Microangiopathy of the brain and retina. Two women (26 and 40 years old) developed an unusual microangiopathy that affected the brain and retina. Psychiatric symptoms initially overshadowed the subacute features of the progressive neurologic disorder. Ophthalmoscopic findings of multifocal branch retinal artery occlusions provided clinical evidence of vasculopathy. Laboratory data did not reveal evidence of the known vasculitides, including systemic lupus erythematosus (SLE) and syphilis. Cerebral angiography suggested vasculitis in the younger patient. Brain biopsy in the older patient (after 3 months of steroid therapy) revealed a sclerosis of the small pial and cortical vessels that was consistent with a "healed" angitis. Both patients seemed to respond to steroid therapy.


Cerebral infarction and migraine: clinical and radiologic correlations. Cerebral infarction was documented by arteriography and serial computed cranial tomography (CT) in four young adults (ages 16 to 32 years) with migraine. In one case, posterior cerebral artery occlusion produced a deep parietotemporal infarct. The other three cases all had frontotemporal infarcts (one hemorrhagic) in the territory of the middle cerebral artery, without major arterial occlusion. Two infarcts produced lasting neurologic deficits; one was associated with mild, transitory symptoms, and one was asymtomatic. Laboratory investigations in two cases revealed no hematologic or cardiovascular predisposition to cerebrovascular disease. Cerebral infarction, as revealed by CT, may be more prevalent in "complicated" migraine than is generally appreciated. Such lesions may or may not develop in chronologic and anatomic relationship to the headache, and may involve either large or small arteries. The prognosis for functional recovery, based on this limited sample, seems favorable.


Behr syndrome: a clinicopathologic report. Two sisters had Behr syndrome; autopsy was performed on one. The autopsy revealed central atrophy of the optic nerves and total disarray of the normal laminar pattern of the lateral geniculate nucleus, dropout of neurons, and gliosis. There were numerous axonal spheroids in the neuropil. Similar spheroids with cell loss and gliosis were also observed in other thalamic nuclei and, rarely, in the pallida. We raise the possibility that Behr syndrome is a manifestation of a heterogeneous group of disorders, and suggest relationship of this particular disease to infantile neuroaxonal dystrophy.


Calcification of the basal ganglia: computerized tomography and clinical correlation. During a 1-year period, 4219 consecutive computerized tomograms (CT) were reviewed for basal ganglia calcification; 14 patients with such calcification were identified. Calcifications on CT scan were bilateral in 12 of these cases and unilateral in 2. All bilateral calcifications were symmetric. The globus pallidus was the site of calcification in 13 of the 14 patients. Bilateral dentate nucleus calcification was seen in one patient. Skull radiograms were normal in all but one. Patients had diverse symptoms that were often explained by other findings, suggesting that calcifications may be coincidental and that basal ganglia calcification may not be a nosologic entity. Disturbances of calcium metabolism were not found in these patients, minimizing the pathophysiologic significance of altered calcium metabolism and the need for extensive endocrinologic evaluation. The finding of basal ganglia calcification alone does not justify invasive diagnostic procedures. Extrapyramidal signs may be associated with basal ganglia calcification; parkinsonism associated with basal ganglia calcification differs from idiopathic parkinsonism in being resistant to levodopa therapy.


Capgras syndrome: a reduplicative phenomenon. A patient recovering from a severe head injury developed a prolonged Capgras syndrome in which he believed his wife and five children had been replaced by nearly identical substitutes. Although this phenomenon is considered a functional disorder in the psychiatric literature, recent reports postulate an organic basis. Recent studies of the comparable neurologic disorder, reduplicative paramnesia, have stressed the importance of bilateral frontal and right hemisphere pathology. Neuropsychologic and neuroradiologic data in our patient revealed this combination, suggesting that the Capgras syndrome may be a form of reduplicative paramnesia with the same pathologic substrate.


Influenza and myoglobinuria in brothers. Two adult brothers became ill within 48 hours of each other, and both had severe myoglobinuria. One brother died of oliguric renal failure. The other did not have renal failure and survived. Acute influenza A infection was documented serologically and from throat washings in the surviving brother, and by isolation of the influenza A virus from throat cultures and lung tissue of the brother who died. It is not certain whether a genetic myopathy made these brothers susceptible to viral-induced myoglobinuria, but a normal response of venous lactate to ischemic work excluded lack of phosphorylase or phosphofructokinase as a cause of the myoglobinuria in the surviving brother. Neither brother had a history of recurrent episodes of myoglobinuria precipitated by exercise, cold, or fasting, thus making carnitine palmityl transferase deficiency unlikely.


Bromocriptine in Parkinson disease: further studies. Bromocriptine was administered to 66 patients with advanced Parkinson disease (PD) and increasing disability despite optimal treatment with levodopa/carbidopa (Sinemet). Forty-five patients tolerated at least 25 mg per day of bromocriptine (the "adequately treated" group) in addition to Sinemet and had significantly decreased rigidity, tremor, bradykinesia, gait disturbance, and total score, but increased involuntary movements. Twenty-five of these 45 patients improved by at least one stage. Among the 45 patients, 27 had "on-off" effects, and in 19 the "on-off" effects decreased on bromocriptine. The mean dose of bromocriptine in adequately treated patients las 47 mg, permitting a 10 percent reduction in the dose of levodopa. Twelve adequately treated patients received bromocriptine for at least 1 year, and 8 continued for longer than this. Bromocriptine was discontinued in 29 of 66 patients because of adverse effects, including mental changes (14 patients) and involuntary movements (9 patients). All adverse effects were reversible. Despite adverse effects, expense, and scarcity, bromocriptine, when added to levodopa, is useful in patients with advanced disease who no longer respond satisfactorily to levodopa, and for whom no other treatment is available.


Spinocerebellar degeneration: hexosaminidase A and B deficiency in two adult sisters. Two adult sisters had spinocerebellar degeneration. Biochemical studies revealed a very low activity of both fraction A and fraction B of the lysosomal enzyme, hexosaminidase, in serum and leukocytes. A skin biopsy showed lesions suggestive of neuronal storage disease. The disorder seems to be an adult form of GM2 gangliosidosis.


Computed tomography in a verified case of tuberculous meningitis. In a verified case of tuberculous meningitis, postcontrast computed tomograms demonstrated enhancement of the area corresponding to the cistern surrounding the brainstem. This enhancement disappeared after successful drug treatment of the meningitis.


Alexia without agraphia: lateral and medial infarction of left occipital lobe. Four cases of alexia without agraphia were studied by 99m-technetium pertechnetate brain scan. Two types of increased uptake were seen. One was of the triangular type near the midline in the posterior view, said to characterize an infarction in the distribution area of the posterior cerebral artery. This was associated with the well-known clinical picture of alexia without agraphia accompanied by hemianopia and color-naming defect, and was confirmed by postmortem examination. The other type of pathologic isotope uptake, observed in three patients, was more laterally placed, in the basal part of the left occipital lobe, and did not reach the midline. In these cases the alexia was transient and not associated with color-naming defects.


Idiopathic hypoparathyroidism presenting as dementia. Subacute dementia was the sole neurologic symptom in a 32-year-old man with idiopathic hypoparathyroidism. This condition resolved with medical therapy, in parallel with the return of serum calcium content to normal.


Ruptured aneurysm of the spinal artery of Adamkiewicz during pregnancy. Solitary aneurysms of the extramedullary arteries of the spinal cord, not associated with arteriovenous malformations from which they are clinically indistinguishable, are rarely reported; only four cases have appeared in the recent literature. An aneurysm of the great anterior radicular artery of Adamkiewicz was found at autopsy in a 34-year-old pregnant woman. The aneurysm had ruptured into the subarachnoid space.


Bedside evaluation of large motor units in childhood spinal muscular atrophy. One hundred patients with motor unit disease were examined to determine the diagnostc reliability of several clinical signs of large motor units. These signs were high-intensity, low-pitched rumbling on skeletal muscle auscultation, voluntary contraction fasciculations, contraction fasciculation trembling, and palpable contraction fasciculations. Among 22 cases of spinal muscular atrophy, contration fasciculation trembling was noted in 86 percent, abnormal muscle auscultation in 68 percent, palpable contraction fasciculations in 64 percent, and voluntary contraction fasciculations in 50 percent.


Quantitative ultrastructural study of muscle satellite cells in Duchenne dystrophy. Quantitative ultrastructural studies of satellite cell populations, and nuclear chromatin analysis of satellite cell nuclei and true subsarcolemmal nuclei were carried out in normal and Duchenne muscular dystrophy (DMD) muscles. There was a remarkable increase in the number of satellite cells in muscles of patients with mild to moderate stages of DMD, as compared to preclinical or very early and probably advanced stages of DMD, and a significant increase in euchromatin content was found in the satellite cell nuclei in DMD. Since it is generally accepted that satellite cells participate actively in muscle fiber regeneration, this study suggests that muscle fiber regeneration is ineffective in DMD.


Reversibility of Parinaud syndrome in thalamic hemorrhage. Parinaud syndrome, associated with a left thalamic hemorrhage, disappeared completely in a 57-year-old woman after ventriculoperitoneal shunt. The syndrome may be attributed to increased intracranial pressure owing to mass effect on the pretectal region and tectum, or to tightness in the incisura causing hydrocephalus secondary to aqueduct compression. The lesions responsible for the syndrome may not be irreversible.


Acute hydrocephalus in cerebellar infarct and hemorrhage. Although cerebellar infarction was known at the turn of the century, not until 1956 was it realized that large cerebellar infarctions could cause acute obstructive hydrocephalus. There are many more reports of cerebellar hemorrhages. The clinical differentiation between hemorrhage and infarction was difficult prior to computerized tomography (CT). Cerebellar hemorrhage is a neurosurgical emergency, as are some cerebellar infarctions. We present three patients with acute hydrocephalus resulting from these vascular syndromes; they are first cases to be successfully treated by ventricular drainage and shunting. Four other cerebellar infarcts demonstrate the efficacy of CT.


Diazepam and dialysis encephalopathy.

Diazepam and dialysis encephalopathy. A patient with the clinical and electroencephalographic features of dialysis encephalopathy exhibited dramatic improvement with the initiation of diazepam therapy. Although improvement was sustained for a period of several weeks, her clinical condition eventually deteriorated despite continued treatment with diazepam and dialysis. Dialysis encephalopathy in this patient is compared with other cases recently reported in the medical literature as having a similar dramatic response to diazepam. It is concluded that diazepam transiently reverses a component of the dialysis encephalopathy syndrome, but it does not appear to change the ultimate prognosis for patients with this condition.


