Patients with high-grade atrioventricular block treated and not treated with a pacemaker. One-hundred and eighty-one patients with chronic and with intermittent high-grade atrioventricular block (AVB) were studied retrospectively. Seventy-one were treated with fixed-rate, 51 with demand-type pacemaker, 59 were treated conservatively. Observation time was three years minimum and 14.5 years maximum. The mean age was about seven years higher, and 8.7% more patients had chronic AVB in the conservatively treated than in the pacemaker-treated group. About 12% more patients had Adams-Stokes attacks in the pacemaker group than in the conservatively treated group. There were 7% more patients with coronary heart disease (CHD) in the pacemaker group, and 10% more with aortic valve disease among the conservatively treated. Totally 4.4% of the patients had a calcification of the mitral annulus fibrosus. The two groups were comparable as regards functional class (NYHA) and heart size. Survival showed 31% more sudden deaths in the conservatively treated than in the pacemaker group. Sudden deaths were not more frequent among the patients with CHD than in those without. Long-term survival showed the more favourable result for the patients with than without pacemaker treatment. There were eight (11.3%) unexplained sudden deaths among the patients treated with fixed-rate pacemaker, only three (5.9%) among those treated with a demand unit. The fixed-rate and the demand units showed a mean longevity of 37.2 and 34.6 months, respectively.


Left anterior hemiblock in acute myocardial infarction. Incidence and clinical significance in relation to the presence of bundle branch block and to the absence of intraventricular conduction defects. The incidence of intraventricular conduction defects was examined retrospectively in 449 consecutive patients with acute myocardial infarction (AMI). The incidence of left anterior hemiblock (LAH), right bundle branch block (RBBB), left bundle branch block (LBBB) and RBBB+LAH was 12.2, 4.2, 3.8 and 2.5%, respectively. At least 24 patients (5.8%) developed LAH as a result of the AMI. LAH was present in 20% (33/164) of patients with anterior infarction, in 14% (18/131) of those with infarction of undetermined localization, and in 3% (4/143) of patients with diaphragm infarction. The incidence of complete atrioventricular (AV) block in patients with LAH was 6% and in patients with no intraventicular conduction defects 7%. In patients with RBBB, RBBB+LAH and LBBB, the incidence of complete AV block was 37, 45 and 18%, respectively. Severe pump failure occurred with the same low incidence in patients with LAH as in patients without intraventricular conduction defects, but was much more common in patients with complete bundle branch block (BBB). The mortality rate for patients with LAH was 22% and for patients with no intraventricular conduction defects 21%. In patients with RBBB, RBBB+LAH and LBBB, the mortality rates were 53, 55 and 53%, respectively. Patients with complete BBB had a higher age and a higher incidence of previous AMI than the others. Compared to patients with no intraventricular conduction defects, the presence of LAH did not increase the mortality rate, or the risk of developing severe heart failure or complete AV block, in contrast to the serious prognosis in patients with complete BBB.


Thrombosis of the inferior vena cava, disseminated intravascular coagulation and gangrene of the penis. A case report. Gangrene of the penis following thrombosis of the lower segment of vena cava inferior is reported in a patient who also exhibited clinical and laboratory signs of disseminated intravascular coagulation. Development of the gangrene may have been related to thrombotic occlusion of the right spermatic vein.


Comparison of the results in patients operated upon for ruptured lumbar discs with and without spinal fusion. A comparative study of 259 patients operated on for ruptured lumbar discs, with and without spinal fusion, has been carried out. Simple removal of the herniated nucleus pulposus was performed in 119 patients while 68 were subjected to combined removal of the herniated disc material and lumbo-sacral fusion. During the first postoperative months the results were similar in the two groups, with a satisfactory result in 89 and 88 per cent of the cases respectively. During the following years a significant difference occurred between the groups. Severe pain recurred in 27% of the patients with simple removal of the herniated disc material and in 15% of those with the combined operation (P less than 0.01). The cause of the recurrence in the patients without fusion was disc herniation in 10% (at the same level in 7% and at a different level in 3%), and adhesions, or osteochondrosis with or without instability in 17%. In the patients with the combined operation the recurrences were caused by pseudoarthrosis in 9%, by disc herniation in 3%, and by other causes in 3%. At the final examination 6--7 years after the first operation, the results were still better in the fused patients, but the difference was no longer significant. Eighty-five per cent of the patients with the combined operation has a satisfactory result with regard to pain as compared with 76% in the other group. Thus, the results show that the combined operation gives better protection against recurrence of pain. However, it is a more extensive procedure and has complications of its own, and it should therefore mainly be used in young patients.


Redundant nerve roots of the cauda equina. A report of five cases. Five personally examined cases of redundant nerve roots of the cauda equina are added to the 13 hitherto on record. Except for segmental neurological deficits, intermittent claudication-like symptoms of the cauda equina dominated the histories of four of our five cases. The diagnosis was confirmed at surgical exploration, which included laminal and dural decompression. At follow-up (two months--three years) the neurological deficit, or the intermittent claudication, or both, had improved in all our patients. The pathogenesis of root redundancy is obscure. It seems that the symptoms arise through the action of at least two factors viz compression of the spinal content and the existence of one or more redundant roots. Wider use of diagnostic aids and surgical exploration would probably show that redundant roots are more common than hitherto supposed.


Lhermitte's sign in thoracic spinal tumour. Personal observation. In a case of midthoracic spinal metastasis with a partial transverse cord lesion a typical Lhermitte's sign was elicited by flexion of the head. This is a very rare phenomenon with thoracic spinal tumours.


Transitory block of the arachnoid granulations following subarachnoid haemorrhage. A postmortem study. The arachnoid granulations of the superior sagittal sinus were examined for blockage by erythrocytes in 43 cases of subarachnoid haemorrhage. Ten cases had survived for more than two weeks after the haemorrhage. Among 33 cases with acute haemorrhage, 17 had evidence of blocking of the granulations. The severity of the block varied from complete clogging of nearly all granulations to slight filling of a few of them. Cases with some days' survival showed evidence of phagocytosis of the entrapped erythrocytes by macrophages. Several of the cases with old haemorrhage had groups of haemosiderin macrophages in the granulations but none showed fibrosis (except for one single villus). It is concluded that clogging of the arachnoid granulations may contribute to the raised intracranial pressure in some cases of acute subarachnoid haemorrhage. However, the observations do not support the hypothesis that the haemorrhage may lead to fibrosis or scarring of the granulations with chronic impairment of the cerebrospinal fluid resorption and subsequent hydrocephalus.


Bulk flow of cerebrospinal fluid through a lumbo-omental pedicle graft in the dog. Perfusion tests were performed in dogs with a pedicle graft of the greater omentum implanted in the lumbar subarachnoid space to measure its capacity to drain CSF. The CSF pressure was set at different levels in the range 0--50 mmHg and the outflow from a complete CSF space and then from the isolated dural sac was recorded in the same dog with an electronic drop recorder. It was shown that the omental graft could transport as much as 30% of the CSF normally carried by the physiological pathways. The spinal outflow in the controls was virtually non-existent. It is concluded that a bulk flow of CSF occurs through the graft. The results suggest that a lumbo-omental pedicle graft could possibly be used as a biological shunt in the treatment of hydrocephalus.


Communicating exophthalmos: a sign of bilateral orbital roof defects. The term communicating exophthalmos is suggested for a condition where manual retropulsion of one eye results in proptosis of the other eye. This sign was observed in a patient with bilateral pulsating exophthalmos. The pulsating exophthalmos was ascribed to orbital roof defects in combination with post-traumatic hydrocephalus. It was controlled by a shunting procedure.


[Modified technique in transsphenoidal operations of pituitary adenomas. Technical note (author's transl)]. High pressure lumbar air insufflation and endoscopical surgical technique and control improve surgical results and widen indications for the transsphenoidal approach to pituitary adenomas. These complementary methods require a sitting position for the patient and an axial approach to the sella turcica. By lumbar high pressure insufflation even very big pituitary adenomas may often be brought into the operation field and make possible a complete extirpation by a transsphenoidal approach. This possibility is increased by an operative technique under endoscopic control, the latter contributing considerably to complete tumour extirpation, especially with endocrine-active tumours.


Optic nerve gliomas. I. Clinical diagnosis and pathology. At the National Institute of Neurosurgery a team of ophthalmologists and neurosurgeons has for 20 years been collaborating in the research and treatment of optic nerve gliomas. Among 34 patients, 30 were under the age of 20 years, and 20 under the age of 10 years. Of the 20 patients younger than 10 years, 16 were girls. The clinical symptoms were classified into three groups: I. Unilateral visual impairment with unilateral axial proptosis (16 patients), strabismus (6 cases), and typical X-ray findings of the skull. II. Uni- or bilateral visual impairment without proptosis (12 patients), depressed vision in the homolateral eye (9 patients), hemianopia (2 out of 4 examined patients) and hemiparesis (6 cases). III. Uni- or bilateral visual impairment without proptosis but with hormonal or metabolic disturbances (6 patients). Carotid angiography and PEG were performed in groups II and III and revealed a picture that is characteristic of suprasellar tumours. 99mTc pertechnetate scanning was done in six cases and showed isotope accumulation in the tumour in five. Pathologically, considering also the clinical aspects, two types of localization merit consideration: 1. The relationship between the tumour and the optic nerve (tumours growing within and extending beyond the optic pathways, respectively) and 2. The site of the tumour within the optic nerve (intraorbital, intraorbital and intracranial, intracranial only, chiasmal, and diffuse). Our data of histology and tissue culture prove the benign nature of the tumour even in the recurrences.


Temporal lobe lesions in head injury.

Temporal lobe lesions in head injury. In cases of closed head injury temporal lobe lesions e.g. contusion, laceration, pulping, or intracerebral haematoma frequently result in an expanding process. These are frequently associated with an overlying subdural haematoma. Eighty five cases of such lesions from a consecutive series of 1,000 cases of head injury have been analyzed. The lesions are caused by severe injury resulting in loss of consciousness and skull fracture. Most of them are contre-coup lesions. Clinically they manifest themselves like any other acute or subacute intracranial hematoma. The majority of the patients have contralateral hemiparesis and pupillary abnormalities. Carotid angiography is valuable for diagnosis. These lesions are likely to be missed when exploratory burr holes are made or, are erroneously diagnosed as acute subdural haematoma or brain oedema. Smaller lesions, not showing progressive deterioration, may respond to conservative treatment. However, surgical decompression is essential in most cases A frontotemporal osteoplastic craniotomy or a large Scoville trephine hole is essential to deal with these lesions adequately.


