Insulin-stimulated bile formation in cats. The effects of insulin on bile flow and composition were examined in fasting, chloralose-anesthetized cats. Insulin in doses from 0.01 to 2.00 U/kg increased bile flow and biliary erythritol clearance without any detectable change in the difference between them; thus insulin presumably had no effect on ductular fluid transport. Continuous infusion of insulin (0.8 U/kg+0.05 U/kg/min or 0.05 U/kg+0.002 U/kg/min) increased biliary erythritol clearance by 22%. The increase was caused by a rise in the bile acid-independent fraction of bile production and accompanied by a parallel increase in the rates of biliary excretion of Na+ and Cl-. When ouabain, 80 micrograms/kg, was injected intraportally during insulin infusion the erythritol clearance, bile flow and the rates of biliary excretion of Na+ and Cl- were lowered towards but not to their preinsulin levels. The effects of insulin on these parameters were unchanged after atropin or gastrectomy and 2-Deoxy-D-Glucose was without effect on bile production. The results indicate that administration of insulin affects bile formation by stimulating the active transport of sodium across the canalicular membrane.


Circulatory and metabolic effects in the brain induced by amphetamine sulphate. Cerebral circulatory and metabolic effects of amphetamine sulphate (0.25-25 mg.kg-1 i.v. or 5-10 mg.kg-1 i.p.) were studied in anesthetized, paralyzed and artifically ventilated rats. Cerebral blood flow (CBF) was measured with a modification of the Kety and Schmidt (1948) technique, and oxygen consumption (CMRO2) was calculated from CBF and arteriovenous differences in oxygen content. Regional CBF was evaluated from the uptake of 14C-ethanol. Cortical metabolites were analysed following freezing of tissue in situ. Amphetamine administration gave rise to a marked increase in CBF that was doubled following 0.25 mg.kg-1 and increased 4-fold following 15 mg.kg-1. However, such excessive increases in flow were confined to frontoparietal cortical regions, while other cortical or subcortical areas showed more moderate hyperemia. The increase in CBF was unrelated to changes in arterial PCO2, blood pressure, or tissue lactate content. CMRO2 increased by 30% to 95% depending on dose and rat strain used. At all doses employed, amphetamine gave rise to glycogenolysis in cerebral cortex but, in animals studied within the first 30 min after 5 mg.kg-1, or less, the only other changes were increases in glucose-6-phosphate and alpha-ketoglutarate concentrations. When the dose was increased to 15 mg.kg-1, there were moderate increased in lactate concentration and lactate/pyruvate ratio. Sixty min after 5 mg.kg-1 there were increases in tissue concentrations of pyruvate, citric acid cycle intermediates and alanine, as well.


The extracellular potassium concentration in brain cortex following ischemia in hypo- and hyperglycemic rats. The extracellular potassium concentration, [K+]e, was measured in the brain cortex of hypo-, normo- and hyperglycemic rats following brain ischemia. The increase in [K+]e in control rats could be characterized by 3 phases: an initial slow rate of rise where the [K+]e rose in 2 min from 3 to 9 mM followed by an abrupt, steep increase to 60 mM within 10 s and finally a slow rise to 80 mM. In the hyper- and hypoglycemic rats the same pattern appeared, but there were significant differences in the time course. The duration of the initial phase was approximately doubled in the hyperglycemic and halved in the hypoglycemic group. The [K+]e at which the steep increase was elicited was 8--10 mM in all groups. It is concluded that the duration of the initial phase is dependent upon available stores of glucose in the brain.


Electric activity of rat anterior pituitary cells in vitro. Regenerative responses were seen in most cells either after cessation of an inward current pulse or during an outward current pulse. Two cell groups were distinguished electrophysiologically. Type I cells showed action potentials with maximum rate of rise of 21.2+/-9.0 V/sec (mean+/-S.D., n=19), while type II cells generated small graded depolarising responses with maximum rate of rise less than 3 V/s. The resting potentials of type I and II cells were 31.8+/-14.9 mV (n=19) and 41.7+/-9.8 mV (n=31), respectively. The steady-state current/voltage relationship was linear for both cell types when the membrane potential was more negative than -60 mV. An outward rectification appeared when the membrane potential was more positive than -40 mV. The input resistance was smaller in type I cells (274+/-212 Momega, n=19) than in type II cells (1 112+/-456 Momega, n=16). Even in Na-free solution regenerative responses were observed in most cells. When the Ca2+ concentration was increased tenfold to 24 mM, the maximum rate of rise of the off-response increased from 1.9+/-0.8 V/s (n=11) to 5.7+/-2.12 V/s (n=5). All-or-none action potentials could be evoked in this Ca2+ rich solution. Action potentials of similar maximum rate of rise could be evoked after replacing 24 mM Ca2+ with isomolar Sr2+. Prolonged action potentials were seen after subsitution of Ca2+ for Ba2+. It is concluded that action potentials in most anterior pituitary cells have a Ca component, which in type I cells is additional to a Na component.


Blood flow distribution in the renal portal system of the intact hen. A study of venous system using microspheres. The blood flow in the renal portal system of intact hens was characterized by determining the fractional distribution of 15 microns and 50 microns microspheres in this system after injection into a leg vein. Validation tests showed that only 50 microns spheres gave reliable estimation of this distribution. The blood flow in the coccy-geomesenteric vein was directed towards the liver in nearly all cases. On the average 44, 47 and 8% of the portal blood from the external iliac vein perfused the ipsilateral kidney, the liver and the lungs, respectively. However, the distribution of portal blood to these organs varied considerably between individuals and changed appreciably within 35 min in half the animals studied. The reason for these variations is not clear. The portal blood from the right and left external iliac veins was asymmetrically distributed in most animals illustrating the importance of local factors in its regulation. Variation was great in the regional distribution of portal blood within the kidney possibly due to local vasoconstriction of portal vessels. Further information e.g. on the regulation of renal portal blood flow is needed to explain its physiological significance. Microspheres provide a convenient method for such studies. A combination of microsphere and Sperber techniques allows us to determine the renal excretion efficiency of a given substance.


Effects of pindolol, sotalol and the optical isomers of propranolol on muscle action potentials and depolarization-secretion coupling in the rat. Muscle action potentials and miniature end-plate potential frequency were studied in different concentrations of pindolol, d- and l-propranolol and sotalol using intracellular microelectrode recording from rat phrenic nerve-diaphragm preparations. d-and l-propranolol at concentrations of 10 to 40 mg/l and pindolol at 20 to 100 mg/l slowed down the rate of rise, prolonged rise and half-decay times and reduced the overshoot of the muscle action potentials. Sotalol had similar effects but only at higher concentrations (100 to 200 mg/l). The drugs had no effect on the increase in the miniature end-plate potential frequence obtained with depolarization by increased extracellular potassium concentration.


Estrogen and the relaxant effect of intramural noradrenaline on calcium induced contractures in depolarized rat uterus. The influence of intramural noradrenaline on calcium induced contractures was studied in isolated preparations of rat uterus. The depolarized (127 mM KCl) myometrium of oophorectomized rats responded with contraction followed by a transient relaxation when exposed to 3 mM calcium. The threshold concentration of calcium, where the transient relaxation began to appear, was between 0.25 and 0.5 mM. Blockade of the beta-adrenoceptors with propranolol or noradrenaline depletion with reserpine completely removed the transient relaxation, indicating that the latter was due to release of intramural noradrenaline. Estrogen treatment abolished the relaxant effect of intramural noradrenaline, whereas progesterone was ineffective in this respect. Preparations from rats in natural estrus responded like estrogenized tissues, and diestrus preparations behaved as uteri of oophorectomized rats without estrogen treatment.


Prostaglandin-mediated inhibition of noradrenaline release: IV. Prostaglandin synthesis is stimulated by myocardial adrenoceptors differing from the alpha- and beta-type. The release of prostaglandin E elicited by sympathomimetic amines was studied in the isolated rabbit heart. The hearts were prepared according to Langendorff, with conventional recording of stroke frequency and contractile force. Assays were made of the outflow of PGE during exposition to equimolar concentrations of methoxamine, noradrenaline, adrenaline and isoprenaline, in the absence and in the presence of phentolamine or propranolol. Noradrenaline caused an almost four-fold increase in the basal outflow of PGE from the heart, while methoxamine (an alpha-adrenoceptor agonist) and isoprenaline (a beta-adrenoceptor agonist) were both ineffective in this respect. Thus, the PGE-releasing capacity of the drugs was not correlated to their ability to activate alpha- or or beta-adrenoceptors. Furthermore, no relation was obtained between the PGE release induced by the drugs and the increase in heart rate and contractile force elicited by them. It is suggested that sympathomimetic drugs trigger PGE synthesis and release in the rabbit myocardium following activation of a hitherto unobserved adrenoceptive mechanism, optimally stimulated by NA.


The clinical genetics of Pick's disease. The families of 11 probands with Pick's disease as determined by histopathological examination, were investigated by interview and acquisition of medical records. The estimated morbid risk was 0.25 +/- 0.08 for parents and 0.07 +/- 0.07 for siblings or probands. Further analyses are presented that seek associations between morbid risk and age, sex and age of onset. Data needed for genetic counseling are included.


Clinical trial with bromperidol in psychotic states. The author has given bromperidol to a first group of fifteen patients with a clear psychotic condition, mostly of the schizophrenic type. The results of this study show that this neuroleptic drug possesses potent antipsychotic properties, being thus very interesting in the treatment of productive psychosis. Its antimanic activity is, however, not pronounced. Therefore, it is not indicated in agitation states requiring heavy and immediate sedation. The general tolerability of the product is excellent. Its side-effects are mostly of the extrapyramidal type, generally mild and easily controlled by antiparkinson medications. Bromperidol, given in one single daily dose, is well accepted by the patients. It is therefore a valuable addition in the neuroleptic therapy as concerns prevention of relapses in psychotic conditions. Its stimulating properties on activity, concentration and socioprofessional adaptation make it particularly adequate for readaptation programs.


Depressive syndrome in schizophrenia.

Depressive syndrome in schizophrenia. A depressive syndrome, closely resembling melancholia, was found in a large proportion of chronic schizophrenic men. Depression was most prominent during acute psychotic phases and was characterized by a delusional core of worthlessness and guilt. The depressive syndrome may persist throughout the patient's psychotic life and appears to be an integral component of schizophrenic psychopathology.


