Health care and workers' self-management in Yugoslavia. The form of communism developed in Yugoslavia since the early 1950s--called workers' self-management--has been of interest to many westerners concerned with the ideas of participatory democracy and workers' self-management. Yugoslavia's economic growth and general openness toward the West have encouraged many people to visit and to investigate the health care system as well as other aspects of the society. It is generally said that self-management is responsible for the remarkable successes that Yugoslavia has achieved. This paper suggests, on the other hand, that many of the successes achieved in the health care system are attributable largely to the fact that self-management is not allowed to work as freely as it does in other sectors of the economy.


Effects of tetrahydrocannabinol on arterial and intraocular hypertension. Clinical studies were conducted to determine the relationship between simultaneous changes in heart rate, blood pressure, and intraocular pressure in systemic normotensive (N=8) and hypertensive (N=8) open-angle glaucoma patients (N=16) after inhalation of tetrahydrocannabinol (THC). Insignificant changes occurred in arterial and ocular pressures after placebo pertubations. The functional responses after 2.8% THC inhalation in sitting normotensive and hypertensive patients included invariable increases in heart rate (range 20-62 beats/min greater than control) followed by substantial decreases in systolic pressure (range 12-52 mmHg less than control), diastolic pressure (range 6-28 mmHg less than control), and intraocular pressure (range 6-21 mmHg less than control). The intensity and duration (3-4 hours) of the arterial and ocular pressure responses to THC were greater in hypertensives than in normotensive patients. The salient observation after THC inhalation was that the changes in ocular pressure paralleled the changes in blood pressure in each glaucoma patient. These findings suggest that the positive chronotropic response to THC tends to maintain cardiac output which limits further decreases in blood pressure and the capillary filtration of aqueous humor decreases or the reabsorption of aqueous humor increases because of the systemic hypotensive effect attending THC inhalation.


Bioavailability study of gitoxin in a solid dosage form. Although the cardiotonic activity of gitoxin is known for almost half a century, this digitalis glycoside has never been used in therapy, due to its apparent lack of resorption after administration by oral route. Recent studies have demonstrated that the bioavailability of gitoxin could be upraised to 100% provided it be given as a hydroalcoholic solution. The present paper deals with the development of a solid dosage form (tablets) using a physical association of gitoxin and sodium escinate.


Chronopharmacokinetics of dipyridamole.

Chronopharmacokinetics of dipyridamole. The experiment carried out in 6 volunteers shows a better availability of a 75 mg single oral dose of dipyridamole administered at 600 than at 2200. The availability of dipyridamole administered at 600. The dependence of kel and t0.5(elim) on the time of drug administration is less distinct.


Gentamicin in the treatment of lower genital tract infections: level of the drug in menses, cervical mucus and vaginal fluid. The concentration of gentamicin in serum, menses, cervical mucus and vaginal fluid of 39 women under treatment with this antibiotic (80 mg every 8 hr i. m.) was tested by the agar diffusion method. The levels of the drug in the serum varied from 1.88-5.41 micrograms/ml with a peak one hour after the last dosage. In the menses the levels ranged from 2.06-5.87 micrograms/ml with a peak also one hour after the last dosage. The concentration of gentamicin in the cervical mucus and vaginal fluid varied from 0.67-5.14 micrograms/ml and 0.63-6.43 micrograms/ml with a peak three hours after the last administration of the drug. Results are briefly discussed.


Time course of clinical-chemical parameters under long-term lithium treatment. In 40 manic-depressive patients under lithium prophylaxis the time course of the following variables has been studied over a period of 3 years (retrospective investigation): Diff. blood smear, hemoglobine, leucocytes, electrolytes in serum, electrophoresis, GPT, GOT, alcaline phosphatase, creatinine and urea in serum. Appr. 1000 blood samples were evaluated. The issue of additional psychotropic medication has been given special consideration.


Kinetics of a rifampicin-trimethoprim combination. Two different regimens of a rifampicin-trimethoprim combination were studied in two groups of healthy volunteers. Each regimen was administered for seven consecutive days. In the first, the treatment consisted of 300 mg of rifampicin and 80 mg of trimethoprim administered t.i.d. In the second 450 mg of rifampicin and 120 mg of trimethoprim were administered b.i.d. Data on serum levels and urinary excretion are discussed.


The effect of the composition of food on the absorption of sulfameter. The present investigation is concerned with the influence of the composition of food on the absorption of sulfameter. Six physically healthy patients each were given 2 g of sulfameter simultaneously with a high lipid, high protein and high carbohydrate test meal. This experiment was designed as a threefold crossover study, and there was a randomized assignment of patients to the different conditions. The results show that sulfameter is significantly better absorbed when administered with a high lipid meal than when given with a high protein or high carbohydrate meal, demonstrated by the areas under the serum concentration curves (AUC), by the peak serum concentration and by the cumulative renal excretion.


Pharmacokinetics of furagin, a new nitrofurantoin congener, on human volunteers. The human pharmacokinetics of a nitrofurantoin congener furagin was studied after a single oral dose of 200 mg and during a 9-day continuous treatment with a dose of 100 mg t.i.d. The same dose of nitrofurantoin served as a reference medication. In the acute cross-over phase food greatly speeded up and atropine somewhat retarded the absorption of furagin, but the total absorption remained virtually unchanged as judged from the unchanged AUC values. The furagin concentrations in serum remain several hours above the MIC concentrations of many pathogenic bacteria. Despite the high concentrations in serum, the urine levels of furagin were generally lower than those of nitrofurantoin. The 24 hr recoveries in urine were 8--13% for furagin and about 36% for nitrofurantoin. In the prolonged trial furagin was absorbed and excreted in the same way as in the acute trial. On the 9th day the concentrations in serum and urine were higher than on the first day. The urinary concentrations of both furagin and nitrofurantoin always remained well above the MIC values of the most susceptible bacteria. Several volunteers complained of nightly cramps in their calves after taking furagin for some days, otherwise the side effects were minimal.


Liver size in evaluating drug metabolizing capacity in man. Liver size, cytochrome P-450 (P-450) concentration in liver biopsy specimens and antipyrine kinetics were studied in 112 consecutive patients undergoing diagnostic liver biopsy. Compared to subjects with normal parenchyma, those with slight or severe parenchymal alterations had enlarged livers with low P-450 concentration and slow antipyrine elimination. In the normal group, the mean P-450 concentration (+/- 1 SD) was 11.10 +/- 2.14 nmol/g liver tissue and the total amount (estimated liver weight g X P-450 concentration nmol/g) 16.06 +/- 3.29 mumol. Previous therapy with enzyme inducing drugs was associated with enlarged liver in subjects with normal histological findings and with fast antipyrine elimination and high P-450 in all groups. Antipyrine elimination rate correlated with liver weight only in subjects with normal parenchyma. The total amount of P-450 was generally more closely related to its concentration than to the estimated liver weight, although in many individual cases a large liver was able to compensate a low P-450 concentration so that the total P-450 was at the normal level. Despite normal or high total P-450, in vivo drug metabolism was impaired in subjects with altered parenchyma, suggesting that other factors were limiting antipyrine elimination in liver disease.


Topical mechlorethamine for psoriasis. An attempt to avoid the development of sensitization by the use of a topical tolerogenic schedule. The topical application of mechlorethamine is associated with a high incidence of irritant contact dermatitis. An attempt was made to avoid this complication by the use of a topical tolerogenic schedule. Seven of ten patients developed contact dermatitis to the medication after they had completed the schedule, The use of this medication in its present form is unlikely to be practical value in the treatment of psoriasis.


Basal cell nevus syndrome and adenocarcinoma of the colon. Response to systemic fluorouracil. A patient with basal nervus syndrome was found to have an adenocarcinoma of the colon. This association, probably fortuitous, made it possible to study the effect of intravenous 5-fluorouracil on the cutaneous basal cell tumors. There was no reaction to this treatment. Subsequently, all visible basal cell tumors were satisfactorily eradicated with topical 5-fluorouracil.


A fractional charge model for empirical calculations of peptide-water interactions. The properties of an empirical model of interaction between a water molecule and polar groups of peptides or small peptides are explored. The H2O molecule is represented by a four-point charges distribution. In electron donor groups, a point charge is located on the axis of the lone pairs orbitals in order to introduce some directionality in hydrogen bonds. The effective potential is approximated by the sum of the coulombic interactions between point charges distribution and of a 6--12 atom-atom potential. The coefficients of this last potential are first adjusted by simulating the geometry of the water dimer. Equilibrium configurations of associated polar molecules and H2O predicted by the model are found to be in good agreement with those resulting from more sophisticated ab initio SCF calculations. Interactions between H2O and the side-chains of the cyclic dipeptide C(L-Thr-L-His) are then calculated. It is shown that internal bridging by water is an essential effect of the solvent. The experimental position of the H2O molecule is reproduced, stability of which depends also on intermolecular interactions.


Studies on protein folding, unfolding and fluctuations by computer simulation. IV. Hydrophobic interactions. The theoretical model of proteins on the two-dimensional square lattice, introduced previously, is extended to include the hydrophobic interactions. Two proteins, whose native conformations have different folded patterns, are studied. Units in the protein chains are classified into polar units and nonpolar units. If there is a vacant lattice point next to a nonpolar unit, it is interpreted as being occupied by solvent water and the entropy of the system is assumed to decrease by a certain amount. Besides these hydrophobic free energies, the specific long-range interactions studied in previous papers are assumed to be operative in a protein chain. Equilibrium properties of the folding and unfolding transitions of the two proteins are found to be similar, even though one of them was predicted, based on the one globule model of the transitions, to unfold through a significant intermediate state (or at least to show a tendency toward such a behavior), when the hydrophobic interactions are strongly weighted. The failure of this prediction led to the development of a more refined model of transitions; a non-interacting local structure model. The hydrophobic interactions assumed here have a character of non-specific long-range interactions. Because of this character the hydrophobic interactions have the effect of decelerating the folding kinetics. The deceleration effect is less pronounced in one of the two proteins, whose native conformation is stabilized by many pairs of medium-range interactions. It is therefore inferred that the medium-range interactions have the power to cope with the decelerating effect of the non-specific hydrophobic interactions.