Extradural haematoma. Report of 132 cases. In a consecutive unselected series of 132 cases of acute extradural haematoma among 9,600 patients who sustained a head injury and were admitted without delay to a regional neurosurgical department during the years 1964 to 1975 the overall mortality was 23 per cent. Associated intradural lesions, the relative infrequency of the lucid interval, sustained loss of consciousness from the time of admission, lack of the classical pupillary changes, and the rapid rise in intracranial pressure in some patients are factors of importance for the prognosis. It should be possible to improve the results and lower the mortality if due consideration is taken of these factors.


The significance for diagnosis and for surgical technique of multiple aneurysms of the same internal carotid artery. A small series of five patients with more than one aneurysm on the same internal carotid artery is reported. The author believes that similar cases must have been observed by many neurosurgeons but can find no specific reference to the technical and diagnostic problems created by such lesions. Sometimes these lesions can be clipped separately, but when the aneurysms are contiguous it may be helpful to apply a clip with its jaws parallel to the long axis of the internal carotid artery. The author suggests that more case reports would help to advertise the relative frequency of such lesions and thereby should improve their management.


Excision of the spinal trigeminal tract. Electron microscopy. In nine patients with trigeminal neuralgia excision of the trigeminal tract was performed instead of tractotomy. In eight of the patients neuralgia was cured. One female patient died due to occlusion of the middle cerebral artery. Electron microscopy disclosed first of all changes in the myelin sheaths. The majority of the changes were non-specific. Only degenerative hypermyelinization was considered to be characteristic for trigeminal neuralgia.


Basilar impression in an achondroplastic dwarf: causative role in tetraparesis. The neurological and radiological findings in a case of chondrodystrophic dwarfism are described. The progressive tetraparesis proved to be based on a high-level medullary compression resulting from basilar impression and upper cervical stenosis. Surgical decompression led to the disappearance of the tetraparetic phenomena. Various aspects of chondrodystrophic dwarfism and basilar impression are discussed in relation to the neurological symptomatology, and the question of whether, in general, more attention should be given to the cranio-cervical region, is raised.


Multi-channel telephone transmission and quantitative on-line analysis of EEG in brain surgery. During the last ten years clinical neurophysiology has used computerized quantitative methods for analysis. Evaluation of the information previously hidden in the signals from the nervous system offers previously unknown uses and applications for neurosurgery. The quantitative EEG (QEEG) for example may offer more reliable and easily understandable information of brain activity than the conventional analogue EEG. The techniques for QEEG-analysis have now reached such an advanced stage that they extract at the same time more information from the EEG than can be achieved by visual interpretation. The problems of distances between neurosurgical departments and computer centers can be overcome by means of telephone transmitter systems, as has been done in the present study. Patients with epilepsy or brain tumour undergoing surgery were analyzed and monitored with the peroperative tele-QEEG-system. Our experiences were encouraging since the neurophysiological part of the work at the operation unit was reduced considerably thanks to the tele-system. At the same time we obtained easily understandable EEG-information which has never previously been available to us.


Cerebral arterial flow dynamics during aneurysm haemorrhage. A case of intraoperative early rupture of an infraclinoid aneurysm is reported with data showing the specific dynamics of cerebral arterial flow during aneurysm haemorrhage. Internal carotid artery flow and arteriial blood pressure were recorded throughout the surgical procedure. The rupture took place during preparations for dural opening at a mean blood pressure of 160 mmHg and at a low intracranial pressure of 5 to 6 mmHg. The dura became instantly tight, and was non-pulsatile within 10 seconds. The parietal epidural pressure rose rapidly to 110 mmHg. There was a brief initial increase in flow as the haemorrhage started, followed by a marked reduction within seconds. End-diastolic blood flow arrest was observed at this stage, demonstrating the self-limiting effect of a subarachnoid haemorrhage. This impaired cerebral perfusion pressure, or transmural pressure, is discussed with regard to the risk of cerebral damage as well as the beneficial effect in the staunching of haemorrhage. Carotid artery flow showed a moderately impaired autoregulation and an increased vascular resistance suggesting a no-reflow phenomenon subsequent to these events.


Timing and indication of surgery for ruptured intracranial aneurysms with regard to cerebral vasospasm. The authors survey 443 cases of intracranial aneurysms treated in the past seven years. 403 cases were operated upon with microsurgical techniques. The operative mortality was 5.4 per cent, and 82.4 per cent of surgically treated cases are well and working, leading useful social lives. It was found that cases submitted to surgery in the first three days after subarachnoid haemorrhage (SAH) (the day of SAH being counted as the first day) showed good results, little appearance of postoperative vasospasm, and no mortality due to vasospasm. Cases operated upon after one week from the insult of SAH also showed good results, whereas fatal postoperative vasospasm was seen in cases operated upon on the 4th--7th day after SAH. Cisternal, ventricular, and epidural drainage are recommended after the clipping of aneurysms in the acute stage of SAH. There were 68 cases with preoperative vasospasm. There was no case in which vasospasm was identified during the first four days after SAH, while 66 per cent of the cases exhibited vasospasm between the sixth and ninth days after SAH. These 68 cases can be classified into four groups: 1. 8 cases died from vasospasm before surgery: 2. 8 cases had renewed bleeding mainly when vasospasm began to subside. 3. 22 cases underwent surgery after vasospasm had subsided, the duration of vasospasm ranging from 8 to 24 days, on an average 14 days; 4. 30 cases underwent surgery while vasospasm was still present; of this group, (4E) 15 cases submitted to surgery, on an average 4.5 days after the onset of vasospasm, manifested deterioration of clinical states because of aggravation or new appearance of vasospasm; (4L, 15 cases which underwent surgery, on an average 7.4 days after the onset of vasospasm, showed no such deterioration. In the follow-up, well and working cases were seen in 45.5 per cent (3.), 60 per cent (4E), and 80 per cent (4L), respectively. The authors classified vasospasm into three types: Type 1, extensive diffuse, Type 2, multi-segmental, and Type 3, local. Type 1 was prognostically worst, Type 3 good, and Type 2 was located between these two types.


Microsurgical treatment of cerebral aneurysms at the bifurcation of the internal carotid artery. With microtechnique, meticulous dissection and identification of critical anatomical structures become realities, contributing substantially to the improved results in the treatment of internal carotid artery bifurcation aneurysms.


Disordered cerebro-vascular physiology in aneurysmal subarachnoid haemorrhage. The technical problems of surgery for anterior circle aneurysm have in large measure been solved. The problem of reduced perfusion to the brain which characterises the patient with aneurysmal subarachnoid haemorrhage in a poor clinical condition demands more subtle physiological handling. It appears likely that maintenance of an intact cell membrane and blood brain barrier may be aided by the exhibition of pre and post-operative steriods, and that concentration on regional perfusion should be the main aim in post-operative management of such cases. This demands maintenance of adequate blood volume, avoidance of platelet stickiness, and utilisation of the pathological paralysis of autoregulation to improve flow to ischaemic zones by hypertensive agents if necessary. The possibility that early operation with evacuation of blood from the basal cisterns may in the end prevent the vascular damage and disordered vaso-reactivity which encourages the development of transient ischaemic deficits, is a concept which has to be actively pursued. The problem is a continuing one which has bedevilled aneurysm surgery for 25 years, but the omens suggest that a solution is appreciably nearer at hand.


Non-operative management of acute upper cervical injuries. The results of a closed, non-operative type of treatment in acute upper cervical injury have been reviewed, especially as they relate to the use of the halo cast or vest. The morbidity with the use of this device has been minimal and there has been no mortality. Early patient mobilization has been readily achieved and in the case of the Hangman's, Jefferson's, and odontoid fractures, stable solid bony healing has been achieved in nearly all cases. Similar results have been noted in the C-1 arch fracture, as well as the acute post-infectious subluxations of C-1/C-2. In a small number of cases involving traumatic C-1/C-2 and occipital/atlas subluxation, there has occurred a significant incidence of instability, despite adequate closed treatment. This has been likely to be due to the serious ligamentous disruption in these cases and it would appear that surgical fusion may be the preferential form of initial treatment in this group of injuries.


Effects of scoring norms on adolescent psychiatric drug users' and nonusers' MMPI profiles. The present study compared the effects of scoring norms on adolescent psychiatric inpatient drug users' and nonusers' MMPI profiles. The results indicated that regardless of drug usage or nonusage the application of adolescent norms yielded less pathological profiles than did the use of adult norms. A further finding was that Scale O, Social Introversion, is the only clinical scale from differentiated users' from nonusers' profiles.


Delinquent and non-delinquent males' perception of their fathers. The purpose of this study was to investigate the differences in delinquents' and non-delinquents' perceptions of their fathers, and the relation between their perceptions and selected background and familial variables. Utilizing a sample of 330 Ss, delinquency was found to be associated with: (a) lack of a warm, loving, supportive relationship with the father; (b) minimal paternal involvement with children; (c) high maternal involvement in the lives of youth; (d) broken homes; and (e) feelings of anomie.


Homosexual behavior and child molestation: a review of the evidence. Male homosexuality and child molestation tend to be associated with each other in the minds of a large percentage of the general public. Designing a research study to test this hypothesis presents a number of methodological problems which are not easily resolved. Existing studies which contain data on this general question provide no reason to believe that anything other than a random connection exists between homosexual behavior and child molestation.


Identification and some characteristics of the enzyme protein of the hormone-sensitive lipase from rat adipose tissue. A tri-, di-, and monoacylglycerol-hydrolyzing enzyme from rat adipose tissue has been detergent-solubilized and separated from monoacylglycerol lipase (H. Tornqvist and P. Belfrage, 1976, J. Biol. Chem. 251, 813-819) and lipoprotein lipase by use of ion-exchange chromatography, broad and narrow pH range electrofocusing and gel chromatography. The final preparation contained several different proteins. One of these, with an apparent minimum molecular weight of 86,000 by SDS-gel electrophoresis, was identified as the enzyme protein of hormone-sensitive lipase: a) the enzyme activity was reproducibly stimulated 50-100% by incubation with cyclic AMP-dependent protein kinase, cyclic AMP and ATP-Mg2+; b) the relative intensity of the Mw 86,000 protein band, and only this, closely paralleled the enzyme activity during narrow pH range electrofocusing and during subsequent gel chromatography of the electrofocusing enzyme peak fraction; c) only the Mw 86,000 protein extensively incorporated 32p from [gamma-32P]ATP after incubation with protein kinase and cyclic AMP. The pI of the enzyme was 6.7, it had the same Stokes radius on Sephadex G 200 as IgG and was 50% inactivated by 10 micron HgCl2, 20 micron PCMB, 50 micron DFP, 10 mM NaF and non-ionic detergents above their critical micellar concentration.


