Cell proliferation in normal and diseased gastric mucosa. Autoradiography after in vitro continuous labelling with tritiated thymidine. The rate of gastric epithelial cell proliferation was studied in healthy volunteers and in patients with different degrees of gastritis. Endoscopic biopsies from the antral and fundic part of the stomach were incubated in vitro with 3H-thymidine for 30, 120, and 210 minutes respectively. Autoradiographs were prepared, and the percentage of DNA-synthesizing cells (labeling index) in the progenitor cell region was estimated. From the successive labeling indices the rate of entry of cells into DNA-synthetic phase (S-phase) and the duration of the S-phase could be estimated. All the biopsies were classified according to the degree of gastritis. The mean (+/-SEM) length of the S-phase was found to be 7.4 +/- 0.3 hours in antral mucosa and 7.2 +/- 0.4 hours in fundic mucosa. There was no significant difference between the S-phase duration in normal mucosa, superficial gastritis, mild atrophic gastritis and severe atrophic gastritis. This observation suggests that the labeling index can be used as an expression for the rate of cell proliferation in human gastric mucosa. A significant correlation between the labelling indices and the degree of gastritis was found in both antral and fundic mucosa. In six cases, labelling indices estimated by cell counts performed on longitudinal or cross sections of foveolae were compared. Ther was no significant difference between the results obtained by the two different counting techniques.


Diaphragmatic blood flow at various levels of ventilation in the rabbit. Diaphragmatic and renal blood flow were measured with Ytterbium-169 and Scandium 46 labelled 15 micron microspheres in sodium pentobarbitone anesthetized rabbits. The first measurement was performed during spontaneous breathing of air and the second measurement after 15 min of breathing 2-6% carbon dioxide in oxygen. The lung ventilation as well as the diaphragmatic blood flow increased significantly during breathing of the carbon dioxide-oxygen mixture. Arterial blood pressure and renal blood flow were not significantly altered by the induced hyperventilation. No significant correlation was found between the magnitude of lung ventilation and diaphragmatic blood flow. The results of the present study indicate that consecutive measurements of diaphragmatic blood flow with radioactive microspheres at various levels of breathing effort is an appropriate method for further exploration of the relationship between diaphragmatic perfusion and working performance.


Evidence for a cholinergic secretory innervation of the guinea-pig endometrium. Uterine mucus secretion was studied by measuring carbohydrate release from everted guinea-pig uteri placed in organ baths. Field stimulation of the organ resulted in a significant increase in carbohydrate out-put, this increase was inhibited by tetrodotoxin, scopolamine and previous destruction of the paracervical ganglia. Previous section of the hypogastric nerve reduced the response to field stimulation, while interruption of the costouterine connexion or the pelvic nerve was without overt effect. Stimulation of the hypogastric nerve increased uterine carbohydrate secretion. Pelvic nerve stimulation produced no significant effect. Carbachol increased the carbohydrate secretion to the same extent as did field stimulation. Isoprenaline and methoxamine were without significant effect. It is suggested that certain endometrial cells have a cholinergic sympathetic secretory innervation with pre- and postganglionic fibers running in the hypogastric nerve.


Inhibition of renal sympathetic nerve traffic from cardiac receptors in normotensive and spontaneously hypertensive rats. The reflex inhibition of the sympathetic outflow to the kidney was examined during volume load with horse plasma in 6 normotensive rats (NCR) and 6 spontaneously hypertensive rats (SRH). The rats were anesthetized with chloralose and urethane. The arterial baroreceptors were denervated. The renal nervous inhibition was mediated via the vagal nerves and was mainly due to activation of receptors in the left side of the heart. The average thresholds in mean left artrial pressure for renal nervous inhibition was 5.4 mmHg for NCR and 9.2 mmHg for SHR indicating a clear resetting of the reflex arch in the hypertensive animal: The reason is probably a decreased distensibility of the wall of the left atrium due to a chronic elevation of left atrial pressure. This resetting of the atrial receptors in the hypertensive animals is probably of importance to allow an adequate filling pressure of the hypertrophied left ventricle and might also be of importance for the reflex neural control of renal function in these animals.


Reversible brain hyperthermia during audiogenic seizures in rats. Reversible brain hyperthermia during audiogenic seizures in rats. Acta Physiol. Pol., 1979, 30 (2): 273--277. Nine rats having inborn audiogenic susceptibility had chronically implanted Cu-constantan thermocouple and epidural EEG electrodes sewed into the skull. In freely moving animals audiogenic seizures were provoked by the use of common electric bell (approx. 100 dB). The EEG trace and brain temperature (with the accuracy of 0.05 degrees C) were recorded simultaneously during 1--8 hours. Temperature increases found during 23 audiogenic seizures were similar to those noted during intensive locomotor activity of animals without seizures. In thermoneutral environment (23 +/- 2 degrees C and humidity 65% +/- 10%) brain temperature never exceeded 41 degrees C.


The effect of noise on cochlear blood flow in the conscious rabbit. The cochlear blood flow was measured with the microsphere method in unanesthetized rabbits, prior to and during noise-exposure. Different sound pressure levels were used: 100 dB, 115 dB and 120 dB. Some of the animals had the cervical sympathetic trunk cut unilaterally. The effects of the delivered noise on the organ of Corti were studied in other rabbits with scanning electron microscopy. In spite of ultrastructural changes indicating damage of sensory cells after 115 dB and 120 dB exposure no changes of the total cochlear blood flow could be observed. After unilateral section of the cervical sympathetic trunk the cochlear blood flow was less on the intact side (25%) already prior to noise exposure and the difference was not significantly affected by noise. Different sizes of microspheres were used: 8.2, 8.4, 8.7, 9,2 mum. The 8.2 and 8.4 mum-spheres seemed well fitted for measurements of cochlear blood flow but passed the cerebral capillaries to a high extent. Control experiments using both 8.2/8.4 mum-spheres and 15 mum-spheres were performed and the degree of passage in different tissues was estimated.


Metabolic responses in feline "red" and "white" skeletal muscle to shock and ischemia. In order to investigate possible differences in the reaction to hypoxic conditions between "red" and "white" skeletal muscle, cats were subjected to a 2 h period of either hemorrhagic shock or hind limb tourniquet ischemia, and the hypoxia induced changes were studied in the soleus and lateral gastrocnemius muscles. Muscle biopsies were analysed for ATP, CP, glucose, G 6-P and lactate. Using microelectrodes, the resting membrane potential was repeatedly measured. Both experimental models resulted in increased tissue lactate levels and a successive decrease in the membrane potential of both muscles studied. No reduction of the high energy phosphagen content (ATP + CP) occurred in any of the muscles during shock. The tourniquet ischemia resulted in a 40% reduction of the ATP + CP content in the soleus muscle, whereas in the gastrocnemius muscle no significant reduction occurred. A significant correlation was found between the tissue lactate content and the membrane potential under both conditions and in both muscles studied. It is concluded that "red" muscles are more susceptible to metabolic derangement than "white" muscles during total ischemia, whereas during hypovolemia "red" muscles appear to be protected from early hypoxic damage, probably due to a redistribution of skeletal muscle blood flow.


Secretion of nitrogenous compounds in the small intestine of pigs. Secretion of nitrogenous compounds in the small intestine of pigs. Acta Physiol. Pol., 1979, 30 (2): 319--326. The study was performed on pigs weighting 50 to 75 kg with temporarily isolated loops of one of the three parts of the small intestine: proximal, middle and terminal. For measurement of intestinal secretion the isolated loops were perfused with N-free solutions and the effluent was collected and analyzed. On a protein diet, under conditions of an isotonic osmotic pressure of the solution, secretion of nitrogen compounds in the upper part was twice that in the lower part of the small intestine, 0.97 against 0.48 g N/m/24 h. A hypertonic pressure increased secretion of N into the intestinal lumen. On a protein-free diet secretion of nitrogen compounds was markedly decreased. Soluble N amounted to about 90% of total N and alpha-amino-N to 50 to 79% of soluble N. Free amino acids made up about 65% and protein 33% of the total alpha-amino-N. There was a large proportion of threonine, 6.0--6.3%, and lysine, 8.0--8.7% in the total amino acids secreted into the intestine.


Continuous measurement of flow rate and volume in the nanoliter range. A simple transducer which is based on changes of electrical capacity with volume is described. The system accomodates fluid volumes of several microliters and the resolution is below one nanoliter. The response time of the transducer is about 10 ms. The system is applicable for continuous recording of flow rates in renal collecting tubules. Pulsatile flow in the duct of Bellini is demonstrated.


Local versus regional cerebral blood flow in the rat at high (hypoxia) and low (phenobarbital anesthesia) flow rates. Local cerebral blood flow (CBF) was measured in rats, using an autoradiographic technique with 14C-iodoantipyrine as diffusible tracer, in situations with low, normal and high flow rates (phenobarbital anesthesia, analgesia with 75% N2O, and hypoxia, respectively). A comparison of the results with previous data obtained in conscious rats (Sakurada et al. 1978) demonstrates that 75% N2O moderately reduces local CBF in some, but not all, cortical and subcortical areas, that phenobarbital anesthesia reduces local CBF to between 30 and 65% of (conscious) control, and that pronounced hypoxia (arterial P02 about 25 mmHg) increases local CBF 3- to 4-fold. A comparison of the values obtained for cortical structures with those previously measured with a technique based on the Fick principle shows that the autoradiographic technique gives similar values at low and normal flow rates but that it moderately underestimates CBF at high flow rates, probably due to diffusion limitation.


Post-exercise changes in muscle glycogen content and blood metabolites in the dogs treated with triiodothyronine. Post-exercise changes in muscle glycogen content and blood metabolites in the dogs treated with triiodothyronine. Acta Physiol. Pol., 1979, 30 (2) : 241--252. Prolonged T3-treatment markedly affected muscle glycogen content which was significantly lower than in controls both under resting conditions and after prolonged exercise. The post-exercise rate of the muscle glycogen resynthesis was inhibited in comparison with controls. Glucose (about 35 g per animal) infused to these dogs after cessation of exercise was able to bring about the rate of glycogen resynthesis to control values, but only during the first few hours of the recovery period. The present investigations confirmed that an excess of thyroid hormones elevates the lipolytic and lactacidemic responses to physical effort, but the pattern of the post-exercise changes in blood FAA and LA levels was similar in both groups. No differences between the control and T3-treated animals were found in the levels of blood catecholamines and insulin before, during and after exercise. Blood glucose level was significantly higher in T3-treated dogs at rest and markedly lower at the end of exercise in comparison with controls. The pattern of changes in BG level during the post-exercise period was similar in both animal groups.