The purely neuroleptic effects and its relation to the "neuroleptic threshold". Since 1953 when for the first time author pointed at correlation between clinical-neuroleptic effectiveness and the extrapyramidal system, more than 50,000 investigations with 30 different short-term and long-term neuroleptics have been carried out on approximately 850 schizophrenics whose extrapyramidal fine movements were tested according to author's handwriting-test. The results have been comprehended by author as follows: 1. the neuroleptic threshold; 2. the neuroleptic potency according to the neuroleptic threshold; 3. the neuroleptic therapeutic range; 4. the disposition to the neuroleptic threshold-dosage.


Rates and risks of depressive symptoms in a United States urban community. The results of a U.S. urban community survey, conducted in 1967 and in 1969, show that 16--18% of the population have depressive symptoms at any one time. Similar rates are reported in five other studies where self-report depression symptom scales have been used. The relationship between depressive symptoms and the diagnosis of major depressive disorders still requires investigation since the presence of depressive symptoms does not necessarily indicate the diagnosis of a major or minor depressive disorder.


Metabolic fate of bromperidol in humans: comparison with rats and dogs. The metabolic fate of an oral dose of 2 mg of 3H-bromperidol has been studied in two human subjects. During 5 days, about 50% of the radioactive dose was excreted by both subjects, somewhat more in the urine than in the faeces. Excretion rates were slow. Concentrations of radioactivity in plasma were low reaching a peak of 6-10 ng equivalents/ml during 1.5-4 hours, but concentrations of the parent drug were less than 0.5 ng/ml at all times. A major metabolite, more polar than bromperidol was present in human urine and is under investigation. The metabolic fate of bromperidol in humans is different from that in rats or dogs.


5-Hydroxytryptamine content of the whole blood in psychiatric illness and alcoholism. 5-Hydroxytryptamine (5HT, serotonin) content of the whole blood has been measured in hospitalized groups of manic, depressed, schizophrenic and alcoholic patients; values were compared to non-psychotic controls. Only depressives had significantly different values. Alcoholics occupied an intermediate position between depressives and controls. Schizophrenics had virtually the same average level. Manic patients showed a very weak tendency toward higher values. Neuroleptic drugs in mania did not alter the blood 5HT levels, but in depression tricyclic antidepressants caused an elevation after 3 weeks of treatment. These post-treatment levels no longer differed significantly from those of non-psychotic controls.


Analytical methods for the determination of bromperidol in plasma. The treatment with neuroleptic drugs, such as the butyrophenones, has been based on clinical empiricism, rather than on pharmacokinetic knowledge or on a clear understanding of the mode of action of the drugs. To obtain pharmacokinetic data a specific and sensitive analytical method is necessary. The determination of butyrophenones in a biological medium poses many analytical problems, due to the low dose of these drugs. Very recently Forsman published a pharmacokinetic study of haloperidol in man by electron capture detection. No such study is available for bromperidol. In our paper, we will present comparative data for the quantitative determination of bromperidol by mass fragmentography, gas chromatography with electron capture detection, and radioimmunoassay. Our results show that for the determination of bromperidol in plasma, only radioimmunoassay is sensitive enough to allow the easy determination of the low plasma levels to be expected for bromperidol.


Current trends of mental health care in Belgium. Till 1970, most psychiatric patients were "treated" in legally closeed wards. The nursing and medical personnel were scarce. A fundamental change is now slowly taking place. From a legal point of view, many patients forcedly admitted are no longer under this legal status. From a hospital point of view, new standards have been enforced concerning medical and paramedical personnel, architecture and function. Another fact: in 1972 the closed psychiatric institutes were at last regarded as hospitals. Paralleling these changes, an effort is being made to create mental health services outside of the hospital. All of these modifications should allow the setting up of a curative and preventive psychiatry. The therapeutic function of the hospital should replace the residential function of the psychiatric hospitals.


Has tryptophan any anticonvulsive effect? In an an intra-individual crossover trial depressed patients were treated with the 5-hydroxytryptamine (5-HT) precursor L-tryptophan (L-TP) and unilateral ECT, or with unilateral ECT alone. The oral dose of L-TP was 6 g the day before ECT and 3 g on the day of ECT, 4 hours before the treatment. The seizure duration was measured on EEG records. The time of the electrical stimulation needed to induce generalized seizures was similar for both treatment alternatives. Thus L-TP seems not to elevate the threshold to ECT-induced convulsions. The mean duration of a seizure was significantly shorter when the patients were treated with L-TP + ECT than when treated with ECT alone. It is suggested that L-TP exerts an inhibitory influence on the ability to sustain epileptic activity.


Testing of roentgen film quality.

Testing of roentgen film quality. Evaluation of film quality is often based upon the film's characteristic curve. A practical test method implying radiography of sandpaper sheets has been devised, yielding crucial information about the quality, which cannot be derived from the characteristic curve. Since this test appears to give more valid information about film quality than conventional sensitometry, it is suggested that the test procedure should be standardised and used by the manufacturers.


Elliptical narrow beam rotation radiography. The basic mathematics for elliptical narrow beam rotation radiography are deduced and exemplified. An analysis of the functioning principle of elliptical systems shows that the essential factor in the image formation is the form of the evolute of the ellipse, which determines the projection of the object. The image layer does not necessarily coincide with the ellipse.


Colour presentation of radiologic images. A technique is described for conversion of black and white fluoroscopic images into colour. The advantages of this technique were investigated with the aid of slides. Although the colour yield in slides is not perfect, this method was chosen because it gives a reproducible image. Lesions were recognized significantly better on colour slides than on black and white slides (p less than 0.02).


Renal circulation after cardiac arrest. Angiography and microangiography. Renal circulation following 3 to 14 min of cardiac arrest was investigated in 21 mongrel dogs by angiography, microangiography and histology. Arrest longer than 7 min caused variable degrees of abnormal angiographic findings after resuscitation: (1) segmental perfusion defects and cortical areas without nephrographic effect, (2) loss of demarcation of cortex and medulla, (3) decreased nephrography, (4) faint and delayed filling of the renal veins, (5) diffuse segmental spasm of the interlobar arteries with delayed emptying. Microangiography demonstrated non-filling of glomeruli in segmental areas of renal cortex, diffuse malperfusion and vasoconstriction as well as obliteration of afferent arterioles due to red blood cell aggregation. No tendency toward recovery within the 5-hour resuscitation period.


Proteinuria following nephroangiography. II. Influence of contrast medium and catheterization in dogs. Major increases of urinary albumin were common following nephroangiography in dogs using Urografin (diatrizoate) or Isopaque Cerebral (metrizoate) as contrast medium. Neither the catheterization procedure nor the injection of a supposed inert solution resulted in significant albuminuria but following injection of contrast medium albuminuria commenced within a few minutes; normalization occurred within 2 days. Higher doses of contrast medium induced massive albuminuria than lower ones.


Uptake of 99Tcm-gluconate and early histologic findings in induced myocardial infarcts in dogs. A new isotope, 99Tcm-gluconate, for detection of myocardial infarction has been investigated experimentally. Great differences in isotope uptake between infarcted myocardium and normal myocardium were found in dogs. A close correlation was found between the isotope uptake and the uptake of basic fuchsin (HBFP) at microscopy in early myocardial infarcts.


Angiographic localization of parathyroid adenomas. The angiographic and operative findings in 35 patients with primary hyperparathyroidism were compared. A non-selective angiography is proposed. The appearance of solid and cystic parathyroid adenomas is described and the differentiation between parathyroid and thyroid adenomas outlined. An overall diagnostic accuracy of 75 per cent was achieved. The indications for parathyroid angiography are discussed.


Scoliosis angle. Conceptual basis and proposed definition. The most commonly used methods of assessing the scoliotic deviation measure angles that are not clearly defined in relation to the anatomy of the patient. In order to give an anatomic basis for such measurements it is proposed to define the scoliotic deviation as the deviation the vertebral column makes with the sagittal plane. Both the Copp and the Ferguson angles may be based on this definition. The present methods of measurement are then attempts to measure these angles. If the plane of these angles is parallel to the film, the measurement will be correct. Errors in the measurements may be incurred by the projection. A hypothetical projection, called a 'rectified orthogonal projection', is presented, which correctly represents all scoliotic angles in accordance with these principles. It can be constructed in practice with the aid of a computer and by performing measurements on two projections of the vertebral column; a scoliotic curve can be represented independent of the kyphosis and lordosis.


Immersion technique in soft tissue radiography of the hands. Soft tissue radiography of hands using the technique of mammary radiography and immersion in a 2.5 cm layer of 1:1 water-ethanol solution is evaluated. Using immersion the average background density decreases with a factor of about 2.5:1, with little deterioration in resolution (MTF). The immersion procedure makes the demonstration and evaluation of soft tissue swelling and periarticular oedema easier.


Roentgen stereophotogrammetry for determination of daily longitudinal bone growth in the rabbit. The spatial location of points in an object can be determined by roentgen stereophotogrammetry. A technique of high accuracy was applied in a determination of the daily skeletal growth of young rabbits. The tibia was labelled with tantalum markers on each side of the growth zones, and the increasing distance between these markers due to longitudinal bone growth was measured. Three different types of markers were tested, and the methodologic error was estimated. It varied between 30 and 43 micrometer for one growth interval, depending on the type of marker used. The method has clinical implications currently under investigation.


Complete reversibility of paraneoplastic acanthosis nigricans after operation. A patient with widespread acanthosis nigricans is described. No abdominal tumour was found. Explorative thoracotomy disclosed numerous enlarged lymph glands containing squamous cell carcinoma. The left lung was removed but meticulous search did not disclose any tumour. The glands were removed as radically as possible. After the operation the skin improved and the lesions have disappeared completely. The observation time is over three years.


Surgical treatment of myelomatosis--a review of 18 cases. The authors review 18 patients with multiple myeloma who had bone destruction of a kind that indicated surgical therapy. Eight patients had paralegic myelopathy and one had compression of the cauda equina. Four of them displayed partial to complete regression. One patient lived for 77 months after the operation, most of the time in excellent condition. The operative technique is discussed, with laminectomy, exeresis, filling of bone with cement and, in some instances, mechanical support from metal plates. Early diagnosis and operation is imperative, postoperative irradiation obligatory in severe cases. Radiation alone may be the method of choice in early stages. The other 9 patients were operated upon for bone destruction in the limbs. A Moore operation on the destroyed hip was performed in one patient, who lived in excellent condition for about four years. Active surgical therapy combined with radiation and cytostatics seems to be of value in many patients with multiple myeloma.