Hepatic ketogenesis and muscle carnitine deficiency. The levels of plasma free carnitine and ketone bodies have been found to fluctuate inversely in fasting individuals without muscle disease. Circulating short-chain acyl-carnitines paralleled beta-hydroxybutyrate levels. A patient with lipid storage myopathy and muscle carnitine deficiency, and his two daughters, developed exaggerated ketogenesis on fasting. The content of total carnitines in the patient's liver was normal, but free carnitine was reduced to 50 percent, and total esterified carnitines were four times greater than the mean value for the controls. The decreased muscle carnitine content in this case may have resulted from chronic hepatic ketogenesis, draining muscle carnitine. Alternatively, decreased muscle carnitine content may have initiated hepatic ketogenesis.


The pathology of drop attacks: a case report. A 65-year-old man had four drop attacks in several days and then a fixed stroke with quadriplegia. At autopsy infarction in the lower pons and upper medulla affected principally the corticospinal tracts. Tegmental destruction included reticular formation nuclei with rostral projections, but spared the lateral reticular formation nuclei, from which arise the descending reticulospinal tracts. This case is the first detailed autopsy report of a patient with drop attacks, and supports the view that at least some drop attacks are caused by transient ischemia of the corticospinal tracts.


Computed tomography in aneurysmal subarachnoid hemorrhage. Among 50 patients with subarachnoid hemorrhage (SAH) from aneurysm, computed tomography (CT) demonstrated evidence of bleeding in 28. In 12 cases, the location and configuration of the high-density blood cast visualized by CT was characteristic and predicted the site of the ruptured aneurysm. CT was reliable in identifying infarction, edema, localized hematoma, hydrocephalus, or rebleeding in patients with SAH and neurologic abnormalities. In four cases, the plain and contrast CT suggested a large intracranial aneurysm. These findings did not permit definitive diagnosis or precise anatomic detail of angiographically defined aneurysms less than 2.0 cm in size.


Brain aluminum in aging and Alzheimer disease. Aluminum was assayed by atomic absorption spectroscopy in 274 brain samples, and assayed in neurons isolated in bulk from the frontal cortex of patients with Alzheimer dementia and from age-matched patients with no neurologic disease. Brain aluminum concentration increased with age, from late middle age to old age. There were no statistically significant differences in brain aluminum concentration between the 10 patients with Alzheimer disease (mean, 2.7 microgram per gram dry weight of tissue; mean age, 81 years), and the 9 nonneurologic controls (mean, 2.5 microgram per gram; mean age, 73 years). In both groups, the hippocampus had the highest concentration of aluminum (5.6 microgram per gram), and the corpus callosum the lowest (1.5 microgram per gram).


Chronic ECHO type 5 virus meningoencephalitis in X-linked hypogammaglobulinemia: treatment with immune plasma. A patient with X-linked hypogammaglobulinemia developed chronic meningoencephalitis. ECHO virus type 5 was repeatedly cultured from cerebrospinal fluid (CSF). Infusions of high-titer, specific plasma resulted in clinical improvement, but failed to eradicate the virus. After more intensive plasma infusions, the virus could not be cultured from the CSF. The patient died 8 months after institution of intensive therapy. The cause of death was unknown. Autopsy showed persistence of perivascular and meningeal inflammation. Specific anti-ECHO-virus-5 plasma was shown to be more effective in lowering CSF ECHO-virus titers than was plasma without anti-ECHO-virus antibody.


Short-latency somatosensory responses in multiple sclerosis. Cervical and cortical somatosensory evoked potentials were measured in 80 patients with suspected or established multiple sclerosis (MS). The cervical response was a more sensitive diagnostic indicator than the cortical response, and was abnormal in 86.7 percent of patients with definite MS and in 40.9 percent of MS suspects. The complementary value of measuring both responses was greatest (89.3 percent) in early probable or latent MS. Comparing the responses obtained from stimulation of the left and right extremities increased the overall diagnostic yield by 25 percent. Abnormal responses were frequently obtained from clinically normal limbs.


Enzyme replacement in Tay-Sachs disease. Enzyme replacement therapy was attempted with two Tay-Sachs-diseased individuals--a 14-month-old child and a 7-week-old infant. Treatment consisted of repeated weekly intrathecal injections of pure hexosaminidase A. Injection of this enzyme resulted in almost complete disappearance of GM2 from the serum, but did not bring about dissolution of the GM2 membranous cytoplasmic bodies in the brain, as detected by electronmicroscopy. Both patients tolerated the treatment without apparent clinical complications, but no clear-cut improvement was noted as a result of prolonged injections of hexosaminidase A. Since this treatment was initiated in both an advanced stage and a very early stage of the disease, we conclude that enzyme replacement treatment by this route is not beneficial for patients with Tay-Sachs disease.


Disordered growth hormone and prolactin secretion in primary disorders of sleep. Growth hormone (GH) and prolactin (PR) secretion were evaluated in 28 patients who had sleep apnea or narcolepsy but no other primary neurologic or endocrine disorders. Eighty-one percent of subjects with impaired alertness failed to demonstrate serum GH concentrations in excess of 5 ng per milliliter following oral administration of L-DOPA, 500 mg. Diminished GH responses to sleep and intravenous arginine were observed in 57 percent and 44 percent, respectively, of patients tested. Sleep-related PRL release was less than normal in women with narcolepsy, with or without sleep apnea. All patients had at least one abnormality in GH or PRL secretion.


Computerized cranial tomography in Wilson disease. Hepatolenticular degeneration (Wilson disease) is suspected by the clinical picture and confirmed by characteristic laboratory demonstration of impaired copper metabolism. Three patients with Wilson disease involving the basal ganglia were shown to have abnormalities on computerized tomography (CT) scan, whereas four other patients without signs of cerebral involvement had normal brain scans. Wilson disease may be added to the long list of diseases to which the EMI scan may make a useful diagnostic contribution.


Transient global amnesia: clinical and electroencephalographic findings in 10 cases. We studied 10 patients with transient global amnesia (TGA). Routine electroencephalograms (EEGs) were normal in six; two showed mild temporal lobe abnormalities, one had bitemporal delta activity with rare sharp waves, and one showed bioccipital rhythmic theta activity. Nasopharyngeal (NP) recordings were obtained in seven patients; five showed independent mesial temporal spike discharges during drug-induced sleep. The discharges are probably due to transient ischemia in deep temporal structures.


Spinal subarachnoid hematomas: clue to a source of bleeding in traumatic lumbar puncture. Although damage to the veins of Batson's epidural plexus is usually considered the origin of bleeding in traumatic lumbar puncture, a lesion of these veins would not explain the cases in which postmortem examination shows blood confined to the subdural and subarachnoid spaces. In two patients who had lumbar punctures a few days before death, there was subarachnoid hematoma of the cauda equina at autopsy. In one of these cases, the radicular vessels were shown to be the source of bleeding. Spinal subarachnoid and subdural hemorrhages after lumbar puncture may be due to laceration of radicular vessels by the spinal needle.


The anatomic basis of visual agnosia.

The anatomic basis of visual agnosia. In a patient with associative visual agnosia without alexia, there was bilateral infarction in the distribution of the posterior cerebral arteries, with corticosubcortical lesions in both occipitotemporal regions, sparing the corpus callosum. Bilateral loss of visual-limbic connections may underlie associative visual agnosia, and bilateral lesions of the inferior longitudinal fasciculi may be the necessary and sufficient lesions for this syndrome. Alexia was absent in this case, perhaps because the corpus callosum was intact.


Myelinotoxic activity on tadpole optic nerve of cerebrospinal fluid from patients with optic neuritis. The myelinotoxic activity of unconcentrated cerebrospinal fluid (CSF) from eight optic neuritis (ON) and five multiple sclerosis (MS) patients with oligoclonal IgG, and from five ON patients without oligoclonal IgG, was tested in the tadpole optic nerve system. CSF from ON or MS patients with oligoclonal CSF IgG gave a significantly greater number of myelinotoxic lesions than did CSF from ON patients without oligoclonal CSF IgG, CSF from control patients, or physiologic saline. Induction of myelinotoxic lesions may be coupled with the presence of oligoclonal IgG. The findings support the hypothesis that there are two different forms of ON, of which one, characterized by oligoclonal IgG in the CSF, is more closely related to MS.


TIA, stroke, and mitral valve prolapse.

TIA, stroke, and mitral valve prolapse. Eight patients with transient ischemic attacks, and three with partial nonprogressive strokes associated with mitral valve prolapse, are reported. No other etiology for their ischemic events was found. Only one episode of ischemia recurred on aspirin treatment, whereas none recurred on sodium warfarin therapy.


Disseminated actinomycosis with spinal cord compression: report of two cases. We studied two patients with vertebral actinomycosis and symptoms of spinal cord compression. Both patients had a chronic illness characterized by multiple draining skin lesions, weight loss, and progressive leg weakness. They responded to antibiotic therapy and corticosteroids without neurosurgical intervention. The patients were treated with antibiotics for 12 months, and remained well, without major neurologic disorder, for 2 years after stopping medication.


Acute hemiparesis in juvenile insulin-dependent diabetes mellitus (JIDDM). Four episodes of acute left hemiparesis occurred in three pediatric-age, insulin-dependent diabetic patients. Each had a concomitant respiratory tract infection and headache, but no obvious signs of systemic hypoglycemia. No cerebral abnormalities were demonstrated by angiography or computerized tomography. The clinical course was benign, with slow but complete resolution of neurologic abnormalities within 8 to 24 hours of onset, and no further neurologic complaints in a 7- to 16-month follow-up.


Increased serum creatine kinase after exercise: a sex-linked phenomenon. The effect of 2 hours of exercise on the serum creatine kinase (CK) level was investigated in 11 men and 9 women. The mean increase of CK 24 hours after exercise was significantly greater in men. The relative lack of CK elevation in women may: (1) indicate that female muscle is less susceptible to damage by adverse factors; and (2) explain discrepancies in previous reports.


The effect of a low-dose oral contraceptive on serum testosterone levels in polycystic ovary disease. A study was designed to determine the effect of a low-estrogen-dosage oral contraceptive on the serum concentration of testosterone-binding globulin (TBG) and total and unbound testosterone in patients with polycystic ovary disease (PCOD). Treatment with norethindrone 0.5 mg and ethinyl estradiol 0.035 mg (Modicon, Ortho) increased the TBG concentration and reduced the unbound serum testosterone concentration.