The effect of vasodilatation and sympathetic nerve activation on net water absorption in the cat's small intestine. The rate of net water uptake from the feline small intestine has been investigated during control conditions, during graded infusions of the vasodilator drug isopropylnoradrenaline, and during electrical stimulation of the regional sympathetic nerve fibres to the gut. Net water absorption rate was largely unaffected by intestinal vasodilatation. The fraction of the absorbate transported via the lymphatics remained also constrant at 20-40% of the total absorption regardless of blood flow rate. Stimulating the sympathetic nerve fibres to the small intestine increased, however, net water absorption rate. The increase was particularly pronounced when blood pressure was kept constant during the period of stimulation. The absorption rate was on an average almost doubled at a stimulation frequency of 8 Hz during constant pressure conditions. The mechanism(s) explaining this nervous control of water absorption are tentatively discussed.


Changes in blood vasotocin level in response to uterine stimulation in the hen. Changes in blood vasotocin level in response to uterine stimulation in the hen. Acta Physiol. Pol. 1979, 30 (2): 267--272. The blood vasotocin level after uterine and vaginal stimulation was determined by bioassay, on the isolated frog bladder. It was found that uterine distension causes a 2--3 fold increase in the blood vasotocin level compared to that before distension. Vaginal distension was without any effect on the blood vasotocon level.


Renin, aldosterone and cortisol during ethanol intoxication and hangover. The effect of ethanol intoxication and hangover on plasma renin activity (PRA), plasma aldosterone (PA) and plasma cortisol (PC) concentrations was studied in 7 healthy supine men in controlled clinical conditions during 18 h beginning at 6 p.m. Large individual variation was observed in the response of PRA, PA and PC to ethanol. Following ethanol, stimulation of PRA was observed at the 14th and the 16th hour (P less than 0.05), of PA at the 4th and the 6th hour (P less than 0.01 and P less than 0.05, respectively) and of PC at the 4th and the 14th hour (P less than 0.01 and P less than 0.05, respectively). Ethanol ingestion suppressed PC during the first hour (P less than 0.02). Water ingestion at 8 a.m. suppressed PA between the 14th and the 16th hour (8-10 a.m.) in control and ethanol experiment (P less than 0.01 and P less than 0.005, respectively). There was a dissociation between PRA and PA, but intra-individually PRA and PA correlated fairly or well. Plasma arginine vasopressin (AVP) and PC were also significantly correlated. The results suggest that changes in PA and PC as well as the dissociation of PRA and PA after ethanol ingestion might be partly related to dehydration and to the increased secretion of hypothalamic and pituitary hormones as well as to sodium and potassium balance. There was a biphasic effect of ethanol, including an inital suppression of PC and a subsequent increase of PC, PRA and PA. Upright posture appears to exaggerate the stimulating effect of ethanol on PRA, PA and PC.


A clinical study of 44 patients with juvenile amaurotic family idiocy. The material presented comprises 44 patients with juvenile amaurotic family idiocy. The disease is distinguished from other types of gangliosidoses, and earlier clinical descriptions are reviewed. The median age of the patients at the onset of the diseases was 5.8 years and median duration of life was 18.8 years. It appears probable that the disease takes two different courses. Besides the earlier described accompanying phenomena, dystonic attack with oculogyre crises have been found in some patients, as well as extreme cases of bradycardia. In 77% of the patients psychotic manifestations have been found, chiefly in the form of frightening visual hallucinations. The pathogenesis and clinical observations of the psychoses are discussed and environmental factors are pointed out as contributing to the pathogenesis of the psychoses.


Depression or asthenia related to metabolic disturbances in obese patients after intestinal bypass surgery. This study was an attempt to compare psychological and biological variables in 43 obese patients after intestinal bypass surgery. The difficulties in expressing the psychological variables quantitatively are discussed on the basis of the concept of transferability. By use of an expanded version of the Beck Depression Inventory and the Marke-Nyman Temperament Scale we could demonstrate that items concerning asthenia (self-dislike, irritability, work retardation, insomnia, fatigability, somatic preoccupation about aches and pains, loss of libido, headache, vertigo, palpitations, dryness of the mouth, thirst or increased liquid intake) had, when summed up, a score distribution indicating bimodality. The asthenic group of patients (n = 19) when compared with the non-asthenic patients (n = 24) showed metabolic deficiencies related to the vitamin D complex with no response to oral vitamin D3 administration measured by plasma levels of 25-hydroxyvitamin D3. The lack of response was associated with low calcium excretion in the urine, higher plasma alkaline phosphatase, and a tendency to higher blood levels of parathyroid hormone.


Video-analytic study of manual kinesics and its lateralization in the course of treatment of depressive syndromes. Video-taped interviews of 47, predominantly endogenous depressive in-patients, recorded on days 0 and 21 of pharmacotherapy were analysed with respect to frequency, duration and side-preference of defined hand movements. The data were related to clinical improvement or deterioration as assessed by judgement of the syndromal aspects: retardation and agitation. 1. Above all, improvement is marked by a decrease of Continuous body-focused movements (C) and an increase of Object-focused movements (O) of the speech primacy type (OS)-deterioration by an increase of C and decrease of OS. 2. The degree of retardation corresponds to O, the degree of agitation, above all to C. 3. O show no side-preference with a higher degree of retardation or agitation respectively, but a marked right perference with a lower degree of retardation or agitation, Discrete body touching (D) shows a left preference only, with a higher degree of retardation. A comparison of sidedness of O between interviews 1 and 2 shows no lateralization trend, either in the improvement or the deterioration group. In contrast, D changed from left weightiness to symmetry, coinciding with improvement but not with deterioration, With reference to the latter findings we discuss the possibility of a particular mode of cerebral lateralization predisposing to endogenous depression.


Alcoholism and antisocial personality.

Alcoholism and antisocial personality. The picture of alcoholism in criminals with an antisocial personality was compared with criminals with other personality disorders. Fewer of those who had an antisocial personality were physically dependent on alcohol than those with other personality disorders. They considered their alcoholism to be a problem and behaved as if it were only rare. However, they had a strong tendency to behave abnormally under the influence of alcohol over and over again. In these respects the situation among those who were below the age of 20 was similar. To a great extent, the fathers of those who had an antisocial personality had also had a tendency towards abnormal behavior under the influence of alcohol. This was not so often found in the control group.


EEG response to sine wave modulated light in XYY, XXY, and XY men. Ten XYY, 14 XXY, and 47 control XY men were located in a birth cohort of non-institutionalized, tall men. Their EEGs were recorded during stimulation with sine were modulated light; 2.5, 5, 10 and 20 Hz were the modulation frequencies. EEGs with and without stimulation were subjected to power spectral analysis. The frequency-specific EEG change due to visual stimulation (i.e. photic driving) was studied. The XYY subjects showed generally lower levels of driving than their XY controls. At stimulation frequencies of 10 and 20 Hz, the EEG driving in the XYY subjects were significantly smaller when measured in the same frequency bands (i.e. 10 and 20 Hz). In addition, stimulation at 10 Hz elicited a significantly smaller response at the third harmonic frequency (i.e. 30 Hz) in the XYY subjects. No consistent differences in EEG driving were detected between the XXY subjects and their XY controls, or between XXY and XYY subjects.


Weight changes with depot neuroleptic maintenance therapy. A prospective study of schizophrenic patients prescribed injectable depot neuroleptic drugs as maintenance therapy showed a clinically significant weight gain in 55% of patients. No significant difference was shown between flupenthixol decanoate and fluphenazine decanoate, nor was a clinically meaningful relationship shown with dose, or the use of anti-parkinsonian drugs. The weight gain continued for at least 2 years following a mental state relapse. It is suggested that the monitoring of weight and giving of appropriate advice on diet are two essential in maintenance therapy of chronic schizophrenia.


Salivary secretion in the affective disorders and schizophrenia. Salivary secretion was measured in 54 psychiatric patients comprising four diagnostic groups: schizophrenia, mania, depression and anxiety state. Detailed psychometric assessment was carried out at the time of measurement. Although salivary flow failed to show an association with either diagnostic category or mental state at the time of examination, it was positively correlated with a subjective rating of appetite. The implications of these findings are discussed.


Etiological relevance of comparisons of high-risk and low-risk groups. The prospective study of groups at high risk for pathology is viewed as an increasingly important strategy in research on the etiology and possible prevention of a wide range of disorders. Yet, relatively little attention has been paid to proper and improper etiological interpretations of results based on studies of such groups. The comparison of groups at high risk and low risk for pathology, prior to the development of relevant disturbances in the subjects, cannot provide evidence that a given factor or a characteristic of the groups does or does not contribute to the etiology of the disturbances which will develop in the subjects. For the data to become etiologically relevant, they must be studied as possible antecedents to disturbances identified by following up the subjects. On the other hand, comparisons of high-risk versus low-risk groups are most appropriately interpreted as reflecting the characteristics, correlates and/or consequences of the risk criterion, and such comparisons may thus contribute to better understanding of the true meaning and ramifications of the risk criterion. Considerable caution must be exercised both by high-risk researchers and by observers of high-risk studies in interpreting the significance of results of these studies.


Human motor activity in decerebrate states and their sequelae. The behaviour of the motor activity was investigated in a selected group of neurosurgical patients with diverse cerebral and spinal lesions, as well as in a group of healthy controls. Under standard conditions the EMGs were simultaneously recorded from six muscles, and the time-voltage integral of the muscle action potentials were continuously recorded. In the foregoing work the behaviour of the motor activity in the decerebrate state and its sequelae is described.