Extreme hyponatremia in patients with myelomatosis: an effect of cationic paraproteins. Three patients with IgG myelomatosis and extreme hyponatremia are described. By isoelectric focusing of the M-component it is demonstrated that the subnormal sodium value is most likely explained by a cationic effect of the myeloma globulin.


Factors responsible for bone marrow toxicity after treatment of myeloma patients with different alkylating agents. Leukopenia and thrombocytopenia were studied after loading doses of melphalan (5 mg/daily for 18-25 days) in 71 myeloma patients. Seventy per cent of the patients developed pronounced leukopenia (white cells less than 2.0 X 10(9)/l) and/or thrombocytopenia (platelets less than 100 X 10(9)/l). The patients with pronounced and moderate hematological side-effects, respectively, were compared for weight and age. The body weight was the same in the two groups, indicating that the patient's weight is of minor importance for the dosage of melphalan. There was a numerical difference in age, on the borderline for statistical significance, indicating that the age of the myeloma patient may be of minor importance for the dosage of melphalan. It is possible that more pronounced age differences may be of greater importance in this respect. Fifteen patients with myeloma were treated with cyclophosphamide. Compared with melphalan, the effect on white cells was the smae, while the incidence of thrombocytopenia was statistically significantly lower with cyclophosphamide.


Relative value of sternal aspiration, iliac crest biopsy and biopsy imprint in the diagnosis of secondary cancer involvement of the bone marrow. Sternal aspirates, iliac crest biopsies and biopsy imprints from 31 patients with verified metastatic cancer to bone marrow were reviewed. All three methods were shown to be complementary, as cancer cell deposits were detected in some cases by one procedure and missed by the others.


Relapsing annular erythema and myeloma successfully treated with cyclophosphamide. We report the history of a patient, who had recurrent patches of erythema on the trunk and extremities for some years. The diagnosis of erythema elevatum diutinum or annulare centrifugum was discussed. The patient developed a monoclonal IgA lambda fraction and clinical signs of myeloma. Treatment with cyclophosphamide stopped the development of erythema and also caused the M-component to disappear. This improvement has persisted even without cytostatic treatment. Another patient with prostatic carcinoma and relapsing annular erythema was cured of his skin lesions, when his carcinoma was treated with estrogens. The literature is reviewed.


Pyoderma gangraenosum (dermatitis ulcerosa) and monoclonal (IgA) globulin healed after melphalan treatment. Case report and review of the literature. Since 1968 we have been treating a patient, who has had a combination of pyoderma gangraenosum (dermatitis ulcerosa) and signs that may indicate early multiple myeloma. She also had carcinoma of the colon, which was successfully operated. The pyoderma healed later after intensive and successful cytostatic treatment of the "myeloma". The ulcers remain practically healed and the protein pattern is normal in May 1977. Such cases are rare and a search in the literature has not been very rewarding. In our own series of more than 200 cases with myeloma this combination is unique. The lieterature is discussed in detail with data on the follow-up on some of the patients.


Osteosclerotic "plasmocytoma" with polyneuropathy, hypertrichosis and diabetes. The combination of osteosclerosis, polyneuropathy, monoclonal immunoglobulin, hypertrichosis, serositis and a number of other symptoms is described. It seems probable that this is a special type of myeloma. Similar cases have been described in Japan and out findings are compared with the Japanese picture. The age of the patients is unusually low. The M-component in the plasma is small. There is very little Bence Jones protein in the urine and osteolytic lesions in the skull do not seem to have occurred. The polyneuropathy may improve during treatment with cytostatic drugs.


Reversible renal failure caused by hypercalcemia. A retrospective study. The influence of hypercalcemia on renal function was studied retrospectively in 13 patients suffering from primary hyperparathyroidism, sarcoidosis, vitamin D intoxication, malignant lymphoma or chronic lymphatic leucemia. Different kinds of treatment, depending upon the primary disease, often induced a rapid fall in the serum calcium concentration. The serum creatinine concentration always fell simultaneously. The serum phosphate concentration fell in all but two patients. Changes in serum calcium and serum creatinine correlated significantly (p less than 0.001), as did changes in serum calcium and serum phosphate concentrations (p less than 0.05). Serum calcium/serum creatinine and serum calcium/serum phosphate ratios were significantly higher in patients with primary hyperparathyroidism than in patients with hypercalcemia of non-hyperparathyroid origin (p less than 0.01, p less than 0.001). This suggests a different effect of calcium on the glomerular filtration rate in hyperparathyroid and non-hyperparathyroid patients, the latter group being more sensitive to the influence of hypercalcemia. Possible explanations for this difference, such as a protective effect of PTH on the glomerular filtration, are discussed.


Serum inorganic phosphate and serum calcium in middle-aged men. II. Relation to glucose and insulin parameters in glucose tolerance tests. Fasting serum inorganic phosphate and fasting serum calcium were measured in 752 49-year-old Malmö males, in whom an oral or i.v. glucose tolerance test, in 189 cases including plasma insulin measurements, was performed as part of an internal medical screening examination. The serum inorganic phosphate and calcium levels were analysed statistically in relation to various glucose and insulin response parameters. A significant, positive correlation of serum inorganic phosphate with the early insulin response in the i.v. glucose tolerance tests was found but not with any of the other glucose or insulin response parameters included in the study. Serum calcium showed no significant correlations. These findings are discussed in relation to the pertinent literature.


Humoral and cellular immunity in sarcoidosis. The Kveim reaction was studied in vivo in 50 patients with sarcoidosis. Commonwealth Serum Laboratories Kveim material and a new Danish Kveim material gave 14 and 8 positive reactions respectively, as well as 6 and 8 equivocal reactions. Forty-six of the patients were also tested in vitro for cell mediated immunity to the Danish Kveim material, using both the leucocyte migration agarose technique and the capillary technique. No significant migration inhibition or stimulation were found. A tuberculin skin test was performed in 49 of the patients, and in 45 a dinitrochlorobenzene sensitivity titer was determined. Both tests revealed a depression of the cell mediated immunity. The serum levels of immunoglobulins IgG, IgA, IgM, IgD, and IgE were determined. The serum of each patient was also examined to determine if organ-non-specific and granulocyte-specific antinuclear factors of IgG class, antibodies against native DNA, rheumatoid factor, mitochondrial antibodies, antibodies against thyroid cytoplasm, and parietal cell antibodies were present. IgG levels were above normal in 28 patients; IgE was above normal in 10 patients, 4 of whom were atopics or had an atopic disposition. Organ-non-specific antinuclear factors were present in 17 patients.


The rheological behaviour of cortical bone and cartilage of Bos taurus. The importance of maximal damping capacity in collagen. The relaxation behaviour of bone and cartilage was investigated with a free-oscillating torsional pendulum. Two relaxations (260 K, and 150 K) were found for bone an; two (at 260 K and 210 K) for cartilage at a frequency of 1 Hz. The translations were the same as those known for collagen. The translation at 260 K is consistent with the frequency of the impulses causing the contraction of skeleton muscles when extrapolated to 37 centrigrades and a frequency of 500 Hz.


Prostaglandins in the sheep fetus: implications for fetal function. 1. In chronically catheterized sheep fetuses, during normal pregnancy, the concentration of PGE in the fetal femoral arterial plasma is invariably greater than that of PGF, and increases during the 12 to 24 hr preceding delivery. The concentration of both PGE and PGF decreases repidly after birth. 2. These changes in fetal prostaglandin levels contrast with the marked increase in PGF, but negligible increase in PGE, in the maternal uteroovarian vein before parturition. 3. The changes in prostaglandin concentrations in fetal plasma at term are associated with only small changes in the concentrations of PGE and PGF in tracheal fluid. In amniotic fluid the concentrations of PGE and PGF increase during the last 4 days in utero. At birth the concentrations of PGE and PGF in fetal urine are similar to the concentrations in amniotic fluid. 4. The concentration of PGE in fetal plasma and in tracheal fluid is significantly elevated for up to 3 days after surgery. The concentration of PGF is significantly elevated in fetal plasma nad tracheal fluid for at least 24 hr after surgery. 5. Three fetuses which were chronically hypoxemic had elevated plasma PGE concentrations in utero. However, acute (1 hr) hypoxia or hypercapnia induced in the fetal lamb by making the ewe breathe appropriate gas mixtures did not produce consistent changes in fetal plasma prostaglandin concentrations. 6. During late pregnancy (day 128) exogenous PGE2 infused at about 1.6 microgram/min for 60 min into the fetal carotid artery achieved concentrations in the fetal femoral artery which were within the physiological range seen at term. At this infusion rate, there was no effect on fetal arterial Po2, Pco2, pH, or hematocrit, and no consistent effect on fetal blood pressure or heart rate. PGE2 infusion had no significant effect on the concentration of growth hormone or prolactin in fetal plasma. Within 30 min after beginning the infusion, however, there was a significant increase in the cortisol concentration in fetal plasma. This effect was seen even at times in pregnancy when the fetal adrenal gland responds only poorly to exogenous or endogenous ACTH.