Affinity chromatography on heparin-sepharose of rat adipose tissue triglyceride lipase from cytosol. Subfractionation of the fat free homogenate of rat adipose tissue showed that a high yield of triglyceride lipase was recovered reproducibly in the microsomal supernatant fraction (cytosol) when rat epididymal fat pads were homogenized in sucrose-EDTA-Tris medium. Triglyceride lipase was bound on heparin-Sepharose. Hydrolyzing activity towards triacylglycerol was eluted as a single, sharp peak in 0.7 M NaCl, 5 mM sodium barbital and 20% glycerol (pH 7.0). The triglyceride lipase was not inhibited by 1 M NaCl and not stimulated by the presence of fresh human serum. A lipoprotein-lipase activity was demonstrable in the cytosol when adipose tissue from fed rats were used. Fasting of the animals lowered this activity.


Mechanism of phospholipase A2 action toward mixed micelles of detergent and phospholipids. Phospholipase A2 from cobra venom (Naja naja naja) is a homogeneous, heat-stable enzyme that has a monomer molecular weight of only 11,000 and contains one histidine and one tryptophan residue. This enzyme acts optimally on phospholipids contained in mixed micelles with the nonionic detergent Triton X-100; the interactions of this detergent with phospholipid in the mixed micelles have been elucidated with 1H- and 13C-NMR. In reacting, the enzyme first associates with the mixed micelle and then exhibits "surface dilution kinetics" in its reaction with substrate. Recent studies show that various reagents completely inactivate this phospholipase A2 resulting in the modification of the histidine in only one-half of the enzyme molecules. These results suggest that the histidine residue, which is essential for activity, exhibits "half-site reactivity." These and other experiments are interpreted in terms of a model that suggests that the monomeric enzyme forms an asymmetric dimer or higher order aggregate at the lipid-water interface. The studies which are described on the interaction of the phospholipase A2 with mixed micelles serve as a general model system for understanding detergent effects on the assay of lipid enzymes.


Phospholipases of plasmic membranes of adipose tissue. Possible intermediaries for insulin action. In the present investigation we have shown that cytoplasmic membranes of adipocytes contain A1 and A2 phospholipase activities which are optimal in a buffer with 5 mM Ca2+ (pH 8.5). Insulin enhances these activities within phosphatidylethanolamine. Insulin increases also the amount of free fatty acids in membranes. Rodbell and Blecher have already shown an insulin-like action of phospholipases towards the uptake of glucose and amino-acids by adipocytes. Shier and Asakawa have recently described that lysolecithin and unsaturated fatty acids can change nucleotide-cyclase activities of cytoplasmic membranes towards GTP and ATP; lysolecithins and Triton X 100 seem to react in an identical way. Results from these studies give new suggestions on insulin action; phospholipase activation changes membrane physiochemical properties inducing an increase of glucose carrier mobility and leading the membrane cyclase enzyme (s) towards GMP cyclic synthesis.


The release of free ethanolamine in rat brain homogenates incubated in Krebs ringer. Ethanolamine in mammalian brain is found chiefly in a lipid-bound form either as the diacyl phospholipid, phosphatidylethanolamine or as the plasmalogen, I-alk-11-enyl-2-acyl glycerophosphoethanolamine and to a lesser extent as the saturated ether analogue. The level of free ethanolamine in brain is very low, probably less than 40 nmol/g brain (Spanner & Ansell, 1977b) while that of phosphoethanolamine is about 1.0 mumol/g brain. Some time ago we found that if brain tissue was incubated in Krebs Ringer bicarbonate (pH 7.4) at 37 degrees, there was a steady release of free ethanolamine by the tissue. The following account is a summary of the findings from experiments designed to determine the source of the ethanolamine liberated.


Membrane-bound base-exchange reactions in animal tissues. The calcium-stimulated incorporation of ethanolamine, L-serine and choline into rabbit synaptosomal phospholipids in vitro has been investigated. The synaptosomal membranes were prelabelled in vitro in their choline-, ethanolamine- or serine-phosphoglycerides by base-exchange and then chasing experiments were performed by displacing the lipid-bound base by ethanolamine, choline or L-serine labelled with a different isotope. The results indicate that membrane phosphatidylcholine, phosphatidylethanolamine and phosphatidylserine are substrates for the exchange with all the three mentioned bases. A very small phospholipid pool (0.5-2% of the total available pool) is active in the calcium-dependent exchange between membrane phosphatidylcholine or phosphatidylethanolamine and free bases, whereas the pool of exchanging phosphatidylserine is sensibly larger (2-9%). In another series of experiments the effect of the base-exchange reaction upon the production of cyclic-AMP at the level of rat brain synaptic membranes has been examined. An exchange with ethanolamine produces a significant decrease of the NaF-stimulated production of the cyclic nucleotide, whereas it increases the noradrenaline-induced production. With some exceptions, the exchange with L-serine produces opposite effects. The possible physiological importance of phospholipid pool at the synaptosomal level is discussed.


Studies on bovine brain membrane-bound neuraminidase (sialidase). 1) Lipophilic ganglioside GD1a (IV3NeuAc, II3NeuAc-GgOse4-Cer) is taken up by the cell membranes and hydrolyzed faster by membrane-bound neuraminidase than are water soluble substrates of the enzyme. 2) The enzymic breakdown of ganglioside GD1a is enhanced by general anesthetics whereas the degradation of the hydrophilic substrate sialyllactitol is reduced by these same agents. 3) General anesthetics lower the microviscosity of membranes as indicated by studies of fluorescence depolarisation with the indicator 1,6-diphenylhexatrien. Decreased microviscosity can result in a higher lateral diffusion of ganglioside GD1a, increasing its interaction with membrane-bound neuraminidase. 4) In vitro studies indicate that the activity of membrane-bound neuraminidase on gangliosides of brain membranes is regulated by the viscosity of these membranes and their monosialoganglioside content.


Characteristics of the brain tissue disialoganglioside G2a. Disialoganglioside G2a was separated by one dimensional two-step TLC between the two ganglioside fractions using long plate precoated with silica H+ florisil in the particular solvent system. Behaviour of this fraction to the enzyme effect and molecule percentages of its components showed the characteristics of the ganglioside containing two N-acetylneuraminic acids. Synthesis dynamics of this fraction in rat brain was very intensive in the myelination period and it practically ended in 40th day. In mutant "Jimpy" mice brain ganglioside G2a served as an indicator of the normal ganglioside synthesis in relation to the changes in myelin sphingolipid molecular structure. Comparative brain studies undertaken in various species, intracellular rat brain fractions, various structures of Torpedo ocellata electric fish, emphasized the importance of this ganglioside in cell membrane formation where it is obligatory component. Quantitative determination of this fraction in Astrocytoma with various malignancy degree offers great help in differential diagnosis.


Congenital 'frozen eyes', with other mesodermal abnormalities: report of a case. A case is reported of a 41/2-year-old girl with generalized fibrosis, no active or passive eye movements, anisohyperopia, craniofacial asymmetry and hypoplasia of a toe. There was no ptosis, nor backward head tilt and only a moderate exotropia. Study of the fixation and of the binocular relationship met with unusual difficulties owing to the absence of eye movements. Mesodermal abnormalities were noted in the anterior chamber. A normal female karyotype was reported and family history was noncontributory.


[Immunosuppressive agents and Behçet's syndrome: critical analysis of results]. 12 patients suffering from Behçet's disease have received immunosuppressive therapy. All patients have been given chlorambucil. In addition 5 patients who were threatened by an acute and permanent blindness from severe retinal vein involvement received antilymphocyte globulins. The follow-up ranges from 1 year up to 71/2 years with an average of 31/2 years. Complete recovery from ocular inflammation has been achieved in all patients. Visual acuity remained unchanged or improved in all patients but 1. Ocular recurrences occurred in 2 patients after decreasing the daily dose of chlorambucil and in 1 patient 2 years after the end of a 1-year treatment. The action of chlorambucil was not so constant upon systemic involvement of the disease than upon ocular inflammation. Nevertheless, 1 patient recovered from severe central nervous system involvement with hemiplegia. The review of the literature and comparison with our own experience leads to suggest that the discrepancy of the published results should be related to the variety of the immunosuppressive drugs which have been tried in Behçet's disease. Chlorambucil seems to be the most effective and the less toxic drug. But its action upon eye inflammation requires 2-3 months to take place. Therefore, in the most severe cases threatened by an acute and permanent blindness, the treatment should be started with antilymphocyte globulins.


The blood supply of the optic nerve.

The blood supply of the optic nerve. The central retinal artery gives, throughout its length, branches, which, in 85% of the cases, supply the anterior segment of the optic nerve. These branches anastomose with collateral branches of the ophthalmic artery, vessels of the pia mater and recurrent branches of the Zinn-Haller circle. The contribute to form the peripheral, periaxial and axial vascular meshwork of the optic nerve. In this series no specific artery of the optic nerve was found, but in 45% of the cases there was an axial vascular meshwork.


A follow-up study of the EOG lightrise in ischaemic retinopathy. In 15 patients suffering from unilateral ischaemic retinopathy (occlusion of the central retinal artery) the EOG lightrise was studied. In all cases except one, a subnormal or absent EOG lightrise was found in the affected eye, if at least the recording was started within 2 weeks from the onset of complaints. In 8 patients the EOG lightrise was followed over an extended period of time, the longest period of control being 11 months. The EOG lightrise of the affected eyes showed a general tendency to recover, notwithstanding permanent loss of vision in most of the cases. The fellow eye in 6 patients showed initially a subnormal EOG lightrise too. The role of the choroidal circulation on the behaviour of the EOG lightrise is discussed.


Preventing scleral erosion after Arruga's cerclage. To avoid the risk of scleral erosion which may follow Arruga's cerclage for retinal detachment, a modified procedure is presented, in which four pieces of a silicone drain, threaded on the encircling suture, are used to protect the sclera against undue pressure of the suture. Observation of distant operative results indicates that this modification makes it possible to leave the suture in its site for a long, if not indefinite, time.