Correlative study between computerized transverse scanning and stereoimpedoencephalography in space-occupying lesions of the brain. Stereoimpedoencephalography (SIEG) is routinely used by the authors during stereotactic investigations of glial brain tumours prior to stereotactic implantation of isotopes or prior to conventional surgery: the brain tissue impedance is measured along a probe track according to the four electrodes impedance technique. The correlation between the tissue structures and the corresponding impedance values has been studied by comparison with the CATScan data reported on the stereotactic schedules; impedance values are influenced by changes in arterial pCO2 and also by other unknown factors; in order to avoid these uninterpretable changes of the impedance, the recorded values have been normalized with respect to the average impedance along a control track in the normal hemisphere. As a rule, the impedance profile exhibits a "hole" at the site of the pathological processes like tumours as well as surrounding oedema, and the delimitation of the pathological area is very similar to that obtained by the CATScan. There is a good linear correlation between the values of normalized impedance and the x-ray absorption as given by the computer listing of the CATScan. Lastly, statistical values of normalized impedances are determined for the main structures of the brain, showing that the tumour tissue has an impedance equal to half the impedance of the normal tissue.


Medial frontal epilepsy: histological, histochemical, and ultrastructural study. Preliminary observations. The authors have studied the histological, histochemical, and ultrastructural aspects of eight corticectomies of epileptogenic foci in the medial surfaces of frontal lobes. In all cases they were able to see more gliosis and fewer neurons than normal. The shape and number of dendritic spines were thought to be normal with the Golgi-Cox method. The histochemical study showed an increment of activity of Glucose-6-Phosphatase, Glucose-6-Phosphatedehydrogenase, adenosintriphosphatase, and acid phosphatase. The electron microscope showed, in every case, a variety of changes, among which the authors can point to perivascular lipid accumulation, and an increase of lipofuscin bodies in the cytoplasm of pyramidal cells.


Acquired hydrocephalus. II. Diagnostic and prognostic value of quantitative isotope ventriculography (QIV), lumbar isotope cisternography (LIC), pneumoencephalography, and continuous intraventricular pressure recording (CIP). The diagnostic and prognostic values of quantitative isotope ventriculography (QIV), lumbar isotope cisternography (LIC), pneumoencephalography (PEG), and continuous intraventricular pressure recording (CIP) were assessed on the basis of the clinical course in 160 patients suspected of having acquired hydrocephalus. The diagnostic value of a given method is defined as its reliability in the diagnosis of hydrocephalus. The reliability in the selection of hydrocephalic patients who will improve on shunt operation is designated as the prognostic value of the method concerned. As the diagnoses are based on isotopic procedures, the diagnostic values of these procedures cannot be assessed. QIV is of greater prognostic value than the other methods of examination. The presence of plateau waves in CIP is a rare, but prognostically valuable sign. The prognostic value of B waves is also good, whereas their diagnostic value is slight. Both from diagnostic and prognostic points of view, PEG is of less value is communicating hydrocephalus on account of the many false findings.


Chronic implanting of electrodes in the cerebellar vermis of the cat. Morphological findings. The morphological modifications of the cerebellar cortex have been evaluated in eight cats with chronic electrodes implanted in the anterior vermis. In a control animal a silastic lamina without electrodes was implanted. Four animals received intermittent stimulations up to 11 hours in one case and 100 hours in the other 3. The stimulation was carried out with pulses of 0.5 msc, 200 cps, and a charge per phase of 0.68 muc. Microscopic examination of the cerebellum showed that the experimental implanting of prostheses of the cerebellar vermis produces tissue lesions consisting of fibrous reaction, imprinting of the cortex, gliosis, and loss of Purkinje cells. These lesions are independent of the electric stimulation, and seem to be related to the pressure of foreign material against the cortex.


Negative exploration for lumbar disc prolapse--findings and possible causes. 32 cases of negative exploration in a joint follow-up series of 3,032 lumbar disc operations are described. Data from 15 hospitals were analyzed by means of questionnaires and computer-aided analysis. Detailed information is given about pre- as well as intraoperative findings. The causes of negative lumbar disc exploration can be divided into two groups. 1. Genuine misdiagnosis where other causes are responsible for the symptoms, and 2. poor technique where despite genuine disc prolapse no evidence was found at operation. The most important causes in the first group were osteochondrotic compression, distended epidural veins, and root tension. The results are less favourable in these patients than in the overall series but, compared to the other complicated courses, the results were markedly better. A review of the literature is given, the possible causes for negative explorations are discussed, and a directive is established for the surgical procedure in cases where an expected prolapse is not found at operation.


Bladder neuropathy in lumbar disc disease. Disturbances of bladder, function often occur in cases of sciatica due to intervertebral disc lesions, although other clinical signs of sacral root compression are absent. In 32 patients, operated upon because of lumbar disc diseases without cauda equina syndrome, micturition symptoms were registered, and bladder function was investigated. Intravesical pressure/volume relations (water cystometry) and simultaneous intravesical pressure/urinary flow relations (urodynamic examination) were recorded preoperatively together with anal sphincter surface EMG. In almost half of the patients cystometry revealed bladder hyposensibility (late first sensation), and a quarter voided mainly by straining (detrusor paresis). These findings were unrelated to the neurosurgical pathology. Pronounced micturition symptoms or abnormal preoperative urodynamic examinations indicated evaluation two months after lumbar disc operation. Two-thirds tended towards recovery, one third remained unchanged.


Terminal ventriculostomy in syringomyelia. The authors report their experiences with two patients suffering from syringomyelia on whom terminal ventriculostomies were carried out. The good results which can be obtained if the patient is in a relatively good neurological condition are pointed out. The principle of terminal ventriculostomy is based on the assumption that syringomyelia is hydromyelia that has become symptomatic; with this in mind, it seems reasonable to relieve the patient's symptoms by draining the distended central canal at the lowest possible level. The father of the operation is Dr. Gardner, who has thoroughly studied syringomyelia, and proved that syringomyelia is not only an active hydromyelia but, that a "non-communicating" syringomyelia is a non-existent entity (1976, 1977).


Effects of follicular development on the ability of cultured porcine granulosa cells to convert androgens to estrogens. Porcine granulosa cells from different stages of follicular development were examined for their ability to convert androgens to estrogens and their ability to secrete progesterone. Granulosa cells from all stages of follicular development can convert androgens to estrogens, and the addition of exogenous androgen is required for estrogen secretion. Granulosa cells obtained from medium and large follicles have a greater capacity to convert androgens to estrogens than do granulosa cells obtained from small follicles. The addition of FSH brought about an increase in estrogen secretion in the presence of androgen only in granulosa cells from large follicles. LH attenuated estrogen secretion in granulosa cells from medium follicles treated with testosterone. Granulosa cells from medium follicles were unable to secrete estrogen from days two to four irrespective of treatment. Androgens augment FSH stimulated progesterone secretion in granulosa cells from medium follicles from days two to four, and the addition of follicular fluid from small follicles stimulates progesterone secretion in the presence of FSH and androgens.


Testosterone synthesis by chicken follicular cells. The roles of theca and of granulosa cells in the synthesis of testosterone (T) in ovarian follicle of hens have been studied. Theca cells alone synthesized no progesterone (P), and no or only negligible amounts of T. Granulosa cells, in contrast, without stimulation produced large amounts of P and small amounts of T. When incubated with ovine gonadotrophins, theca cells showed greater response than granulosa cells in synthesizing more T (2- to 2.5-fold increase). Combination of the two follicular cell types decreased synthesis of P, but increased that of T (9- to 17-fold). When 0.1 microgram of ovine luteinizing hormone (oLH) was added to the combined cells, T concentrations increased most dramatically, a 83-fold increase was seen after 12 h of incubation. Theca cells incubated with exogenous P also produced large amounts of T. These results indicated that in hens, theca cells may be the major site of follicular T synthesis, however, theca cells alone cannot synthesize T unless granulosa cells or P were added. It is suggested that granulosa cells may use P as a precursor, and that P is converted to T in the theca cells.


Modulation of thecal progesterone secretion by estradiol-17 beta. The effects of estradiol-17 beta on progesterone secretion by isolated bovine theca interna were studied. Preparations of theca interna were obtained from preovulatory follicles of Holstein heifers (n = 5) prior to the endogenous LH surge and cultured for 3 days in a defined medium containing various concentrations of estradiol (0, 0.001, 0.01, 0.1, 1, or 10 microgram/ml). Secretion of progesterone by control theca was low during the first 24 h of culture and increased steadily during the subsequent 48 h. The lowest concentration of estradiol (0.001 microgram/ml) significantly stimulated thecal progesterone production, while higher concentrations (0.1, 1, and 10 microgram/ml) significantly inhibited secretion of progesterone. Estradiol content of the follicular fluid of these preovulatory follicles and several others (n = 13) averaged 1.5 microgram/ml +/- 0.1 (SEM). It is concluded that bovine theca interna is capable of secreting progesterone, that high intrafollicular concentrations of estradiol may inhibit thecal progesterone production in vivo prior to the LH surge, and that estradiol concentration may be be an important modulating factor in the control of follicular progesterone secretion.


Long term perifusion of rabbit ovarian follicles. Preovulatory follicles were dissected from ovaries of estrous rabbits. Four follicles were placed in each chamber of a perifusion system. Medium 199, containing 10% rabbit serum and antibiotics, eluted through the chambers at a rate of 1 ml/10 min. Every 6 h for 36 h, 1 microgram of LH and 50 ng of FSH were injected into each chamber. P4, T and E2 were measured in the medium. P4 exhibited a peak after each of the injections at 6, 12, 18, 24 and 30 h. E2 and T gave major peaks after the injection at 0 time, with minor peaks after the injection at 6 h; thereafter T and E2 secretion gradually decreased to levels below those of baseline.


Action of porcine follicular fluid oocyte maturation inhibitor in vitro: possible role of the cumulus cells. To study the mode of action of porcine follicular fluid oocyte maturation inhibitor isolated cumulus-enclosed or mechanically denuded pig oocytes were used. Two types of culture media were employed, a complex containing 15% pig serum (TC199A) and a defined, minimal medium (BMOC). The maturation of cumulus-enclosed oocytes was comparable in the two types of culture media, but only in the complex medium did the cumulus cells remain functional in terms of morphology and progesterone secretion. The low molecular weight portion of follicular fluid partially inhibited oocyte meiosis and cumulus progesterone secretion in 199A. No inhibition of oocyte maturation was seen when follicular fluid was added to BMOC. Since denuded oocytes did not respond to follicular fluid in either culture medium, it is suggested that the cumulus cells may mediate the action of the follicular fluid oocyte maturation inhibitor.