Syntheses and characterization of tetra-gamma-benzyl-L-glutamates. Monodisperse tetra-gamma-benzyl-L-glutamates are prepared by coupling two kinds of dimers by means of dicyclohexylcarbodiimide and then converting a terminal group into the other. An o-nitrophenylthio group is used for blocking the amino terminal, and a p-nitrophenyl ester or an ethylamide substitutes the carboxyl end. The amino-terminal-deblocked tetramer, HCl,H-[Glu(OBzl)] 4-NHEt, is alos prepared. Infrared spectra in nujol mull indicate that all the tetramers are in the beta-structure of antiparallel chains in the solid state. Circular dichroism spectra show that the amino-terminal deblocked tetramer keeps the beta-conformation in ethylene dichloride, while it has the solvated sigma-conformation in trifluoroethanol and in dioxane.


Quantitation of some amino-terminal residues in proteins using 3H-labelled dansyl chloride and 14C-labelled amino acids. A method for quantitation of amino-terminal residues in proteins is presented. The method is a modification of a double isotope-labelling technique, using 3H-labelled dansyl chloride and 14C-labelled amino acids as internal standards. The method is demonstrated on human fibrinogen, horse myoglobin and on mouse myoloma IgA. A linear relationship between the ratio 3H/14C in the separated amino-terminal amino acid of the protein and the amount of protein added in the labelling mixture was obtained with standard deviations of +/- 7.4% +/- 3.4% and +/- 10.3%, respectively. An application of the method is demonstrated by measuring the increase in amino-terminal glycine in fibrinogen following the proteolytic action of thrombin. The method seems to be useful when 0.1 nmol or more of protein is used.


The avoidance of sucrose by thiamine-deficient rats. Rats were fed carbohydrate-free diets without thiamine. Sucrose was offered separately, either before the thiamine was removed, or when it was removed, or at varying periods after it was removed. In the absence of dietary thiamine, sucrose consumption began at a high level, but was then reduced. Thereafter, death due to thiamine deficiency followed at intervals that varied from 4 weeks to 12 months. Survival was shortest in those rats that ate sucrose in largest amounts or at shortest intervals; survival was longest in those rats that avoided sucrose altogether for long periods. Sex or age did not appear to affect survival. The results are interpreted as demonstrating a conflict between the avoidance of sucrose so as to avoid the unpleasant symptoms of thiamine deficiency, and the consumption of sucrose so as to obtain the pleasure of its high palatability.


The effects of riboflavin administration on iron metabolism parameters in a school-going population. The effect of riboflavin administration on iron metabolism was studied in a group of riboflavin-deficient children with Erythrocyte Glutathione Reductase (EC 1.6.4.2) reactivation above 1.20. The results have shown that the administration of riboflavin has resulted in a decrease of serum iron as well as in transferrin saturation which was accompanied by an increase in blood hemoglobin in subjects with initially lower hemoglobin values (less than or equal to 13.5 g/100 ml). There was, however, no change in blood hemoglobin in the group with initially higher hemoglobin values (greater than or equal to 14.0 g/100 ml). The results suggest that inadequate riboflavin intake may affect the iron utilization. The possible mechanism of riboflavin action on iron utilization is discussed.


Sectrofluorimetric micromethod for determining riboflavin in the blood of new-born babies and their mothers. A microdetermination of riboflavin on the blood of new-born babies and their mothers was developed on the basis of hydrolysis of the blood in a trichloroacetic acid medium, separation of riboflavin and FMN on a Florisil column and measurement of the content spectrofluorimetrically by the standard addition method after elution with collidine buffer. The sensitivity of the method is 0.01 microgram/ml, the blood sample size 0.5--1.0 ml. The normal level in new-born babies in the first day of life was found to have an average value of 17.1+/-2.4 microgram/100 ml, in women 14.2+/-2.5 microgram/100 ml; the contents in cord blood and maternal vein blood were also determined.


Vitamin C deficiency in guinea pigs: changes in urinary excretion of proline, hydroxyproline and total amino nitrogen. 1. The age-related decrease in hydroxyproline : creatinine ratio in young guinea pigs was significantly smaller in vitamin C-deficient animals than in pair-fed controls. The same was true for proline : creatinine and total amino nitrogen : creatinine ratios, but hydroxyproline : total amino nitrogen and proline : total amino nitrogen ratios were not significantly affected by deficiency. 2. Although the proline : hydroxyproline ratio was unaffected in unfractionated urine, acute or chronic deficiency produced a small but significant increase in this ratio in collagenase digests of the acetone-insoluble fraction. 3. In scorbutic animals, therefore, collagen probably turns over more rapidly than in animals matched for inanition. Some at least, of this increase could represent the rapid turnover of underhydroxylated nascent collagen. Because it contains the degradation products from collagen from many tissues, differing widely in sensitivity to vitamin C status, the urine is unlikely, however, to provide a specific and sensitive functional index of vitamin C status.


Effect of retinol on the molecular species of hepatic phosphatidyl choline in young rats. Effect of feeding 1.5 and 12 mg retinol respectively for two days to young rats on the distribution and synthesis of molecular species of PC in liver was studied. A significant decrease was observed in the amounts of trienoic and tetraeonic PC in rats fed 12 mg retinol. Feeding of retinol did not affect the synthesis of PC via CDP - choline pathway but enhanced the synthesis of hexaenoic PC via N-methylation of PE.


The nutritional value of irradiated casein-fat mixtures-effect of anaerobic conditions, storage time, added vitamin E and degree of unsaturation of lipids. The effect of oxygen elimination during irradiation (5 Mrad) and subsequent storage, storage time (12 weeks), degree of lipid-unsaturation and added antioxidant (vitamin E) in protein-lipid mixtures (casein : fat - 11.1 : 4) on the nutritive value of protein was studied during 8-day nitrogen balance trials in 12 groups of 6 weanling rats each. When casein-cocofat-cornoil mixtures were irradiated and stored under aerobic conditions a reduction of NPU appeared upon prolonged storage time, which was prevented by excluding oxygen during irradiation and storage. When the lipid component consisted entirely of cocofat no loss in NPU occurred under aerobic processing and storage conditions throughout the 12 week storage period. Replacement of cocofat through sunfloweroil resulted in a drastic reduction of NPU and in growth inhibition, which was not prevented by the addition of vitamin E (0.05 g/100 g lipid). Irradiation of casein-lipid mixtures resulted in a significant increase of carbonyl compounds. A further increase was effectively prevented by elimination of oxygen during irradiation and storage. A drastic increase of carbonyl compounds as well as a significant reduction of available lysine occurred in casein-sunfloweroil mixtures. Added vitamin E afforded only limited protection against these changes.


Effect of dietary selenium and vitamin E on the antioxiant defense systems of rat erythrocytes. The effect of dietary selenium and vitamin E on the important cellular antioxidant defense systems was studied in rat erythrocytes. Weanling male Sprague-Dawley rats were fed a basal selenium and vitamin E deficient diet and supplemented with either none or 0.5 ppm selenium and either none or 45 ppm vitamin E for 35 or 40 days. Depletion of dietary selenium resulted in marked decrease of glutathione (GSH) peroxidase in the red cells, but the levels of GSH, catalase and superoxide dismutase were not significantly altered. The red cells of rats fed the basal diet deficient in both selenium and vitamin E had significantly lower levels of GSH and GSH peroxidase, but not of catalase and superoxide dismutase, than in those fed the basal diet and supplemented with either selenium, vitamin E or both. The results suggest that depletion of dietary selenium and vitamin may have a precipitate effect on lowering the levels of GSH and GSH peroxidase in rat erytyrocytes.


The ubiquitousity of labelled tocopherol in the cockerel body. A recovery experiment with a young cock weighing 1 kg showed that after 3 days, radioactivity from the labelled vitamin E was distributed to tissues of all of the 11 organs being investigated. The liver had the highest concentration of the label, but gut, fat tissue and muscle had a total content each comparable with that of the liver. The air expired during the 3 days also exposed radioactivity.


Food intake patterns of infants with high serum cholesterol level at six months. In our longitudinal study on the influence of nutrition upon health during infancy we found in a cohort of 556 infants in good health, 6.4% of infants at six months with a total serum cholesterol level above 200 mg/100 ml. Because of the known importance of hypercholesterolemia for health we studied the role of the food intake patterns during the first six months in relation to the serum cholesterol. We analysed the 24 hours dietary recalls, the dietary habits and a set of biochemical determinations used for evaluation of nutritional status: 35 infants, 21 girls and 14 boys, were compared with a control group matched for sex and birth date. There were no differences in mean body weight and socio-demographic characteristics. Daily energy and protein intake was higher in the study group. Analysing milk consumption we found that the daily intake was always higher in the high cholesterol group. The solid foods were introduced earlier in the study group, i.e. for 46% of infants in the second week of life. The serum levels of vitamins A, C, and E, and of triglyceride were higher in the high cholesterol groups. At twelve months 33% of infants with the cholesterol level above 200 mg/100 ml we included in the studied group remain still with a high level. This tendency underlines the need of further research.


The effects of antioxidants on the content of polyunsaturated fatty acids in the hen's egg. In experiments to see whether, in the possible interests of human health, the polyunsaturated fatty acid (PUFA) content of the chicken's egg can be increased by nutritional means, three strains of hen, light, medium, and heavy, each at the peak of lay, were first fed a basal, commercial, low-fat diet. The hens were then transferred to one of the following diets: basal + safflower oil (SO); basal + SO + butylated hydroxytoluene; or basal + SO + dl-a-toco-pheryl acetate. The diets were designated "Blank", "BHT", and "Vitamin E", respectively, the second and third containing the added antioxidants. The eggs produced were weighed, and their yolks weighed and analysed for lipid components. Additional of SO (7.5%) to the basal diet led to the PUFA content of the yolk lipids rising by 15.4% (linoleic acid, 14.1%), the magnitude of the increases being unaffected by the antioxidants. Diet "BHT" produced larger eggs and yolks than the other diets, but the proportion of yolk was the same on the three types of feed. The total cholesterol content of egg yolks was significantly affected neither by diet, nor by strain or age of hen. The implications of these results are discussed.


Iron intake by teenage girls and by pregnant women. A dietary study among 110 teenage girls and 87 pregnant women revealed that their mean iron intake was lower than the Recommended Dietary Allowances. The explanation is assumed to be a relatively low energy intake. Considering the composition of Scandinavian food, in which about 40% of the energy calories are derived from animal products, it is suggested that about 90% of all pregnant women can cover their iron requirement without further supplements.