A clinical approach to the medical treatment of uveitis. Uveitis is divided into five clinical groups based on its severity and natural history. By using this classification appropriate and graded forms of therapy can be applied to individual patients with uveitis. In Group 1 patients (anterior uveitis syndrome) topical cortisone drops or ointment will control the disease. Group 2 (posterior uveitis) patients require local steroids (topical, subconjunctival or retrobulbar) and systemic steroids. Appropriate specific therapies are indicated if a causal organism can be identified. Patients in Groups 3 (cyclitis), Group 4 (uveitis in children) and Group 5 (severe intractable uveitis) are exposed to a high risk of cystic macula degeneration and must be treated with local and systemic cortisone and cytotoxic drugs if the steroid fails to control the inflammation or if cortisone has to be used excessively high dosage. The recommended regime of treatment is summarised in the diagram in figure 7.


Intravitreal silicone injection.

Intravitreal silicone injection. A clinico-pathological report is presented of a case of intravitreal silicone injection in which the eye had to be enucleated 7 years later. Numbers of highly refractile silicone particles of various size were found in all the ocular tissues except the sclera. A great number of silicone cavities were present in most tissues, and many contained silicone globules. The presence of silicone within the lens was confirmed by electron microscopy.


Contribution on the ultrastructure of intraocular melanoblastomas. The nucleoli and intercellular spaces were studied in 10 cases of intraocular melanoblastoma. The sizes of the nucleoli vary from 1.5-2.0 micrometer. The various nucleolar types seen in other tumours were also observed in melanoblastoma. The width of the intercellular spaces varied from 230 to 1,300 A. In the gaps ruthenium red-positive material was shown. In some of the cases this material exhibits a peculiar regular structure, the fundamental units of which are built up of filaments of the same size as found in the intercellular material of other places, however, more or less electron-dense periods alternate.


Juvenile retinal vasculitis of the central variety. Central retinal vasculitits of the type reported herein occurs monocularly in young males. The presenting symptom is always a massive vitreous hemorrhage with gross visual loss, which tends to persist indefinitely. Vitrectomy through the pars plana is followed by complete visual recovery; the condition becomes quiescent, although recurrent hemorrhages may occur. Other complications seen after surgery are glaucoma and retinal detachment. 6 cases were seen in a period of 11/2 years.


[Iris angiography studies in patients with diabetes mellitus]. Fluorescence angiography of the iris was performed on 75 patients with diabetes mellitus. The changes in the iris were classified as iridopathia diabetica simplex (ID-s) and iridopathia diabetica proliferans (ID-p), corresponding to similar changes in diabetic retinopathy. Thus punctate leakage of dye, especially around the pupillary margin, was classified as ID-s, whereas additional, angiographically verified new vessel formation was described as ID-p. 69 of the 75 patients (92%) showed diabetic changes of the iris. Of these, 50 (67%) had ID-s changes and 19 (25%) had ID-p changes. The incidence of diabetic iris changes appeared unrelated to age but appeared to increase with duration of the diabetes. A correlation between the onset of diabetic vascular changes of the iris and that of the retina could not be confirmed: the diabetic changes in the iris vessels can precede those of the retina whereas, on the other hand, almost all patients with a diabetic retinopathia also show an iridopathy. The clinical value of iris angiography lies therein that the first findings of diabetic vascular damage can be seen in the iris earlier than in the retina, the iris appearing normal on slit-lamp microscopy.


[Comparison of macular electroretinography and psychophysical tests in diabetic retinopathy with intraretinal edema]. Short comparison between psychophysic and electrodiagnostic tests in 20 eyes with macular edema from diabetic retinopathy. De Lange's curve, the critical flicker frequency in central fixation and the macular ERG are compared with the classical EOG and global ERG data. The methodology is briefly described. It allows a new approach of the macula and the macular ERG responses confirms the clinical tests.


Radioisotopes for research into vitreous and zonule. A survey of the use of radioisotopes for research into the vitreous and the zonule is presented. gamma-Rays emitting isotopes are useful for the investigation of transport and diffusion of substances, while 3H-thymidine is the substance of choice for the investigation of cell kinetics. The formation of the vitreous and the zonule during and after embryonal development can be studied by histoautoradiography using labelled precursors of collagen and aminoglycans. Cell kinetic investigations shows that the cells usually found in the vitreous are macrophages which have migrated into the eye. Therefore the existence of a specific vitreous cell is unlikely. The development of the zonule can be readily traced by histoautoradiography which shows that it is neither topographically nor temporally related to regression of the primary vitreous. The incorporation of cystine and glucose into the zonular fibers is of special interest. This suggests that the zonular fibers are not made up of normal collagen; they may consist of some sort of procollagen which is perhaps secreted by the ciliary epithelium.


[Unilateral aphakia and pseudophakia].

[Unilateral aphakia and pseudophakia]. Aniseikonia as well as binocular vision and depth perception are measured in 114 patients with unilateral pseudophakos. 86% of the cases exhibit a small degree of aniseikonia (3% or less). However, binocular vision and stereopsis remain subnormal or approximatively normal.


[Family-groups in a children-psychiatric-hospital (author's transl)]. The author presents a report of a kind of care for children, suffering from behavior disorders, which consists in structure of a large-family. The first experiences show, that children suffering from minimal brain dysfunction and secondary manifestation of deprivation better grow up in family-groups than in groups of children of the same age.


[Value and value in use of "hygiene in crèches" (author's transl)]. The results of an investigation of crèches in an urban and in a rural district are discussed in regard of the possibilities of improving the material conditions and equipment in connection with their economic effects (milk kitchen, microclimate, crèches for staff training, problems of supply). The special problems of building crèches in rural areas are explained. Based on own investigative results and on economic calculations the economic benefit of crèches and the economic loss in absent morbidity of children were computed. On this background and by the help of a comparison of extreme groups, of a comparison of the rural with the urban district and of factor analysis (two forms) the attempt is made to evaluate the main causes of children's absent morbidity especially of the morbidity of the respiratory system. Conclusions with respect to the future development of building crèches are performed.


[Investigations on the clothing of preschool-children during winter (author's transl)]. These investigations should control the effect of increased indoor-temperatures in facilities for children and flats on the clothing-habits of 1--3 aged children during the heating period. The indoor- and outdoor-clothing was scored by the number of dress-layers investigated in 977 crèche-children. All these attempts were carried out while 23 days during the winter 1976/77 in 2 crèches which differed significantly referring to the distribution of indoor-temperature. The statistical evaluation results that all children were dressed nearly in the like wise in spite of a considerable difference of the temperature in both crèches; only the covering of the arms was significant less in the warmer new-builded crèch. The investigations showed further that the outdoor-clothing of the children was often not according to the climate. Even 10 degrees C difference of temperature were rarely followed by variations of the outdoor-clothing. Finally the dress of 1--3 aged children can be estimated as too abundant.


[Body-weight-development of children in Görlitz (author's transl)]. The different phases of increase of body-weight in boys and girls are studied. The development of body-weight from three anual-sets of children, who are born in the town of Görlitz, from birth to time of school-absolvation is presented.


[Value of the discover mental defects for the pathogenesis of psychosocial disorders by normal pupils--a study about patients of a neuropsychiatric station for children (author's transl)]. 200 normal pupils were tested, to discover mental defects by HAWIK IQ less than or equal to 84. All tested pupils were treated stationary for psychosocial disorders. 37 mental defects were demonstrable. The mental defect gets the third rank in the quantity of pathological causes for psychosocial disorders. The atmosphere reactive disorders head the list followed by partial psychological disorders of performance. The early recognition of these defects is of necessity in medical, psychological and pedagogic view.


The elderly patient: a dental thought.

The elderly patient: a dental thought. The attention of doctors is drawn to the advantages of having a dentist as part of the team dealing with the problems of the elderly. Often the dental aspect is overlooked, but there is evidence that some geriatricians are aware of the value of the dental view. Problems associated with probable large undiscovered needs are not adequate excuses for failure to create awareness of them in the minds of appropriate authorities. A plea is made for better inter-professional co-operation using a personal experience as a successful example of team-work.


Reduced induction of drug metabolism in the elderly. Young and elderly subjects were given the hypnotic dichloralphenazone (Welldorm) in a dose of 20 mg/kg nightly for two weeks and the extent of induction of liver microsomal drug metabolism was assessed from alteration in the plasma elimination of quinine and antipyrine (phenazone). With both indices, there was a significant increase in plasma drug clearance in young subjects following dichloralphenazone treatment but no significant alterations occured in the elderly group. These results indicate that, in addition to being less able to metabolize some drugs, elderly patients show a reduced induction response. They may therefore be less likely to become tolerant to those drugs which are inactivated by metabolism.


Reality orientation therapy: a study investigating the value of this therapy in the rehabilitation of elderly people. The Leeds Technique for Therapy with the Aged is described and evaluated. The purpose of the study was two-fold--to evaluate the therapy itself, and to examine it as a possible extra incentive for nurses working with the aged. Forty-six elderly patients were included in the study. Fourteen took part in a pilot study. Later, in a more carefully controlled investigation, the remaining 32 patients were divided into two groups, one of experimental subjects and one of control subjects. Improvement was assessed using the Clifton Assessment Schedule (CAS) and the Stockton Geriatric Rating Scale (SGRS). Twenty-five of the 30 experimental subjects improved and 10 were discharged. Eight of the 16 control subjects improved, but none was discharged.


Vitamin D hydroxylation in youth and old age. The effects of the subcutaneous injections of 50 000 i.u. of vitamin D on 25-hydroxy-vitamin D levels were measured in young controls, old people living at home, and in elderly in-patients. Responses were substantially reduced in both groups of old people, particularly in those living at home. This phenomenon may be due to the effects of ageing or disease on 25-hydroxylase activity.


Capillary fragility in elderly in-patients. Capillary fragility has been examined in 110 elderly patients, excluding those patients who might have been expected to have abnormal fragility. Nonetheless, fragility appeared to be greater in elderly patients than in younger subjects. It was much increased in the non-paralysed arm of hemiplegic patients but not in the paralysed arm--perhaps because petechiae were obscured by trophic changes. Capillary fragility was significantly correlated with systolic blood pressure but not with age. This suggests that higher values in elderly patients may be related to the high prevalence of arteriosclerosis rather than to age itself.