The influence of follicular fluid on progesterone secretion by porcine granulosa cells in vitro. Porcine follicular fluid contains at least two factors which can modify porcine granulosa cell function in vitro. One factor, found primarily in fluid from 1--2 mm follicles inhibits LH stimulated cyclic AMP accumulation, basal and LH stimulated progesterone secretion, and morphological luteinization of granulosa cells from medium sized (3--5 mm) and large (6--12 mm) follicles. Following inhibition by the follicular fluid luteinization inhibitor, incubation with both OH and a phosphodiesterase inhibitor partially restores cyclic AMP accumulation and fully restores progesterone secretion. This suggests that the defect induced by the luteinization inhibitor is primarily an alteration of cyclic nucleotide metabolism. Another factor found primarily in fluid from large preovulatory follicles stimulates basal and gonadotrophin stimulated progesterone secretion by granulosa cells from small antral follicles. We hypothesize that it may be necessary for the fluid within an individual follicle to shift from being inhibitory of luteinization to being permissive or stimulatory for the granulosa cells to mature rather than become atretic.


Follicular determinants of corpus luteum function in the human ovary. The corpus luteum is a direct continuation of preovulatory follicle development. Growth and differentiation of a follicle to the preovulatory stage depends on certain endocrine changes taking place within the follicle itself (5). These endocrine changes markedly influence the viability, the rate of proliferation, and the biosynthetic potential of granulosa cells. Therefore, the sequence of endocrine events within the developing antral follicle is likely to be of considerable importance for the formation and secretory activity of the corpus luteum. If granulosa cells in developing antral follicles are exposed to certian hormones in the wrong sequence, the follicle may be prevented from developing into a normal corpus luteum. For example, if granulosa cells in antral follicles are not exposed to FSH, they are unable to generate high levels of oestrogen (Table 1). In the absence of oestrogen, granulosa cells do not increase in number. The same end result may also arise if the granulosa cells are exposed prematurely to elevated levels of LH or to high levels of prolactin: LH blocks granulosa cell mitoses even if the cells are exposed to oestrogen (1, 21); high levels of prolactin in antral fluid are associated with low levels of oestrogen and a reduced rate of granulosa cell proliferation. In women, it is likely that a fully functional corpus luteum is formed from a follicle that was exposed to the most favourable sequence of endocrine changes during its antral stages of development.


Effect of oestradiol-17 beta and gonadotrophins on prostaglandin production by pre-ovulatory pig follicles superfused in vitro. Pre-ovulatory pig follicles were superfused in vitro with oestradiol, LH or FSH in the presence and absence of indomethacin. Prostaglandin E2 ANd F2 alpha and oestradiol were measured in the same samples of superfusate. LH and FSH caused an increase in levels of both prostaglandins (approximately 2-fold) but the most marked effect was of oestradiol in PGE2 where a 4-fold increase in levels above controls was observed. In all cases indomethacin inhibited the effects. Both gonadotrophins caused an increase in oestradiol production although the response to LH was much slower than to FSH. The results show a possible relationship between FSH, oestradiol and PG synthesis in the pre-ovulatory pig follicle.


Interactions between neuraminidase-treated lymphocytes and liver cells. Neuraminidase-treated rat lymphocytes and rat hepatocytes spontaneously aggregate when mixed in vitro. Adhesion between cells is due to stereo-specific interactions between a mammalian hepatic membrane lectin and galactosyl residues which are exposed on the lymphocyte surface after removal of sialic acid residues. The hepatic galactose specific lectin may play a role in the accumulation of recirculating desialylated lymphocytes in the liver.


Germinal center formation in BSA-tolerant chickens. In chickens rendered neonatally tolerant to BSA the germinal center formation was significantly decreased after stimulation with BSA at the age of 3 weeks. At the breakdown of tolerance after the age of 6 weeks the IgG antibody formations recovered before the IgM production. Stimulation of tolerant birds with unrelated antigens resulted in slightly decreased antibody response but the germinal center formation was on the same level as in normal controls.


Induction of tolerance to DNCB-contact sensitivity in guinea pig fetuses. 1. Female guinea pigs made tolerant before pregnancy do not transfer tolerance to their offspring. This result favours the concept of cellular mechanism of tolerance. 2. Guinea pig fetuses become tolerant when exposed to the tolerogen in the last two weeks of pregnancy. This is due to active tolerization by the tolerogen passing the placental barrier. 3. Fetuses exposed to the antigen earlier did not develop tolerance. This is due to immunological immaturity rather than to insufficiently developed vascularization. No functional active depot of tolerogen is formed. 4. Guinea pigs become immunologically mature between the 54th and 61st day of fetal live.


In vivo activity of lymphocytes sensitized in vitro by antigen-fed macrophages: inhibition of lymphoma growth. In previous studies, we have shown that macrophages fed with radiation leukemia virus could induce primary in vitro sensitization of lymphocytes which could be measured by their cytotoxic activity against target cells. In the present study, we tested the in vivo influence on tumor growth of such lymphocytes. We found that macrophage-mediated sensitized lymphocytes could protect mice against tumor growth if injected into normal recipients four days prior to challenge with lymphoma cells. The protective function of such lymphocytes was not affected by their irradiation, but no protection occurred in sublethally irradiated recipients. This indicated that the sensitized lymphocytes did not inhibit tumor cell growth directly but recruited an effector protective response in the recipient mice. This protective activity was different from the one elicited by lymphocytes which had been sensitized directly against cells carrying antigens cross-reacting with RadLV. The protective activity of the directly sensitized lymphocytes was radiosensitive and was probably mediated by their direct cytotoxic activity against tumor cells.


Comparison of the ability of eosinophils and neutrophils, and of eosinophils from patients with S. mansoni infection and normal individuals, to mediate in vitro damage to schistosomula of S. mansoni. A reliable and reproducible method that produces separate fractions of pure eosinophils and neutrophils from normal peripheral blood was described. The interaction of eosinophils and neutrophils with antibody coated schistosomula was examined in vitro. Neutrophils were highly active in the 51Cr release assay and most formed rosettes with antibody coated red cells, but they adhered poorly to schistosomula and did not kill the organisms. Eosinophils, although they were less active in the 51Cr release assay than neutrophils and few formed rosettes, adhered strongly to schistosomula and, in the presence of antibody, were able to kill organisms. Organisms from patients with S. mansoni infection and eosinophilia were more effecient than eosinophils from normal individuals in their capacity to release 51Cr from labelled somula in the presence of antibody.


Peripheral blood lymphocyte subpopulations in multiple myeloma. Antisera raised against idiotypic determinants of myeloma proteins and macroglobulins have been used to differentiate peripheral blood lymphocytes populations from individual patients. I.D.-positive lymphocytes not resembling plasma cells have been regularly found in peripheral blood in these diseases. This lymphocyte population is heterogeneous with respect to non-tumor-specific surface markers, such as SRBC-, Fc- and C-receptors. Tumor specific idiotypic determinants will thus allow a more correct recognition of the total tumor cell compartment in these diseases.


Pathophysiology of blood pressure in the elderly. Several of the factors responsible for circulatory control are modified in the elderly. Loss of elasticity of the aortic wall produces a widened pulse pressure and a high incidence of systolic hypertension. Attempts to normalize this may be associated with disabling diastolic hypotension. Arterial baroreceptor sensitivity and responsiveness of the renin-angiotensin system is reduced. Further, the renal capacity to conserve sodium and water is impaired. All these increase the risks associated with antihypertensive treatment, but do not contra-indicate such treatment.


Should we treat hypertension in the elderly? The argument for treating hypertension in old people is essentially that the treatment is beneficial in young people. Direct evidence of benefit in old people is limited. Further evidence is awaited from the European Cooperative Study. Critical examination of the indirect evidence gives limited support to treatment of certain sub-groups of the elderly only. Much present practice appears to be unsound.


Glucose tolerance, plasma insulin levels and insulin sensitivity in elderly patients. The oral glucose tolerance test (OGTT) and the intravenous glucose tolerance test (ivGTT) were carried out in 23 elderly patients (mean age 79 years) and in 14 healthy young adults (mean age 28 years). The ivGTT was followed immediately by a second injection of glucose, this time with insulin added. The percentage rate constants for the disappearance of glucose alone (KG, % min-1) or with added insulin (KG+I, % min-1) were calculated. Seventeen of the elderly patients had a blood glucose value at 120 min in the OGTT greater than or equal to 7.7 mmol/1 (140 mg/100 ml) or had KG less than or equal to 1% min-1 and 13 were 'diabetic' by both criteria. This was associated with a sluggish pattern of insulin release and with diminished insulin sensitivity (KG+I). Since these changes could reflect impaired inhibition of hepatic glucose output, a preliminary attempt was made to assess gluconeogenic capacity. After the injection of substrate levels of L-alanine, plasma levels of glucose and alanine both rose but fell more slowly in the elderly than in young adults, suggesting impaired transmembrane transport of both substances in old people. After injection of alanine, plasma insulin rose to a lesser extent and glucagon to a greater extent in the elderly than in young adults.


Motor complications of herpes zoster.

Motor complications of herpes zoster. Motor involvement is uncommon in herpes zoster. Of 14 subjects observed over an arbitrary period of five years, nine had flaccid limb paralyses, involving the upper limb in eight patients. Recovery was not always complete and occurred over a period of nine weeks to four years.


The prevalence, severity and factors associated with urinary incontinence in a random sample of the elderly. A study to determine the prevalence of urinary incontinence in a random sample of a total elderly community is described. The prevalence of incontinence in women aged 65 years or more was found to be 17% and in men 11%. The findings show that the prevalence of incontinence is particularly high among residents of old people's homes and geriatric hospitals, but that the majority of cases occur within the general community. The prevalence increases with age in both sexes; associations with a history of cerebrovascular disease, certain surgical procedures, multiple hospital admissions and drug usage are described. The findings of a follow-up study suggest that, although the disorder is long-standing and severe in a proportion of subjects, it is transient in approximately a third of all elderly subjects with the condition.