Effects of low-birth-weight breech delivery on neonatal mortality. The influence of breech presentation on neonatal mortality was studied in 77 viable low-birth-weight breech deliveries. Neonates were divided into 3 weight groups: 1000-1499 g, 1500-1999 g, and 2000-2499 g. The antepartum and intrapartum characteristics of the 3 weight groups were detailed. The 17 neonates who died were studied to determine if alternative delivery methods would have prevented their deaths. Survival rates were 45% in the 1000-1499-g group, 76% in the 1500-1999-g group, and 97% in the 2000-2499-g group. Cervical head entrapment and fetal bradycardia were ominous intrapartum complications, but severe prematurity with respiratory distress syndrome and fetal hydrops were the primary causes of neonatal death. From these data, it is concluded that 1) intrapartum management and delivery of the low-birth-weight breech presentation infant should be individualized, and 2) cesarean section for routine delivery is not justified.


Results of hearing testing at 7-year follow-up of kanamycin-treated newborn infants. A follow-up study 7--8 years after kanamycin treatment of 83 newborn infants in the Tampere University Central Hospital is described. The Apgar scores ranged from 1 to 10, about half of the patients being premature. Only in 1 case (1.2%) a slight bilateral high-tone loss was found. This patient's birth had been complicated by ablation of the placenta with subsequent cesarean section and he had neonatal sepsis as well. The cause of this hearing defect is thus not necessarily the use of kanamycin. Because of the extended use of reserve antibiotics, microorganisms resistant to modern antibiotics may necessitate in some vital cases the use of kanamycin. Our results indicate that, if serum concentrations are monitored adequately, the use of kanamycin does not necessarily result in a hearing defect.


Neurinoma of the facial nerve.

Neurinoma of the facial nerve. This paper deals with 2 cases of peripheral facial paralysis, due to intratemporal facial neuroma of tympanic (case No. 2) and vertical (case No. 1) segments of the Fallopian canal. The authors present a literature review of the intratemporal facial neuromas with special reference to clinical-surgical and differential diagnostic aspects. It is difficult to detect a Schwannoma of the facial nerve during a peripheral facial paralysis; radiological studies of the mastoid and Fallopian canal are essential for this diagnosis. Treatment of neurinomas of the VIIth nerve is always surgical, the authors emphasize the necessity of an 'en masse' tumor-nerve removal and the use of a nerve graft.


Criteria for the evaluation of nystagmus. Suitable criteria are reported for the analysis and evaluation of the caloric nystagmus as well as for the differentiation of the pathological from the physiological spontaneous nystagmus. Relative values for the difference and the directional preponderance, related to the intensity of the total reaction, seem to be the most appropriate criteria for the evaluation of the caloric test. The values obtained in patients should be compared with interquantile areas of healthy subjects. The parameters 'maximum slow phase velocity' and 'maximum frequency' seem most suitable for the assessment of the reaction intensity in the ENG. At present, the examination with Frenzel's glasses represents the best possibility for differentiation between physiological and pathological spontaneous nystagmus.


Transorbital injury from a harpoon involving the paranasal sinuses. A harpoon accidentally entered the right eye of a 15-year-old boy. No loss of consciousness occurred. After neuro-radiological assessment, the object which had penetrated the sphenoid sinuses was removed without mishap. He made a good recovery but has, as permanent deficits, an inferotemporal field defect, diminished visual acuity with optic atrophy, a sensory pupillary defect and right ptosis. The need for hospitalisation and a team approach to penetrating injuries of the face is discussed.


An X-linked recessive cardiomyopathy with abnormal mitochondria. A transvascular endomyocardial biopsy from an infant with cardiomyopathy and chronic congestive heart failure showed abnormal mitochondria when examined by electron microscopy. At necropsy, similar abnormal mitochondria were seen in skeletal muscles, liver, and kidney. The patient's family pedigree revealed several male babies who had cardiac disease and died in infancy. Myocardium obtained at necropsy from three cousins contained mitochondria with abnormalities similar to those from the proband. An X-linked recessive cardiomyopathy seems likely in this family.


Effect of hemodilution and hemoconcentration on red cell flow velocity in the capillaries of the rat mesentery. Erythrocyte velocities in capillaries of rat mesentery were measured during systemic normotension and hypotension over a range of hematocrit from 0.31 +/- 0.06 to 0.58 +/- 0.04. Velocity was measured according to the method of Tompkins, Monti and Intaglietta. The hematocrit was varied by isovolemic exchange of blood with 4.5 g% albumin solution (bovine) or packed red cells (Hct. approximately 0.9). Hypotension was induced by hemorrhage to a preselected pressure of about 35 mm Hg. Under normotension red cell velocity stayed almost constant over a range of Hct. from 0.31 +/- 0.07 to 0.58 +/- 0.09. However, during hypotension significant differences were found for control animals (Hct. 0.43 +/- 0.07), hemodiluted animals (Hct. 0.31 +/- 0.06), and hemoconcentrated animals (Hct. 0.58 +/- 0.04). Velocities amounted to 36 +/- 21%, 52 +/- 24%, and 29 +/- 27% respectively, compared to control velocity. These marked differences in red cell velocities are explained by the strong effect of the hematocrit levels on apparent blood viscosities. It is assumed that the post-capillary microvascular bed is the site where the hematocrit level will affect apparent blood viscosity most intensively.


Cross-tachyphylaxis of the pressor response to angiotensins in conscious rabbits. The effect of tachyphylaxis to angiotensin II amide on the pressor potency of angiotensin I, II and III and noradrenaline was investigated in conscious rabbits with indwelling cannulae. No significant difference was observed between the reduction in responses to angiotensin II (58 +/- 4%) and angiotensin III (42 +/- 6%) but angiotensin I (15 +/- 5 %) and noradernaline (17 +/- 10%) responses were less markedly inhibited. If all angiotensin I pressor activity was mediated through its conversion to angiotensin II one would expect an equivalent degree of cross-tachyphylaxis to occur with the two peptides. Our results suggest that angiotensin I may have significant inherent pressor activity of its own, independent of conversion. This compound is already known to have activity at other target tissues. The absence of a significant difference in the degree of tachyphylaxis with angiotensin II and III may indicate they have substantially common pathways as pressor agents.


Effects of halothane on caffeine-induced tension transients in functionally skinned myocardial fibers. The effects of halothane on caffeine-induced tension transients in functionally skinned myocardial fibers were investigated. Fiber bundles from mechanically disrupted rabbit right ventricular papillary muscles were mounted on a tension transducer. The fiber preparation was loaded with Ca2+; Ca2+ was then released by the use of caffeine (25 mM); and the area of the resulting tension transient was measured. Each preparation was sequentially transferred from control to test to control solution. The control solutions were equilibrated with 100% N2, and the test solutions with a mixture of N2 and various halothane concentrations. The preparation was exposed to halothane during the Ca2+ uptake or the release phase only, or during both Ca2+ uptake and release phases. The areas of the test tension transients were compared with those of the two control tension transients. It was found that halothane depressed the caffeine-induced tension transient either during the uptake phase or the combined-uptake-and-release phase but not during the release phase. The halothane-induced depression was dose-dependent, reversible, and comparable to the depression observed in intact isolated papillary muscles. We conclude that halothane could induce myocardial depression by inhibiting Ca2+ uptake by the sarcoplasmic reticulum.


Phosphate transport by rat renal brush border membrane vesicles: influence of dietary phosphate, thyroparathyroidectomy, and 1,25-dihydroxyvitamin D3. In the present work we have investigated whether the changes in the renal handling of inorganic phosphate (Pi) induced by 1) dietary Pi, 2) removal of parathyroid glands and 3, 1,25-dihydroxyvitamin D3 [1,25(OH)2D3], are associated with alterations in the Na-dependent Pi uptake by brush border membrane vesicles (BBMV) isolated from renal cortex. Sham-operated (SHAM) or thyroparathyroidectomized (TPTX) rats treated or not with 26 pmol/day of 1,25(OH)2D3 i.p. were fed low (0.2%) or high (1.2%) P diet for 7 days. The results showed that in SHAM, TPTX and TPTX+1,25(OH)2D3 the Pi uptake by BBMV was greater after low than high Pi diet. It was greater in TPTX than in SHAM counterparts fed either diets. In TPTX fed low or high Pi diet 1,25(OH)2D3 decreased the Pi uptake to the level observed in SHAM. A striking parallelism was found between variations in Pi uptake by BBMV and in the tubular Pi reabsorption of the whole kidney. The Na-dependent glucose, the mannitol uptake by BBMV, and the alkaline phosphatase activity in cortical homogenates and BBMV were not affected by the various treatments. Thus, dietary Pi, chronic TPTX and 1,25(OH)2D3 appear to specifically affect the Na-dependent Pi transport system bound to the brush border membranes of renal cortical tubules. The alterations observed at this membrane level could account, at least in part, for the changes induced by these factors on the overall tubular reabsorption of Pi.


The effects of blood osmolality changes on cat carotid body chemoreceptors in vivo. The possibility that carotid chemoreceptors respond to changes in plasma osmolality was investigated in the cat, perfusing the carotid artery with blood made hyper- or hypo-osmotic and recording chemoreceptor activity from carotid nerve fibers. Blood made hyperosmotic with sucrose or NaCl reduced the chemoreceptor discharge, while hypoosmotic blood increased chemoreceptor activity. The minimal osmolality variation necessary to obtain a detectable frequency change was 3--8% of the control. Frequency changes of 30% of the control were obtained with a 20% variation in osmolality. The frequency variations produced by the osmotic changes lasted as long as the infusion was maintained (up to 15 min). In some instances a rebound was observed when iso-osmotic saline was perfused again. A transient change in frequency and a clear rebound were obtained when blood made hypersomotic with glycerol was perfused. These effects probably reflect a rapid change in intracellular osmolality due to the free passage of glycerol across cellular membranes. The modifications in chemoreceptor activity consecutive to osmolality variations are the opposite of those observed in isolated and superfused carotid bodies. As it is known that osmolality values affect the smooth muscle of the blood vessels, we conclude that our results are mainly produced by changes in carotid body blood flow due to a direct effect of hyper- and hypo-osmotic solutions on vascular muscle tone. Chemoreceptor excitation during a decrease in blood osmolality may contribute reflexly to the increased vascular resistance observed during acute osmolality reductions in man.