Ratio of hemoglobin iron to liver in rats fed different amounts of iron. Groups of young rats were fed diets containing amounts of iron designed to provide 0.1, 0.3, 1, 3, 10 or 30-times the iron requirement for the rat, and containing two different levels of protein. Iron deficiency anemia was most pronounced in rats receiving the larger amount of protein. In the case of most normal diets, the ratio of iron in the hemoglobin to iron stored in the liver was 26 +/- 6. This is in marked contrast with the ratio of 4.3 found in rats fed a common breakfast cereal.


How fair is the culture I.Q. test?

How fair is the culture I.Q. test? If a measure of intelligence is culturally biased it is assumed that disadvantaged individuals will score lower on it than on a less biased instrument. The Cattell purports to be "culture fair" and it was compared to the WISC with a delinquent juvenile population, controlling for both order effects and individual administration. The results reveal consistently lower mean I.Q. scores for the Cattell under all conditions. The Cattell appears to be a more difficult test for this population. It is concluded that considerable caution should be exercised inusing the Cattell as a culture fair method of I.Q. evaluation with underprivileged delinquent youth.


Occupational therapy and psychiatry.

Occupational therapy and psychiatry. The origin of occupational therapy is deeply rooted in psychiatry, and in psychiatry occupational therapy often found the support and guidance necessary for its deveolpment and recognition. Today this close association no longer exists. Some factors leading to this professional distance have been outlined and changes conducive to a greater awareness of the role and function of occupational therapy in psychiatry have been suggested. An attempt has also been made to clarify the concept of occupational therapy and to discuss the contribution of the occupational therapist in certain specific areas of psychiatric treatment.


The long-distance psychiatric patient in the emergency room. Insights regarding travel and mental illness. This paper deals with the motivational, demographic and clinical characteristics of individuals who seek psychiatric help at facilities located a great distance from their places of residence. The study identifies two subgroups within this category. The first (Intentional or Type A) group is constituted by persons who, owing to their concerns with the social stigma of mental illness, or driven by the desire for a magical solution to their problems, purposely undertake the journey to a distantly located psychiatric center. The second (Incidental or Type B) group consists of vacationers, hitch-hikers and skid-row individuals. While these "long distance patients" (LDP) did not show any differences when compared with the remainder of clinic attendance on demographic variables, distinct clinical features differentiated the two populations. Most significantly the LDP had a higher incidence of schizophrenia and alcohol related problems. The difference was entirely accounted for by the Type B subgroup ((LDP less than 0.01; Type A, NS; Type B less than 0.001). Implications of this finding have been discussed in view of the suggested relationships between travel and mental illness. Administrative problems of the LDP have been briefly commented upon.


The Oedipus complex or hey, Mom. Where is Daddy? After investigating as much literature as I could on the Oedipus Complex or whatever name is interspersed, such as sex-role differentiation, identification, etc. the following conclusions were significant. Possible disturbance in sex-role identification, child develops avoidance systems and rejects parents, homosexuality, emotional maladjustment, shyness, resentfulness, dependency, harder to train, not "manly enough", apprehension, immaturity, compensatory masculinity, anti-social behaviour such as truancy, damaging or destroying private or public property, having premarital and extra matital sex relations and theft of property. Father's presence then, is of the utmost importance in the rearing of their children, particularly sons. They are necessary in the sharing with mothers of all phases of child.


Scanning electron microscopic investigations on the morphology and phase conversions of uroliths. The most frequent structures of the majority of possible urolith components are assessed by scanning electron microscopic investigations. Typical examples of the conversion of uric acid dihydrate into uric acid, weddellite into whewellite and MgHN4PO4 . 6 H20 into MgNH4PO4 . H2O are given.


Analysis of urinary tract infections in patients undergoing prostatectomy. Analysis is presented of 260 patients on whom in the years 1974--1976 an operation for adenoma removal was performed. 115 patients (44.2%) had a permanently placed catheter or were repeatedly catheterized before operation, and 145 (55.8%) were able to urinate without any need for catheterization. In the group of preoperatively catheterized patients infection of the urinary system was demonstrated in 84 cases, which amounts to 75%. Among patients not catheterized before operation, infection already existed in 29 cases (20%). Operation by Millin's method was carried out in 181 patients; non-infected urine was postoperatively found in 40 cases, which amounts to 22.3%. 79 patients were operated on by the transvesical method; in this group non-infected urine was found in four cases, i.e. 5.1%. Calculated x2 indicated a significant connection between the investigated items, consisting in a much more frequent occurrence of urinary system infection in patients operated on by the transvesical method. The duration of catheter reposition in the urinary bladder after prostatectomy considerably influences the number of postoperative infections of the urinary system.


Polyps of the urethra in children.

Polyps of the urethra in children. The authors present two cases of polyps of the urethra occurring exclusively in boys: one in a 12-month-old infant, the other in a 15-year-old boy. In both patients the polyp caused dysuria or urinary retention. Diagnosis was based on mictional cystography. This examination usually gives a picture of a filling defect spotted in the area of the bladder neck. During miction the defect may move deeper into the urethra. An endoscopic examination may be also helpful. The authors believe that treatment should consist in total excision of the polyp together with its base through the open urinary bladder. Polyps of the urethra have to be differentiated from a valve of the posterior urethra or a shadowless calculus. After total excision of the polyp prognosis is good.


Roentgenological investigations of the urethra in the dianosis of prostatic cancer. The reliability of roentgenological demonstration of the urethra in prostatic cancer has been examined and the advantages of double contrast retrograde urethrocystography and resistance miction-cystourethrography are accentuated. These investigations are indicated in preparation for radiotherapy, operative therapy, transurethral resection and after reduced uroflow.


Operative blood loss during common urological operations. The knowledge of mean blood loss during common urological procedures may be of some help for the surgeon in the appraisal of the magnitude of bleeding and planning blood transfusion. In 9 types of common urological operations (160 patients) the operative blood loss was determined. Results were mathematically evaluated.


Replacement of the ureter by means of a narrowed terminal ileal segment in one stage. A proximally hypoplastic ureter causing hydronephrosis was replaced by a tightened ileal segment. The operation was performed in one stage and proved to be successful 10 years later.


Measurement of total-body 40potassium in patients with urate calculi. Fifty-eight patients with urate calculi and 31 patients with other (non-urate) calculi were examined for total-body potassium by means of a total-body counter. The patients with urate calculosis were found to differ significantly in their total-body K from patients with other calculi as well as from normal subjects. The results indicate that total-body potassium deficiency is one of the factors causing urate calculosis.


Effects of experimental embolization of superior mesenteric artery branch on the intestine. A primary mesenteric branch of the superior mesenteric artery was embolized with Amicar-mixed clots in seven dogs and with gelatin sponges in five dogs. All of the dogs embolized with Amicar-mixed clots survived the experimental period and no mesenteric damage was found with postmortem studies. Three of the five dogs embolized with gelatin sponges showed a local stricture within the embolized segment of intestine. Collateral blood supply to the strictured segment of bowel in these three dogs developed via arterial arcades, mural branches of the vasa recta and omental arteries.


The radiologic assessment of vessel wall thickness. A method allowing accurate and repeated measurements of vessel wall thickness has been developed. It consists of permanent opacification of the outer wall with tantalum in conjunction with magnification angiography. The technique was tested in a model, in human saphenous vein specimens, and in long-term experiments in rabbit blood vessels. Eighteen rabbits underwent exploratory surgery, after which the abdominal aorta, inferior vena cave, and the femoral and carotid arteries were coated with tantalum paste. Subsequently, magnification angiograms were performed from one to 14 months later. The wall thickness ranging between 100 and 300 micron was clearly visualized. While no gross inflammatory or foreign body reaction was seen, small granulomata adjacent to the blood vessels were frequently identified. The method described can be valuable in studying the natural history of the atherosclerotic process, particularly the behavior of vascular grafts.


A comparison of the cardiovascular responses to carotid injections of ionic and nonionic contrast media. Selective injection of contrast media into the canine common carotid artery results in alterations in carotid flow, heart rate, and systemic arterial pressure. In this study the responses to injections of the nonionic agents metrizamide and iopamidol were compared to the responses to the ionic agents meglumine iothalamate, meglumine sodium diatrizoate, mannitol, and saline solution. Heart rate and pressure responses were smallest for metrizamide, greater for iopamidol, and greater still for the hypertonic ionic agents: responses were roughly correlated to agent osmolality. Carotid flow increased with all agents and was roughly proportional to the agent's osmolality. The exception was metrizamide which despite its lowest osmolality, produced a large increase in flow which was maintained much longer than for other agents. The total response to the nonionic agents was judged less severe than to the ionic agents; however, the responses to all agents were transient and not life threatening.


Renal excretion mechanism of a nonionic contrast agent. The renal excretion mechanism of a nonionic experimental contrast agent, C-29, was investigated in rabbits in comparison with the ionic contrast agent sodium diatrizoate under conditions of free urine flow and ureteral stasis. The two contrast agents were injected as a mixture of 125I-C-29 and 131I-sodium diatrizoate, in doses of 25 and 250 mg I/kg. The results indicate that, during the period relevant for urographic examinations, C-29 may have a renal clearance as low as 0.7 times that of sodium diatrizoate under conditions of both free urine flow and ureteral stasis. The biologic half-life of C-29 is 41-50 min.


The influence of fasting on opacification of the gallbladder during oral cholecystography using two consecutive doses in a canine model. Oral cholecystography was performed in eight adult mongrel dogs. Contrast agents (Telepaque and/or Bilopaque) were administered in six different combinations, given as two consecutive doses with and without food. A combination of Bilopaque alone on both days and a combination of Telepaque with food on the first day and Bilopaque alone on the second day each proved to be the best method in 37.5% of the dogs. Telepaque with food on both consecutive days was the best method in 25% of the dogs. Among the eight combinations, two consecutive doses of Bilopaque alone or a combination of Telepaque with food on the first day and Bilopaque alone on the second day resulted in the most dense opacification of the gallbladder. Clinical implications of these results are discussed.