Preclinical safety evaluation of 15[S]15-methyl prostaglandin F2alpha : reproduction and teratology. The abortifacient 15[S]15-methyl prostaglandin F2alpha, designated PGF2alpha (M), was tested in pregnant rats and rabbits for purposes of preclinical safety evaluation. The material tested was the tromethamine salt of PGF2alpha with the generic name, carboprost tromethamine. Doses of 0.25, 0.50, and 1 mg/kg given by subcutaneous injection to male and female rats for 3 or 6 consecutive days before mating did not have an adverse effect on reproduction. The principal finding in rat and rabbit teratology studies was that PGF2alpha (M) had a high order of embryolethality regardless of when it was administered. Rabbits were more sensitive than were rats and PGF2alpha (M) interfered with nidation or early embryonic development when given during the second week of gestation. The largest dose of PGF2alpha (M) that allowed some fetuses to survive was 0.25 mg/kg for rats and 0.005 mg/kg for rabbits when given by subcutaneous injection for 3 consecutive days at some point during organogenesis. Fetuses from rabbits given the doses of 0.0025 and 0.005 mg/kg were normal. There were a variety of skeletal anomalies (mostly of ribs and thoracic vertebrae) in fetuses from rats given, by subcutaneous injection, doses of PGF2alpha (M) ranging from 0.25 to 0.05 mg/kg for 3 consecutive days at some point during organogenesis. Although there were few gross or visceral anomaliies in either rats or rabbits, the incidence of osseous anomalies in rats was of both statistical and biologic significance. Rats given PGF2alpha (M) by subcutaneous injection beginning on the 15th day of gestation in a perinatal-postnatal study were most sensitive to the abortifacient. In that study the no-effect level was 0.0001 mg/kg. At larger doses ranging from 0.25 to 0.003 mg/kg, treatment was associated with abortion, poor viability, and impaired lactation.


Hemodynamic effects of prostaglandin E1 on lambs in utero. Fetal tissues and the uteroplacental circulation are known to be exquisitely sensitive to the prostaglandins. E-series prostaglandins cause generalized vasodilatation in mature animals. This phenomenon is observed in the fetus but its effects are markedly obscured by the decrease in umbilical-placental flow. Comparison to hemodynamic data in hypoxemic fetuses clearly demonstrates that these effects are both qualitatively and quantitatively different, and therefore are likely to be due either to the direct effect of the drug, or to reflexes elicited by the marked compromise of the umbilical-placental flow.


Identifying vestibular procession dysfunction in learning-disabled children. The purpose of this investigation was to identify neurobehavioral functions of the vestibulo-proprioceptive system that would aid the clinician in evaluating vestibular processing dysfunction in learntibulo-proprioceptive function were subjected to multiple regression analysis. Data analysis revealed that four variables shared significant variance with Southern California Postrotary Nystagmus Test scores. It is suggested that these variables can provide additional information in evaluating vestibular processing dysfunction in learning-disabled children.


Postrotatory nystagmus duration as a function of communication disorders. The purpose of this study was to explore the relationship between functioning of the vestibular system, measured by duration of postrotatory mystagmus, and specific communiccation disorders (articulation, speech and language, and language). A total of 190 children participated in the study, 173 of which were included in the final data analysis. The findings revealed a depressed mean duration of postrotatory nystagmus in all categories of communication disorders when compared to the control group. In addition, the language group had a sig;ificantly lower mean duration of postrotatory nystagmus when compared to the articulation and speech and language groups. Although the test measure did discriminate between groups, it did not discriminate well between children within groups.


Health policy and planning: Public Law 93-641. The policy and planning aspects of Public Law 93-641 (The National Health Planning and Resources Development Act) introduce important implications for the health care delivery system. The law contains the first delineation of a national health policy, as well as innovative provisions for the development of regional health plans. On the basis of these policies and plans, decisions are made that affect the allocation of health resources such as manpower and facilities. This paper discusses the national policies called for in the law and the planning process at the regional level. By viewing the politics and technology of plan development, the importance of and avenues for participation are clarified.


Participating in health planning.

Participating in health planning. The implementation of the Health Planning and Resources Development Act of 1974 (P.L. 93-641) brought about the realization that occupational therapists can and should participate in a formalized manner in the health planning process. Successful attempts by District V of the Iowa Occupational Therapy Association, and by the Iowa Occupational Therapy Association, to seat an occupational therapist on the governing board of the Illowa Health Systems Agency and on the Iowa State Health Coordinating Council yielded a greater understanding of the law and of the activities of health systems agencies. This article describes the process of selecting representatives for health systems agencies governing boards as it pertains to allied health professionals.


Middle ear effusion: current concepts.

Middle ear effusion: current concepts. Middle ear fluid is a common problem in children. Eustachian tube dysfunction has been considered the key to the pathogenesis of this disorder, but new studies show that other factors may be operative. Inflammation appears to play a significant role in high-viscosity effusion, and these effusions may be related to acute suppurative otitis media. Since persistent mild hearing loss may adversely affect verbal development, new emphasis on early treatment of middle ear effusion is warranted.


What not to do in pheochromocytoma.

What not to do in pheochromocytoma. Use of a screening VMA procedure rather than a specific assay may yield false-positive results. Plasma catecholamine levels should be obtained in the unstressed, supine patient. Pharmacologic tests are less reliable than chemical tests. In the presence of a pheochromocytoma, phenoxybenzamine should be administered before any manipulative procedures, as well as prior to surgery. This agent should be given along initially; propranolol may be added preoperatively.


The effectiveness of sickle cell counseling. Patients received information about hemoglobinopathies before blood testing. Those in whom sickle cell trait was confirmed were counseled. Then, this group responded to a questionnaire to evaluate understanding and retention of information about sickle cell disease. Ninety percent correct responses were obtained on general information. However, only 70 percent correct responses were received on questions about genetics. Modifications of techniques of sickle cell counseling are suggested by these results.


Whiplash syndrome.

Whiplash syndrome. Whiplash, or cervical acceleration extension injury, is due predominantly to hyperextension and prolongation of the neck, with rebound flexion. A variety of disabling soft tissue injureries may result, including vertebral arter damage. While x-rays are generally unremarkable, they should be obtained. Rational management is based on rest, heat and analgesics, muscle relaxants, isometric exercises and an informed patient. The assumption that whiplash syndrome occurs only in neurotic or litigation-minded patients should be discouraged.


Benign intracranial hypertension.

Benign intracranial hypertension. Although antecedent factors are occasionally implication, most cases of benign intracranial hypertension are idiopathic and occur in young adult women who otherwise appear healthy. The natural course is usually one of spontaneous recovery, although medical intervention may accelerate improvement. Computerized tomographic scanning is the procedure of choice for excluding more ominous conditions, such as brain tumors. The most serious complication of this syndrome is visual loss and in these patients the disease is not "benign."


Breast feeding and infant nutrition.

Breast feeding and infant nutrition. Breast feeding is a management problem requiring knowledge of the physiology of lactation, maternal and infant nutritional requirements, and specifics such as drugs which enter the milk. The job of the physician is to allay anxiety; this helps establish the let-down reflex and increases milk production. "Caking," mastitis and even abscesses are not indications for weaning. Rest, warm compresses and frequent nursing are indicated. Breast-fed infants have less tendency to obesity than those who are bottle-fed. Early solid foods in the diet are not needed.


Dust exposures in the Canadian grain industry. Total dust concentrations measured in 8 terminal, 9 transfer and 14 country grain elevators ranged from 0.18 to 781 mg/m3. Results indicate that elevatormen performing housekeeping and maintenance chores or working in transfer galleries are more likely to be exposed to high concentrations. Dust exposures can be related to the amount of grain handled and the extent of dust control measures in effect at a worksite. The respirable mass fraction of grain dust varies according to the type of grain handled. The quartz, inorganic material and fungal spore content and particle size of the dust from specific grains were also studied.


Theoretical modeling of fine-particle deposition in 3-dimensional bronchial bifurcations. A theoretical model is developed for the prediction of the peak to average particle deposition flux in the human bronchial airways. The model involves the determination of the peak flux by a round-nose 2-dimensional bifurcation channel and the average deposition flux by a curved-tube model. The "hot-spot" effect for all generations in the human respiratory system is estimated. It is found that the peak deposition flux is higher than the average deposition flux by a factor ranging between 5 and 30, depending on the generation number. The importance of this peak to average deposition flux ratio on consideration of environmental safety studies is discussed.


Methods developed for the mass sampling analysis of CO and carboxyhemoglobin in man. Gas chromatography was used to quantitate CO in air and also as an indirect means of determining %COHb in blood. The blood was then used to calibrate four CO-Oximeters used in a survey to determine average COHb levels in various segments of the U.S. population. Mean differences, both between the two methods of analysis and between pairs of CO-Oximeters were less than 0.1% COHb saturation. COHb values obtained on consecutive days using one CO-Oximeter were repeatable within a S.D. +/- 0.13% COHb.


A portable optical particle counter system for measuring dust aerosols. A portable battery-operated optical particle counter/multichannel analyzer system has been developed for the numbers size distribution and number concentration measurement of light-absorbing irregular-shaped dust particles. An inertial impactor technique has been used to obtain calibration curves by relating the magnitude of the optical counter's signal to the particle's aerodynamic or Stokes' diameter. These calibrations have been made for aerosols of coal, potash, silica, rock (copper ore), and Arizona road dust particles.


Dust loading characteristics of high inertial fibrous filters. The dust retention efficiency of a model fibrous filter operated in the high inertia regime has been measured over the size range 2-22 micrometer. The results of a program to measure the influence of loading on grade efficiency are reported. It is shown that the efficiency of particle retention increases with loading initially, then falls off as the filter becomes loaded to its maximum capacity. The effect of test dust feed size distribution has also been investigated. Under some circumstances this parameter may have a critical effect on the overall efficiency. The mechanisms responsible for the observed behavior are described and their implications in fibrous filtration discussed.


An automated system for the determination of lead in blood, manganese in urine and nickel in waste water. An automated system has been developed to analyze lead in blood, manganese in urine and nickel in waste water at a rate of 20 to 30 samples per hour. The analysis is based on direct chelation without digestion, extraction into methyl isobutyl ketone and flame atomic absorption spectrophotometry. The applicability of the system in the field of occupational and environmental medicine is discussed.


A field portable mass spectrometer for monitoring organic vapors. A portable mass spectrometer has been designed and built under the sponsorship of the US Army for the purpose of monitoring low concentrations of specified organics in the ambient atmosphere. The goals of the development were discrimination, sensitivity, portability, simplicity of operation, economy and convenience. These objectives were met in a system consisting of a computer operated mass spectrometer with a Llewellyn membrane separator inlet system housed in two 26 x 18 x 9 inch aluminum cases with a total weight less than 150 pounds. This system has shown the capability for field detection of hundreds of specific organic vapors at the parts per billion level in the ambient and workplace environments.