Will drugs help patients with Alzheimer's disease? Recent studies have shown a defect in the cholinergic system of the cerebral cortex of patients suffering from nonvascular senile dementia. This observation suggests the possibility of instituting some kind of replacement therapy and trial have been carried out. At this juncture it seem pertinent to ask what lessons can we learn from Parkinson's disease, what is the evidence for a biochemical defect, is this defect relevant and can it be remedied? These questions are considered in turn and suggestions are made about the likely difficulties to be overcome in a search for a treatment of dementia.


Infectious mononucleosis in the elderly. Infectious mononucleosis (IM) was diagnosed in four patients over the age of 50 years. Their age, absence of splenomegaly, lack of significant lymphadenopathy in three and an atypical presentation in one all contributed to a delay in the diagnosis. In two patients, in whom complications occurred, the Paul-Bunnell test was repeatedly negative. Confirmation of the diagnosis was made by the measurement of the Epstein-Barr virus IgM using differential sucrose gradient centrifugation. Because the presentation and clinical features of IM can be misleading in the elderly, we believe that a significant number of cases may go unrecognized.


Vascular pathology in hypertension.

Vascular pathology in hypertension. The pathological changes in blood vessels observed in primary (essential hypertension) are similar to those seen in secondary hypertension due to renal disease or other causes. In benign hypertension, the major changes are in the small arteries and arterioles especially in the kidney. Interlobular arteries exhibit intimal thickening and duplication of the elastic lamina (elastosis) and there is hyaline change in the media of many arterioles. In some respects these changes are an accentuation of vessel ageing. Malignant hypertension usually presents in a younger age group (35--50 years) and is characterized pathologically by fibrous endarteritis in the interlobular arteries of the kidney and fibrinoid necrosis in the walls of a proportion of the efferent glomerular arterioles. Similar vessel changes are seen in other organs but many of the pathological changes in the heart and brain of patients with benign hypertension are related to the accentuation of arterosclerosis. There is an increased mortality from cardiac failure, myocardial infarction, cerebral haemorrhage and subarachnoid haemorrhage due to ruptured berry aneurysms in patients with benign hypertension. Although there is ischaemic damage to the kidneys in benign hypertension, death from renal failure is uncommon. Severe ischaemic damage to renal glomeruli and renal failure does, however, occur in malignant hypertension.


Synergism between subthreshold doses of phenylbutazone and prednisolone in rat hind-paw carrageenan edema. When phenylbutazone (PhB) and prednisolone (PD) or cortisol acetate (HC) were administered together by oral route a synergic inhibitory effect on rat hind-paw carrageenan edema occurred, marked antiphologistic effect being obtained by associating subthreshold doses of drugs. By administering a fixed subthreshold dose of PD with increasing subthreshold doses of PhB, statistically significant phlogosis inhibition was obtained, the degree of which was directly related to the amount of PhB. Finally, the association of near maximal effective doses of PhB and PD gave an inhibition greater than that produced by a maximally effective dose of each of the associated drugs.


Effect of ergometrine on contractile force of guinea-pig isolated heart: antagonism by cimetidine. The action of ergometrine on contractile force of guinea-pig isolated heart was investigated and the effect of receptor antagonists on the inotropic effect of ergometrine, isoproterenol, dopamine and histamine was evaluated. Ergometrine was found to have a good dose-dependent inotropic effect and the antagonism of cimetidine toward this action is reported. Experiments carried out in hearts in which a massive depletion of mast-cells histamine was produced are in favour of a direct action of the drug on H2-receptors.


Combination bronchodilators: antagonism of airway smooth muscle contractions in vitro. The component drugs of fixed-dose combination bronchodilators may interact in a synergistic manner to antagonize airway contractions. To examine this hypothesis, combinations of ephedrine (E) and theophylline (Th) or salbutamol (S) and theophylline were tested for their ability to relax contracted guinea-pig airway smooth muscle in vitro. The combination bronchodilator effect was compared to the summed effects of the component drugs given individually (i.e. a theoretical additive response, Ta). Relaxation responses to combination bronchodilators were considered less-than-additive if significantly less than Ta, additive if non-significant and greater-than-additive or synergistic if the values were significantly greater than Ta. It was found that the E-Th combinations interacted primarily in an additive fashion to relax contractions induced by histamine, acetylcholine and 5-hydroxytryptamine at concentrations that produced one-half maximal contractile response (ED50). Similarly S-Th combinations interacted in an additive manner to reverse histamine and acetylcholine contractions. In the case of both E-Th and S-Th combinations, the drugs were more effective in reducing the smooth muscle contractions when given during rather than prior to the response. It may be concluded that beta-sympathomimetics and methylxanthines when combined do not interact in a synergistic fashion to produce relaxation of contracted airway smooth muscle.


Dysphagia: an evaluation and treatment program for the adult. Dysphagia, or difficulty swallowing, can interfere with independent feeding in the physically disabled adult. The physiology of normal swallowing and neuromuscular pathology of dysphagia applicable to the occupational therapist are reviewed in this paper. Pertinent nursing care of the respiratory and gastrointestinal tracts are described. Normal and pathological reflexes involved in swallowing include gag, bite, and suck-swallow. Head, neck, and jaw stability are necessary for swallowing. Methods for evaluating the appropriate reflexes, sensation, and orofacial movement of the adult neurologically impaired patient are presented. Proper positioning is described and treatment suggestions are offered and applied to four case studies.


IgE levels of infants with complications after pertussis vaccination. IgE levels of 31 infants who had severe complications after whooping cough vaccination, were determined by RIST. The patients had convulsions, encephalitis or anaphylactic shock symptoms. All but two had elevated IgE levels for their age. It is suggested that, in certain genetically predisposed human beings, pertussis antigen can also induce IgE synthesis, as has already been established in rodents.


[Bonchodynamic tests in the study of bronchial asthma]. One characteristic of chronic obstructive bronchopneumopathies, especially bronchial asthma, is the slowing down of respiratory flow. Spirographic studies are therefore valued highly among specialists in respiratory pathology. All of those working in this field of physiopathology, however, agree that broncodynamic provocation tests are not fully specific for bronchial asthma. One important problem is the difficulty in determining the quantity of product inhaled by the patient, making the test even less precise. With our method, based on the broncotest developed by Piglowski, we are able to determine the quantity of inhaled material with a fairly high degree of accuracy. It thus represents a quantitative study and is much more specific. One hundred patients with bronchial asthma, whose ages ranged from 14 to 60 years, were selected for this study. We found that 100% of them (except for one 16-year-old patient whose case has been commented on) were positive for the acetylcholine aerosol test and for beta-2adrenergics (phenotherol). These results enabled us to establish diagnostic patterns for the severity of bronchial hyperactivity in relation to the number of micrograms needed to provoke a 20% variation in the VEMS. We consider it very important to determine the threshold does of acetylcholine, since it may serve in both diagnosis and prognosis. We believe that this method may represent a new direction in pharmacodynamic examination of asthma patients.


[Sensitization to digoxin with demostration of reagini antibodies]. The author presents the case of a male patient, 60 years old, suffering a chronic obstructive bronchopneumopathy with cor pulmonale in a state of cardiorespiratory insuffiency. Without any personal or familial history of allergy, a few minutes after the ingestion of .5mg of Digoxin a picture occurs of urticaria, angioneurotic edema and asthmatic crisis that disappears with sympatheticomimetics. No other medication was used, previously or at the time. The existence of reaginic antibodies is made evident with positive reactions to Digoxin and C Lanatosid in a Leftwich passive transference test and cutaneous tests. No alteration was found in the number of platelets and leucocytes nor in the percentage of eosinophils within 24 hours after the anaphylactic accident. The oral provocation test with the excipient of the commercial preparation was negative; the tolerance to Methyl-Digoxin complete. The literature referring to sensitization to digitalis glycosides is reviewed and some consideration is given to its mechanism.


The protective effect of Ketotifen in respiratory allergy. During the last two years many works have dealt with the anti-anaphylactic properties of HC 20-511, which chemically belongs to the cycloheptathiophene group of drugs. The excellent results obtained by different authors using this drug in various allergies, decided us to study its protective use in patients affected by rhinitis and/or extrinsec bronchial asthma, especially in connection with pollinoisis. We selected a group of patients of both sexes over 12 years of age, including those who had already received immunotherapy treatment. Diagnosis was determined by means of a clear clinical history, skin tests, and exposure tests to specific antigens, using the Gronemeyer and Fuchs method. The drug was administered orally (1 mg./twice a day) for 3 months. Exposition tests were carried out before beginning treatment and at 30 and 90 days, and measurement of vital capacity, FEV1, Maximal flow and Pneumometry were carried out. A check on the clinical state of the patient, as well as on his tolerance to the drug, and on additional intake of other anti-asthmatic drugs (corticoids, Beta-stimulants) was made every 15 days. The results were highly satisfactory and a positive improvement in the clinical state of 70% of the patients after three months of treatment was noticed. When carrying out bronchial provocation tests, a minor decrease in FEV1 as well as in bronchopneumetric values were undoubtedly noticed in the patients under treatment when compared with the basal tests. Tolerance to the drug was excellent, its undesirable effects being secondary to its antihistaminic activity.


Malaria--a red alert.

Malaria--a red alert. Imported malaria has been increasing in the United States. Locally acquired cases are reported in drug addicts. Extended incubation periods can be misleading. Pyrexia is the most common manifestation, but it may not follow a regular pattern. A high index of suspicion and examination of peripheral blood smears establish the diagnosis. Chloroquine and primaquine are the drugs of choice for uncomplicated malaria; quinine sulfate is preferred in the treatment of chloroquine-resistant malaria. Malarial prophylaxis should include travelers' education and chemoprophylactic agents such as chloroquine, chloroguanide, pyrimethamine and amodiaquine.


Physical examination of scuba divers.

Physical examination of scuba divers. With the increasing popularity of courses in scuba diving, prospective diving students coming to physicians for medical examinations are presenting a wide range of ages and physical makeup. A working knowledge of medical fitness for diving and of diving medical emergencies will assist the nondiving physician in establishing a basic medical history and examination for the student scuba diver.