Effects of intracoronary administration of contrast materials on left ventricular dimensions and rate of relaxation. The effects of intracoronary administration of ionic and nonionic contrast materials on (LV)left ventricular contractile state, relaxation rate (peak -dp/dt and [-dp/dt]50), and dimensions were determined in eight morphine-chloralose anesthetized dogs. Meglumine sodium diatrizoate caused decreases in peak dp/dt and -dp/dt and increases in left ventricular end systolic dimension (LVESD'), end diastolic dimension (LVEDD'), and end diastolic pressure(LVEDP). The decreases in peak -dp/dt and(-dp/dt)50 persisted after peak dp/dt returned to and exceeded control levels. Calcium meglumine sodium metrizoate caused increases in peak dp/dt but decreases in peak -dp/dt and(-dp/dt)50 and no significant changes in LVEDP, LVESD', or LVED'D. Metrizamide caused no significant changes. Ionic contrast materials induce important changes in LV dimensions and rate of relaxation in addition to producing a depression in contractile state. The decreases in  relaxation rate are not reversed by addition of calcium ions.


In vivo measurement of absolute tissue iodine content by fluorescence excitation. A method based on the measurement of fluorescent and transmitted photons has been developed for the quantitative determination of stable iodine concentrations in tissues. The results are independent of the thickness of the material surrounding the measuring site. The method yields an accuracy of better than 3% for both Ge semiconductor and NaI(TI)detector arrangements.


Sequential changes in the CT numbers of the normal canine kidney following intravenous contrast administration. II: The renal medulla. Following the intravenous administration of sodium and meglumine salts of both diatrizoate and iothalamate (at doses of 310-880 mg I/kg body weight) sequential changes in computed tomographic (CT) numbers of the inner medulla were determined in three dogs, using a 30-second CT scanner. Peak medullary enhancement was greater than, and usually occurred 1-2 minutes after, peak cortical enhancement. The CT number of the medulla increased linearly with increasingly large doses of the contrast agent. At peak enhancement, the meglumine salts produced a significantly lower (p less than 0.025) mean CT attenuation value of the medulla than did the sodium salts. The difference in mean attenuation values between the sodium salts and meglumine salts was maximum (50-60 HU)at peak enhancement. Our data indicate the known difference in renal handling of the meglumine and sodium salts is readily detectable by CT.


Regional cerebral mode transit time and the derivative of the regional cerebral function recorded for intravenous administration of a non-diffusible tracer. The meaning of the time from origin to first peak and from peak to peak of the derivative of the regional cerebral functions recorded after intravenous administration of a non-diffusible tracer is analyzed. Data obtained by cerebral and cardiac monitoring and evaluation of both times in patients with carotid thrombosis, indicates that the time from origin to first peak may be a better estimate of regional cerebral mode transit time than the time from peak to peak.


Assessment of pyeloureteral function using a flow velocity and cross-sectional diameter probe. The response of the healthy pyeloureteral system of the pig to stepwise increments of urine flow was measured using a flow-velocity, diameter probe. The following urodynamic parameters were measured: renal pelvic pressure, ureteral flow-velocity and diameter, and associated bolus volume in the range of urine flow rates of 0.3 to 10 ml per min. The results show that the diameter sensoring portion of this probe can reliably sense ureteral peristalsis over the entire range of urine flow rates; small alterations in ureteral diameter occurring in dilated ureters after high diuretic loads can also be detected. Data obtained using the flow-velocity portion of this probe indicate that at urine flow rates less than 0.5 ml per min flow-velocity changes of a bolus can be reliably identified. At these flow rates the maximum flow-velocity occurs at the leading edge of the bolus and is invariant with the size of the bolus. At urine flow rates more than 1 ml per min the flow-velocity curve is polyphasic, indicative of an alteration in the mechanism of urine transport by the ureter at these flows. Collectively, data obtained using this probe provide dynamic information concerning the physiologic properties of the upper urinary tract not currently attainable in existing pressure/flow methodologies.


Sacral root stimulation in controlled micturition. Peripheral somatic neurotomy and stimulated voiding. Stimulation of the sacral ventral roots with the largest detrusor representation was found to be moderately successful for bladder emptying in acute canine experiments. However, removal of spinal reflexes arising from sacral root stimulation did not eliminate sphincteric resistance. For that reason ventral roots were stimulated after peripheral somatic neurotomy. Unilateral pudendal nerve sectioning was compared with selective sectioning of the somatic fibers of S2, the root with the greatest detrusor representation in canines. Both were equally effective in significantly reducing outlet resistance. Selective nerve section has one advantage: it preserves more of the nerve pathways involved in reflexogenic erection.


Studies on lactic dehydrogenase of patients with urinary bladder tumors. I. Urinary lactic dehydrogenase. Urinary lactic dehydrogenase (LDH) activity and isozyme pattern were investigated in 38 patients with bladder tumors of various stages and grades and in 10 healthy persons. Urinary LDH activity was markedly elevated and directly correlated with histologic stage and grade of tumors. The urinary LDH isozyme pattern differed significantly from that of normal urine even in early and well-differentiated tumor cases. LDH4 and LDH5 became more prominent as the degree of the histologic stage and grade of the tumor increased. In the patients with tumors more advanced than stage T2, LDH4 and LDH5 were greater than LDH1 plus LDH2, the reverse of what is found in normal urine. As analogous result was obtained in patients with tumors of grade II or higher. No appreciable difference was found in the LDH isozyme pattern of patients with single or multiple tumors although the total activity was greater with multiple tumors. A comparison between LDH isozyme pattern in urine and in tumor tissue was evaluated in 26 patients with a good correlation (r = 0.40, P less than 0.05). Comparison of the results with urine LDH and urine cytology was attempted for each stage and grade. In 5 of 16 cases having negative urine cytology, a positive isozyme index was present and 10 of 13 cases having positive urine cytology had a positive isozyme index. These data suggest that evaluation of urinary LDH combined with urinary cytology might be of value in the diagnosis of bladder tumors and for following patients who have had bladder tumors.


Partial inhibition of castration-induced involution in rat prostate by chloroquine. A preliminary observation. The effect of chloroquine phosphate, a membrane stabilizing agent, on castration-induced involution in the prostate was investigated in adult Sprague-Dawley rats. Chloroquine phosphate (75 mg per kg of body weight) was administered daily by gastric tube on 4 consecutive days beginning 1 day before castration. Control rats received water. All animals were sacrificed 7 days after castration and the ventral prostates were analyzed. The chloroquine group had a mean prostatic weight 17 per cent greater than that of the water-fed control group (P less than 0.01) despite a modest loss in body weight. The activity of cathepsin D, a lysosomal enzyme, in the prostate of treated rats was double that measured in control rats. Histologically, prostates from chloroquine treated rats contained more lysosomal particles that were larger than those from control rats. Serum testosterone reached castrate levels in both groups of animals within 24 hr of castration. These results indicate that it is possible to reduce the rate of prostatic regression by chloroquine, although at a small magnitude, probably through the action of membrane stabilization.


Attenuation by monosodium urate of the inhibitory effect of glycosaminoglycans on calcium oxalate nucleation. The interaction between mucopolysaccharide (glycosaminoglycans) and monosodium urate, with respect to their effects on spontaneous precipitation of calcium oxalate, was explored in vitro. Heparin and, to a lesser extent, chondroitin sulfate were found to inhibit calcium oxalate precipitation. The formation product ratio (FPR, limit of metastability or the minimum supersaturation required for spontaneous nucleation) of calcium oxalate was increased 29 per cent by 0.05 mg of heparin per liter, and by 70 per cent with 1 mg of heparin per liter. The increment produced by heparin was much less pronounced when the solution containing the mucopolysaccharide was preincubated with crystalline monosodium urate. Pretreatment of the solution containing heparin (0.05 mg per liter) by monosodium urate (0.5 mg per ml) virtually eliminated the inhibitory action of heparin. Studies with radioactive heparin indicated that monosodium urate binds heparin. In contrast, the inhibitory effect of chondroitin sulfate was unaltered by prior exposure to monosodium urate. The results indicated that monosodium urate may attenuate the inhibitor activity of certain mucopolysaccharides such as heparin and facilitate the calcium oxalate precipitation. The findings provide further support for the important etiologic role of hyperuricosuria in the formation of calcium oxalate stones.


Effect of parathyroidectomy on crystallization of calcium salts in urine of patients with primary hyperparathyroidism. The effect of parathyroidectomy on the crystallization of calcium salts in urine was examined in seven stone-forming patients with primary hyperparathyroidism. After parathyroidectomy, urinary calcium decreased significantly from 205 +/- 30 to 67 +/- 11 mg per day (P less than 0.01); there were no significant changes in urinary phosphorus, oxalate, magnesium, sodium, potassium, uric acid, pH, or total volume. The urinary activity product ratio (state of saturation) of brushite (CaHPO4.2H2O) and calcium oxalate decreased significantly from 1.34 +/- 0.14 to 0.75 +/- 0.18 and from 3.20 +/- 0.56 to 1.53 +/- 0.21 respectively (P less than 0.05), owing principally to the decline in urinary calcium. Moreover, the urinary formation product ratio of calcium oxalate, which reflects the minimum supersaturation required for spontaneous nucleation, increased significantly after parathyroidectomy, from 7.19 +/- 1.19 to 12.99 +/- 1.69 (P less than 0.001). The results indicate that parathyroidectomy restores the normal urinary environment with respect to saturation and inhibitor and/or promoter activity.


Rosoxacin and cinoxacin distribution in prostate, vagina, and female urethra. An experimental study in dogs. Rosoxacin and cinoxacin, two new compounds structurally related to nalidixic acid, were investigated in dogs. Our primary interest was in the beneficial effects of the two drugs when used in the treatment of urinary tract infections. The distribution of rosoxacin and cinoxacin was investigated in prostatic tissue, prostatic interstitial fluid, and prostatic secretion, and in vaginal and female urethral secretions. Concentrations of both antibiotics were also measured in plasma, various tissues, and spinal fluid. The amounts of rosoxacin and cinoxacin in all tested tissues, fluids, and secretions were in the range of the minimal inhibitory concentrations for most Gram negative organisms found in urinary tract infections. This suggested possible beneficial effects of these drugs when the infection involves the above tissues. Rosoxacin concentration ratios were higher than those of cinoxacin relative to plasma concentration in prostatic, vaginal, and urethral secretions, as well as in prostatic and other tissue. These ratio differences were explained by the different physiochemical properties of the two drugs.