Spasmolytic action of histamine in airway smooth muscle of horse. Histamine, 2-methylhistamine (a specific H1-agonist), 5-HT, PGF2alpha, SRS-A, bradykinin (BK) and carbachol contract bronchial and tracheal smooth muscles of the horse. Isoprenaline, PGE1, E2, dimaprit and 4-methylhistamine (last two = specific H2-agonists) relaxed airways which were partially contracted to carbachol. Mepyramine (a specific H1-antagonist) selectively antagonized contractions to histamine. In the presence of mepyramine, histamine caused relaxation of airways partially contracted to carbachol. Metiamide and burimamide (specific H2-antagonists) specifically antagonized or reversed histamine-induced bronchorelaxation. However the H2-antagonists, indomethacin and propranolol each failed to block histamine-induced relaxations in trachea. Thus, the results of this study show: (i) preponderence of H1-receptors-mediating contractions in horse airways; (ii) presence of H2-receptors-mediating bronchorelaxation and (iii) the existence of an atypical (relaxant) response (resistance to H2-antagonists; indomethacin and propranolol) in the horse trachea.


Effect of histamine methylation inhibitors on entry of 14C-histamine into brain. Pretreatment of mice, rats and guinea pigs with inhibitors of histamine methylation, followed by systemic injection of 14C-histamine, results in a significant increase in brain 14C-histamine relative to controls. It is suggested that the histamine methylating enzyme participates in the blood-brain barrier to histamine.


Effects of fenoprofen and benoxaprofen on human lymphocytes: inhibition of tritiated thymidine uptake. The effects of the related nonsteroidal anti-inflammatory agents, fenoprofen and benoxaprofen, on in vitro responses of normal human peripheral blood lymphocytes were examined. Drugs caused dose-related inhibition of stimulated cell responses. Fifty percent inhibition occurred at 400 microgram/ml calcium fenoprofen and 250 microgram/ml sodium benoxaprofen. Drugs affected not only responses to soluble phytomitogens but also responses to specific antigens and allogeneic lymphocytes. Numbers of viable cells in cultures with and without mitogens and drugs were similar at beginnings and ends of experiments, excluding drug-related cytotoxicity. Inhibition by drugs was greater when cells were cultured in medium alone than in medium with plasma. Cells that were exposed overnight to drugs and then washed and stimulated did not respond as well as did cells not exposed to drugs. These data indicated that fenoprofen and benoxaprofen exhibited noncytotoxic, incompletely reversible inhibition of nonspecific, specific, soluble and insoluble, mitogen-stimulated lymphocyte responses. These findings may pertain to the anti-inflammatory efficacy of these drugs.


A comparison of the anti-inflammatory effects of copper aspirinate and other copper salts in the rat and guinea pig. A comparison of the anti-inflammatory (AI) activity of copper compounds in models of kaolin-induced paw oedema and u.v. erythema in the rat and guinea pig is described. The results demonstrated considerable species variation, the guinea pig being more sensitive to the AI and irritant effects of copper aspirinate and the other copper compounds. The route of administration of these compounds was also an important factor in interpreting AI activity obtained. Indeed, the counter-irritation effects of the copper compounds may be largely responsible for the AI activity obtained after subcutaneous administration. The comparison between copper aspirinate and aspirin, performed in order to determine whether a copper complex of an AI drug was more active than the parent AI compound, failed to produce a clear difference in activity although copper aspirinate was more effective than aspirin in certain cases. It is concluded that this study highlights the complexities of copper therapy against inflammatory processes and furthermore indicates the importance of species, the model of inflammation and route of drug administration in interpreting data obtained with copper containing compounds.


The neutrophil adherence assay as a method for detecting unique anti-inflammatory agents. Neutrophil adhesiveness is an important component of the pathophysiology of the inflammatory process. Modulation of this function could result in a reduction in the degree of inflammation and connective tissue damage. A simple technique using filtration of whole blood through nylon fiber columns has been developed to study the effect of anti-inflammatory agents on the adherence of rat peripheral blood neutrophils. Gold and chloroquine, in addition to many standard anti-inflammatory drugs, have been shown to cause inhibition of neutrophil adherence. Measurement of this parameter of cell behavior has the potential of detecting anti-inflammatory agents not normally effective in the standard animal models.


Effect of fenclofenac on prostaglandin production in carageenin air bleb exudates in rats. Employing a modified carrageenin air bleb technique in rats, the effect was studied of fenclofenac and standard drugs (acetylsalicylic acid, indomethacin and phenylbutazone) on prostaglandin production in inflammatory exudate. In common with the standard drugs, fenclofenac reduced exudate prostaglandin levels, being approximately equipotent with phenylbutazone in this respect. Also, an attempt was made to relate the effect of fenclofenac and standard drugs on prostaglandins to their acute anti-inflammatory activity as determined in a modified carrageenin paw oedema test in rats. Whilst acetylsalicylic acid and phenybutazone significantly inhibited oedema at doses producing 80% inhibition of prostaglandin production in air bleb exudate, fenclofenac and indomethacin did not. The overall results were considered to support the view expressed by other workers that the acute anti-inflammatory activity of acidic anti-inflammatory agents does not result solely, if at all, from inhibition of prostaglandin synthesis.


Accumulation of blood platelets in carrageenin rat paw oedema. Possible role in the inflammatory process. The accumulation of blood platelets in the carrageenin-induced paw oedema in rats was studied, using 51Cr-labeled platelets. A maximum in the accumulation was seen after 4 hours, followed by a decline after 5--6 hours. During the first 6 hours of the oedema formation, change in blood volume were small. A comparison was made with the accumulation of both 125J-albumin as a measure of extravasation and 125J-fibrinogen as an indication of blood clotting. When platelet aggregation was measured during the first 6 hours of the oedema formation, the lag time between the addition of collagen and the beginning of the aggregation was increased. No change in platelet serotonin was seen. These data support the idea that platelets participate in the inflammatory process.


Coumarin toxicity in different strains of mice. The general toxic effects of coumarin, as well as coumarin hepatotoxicity were found to be less in DBA/2J mice than in CH3/HeJ mice. These results are discussed in the context of a strain-specific coumarin metabolism and indicate the need for suitable animal models to assess the toxicity of a given substance in man.


Free radical damage produced by carbon tetrachloride in the lipids of various rat tissues. Alterations produced by carbon tetrachloride in the lipids of extrahepatic tissues were studied. Consistent incorporation (about one-half of that occurring in the liver) of 14C from 14CCl4 was found in the phospholipids of the intestinal mucosa; kidney, adrenal and lung phospholipids were labeled to a lower extent, while spleen, testis, brain, heart and skeletal muscle lipids showed minor levels of radioactivity. The analysis of fatty acid methyl esters derived from phospholipids by gas-liquid chromatography (GLC) with an electron capture detector (ECD), showed ECD response similar to that observed with the liver, in the case of the intestinal mucosa and the kidney; on the contary no ECD response was seen with the organs, such as skeletal muscle, heart and testis in which the incorporation is almost negligible. Unlike liver phospholipids, the phospholipids of the intestinal mucosa and the kidney did not show diene conjugation absorption. Also, no evidence of lipid peroxidation was found in the thin-layer chromatographic analysis of fatty acid methyl esters prepared from the phospholipids of these organs. Possible meanings of these results are discussed.


51Cr release cytotoxicity assay evaluated with fluoride and cadmium. The sensitivity of the 51Cr release assay was evaluated with two known cytotoxic agents; fluoride and cadmium. The sensitivity was far less than that of other assays, e.g. growth inhibition of cultured cells, and additional a two-peaked dose-response curve was found with cadmium.


Use of MAOI antidepressants.

Use of MAOI antidepressants. The monoamine oxidase inhibitors (MAOIs) exert significant antidepressant, antianxiety and antiphobic effects. They are safe, provided the patients are carefully selected for treatment and are given instructions on incompatible foods and drugs that must be avoided. The MAOIs represent effective alternatives to the tricyclic antidepressants. Phenelzine is an excellent agent for treating ambulatory patients with neurotic depression and those with agoraphobia and social phobias.


The team approach to treatment of the cleft lip and palate. The team consists of a family physician, plastic surgeon, orthodontist, prosthodontist, otolaryngologist, speech therapist, audiologist and social worker. A cleft lip is usually repaired when the child weighs 10 lb., is 10 weeks old and has 10 Gm. of hemoglobin. Defects of the secondary palate are repaired between one and two years of age; residual lip or nasal deformities are corrected before the child starts school. Further cosmetic surgery is delayed until adolescence, when facial growth has been completed.


Rheumatoid arthritis.

Rheumatoid arthritis. Management should help relieve symptoms, increase or maintain function, produce few side effects and keep the cost to a minimum. Aspirin remains the first-line drug; other nonsteroidal anti-inflammatory drugs may be useful when aspirin cannot be tolerated. Symptoms and signs of rheumatoid disease may be suppressed by corticosteroids, but only gold compounds, penicillamine and cytotoxic therapy have been shown to decrease disease activity and lessen permanent joint damage.


Acute epiglottitis in adults.

Acute epiglottitis in adults. Acute epiglottitis in adults is a serious, often rapidly fatal disease, unless diagnosed promptly. Any adult with pain the the throat out of proportion to the visible signs of pharyngitis should have a right and left lateral soft tissue radiograph of the neck and/or indirect laryngoscopy. When expertly interpreted, the roentgenograms can be of inestimable value. Appropriate therapy, including antibiotics and possibly a tracheostomy, should be started immediately.


Clinical, electrocardiographic and electrophysiologic observations in patients with paroxysmal supraventricular tachycardia. Seventy-nine patients without ventricular preexcitation but with documented paroxysmal supraventricular tachycardia were analyzed. Electrophysiologic studies suggested atrioventricular (A-V) nodal reentrance in 50 patients, reentrance utilizing a concealed extranodal pathway in 9, sinus or atrial reentrance in 7 and ectopic automatic tachycardia in 3. A definite mechanism of tachycardia could not be defined in 10 patients (including 7 whose tachycardia was not inducible). The three largest groups with inducible tachycardias were compared in regard to age, presence of organic heart disease, rate of tachycardia, functional bundle branch block during tachycardia and relation of the P wave and QRS complex during tachycardia. A-V nodal reentrance was characterized by a narrow QRS complex and a P wave occurring simultaneously with the QRS complex during tachycardia. Reentrance utilizing a concealed extranodal pathway was characterized by young age, absence of organic heart disease, fast heart rate, presence of bundle branch block during tachycardia and a P wave following the QRS complex during tachycardia. Sinoatrial reentrance was characterized by frequent organic heart disease, a narrow QRS complex and a P wave in front of the QRS complex during tachycardia. In conclusion, a mechanism of paroxysmal supraventricular tachycardia could be defined in most patients. Observations of clinical and electrocardiographic features in these patients should allow prediction of the mechanism of the tachycardia.