Projection of scrotal thermal afferents to the preoptic and hypothalamic neurons in rats. Effects of thermal stimulation (18--41.5 degrees C) of the scrotum were observed on neurons in the preoptic area and hypothalamus (POHY) in anesthetized rats. Changes in firing rate of POHY neurons occurred, with three exceptions, within the scrotal temperature range of 30--41 degrees C. There was no dynamic response and little or no sign of rapid adaptation. Out of 46 warm-sensitive neurons, 34 increased and 9 decreased in firing rate with a rise in scrotal temperature. Out of 26 cold-sensitive neurons, 19 were excited and 4 were suppressed by scrotal cooling. The 3 exceptions were excited by scrotal cooling. The 3 exceptions were excited by scrotal warming above 36 degrees C, and were also excited by cooling below 30 degrees C. Out of 54 thermally-insensitive neurons, 16 were excited by scrotal warming 7 by cooling and 2 by warming and cooling. The scrotal temperature change needed to produce full change in POHY neuronal activity varied from less than 1 degree C to 7 degrees C, and was usually less than 4 degrees C. Thermal stimulation of either half of the scrotum had identical influence on the same POHY neuron.


Effect of divalent cations on spontaneous and evoked activity of single mammalian auditory neurones. Recordings were obtained from single primary auditory neurones in the guinea pig cochlea during perfusion of the scala tympani with solutions containing elevated concentrations of Mg2+, Mn2+ and Co2+, or with lowered concentrations of Ca2+. Such perfusions caused a reversible depression of spontaneous firing rates. This is consistent with the notion that spontaneous firing is the result of background release of excitatory transmitter from cochlear hair cells, in the absence of acoustic stimulation. The above ion modifications also produced varying changes in single neurone response curves to acoustic stimuli. In one half of the 14 neurons studied these changes were also compatible with a classical blockage of synaptic transmission. The other half however, showed little or no change in sensitivity at low frequencies while large threshold elevations occurred at high frequencies.


On the time course of the acetylcholine-induced hyperpolarization in quiescent guinea-pig atria. The time course of the action of acetylcholine (ACh) released from postganglionic parasympathetic nerve endings was studied in quiescent preparations of right atria from the guinea-pig heart. ACh release was induced by stimulation with single impulses subthreshold for excitation of atrial muscle cells. After stimulation a hyperpolarization of the atrial cell membrane could be recorded. At 35 degrees C time to peak (ttp) was reached 580--890 ms after the stimulus pulse. The hyperpolarization declined exponentially with a time constant of 1.6--3.4 s. The early rising phase was proportional to t3 where t is time and displayed a Q10 of about 12. The decay was less temperature-dependent (Q10 of ca. 1.5). Superfusion with solutions containing caffeine (0.25--2.0 mM) an inhibitor of cyclic nucleotide phosphodiesterases resulted in a prolongation of ttp, a flattering of the hyperpolarization maximum and an increase of the time constant of decay. It is suggested that a least three successive reactions are involved in the formation of ionic conductance channels after ACh receptor interaction. The results obtained with caffeine support the idea that formation of a cyclic nucleotide might participate in muscarinic action of ACh in the atrium.


Simultaneous measurements of microflow and evoked potentials in the somatomotor cortex of the cat brain during specific sensory activation. The behaviour of both microflow and evoked potentials was investigated in the right somatomotor cortex of the cat (anaesthetized with chloralose) during electrical stimulation of the contralateral left forepaw. Frequency, amplitude, and time of stimulation were varied. Using the local hydrogen clearance method the changes of microflow were continuously monitored in the same cortical area from which the evoked potentials were recorded. The experiments have shown that activation of the somatomotor cortex by somatic stimulation of the contralateral forepaw results in changes of microflow which clearly correlate to the side and amplitude of the primary evoked potentials. An increase in flow as well as in amplitude of the potentials depends on the stimulation parameters. The changes of microflow are limited to a small area of 1--2 mm in diameter. We conclude that a tight coupling of flow to functional activity exists in the microcirculatory range.


Risk and advantages of using strongly beveled microelectrodes for electrophysiological studies in cardiac Purkinje fibers. Conventional microelectrodes (tips with a diameter of 0.5 micrometer, a resistance of 8 MOhm, and a tip potential of -4 mV) were mechanically beveled over a length of 1--2 micrometer (resistance 2.5 MOhm, tip potential between 0 and -1 mV). Properties thought to be relevant for intracellular techniques were studied on the cardiac Purkinje fiber. The comparison with conventional microelectrodes suggests that beveled microelectrodes have an advantage as stated: 1. Intracellular impalement is favoured by the proper shape and the greater mechanical stability; the beveled tip penetrates the connective tissue smoothly without breaking or plugging. 2. Current injection (constant current mode) can be done without blocking or polarizing the tip. The 2 microelectrode voltage clamp technique (Deck et al., 1964) is improved by having lower noise and better stability, by a faster response time, and a greater range of clamp potentials (up to +80 mV). 3. The spontaneous release of the electrolytes filling the microelectrode has a 3-fold greater rate (0.015 pMol/s); this enlargement does not change the electrophysiological properties of the fiber. 4. Intracellular pressure injection requires pressures of 0.3--1.5 bar only to inject the solutes with rates between 1 and 100 pMol/s.


Construction and function of a new hydraulic cuff occluder. The construction of a new type of vascular cuff occluder for use in conscious animals is described. This occluder has the following features: 1. Safe complete vessel occlusion. 2. Occlusion at a definite cuff pressure with extrathoracally pressure control behind the cuff. 3. Long term implantability. 4. Possibility of multiple usage and sterilization.


The "chronic" ear: how to manage mild to severe otitis. Otitis media initially involves only the mucosa, but if unchecked, may eventually spread to bone, causing bony erosion and severe osteitis that can have life-threatening CNS complications. Placement of a PE tube generally is all that is necessary to eliminate middle ear fluid and restore normal hearing in serous otitis media and adhesive otitis media. Mastoidectomy is required in more advanced chronic ear disease; if disease is not too extensive, hearing may be restored by tympanoplasty.


Tonic immobility: effects of dopamine receptor blockade and stimulation. Blockade of dopaminergic receptors by haloperidol enhanced the duration of tonic immobility in chickens. Apomorphine, a dopamine receptor agonist, produced short durations. Apomorphine also produced an increase in stabilimeter activity. These data suggest dopaminergic involvement in tonic immobility, and support a competing response interpretation of the apomorphine effect.


Scotophobin A causes several responses in goldfish if the pineal gland is present. Rat scotophobin A increased dark avoidance in goldfish in dark and light avoidance shuttlebox experiments, controlled for general and light cycling-induced swimming activity. A possible site of action for scotophobin was suggested by the reports that dark avoidance was also increased in goldfish by pinealectomy, a treatment which increased shock sensitivity as well. It was found that scotophobin alone decreased the voltage required to induce tail-flip contractures in goldfish. The pineal gland was further implicated in the mode of action of scotophobin when it was found that this peptide suppressed the norepinephrine-induced aggregation of goldfish chromatophores whose state is in part controlled by pineal melatonin. Pinealectomized goldfish became insensitive to the effects of scotophobin upon both light-dark preference and chromatophore aggregation state. There observations strongly suggest that the pineal gland is required for the action of scotophobin.


Altered response to apomorphine and haloperidol after nine days of cocaine injections. Sprague Dawley rats, pretreated with nine daily injections of 20 mg/Kg cocaine or saline, were evaluated for aspects of their behavioral response to apomorphine, haloperidol, or cocaine, twenty-four hours after their last pretreatment injection. Data obtained from saline and cocaine pretreated animals indicated that: cocaine pretreated rats were more sensitive to haloperidol-induced catalepsy, less responsive to some of the stereotypic effects of apomorphine and similar in their responses to the anticataleptic properties of cocaine.


An electrophysiological correlate of amphetamine revealed motor imbalance in albino rats. Ten out of eleven Wistar rats displayed a reliable interhemispheric asymmetry of the secondary slow negative wave (SNW) of the visual evoked potential. A more synchronized EEG was observed on the side of facilitated SNW. The analysis of rotation directionality in the rotometer of these rats after IP (+)-amphetamine administration (1.25 mg/kg) showed that rats reliably rotated towards the side with a more facilitated SNW. It is believed that an imbalance of nigrostriatal DA content underlies the interhemispheric asymmetry of EEG and evoked potentials.


Metabolism correlates of cocaine-induced stereotypy in rats. An increase in stereotyped behavior was observed in rats injected daily with cocaine (40 mg/kg, IP), as compared with the first day. This increase persisted 14 days after discontinuation of the drug treatment, and corresponded to increased levels of 3H-cocaine norcocaine and benzoylecgonine in brain. Pretreatment of the animals with SKF-522A, an inhibitor of cocaine demethylation, produced a decrease in stereotypy rating and concomitantly a lower level of 3H-norcocaine in the brain. The role of this metabolite in the production of cocaine-induced stereotyped behavior is discussed.


Behavioral and biochemical effects of chronic consumption of ethanol by hamsters. Male Syrian Golden-Hamsters consumed about 90% of their fluid as an ethanol-water solution when given a choice between water and ethanol-water solutions. This resulted in a daily alcohol intake of about 11 g/kg. After 53 days of alcohol ingestion there was no evidence of tolerance to the soporific effects of parenterally administered ethanol and removal of the ethanol solutions failed to produce any signs of alcohol withdrawal. However, after cessation of ethanol ingestion, the acquisition of escape responding from footshock was impaired in the alcohol group as compared to a control group. Biochemical and ultrastructural analyses demonstrated that chronic ethanol ingestion hepatic glycogen and plasma triglycerides without altering either the hepatic or plasma concentrations of phospholipids, free cholesterol or cholesterol esters. These results demonstrate that the hamster has an unusual metabolic response to ethanol. These findings are contrasted to the biochemical and behavioral effects of the drug in other species.


Diurnal rhythms in noradrenaline turnover and motility after reserpine and 6-hydroxydopamine. Experiments were performed in male Wistar rats synchronized by controlled conditions of light (0700--1900 hr) and of darkness (1900--0700 hr). Separately in each photo-period the effects of reserpine or 6-OHDA on the cardiac noradrenaline turnover. Whereas peripheral chemical sympathectomy did not greatly affect the diurnal rhythm in the motor activity were investigated. Initial depletion of the cardiac noradrenaline after acute application of either drug was significantly greater when injected at 2000 hr compared to 0800 hr. In both photo-periods the cardiac turnover of noradrenaline was increased after peripheral chemical sympathectomy with 6-OHDA as well as after amine depletion with reserpine. Inhibition of the protein synthesis had no effect, ganglionic blockade by chlorisondamine on the other hand abolished the rhythm in the motor activity, subacute treatment with reserpine differently affected motor activity in both photo-periods, depending on the time of drug application within 24 hr of a day. The results show that diurnal variations in the levels of neuronal and of motor activity are able to influence drug effects and have thus to be taken into account in animal studies.


