation and carnification of cells and plasma proteins within the lung parenchyma due to increased extravasation. On the basis of pathophysiological considerations however, it seems reasonalbe to interrupt these reactions through early use of monophasic proteo- and fibrinolysis. The indication for and prognosis of a monophasic streptokinase activated fibrinolytic and proteolytic therapy was first examined in 18 patients with a clinically manifest shock lung. In 11 patients the severe initial pulmonary changes could be reversed within 48-60 hours after the beginning of treatment. The normalization of lung function was confirmed clinically and by means of x-ray and blood gas analysis. In 7 patients in which acute renal failure had occurred the progression of pulmonary failure could not be interrupted. The present study demonstrates for the first time the possibilities of fibrinolytic treatment of the shock lung. The risk of haemorrhagic complications especially in the immediate postoperative or post traumatic phase could be limited by a high dose streptokinase therapy. Under these condition the formation of excessive amounts of free plasmin in the circulation was prevented and the so-called endogenous lysis was primarily achieved.


[Changes of intraocular pressure in healthy-eyed patients under neuroleptanalgesia in abdominal surgery (author's transl)]. Ocular pressure was measured in 60 patients under neuroleptanalgesia with three different modes of induction (N2O, ketamine, thiopentone), during abdominal operations lasting at least one hour. The effect of premedication, of three different induction agents and of decurarisation on intraocular pressure were tested. It became apparent that after premedication and during the induction stage a decline of intraocular pressure (IOP) occured but did not last longer than 60 minutes. Decurarisation had no influence on the IOP. The causes of these changes and discussed.


[Heparin assay in plasma. Comparison of different methods (author's transl)]. Four different heparin assay methods were compared. Only procedures which can be routinely carried out in clinical laboratories were taken into consideration. A range of heparin concentrations was chosen for these tests which is likely to be expected in low dose heparin prophylaxis. The lowest sensitivity was found when the thrombin clotting time was applied, and slightly better results were obtained by the aPTT method. Addition of purified antithrombin III to the reaction mixtures improved the sensitivity of both methods. When factor Xa was used in a clotting test, the results were comparable to the aPTT method. The sensitivity was however, about 10 times higher when the remaining factor Xa was directly measured in a photometric assay system with a chromogenic substrate. The advantages and disadvantages of the different methods and the usefulness of heparin assays for clinical purposes are discussed.


Evidence for an input to the molecular layer and the stratum granulosum of the dentate gyrus from the supramammillary region of the hypothalamus. Injections of a mixture of tritiated amino acids were made into the posterior hypothalamus in a series of rats and cats. In every case in which the injection involved a significant proportion of the cells in the supramammillary region, labeled fibers could be followed to the dentate gyrus, the anterior hippocampal rudiment and the induseum griseum of both sides. In the dentate gyrus the hypothalamic afferents terminate in a narrow band in the outer half of the stratum gramulosum and the inner 20 micron or so, of the stratum moleculare, immediately deep to the zone of termination of the associational and commissural afferents. As judged by silver grain counts across the width of the zone of labeled terminals, the projection to the ipsilateral side is several times as heavy as that to the contralateral side, and although it involves the entire septo-temporal (=rostro-caudal) extent of the gyrus on both sides, the projection to the suprapyramidal (inner) blade of the dentate gyrus is approximately twice as heavy as that to the infrapyramidal (outer) blade.


Catecholamines in the yolk sac epithelium of the rat. Catecholamines were found histochemically in the visceral yolk sac of the rat from embryonic day (ED) 10, i.e. before the amines become detectable in peripheral or central neurons of the fetus. Formaldehyde-induced fluorescence was confined to the apical part of the yolk sac epithelial cells. The specificity of histofluorescence has been confirmed by borohydride reduction, microspectrofluorimetry revealing an emission peak at 480 nm and administration of reserpine. The catecholamines present were identified by mass fragmentography using N,O-trifluoroacetyl derivatives. At ED 13 both dopamine and norepinephrine were present, while only dopamine was detected at ED 18 1/2. Maternal circulation or the epithelial cells themselves appear as possible sources of these catecholamines. The occurrence of amines in the yolk sac epithelium may reflect an intracellular role of these compounds, a barrier function of the epithelium or a step in a transport to the fetus where the amines might assume regulatory functions.


Taste buds in vallate papillae grafted to the anterior chamber of the eye. Vallate papillae from rats were grafted to the anterior chamber of the eye of the same animal. Longterm grafts showed small taste buds located in epitelial cavities which were probably the remnants of trench walls. These grafts have been reinnervated by local nerves. Excretory ducts and serous acini of Von Ebner's glands were also present. The latter showed secretory granules in their cells. The specificity of the nerve fibers and of the epithelium in relation to the induction of taste bud differentiation are discussed.


Development of the intrarenal vascular system of the puppy kidney. This study investigates the development of the vascular system of the puppy kidney (1-21 days after birth) after preparing casts of the renal vessels. At two days, the intrarenal vascular system distal to the afferent arteriole is strikingly different than that of the adult. The glomeruli of the outer cortex consist of a single dilated vessel while those of the mid and inner cortex posses an increasingly larger number of capillary loops. The efferent arterioles vary greatly in appearance from outer to inner cortex. Those in the nephrogenic zone are characteristically short and narrow and join a larger venous vessel termined a sinusoidal capillary. An efferent system somewhat similar to that of the adult is seen in the mid and inner cortex. One of the most obvious differences noted between the puppy and adult kidney is the relative lack of peritubular capillary networks throughout the cortex of the puppy kidney. The puppy possesses large, irregular vessels termed sinusoidal capillaries. The most rudimentary sinusoids are found in the outer cortex with more mature vessels in the inner cortex. The vascular arrangement of the efferent arteriole and sinusoidal capillary appears as a post-glomerular shunt. Functionally, the shunt would direct blood flow away from the proximal tubule and thus could result in a low extraction ratio and Tm for secreted solutes.