Ureteral plication. A new concept in ureteral tailoring for megaureter. Currently, the most favored surgical procedure used to restore normal peristalsis to massively dilated adynamic ureters is ureteral tailoring. This procedure, however, seriously jeopardizes the ureter's blood supply and frequently results in ischemia with ureteral stenosis and further renal deterioration. To preserve the distal ureter's vasculature a new technique of reducing ureteral caliber and restoring normal peristalsis with minimal disruption of the blood supply was developed and performed in 14 dogs with excellent results.


Analysis of renal calculi from a marine mollusc (Marcocallista nimbosa). Implications for the study of urolithiasis. An X-ray diffraction analysis of kidney stones from the bivalved mollusc Macrocallista nimbosa has revealed the calculi composition to be amorhpous calcium phosphate. The use of this animal for the study of urolithiasis is suggested because of the spatial and temporal ubiquity of its renal calculi.


Netilmicin and tobramycin. Comparison of nephrotoxicity in dogs. We compared the effects of netilmicin and tobramycin on renal function and histology in dogs. Separate groups, each containing 5 dogs, received control injections, or either netilmicin or tobramycin at doses of 25, 50, or 75 mg per kg of body weight per day for 14 days. Renal function decreased markedly only in the group receiving the 75-mg tobramycin dosage; the serum creatinine levels rose from 1.0 +/- 0.1 to 3.6 +/- 0.9 mg per 100 ml (P less than 0.05) and the endogenous creatinine clearance fell from 42.5 +/- 9.4 to 7.8 +/- 2.2 ml per min (P less than 0.05). Dogs in this group developed glycosuria, proteinuria, and polyuria, and three died before the end of the study, probably from neuromuscular toxicity. Peak drug levels were stable when renal function was normal, but increased when renal failure occurred. Light microscopic changes occurred in all groups receiving either drug, but were most severe in the high-dose tobramycin group. Ultrastructural changes were similar in all groups and identical to changes produced by gentamicin. These results show that, on a weight basis, netilmicin is less nephrotoxic than tobramycin in dogs.


Absence of association between HLA antigens and primary open angle glaucoma in Israel. HLA antigens of the A and B loci were determined in 57 Israeli patients with primary open angle glaucoma (POAG) presenting visual field loss and in 715 normal control subjects. The glaucoma patients and control subjects were non-related and randomly selected from the Jewish Israeli population. Frequencies of HLA antigens among the POAG patients showed no differences from those observed in the control subjects. Similar results were observed for all patients as well as within subgroups of the patient population as defined by origin. Thus, the association reported between B7 and/or B12 and POAG in white and black Americans could not be confirmed in an Israeli population.


Glucose production by the perfused liver of the spiny mouse (Acomys cahirinus): sensitivity to glucagon and insulin. Hepatic glucose production and its responses to glucagon and insulin were studied in perfused livers obtained from spiny mice (Acomys cahirinus)--rodents characterized by normoglycemia, decreased glucose tolerance and decreased insulin secretion--and from Swiss albino mice. The dose-response characteristics of glucagon-induced hepatic glucose output were similar in spiny and albino mice. However, maximally stimulated glucose production were significantly lower in the spiny mouse. Furthermore, the liver of the spiny mouse was more sensitive to the action of insulin: 0.5 X 10(-6) M insulin significantly inhibited the action of glucagon in spiny mice but not in albino mice. It is proposed that the increased sensitivity of the hepatic glucose output to insulin and the decreased maximal stimulation by glucagon may be factors that limit the negative effects of the impaired insulin secretion in spiny mice, thereby reducing the severity of the glucose intolerance. Analogous mechanisms may be present in the early stages of the diabetic syndrome in man.


Effect of estradiol on erythropoiesis and megakaryocytopoiesis in mice. The effect of four 1.0-mg estradiol benzoate injections on hemopoiesis in the spleen and bone marrow in mice was studied. The number, concentration and mitotic activity of megakaryocytes (MKC) and number of MKC colonies in the spleen were found to be increased one and two weeks after cessation of the estradiol injections. MKC concentration in the bone marrow rose during the experimental period. The MKC increased in number during the first week after estradiol, but dropped to normal after the second week. The number and mitotic activity of erythroid precursors increased in the bone marrow and spleen three days after the cessation of estradiol injections. These findings suggest that estrogen enhances megakaryocytopoiesis and erythropoiesis in the bone marrow and spleen in mice.


Age-related changes in antibody-dependent cell-mediated cytotoxicity in mouse spleen. The age-related variation in antibody-dependent cell-mediated cytotoxicity (ADCC) in spleen was examined in four different mouse strains (DBA/2, Balb/c, NZB and NZB/NZW). The ADCC effector activity against antibody-coated chicken red blood cells in untreated spleen from all four strains was roughly comparable. An initial rise in activity with increasing age until two to three months was followed by a sharp decline in effector activity. Treatment of the spleen cells with poly-l-lysine-coated carbonyl iron to remove phagocytes resulted in a decrease in ADCC activity in NZB, NZB/NZW and DBA/2 strains at all ages examined. The same general pattern of age-dependent decline was still seen in these depleted spleens. However, the same treatment essentially abolished ADCC in Balb/c spleen at all ages studied.


Medullary carcinoma of the thyroid.

Medullary carcinoma of the thyroid. Three patients with medullary carcinoma of the thyroid gland, one sporadic and two familial, are described. One of the patients presented at a late stage of the disease with evidence of wide dissemination and severe diarrhea, which was controlled by indomethacin. The value of venous catheterization and plasma thyrocalcitonin measurements in evaluating the extent of the disease was demonstrated in this case.


Traumatic labyrinthine fistulas.

Traumatic labyrinthine fistulas. During the last 10 years, the rupture of the inner ear windows, as an entity, has been introduced in the differential diagnosis of the acute vestibulocochlear syndrome. Head trauma, Valsalva-like maneuvers and barotrauma due to diving accidents are now described as etiologic factors in the pathogenesis of labyrinthine fistula. Four cases were explored and repaired in the last four years in our department. Ataxia was the prominent symptom in three, while positional nystagmus and vertigo were consistent findings in all four cases. The definitive evidence of the fistula can be proved only by exploratory tympanotomy. In this report, the importance of the consideration of this entity in the differential diagnosis of vestibulocochlear syndrome in victims of traffic and diving accidents is emphasized.


Acute myocardial infarction in a hemophiliac. An acute myocardial infarction was observed in a 62-year-old patient with hemophilia A, as well as myxedema, hypertension, obesity, hypercholesterolemia and angina pectoris. The occurrence of myocardial infarction in hemophiliacs is rare, and, to the best of our knowledge, this patient represents the fourth documented case in the literature.


Cat-scratch disease presenting as status epilepticus. A case report. A 12-year-old Bedouin boy presented with sudden asymmetrical status epilepticus. The presence of a scalp wound, rubbery cervical lymphadenopathy and a history of contact with cats suggested the diagnosis of cat-scratch disease complicated by encephalopathy. The diagnosis was supported by histological examination of a cervical lymph node and a positive skin test with cat-scratch antigen. The rapid establishment of the diagnosis avoided the necessity of elaborate and complicated neuroradiological investigations.


Estimates of preventive versus nonpreventive medical care demand in an HMO. Multiple regression analysis is used to investigate whether medical services in a large HMO are distributed primarily on the basis of need and predisposing factors (such as health status, age and sex) or according to enabling characteristics (such as coinsurance and income) of the population. Equations are formulated to estimate the likelihood and volume of preventive visit demand, nonpreventive visit demand and hospital admissions for a sample of 3,892 individuals enrolled in the Kaiser Foundation Health Plan of Portland, Oregon. The results indicate that predisposing and need factors are the main determinants of nonpreventive visits and hospital utilization, while enabling characteristics are important determinants (along with age and education) of preventive utilization. There are marked differences in the impact of explanatory factors on utilization by dependents (children) versus nondependents (adults).


The effect of personal health care services on longevity in an economically advanced population. This article is an attempt to assess the effect of personal health care on longevity. It is assumed throughout that personal health care has a differential impact on the various causes of death. Historical and cross-sectional comparisons of the relative incidence of certain causes of death can, under this assumption, provide some insight into the effectiveness of personal health care generally and may provide a gauge of the relative benefits of different personal health care delivery systems. Using the U.S. male population of 1964 as a reference point, it is estimated that the withdrawal of personal health services would result at the most in a decrease in average length of life from 66.9 to 60.5 years.


Indexes of severity: conceptual development. A discussion of severity index development is presented in relation to conceptual issues in index definition, analytic issues in index formulation and validation issues in index application. The CHOP index is discussed along with six severity indexes described in an earlier paper dealing with underlying concepts to illustrate the material presented. Replies are provided to specific questions raised in an accompanying paper discussing the Injury Severity Score. This conceptual material is presented to provide a foundation for severity index development, to suggest criteria to be used in their formulation and testing, and to identify analyses that can lead to the successful selection and application of an index for a defined purpose.


Indexes of severity: underlying concepts--a reply. A recent paper on the concepts underlying six indexes of severity that have been proposed for health services research claimed to identify deficiencies in each. A close examination reveals that the criticisms are generally without substance, and that the claim that the indexes "violate some of the principles implied by their formulation" is in error. Most of the objections apparently stem from fundamental confusion concerning the use of such indexes. Two of the indexes in question, the Abbreviated Injury Scale AIS) and the Injury Severity Score (ISS), have been validated and are being used widely both in the United States and elsewhere as the principal descriptors of trauma in motor vehicle crashes. The use of these indexes has contributed significantly to motor vehicle crash research and to the improvements in vehicles and highways that are reducing the trauma resulting from such crashes.


An ambulatory care classification system: design, development and evaluation. A medical classification system for coding a patient's reason for visit has been developed for use in the National Ambulatory Medical Care Survey and for ambulatory care settings. The code is developed in a modular structure and includes modules for Symptoms; Diseases; Diagnostic, Screening and Preventive Procedures; Therapeutic Procedures, Process Problems and Counseling; Injuries and Adverse Effects; Follow-ups for Test Results; and Administrative Reasons for Visits. The system was evaluated in coding tests, through review by medical societies representing the major specialties, and by other health care providers. An extensive coding index is available.