Impairment of acquisition of a DRL schedule following prolonged ethanol consumption. Two groups of male hooded rats (N = 9) were given either ethanol or sucrose solutions as their only source of fluid for six months. Thirty days after the ethanol treatment, the rats were reduced to 85% of their free-feeding weights and allowed to obtain 45 mg of food pellets on an FR 1 schedule fof five consecutive days. Subsequently, the rats were tested on four DRL schedules (6. 12, 18, 24 sec). There was no difference between the two groups on FR 1 or DRL 6 sec schedules; however, when the DRL interval was lengthened to 12, 18, and 24 sec, the ethanol group required more sessions than the sucrose group to reach criterion performance. After increases in the DRL interval, the modal interresponse time of the ethanol group shifted more slowly than that of the sucrose group.


Rat rotation monitoring for pharmacology research. Much current neuropharmacological research describes drug site of action and effect in terms of rotational behavior in rats. Such studies at the National Institutes of Health led to the development of required instrumentation capabilities. The method developed for quantifying rotational behavior to the exclusion of other locomotor activity is presented. Such full turns counts can be output as mechanical counter inputs, computer inputs, user-selected time interval subtotals, summary totals, or a voltage proportional to cumulative count which provides turning-rate data when recorded on strip-chart. The latter two options are described herein.


A reward-reduction model of depression using self stimulating rats: an appraisal. A potential model of depression using a "reward reduction" technique with intracranial self-stimulation (ICSS) has been suggested. A number of rats with electrodes chronically implanted in the medial forebrain bundle were trained on this paradigm. The model involved the use of progressively increasing fixed ratio (IFR) schedules. Two tricyclic antidepressants, imipramine and protriptyline, were administered. Neither of these drugs resulted in the response enhancement which had been predicted. Only d-amphetamine (0.5 mg/kg) produced the predicted "antidepressant" action. It was concluded that response instability made this test difficult to operate and that even animals with adequately stable baselines did not produce a response pattern which could be categorised as specifically antidepressant.


[Production of granules with controlled drug release rate (author's transl)]. A procedure for microgranulation is described (cf. [7]) which is based on the use of formaldehyde-treated gelatin. The drug (Drotaverin: No-Spa) contained in the matrix is released, dependently of the formaldehyde concentration in the matrix, at a predetermined rate. The release (first-order kinetics) is rapid at low formaldehyde concentrations, and slower at higher formaldehyde concentrations.


The binding of colchicine and its derivatives to bovine and human serum albumin and human plasma. The protein binding of colchicine and its derivatives demecolcine and desacetylcolchiceine was studied by equilibrium dialysis at 22 degrees C and pH 7.38 in bovine and human serum albumin and human plasma. Colchicine and demecolcine (2 X 10(-4) -5 X 10(-4) mol/l) is not bound to proteins. The binding of desacetylcholchiceine was 60--80% in the range 10(-4)-5 X 10(-4) mol/l. The association constant for a single binding site was 8.03 X 10(3) 1/mol for human serum albumin and 13.20 X 10(3) 1/mol for human plasma. The binding profiles for desacetylcholchiceine were quite similar in human serum albumin (4% conc.) and human plasma (3.8% conc. of albumin fraction). We suggest that desacetylcolchiceine was likely to be bound predominantly to albumin. Salicylic acid in vitro, at clinical concentrations (1.8--14.5 X 10(-4) mol/l), significantly decreases the binding of desacetylcolchiceine to human serum albumin.


Sleep deprivation and circadian rhythm in depression. The effect of total sleep deprivation for one night on the depressive state (measured using the depression rating scale of Bojanovsky and Chloupkova) and the patients' actual state of well being (measured using the self-rating scale of von Zerssen) is investigated in a group of 40 randomly selected inpatient depressives (29 endogenous depressives, 11 neurotic depressives) over a period of 36 h. The endogenous depressives exhibited a statistically significant change. The total index of the depression scale improved by 22.6%, recorded as a 'daily mean difference'. The individual symptoms of depressive mood, lack of interest, inhibition and inappetence were significantly improved. The feature of vital disorders and its common appearance with diurnal variations correlates positively with the degree of sleep deprivation effect. The symptomatology of the neurotic depressive patients also showed a significant improvement but the relatively small group of particularly severe neurotic depressives who also exhibited vital disorders is not representative. In a group of cases, sleep deprivation caused reversion in the depressive symptomatology not only during the night of deprivation but influenced the diurnal rhythm of the depressive symptomatology on the following day, in a therapeutically favourable direction. The results are compared with those of other studies. The methodological problems are discussed and methodological improvements for further investigation are proposed.


Retrograde amnesia for old (reactivated) memory: some anomalous characteristics. Old memory, when reactivated by cue exposure, was disrupted by mild or deep hypothermia treatments. New memory was impaired only by deep cooling. Moreover, old but not new learning showed spontaneous recovery. Old reactivated memory may be qualitatively different from newly acquired memory.


Inherited epilepsy: spike-wave and focal motor seizures in the mutant mouse tottering. Mice with the mutant gene tottering (tg, chromosome 8, autosomal recessive) show, in adolescence, abnormal bursts of bilaterally synchronous spike waves as revealed in electrocorticograms recorded over long periods. The spike waves are accompanied by behavioral "absence" attacks and intermittent focal motor seizures showing somatotopic progression. Cerebral metabolic activity during seizures was assayed by autoradiography of brain sections from mice injected intravenously with 14C-labeled 2-deoxyglucose. Metabolic activity was increased bilaterally in selected brainstem structures. Spontaneous electrocorticographic and clinical seizures of this general pattern were recognized hitherto only in humans.


Membrane potential changes during chemokinesis in Paramecium. Intracellular recordings show that (i) paramecia hyperpolarize slightly in attractants and depolarize in repellents that depend on the avoiding reaction (an abrupt change of swimming direction), and (ii) paramecia more strongly hyperpolarize in repellents and more strongly depolarize in attractants that depend on changes of swimming velocity. These membrane potential changes are in agreement with a hypothesis of membrane potential control of chemokinesis in Paramecium.


Thrombotic thrombocytopenic purpura. An extended editorial. A hypothesis for the pathogenesis of TTP is developed, centered on the views and findings of Kwaan (Fig. 8). By a series of deductions, inferences, and extensions, an attempt has been made to define considerably more restrictively than heretofore a TTP paradigm of clinical (Tables 1,2,3) and laboratory (Table 4) features. Revisions may be required in the future as increase of knowledge indicates. By similar methods rational, exigent therapeutic measures are selected (Table 5). The innovative therapeutic use of plasma transfusion, as proposed by Byrnes and Lian and their co-workers, is compatible with the paradigm in all respects. The paradigm discriminates for authentic cases of TTP among spurious if similar entities. Such sequestration will constitute a homogeneous universe of case material appropriate for study. The prospective use of the TTP paradigm defined in this papd therapeutic protocol, jointly developed, may accelerate our knowledge and improve our effectiveness in this lethal, if uncommon, disease [49,76,111,170].


Antenatal intestinal perforation and meconium peritonitis associated with the neonatal small left colon syndrome. Although NSLCS has been considered to have a benign course, we have described an infant who had intrauterine intestinal perforation and meconium peritonitis associated with the NSLCS. Infants of diabetic mothers who are stillborn or who develop abdominal distention shortly after delivery should be suspected of having this complication of NSLCS. This disorder must also be considered in the differential diagnosis of infants who present with meconium peritonitis.


Isolation of keratomycetes from the soil of wild animal cages and enclosures in the zoo of the Parco Nazionale d'Abruzzo, Italy. The keratinophilic fungi present in the soil of wild animal cages and enclosures in the zoo of the "Parco Nazionale d'Abruzzo", at Pescasseroli, Italy were studied. The goal of the investigation was to determine what species of such fungi existed in wild animal habitats in that area and what variation there may be in their frequency in connection with the seasons. The most prevalent fungus was Trichophyton ajelloi, followed in decreasing order by the Chrysosporium species (C. keratinophilum, C. tropicum, C. state of Ctenomyces serratus). The Microsporums were relatively rare. The perfect forms Arthroderma uncinatum, A. quadrifidum, Nannizzia cajetani and Ctenomyces serratus were isolated from plates containing their corresponding imperfect forms. The recurrence of the species present in the soil of each cage and enclosure in April and in July was remarkable.


Primary intraventricular choriocarcinoma. A case of a choriocarcinoma within the third ventricle in an eight-year-old girl is described. The patient died suddenly five days after operation. The post mortem examination showed an intraventricular hemorrhage with obstruction of the foramina of Monroe. An additional case in a 16-year-old young man, with similar location and without necropsy, is described. Discussion of the primary origin and etiology of these tumors is presented.


Repair of small blood vessels with the neodymium-YAG laser: a preliminary report. A technique for repair of incisions in small blood vessels (diameter, 0.3 to 1.0 mm) in the rat is described using a Neodymium-YAG laser. It is possible to seal the incision without the use of sutures and to preserve the lumen of the vessel. The advantages of this technique over electrocoagulation and microsuture techniques are pointed out. Although the work is in preliminary stages, the technique is considered to be relatively safe, and the potential use of the application in human surgery is indicated. The possible complications of this technique are pointed out.


Metastatic cerebral choriocarcinoma without pelvic or pulmonary metastases. A unique case of chorionic carcinoma of the right frontal lobe of the brain with extensive subarachnoid and intracerebral hemorrhage is presented. No pelvic or pulmonary findings by physical or X-ray examination were present. The craniotomy, irradiation and chemotherapy effected a cure. A nephrectomy was necessary during the postoperative period.