A modified impinger for personal sampling. The performance of a modified impinger is described. Laboratory and limited field studies found that the modification made the device relatively spill-proof. In addition, the collection efficiency of the spill-proof impinger was compared to the standard midget impinger. For particles larger than 0.8 micrometer equivalent aerodynamic diameter, the impaction efficiencies of the two devices were found to be identical. However, the capture efficiencies of the two devices were not always found to be equivalent. In three tests, the modified impinger collected proportionately more material than the midget impinger. In three other tests, the capture efficiencies of the two devices were found to be equivalent.


Personnel monitoring for tetraalkyl lead in the workplace. Personnel monitoring for alkyl lead and inorganic lead in air was carried out for six weeks on five workers in an alkyl lead manufacturing plant. Lead in air values were compared to biological values for lead blood, lead in urine, and delta aminoleuvlinic acid in urine. While variations in each of these measurements occurred, there was no correlation between any of these three measurements and lead in air. Measurements of atmospheric exposure to alkyl lead by personnel monitoring does not provide an accurate assessment of the degree of hazard to workers. When such measurements are performed frequently, they can provide information useful in controlling respiratory exposure. Biological monitoring of lead in urine as practiced by the alkyl lead industry remains the best protection against overexposure to organic lead.


Determination of airborne organic vapor mixtures using charcoal tubes. The charcoal tube method for organic vapor analysis has been extensively utilized by this laboratory to monitor factory environments throughout a multisite manufacturing complex. Atmospheres sampled generally contain several chemicals that contribute to total exposure, and it is necessary to modify procedures developed for individual compounds. Examples of such alterations, to effect acceptable collection/recovery of organic analytes, are cited. Topics discussed include selection of desorption solvent, influences of temperature and polar compounds on desorption efficiency, and overall efficiency as a superior measure of method validity. A simple qualitative analysis scheme described in the literature is used to suport identification of chromatographic peaks. A critique of this technique is presented along with a practical factory analysis application.


Field evaluation of selected monitoring methods for phosgene in air. Four selected methods have been evaluated and field tested as candidates for a specific, continuous procedure for monitoring phosgene in air at or below concentrations of 0.05 ppm. The methods evaluated were automated colorimetry, gas chromatography, infrared spectrophotometry and a recently developed paper tape monitor. A standard manual colorimetric procedure was used as a reference method. The paper tape, infrared and automated gas chromatographic techniques most closely fulfilled the criteria set forth for an "ideal", selective, continuous procedure for phosgene.


The nuclear worker and ionizing radiation. Research on medical X-ray exposure sheds light on the health effects expected for workers exposed to ionizing radiation. Factual information confirming this relationship and also demonstrating the need for reviewing permissible exposure levels for workers is given. Suggestions for more sophisticated health monitoring of workers exposed to hazardous technologies are made, and the question of occupational hazards which threaten the worker's family is raised.


Drywall construction and asbestos exposure. The rapid development of the drywall construction trade in the United States is described. It is estimated that some 75,000 U.S. construction workers are currently employed in this trade. The use of a variety of spackle and taping compounds is shown to be associated with significant asbestos exposure; air samples taken in the breathing zone by drywall tapers during sanding of taping compounds show fiber concentrations exceeding, by several times, the maximum level permitted by United States Government regulations. These findings are given together with the result of a clinical field survey of drywall construction workers demonstrating that asbestos disease may be an important health hazard in this trade.


Development of methodologies to assess the relative hazards from thermal decomposition products of polymeric materials. The physiological stress imposed upon mice due to the irritating properties of thermal decomposition products of polymeric materials was evaluated. Acute lethality and histopathological evaluation were included in the study. The rankings of the polymeric materials studied from most to least hazardous was concluded to be polytetrafluoroethylene greater than polyvinyl chloride greater than Douglas Fir and flexible polyurethane foam greater than fiber glass reinforced polyester greater than copper coated wire with mineral insulation.


A six-year follow up study for evaluation of the 85 dBA safe criterion for noise exposure. This study included 114 workers who have been exposed to noise levels of 78 to 91.4 dBA and followed over a six year period. Workers exposed to nose levels up to 85 dBA eight hours daily for six days per week and for twelve years showed a slightly higher (1%) hearing impairment than the corresponding control subjects. Impairment of hearing among workers exposed to higher noise levels was 9.6%.


Influence of sonic noise on human stereoscopic depth perception. Scientific establishment of the no-effect response to finite levels of exposure to a physical or chemical agent is indeed a rigorous exercise and is frequently controversial. In earlier research by Slutsky under direction of the senior author, a statistically significant increase in stereoscopic depth perception error was noted among 24 test subjects exposed to high intensity noise. Additional extensive research reported in this paper indicates that error in stereoscopic depth perception is not significantly altered by exposure to continuous white noise of short duration at levels ranging from 70 to 115 dBA. Furthernore, exposure of humans for periods of a few minutes to white noise in octave bands centered on 250 Hz, 1000 Hz, 4 kHz and 16 kHz at 115 dB does not affect their depth perception measured by the Howard-Dolman test. A comprehensive analysis of depth perception errors measured under noise exposure conditions (n = 4040) in comparison with those obtained under control conditions (n = 1430) produced a mean change in error of -0.38 mm, a statistically insignificant difference (p = 0.17). Even if such an error were attributable to high level noise, it should be noted that minus sign designates an improvement of depth perception in noise and that it is difficult to imagine visual tasks in which change in error of +/-0.38 mm at a distance of 6.0 meters is meaningful.


Field comparison of two methods for the determination of NO2 concentration in air. A field test of two sampling methods for the determination of NO2 concentration in air is reported. All samples were collected in an underground salt mine in which diesel equipment is operated. Although each method has it own advantage, both appear to be suitable for most industrial hygiene applications.


The collection of arsenic oxide vapor in water-filled impingers. The efficiency of water as a collection medium for arsenic oxide vapor was investigated. The vapor was generated by passing air over arsenolite (As2O3, s) at various flow rates and temperatures, passed through a particulate filter and then was collected in a series of chilled Greenburg-Smith impingers. It was found that the first impinger always collected at least 90% of the vapor while the remainder, within the limit of detection, was collected in the second impinger. No differences were found between water and 2% sodium hydroxide when used as a collection medium. Up to 15% of the collected arsenic may be absorbed on the walls of the impinger train; this amount will not dissolve in water and will be lost unless the train is thoroughly washed with hydroxide.


Septicemia in patients with an endocardial pacemaker. The records of 1,235 consecutive patients treated with long-term pacing by the endocardial route between 1964 and 1977 were analyzed to determine the incidence, mechanism, course and treatment of septicemia. Septicemia developed in 12 patients (1 percent), and Staphylococcus aureus was isolated from the blood culture in 10. All patients were treated with the usual prolonged course of bactericidal drugs. Treatment was successful in only two of the seven patients whose endocardial pacing system was left in place; in three of the seven the septicemia recurred, necessitating removal of the endocardial system, and two of these patients died. In the remaining four patients the endocardial wire was promptly withdrawn, with use of a thoracotomy when necessary, and an epicardial system inserted; all of these patients survived. This is the treatment of choice.


Intracardiac electrocardiography during permanent pacemaker implantation: predictors of cardiac perforation. Intracardiac electrograms from 50 successive patients undergoing permanent pacemaker implantation have been analyzed. There were 29 male and 21 female patients aged 14 to 93 years (mean age 68.4 years). The electrograms were obtained using methods that simulated the wave form that would be detected by unipolar cardiac pacemakers. Three types of electrographic patterns were identified: qR pattern with a q/R ratio of less than 1 (type I): QR pattern with a Q/R ratio between 1 and 4.4 (type II); and Qr pattern with a Q/r ratio between 12 and 15 (type III). A type I pattern was seen in 29 patients (58 percent), type II in 18 (36 percent) and type III in 3 patients (6 percent). The duration of the follow-up period ranged from 3 weeks to 20 months (mean 9.7 months); three patients were lost to follow-up study. There were four deaths apparently unrelated to the pacemaker. Recognizable problems (either pacing or sensing failure) occurred in one patient (6 percent) with a type II pattern, in two patients (66.7 percent) with a type III pattern and in no patient with a type I pattern. On the basis of these data it is suggested that at the time of pacemaker implantation, intracardiac electrograms with a type I pattern indicating good pacing thresholds and sensing should be sought. If type II wave forms occur with good pacing thresholds and sensing then the electrode could probably be left in position. The incidence of a type III pattern is rare; when it does occur it is greatly suggestive of myocardial perforation. When this pattern is seen, the pacemaker catheter must be repositioned.


Two dimensional echocardiographic recognition of the descending thoracic aorta. Two dimensional echocardiography was used to identify the descending thoracic aorta in 106 subjects. In 12 of these subjects, contrast injection techniques were used to identify this structure as it descended posteriorly adjacent to the atrioventricular groove. The course of the descending thoracic aorta was mapped using both the long axis and transverse axis views. The normal descending thoracic aorta (26 subjects) measured 10 +/- 1.4 mm/m2 during diastole. Unusual M mode echocardiographic patterns of the descending aorta may be confused with other disease states; they are clarified with the two dimensional study. The size and appearance of the descending aorta in different types of cardiovascular disease, including aortic aneurysm, in 80 patients are described. It is anticipated that two dimensional echocardiography will prove to be a useful method of studying patients with aortic disease.


Q-aTc interval as a clinical indicator of hypercalcemia. The charts were reviewed of more than 200 patients discharged from the hospital between 1972 and 1977 with a diagnosis implying abnormal calcium metabolism. When all other variables known to affect the Q-T interval were eliminated, serum calcium concentrations on 65 occasions in 39 patients were found to correlate significantly (P less than 0.001 or better) with the following electrocardiographic intervals: Q-aTc (beginning of QRS complex to apex of T wave), Q-oTc (beginning of QRS complex to onset of T wave) and Q-Tc (beginning of QRS complex to end of T wave). Of these, the Q-aTc interval was the more easily and precisely measured at elevated calcium levels and exhibited the strongest correlation (P less than 0.0001) over the range of calcium levels measured. The relation was linear and could be used to estimate serum calcium levels from measured Q-aTc intervals. For a Q-aTc interval of 0.29 second or less (range 0.23 to 0.29) the serum calcium was estimated to +/- 1.9 mg/dl with 95 percent confidence. For a Q-aTc interval of 0.27 second or less, the correspondence with hypercalcemia in the study series was 90 percent or better. When all other factors known to affect the Q-T interval are ruled out, the shortening of the Q-aTc interval appears to be a useful clinical indicator of hypercalcemia.