Multiple intracardiac recordings in evaluation of patterns occurring during attempted his bundle pacing in man. The various patterns resulting from stimulation through the catheter electrodes recording His bundle activity were evaluated in 30 patients using intracardiac electrograms from the right ventricular apex (RVA), posterosuperior wall of the left ventricle (LV), high right atrium (HRA) and left atrium (LA) in the vicinity of the coronary sinus. His bundle pacing was characterized by a QRS complex and stimulus (St)-V, St-RVA and St-LV intervals that equated the QRS configuration, H-V, H-RVA and H-LV intervals of sinus beats. Right septal pacing produced pattern of "complete" left bundle branch block (with normal electrical axis) associated with St-V intervals of 0 msec, and St-RVA and St-LV intervals of different duration from that of the H-RVA and H-LV intervals recorded during sinus rhythm. Fusion beats resulting from simultaneous activation of His bundle and right septal muscle were characterized by St-V intervals of 0 msec and St-RVA or St-LV intervals of similar duration to that of the H-RVA or H-LV intervals of sinus beats. Fusion QRS configuration depended on the type of ventricular complex present during sinus rhythm. Analysis of the retrograde atrial activation intervals permitted differentiation among impulse initiation at the low right atrium, His bundle or right septal muscle. Simultaneous recording of multiple atrial and ventricular electrograms has enhanced understanding of the complex patterns observed during attempted His bundle pacing in man.


Relations between ventricular refractoriness and regional myocardial blood flow after acute coronary occlusion. Myocardial ischemia has been associated with dispersion of ventricular refractory periods and this dispersion has been related to the ventricular arrhythmias seen with coronary occlusion. This study relates the degree of change in measured ventricular refractory period with the degree of regional myocardial blood flow abnormality after coronary occlusion. When regional myocardial blood flow is less than 70% of that of nonischemic areas, refractory periods are significantly (P less than 0.001) shortened. The greatest change in refractory periods occurs in areas with a regional myocardial blood flow that is 21 to 40% of that of nonischemic areas. Marked (less than 20%) and minimal (61 to 80%) reductions in regional myocardial blood flow are associated with less, but still significant, shortening of ventricular refractory periods. Thus dispersion of refractoriness can be related to the inhomogeneity of regional myocardial blood flow after acute coronary occlusion. Interventions designed to salvage ischemic myocardium by increasing regional myocardial blood flow may affect dispersion of ventricular refractory periods in complex and divergent ways.


Second degree His-Purkinje block during his bundle pacing. This report presents, for the first time, clear evidence supporting the occurrence of Wenckebach and 2:1 H-V block during His bundle pacing. The simultaneous recording of various intracardiac electrograms, as well as the comparison of the effects produced by selective His bundle pacing and high right atrial pacing at the same rates, permitted the identification of conduction disturbances located distal to the paced His bundle site. This could be done although one criterion usually required to diagnose selective His bundle pacing (namely, stimulus-V intervals of constant duration) was not present.


Atrioventricular nodal gap conduction as a manifestation of dual nodal pathways. Electrophysiologic studies were performed in a 76 year old patient for evaluation of sinus bradycardia. Atrial extrastimuli were induced during sinus rhythm at progressively decreasing coupling (A1-A2) intervals. At an A1-A2 interval of 420 msec, right bundle branch block developed, and at 370 msec conduction failed below the His bundle. When the interval was reduced to 320 msec, conduction resumed with a normal QRS pattern with an abrupt increase in A-H intervals from 165 to 305 msec. These findings are interpreted as type I or atrioventricular (A-V) nodal gap conduction physiologically related to conversion from a rapid to a slow A-V nodal conduction mode.


Self-initiated conversion of paroxysmal atrial flutter utilizing a radio-frequency pacemaker. A patient is described with drug-resistant recurrent paroxysmal atrial flutter. Electrophysiologic studies demonstrated that flutter was inducible with rapid atrial stimulation (stimulation rates of 375 to 400/min) and convertible with rapid atrial stimulation (rates of 400 to 460/min). Because of the latter response, a radio-frequency atrial pacemaker was implanted, which allowed self-initiated conversion of flutter episodes with rapid stimulation.


Roles of psychologic stress and autonomic nervous system changes in provocation of ventricular premature complexes. Neural and psychologic factors have been implicated as risk factors for ventricular arrhythmias and sudden death in man. However, the relation between these factors and arrhythmia has hitherto not been systematically explored. We examined the effect of psychologic stress testing in 19 patients with advanced grades of ventricular arrhythmias. Psychologic stress consisted of mental arithmetic, reading from colored cards and recounting emotionally charged experiences. Such testing induced a significant increase in ventricular premature beat frequency in 11 of 19 patients (P less than 0.05). One patient experienced paroxysms of ventricular tachycardia. In 14 of these 19 patients elicitation of vagal or sympathetic autonomic reflexes failed to induce significant arrhythmia in all but one patient. It is concluded that (1) objective psychologic tests may precipitate ventricular arrhythmia in susceptible patients, and (2) evocation of peripheral autonomic reflexes is an insufficient trigger for enhanced ventricular ectopic activity.


Cardiac manifestations in polymyositis.

Cardiac manifestations in polymyositis. Twenty-one patients with polymyositis were prospectively examined with echocardiography, phonocardiography and electrocardiography. Cardiac performance, estimated with echocardiography, was enhanced as shown by a significant (P less than 0.01) increase in ejection phase indexes of left ventricular function compared with values in a matched control group. Known causes of the high output state, such as anemia or thyrotoxicosis, were not clinically evident. There was no evidence of left ventricular enlargement, left ventricular wall hypertrophy, or left atrial enlargement in the echocardiogram or chest X-ray film. The echocardiogram showed systolic mitral valve prolapse in 11 of 17 patients (65 percent) with an adequately imaged mitral valve; midsystolic clicks were present in 7 of these. One patient, who did not have prolapse, had echocardiographic evidence of a small pericardial effusion. Electrocardiographic abnormalities were present in 11 of 21 patients (52 percent) and included evidence of atrioventricular conduction disturbances, atrial and ventricular arrhythmias and left atrial abnormality. The pathophysiology of mitral valve prolapse and increased systolic left ventricular function in polymyositis remains uncertain; however, the spectrum of cardiac abnormalities, detected noninvasively in 16 of 21 of our patients (76 percent) may represent a high frequency rate of cardiac involvement in this disease.


Synchronized retroperfusion of coronary veins for circulatory support of jeopardized ischemic myocardium. A retroperfusion system was developed that augments retrograde delivery of arterial blood into an acutely ischemic myocardial region during diastole and facilitates coronary venous drainage in systole. An electrocardiogram-synchronized, gas-actuated bladder pump propels retroperfusate through an autoinflatable balloon catheter whose tip is placed within the regional coronary vein that drains the ischemic myocardium. Experiments were performed in 26 closed chest dogs with 4 hour intracoronary balloon occlusion of the proximal left anterior descending coronary artery. An untreated control series consisted of 13 dogs; the remaining 13 dogs were treated with retroperfusion, which was initiated after the first hour of acute coronary occlusion. Synchronized retroperfusion resulted in a significant 37 +/- 10 per cent (mean +/- standard error of the mean) decrease in left ventricular end-diastolic pressure from 11 +/- 2 to 5 +/- 21 mm Hg, a 20 +/- 4 percent decrease in peak systolic pressure (140 +/- 7 to 110 +/- 6 mm Hg) and a 25 +/- 6 percent reduction in systemic vascular resistance (3,880 +/- 340 to 2,380 +/- 300 dynes sec cm-5). Ischemic region intracoronary S-T segment elevation decreased 40 +/- 15 percent, and potassium loss was reduced 92 +/- 22 percent. Partial pressure of oxygen measured distal to the coronary occlusion decreased 36 +/- 2 percent, suggesting oxygen delivery to and extraction by the jeopardized ischemic myocardium. Ventriculography in four dogs revealed an increase in left ventricular ejection fraction and reversal of ischemic segment dyskinesia by synchronized retroperfusion. A nitro-blue tetrazolium study of 10 excised hearts indicated that 3 hours of synchronized retroperfusion significantly reduced the size of ischemic injury to 3.3 +/- 2 percent of the left ventricle (versus 16.2 +/- 5 percent in the untreated control group). In addition, retroperfusion appeared to correct ischemic arrhythmias. The experimental data suggest that this treatment is capable of improving cardiac function and salvaging jeopardized myocardium. Clinical application is envisioned as a prompt temporary emergency support for acute and profound ischemic dysfunction not readily treatable by other interventions.


Role of delayed intraaortic balloon pumping in treatment of experimental myocardial infarction. Intraaortic balloon pumping improves coronary blood flow characteristics while simultaneously reducing myocardial oxygen demands by reducing aortic systolic pressure. Clinical application of intraaortic balloon pumping has largely been in the "high risk" patient (cardiogenic shock, postinfarction angina, left main coronary artery disease and unstable angina) for support during diagnostic studies or cardiac surgery, or both. In addition, there is some evidence that balloon pumping immediately after coronary occlusion reduces the size of experimentally induced myocardial infarcts. In this study, myocardial infarcts were produced by ligation of the left anterior descending coronary artery in 12 dogs, 6 of which were treated with balloon counterpulsation beginning 3 hours after coronary occlusion. All dogs were killed 8 hours after coronary ligation. Intraaortic balloon pumping resulted in the expected hemodynamic changes (decreased aortic systolic pressure, left ventricular end-diastolic pressure and heart rate and increased aortic peak diastolic pressure). In addition, there was a significant reduction in infarct size in the group with balloon pumping as determined with epicardial S-T segment mapping, myocardial imaging with technetium-99m-glucoheptonate and histochemical staining with nitroblue tetrazolium. These results suggest that even when instituted as long as 3 hours after coronary occlusion, intraaortic balloon pumping results in significant reduction in infarct size and, it might be speculated, the mortality and morbidity associated with acute myocardial infarction may also be decreased.