The time course of myocardial high-energy phosphate degradation during potassium cardioplegic arrest. Myocardial high-energy phosphate and glucose-6-phosphate levels were determined in the in vivo pig heart model during ischemic arrest and reperfusion to determine the effectiveness of potassium cardioplegia in myocardial protection. Thirty-five pigs were divided into six experimental groups consisting of 2-hour normothermic arrest, 2-hour hypothemic arrest, 2-hour normothermic cardioplegic arrest, and 1-, 2-, and 3-hour hypothermic cardioplegic arrest. Myocardial biopsies from the left ventricle were obtained prior to arrest, every 30 minutes during the arrest interval, and at 30 and 60 minutes of reperfusion. The measurement of adenosine triphosphate and creatine phosphate showed that (1) cardioplegic arrest requires hypothermia to preserve high-energy phosphate levels in myocardial tissue; (2) hypothermia, while not completely protective alone, is more effective than potassium cardioplegia alone in providing myocardial preservation during 2-hour ischemic arrest; (3) the combination of potassium cardioplegia and hypothermia is additive in providing an effective means of maintaining myocardial high-energy phosphate stores during 1, 2, and 3 hours of ischemic arrest; (4) myocardial reperfusion does not allow a return to preischemic adenosine triphosphate (ATP) levels after 2 hours of arrest, except following hypothermic cardioplegia; and (5) extension of the duration of ischemic arrest to 3 hours using hypothermic cardioplegia prevents recovery of high-energy phosphate stores to preischemic levels during reperfusion. Optimal preservation can be achieved during 2 hours of ischemic arrest by using hypothermic potassium cardioplegia. The effects of myocardial reperfusion, however, prevent full ATP and creatine phosphate (CP) recovery following 3 hours of arrest. No other technique studied was as effective in providing myocardial preservation.


Angiogenesis capacity as a diagnostic marker for human eye tumors. Solid tumors have the capacity to continuously stimulate the proliferation of new capillaries. Aliquots (0.1 cc) of aqueous humor were aspirated from the anterior chamber of the eye of 38 patients undergoing elective ophthalmologic surgery. The material was lyophilized and then inplanted on the chorioallantoic membrane (CAM) of 10-day-old chick embryos for bioassay. The angiogenesis capacity of each sample was graded as negative or positive. Nine of 10 patients with histologically proven retinoblastoma had positive vascular responses. Seven of 11 patients with choroidal malignant melanoma had a positive response to their aqueous humor on the CAM. Aqueous samples from eyes with an iris and ciliary body malignant melanoma and a metastatic breast carcinoma to the iris had a positive angiogenic response. By contrast, only one of 15 patients undergoing operation for cataracts, glaucoma, or other nonmalignant ocular disease showed an angiogenesis response. The one patient who a positive assay later developed lymphocytic leukemia. These studies show that certain intraocular tumors display angiogenesis capacity before clinically evident neovascular changes of floating tumor cells are seen. Patients without tumors showed no angiogenesis response.


[Incidence of hypomagnesaemia in dry cows (author's transl)]. In the late summer and early autumn of 1977, seven cases of milk fever were observed on a dairy farm. It was believed that condition was most likely to be due to preparturient hypomagnesaemia. Therefore the magnesium levels in the blood and urine of both lactating and non-lactating cows were determined in this herd during several months.


Substrate properties influencing ultrastructural differentiation of mammary epithelial cells in culture. Epithelial cells dissociated from mammary glands of midpregnant mice and cultured with lactogenic hormones on plastic or collagen gel substrates have been shown to vary in their extent of differentiation, as identified by the presence of secretory organelles and accumulation and secretion of casein. Morphological and biochemical differentiation was obtained on floating collagen gels. At least four unique factors provided by the floating collagen gel substrates are not found on plastic substrates: access of nutrients to basolateral cell surfaces, close proximity of cells to the medium surface and gas phase, interaction of epithelial cells with stromal elements, and substrate flexibility permitting cell shape change. In this study, we have attempted to assess the relative contributions of these factors in the ultrastructural differentiation of mammary cells in culture. None of these factors alone is responsible for the differentiation achieved when all are present. The novel aspect of this research is the identification of the cells' apparent requirements for basolateral access to nutrients and for freedom to assume a preferred shape in order to achieve differentiation.


An outbreak of malignant catarrhal fever in red deer (Cervus elephus). Nine of 15 housed red deer developed an acute disease. Six died and three were killed when severely affected. The clinical and post mortem changes suggested a diagnosis of malignant catarrhal fever (MCF) which was consistent with the pantropic lymphoproliferative histopathological lesions observed. Attempts to isolate an agent or transmit the condition to cattle failed. The relation of the vasculitis to the pathogenesis of the disease and the susceptibility of red deer are discussed.


Plasmapheresis for thrombotic thrombocytopenic purpura (TTP). A 70-year-old woman with thrombotic thrombocytopenic purpura (TTP) was treated with plasmapheresis using fresh frozen plasma as a fluid replacement. Complete recovery and lasting remission were observed. It appears that plasmapheresis combined with massive fresh frozen plasma can be an effective mode of treatment for patients who were, otherwise, refractory to conventional therapy.


[Twenty-five years' experience in epidemiology and prophylaxis of epidemics at the Centre for Salmonella of Hamburg (author's transl)]. Salmonella-epidemiology has changed fundamentally since underdeveloped countries have entered international trade and export food-supplies which, due to less stringent controls, are already contaminated either in the countries of origin or in transit. This is shown by numerous case histories of food-poisoning. Multifarious causes of infection from imported food-stuffs are exposed and also the epidemiological consequences from latently infected fat-stock and poultry. Prophylactic measures and advice on preventive treatment are given. The progressive automation in many factories and plants, with aspirations to the highes-degree of efficiency, frequently hides potential sources of infection with a shining facade of chrome and plastic. In the planning and servicing of technical installations, which later may well prove to be a source of infection, sanitary experts are rarely consulted, or if so too late. This paper also emphasises the considerable influence of mass-tourism with the consequent introduction of exotic Salmonella serotypes, and also the potential danger of faeca contamination on motorway rest-stops.


[Hemolytic properties of activated (adhesive) peripheral blood lymphocytes from schizophrenia patients]. The hemolytic properties of adhesive and nonadhesive lymphocytes in the blood of schizophrenic patients and normal donors were studied. It was  demonstrated that adhesive lymphocytes possess hemolytic properties. It was shown as well, that the content of hemolytic active lymphocytes in the adhesive fraction of peripheral blood cells in schizophrenic patients is ten times higher than in a similar cell fraction of normal donors.


[Evoked potentials during elaboration of fine differentiations]. The paper deals with the character of changes in the EP form recorded from the visual cortex of a rat during elaboration of a system of positive and negative (with different degree of precision) conditioned defensive reflexes. It has been shown that in a state of a consolidated habit of pain stimulus avoidance in a shuttle box a negative component with peak latency up to 70 msec develops in EP to the differentiation stimulus of 0.5 c/s. This component is much less pronounced to the 2 c/s conditioned stimulus. When a more precise differentiation stimulus (1 c/s) was presented to the animal in this state the development of the studied component depended on the subsequent behavioural reaction: it developed if the animal reacted in the same way as to the differentiation stimulus. This fact suggests that the generation of this component is connected with the inhibitory processes developing at the time when the animal is choosing its behavioural reaction.


[Psychotropic effect of Elroquil].

[Psychotropic effect of Elroquil]. The psychotropic effect of Elroquil has been studied in 13 cats (8 of them having electrodes implanted in the hypothalamus). Diazepam was used as the reference drug. By electrical stimulation of the brain structures various states of excitation, such as rage, anxiety, restlessness and negation could be provoked. Evaluation was made by a scoring scale and multivector analysis. When administered in doses of 15--20 mg/kg, Elroquil had a reliable tranquilizing effect, without any negation occurring. Only in doses of 40 mg/kg had aggressiveness and rage to be subdued. However, a neurosis-like condition could not be managed. Characteristically, Elroquil neither changed the group behavior of the animals, nor eliminated conflict situations. Ataxia was not stimulated. The vegetative correlation of emotional strain was changed in length but not in intensity.


[Comparative analysis of the stability of cardiovascular system functions in immobilized rats of different strains]. The dynamics of arterial pressure and heart rate was studied in rats of different genetic lines (non-linear, Wistar, Way and August) during immobilization emotional stress. Different lines were characterised by different stability and ability of adaptation to emotional stress. Prognostic criteria were specified that enable to foresee at an early stage of emotional stress the disturbances of cardio-vascular control. The conclusion is made that resistancy against cardio-vascular disturbances during emotional stress is of genetic nature as well as may be due to characteristics of individual growth.


Interaction of daily injections and subcutaneous reservoirs of melatonin on the reproductive physiology of female Syrian hamsters. This study investigated the ability of continuously available melatonin (from sc melatonin-beeswax pellets that were implanted bi-weekly) in overcoming the antigonadotrophic action of single daily melatonin (25 microgram) injections given late in the light period to female Syrian hamsters kept in light:dark cycles of 14:10. The melatonin-beeswax pellets contained either 1, 50, 500 microgram, 1 or 10 mg melatonin and 25 mg beeswax. Daily melatonin injections into hamsters implanted with beeswax only caused vaginal acyclicity in 60% of the animals within 6 weeks. After 10 weeks of treatment, uterine weights and pituitary levels of immunoreactive prolactin were still greatly depressed. Beeswax pellets containing either 500 microgram, 1 or 10 mg melatonin overcame the inhibitory effects of daily melatonin injections. Thus, the vaginal cycles and pituitary hormone levels of these animals were indistinguishable from those of untreated control animals. Beeswax pellets containing either 1 or 50 microgram melatonin were incapable of counteracting the antigonadotrophic effects of daily injections of melatonin. This is the first report that continuously available melatonin can negate the effects of daily injections of melatonin in female hamsters. When measured after 10 weeks, none of the treatment procedures significantly influenced circulating levels of luteinizing hormone or prolactin.


Influence of ethanol and dexamethasone on blood-brain barrier dysfunction to albumin. Stab-wounded ethanol-intoxicated and non-intoxicated rats were studied with respect to the effect of postoperative dexamethasone treatment on blood-brain barrier dysfunction to bovine albumin. In ethanol-intoxicated rats, fluorescence microscopy revealed an increased area of extravasation of fluorescent tracer, compared to non-intoxicated ones. No significant effect of dexamethasone treatment was observed in non-intoxicated rats. In ethanol-intoxicated rats, dexamethasone treatment resulted in a decreased area of extravasation. Quantitative immuno-electrophoretic measurements of exogeneous bovine albumin confirmed a significant decrease of blood-brain barrier dysfunction to albumin after dexamethasone treatment in ethanol-intoxicated rats, while no significant effect was observed in non-intoxicated ones.


Reduction of bladder contractility after alpha-adrenergic blockade and after ganglionic blockade. Seven spinal cord injured patients were evaluated with cystometry bladder, electromyography, and pressure profiles  of the external urethral sphincter before and after phenoxybenzamine administration. Seven more patients were evaluated before and after mecamylamine administration. Both drugs reduced the contractility of the bladder. The reduction of bladder contractility may reflect decreased sympathetic stimulation to the bladder. Bladder electric potentials reflect the intrinsic tone of the detrusor muscle.