[Scanning electron microscopy study of autologous vein and fascia lata before and one year after implantation into the arterial blood stream]. The present communication deals with scanning electronmicroscopical changes of autologous vein and autologous fascia lata, which were used as arterial implants. We examined material, which could be removed during reoperation for vascular occlusion. After one year, the surface exposed to the blood stream shows a homogenous layer of fibrin. Whilst the elastic fibers of fascia lata-transplants have nearly completely disappeared, we can still find them in the vein. This might be the essential reason for the longer survival of venous implants into the arterial blood stream.


[Therapy of pleural empyema after pneumonectomy with open-window drainage and continuous rinsing]. From 1961 to 1977 24 thoracic empyemas (=4,75%) after 507 pneumonectomies were observed at the Surgical Clinic A of the Zurich University Hospital. Two methods for the management of this condition are discussed: open-window drainage (CLAGETT) and continuous rinsing of the pleural cavity (LUIZY). The first mentioned method proved to be a palliative one in our patients: no thoracostomy could be re-closed operatively. Two thoracic windows healed up spontaneously without recurrence of an empyema; one patient died shortly after the operation from respiratory insufficiency. Of the five patients treated by continuous rinsing, four were cured as for their empyema, but one of the latter died from renal insufficiency. In one case an open-window drainage finally had to be accomplished.


[Pacemaker implantation under local anesthesia]. 102 pacemakers have been implanted under local anesthesia. The electrodes have been introduced through the left vena cephalica and the pacemakers placed in the infraclavicular groove. Exchanged pacemakers have been put in the already existing cavity. The wounds have been closed by sutures consisting solely of polyglycolic acid. One hematoma and one infection have been observed. In 12% of the cases the electrode was introduced through the vena jugularis externa, owing to obstruction or unsuitable size of the vena cephalica. Reoperation was necessary in 3 cases due to dislocation of the electrode, and in one case due to the perforation of the ventricle caused by the electrode.


[Experiences with the Sarmiento-cast].

[Experiences with the Sarmiento-cast]. The patella-tendon-bearing cast described by Sarmiento was used in the treatment of 96 tibial fractures. Full weight-bearing was permitted even if the fractures were completely unstable and had a marked tendency to shorten. Only in one case weight-bearing led to a dislocation of the fragments. Specific complications were not seen. It was evident that the PTB-cast was most advantageous to the patient in comparison with a conventional cast and sometimes even in comparison with an osteosynthesis, which does not tolerate weight-bearing. To integrate the Sarmiento-cast in the routine of a small or middle sized hospital, we recommend to observe the following rules: 1. The cast is not applied immediately after the accident, but after one to three weeks of conventional conservative treatment. 2. It is made by two specially trained doctors. 3. The controls of the out-patients are performed in the hospital and not delegated to the family doctor.


[Management of traumatic rupture of the aorta]. Traumatic rupture of the thoracic aorta is a common injury in automobile accidents. It is the result of a crushing chest injury, most frequently associated with sudden deceleration. Approximately 10 to 20% of the individuals with traumatic rupture of the aorta survive temporarily. Diagnosis may be difficult, but if the lesion is promptly diagnosed, appropriate surgical treatment may be life-saving. 9 patients with traumatic aortic rupture have been operated on at our unit since 1969. 2 died postoperatively from acute respiratory distress syndrome. 7 survived the immediate postoperative period without major complications. 2 of them died later after four weeks because of complications not related to the operation. Based on the literature and on our own experience some directions in the management of the traumatic rupture of the thoracic aorta are presented.


[Functional and oncologic results after bronchial or blood vessel anastomosis in the resection therapy of bronchogenic carcinoma]. In treatment of bronchogenic carcinoma twelve selected patients had economical resections. To avoid a pneumonectomy, lobectomies or bilobectomies were associated twice with bronchial excision, 8 times with bronchial resection (sleeve resection) and twice with resection and anastomosis of pulmonary artery. Nine patients underwent clinical, radiologic and szintigraphic control. Except one case all patients showed good functional results. The anastomosed lobes were perfused and ventilated proportionally to the number of segments. The quality of life after partial pulmonary resections had deteriorated only to a small extent compared with the preoperative state. These results were emphasized by the only poor result which (after atelectasis of the anastomosed lung) corresponded functionally to a pneumonectomy. --The two cases of anastomosis of pulmonary artery showed a short survival. Both corresponded to a stage II of tumor classification. Of the other patients (all stage I) three are alive more than five years.


[Breast cancer in males].

[Breast cancer in males]. Until 1971 13 cases of breast cancer in men were observed in our service. In the world literature it accounts for 1% of all cancer of the breast; in our series we have found 4% of all breast cancer. Men present themselves for treatment later and with more advanced local signs than women. In our series, the greatest number of cases occurs near the seventies in men, which is about twenty years later than in women. The etiology is remained unknown, but Klinefelter's disease seems to be a risk for breast cancer. If there are no metastasis, we prefer in our service the surgical treatment as unique treatment. If possible the operation of Patey is realised, but sometimes we have to do a simple mastectomy only as a safe alternative for poor risk patient. In case of metastatic breast cancer the adjuvant treatment was X-ray therapy, chemotherapy and in some of our cases hormonotherapy. We do not have any experience with suppressive hormonal therapy such as orchiectomy or adrenalectomy. Most of the authors think that prognosis of breast cancer in males is worse than in women; the constant central localization of the tumour may be an explanation for that. The fate of women with central lesions is as poor as in males.


[Vaccination against staphylococcal infections in animal experiments]. Based on favour and clinical observations we have undertaken to observe the effect of vaccination against staphylococcic infection in the mouse. A standard amount of staphylococcus was used together with a metal implant. After two weeks in the control group always an infection could be observed, and germs could be cultivated. In the groups with staphypan and in the groups with vaccinated specific vaccinia a less strong infection was observed, while a vaccinia made from salmonella typhimurium and diphtheria-toxoid showed the strongest effect. The use of unspecific vaccinia deserves further attention in relation to operations which can be made after vaccination of the patient.


[Inclined plate screws - in vitro measurement of the stability of transverse osteotomy of tibia]. A compression plate which is exactly contoured to the bone surface produces asymmetric compression: only part of the cortex near the plate is compressed. Therefore a compression plate is not meant to be used selfstanding, it will rather be combined with additional means. Two of these have been studied: the increased stability provided by the use of lagging, inclined plate screws was compared to the one provided by the spring effect of a plate prebent for central elevation. 7-hole dynamic compression plates (DCP) and 4.5 mm cortex screws were used to stabilize transverse osteotomies in human tibiae in vitro. Flexural and torsional testing revealed that the use of an inclined lag screw or a prebent plate increases stability compared to the one achieved with an exactly contoured plate alone. Preliminary tests suggest, that a combination of plate lag-screw and prebending offers stability up to high loads.


[Importance of the friction between plate and bone in the anchoring of plates for osteosynthesis. Determination of the coefficient of metal-bone friction in animal in vivo]. In mechanical devices in general the friction plays an important role in force transmission. To find out about the magnitude of frictional forces between internal fixation plate and bone in vivo, simultaneous strain recording in plated bone and instrumented plate were performed. After 3 weeks of implantation the torque applied to a single plate-screw was set to definite levels. Thus it could be determined at what level of screw compression and at what tangential load of the related surface bone-plate, gliding occurred. The coefficient of friction was found to be 0.2 +/- 0.09 (x +/- Sx). It can be concluded that in vivo friction produced at the plate-bone contact surface is able to guarantee stability of fixation.


[A method of quantitative determination of tissue tolerance in decreased relative movement between implant and tissue]. A method of testing in vivo tissue tolerance to different implant materials is presented. It aims at reduction of variance due to mechanical irritation at the tissue-implant interface through the use of cylindrical implants with grooves. The special type of histological preparation which is necessary and problems encountered when using these techniques are described. The numerical evaluation of round cells and foreign body giant cells seems to give uniform results with low variance, which could be of interest for standard testing of material.


[Regional gastric blood flow in hypovolemic shock in rats]. The effect of hypovolemia on the mucosal blood flow of gastric corpus and antrum were tested with the microspheres method 30 and 60 min after induction of shock in the rat. The results demonstrate a marked reduction after 30 min, with return to control values after 60 min, without any significant differences between corpus and antrum. It is concluded that the differences in energy metabolism between these two regions of gastric mucosa, cannot be attributed to different degrees of ischemia.


[Acute pancreatitis in animal experiments - a new method]. Acute pancreatitis was induced in 30 minipigs (Göttingen) by implantation of a T-drain into the Ductus Wirsungianus. The distal part of the T-drain, which led into the duodenum was stenosed to 1/3 of the original diameter. The inflammation was caused by stenosis of the Ductus Wirsungianus additionally by application of contrast medium. The course of the inflammation was demonstrated by biochemical, roentgenological and histological examinations.


[In vitro study of isolated chondrocytes concerning the prognosis of transplanted cartilage]. In order to find out reliable criteria to conclude on the prognosis of transplanted cartilage the quality of isolated rabbit chondrocytes was assayed in vitro. Using a semisolid medium a culture system is introduced, which is able to detect colony forming units of chondrocytes. Furthermore their proliferative and differentiating capacity was investigated. Colony formation in vitro follows a strict dose response relationship. An inverse relationship was observed between the age of the donor and the colony incidence in vitro. Cells from neonatal cartilage could be induced to grow as fibroblastic colonies in the presence of conditioned medium from fibroblastic monolayer cultures. No effect, however, could be observed with chondrocyte derived conditioned medium.


[Morphological and biochemical examinations of different suture materials in colon anastomosis in the rat]. Histological, mechanical and biochemical examinations in the one layer colon anastomosis of the rat have shown that the synthetic resorbable suture material as Dexon and Vicryl are as good or even better than silk or catgut chromic. The most favourable histological reaction is observed with Dexon. Collagenolytic activity and collagen content are not influenced by the suture material during the first 14 postoperative days.


[Autoimplantation of splenic tissue into the peritoneal cavity of irradiated rats]. A simple technique is described for the autoimplantation of splenic tissue in the peritoneal cavity of rats. The effect of splenic implants on irradiated splenectomised rats was investigated, by following the evolution of the implants both microscopically and macroscopically. The effect on haemopoiesis was also observed. The dose of irradiation given was sublethal, do not think it necessary to put in, and non lethal.