Phase equilibrium method for determination of desorption efficiencies. The principle of phase equilibrium is applied to the determination of desorption efficiencies of organic compounds collected on activated charcoal. The method depends on the existance of a true equilibrium distribution between the adsorbed and solution phases of organics in the desorption solvent--adsorbent matrix. Improved and more consistant desorption efficiencies are obtained by considering the effects of variations in the adsorbent--solvent ratio and equilibrium temperature at time of analysis. The technique may also provide early detection of interaction or reaction of the sorbate on the adsorbent surface.


Effects of short-term exposures to sulfuric acid and ammonium sulfate aerosols upon bronchial airway function in the donkey. The effects of one-hour inhalation exposures to 0.3-0.6 micrometer H2SO4 and (NH4)2SO4 aerosols in the donkey were studied in terms of alterations in pulmonary flow resistance and dynamic compliance, and changes in the regional deposition and tracheobronchial mucocilliary clearance of an inert test aerosol. Short-term slowing of clearance followed certain single exposures to H2SO4 at 194-1364 microgram/m3 in three of four animals, while two of the four demonstrated a more persistent slowing of their clearance. These exposure levels produced no measurable change in resistance, compliance or regional deposition. Exposures to (NH4)SO4 up to approximately 2000 microgram/m3 had no mearurable effect upon resistance, compliance, regional deposition or mucociliary clearance.


The generation of aerosols of carcinogenic aromatic amines. A system for producing test atmospheres of carcinogenic aromatic amines is discussed. The aerosol generator, a specially disigned compressed-gas nebulizer, operated at a temperature above each compound's melting point utlizing nitrogen as the driving force. The nebulizer output and size distributions of aerosols of 4,4'-methylenebis(2-chloroaniline) (MOCA), benzidine, and 3,3'-dichlorobenzidine are given.


Biotransformation of n-hexane and methyl n-butyl ketone in guinea pigs and mice. Peripheral neuropathies caused by exposures to the industrial solvents n-hexane and MBK exhibit strinkingly similar characteristics. In in vivo studies, the metabolites of MBK and n-hexane identified in blood and urine of guinea pigs were 2-hexanol (partly as glucuronide in urine); and 2,5-hexanedione which was detected only in MBK treated groups. Phenobarbital pretreatment increased 2-hexanol urinary excretion in both solvent treatment groups. In in vitro studies, hepatic reduction of MBK required the cytosol fraction to form 2-hexanol; whereas the oxidation of MBK and n-hexane required the microsomal fraction to form 2,5-hexanedione and 2-hexanol, respectively. The in vivo and in vitro biotransformation of MBK and n-hexane to a common metabolite (2-hexanol) suggests that the neurotoxic action of these solvents may be metabolite related.


A field evaluation of noise-induced temporary threshold shift. Noise-induced temporary and permanent threshold shifts of 9 brewery workers were obtained by means of 6 hearing tests during two consecutive days. Subjects had been exposed 6 to 8 hours daily to a bottling noise for approximately 15 years. Results confirm that empirical rules predicting exponential growth and recovery of TTS during and following a work-day apply in men who have a significant permanent threshold shift from repeated exposures to the same work-day noise for a number of previous years.


Clinical assessment of serum myosin light chains in the diagnosis of acute myocardial infarction. Serum myosin light chain levels were quantitated with radioimmunoassay in patients admitted to the coronary care unit. In this study there were 29 patients with acute myocardial infarction, 84 with chest pain but without myocardial infarction and 5 with chest pain but with preexisting electrocardiographic abnormalities that could not be interpreted using standard criteria. Values for human cardiac light chains in normal human sera averaged less than 2 ng/ml, and values in the 84 patients without myocardial infarction fell into this category. The 29 patients with myocardial infarction all had elevated light chain concentrations (average 10.9 +/- 1.3 ng/ml; range 4 to 35 ng/ml). In this study there were no false positive or false negative results. Use of this assay has permitted separation of patients with and without myocardial infarction. The assay for cardiac light chains provides a biochemical marker of high sensitivity and specificity that is useful in the diagnosis of infarction.


Time-related changes in the Q-T interval in acute myocardial infarction: possible relation to local hypocalcemia. In 63 patients with either acute transmural or nontransmural myocardial infarction, the Q-T interval was prolonged beyond normal limits on at least 1 of the 5 days after infarction in 27 patients (8 with transmural and 19 with nontransmural infarction). The time-related changes in the corrected Q-T (Q-Tc) interval were defined for the entire sample and showed significant expansion, maximal on day 2, from a preinfarction control value. By day 5, the Q-Tc interval was no longer significantly prolonged and was not expanded beyond normal limits in any patient. Various possible causes of Q-T prolongation in myocardial infarction are local hypothermia, local conduction delay, neurogenic effect and local hypocalcemia. Collateral evidence suggests that the letter may contribute significantly to prolongation.


Modification of intraaortic balloon catheter to permit introduction by cardiac catheterization techniques. Intraaortic balloon counterpulsation has been widely applied for treatment of left ventricular pump failure and intractable angina. However, its use has been limited by the difficulty of balloon insertion in some patients and vascular complications in others. An AVCO intraaortic balloon was modified by the addition of a central lumen to allow pressure monitoring, injection of contrast medium and passage of a guide wire. The device was successfully used in 15 of 16 patients, including 4 of 5 in whom attempts to place a standard balloon catheter had failed. No significant vascular complications occurred in any patient. The modified balloon catheter appears to increase the efficacy and safety of insertion and allows immediate and continuous monitoring of arterial pressure.


Pathologic anatomy of Ebstein's anomaly of the heart revisited. The typical textbook description of Ebstein's anomaly of the heart usually singles out and emphasizes the downward displacement of septal and posterior leaflets of the tricuspid valve. An anatomic reappraisal of this uncommon anomaly suggests that other structural abnormalities of import should be equally stressed. Among the 15 well preserved autopsy specimens in this series, enlargement of the right atrioventricular (A-V) junction and malalignment of the giant and sometimes muscularized anterior leaflet of the tricuspid valve were consistently found. In addition, massive aneurysmal dilation of the right ventricle was present in almost two thirds (9 of 15) of the hearts. Our observations raise the possibility that abnormal embryonic development of the right A-V junction may be the primary event that leads to malformation of the tricuspid valve apparatus.


Pathogenesis of persistent truncus arteriosus in light of observations made in a dog embryo with the anomaly. Among 36 embryos obtained from a strain of Keeshond dogs in which there is a large incidence of spontaneously occurring conotruncal anomalies, a specimen with persistent truncus arteriosus, type 1 was found. The embryo had a crown-rump length of 20 mm. The specimen was serially sectioned and a wax plate reconstruction was made of the heart and proximal great vessels at a magnification of X100. The truncal valve was quadricuspid and dysplastic; associated anomalies were a right subclavian artery arising anomalously from the descending aorta, a single coronary artery, an absent ductus arteriosus and a small persistent left cranial (superior) vena cava. The truncus cushions were hypoplastic, had failed to fuse and each had simply produced an arterial cusp. The observations made on this embryo support the view that in persistent truncus arteriosus there is failure of septation of the truncus arteriosus. No evidence was found in favor of the concept that persistent truncus arteriosus represents a form of tetralogy of Fallot with atresia of the subpulmonary infundibulum and partial or complete absence of the aorticopulmonary septum.


Electrophysiologic effects of hydralazine on sinoatrial function in patients with sick sinus node syndrome. The electrophysiologic effects of hydralazine were evaluated in nine hypertensive patients with sinoatrial dysfunction. Intravenous hydralazine, 0.15 mg/kg, caused no significant reduction in arterial blood pressure. Yet this dose of hydralazine increased heart rate from 61.9 +/- 4.1 beats/min (mean +/- standard error of the mean) to 68.6 +/- 4.9 (P less than 0.001). Sinus nodal recovery time upon termination of atrial pacing shortened from 3,207 +/- 1,098 to 2,064 +/- 573 msec (P less than 0.05) and second escape cycles shortened as well (P less than 0.025). Acceleration of heart rate and abbreviation of recovery time did not closely correlate with change in blood pressure (r = 0.41 and 0.18, respectively). Junctional escape beats became more frequent and junctional escape time shortened from 2,525 +/- 692 to 1,705 +/- 382 msec (P less than 0.05). Sinoatrial conduction time tended to shorten, but a significant change was not observed. Atrial tachyarrhythmias did not occur and atrial refractoriness was unchanged. Thus, a minimal blood pressure response to hydralazine was associated with enhanced automaticity. Hydralazine merits clinical trial for treatment of sick sinus syndrome with concomitant hypertension.


Propranolol rebound--a retrospective study. To assess the effects of sudden withdrawal of propranolol on inpatients with coronary artery disease, 102 patients admitted for cardiac catheterization were evaluated. Criteria for inclusion in the study were angiographically documented coronary artery disease, propranolol therapy at a mean daily dose of at least 80 mg and abrupt discontinuation of propranolol therapy before catheterization. There were 55 patients (mean age 52.5) who discontinued propranolol therapy (mean daily dose 127 mg) and a control group of 47 patients (mean age 53) who continued to receive propranolol (mean daily dose 143 mg). The criteria for morbidity were death, myocardial infarction or change in pain pattern. In the withdrawal group there were no deaths, one myocardial infarction judged to be related to catheterization and only one instance of a change in pain pattern. Thus, propranolol rebound appears to occur infrequently among hospitalized patients with reduced activity.


Effusive-constrictive hemodynamic pattern due to neoplastic involvement of the pericardium. Eight patients with metastatic malignancy of the pericardium who demonstrated the hemodynamics of subacute effusive-constrictive pericarditis were studied. All patients had clinical evidence of cardiac tamponade due to malignant pericardial effusion and were referred for therapeutic pericardiocentesis. In six in whom pericardiocentesis was successfully performed, right atrial pressure remained elevated after pericardiocentesis and return of the intrapericardial pressure to zero; in these patients, hemodynamic data were initially compatible with tamponade but suggested constriction after removal of the pericardial fluid. In the remaining two patients, echocardiography revealed pericardial fluid, but attempted pericardiocentesis was unsuccessful. In these two patients, the hemodynamic data suggested pericardial constriction; subsequent pathologic examination revealed neoplastic involvement of the visceral pericardium. Thus, subacute effusive-constrictive pericarditis, previously recognized as a complication of tuberculosis or mediastinal radiation, may also be due to metastatic malignancy. The syndrome can readily be demonstrated when right heart catheterization is performed in conjunction with pericardiocentesis.