Corneal endothelial cell density in iridocyclitis. The endothelial cells of both eyes of 60 unilateral iridocyclitic patients were photographed with a specular microscope to establish the possible effect of iridocyclitis on corneal endothelial cells. Chronic severe iridocyclitis with mutton-fat keratic precipitates (KP) lowered the central endothelial cell count. Five patients out of the seven with mutton-fat KPs had a distinctly lower central cell density in the affected eye. In the remaining patients, no significant difference in cell densities could be demonstrated between affected and healthy eyes. Neither the inflammatory process itself nor the round white KPs had a deleterious effect on the central corneal endothelial cell densities.


Isolation of a glycopolypeptide fraction with Lactobacillus bifidus subspecies pennsylvanicus growth-promoting activity from whole human milk casein. Human milk casein samples were digested with trypsin and chymotrypsin, and a glycopolypeptide fraction was isolated from the soluble portion of the digests by a series of gel filtration steps. The glycopeptide fraction stimulated the growth of Lactobacillus bifidus subspecies pennsylvanicius to the same extent as a whey glycopolypeptide fraction previously isolated (Pediat. Res. 10: 1, 1976). It contained between 60 and 70% carbohydrate consisting of galactose, galactosamine, glucosamine, fucose, and sialic acid. This, along with its apparent molecular weight of near 30,000 was also similar to the respective parameters of the whey glycopolypeptide. It is proposed that human milk casein may serve a dual function: that serving the nutritional needs of the breast-fed infant, and that stimulating the growth of L. bifidus subspecies pennsylvanicus. Additionally, the whey glycopolypeptide may arise from casein through proteolysis by an endogenous milk protease.


Vitamin A transporting plasma proteins and female sex hormones. Retinol-binding protein, prealbumin, and sex steroid plasma levels have been estimated daily in four women during the course of a normal menstrual cycle and in three women during treatment with combined oral contraceptives. The retinol-binding protein level showed a bicyclic variation during the menstrual cycle, whereas for prealbumin no consistent pattern of variation was observed. Oral contraceptive therapy induced a significant increase of retinol-binding protein which was correlated with the increase of vitamin A. The increase was about 35% for the formulation containing synthetic estrogen as compared with 15% for the one with natural estrogen. In relation to retinol-binding protein, the plasma level of prealbumin showed a less rapid increase but the final increment after oral contraceptive therapy appeared to be of the same magnitude for both proteins.


An evaluation of currently available methods for plasma fibrinogen. Fibrinogen levels in a variety of clinical plasma samples were assessed concurrently by several methods. Technics that appeared to provide the best improvements over the basic varieties of methods for fibrinogen assay were used. Results were correlated against a reference method based on Ancrod clottable fibrinogen and calibrated by ultraviolet absorbance with alkaline solutions of carefully dried fibrin standard. The best correlations with the reference method were achieved by an immunologic method using the Centrifichem principle and by heat precipitation with quantitation by packing in microhematocrit tubes. A modified clot opacity method also gave acceptable results. The turbidimetric ammonium sulfate and sodium sulfite precipitation methods correlated less well with the reference method, and in particular, the sodium sulfite technic gave high apparent fibrinogen levels with jaundiced plasmas. Neither of the turbidimetric methods were useful for fibrinogen levels below 50 mg/dl. The thrombin time method showed excellent sensitivity to fibrinogen, even at very low fibrinogen levels, but did not correlate well with the reference method.


Aggregation of blood pressure in the families of identical twins. The multiple relationships which exist within families of adult monozygotic (MZ) twins permit evaluation of genetic and environmental variance and provide a direct test of maternal effects. Systolic blood pressure (SBP) was measured in 610 members of the families of 76 MZ twin pairs. Age and sex effects on BP were removed via a Z-transformation. Correlations for SBP were .72 for MZ twins and .23 for full siblings. Regression of offspring on single parent was .26. The husband-wife correlation was significant, but it was no higher than the resemblance of a twin to the spouse of his co-twin. Comparisons of maternal and paternal half-siblings provide no evidence of maternal influences on SBP. To evaluate whether familial resemblance of BP is mediated by body size, the original systolic pressures were adjusted by stepwise multiple regression of age, sex, height, weight and skinfold thickness. Adjusting BP for effects of body size reduced regression of offspring on mid-parent from .40 to .23. The authors conclude that familial aggregation of systolic pressure reflects additive genetic variance mediated, in part, by body size and augmented by social homogamy arising from non-random mating.


Detection of genetic variance in blood pressure of seven-year-old twins. Results from twin studies in older children and adults indicate that there is significant genetic variance for blood pressure (BP). Utilizing date which were collected in 12 US university-affiliated hospitals in 1966-1973 in the Collaborative Perinatal Project (NCPP), the authors sought to determine if the effects of heredity on BP variability are apparent in younger twins. BP was determined in 197 pairs of like-sexed twins at seven years of age. Significant genetic variability for diastolic blood pressure (DBP) was found in the twins, with a heritability estimate of 0.53. Systolic blood pressure (SBP) results tended in the same direction but were not statistically significant. The trends were comparable for both sexes and races. These findings suggest that even at a young age substantial genetic influences on DBP variability are detectable.


Posttransfusion purpura: therapeutic failure of PlAl-negative platelet transfusion. The effect of platelet type-specific transfusion in posttranfusion purpura is reported. Seven days after receiving 4 units of whole blood during total hip replacement a 69-year-old woman developed fulminant thrombocytopenic purpura. Her undiluted serum inhibited the clot retraction of PlAl-positive but not PlAl-negative blood. Anti-PlAl titer of her serum, determined by 51Cr platelet lysis technique, was 1:64. The serum had no lytic activity against platelet-rich plasma from two PlAl-negative donors. No anti-HLA antibody was detectable in the serum by lymphocytotoxicity technique, and serum obtained prior to transfusions had no platelet lytic activity. Four units of PlAl-negative platelet concentrate were administered, the first instance in which this treatment has been used. No rise in platelet count ensued, and the patient succumbed to purpura. Exchange transfusion or plasmapheresis remain the treatments of choice.


Ovarian hyperandrogenism with normal and abnormal histologic findings of the ovaries. Thirty-one patients with clinical features of polycystic ovary syndrome (PCO) were studied to determine the correlation between biochemical and histologic findings. The biochemical features investigated were the effects of adrenocortical and ovarian suppression by dexamethasone and oral contraceptives (Ovulen) on plasma free androgens. Four patients showed a histologic picture consistent with PCO (Group A), and five had histologically normal ovaries (Group B). The remaining 22 patients had no tissue available for histologic examination (Group C). The baseline values of plasma free testosterone (FTel) were higher and those of testosterone-binding globulin (TeBG) were lower (p less than 0.05) in Group A than in Group B, although plasma total testosterone (T) and the free 17beta-hydroxysteroid androgen index (FHSl) were similar in the two groups. During dexamethasone administration in all study groups, T and FTel fell slightly (17.7% to 33.8%), and FHSl levels decreased moderately (36% to 46.6%); in no case did both indices of free androgen levels fall to the normal range for dexamethasone-suppressed women. However, no change was noted in TeBG in all three groups. On the other hand, Ovulen treatment suppressed T and free androgens to normal in all groups, and raised TeBG more than 350% from the baseline. These data suggest a decrease in androgen production. The effects of dexamethasone and Ovulen on all three groups were similar in percent changes. As Group B patients resemble those of Group A biochemically and clinically, except for possibly being less hyperandrogenic, the concept of ovarian hyperandrogenism should be expanded to include patients with no anatomic ovarian abnormality, particularly in milder cases.


Sexual behavior and response in relation to complications of pregnancy. A detailed written questionnaire survey of 155 puerperas is reviewed. Sexual and obstetric data were examined for possible associations leading to premature or low-birth-weight infants. Among 25 patients delivering premature infants (16 with babies weighing less than 2,500 grams), no significant association could be made between coitus, orgasm, and/or other sexual experiences and the proximity to the onset of labor. Orgasmic patients appeared to have a consistently lower percentage of early deliveries. No particular method of sexual gratification was unique except that masturbation was consistently associated with a lower risk of prematurity throughout various stages of gestation. Speculations are advanced to explain these observations. Sexual activity appears to be safe throughout pregnancy in almost all patients. Ruptured membranes on admission may be associated with recent sexual stimulation without orgasm.


Anterior segment metastases from an ovarian choriocarcinoma. A 28-year old woman with ovarian choriocarcinoma developed a uveitis in her left eye. Subsequently, a mass was observed in the anterior segment of that eye together with a subconjunctival mass that appeared to extend from it. Biopsy of the subconjunctival nodule showed two different cell types consistent with the cytotrophoblastic and syncytiotrophoblastic elements typical and choriocarcinoma. No abnormalities of the posterior segment were found on careful examination. Treatment consisted of systemic chemotherapy with a variety of therapeutic agents, argon laser photocoagulation of tumor seedings in the anterior chamber angle, radiation to the eye, and finally, subconjunctival injections of methotrexate. The eye became blind and painful and was enucleated. Histopathologic examination revealed residual tumor cells in the anterior segment indicating treatment changes, but there were no abnormalities posteriorly. Choriocarcinoma metastatic to the eye has been reported infrequently, and this is the first case in which anterior segment metastases have been observed and the effects of treatment thoroughly documented.


The addictions as pathological mourning: an attempt at restitution of early losses. Drug abuse is an attempt to resolve through the use of chemicals the psychic disequilibrium caused by intrapersonal (narcissistic) losses. The chemical equilibrium creates a false sense of quiet which retards the completion of the process of mourning for these losses. Due to the unconscious need to express these losses, addicts pick up clothing styles, behavior patterns, and grooming habits from the Judeo-Christian mourning and black ghetto rituals. In order to successfully give up the drug, the addict must resolve his grief by completing the stages of mourning in the process of group therapy.


Neurologic complications following the treatment of human Babesia microti infection with diminazene aceturate. A 65-year-old man infected with Babesia microti failed to respond to therapy with oral chloroquine phosphate. He was then successfully dreated with diminazene aceturate, an experimental anti-protozoal agent. After his recovery from babesiosis, the patient developed acute idiopathic polyneuritis (Landry-Guillain-Barré Syndrome), which was probably related to his diminazene therapy.