Insulin therapy for depressed myocardial contractility after prolonged ischemia. Insulin was administered to two patients whose diminished myocardial contractility made it difficult to terminate cardiopulmonary bypass. In both instances, bypass was successfully terminated shortly after the insulin injection. These clinical observations led to experiments under the controlled conditions provided by the isolated, working rat heart preparation. The recovery of contractility after 30 minutes of severe ischemia was assessed in all 11 control and 11 insulin-treated hearts. Myocardial performance, as judged by the product of heart rate and peak systolic blood pressure, was significantly greater in the insulin-treated hearts. These clinical observations and experimental findings suggest the need for more extensive study of the potential value of insulin in treating depressed contractility after prolonged myocardial ischemia.


Computer analysis of left ventricular dynamic geometry in man. Analysis of left ventricular performance in 20 normal patients was undertaken using biplane cineangiography and a semiautomatic computer image processing system. The analysis included evaluation of volumes, ejection fraction, regional shortening, patterns of ejection and filling and, when simultaneous left ventricular pressure was recorded stroke work, stroke power, wall stress and internal myocardial work. All of these data were calculated from digitized images stored permanently on digital magnetic tape, and can be reproduced without reanalysis of the cine film. Normal left ventricular function is described by an end-diastolic volume index of 82 +/- 3 ml, an ejection fraction of 60 +/- 2 percent, left ventricular mass index of 97 +/- 6 g/m2, peak first derivative of volume (dV/dt) of 485 +/- 28 ml/sec, anterior shortening of 48 +/- 2.3 percent, inferior shortening of 33 +/- 1.7 percent, lateral shortening of 29 +/- 1.5 percent, anterior mean shortening velocity (Vcf, in percent of end-diastolic length [L]/sec) of 1.5 +/- 0.1 L/sec, inferior Vcf of 1.1 +/- 0.06 L/sec and lateral Vcf of 0.94 +/- 0.2 L/sec, stroke work of 1.33 +/- 0.21 joules, mean stroke power of 3.7 +/- 0.62 joules/sec, integrated left ventricular pressure (tension-time index) of 2,866 +/- 340 mm Hg-sec, and integrated stress (stress-time index) of 7,260 +/- 765 (X 10(3)) dynes sec/cm2. Internal myocardial work was calculated from the strain energy. More internal work was expended in circumferential than logitudinal shortening (circumferential, 0.69 +/- 0.1 joules; longitudinal, 0.41 +/- 0.08, P less than 0.01), because hoop stress was greater than meridian stress (hoop, 201 +/- 20 dynes/cm3 X 10(3); meridian, 126 +/- 13, P less than 0.001). This analysis of left ventricular performance provides a reliable means for identifying abnormal ventricular function and may be more sensitive than any one measurement alone. The use of digital image processing makes this complex functional analysis of left ventricular performance feasible.


Echocardiographic assessment of pulmonary arterial pressure in children with complete right bundle branch block. The time interval between tricuspid valve closure and pulmonary valve opening, termed the isovolumic contraction time of the right ventricle, was evaluated echographically in 38 normal children and within 24 hours of cardiac catheterization in 53 children with congenital heart disease and normal conduction as assessed with the electrocardiogram. In the 53 patients with congenital heart disease, isovolumic contraction time was strongly influenced by right ventricular afterload, as defined by pulmonary arterial end-diastolic pressure (r = 0.87). It was possible to utilize isovolumic contraction time to separate patients with normal or elevated values for pulmonary arterial end-diastolic pressure. Similar correlations were demonstrated between isovolumic contraction time and mean pulmonary arterial pressure and calculated pulmonary vascular resistance. Evaluation of 15 children with complete right bundle branch block revealed values for isovolumic contraction time that did not significantly differ from those of patients with similar pulmonary arterial end-diastolic pressure but no conduction abnormalities. These findings indicate that serial echographic evaluation of the interval from tricuspid valve closure to pulmonary valve opening can give an accurate reproducible assessment of right ventricular afterload in many children with congenital heart disease and complete right bundle branch block


Abrupt cessation of clonidine administration: a prospective study. In 20 patients with mild to moderate hypertension, the effects of abrupt cessation of clonidine therapy on blood pressure, heart rate and catecholamine excretion were evaluated. In a double blind, crossover study, placebo was substituted for clonidine after 3 days of therapy and again after 30 days. The results demonstrated no instances of clinically significant symptoms or overshoot in blood pressure or heart rate. There was an overshoot in norepinephrine excretion that approached the upper limits of normal. Thus, a clinical withdrawal syndrome associated with abrupt cessation of clonidine was not seen in this study of patients without severe hypertension who were given the drug without a diuretic agent.


Unstable angina pectoris: a randomized study of patients treated medically and surgically. Fifty patients with the clinical syndrome of unstable angina pectoris were evaluated. Twenty-seven were randomized into medical or surgical treatment groups and subsequently followed up. The results of the study reveal that: (1) there is approximately a 16 percent incidence rate of significant left main coronary artery disease in patients with this entity at our institution; (2) 10 percent of patients do not have angiographically significant coronary artery disease; (3) pain relief is better in the surgically treated patients, but the 1 1/2 year survival rate is not significantly different between the groups; (4) 50 percent of the medically treated patients again had the syndrome of unstable angina pectoris in the initial few months of the follow-up period; (5) the operative and late postoperative mortality rate in patients presenting with unstable angina pectoris and left main coronary artery disease in this small group of patients was 43 percent; and (6) four of six patients with this syndrome whose condition was deemed inoperable and who were not randomized died within the subsequent few months.


Anomalous left circumflex coronary artery: "normal" variant of uncertain clinical and pathologic significance. Anomalous origin of the left circumflex artery from the aorta is generally viewed as a benign coronary arterial anomaly. Three such cases are reported in which the anomalous artery was totally occluded. Although coronary atherosclerosis was present in all three cases, the proximal segment of the anomalous circumflex vessel was particularly severely affected in each patient. Two patients had a myocardial infarct in the distribution of the aberrant vessel. Accurate angiographic diagnosis is needed before cardiac surgery is performed, whether for valve replacement or myocardial revascularization, because this variant may be less benign than one believed.


Physical growth and development of urban native Americans: a study in urbanization and its implications for nutritional status. Anthropometric measurements and hematocrits are reported on a mixed longitudinal sample of 1309 urban native Americans from Minneapolis from 22 days through 19 years of age (the sample size for each measurement varied from 276 to 1309). The results are compared to the United States national probability samples from the National Center for Health Statistics (HANES and HES), as well as, from 6 through 12 years, to a sample of related American Indians from a reservation in northern Minnesota. Compared to the United States standards, the urban sample is slightly shorter and, in general, consistently heavier. The skinfold thicknesses (triceps and subcapular) varied by site, sex, and age, relative to the standard. In general, the native Americans had thicker skinfolds except for males below 6 years of age, and for the subcapsular in female at all ages. Relative to the sample from the reservation, the urban natives are taller, heavier, with thicker skinfolds and greater weights-for-height. The potentially greater risk for obesity associated with urbanization is discussed. While the mean hematocrits were very close to accepted standards, 35% of infants and children less then 6 years of age had values less than 34.


Westernization of diet and serum lipids in Ethiopians. The dietary pattern, physical work output, and blood lipids were studied in three groups of healthy, young, urban Ethiopian men differing in the degree of "Westernization." The results showed striking increases in serum lipids that were associated with the degree of Westernization of the diet. These changes could not be accounted for by differences in other group characteristics such as age, weight, smoking, or length of residence in Addis Ababa. The effects of the level of physical work output on serum lipids were equivocal because the methods used for the assessment of energy output yielded crude approximations only.


Trans-isomeric fatty acids present in West German margarines, shortenings, frying and cooking fats. Fatty acid patterns were determined in 83 brands of margarine, 9 brands of low-calorie margarine and 18 brands of shortening, frying and cooking fat purchased at random from the retail marker in the Federal Republic of Germany in 1973/1974, and a second time in 1976. As a result of gas-liquid chromatographic analyses on a Silar 10 C coated packed column, complemented in some cases by the values recorded on a highly selective SP 2340 capillary column, trans-octadecenoic acids ranging from 53.2 to 0.1% were measured. None of the products examined was completely free of trans-fatty acids. High values of trans-octadecenoate were always accompanied by positional isomers of cis-octadecenoate, by 9trans,12trans-octadecadienoate and by 9cis,12trans-octadecadienoate and 9trans,12cis-octadecadienoate. Furthermore, two mixed geometric isomers derived from linolenic acid (probably 9cis,12cis,15trans-octadecatrienoate and 9trans,12cis,15cis-octadecatrienoate) could be identified, provided that the individual brand contained sufficient linolenic acid. Following partial hydrogenation, transhexadecenoate, 0.1 to 0.2%, was detected in some of the edible fats.


Nutrition survey of Finnish rural children. IV. Serum cholesterol values in relation to dietary variables. In connection with a survey of child nutrition in Finland a study was carried out on the serum cholesterol concentration in childhood and its relationship to dietary and other variables. The material consisted of 1496 children ages 5, 9, and 13 years from 14 local districts in Finland. Total cholesterol was determined from nonfasted venous serum samples by a modification of the p-toluenesulfonic acid reaction. Food consumption was investigated by the 24-hr recall method and nutrient intakes determined from these results using food composition tables. For analysis, children in each age group were classified into low, medium, and high cholesterol groups. The serum cholesterol concentrations of the 5, 9, and 13 year olds were 6.03 +/- 1.03, 6.16 +/- 1.04, and 6.08 +/- 1.01 mmole/liter (233 +/- 40, 238 +/- 40, and 235 +/- 39 mg/100 ml), respectively. Of the children 10% had serum cholesterol concentrations of 7.4 mmole/liter (286 mg/100 ml) or more. Serum cholesterol concentration was not correlated with sex, relative body weight, or systolic or diastolic blood pressure. High cholesterol concentrations appeared to be associated with traditional dietary habits and especially with a high proportion of saturated fats in the diet.


Digestion of certain fractions of dietary fiber in humans. The digestion of cellulose, hemicellulose, and lignin has been investigated in humans. Two groups of subjects were studied--healthy subjects with an ileostomy and normal subjects. Both were put on a fixed diet of known cellulose, hemicellulose, and lignin content. From the feces excreted the fiber components were measured by the acid and neutral detergent method. From the small bowel 84.5% of the ingested cellulose was excreted from the ileostomy subjects. From the normal subjects 22.4% of the ingested cellulose was excreted, indicating approximately 80% of the cellulose was digested in the normal subjects. From the water insoluble ingested hemicelluloses 27.5% were excreted from the small bowel, 4.0% from normal subjects. That is approximately 96% digestion of the hemicelluloses in normal subjects. Lignin was found to be undigested in both the small and large bowel. This has important implications in future fiber research.