[Morphological liver changes after portacaval and splenocaval anastomosis in rats]. Body weight, liver weight and liver histology in rats 3 weeks after portacaval and distal splenocaval anastomosis were analyzed. Rats with portacaval shunt showed a reduction of body and liver weight and histological signs of liver atrophy. There was no difference between the results in rats with splenocaval shunt and controls.


[Compression of the celiac trunk by the median arcuate ligament]. A relatively large series of 20 operated patients, aged 28 to 66 years, with median arcuate ligament syndrome is presented. There has been a change in the pattern of presentation of this condition in recent years. Early diagnosis can now be made with greater frequency than previously. The origin and the symptoms due to the intermittent, chronic abdominal ischaemia are discussed. The preliminary results suggest that surgical decompression is effective in inducing favourable changes in 60% of patients.


[2 years experience with the Octopus universal retractor holder]. On 978 operations of all fields of surgery, the new automatic retractor holder has been successfully used. The holder arms are provided with three joints and can be secured in any desired position to keep the edges of the incision and organs in the necessary situation for operating. All joints are locked by operating the central pivot. The advantages of this new automatic retractor holder was described.


[Diagnostic arthroscopy and arthroscopic surgery: experiences with 500 knee arthroscopies]. A diagnosis by clinical examination and arthrography was not possible in 160 out of 500 arthroscopically examined patients, most of them with post-traumatic knee disorders. In 157 cases the clinical diagnosis was wrong, and in another 58 cases incomplete. Only in 89 patients (18%) arthroscopy proved the clinical diagnosis to be correct. At arthroscopy, a meniscal injury was found in 156 patients (medial meniscus 57, lateral meniscus 64, both menisci 8). With regard to the menisci a previous arthrography was found correct only in 103 out of 213 cases, i.e. in 48%. Lesions of the articular cartilage were present in 210 patients, although they were expected clinically in only one third of these cases. Normal intraarticular structures were found in 95 examinations. The arthroscopic examination was insufficient three times because of a protruding fat pad, and wrong in 2 patients in whom an arthroscopically diagnosed meniscal tear could not be found at arthrotomy. The morbidity of arthroscopy is small. Only complications: A local allergic reaction because of a wound spray in four cases, bronchial asthma following general anesthesia in two patients. No infection occurred. Several therapeutic procedures may be carried out through the arthroscope. So loose bodies were removed from the joint in 39 and partial meniscectomy performed in 13 patients, all of them being treated as out-patients.


[Surgical intervention in traumatic orbital syndromes]. Craniofacial traumata may be accompanied by retroorbital fractures with severe ophthalmologic complications. Each of the clinical syndromes is characterized by a combination of ophthalmoplegia, paralyzed pupillary function and visual disorder. These deficiencies are caused by injury of muscles, nerves and vessels and compressive retroorbital hematoma. In the case of such damage, the poor prognosis can be improved by surgical intervention consisting in the evacuation of the retroorbital hematoma.


[Principles of treating facial fractures]. The therapy of facial fractures is aimed at an early definitive treatment. Exact repositioning of the fragments is first achieved by setting the right occlusion. Intermaxillary fixation is then performed by interdental arch bars reenforced with acrylic material and intermaxillary rubber bands or wire. The middle third of the face is mainly subjected to static forces. Fractures in this area are therefore set and fixated with interosseous wire ligatures. Craneofacial suspension is carried out by means of a craneofixateur extern. Fractures of the mandible are treated differently. In order to counteract the strong dynamic forces internal fixation is necessary using compression plates in combination with tension bands. Another modality of treatment by a specially designed plate with excentric gliding holes renders the tension bands superfluous since it is capable of applying compression forces also at the dental area. In fractures with osseous defects long plates are used which stabilize the mandibular arch. If the articular prominence is missing these plates may be applied with a capitular end in order to reconstruct the articulation.


[Prognosis of iatrogenic and accidental vascular trauma]. The prognostic of vascular trauma does not only depend on the associated lesions and time before treatment. Without obvious symptoms, serious vascular lesions can be overlooked. A preexisting arteriosclerosis explains the different outcome in geriatric patients. 84 cases of vascular trauma were observed between 1969 and 1977. 33 of these cases were iatrogenic. The patients involved are examined clinically and undergo ultrasonic velocity detection before and after effort (test of Strandness). The outcome showed 5 deaths, 7 amputations and 8 vascular sequela. Only 2 deaths and 3 amputations are directly related to the vascular trauma.


[Determination of the conditions of extra-anatomical arterial cross-over-shunts]. Extra anatomical cross-over-shunts are feasible even when the lending extremity is itself afflicted by obliterative arterial disease provided that 1. global irrigation of the lending extremity exceeds perfusion of the borrowing extremity, 2. pulse-volume-recording (PVR) corresponds to categories 1--3 as defined by Raines, 3. ankle pressure of the lending extremity is not less than 70 mm of mercury or 4. ankle pressure of the leading extremity corresponds to 60% or more than the systemic blood pressure.


[Infection after vascular surgery].

[Infection after vascular surgery]. Infection after vascular surgery is a feared complication whose mortality rate remains high, inspite of an aggressive surgical approach, actually admitted by most of the authors. From 1970 to 1977 we have observed 6 infections after 1049 arterial operations: 5 out of 228 synthetic by-passes and 1 out of 296 venous by-passes. The global infection rate is 0.5%. This complication occurred in 2.1% of the cases after synthetic by-passes. Two out of these 6 infected patients had to be amputated and they died. We think that the general accepted treatment remains valuable in most of the cases, but that a more simple and less aggressive surgical approach can be of great interest in particular situations.


[Deep venous thrombosis of the lower limb: experiences of thrombectomy within and outside the iliacofemoral segment]. A series of 23 venous thrombectomies of the lower limb is presented. In 19 instances indirect thrombectomy of the iliacofemoral segment was performed. 1 direct thrombectomy of the v. cava inferior led to full lumen restoration. Direct thrombectomy of the popliteal vein was attempted in 3 cases, resulting in phlebographic and clinical normalization in 2 instances. In no instance did pulmonary embolism occur during or after venous thrombectomy.


[Registration of fibular movements in vivo in relation to the tibia at the level of the ankle joint]. Fibular movements in relation to the tibia are known on extension and dorsiflexion of the ankle-joint and have been proved by experiences on cadaveric preparates using outstanding points of relation. To registrate fibular movements in vivo a special trigonometric system has been developed permitting calculation of definite movement in frontal and sagittal plane as well as a rotation around axis. Twelve healthy volunteers were examined in this way during extension and dorsiflexion of the ankle, with and without weight-bearing. The results showed that we should not consider isolated fibular movement but analyse simultaneous complexity of movements in a graphic comparison. Under these conditions we observe a very high significance of fibular movements depending each of other. The emphasis can be designed in a field covering all the points reached by fibular movement in frontal and sagittal plane of the twelve healthy volunteers during movement of the ankle; it shows that the fibula functions like a guide-stick for ankle movement. Reflecting on the designed fields of healthy persons, some patients with posttraumatic pathological alterations of the ankle-joint have been analysed.


[Early scanning electron microscopy changes of the surface of the leaflets of orthotopic transplanted glyceraldehyd-conditioned conus-pulmonalis xenografts. An experimental study in dogs]. The surface of the leaflets of orthotopic transplanted glutaraldehyd-conditioned conus-pulmonalis xenografts show when analysed by a scanning microscope the following constant changes. Within seconds the surface of the leaflets is covered by a grainy layer of proteins followed by fibrin threads. Cellular elements of the blood--like platelets, white blood cells, macrophages and microthrombi--are incorporated in the fibrin network. This leads, after several weeks to a fibrous layer especially over the stiff parts of the valve. No endothelium was seen even after 6 months.


[Scanning electron microscopy study of autologous fascia lata and bovine xenograft as arterial prosthesis. An experimental study]. The present communication deals with the decomposition of thrombi and the formation of an endothelium in two different vascular prothesis. Devitalized bovine arteries which were enzymatically reduced to a collagen reticulum, and tubes made of autologous fascia lata were implanted into the arterial bloodstream of dogs. The implants were left in place for a time ranging between 30 min and four months. They were examined by scanning electronmicroscope with the cortical point method. This enabled us to reach the following conclusions: unprepared autologous fascia lata implanted into the arterial bloodstream has much more thrombogenous qualities than solcograft. The decomposition of thrombi and the formation of an endothelium is much faster accomplished in fascia lata than in the devitalized bovine artery. It is not possible to distinguish solcograft and fascia lata by the formation of endothelium only.


Localization of lactate dehydrogenase isozymes in human muscle tissues by the mixed aggregation immunocytochemical technique. Lactate dehydrogenase (LDH) isozyme composition and localization was determined in sections of skeletal, heart and smooth muscle by the mixed aggregation immunocytochemical method using first antibody directed against purified human LDH-A4 (M4) or LDH-B4 (H4) followed by the enzymes LDH-A4 and LDH-B4, respectively. An even distribution of the two monomers in all fibres was seen with heart muscle and smooth muscle. Heart muscle had a low concentration of A-monomers and a high concentration of B-monomers, whereas the smooth muscle had equal concentrations of the two monomers. In contrast, skeletal muscle from m. quadriceps femoris was found to be composed of two muscle fibre types, one containing mainly A-, the other mainly B-monomers. On the basis of succinate dehydrogenase activity it was shown that the red (type 1) fibres contain mainly B-monomers and the white (type 2) fibres mainly A-monomers of LDH.