Kinetics of Dipetalonema viteae infections established by surgical implantation of adult worms into hamsters. Native LVG strain hamsters were infected with Dipetalonema viteae by the surgical implantation of adult worms. Groups of hamsters received either 50 male, 50 female, 50 male plus 50 female or 25 male plus 25 female worms per hamster. Approximately 50% of the transferred worms became established in the recipient hosts regardless of the number or sex of the worms implanted. Microfilaremia occurred in recipient hamsters within 1 week after the transfer of female or male plus female worms. This microfilaremia became negative on week 9 post-transfer and no microfilaremia developed in these hamsters following a secondary challenge infection of male plus female worms. Hamsters whose primary infection consisted solely of male worms developed a microfilaremia when challenged with male plus female worms.


Niclosamide as a treatment for Hymenolepis diminuta and Dipylidium caninum infection in man. In the 5-year period 1973-1977, 43 patients infected with Dipylidium caninum and 43 patients infected with Hymenolepis diminuta were treated with Yomesan (niclosamide) in the dosages recommended by the Parasitic Disease Drug Service, Center for Disease Control. The first post-treatment stool specimen and 1-week and 3-month specimens were examined in 13 patients with D. caninum and 19 patients with H. diminuta. One hundred percent (13/13) of those with D. caninum and 89% (17/19) of those with H. diminuta had negative examinations at 3 months and were considered cured. Two patients with persistent H. diminuta were cured with a second course of drug without changing the dosage or time schedule. Four of these cases had been unresponsive to an initial course of quinacrine hydrochloride. Thus, niclosamide seems to be an effective, relatively nontoxic drug for the initial therapy of these cestode infections.


Echinococcus vogeli in man, with a review of polycystic hydatid disease in Colombia and neighboring countries. Three cases of polycystic hydatid disease (PHD) from Colombia are reported and 11 others from the region are reviewed. When cysts from two patients were fed to a dog and an ocelot about 250 mature and gravid specimens of Echinococcus vogeli and two poorly developed strobilae, respectively, were recovered. These human cases constitute the first record of the larval stage of E. vogeli, previously known only from the strobilar stage in the type host, the bush dog (Speothos venaticus). Based on the morphological characteristics of the protoscolex rostellar hooks from other PHD cases (6 Colombian, 1 Ecuadorian, and 1 Panamanian), it was concluded that all were also due to E. vogeli, rather than to E. oligarthrus as had been previously suggested. Although E. oligarthrus is or may be present in the same areas, so far no human infection due to this parasite has been confirmed. Of the 14 cases reported, 13 were pathologically proven to be PHD. Clinically, eight had an undiagnosed tumor-like mass in or near the liver, one had a subcutaneous mass in the anterior sixth intercostal space, and in two the cysts were in the chest. Two were autopsy findings. In contrast to E. multilocularis, the cysts produced by E. vogeli were found to be relatively large and filled with fluid; brood capsules and protoscolices were numerous. Focal necrosis was commonly observed but large necrotic cavities were not seen. The main natural intermediate host is the paca (Cuniculus paca); man probably obtains the infection by contamination from feces of infected hunting dogs.


The effects of chronic disulfiram treatment on mice infected with Schistosoma mansoni. Compounds which block the formation of the egg shell in female schistosomes are thought to have chemotherapeutic value. One of these compounds, disulfiram, when given chronically in the diet produced a 60% reduction in the mortality of mice carrying a heavy schistosome burden. This reduction in mortality was associated with an 80% decrease in granuloma formation. On the other hand, there was no decrease in the amount of periportal inflammation in drug-treated animals. While the use of this drug results in significant amelioration of schistosomal pathology, its effects are rapidly reversible, thus severely limiting its chemotherapeutic potential.


A longitudinal study of schistosome vector snail populations in Liberia. Seasonal changes in populations of Biomphalaria pfeifferi and Bulinus globosus were observed at 62 locations in Liberia, West Africa. All varieties of water in both urban and rural locations were sampled. A wet season decrease and dry season increase of B. globosus populations in both urban and rural locations, similar to that reported elsewhere in West Africa, was observed. Similar fluctuations of B. pfeifferi populations were noted. The prevalence of schistosome infected vector snails varied markedly between rural and urban locations. At rural sites parasite prevalence followed the appropriate vector snail prevalence. At urban sites a portion of the vector snail population appeared relatively unaffected by seasonal changes. This stable population harbors a reservoir of infected snails that sustain year round transmission. Human infection was sampled in school children in the study area and prevalence of approximately 50% was found for both Schistosoma mansoni and S. haematobium. Added to the malacologic information this suggests less than hyperendemic transmission. The data suggest that urban environments should receive priorities for control programs.


A new form of abdominal zygomycosis different from mucormycosis: report of two cases and review of the literature. Two cases of abdominal zygomycosis occurring in apparently healthy individuals are presented. They had chronic evolution and histologic aspects similar to those found in subcutaneous zygomycosis. In both cases there was involvement of stomach and transverse colon. In one case the liver, biliary system, pancreas, and duodenum were also involved. Fungal cultures were negative. These cases apparently represent a new form of zygomycosis because, although visceral in localization, the disease presents an evolution and histologic features different from the classical form of visceral zygomycosis. Since this infection can be treated the importance of early diagnosis is stressed.


Sodium nitroprusside: hemodynamic dose-response during enflurane and morphine anesthesia. To date there has been no description of the hemodynamic dose-response relationship between enflurane and sodium nitroprusside (SNP), although these drugs are often used together to induce deliberate hypotension. Utilizing aortic root cannulation and thermistor-tipped pulmonary artery catheters, this relationship was studied in six beagles during 1 and 2% enflurane anesthesia and compared with the hemodynamic response induced by SNP in the awake state and during anesthesia with intravenous morphine (6 mg/kg). Each animal received a standard infusion of 100 microgram/kg of SNP administered at three different flow rates (5, 10, and 20 microgram/kg/min). SNP infusion resulted in dose-related reductions in mean arterial pressure, systemic vascular resistance and left ventricular stroke work, whereas cardiac output increased. Enflurane potentiated the hypotensive effects of SNP in a dose-related fashion. During morphine anesthesia, however, the hemodynamic effects of SNP were virtually indistinguishable from those observed in the awake state.


The hemodynamic effects of halothane in anemic dogs. Hemodynamic dose-response curves and MAC, apneic and lethal concentrations for halothane were determined in two groups of dogs at a normal hematocrit (Hct) (39 +/- 6), and during acute anemia (n = 4) and subacute anemia (n = 4), with a combined Hct of 18 +/- 6. The ratio of subendocardial/subepicardial blood flow was determined by the injection of radioactive microspheres. MAC, apneic, and lethal concentrations of halothane were not significantly different in anemic animals. There were also no differences in the halothane dose-response curves plotted for cardiac output, blood pressure, heart rate, left ventricular end-diastolic pressure, or arterial base excess. In 32 microsphere injections with Hct as low as 13, no dog had redistribution of myocardial blood flow suggestive of subendocardial ischemia. We conclude that halothane is a safe anesthetic during severe anemia.


Anesthesiology and the graduating medical student: a national survey. Each year, many anesthesiology housestaff positions remain vacant or are filled by foreign medical graduates. While possibly reflecting an overabundance of such housestaff positions, this situation also suggests a lack of U.S. student interest in anesthesiology. To investigate this phenomenon, the authors conducted a survey of American medical school graduates of 1976. The results reveal that 65% of students receive minimal or no systematic exposure to anesthesiology or anesthesiologists. When such exposure occurs, it comes after many students have developed strong specialty preferences. Many students saw anesthesiology as limited in scope and unchallenging and indicated that they did not select anesthesiology because it entails insufficient primary patient care. Contrasts between those entering and not entering anesthesiology suggest, however, that certain variables which are subject to manipulation--such as amount, timing, and content of exposure to anesthesiology--could alter student attitudes and potentially generate increased student interest in the specialty.


Cardiovascular effects of fentanyl during enflurane anesthesia in man. The cardiovascular effects of three doses of intravenous fentanyl (50, 100, and 200 microgram) were determined in 42 adult patients undergoing intraabdominal surgical procedures with enflurane (2--3%) and nitrous oxide (50%) in oxygen. Fentanyl was administered a minimum of 40 minutes after induction of anesthesia and 30 minutes after initiation of the surgical procedure. Stroke volume, heart rate, cardiac output, mean arterial and central venous blood pressures, and peripheral arterial resistance were determined by computer analysis of the central aortic pulse-pressure curve according to the method of Warner. Measurements were made before and 2, 4, 6, 8, and 10 minutes after fentanyl. Fentanyl (50 microgram) produced increases in stroke volume and cardiac output as well as a decrease in peripheral arterial resistance but did not alter heart rate or mean arterial blood pressure. Fentanyl (100 microgram) did not significantly change any variable at any time. Fentanyl (1l (200 microgram) produced sustained decreases in stroke volume, cardiac output and mean arterial blood pressure and increased central venous pressure but did not alter heart rate or peripheral arterial resistance. The data indicate that fentanyl (50--100 microgram) stimulates or has no effect on cardiovascular dynamics during enflurane-nitrous oxide anesthesia but fentanyl (200 microgram) produces significant cardiovascular depression. Our findings suggest that small doses of intravenous fentanyl may be of benefit during enflurane-nitrous oxide but larger doses should probably be avoided.


Enflurane and methoxyflurane metabolism at anesthetic and at subanesthetic concentrations. In an attempt to determine the importance of concentration of an anesthetic agent as a determinant of the extent of its biotransformation, we measured fluoride excretion in groups of Fischer 344 rats treated with one of several subanesthetic or an anesthetic concentration (1 MAC) of either enflurane or methoxyflurane. Anesthetic administrations (2.0% enflurane or 0.26% methoxyflurane) ranged from 0.15 hours (9 minutes) to 4.8 hours. Subanesthetic exposures, all of 48 hours duration, ranged in concentration from 0.2% enflurane to 0.0016% methoxyflurane. Greatest metabolism occurred at the lowest concentration time (MAC-hours) of subanesthetic administrations and at the shortest duration of anesthetic exposure. Increasing time in the case of anesthetizing exposures, or concentration in subanesthetic exposures, increased the amount of metabolite produced. However, the increased production of metabolite was not proportional to the increase of concentration or duration of exposure. Enzyme induction was ruled out as an important factor in the larger amount of metabolism seen during the subanesthetic exposures. Therefore, the exposure of a patient to the metabolites of an anesthetic is actually low although the anesthetic is administered at a high concentration.