Relative chromium response as an indicator of chromium status. Twenty-seven women ages 40 to 75 were divided into normal (n = 15) and hyperglycemic (n = 12) groups on the basis of 3-hr glucose tolerance tests. Each subject received 5 g of brewer's yeast extract containing 4 microgram of chromium daily for 3 months. Glucose, insulin, and chromium levels were analyzed by oxidase, radioimmunoassay, and radiochemical neutron activation analysis methods, respectively. The fasting and 1-hr serum chromium levels (ng/ml) changed from 1.67 and 1.43 to 1.46 and 1.86 in the normal group, and from 1.89 and 1.03 to 0.94 and 1.03 in the hyperglycemic group. Considerable changes occurred in the relative chromium response (RCR) at the 1-hr point. RCR is defined as (1-hr serum chromium level/fasting serum chromium level) X 100. Among the normal subjects, 73% showed an improved RCR after the supplementation: mean RCR was 107% before and 140% after. Among the hyperglycemic subjects, 75% showed an improved RCR: mean RCR was 81% before and 149% after the supplementation. The increased RCR was associated with decreased serum insulin and glucose levels. This is interpreted as reflecting an improved chromium status for the majority of individuals in both groups after the supplementation. The observations suggest that 1) in response to a glucose load, serum chromium levels drop in subjects with presumably inadequate chromium storage; 2) a low value of relative chromium response at the 1-hr point indicates a suboptimal chromium nutritional status.


Protein and energy utilization in men given a rural Guatemalan diet and egg formulas with and without added oat bran. Healthy men were fed a fiber-free formula diet providing the FAO/WHO Safe Level of egg protein (0.57 g/kg) and a rural Guatemalan diet giving 0.0875 g of protein per kilogram, the recommended dietary allowance for Central America and Panama.  For comparison an egg formula diet was fed at the higher protein level, with and without oat bran (0.6 g/kg). All diets maintained nitrogen balance over the 15-day test periods, and balance was distinctly positive at the higher intake of egg protein. Addition of bran doubled the fecal excretion of dry matter and energy; digestibility of energy and protein was reduced 3 to 4%. With the Guatemalan diet, fecal dry matter, nitrogen and energy excretions were nearly four times as high as with egg formula. Relative to egg ( = 100%), protein digestibility of the Guatemalan diet was 78% and total digestible energy was 92%. Present recommended dietary allowances of protein maintain nitrogen equilibrium at an energy intake of 40 kcal/kg in spite of the large fecal losses.


Influence of sampling on fatty acid composition of human milk. To study effects of sampling on the fat and fatty acid composition of human milk, three subjects each obtained four complete expressions of milk in sequential fractions from each breast. Two subjects collected partial expressions of about 5 ml of milk from each breast frequently over a 2-mont period. Milk samples were analyzed gravimetrically for fat and by gas chromatography for the fatty acids 10:0, 12:0, 14:0, 14:1, 16:0, 16:1, 18:0, 18:1, and 18:2. While hindmilk contained a higher percentage of fat than foremilk, fatty acid composition of the milk fat did not vary throughout a nursing. Fatty acid composition from pairs of left and right breast samples collected at the same nursing did not differ. Therefore, fatty acid analyses of human milk will be representative of the entire nursing if the sample is taken from either breast at any time during the nursing.


Functional adaptation of the intestinal mucosal enzymes after jejunoileal bypass for morbid obesity. Functional adaptation of the villus brush border and crypt have been evaluated preceding and following jejunoileal bypass for morbid obesity. Before surgery, 26 of 101 patients who were at least 100% above their ideal weight were randomly included into the study group, and control tissue specimens were collected from the jejunum and ileum. When five patients required revision of the bypass, jejunal and ileal specimens were collected from the functional (included) and nonfunctional (excluded) segments. At 19.2 +/- 5.0 (SD) months following the bypass procedure, there was an increase in alkaline phosphatase, sucrase and thymidine kinase specific activities within the functional remnants; the included ileum demonstrated a greater degree of adaptation than the included jejunum. In the nonfunctional jejunum there was a decrease in alkaline phosphatase and thymidine kinase specific activities, whereas no statistical alteration in mucosal enzyme activities occurred within the nonfunctional ileum. Serum total protein concentrations and serum magnesium levels were also evaluated before bypass and at revision. Mean serum magnesium levels became decreased, whereas serum total protein concentrations were not altered.


Effect of fiber from fruits and vegetables on metabolic responses of human subjects I. Bowel transit time, number of defecations, fecal weight, urinary excretions of energy and nitrogen and apparent digestibilities of energy, nitrogen, and fat. Twelve men 37 to 58 years of age consumed two diets for a period of 26 days each in a cross-over design. The high fiber diet contained fruits and vegetables and the lower fiber diet contained fruit and vegetable juices. Neither diet contained whole grain cereals or nuts. Some nutrients were added to the low fiber diet in order to make the diets equivalent insofar as possible in all respects except fiber. The inclusion of fruits and vegetables in the diet decreased bowel transit time, increased fecal weight, increased number of defecations, increased fecal excretions and decreased apparent digestibilities of energy, nitrogen, and fat. Six of the 12 subjects had diastolic blood pressure of 80 or more when consuming the low fiber diet. The diastolic blood pressures of these six men were significantly lower when the high fiber diet was consumed.


Water requirements of breast-fed infants in a hot climate. To estimate the water requirements of exclusively breast-fed infants in a hot climate, theoretical calculations of water requirements were made and a field study was carried out in Jamaica. Three urine samples were collected from each of 16 infants. The specific gravity of individual urine samples ranged from 1.005 through 1.015, with a mean of 1.009 (SD +/- 0.002). Corresponding values for osmolality were calculated to be 103 through 468 mOsmole/liter with a mean of 258 mOsmole/liter. The mean specific gravity for an infant ranged from 1.006 through 1.012, or 139 through 358 mOsmole/liter. The mean outdoor temperature was 27.6 C and the humidity 76%. Because the values for specific gravity were universally low it was concluded that healthy, exclusively breast-fed infants living in a hot humid climate will manage well without additional water. Additional water may be desirable during illness.


The effect of glucose loading on urinary excretion of chromium in normal adults, in individuals from diabetic families and in diabetics. This study was designed to investigate the effect of oral glucose tolerance tests (OGTT) on urinary chromium excretion in normal individuals, in individuals belonging to diabetic families, and in diabetics. The results can be summarized as: 1) eight of the 10 normal adults showed a significant increase both in terms of chromium per minute and chromium/creatinine (Cr/Cre) ratio after OGTT, and the difference between the mean values before and after OGTT was significant, 2) Of the 13 individuals from diabetic families, only five increased their chromium excretion and chromium/creatinine ratio after the glucose challenge (39%). However, the mean values for the group before and after OGTT remained statistically unchanged, 3) three of eight overt diabetic subjects (38%) showed moderate increase the chromium excretion and Cr/Cre ratio after OGTT, but the mean values were not effected. The creatinine values in urine remained constant before and after OGTT in all groups. These results suggest that a positive Cr/Cre response is more likely to occur in groups of normals than in groups of diabetics, and in individuals from diabetic families.


Urinary ascorbic acid excretion in the human as affected by dietary fiber and zinc. The objective of the project was to study the effect of dietary pectin, cellulose, hemicellulose, and zinc on human urinary excretion of ascorbic acid. The project consisted of two 33-day controlled feeding studies involving a total of 19 adult men and women normal health. Within each study all subjects received all experimental treatments. In study A during the four 7-day experimental periods the ground peanut based diets were varied as follows: no supplement, 14.2 g of hemicellulose supplement, 14.2 g of cellulose supplement, or 14.2 g of pectin supplement per subject per day. Mean urinary excretion of ascorbic acid by subjects while receiving these supplements were 26.10, 32.27, 26.27, or 20.60 mg/day, respectively. In study B during the four 7-day randomly arranged experimental periods, the following alterations were made to the basal diet: supplement of 14.2 g of pectin plus 1.3 g of zinc, 14.2 g of pectin plus 9.3 g of zinc, 4.2 g pectin plus 1.3 g of zinc, and 4.2 g of pectin plus 9.3 g of zinc. Mean urinary ascorbic acid excretion of subjects while receiving these diets were as follows: 20.61, 23.18, 28.07, 18.99. Hemicellulose supplement enhanced urinary excretion of ascorbic acid while pectin and zinc resulted in decreased urinary excretion of this vitamin. Increased urinary excretion of ascorbic acid at constant intake levels is thought usually to be indicative of enhanced absorption or of decreased need.


Hair analysis of trace minerals in human subjects as influenced by age, sex, and contraceptive drugs. Eleven male and 16 female residents of Tucson, Arizona volunteered blood and hair samples and dietary information. Hair and blood samples were analyzed for zinc, copper, magnesium, and iron. Dietary records were calculated for the same. Female subjects had a higher mean hair zinc level than male subjects, but serum zinc was not different for the two groups and mean dietary zinc intake was greater for males. The only difference observed with age was a decrease in hair zinc level over 50 years of age. The taking of oral contraceptives resulted in mean hair copper level numerically decreased while serum copper increased. Mean hair zinc increased with contraceptive use and serum zinc decreased. Mean dietary intakes of copper and zinc were not different between nonpregnant control women and women taking oral contraceptives. For human subjects, mineral concentration of hair, serum, and diet do not correlate well, emphasizing that influencing factors and must be considered in interpreting hair analysis results.


Maternal and cord blood metal concentrations and low birth weight--a case-control study. There has been speculation on the possible role of trace metals in contributing to the occurrence of low birth weight, but few data are available for most metals. Twenty-five women giving birth to infants weighing between 1500 and 2500 g (cases) and 50 women giving birth to infants weighing more than 2500 g (controls) were studied. The cases and controls were matched for age +/- 4 years), race, and socioeconomic status. Cord blood and maternal blood collected at delivery were analyzed by atomic absorption spectrophotometry for calcium, magnesium, copper, lead, and iron. Significant differences between the mean blood metal concentrations of the low birth weight and control groups were found for calcium (P less than 0.001) and iron (P less than 0.05) in the maternal blood samples and for calcium (P less than 0.001) and iron (P less than 0.01) in the cord blood samples. All concentrations were lower in the low-birth weight group except for the maternal iron level. No significant differences between the low birth weight and control groups were found for copper, lead, and magnesium in either maternal or cord blood.