Right and left ventricular function after the Mustard procedure in transposition of the great arteries. Right and left ventricular function was assessed at cardiac catheterization in 33 asymptomatic patients 0.5 to 11 years (mean 4.6) after the Mustard operation for complete transposition of the great arteries. Ages at operation had ranged from 0.5 to 16 years (mean 4.2 years). Right ventricular function was assessed using videodensitometric determination of ejection fraction and ventricular volume data. Ventricular volumes were obtained by computerized video analysis utilizing Simpson's rule. The right ventricular ejection fraction was 37 +/- 11 percent (standard deviation), as assessed with videodensitometry and 42 +/- 10 percent as assessed with ventricular volume--both values less than normal (P less than 0.001). Right ventricular end-diastolic volume was significantly greater than normal (P less than 0.001) and averaged 202 +/- 70 percent, but left ventricular end-diastolic volume averaged only 125 +/- 53 percent. These observations after the Mustard operation indicate that right ventricular function is seriously decreased with relatively preserved left ventricular function. They support efforts for surgical correction utilizing the left ventricle as the systemic ventricle.


Quantitative analysis of postoperative changes in the pulmonary vasculature of patients with complete transposition of the great arteries and pulmonary hypertension. Postoperative changes in the medial thickness of the small pulmonary arteries and the degree of pulmonary vascular disease were estimated histometrically and histopathologically in three cases of late death after total correction of complete transposition of the great arteries with large ventricular septal defect and pulmonary hypertension. In the postoperative course of two of the three cases extreme medial hypertrophy of the small pulmonary arteries as well as severe pulmonary vascular disease were found. In the third case, the thickening of the media was mild and pulmonary vascular disease had not progressed owing to a residual ventricular septal defect. Examination of three additional cases of late death and 15 autopsy cases of complete transposition of the great arteries revealed that hypertrophy of pulmonary arterial media after radical surgery for complete transposition of the great arteries is a common phenomenon. In cases of complete transposition of the great arteries with severe pulmonary hypertension, the deveopment of marked hypertrophy of the media accompanied by pulmonary vascular disease after total correction is usually seen and seems to be the most likely cause of death in the postoperative period.


Differences in hemodynamic effects of nitroprusside and prazosin in severe chronic congestive heart failure: evidence for a direct negative chronotropic effect of prazosin. To compare the hemodynamic effects of prazosin and nitroprusside in patients with severe congestive heart failure, nine patients with heart failure refractory to conventional therapy received oral prazosin and intravenous nitroprusside administered so as to produce a similar decrease in left ventricular filling pressure in each patient. By this comparison, both drugs produced similar decreases in mean right atrial pressure, mean pulmonary arterial pressure and systemic and pulmonary vascular resistance. However, with nitroprusside, cardiac index increased more (+0.97 versus +0.73 liters/min per m2, P less than 0.01) and mean arterial pressure decreased less (-13.7 versus -18.3 mm Hg, P less than 0.05) than with prazosin. Both drugs produced similar changes in stroke volume index (+11.7 cc/beat per m2 with nitroprusside and +12.5 with prazosin) and stroke work index (+8.1 g-m/m2 with nitroprusside and +6.6 with prazosin). Therefore, the differences in the hemodynamic responses observed with the two agents were due to the significantly greater decrease in heart rate with prazosin (-8 beats/min) than with nitroprusside (-2 beats/min, P less than 0.05). These clinical data support experimental evidence suggesting that there is a significant negative chronotropic action of prazosin independent of its peripheral vascular effects.


Effects of antihypertensive therapy on cardiovascular response to exercise. The effects of alpha methyldopa and hydrochlorothiazide therapy on exercise induced changes in arterial pressure, heart rate, rate-pressure product and total duration of exercise were evaluated with graded treadmill exercise. Although both agents were equally effective in reducing resting arterial pressure, alpha methyldopa appeared to provide slower build-up, a lower ceiling and more rapid recovery of arterial pressure in response to exercise stress than did hydrochlorothizide. Alpha methyldopa significantly reduced the degree of rise of the rate-pressure product (an index of myocardial oxygen consumption) during the exercise and recovery phases, whereas hydrochlorothiazide failed to do so. The total duration of exercise (an index of work capacity) was unchanged with either hydrochlorothiazide or alpha methyldopa. Therapy with alpha methyldopa presumably reduced myocardial oxygen demand without reducing work capacity.


Management of intractable ventricular tachyarrhythmias after myocardial infarction. Twenty-five patients with recent or old myocardial infarction were studied because they had life-threatening ventricular arrhythmias that required repeated cardioversions and were intractable to medical management. All patients had had a large anterior infarction a mean of 4.6 weeks before the emergence of the arrhythmias and all had severe left ventricular dysfunction. Cardiac catheterization or autopsy revealed a left ventricular aneurysm in 18 of 18 patients and obstruction of the left anterior descending coronary artery in 20 of 20 patients. Of 16 patients treated surgically with aneurysm resection or coronary bypass grafting, or both, 10 (62 percent) were alive after 3 to 39 (mean 26) months of follow-up. The perioperative mortality rate was 31 percent and only one patient died during the postoperative follow-up period 4 months after discharge from the hospital. By contrast, all nine medically treated patients died either in the hospital (four patients) or suddenly within 2 months of discharge (five patients). Ventricular fibrillation was documented as the cause of death in five of these patients. Surgical intervention was found to improve significantly the survival of these patients (P less than 0.02). The perioperative mortality rate was lower when at least 4 weeks had elapsed from acute infarction to surgery (10 versus 67 percent) and when the procedure included coronary bypass grafting (13 versus 50 percent), although these differences were not statistically significant (P greater than 0.05).


Polymorphous ventricular tachycardia: clinical features and treatment. Thirty-four cases of ventricular tachyarrhythmia characterized by polymorphy of the QRS complexes with changing R-R intervals and a heart rate of 150 to 300 beats/min, termed polymorphous ventricular tachycardia, are described. The factors involved in the appearance of this arrhythmia were the administration of antiarrhythmic drugs (quinidine 22 patients, procainamide 5 patients, ajmaline 1 patient), antianginal drugs (prenylamine [Synadrin] 4 patients) and antidepressant drugs (thioridazine 1 patient). Twenty-one patients were treated for premature ventricular complexes, three for chronic recurrent ventricular tachycardia, six for atrial flutter and fibrillation, three for anginal pain and one patient for mental depression. All patients except one had a drug-induced prolonged corrected Q-T interval before the appearance of polymorphous ventricular tachycardia. Most of the patients with this arrhythmia were considered to have severe myocardial disease. Lidocaine and electric cardioversion were administered to all patients, but were effective only in seven patients whose tachycardia occurred in short, single episodes. The most effective treatment (17 patients) was temporary ventricular pacing at rates ranging from 100 to 140 beats/min. Intravenous isoproterenol proved to be successful in another 10 cases. It is concluded that patients with severe myocardial involvement receiving antiarrhythmic drugs for premature ventricular complexes, especially the multiform variety, are at high risk for the development of polymorphous ventricular tachycardia.


Noninvasive diagnosis of left ventricular pseudoaneurysm: role of two dimensional echocardiography and radionuclide gated pool imaging. This report describes a case of left ventricular pseudoaneurysm diagnosed with two dimensional real time echocardiography. The two dimensional echocardiogram identified not only the pseudoaneurysmal sac but also the site of left ventricular rupture. When supplemented with radioisotope gated cardiac blood pool scanning, the noninvasive studies demonstrated combined true and false left ventricular aneurysms. Left ventricular pseudoaneurysm can be diagnosed using two dimensional echocardiography and nuclear imaging, permitting early operative intervention before fatal rupture.


Absence of paradoxical pulse in patients with cardiac tamponade and atrial septal defects. Five patients with atrial septal defect and proved cardiac tamponade had neither paradoxical pulse nor the inspiratory reduction of left ventricular internal dimension associated with this sign. It is assumed that equilibration of flow across the atrial septal defect prevented paradoxical pulse. Patients with a large atrial septal defect and tamponade do not manifest a paradoxical pulse.


Dissecting aortic aneurysm involving a right-sided aortic arch. In this case, the first reported instance of aortic dissection involving a right-sided arch, an anomalous fourth arch vessel, the left subclavian artery, arose from a congenital aortic diverticulum. This report emphasizes the need for precise anatomic definition with aortography to permit appropriate therapy when congenital anomalies of the aortic arch are complicated by dissecting hematoma.


Ultrastructural study of granules in the corpora letea of several mammalian species. The ultrastructure of the corpora lutea of the goat, cow, rabbit, pig and guinea pig have been examined at a stage when progesterone was being secreted by the luteal cells. Densely staining granules, 0.2micrometer in diameter, are present within the luteal cells of all the species examined. Granules were detected in the extra-cellular spaces of the corpora lutea of the goat, cow and pig, but not of the rabbit or guinea pig. The luteal cells of the various species have the same basic structure but differ in the amounts of lipid and forms of smooth endoplasmic reticulum present. A common mechanism of hormone secretion, in granule form, is postulated for all luteal cells.


A morphometric study quantifying the mucus content of proliferating colonic epithelial cells. We report a quantification of the maximum mucus accumulation in proliferating rat colonic epithelial cells. The proliferative potential was determined by radioautographic study of one-hour pulse exposures to tritiated thymidine, mucous content was determined by Periodic-acid Schiff (PAS) staining. We examined 55 labeled mucous cells in 0.5- to 1-micrometer serial sections. The maximum thecal and nuclear profiles of these cells were photographed and their surface areas were determined utilizing a coordinate sensor. The data were expressed as a theca-to-nucleus (T/N) ratio. The maximum (T/N) ratio for a labeled mucous cell was 3.0. We performed a similar analysis on 22 unlabeled mucous cells from upper crypt regions and surface epithelium to derive the range of (T/N) ratios for terminally differentiated mature mucous cells. The range of (T/N) ratios from these cells was from 4.8 to 16.4. Our study shows that proliferative potential of mucous cells is determined by the interrelationship between mucus accumulation and nuclear size.


Morphology of rabbit collecting duct.