Significance of changes in R wave amplitude during treadmill stress testing: angiographic correlation. Coronary angiograms and treadmill stress tests were reviewed in 89 patients. Changes in R wave amplitude were measured in the control and immediate postexercise periods. Of 45 patients with normal coronary arteries, 41 (91 percent) had a decrease in R wave amplitude (P less than 0.01); 3 (7 percent) had an increase in amplitude, including 2 with abnormal left ventriculograms. The remaining patient (2 percent) had abnormal wall motion but no change in R wave amplitude. Among the 44 patients with significant coronary artery disease (70 percent or greater luminal narrowing in one or more vessels), R wave amplitude increased after exercise in 26 (59 percent) with more severe coronary artery disease. R wave amplitude decreased in 18 patients (41 percent) with normal or minimally abnormal resting ventriculograms and less severe coronary artery disease (P less than 0.01). Changes in R wave amplitude reflect ventricular function, an increase in R wave amplitude reflecting more severe dysfunction and severe coronary narrowing. A decreased R wave amplitude indicates normal or minimal dysfunction and is strongly associated with normal coronary angiograms.


Correlative studies of serum digitalis levels and the arrhythmias of digitalis intoxication. Correlative studies of serum digoxin levels, cardiac rhythm and related clinical laboratory data were carried out in 114 patients. Seventy-three patients who presented with 79 episodes of arrhythmias typical of digitalis intoxication could be separated into a normokalemic group of 55 patients whose serum digoxin level was 6.68 +/- 0.17 ng/ml (mean +/- standard error of the mean), and a hypokalemic group of 24 with a mean serum digoxin level of 1.13 +/- 0.04 ng/ml (P less than 0.001). Of 45 consectutive normokalemic patients with a high serum digoxin level (more than 2 mg/ml) who underwent serial studies, 17 had arrhythmias. Serial studies in 10 hypokalemic patients revealed an inconsistent relation between presence of arrhythmia and serum digoxin level. During repletion of serum potassium in seven of these patients with an arrhythmia, the arrhythmia disappeared without a significant change in serum digoxin level in four patients. A group of seven patients had 16 episodes of serum digoxin level greater than 2.2 ng/ml, but an arrhythmia occurred during only 3 of these episodes. A sharp border between toxic and therapeutic serum digoxin values was not found in these groups of study patients. The serum digoxin level at which arrhythmias occurred appeared to be variable for both groups and individual patients. However, correlative studies utilizing serum digoxin levels can define existing thresholds for therapeutic and toxic effects and may often be more useful than isolated observations.


Hemodynamic significance of the length of a coronary arterial narrowing. The hemodynamic significance of the length of a coronary arterial narrowing is unclear. Accordingly, the influence of the length of a given coronary narrowing on coronary hemodynamic responses was studied in 14 dogs. Recordings were made as short fixed diameter reductions were progressivley lengthened to 5, 10 and 15 mm by the addition of plastic occluders. Resting coronary blood flow decreased and pressure gradients developed across short (snare) narrowings greater than 80 percent (critical stenosis). Short 40 to 60 percent narrowings had no significant resting hemodynamic influence, but increasing their length to 10 and 15 mm consistently resulted in significant pressure gradients and flow reductions. Reactive hyperemic coronary blood flow expressed as repayment of flow debt (after 10 seconds of coronary occlusion) decreased progressively as these narrowings were lengthed. The effect of 15 mm long narrowings on resting and reactive hyperemic flows was similar to that of short 90 percent narrowings. These data indicate that there is uncertainty about the significance of coronary diameter reductions previously considered hemodynamically unimportant. In our studies, significant changes in resting and reactive hyperemic coronary flows and resting pressure gradients occurred as the length of a given degree of narrowing was increased.


Techniques for right and left ventricular endomyocardial biopsy. Right ventricular endomyocardial biopsy using percutaneous right internal jugular approach proved a safe and easily performed technique in more than 1,300 procedures. Adequate tissue was obtained in more than 98 percent of patients and morbidity rate was remarkably low. Other approaches to the right ventricle may be used, but retrograde left ventricular endomyocardial biopsy appears to be the safest and most reliable alternative to transjugular right ventricular biopsy. The safety and success of the techniques for right and left heart biopsy described depend on meticulous attention to methodologic detail.


Retrograde left ventricular catheterization in patients with an aortic valve prosthesis. Twenty-seven consecutive patients with an aortic valve prosthesis were evaluated with retrograde left ventricular catheterization. The prosthesis was successfully crossed, permitting hemodynamic and angiographic evaluation of function of the prosthetic valve, left ventricle and mitral valve in all 27 cases. No complications were encountered. In patients with active endocarditis or recent embolization, the retrograde technique was avoided when possible, and attempts were made to utilize other techniques for study. However, three such patients were evaluated with the retrograde technique without complication. Examination of pressure tracings and cineangiographic films suggested only minor interference with valve poppet movement induced by the catheter transversing the valve. In three cases, hemodynamic data were recorded with the catheter crossing the prosthesis at one time and a paraprosthetic valve defect at another time. Identical gradients were recorded. This series documents the safety and efficacy of the retrograde approach, which is proposed as an alternative to the transseptal technique and left ventricular puncture.


Assessment of cardiac performance with quantitative radionuclide angiocardiography: right ventricular ejection fraction with reference to findings in chronic obstructive pulmonary disease. A reproducible noninvasive technique for measuring righ ventricular ejection fraction was developed using first pass quantitative radionuclide angiocardiography. Studies were obtained in the anterior position with a computerized multicrystal scintillation camera with high count rate capabilities. Right ventricular ejection fraction was calculated on a beat to beat basis from the high frequency components of the background-corrected right ventricular time-activity curve. In 50 normal adults, right ventricular ejection fraction averaged 55 percent (range of 45 to 65 percent). This radionuclide measure of right ventricular function was reproducible, with minimal inter- and intraobserver variability, and was sensitive to changes in inotropic state induced with isoproterenol. In 36 patients with chronic obstructive pulmonary disease, right ventricular ejection fraction ranged from 19 to 71 percent. All 10 patients with corpulmonale, as well as 9 additional patients, had an abnormal right ventricular ejection fraction. Arterial oxygen tension and forced expiratory volume were depressed significantly more in patients with abnormal right ventricular ejection fraction than in subjects with normal right ventricular function. There was no relation between abnormalities in right and left ventricular ejection fraction.


Primary repair of complete atrioventricular canal in patients less than 2 years old. Twenty-seven consecutive patients less than 2 years of age underwent primary intracardiac repair of complete atrioventricular (A-V) canal. Three (19 percent) of the 16 operated on after January 1, 1975 died in the hospital, a smaller proportion than the 8 of 11 patients who died in the hospital after operation between 1972 and 1975 (P = 0.005). The date of operation as a continuous variable is also related to the probability of hospital death (P = 0.016). Age at operation was not related to hospital mortality among the total group of 27 infants, nor were the anatomic characteristics of the anterior and posterior bridging leaflets, the location and size of the interventricular communications or the duration or technique of profound hypothermia (total circulatory arrest versus low perfusion flow rate). The improved results in the 16 patients operated on since January 1, 1975 are believed to be primarily the result of an improved ability to construct "mitral" and "tricuspid" valves from the common A-V valve. Fourteen of the 16 hospital survivors are alive and well 5 to 60 months after operation. These results and the natural history of patients with this malformation indicate that there should be no change in the policy of performing elective intracardiac repair before age 2 years and primary repair rather than pulmonary arterial banding when operation is required in the early months of life.


Hypertensive pulmonary vascular disease in alpha-transposition of the great arteries. In subjects with classic complete transposition (d-transposition) of the great arteries, the pulmonary arterial plexiform lesion, characteristic of chronic high levels of pulmonary arterial pressure, was observed in those with an intact ventricular septum as well as in those with a ventricular septal defect. The lesion was not observed before age 12 months. Among 16 patients aged 12 to 30 months, the plexiform lesion was observed in 6 of 12 patients (50 percent) with an intact ventricular septum and a closed ductus arteriosus and in 1 of 4 patinets with an associated ventricular septal defect. The basis of the plexiform lesion, which is considered a sign of chronic severe pulmonary hypertension, occurring in subjects with an intact ventricular septum and a closed ductus arteriosus is not explained. The phenomenon observed in this study confirms the earlier observations of others.


Musical murmurs: an echo-phonocardiographic study. Five patients with muscial murmurs were studied noninvasively with simultaneous echocardiography and phonocardiograpy and phonocardiography. Three patients had aortic regurgitation, one mitral regurgitation and one tricuspid regurgitation. The frequency of the muscial murmurs ranged from 40 to 158 cycles/sec. The patient with tricuspid regurgitation manifested an inspiratory honk. Simultaneous echo-phonocardiography revealed regular valve leaflet flutter (aortic, mitral or tricuspid) at a frequency identical to that of the simultaneously recorded muscial murmur. This study demonstrates that echocardiography is a useful noninvasive tool in identifying the site of origin of musical murmurs.


An electron microscopic study of the cavernous bodies in the lamprey gill filaments. The cavernous body in the lamprey gill filament was studied by electron microscopy. This body lies along the outer border of the axial plate of each gill filament and freely communicates with an afferent filament artery. Two series of blood channels run alternately, passing through the cavernous body, and lead to the marginal channels in the secondary lamellae. On the other hand, narrow blood spaces left in the cavernous body lead to the blood lacunae in the axial plate (osmoregulatory region) and to those in the secondary lamellae (respiratory region). All the blood in the cavernous body is finally collected by an efferent filament artery. The cavernous body is traversed by numerous trabeculae and collagenous columns which run diagonally in the blood spaces to connect the walls of the cavernous body. All the walls of the cavernous body, including trabeculae and collagenous columns, are completely surrounded by the cytoplasmic flanges of specialized cells called here "cavernous body cells." These cells are about 30 mu in diameter and characterized by (1) association with collagenous columns or trabeculae and also by the presence of (2) coated caveolae and vesicles, (3) vacuoles and (4) cytoplasmic granules in their cytoplasm. These cells are considered to be related to the pillar cells in origin because of their close association with collagenous columns or trabecule. The functional significance of the cavernous body and the cavernous body cells is discussed.