A gel-sandwich technique for the qualitative and quantitative determination of dehydrogenases in the enzyme histochemistry. I. Development of the new methods on the example of LDH (E.C. 1.1.1.27). A gel-sandwich technique for the histochemical demonstration of dehydrogenase is introduced with LDH set up as an example. Especially suitable, of the gels examined, for this technique is 1.5% W/V agar-agar low gel strength. In it several reaction ingredients for the histochemical reaction are dissolved. Considering LDH the following gel composition showed good results: 1.5% W/V agar-agar low gel strength, 5 mM TNBT in 150 microliter DMF, 120 mM L-lactate, 3--5 mM NAD+, 10 mM amytal, 22,4--32 X 10(-5) M Meldola Blue, 160 mM soldium phosphate buffer pH 7.6 (total solution of 1 ml). After the solidification of the gel, gel-bars were frozen with CO2-snow. The 40--80 micrometer thick gel slices were gained in the cryostat. Of the three different arrangement possibilities of the gel slices and the tissue-sections a sandwich arrangement (cover-gel slice--tissue section--ground-gel slice) produced the best results. The enzyme reaction is started by thawing of the gel slices (together with the tissue sections) and by putting them between the hotplate and the evaporator-head-piece, especially developed for this technique. The gel slices also remain in combination with the tissue sections after the reaction. The influence of the gel in combination with the electron carrier Meldola Blue on the spontaneous reduction rates of ditetrazolium salts in day light, were examined as well as the diffusion rates of TNBT and NADH out of gel slices and the influence of DMF and DMSO on the LDH activity. This technique prevents both, the loss of enzymes and the loss of reduction equivalents. There are given presuppositions for qualitative and quantitative histochemical investigations as well. The advantages of the new gel technique are discussed.


Cytochemical reaction for cationic proteins as a marker of primary granules during development in chick heterophilis. The ammoniacal silver reaction (ASR) for cationic proteins was used as a cytochemical marker for the primary or A granules in the cytoplasm of developing heterophils of chick bone marrow. The presence of the electron-dense particulate reaction product of silver, which is localized in the fully formed rod-shaped A granules, provides a marker by which the A granules could be distinguished from the B granules of similar size and by which the formation and maturation of both granule types could be followed through the developmental stages. Progressive developmental stages were ascertained on the basis of decreasing cell size, increasing condensation and margination of the chromatin, and the number and morphology of the granules; the stages were divided into promyelocyte, myelocyte, metamyelocyte and heterophil. During the promyelocyte stage, the first appearance of the electron-dense, membrane-bound, spherical granules (0.3--1.0 micrometer in diameter) is observed in the vicinity of an extensive Golgi complex. They occur in a cytoplasm containing rough-surfaced endoplasmic reticulum, ribosomal clusters, centrioles, mitochondria, microtubules, as well as the membranes, saccules, vesicles and vacuoles of the Golgi complex. These granules are considered as primary but their presence as the only granule type appears very brief. The ASR reaction product is first detected on the surface of these primary granules in late promyelocytes or myelocytes. The secondary or B granule, devoid of reaction for cationic protein at all stages, appears as a condensing vacuole in promyelocytes, but after some A granules are already present. The vacuole contents condense to form the B granules which are 0.1--0.6 micrometer in diameter, often oval-shaped, and contain a loose filamentous material surrounded by a membrane. Tertiary C granules or lysosomes appear during the myelocyte stage as dense core vesicles (0.1--0.2 micrometer in diameter) negative for cationic protein.


Histochemical demonstration of mouse submandibular esterproteases with a new chromogenic substrate. A new method for the histochemical demonstration of mouse submandibular esterproteases has been developed. The substrate is N-acetyl-L-methionine alpha-naphthyl ester. The main enzyme reaction was found in the apical region of the secretory tubules with a marked sex difference as expected. First attempts were made to differentiate histochemically between the various esterproteolytic enzymes.


Influence of expiratory flow rate on "closing volume" measurement. The influence of expiratory flow rate (VE) on the onset of phase IV was studied in 15 normal subjects. VE was controlled voluntarily and varied between 0.2 and 2.5 l/s. All subjects showed significantly higher values for CV/VC, % at expiratory flow rate of 1.0 and 1.5 l/s, compared to those estimated at 0.2 l/s. The correlation between CV and volume of flow limitation (VFL) was also studied. For most of the subjects a considerable disagreement between the two values at very low VE was found. At higher flows, however, CV and VFL agreed well. Our results indicate that CV measurement is markedly influenced by VE in the range 0.2--1.5 l/s. This finding gives further support to the hypothesis that CV is determined in part by dynamic flow-limiting properties of the lung as well as by true airway closure.


Tonometer for calibration and evaluation of oxygen microelectrodes. A temperature-controlled tonometer for the calibration of oxygen microelectrodes is described. The tonometer equilibrated a fluid with a known gas tension within 30 s and has eliminated many problems previously associated with microelectrode evaluation.


Dynamic mechanisms determine functional residual capacity in mice, Mus musculus. Awake mice (22.6--32.6 g) were anesthetized intravenously during head-out body plethysmography. One minute after pentobarbital sodium anesthesia, tidal volume had fallen from 0.28 +/- 0.04 to 0.14 +/- 0.02 ml and frequency from 181 +/- 20 to 142 +/- 8. Functional residual capacity (FRC) decreased by 0.10 +/- 0.02 ml. Expiratory flow-volume curves were linear, highly repeatable, and submaximal over substantial portions of expiration in awake and anesthetized mice; and expiration was interrupted at substantial flows that abruptly fell to and crossed zero as inspiration interrupted relaxed expiration. FRC is maintained at a higher level in awake mice due to a higher tidal volume and frequency coupled with expiratory braking (persistent inspiratory muscle activity or increased glottal resistance). In anesthetized mice, the absence of braking, coupled with reductions in tidal volume and frequency and a prolonged expiratory period, leads to FRCs that approach relaxation volume (Vr). An equation in derived to express the difference between FRC and Vr in terms of the portion of tidal volume expired without braking, the slope of the linear portion of the expiratory flow-volume curve expressed as V/V, the time fraction of one respiratory cycle spent in unbraked expiration, and respiratory frequency.


Ventilation and gas exchange during phasic hindlimb exercise in the dog. To investigate the importance of the major neural afferent component from the exercising extremities in exercise hyperpnea, rhythmic contraction of hindlimb muscles was produced in the dog, by electrically stimulating the peripheral cut ends of the sciatic and femoral nerves, bilaterally, for 4- to 5-min periods. VE, VCO2, and VO2 were computed breath-by-breath and PaCO2 was monitored continuously with an indwelling arterial electrode. During exercise, VO2 and VCO2 were approximately doubled in the steady state, rising with t1/2 of 25 +/- 2 and 35 +/- 4 s, respectively. VE increased within five breaths after exercise onset, and thereafter rose to a steady state with a t1/2 of 37 +/- 5 s. Mean PaCO2 increased transiently within the 1st min of stimulation but was not significantly different from control in the steady state. We conclude that the major neural afferent component from the contracting muscles is not an obligatory requirement for normal ventilatory response in the steady state of phasic exercise.


Physical performance and peak aerobic power at different body temperatures. In eight male subjects we studied the effect of different core (esophageal, (Tes 34.9--38.4 degrees C) and muscle (Tm 35.1--39.3 degrees C) temperature on 1) physical performance (time to exhaustion at a standard maximal rate of work, WT), 2) aerobic power (VO2), 3) heart rate (HR), and 4) blood lactate (LA) concentration during exhaustive combined arm and leg exercise. In three subjects the effects at different mean skin temperatures (Tsk 27 and 31 degrees C, respectively) were also studied. Peak VO2 was positively correlated to both Tes (r = 0.88) and Tm (r = 0.91). None of the subjects attained control VO2max at Tes and Tm lower than 37.5 and 38.0 degrees C, respectively. HR was correlated to both Tes (r = 0.97) and Tm (r = 0.95). Different Tsk did not affect peak VO2 and HR at subnormal body temperatures. Pulmonary ventilation was independent of Tes and Tm in all experimental situations. LA was significantly higher at Tes 37.5 degrees C compared to both Tes 34.9 and 38.5 degrees C, respectively. At Tes less than 37.5 degrees C and Tm less than 38.0 degrees C, there was a linear reduction in WT (20%.degrees C-1), peak VO2 (5--6%.degrees C-1), and HR (8 beats.min-1.degrees C-1) with lowered Tes and Tm.


Effects of extrapulmonary airway distension on breathing in anesthetized dogs. Anesthetized dogs with open chests were perfused with a pump-oxygenator. We first observed the effects of intermittent periods of sustained inflation of both lungs, of only one lobe, and of an intra-airway balloon on the diaphragm electromyogram (EMG). Lung or lobe inflation with low pressures depressed respiratory frequency (fr) by prolonging expiratory time (TE) in proportion to inflating pressure, but balloon inflation was without effect. We next intermittently inflated one or two lobes after all others were ligated and thereafter inflated all the extrapulmonary airways following total lung excision. Lobe inflation, by varying TE, decreased fr at low pressures and often increased fr at higher pressures. Extrapulmonary airway distension slightly increased fr and the mean rate of rise of the integrated EMG, but decreased inspiratory time and peak EMG amplitude. TE was slightly prolonged by low pressures when using sustained airway pressurization but was shortened by higher pressures when distending cyclically. In comparison to lobe inflation, the effects from isolated airways were small, and the inhibitory effect of lung inflation could not be attributed to them.


Fatigue of inspiratory muscles and their synergic behavior. The time (tlim) required to produce inspiratory muscle fatigue was measured in five normal subjects breathing at functional residual capacity (FRC) against a variety of high inspiratory resistive loads. In every breathing test the subjects generated with each inspiration a mouth pressure (Pm) that was a predetermined fraction of maximum Pm (Pmmax). They continued breathing until they were unable to generate this Pm. The Pm/Pmmax that could be generated indefinitely (Pmcrit) was around 60%. The inspiratory power output at that level of breathing was 6.6 kg.m/min (Wcrit). In three of those subjects the same experiment was conducted at an end-expiratory volume of FRC + one-half inspiratory capacity (1/2IC). The higher lung volume was actively maintained by the subjects watching end-expiratory transpulmonary pressure on an oscilloscope. For any fraction of the maximum mouth pressure at FRC + 1/2IC (Pm'max), tlim was shorter than FRC. Pmcrit decreased to 30% Pm'max and Wcrit to 2.6 kg.m/min. Monitoring the abdominal pressure revealed that the contribution of the diaphragm and intercostal accessory muscles alternated in time, possibly postponing the onset of fatigue.


Bradycardia during face cooling in man may be produced by selective brain cooling. In human subjects, bradycardia was produced by immersing the subjects' faces in water at 15 degrees C when they were hyperthermic. When they were hypothermic, the same face cooling produced tachycardia. It is suggested that the difference in cardiac response originates in selective brain cooling during hyperthermia, by venous return from the face to the brain, via ophthalmic veins.