Morphology of rabbit collecting duct. Recently the assumed structural and functional homogeneity of the collecting duct (CD) has been questioned. The objective of this study was to determine if heterogeneity occurs in luminal surface membrane structure or in cytoplasmic configuration of cells in the collecting duct or both. Straight segments of cortical and medullary CD were examined in perfusion-fixed rabbit kidneys with scanning electron microscopy (SEM), light (LM) and transmission electron microscopy (TEM). Principal cells were the most abundant cells in all CD regions; intercalated cells comprised 37% of the cell population on the cortex, 18% in the outer medulla, and less than 1% in the inner medulla. SEM revealed two surface patterns among the ciliated principal cells: 1, located in the cortex and outer medulla, with few surface microvilli, and 2, located in the inner medulla, with abundant microvilli. Intercalated cells exhibited four distinctive luminal surface configurations: I, numerous short microvilli; II, both short and elongate microvilli; III, microplicae alone; and IV, both microvilli and microplicae. Intercalated cells with patterns I and II were predominant in the cortex, while cells with patterns III and IV were most common at the corticomedullary junction. TEM confirmed that marked variation existed in cytoplasmic structures of both principal and intercalated cells. These findings may either indicate the presence of several specific types of principal and intercalated cells or reflect different functional states of the principal and intercalated cells. Regardless of their significance, their presence must be considered in studies seeking to establish precise structural-functional relationships in this region of the rabbit renal tubule.


Freeze-fracture demonstration of communicating junctions between interstitial cells of the pulmonary interalveolar septa. Interstitial cells in the interalveolar septa of lungs, which are considered to be myofibroblasts, are coupled by communicating junctions.


Reduced cell proliferation in fetal lung after maternal administration of pilocarpine: a scintillation autoradiographic study. Fetuses were obtained on the 28th gestational day from pregnant New Zealand white rabbits treated daily, on the 24th through the 27th gestational day, with pilocarpine HCl, 5 mg/kg in saline, or saline alone. Lung fragments from these fetuses were incubated for two hours in medium containing 3H-thymidine. Scintillation autoradiography of 1-micrometer-thick sections of these fetal lungs revealed that the lung tissue from pilocarpine-treated fetuses had significantly lower labelled cell indices for both alveolar epithelial cells and interstitial cells. These results indicate that pilocarpine treatment promotes differentiation of immature cells in the fetal lung at the expense of cell proliferation.


The habenular nuclei of the elasmobranch "Scyllium stellare": myelinated perikarya. Some habenular cells of the elasmobranch, Scyllium stellare, have a perikaryon completely enveloped by myelin of the compact type. They are found only in the left habenula and not in the right. The myelin sheath accompanies the proximal segment of the process arising from the perikaryon, in a node of Ranvier-like pattern. The identity of these myelinated cells and the functional significance of their myelination are unknown.


The Clara cell: a comparative ultrastructural study in mammals. Clara cells in the terminal bronchoiles of mouse, rat, rabbit, calf and human were compared by light, transmission and scanning microscopy, and species-differences were clearly present. Mouse Clara cells were most numerous and mouse and rabbit Clara cells had large dense mitochondria. Rabbit and calf had glycogen in Clara cells and rat Clara cells had the most variability in secretory granules, some of which had a crystalline structure. Calf Clara cells had deeply indented nuclei. Human Clara cells had the most prominent nucleoli and lacked smooth endoplasmic reticulum, which was a prominent feature of most other species. No evidence of apical extrusion or apocrine secretion of Clara cell secretory granules was observed.


Morphogenesis of the fetal membranes of an American mole, Scalopus aquaticus. Scalopus membranes are characterized by: Superficial nidation; antimesometrial orientation of the embryonic disc; amniogenesis by folding; an extensive but transitory choriovitelline placenta; a large yolk sac with late and incomplete inversion; large persistent allantoic vesicle; a very broad, thin, villous, epitheliochorial chorioallantoic placenta of annular shape interrupted mesometrially, dotted with numerous areolae, and bordered by a nonvillous sparsely vascular chorioallantoic membrane connected with the persistent bilaminar omphalopleure by a very narrow rim of chorion. There is no decidua. Electron microscopy shows that at 8 mm, CR, (limb bud embryo) the uterine epithelium of the interhemal membrane may be 0.5 micron or less in thickness, but that it shows no signs of degeneration. Trophoblastic microvilli often penetrate the epithelium to within 0.2 micron of its base. At this time there is active secretion by the uterine glands, and cellular hypertrophy and cytolysis of the epithelium at the gland mouths, with active phagocytosis by the areolar cytotrophoblast. The occurrence of absorptive areolae in an insectivore emphasizes the probable primitiveness of this widely distributed placental mechanism. In spite of similarities of the yolk sac to that of rabbits and rodents, the bilaminar omphalopleure produces no invasive trophoblastic giant cells. The definitive membranes of Parascalops breweri and Scapanus latimanus are like those of Scalopus. The placentae of Talpa europaea, Condylura cristata, and Neurotrichus gibbsii are discoid and relatively much smaller, thicker and more complex in internal structure. There is some reason to believe that the fetal membrane systems of moles and shrews (Soricoidea) are more like those of the ancestral mammalian stock than are those of any other recent eutherians.


Ultrastructure of the renal corpuscle of the garter snake Thamnophis sirtalis. The renal corpuscle of the garter snake was examined using scanning and transmission electron microscopy, freeze-fracture and tracer experiments. The renal corpuscle was small and glomerular architecture simple. The visceral epithelium was composed of irregular, highly branched podocytes with broad, interdigitating foot processes. Numerous cell junctions, including fasciae occludentes and adhaerentes, occurred between podocytes. The podocytes bore numerous microvilli which projected into the urinary space and contained large bundles of microfilaments. The podocytes lay on a basal lamina which appeared to act as a primary filtration barrier.


Loss of body nitrogen on fasting.

Loss of body nitrogen on fasting. An analysis of the change in total body nitrogen during fasting shows that it declines exponentially, a small fraction being lost rapidly (t 1/2 of a few days), and the remainder being lost slowly (t 1/2 of many months). The obese faster loses N, and weight, at a slower relative rate than the nonobese; and the ratio of N loss to weight loss during an extended fast is inversely related to body fat content, being about 20 g/kg in the nonobese and about 10 g/kg in those with body fat burdens of 50 kg or more. The loss of body N on a low protein-calorie adequate diet can also be described in exponential terms, and this function allows an estimate to be made of the N requirement.


Nitrogen balance in obese patients receiving a very low calorie liquid formula diet. Eleven obese patients were placed on a liquid formula diet containing 320 kcal (1.34 MJ), 31 g protein, 44 g oligosaccharides, 1.5 g fat, vitamins, and essential minerals for a period of 4 weeks under metabolic ward conditions. The diet was well tolerated, and mean weight loss was 2.49 kg/week during the 4-week period. Nitrogen excretion diminished in all patients during the period of treatment, but nitrogen balance remained slightly negative in most patients, mean daily deficit being 1.3 g N/day at the end of the study. The rate at which nitrogen was loss declined in a biphasic fashion, a slower second phase after an initial rapid period of adjustment to the diet. During the study a mean of 4.1 +/- 1.4% SD of calculated total body nitrogen was lost. Potassium excretion studies did not reveal significant potassium losses. The amount of nitrogen loss was correlated with the urinary creatinine excretion, suggesting that nitrogen loss during reduced dietary intake of protein is largely dependent on the size of the lean body mass.


The short-term effects of protein intake on 3-methylhistidine excretion. The urinary excretion of 3-methylhistidine is used as a convenient index of muscle protein catabolism. Histidine is methylated in peptide linkage within muscle protein, and is quantitatively excreted when the protein is catabolized. 3-Methylhistidine would be expected to be present in ingested muscle protein, and unless altered in the digestive process, to be excreted as a function of intake. We studied its excretion at four levels of mixed protein intake, in separate groups of obese subjects, on the 1st day of altered input, with and without concurrent energy provision. A significant (P less than 0.001) linear relationship between protein intake and 3-methylhistidine excretion was observed, with a mean excretion of 198 mumoles/day at 0 intake, and an increment of 1.34 mumoles/g of ingested protein. There was no relationship between its excretion and the concurrent nitrogen balance. Thus, estimates of muscle protein catabolism with this method require that muscle protein be absent from the diet or its contribution quantified.


Increased taste thresholds of amino acids with age. Taste detection thresholds for 19 L-amino acids and four monohydrochloride derivatives were determined for young and elderly subjects. Although the ranges of the thresholds were extensive, the elderly were found to have significantly diminished sensitivity. On the average, thresholds were 2 1/2 times higher in the elderly than in young subjects. Relationships between the taste detection thresholds of amino acids, their chemical structures, and suprathreshold taste qualities were found. Amino acids with aliphatic side chains and those containing hydroxyl groups and having sweet tastes at suprathreshold concentrations tended to have the highest thresholds. Amino acids containing sulfur, as well as those with acidic or basic groups, tended to have the lowest thresholds.


Effect of high carbohydrate feeding with dextrose or sucrose on adipose tissue lipoprotein lipase activity and plasma triglyceride levels in hemodialysis patients. The acute effect of feeding high concentration carbohydrate meals containing equicaloric amounts of dextrose or sucrose on the activity of adipose tissue lipoprotein lipase and the concentration of plasma triglyceride was assessed in 11 hemodialysis patients. Dextrose feeding resulted in higher postprandial glucose levels and a greater insulin response than sucrose. The relationship between the postprandial change in the activity of adipose tissue lipoprotein lipase and the insulin response to feeding almost reached statistical significant (rs = 0.40, P = 0.08, n = 20), and the increase in the activity of the enzyme after dextrose feeding was greater than after sucrose (P less than 0.01). There was a significant decrease in plasma triglyceride levels after dextrose feeding (P less than 0.01), but no change was observed after the ingestion of sucrose. These results indicate that the inability of the administered sucrose to raise the plasma insulin concentration to the same level as isocaloric amounts of dextrose probably accounts for the smaller increase in the activity of adipose tissue lipoprotein lipase after sucrose. The failure of plasma triglyceride levels to fall after sucrose feeding suggests that the extent to which the activity of adipose tissue lipoprotein lipase increases postprandially may be important in the regulation of triglyceride metabolism in hemodialysis patients.