Isolated perfused dog lungs: a comparative stereologic comparison with normal dog lungs. Established stereologic techniques were used to evaluate the morphologic integrity of isolated dog lungs perfused with plasma for periods of 30 minutes, 1 hour and 2 hours. The morphometric data from the isolated lung preparations were compared to similar morphometric evaluations of dog lungs fixed immediately after removal from the thorax. In the isolated lungs capillary surface and volume densities were both substantially decreased. These estimations of capillary surface density provide a morphologic definition of capillary surface area which should be useful in the estimations of endothelial permeability in isolated lungs. This morphometrically defined decrease in capillary volume density was attributed, in part, to swelling of the endothelial cells. Alveolar surface density was also decreased and the type-I epithelial cells were increased in thickness. In both the endothelial and epithelial cells, cytoplasmic volume densities of the mitochondria and smooth endoplasmic reticulum were increased, while those of the rough endoplasmic reticulum and micropinocytotic vesicles were unchanged. The thickness of the interstitial compartment of the air-blood barrier and the volume densities of the peribronchial, peribronchiolar, and perivascular connective tissue sleeves were unchanged; there was no evidence of interstitial edema in the isolated lungs. These morphologic change must be considered in the interpretation of physiologic studies which employ isolated perfused dog lung preparations.


An ultrastructural study of developing extracellular matrix in vitelline blood vessels of the early chick embryo. This investigation was designed to describe the morphological events in embryonic development of peripheral blood vessels (vasculogenesis) and to relate this process to the appearance of extracellular matrix (ECM) during growth and maturation of these tissues. Extraembryonic vitelline vessels of the early chick embryo were chosen for this study and light, transmission, and scanning electron microscopy were carried out on vessels excised from chick embryos (Hamburger-Hamilton stages 8 through 23). Our data show that early (stage 10) vessels are composed of two distinct epithelial layers, an inner layer of presumptive endothelium surrounded by a layer of splanchnopleuric mesoderm. During development, the inner layer gives rise to mature vascular endothelium while splanchnopleuric mesoderm differentiates to form primitive vascular smooth muscle. Ultrastructural studies show the presence of collagen and basal lamina in the extracellular space between these two layers during initiation of endothelial and smooth muscle cytodifferentiation. Furthermore, ruthenium red-positive material is present on basal surfaces of developing vascular endothelium at this time, indicating possible glycosaminoglycans (GAG) or other polyanionic components of the ECM. These data suggest that the sequential production of basal lamina, collagen (s), and/or GAG's by developing peripheral vessel wall epithelia may be critical to their final differentiation.


Early postnatal development of ependyma in the third ventricle of male and female rats. Ependyma in the third ventricle of developing male and female rats (0, 5, and 10 days postpartum) were compared with those of sexually mature male rats by means of scanning electron microscopy (SEM) and transmission electron microscopy (TEM). No sexual dimorphism appeared in the developmental group. At all ages the dorsolateral ventricular wall was composed of ciliated ependymal cells, while ependymal cells of the ventrolateral wall exhibited apical microvilli and bleb-like irregularities. While SEM revealed similarities in apical morphology between ependymal cells adult and developing animals, TEM revealed marked differences between these cells. Many ciliated ependymal cells in developing animals resembled those of the adult while other neonatal cell profiles suggested ciliogenesis. Adult male rats exhibited two distinct tanycyte populations. One population, characterized by elaborate intercellular interdigitations and basal processes containing predominantly fine filaments, occurred adjacent to the ventromedial nucleus (VMN). The second population, characterized by less extensive intercellular interdigitations and basal processes containing, primarily microtubules, lined the roof of the lateral recess adjacent to the arcuate nucleus. Many tanycytes at the level of the arcuate nucleus in developing rats resembled closely those of the adult. In contrast, developing ependymal cells at the level of the VMN differed differed from their adult counterparts in that they exhibited little intercellular interdigitation and projected basal processes characterized by an internal framework of microtubules. Similarities in cytology between developing and adult tanycytes of the arcuate region suggest that the adult function of this population may be operative in the early postnatal period. In contrast, the differing cytology between adult and developing tanycytes of the VMN region suggests that the function of these cells is age-dependent.


Scanning electron microscope studies of the papilla basilaris of some turtles and snakes. The papillae basilares of three species of turtles and four species of snakes were studied by SEM. The papillae of turtle are relatively large among reptiles and are characterized by a long, horizontal middle section resting on wide basilar membrane. Both terminal ends of the papilla extend onto the surrounding limbus in the form of a forked or "T" -shaped end or as a curved, "hook"- like processes. Details vary with the species. In the three species of turtles studied, there were between 1,100 and 1,400 hair cells on a papilla. The tectorial membrane covering the horizontal portion of the papilla is heavy in appearance and tightly attached to the kinocilial bulbs. The terminal ends of the papilla are covered by a thin gelatinous material. In addition, mat-like tectorial network covers the supporting cells and extends from the microvilli of the supporting cells to the overlying tectorial membrane. All hair cells are unidirectionally and abneurally oriented. The supporting cell surfaces form a large part of the papilla and, thus, hair cell density is low. The papillae of the two boid snake species studied are moderately long among snakes and contain a moderate number of hair cells (574 in Epicrates and 710-780 in Constrictor). Papillar form is elongate, avoid, or canoe-shaped. The tectorial membrane may be either highly fenestrated or moderately dense and covers all but a few of the terminal hair cells. A tectorial-like mat covers all but a few of the terminal hair cells. Most hair cells are unidirectionally and abneurally oriented. A few terminal cells in boids may show reverse orientation. Hair cell density is similar to that of turtles.


A light and scanning electron microscopic study of the basial papilla in the salamander, Ambystoma tigrinum. The basilar papilla and basilar recess of Ambystoma tigrinum have been investigated by light and scanning electron microscopy. The recess is an evagination of the lagena, and is invested externally by dense periotic connective tissue, except over a thin area of one wall abutting against a periotic diverticulum communicating with the periotic sac. The surface and histological features of the non-sensory lining epithelium are described. The basilar papilla occupies both slopes of an elevation adjacent to the thin wall of the recess, and consists of 40 to 80 sensory cells interposed between sustentacular cells. The sensory cells are innervated by 30 to 40 nerve fibers exhibiting two ranges of diameter, and they are capped by typical ciliary bundles that are taller at the center of the receptor than at its periphery. Bundles in the proximal and distal halves of the papilla are polarized, respectively, toward the saccule and toward the thin wall in contact with the periotic diverticulum; this divergent pattern of polarization has not been reported previously in the basilar papilla of other vertebrates. A tectorial body overlies only the bundles in the distal half of the receptor, and is attached to both the neuroepithelium and the opposite wall of the recess. Functional considerations are discussed, and comparisons are made with conditions reported in frogs and toads. The findings suggest that the basilar papilla and recess in caudate and anuran amphibians arose from common precursors and probably function in a similar manner.


Ultrastructure of Merkel corpuscles and so-called "transitional" cells in the white Leghorn chicken. In the chicken Merkel corpuscles are located in the dermis and consist of specialized Merkel cells, discoid nerve endings and lamellar cells. Merkel cells contain characteristic membrane-bound dense-core granules and bundles of microfilaments. Asymmetric junctions, synapse like, with thickened membranes and clusters of dense-core vesicles were observed between the Merkel cells and the nerve endings. The nerve ending is derived from myelinated nerves and sometimes contains clusters of clear vesicles. A laminar system formed by lamellar cells of the Schwann cell type encloses the Merkel cells and the nerve endings. So called "transitional" cells, showing some of the morphological features of both keratinocytes and Merkel cells, were observed in the basal layer of the epidermis. One was located partly in the epidermis and partly in the dermis. The structure of Merkel corpuscles is compared with that of Merkel cells in other tetrapods. The developmental significance of "transitional" cells and the origin of Merkel cells are discussed.


Development of the diarthrodial joints in the rat embryo. The development of appendicular synovial joints of both legs was studied with histological and histochemical techniques in 43 rat embryos aged 12 to 21 days. From this and previous studies, it appears that joints develop by a sequence of cellular events leading to a full expression of the phenotypic characteristics. The classically described stages: cell condensation, three layered mesenchyme, vascular invasion and joint clefting, were chronologically recorded in all joints. The observations relevant to the intra-articular structures, such as joint capsule, menisci and ligaments, were also presented. Previously unreported, cellular aspects were described during joint morphogenesis and their biological significance was discussed. Among these cellular aspects, of particular interest are: a. an early wave of cell necrosis occurring immediately after differentiation of the interzone. Disappearance of necrotic cells is thought to prevent chondrification of this tissue by clearing up the cells with chondroblastic potentialities; and b. a morphologically peculiar type of cells that differentiate alongside, and by the time of, clefting and seem to be related to this process. Thus, the joint clefting appears also to result from a cell-tissue related phenomenon, acting in conjunction with the joint motion, the importance of which has been previously demonstrated.


Glucocorticoid-induced alterations in collagen of neonatal mouse condylar cartilage. Neonatal mice were treated with a single dose of triamcinolone hexacetonide, a long-acting synthetic analogue of cortisol, and their mandibular condyles were studied ultrastructurally ten days thereafter. A pronounced decrease in the number and size of matrix granules (proteoglycans) was found in the cartilaginous matrix of triamcinolone-treated condyles. In contrast, a marked increase concomitant with significant structural changes was noted in collagen fibrils. An obvious enhancement of collagen fibrillogenesis was noticed in the pre-mineralizing extracellular matrix. Atypical, wider than normal, banded collagen fibrils were found to form dense meshworks which appeared to lack any specific orientation or organization. It is proposed that glucocorticoid hormones, given systemically to neonatal mice, interfere with regulatory mechanisms involved with the biosynthesis of cartilaginous matrical macromolecules, i.e., proteoglycans and collagen and thereby promote certain aging processes within active growth centers.


Scanning electron microscopy of epidermal cell migration in wound healing during limb regeneration in the adult newt, Notophthalmus viridescens. The epidermal cells which migrate over the wound surface of the amputated limb of the adult newt were examined using the scanning electron microscope. Specimens were prepared routinely for scanning electron microscopy or were embedded in Epon 812 for light microscopic observations. A cuff of epidermal cells was seen at the edge of the wound, from which cells appeared to migrate over the wound surface. As early as five hours after transection of the limb, the basal layers of this cuff appeared to send out pseudopodial projections. These seemed to establish a physical contact with a fibrin-like substratum, which apparently served as a means of support for the migrating cells. Subsequently, the epidermal cells became elongate and had the appearance of streaming toward the center of the wound. Between 10 and 13 hours post-amputation, the cells in the central region of the stump were rounded up and some possessed microappendages resembling microplicae and microvilli. Throughout the entire period of wound coverage, the cells seemed to maintain contact with the fibrin network, which appeared to be the first structural element of wound architecture. As a result of these observations, the mechanism by which the epidermal cells migrate has been clarified.


Insemination-induced histolysis of the flight musculature in fire ants (Solenopsis, spp.): an ultrastructural study (1). The fine structure of the insemination-induced flight muscle degeneration (histolysis) in the queen fire ant (Solenopsis spp.) has been investigated. Within 2 hours post-insemination, degenerative changes are detectable in the most peripheral fasciculi of the fibrillar flight muscle. Histolysis proceeds internally with time. Myofibril (sarcomere) dissolution begins with myofilament breakdown and continues until only free Z-line material remains. The latter subsequently disappears leaving, at the terminal stages, only nuclei, lamellar bodies (myelin figures), and tracheoles as residual myoid elements. Lysosomes and/or phagocytes do not appear to play a primary role in the initiation and continuance of this process.


Energy expenditure and body composition during weight reduction in hyperplastic obese women. The energy expenditure and body composition changes in out-patients during a long-term weight reduction with a diet recommended to provide 1100 kcal were studied in eight hyperplastic obese women. The study was focused on finding plausible explanations for the decreasing weight loss rate after several weeks of successful weight reduction. Using a heart rate monitoring method, the energy expenditure was measured four times at selected intervals during the study. Then, the energy intake was calculated on the basis of three dietary recordings lasting from 4 to 7 days. The recorded energy intake increased at the end of the weight reduction, but no changes in daily energy expenditure were found. The oxygen consumption during standardized cycling, walking, and domestic work decreased, but when the patient was at rest, no changes occurred during the weight reduction. The weight loss predicted from the energy balance and body composition changes was considerably greater than the actually determined weight loss. Large discrepancies were found after 5 weeks on the weight reducing regimen between the recorded dietary intake and what could be calculated from urinary nitrogen losses. With the available methods for determining energy intake and expenditure, it was considered impossible to fully explain the reason for the weight plateau observed after long-term weight reduction in out-patients.


Relation of specific dynamic action of food (SDA) to growth in rats. The relation between food induced thermogenesis and anabolic processes was investigated in normal and malnourished rats. The metabolic rate was measured 5 and 17 hr after food removal. The difference between the two measurements was 3.9% during growth arrest of malnourished rats gaining 0.6 g/day, but 20.0 and 28.7% during growth recovery when rats were gaining 4.1 and 5.3 g/day, respectively. The 5 hr postprandial metabolic rates rose in normal rats from 15.6 kcal/day at 4 weeks to 45.3 kcal/day at 15 weeks, and then declined to 38.5 kcal/day at 36 weeks. The difference between 5 and 17 hr postprandial metabolic rates was 28.8% in 5 to 15-week-old rats gaining 5.2 g/day, and 1.1% in 24 to 32-week-old rats who were no longer gaining weight.


Effect of oral alanine loads on plasma amino acids in oral contraceptive users and control women. Plasma amino acids were determined before and after orally administered alanine loads in five women using an estrogen-containing oral contraceptive and four healthy female controls. Oral contraceptive users and significant reductions in fasting plasma valine, methionine, isoleucine, tyrosine, phenylalanine, histidine, glutamic acid, and alpha-aminobutyric acid. With the exception of alpha-aminobutyric acid, these differences between the two groups were eliminated within 3 hr of alanine ingestion. This effect was due to a gradual increase in the plasma amino acids of the oral contraceptive-treated women, plus no change or slight reductions in the controls.


Studies of vegans: the fatty acid composition of plasma choline phosphoglycerides, erythrocytes, adipose tissue, and breast milk, and some indicators of susceptibility to ischemic heart disease in vegans and omnivore controls. The fatty acid composition of erythrocytes, of plasma choline phosphoglycerides, and of adipose tissue, serum cholesterol, triglyceride and vitamin B12 concentrations, weights, heights and skinfold thickness were determined on 22 vegans and 22 age and sex matched omnivore controls. The fatty acid composition of breast milk from four vegan and four omnivore control mothers, and of erythrocytes from three infants breast fed by vegan mothers and six infants breast fed by omnivore control mothers was determined. The proportions of linoleic acid and its long-chain derivatives were higher, the proportion of the long-chain derivatives of alpha-linolenic acid was lower, and the ratio of 22:5omega3/22:6omega3 was greater in the tissues of the vegans and infants breast-fed by vegans than in controls; the most marked differences were in the proportions of linoleic (18:2omega6) and docosahexenoic (22:6omega3) acids. Weights, skinfold thickness, serum vitamin B12, cholesterol and triglyceride concentrations were less in vegans than in controls. The difference in serum cholesterol concentration was most marked. It is concluded that a vegan-type diet may be the one of choice in the treatment of ischemic heart disease, angina pectoris, and certain hyperlipidemias.


Vitamin B12 assimilation from chicken meat. Chicken meat labeled in vivo with radio-B12 was ingested by normal volunteers. The absorption, measured by the fecal excretion method, was similar to that reported for crystalline radiocyanocobalamin and for mutton, but exceeded that from eggs. Parenteral injection of 1000 microgram of nonlabeled vitamin B12 did not interfere with the absorption of the radio-B12 from the meat. The urinary radioactivities, which were as low as those after oral administration of radioactive hydroxocobalamin and vitamin B12 coenzyme, suggested that the radio-B12 was present in meat in coenzyme form or was converted into the stable hydroxoform during the process of cooking and digestion. Patients with pernicious anemia showed insignificant urinary radioactivities in a standardized urinary excretion test using chicken meat whereas subjects with simple gastric achlorhydria and partial gastrectomy had subnormal values although their absorption of crystalline radiocyanocobalamin was normal. The subnormal serum vitamin B12 concentration seen in these latter subjects may, therefore, be due to impaired assimilation of vitamin B12 from food.


Effect of physical activity on human potassium metabolism in a hot and humid environment. Previous investigations have suggested that there are high potassium losses during heavy physical activities in hot climates. In order to determine if high levels of potassium losses could be offset by potassium loading, this study was conducted with five long-distance track runners who had trained in hot and humid environments. The liquid supplements containing 4.3, 98.0, and 0.0 mEq/liter of potassium were given 1 to 2 hr before physical activity. The daily diet contained 2.6 g of potassium. A sodium and potassium balance study was conducted in which stool, urine, and dermal losses were measured. In order to determine if there was a change in the distribution of body potassium during physical exercise, seven subjects total body potassium was estimated before and after exercise. This measurement was performed by counting 40K in a whole body counter. Although the subjects with potassium supplementation and higher urinary sodium and potassium losses, the 98 mEq/liter of potassium supplement resulted in a positive potassium balance. The subjects' potassium requirements exceeded the National Research Council suggested dietary intake. The total body potassium measurements indicated that the counting efficiency of 40K increases significantly immediately after the period of vigorous exercise.


Biochemical effects of mercury poisoning in rats. Acute HgCl2 poisoning was shown to decrease significantly the pyruvate dehydrogenase (PyDH) and alpha-ketoglutanic dehydrogenese (alphaKgDH) activity in the kidney and liver but not in the brain. Rats receiving 77% of the 2 hr 50% lethal dose showed 57% of normal renal PyDH activity and 69% of normal renal alphaKgDH activity. Chronic Hg Cl2 poisoning resulted in an unexpected increase in PyDH and alphaKgDH activity in the kidneys where mercury was most concentrated. In acute methyl mercury injection, no significant effect on PyDH or alpha KgDH activities was observed after 2 days. Less mercury was accumulated in the tissues with methyl mercury poisoning than in the other treatments.


Hematopoietic studies in vitamin A deficiency. Recent studies of experimental vitamin A deficiency in man led the authors to conclude that anemia may result from lack of vitamin A. A review of numerous nutrition surveys in underdeveloped countries enhanced the suspicion that deficiency of vitamin A does contribute to the prevalence of anemia. Preliminary studies of vitamin A-deficient rats confirmed previous observations that anemia may result from lack of this vitamin. The livers of these animals had very low concentrations of vitamin A but normal or increased concentrations of iron. The finding of anemia is in contrast with other reports that vitamin A deficiency may cause elevated values for hemoglobin and hematocrit. The authors suggest that loss of taste and smell as a result of deficiency may account for refusal of experimental animals to eat and drink enough to prevent inanitation and dehydration. The resulting hemoconcentration may mask the true hematological picture, which is one of anemia.


Vitamin B6 status in women with postpartum depression. We have assessed the vitamin B6 status of 40 nonpregnant women of reproductive age, 30 pregnant women, 20 postpartum, not depressed, women and 24 postpartum, depressed women by means of the erythrocyte glutamate-oxaloacetate transaminase activation test (alpha EGOT). The level of mental depression was evaluated in the nonpregnant controls, the postpartum controls and the postpartum, depressed patients by the Beck Depression Inventory and the Depression Adjective Check Lists. The results of the alpha EGOT did not indicate any significant differences between the postpartum, depressed patients and any of the control groups. The Beck and Depression Adjective Check Lists scores were significantly higher in the postpartum depressed patients than in the postpartum controls or nonpregnant controls. On the basis of this study, there is no evidence for vitamin B6 deficiency in women suffering from postpartum depression.


Attained growth status of selected groups of Israeli children. Analyses of available growth data from different groups of Israeli children revealed wide differences in attained growth in groups of children whose parents immigrated from different countries. By means of analyses of variance, it was shown that these differences in growth are most likely due to differences in the socioeconomic level of the family, rather than being related to parental country of origin. The data also suggest that nutrition problems among Israeli children, although not very severe, reflect a moderate degree of maldistribution of available food resources in different socioeconomic and cultural subgroups. The data also support the applicability and usefulness of a reference population data base drawn from children in the United States, in evaluating the attained growth status of children in different population groups.