Effects of endurance exercise on coronary collateral blood flow in miniature swine. Coronary collateral blood flow was measured in 7 miniature pigs, exercise trained (ET) for 10 mo by running about 35 km/wk, and in 10 sedentary control pigs (SC). In acute, open-chest preparations, radiolabeled (85SR, 141CE, or 51Cr) microspheres, 15 +/- 5 micron in diameter, were injected into the left atrium during each of three conditions: control (C), total occlusion of the left circumflex artery (TO), and TO plus mechanically elevated aortic pressure (TOP). Blood flow to the circumflex bed during control condition in ET and SC was 0.36 +/- 0.07 (SE) and 0.43 +/- 0.10 ml.g-1.min-1, respectively. During TO, circumflex flow in ET and SC fell to 0.05 +/- 0.01 and 0.06 +/- 0.01 ml.g-1.min-1, respectively. In the presence of TOP, left circumflex flow in ET and SC rose to 0.11 +/- 0.04 and 0.11 +/- 0.02 ml.g-1.min-1, respectively. Blood flow to the tissue bed of the left anterior descendens was the same in both groups of pigs under all conditions. Thus, 10 mo of endurance exercise training seems to have no effect on the development of coronary collaterals in the left ventricles of pig hearts.


Myocardial ATP synthesis and mechanical function following oxygen deficiency. The relationship between oxygen deficiency-reduced high energy phosphate levels and their resynthesis upon return to aerobic conditions was investigated in the isolated perfused rat heart. Any net adenosine triphosphate (ATP) hydrolysis during anoxia tended to impair ATP resynthesis with subsequent aerobic perfusion. Thirty minutes of ischemia reduced myocardial ATP 50%, and with restoration of aerobic conditions ATP increased to only 60% of control levels. The major source of postischemic and postanoxic ATP was adenosine 5'-monophosphate and adenosine 5'-disphosphate. Loss of purine base from oxygen-deficient cells limited restoration of ATP. The inclusion of adenosine, ATP, or creatine phosphate (CP) in the perfusate did not enhance postischemic tissue adenine-nucleotide concentrations. Postischemic and postanoxic CP concentrations returned to control values and were independent of ischemic and anoxic ATP and CP concentrations. Complete resynthesis of CP suggests that cellular energy-producing pathways were functional. Ventricular performance was directly related to tissue ATP concentration in aerobic control, postischemic, and postanoxic hearts. Thus, loss of adenine nucleotides during oxygen deficiency may impair subsequent aerobic synthesis of ATP and mechanical function.


Decreased reactive hyperemia after coronary perfusion with nonoxygenated solution. To gain more knowledge about the factors involved in reactive hyperemia in the coronary vessels, we performed comparative studies on the reactive hyperemia occurring after coronary occlusion and after coronary perfusion with nonoxygenated Tyrode solution. The peak coronary reactive hyperemic flow following 3 min of coronary perfusion with nonoxygenated Tyrode solution increased to only 142 +/- 16% of the control in contrast to 455 +/- 75% following 3 min of coronary occlusion alone. Myocardial oxygen uptake during reactive hyperemia was also much smaller after perfusion with Tyrode solution. First, the evidence suggests that the decreased reactive hyperemia after coronary perfusion with the nonoxygenated Tyrode solution is due to "washout" of the vasodilatory metabolites from the myocardium. Second, it suggests that there is a smaller "energy debt" during perfusion with Tyrode solution, so that deterioration of myocardial function due to oxygen deficiency is less severe than in coronary occlusion alone.


Effects of central and peripheral angiotensin blockade in hypertensive rats. The angiotensin II (AII) antagonist [Sar1-Ala8]AII (Saralasin) was injected into the brain ventricles (IVT) and intravenously (IV) in five different types of hypertensive unanesthetized rats. Renal hypertension was studied 16-22 days after kidney clipping. Intravenous infusions of cumulative doses (0.1-100 microgram/kg per min) and IVT injections (5-40 microgram) of Saralasin did not change mean arterial pressure (MAP) in controls and in one-clip, one-kidney Goldblatt hypertension, whereas MAP decreased in one-clip, two-kidney Goldblatt hypertension following IV and IVT Saralasin. In two-clip, two kidney hypertensive rats, IVT Saralasin decreased MAP but was ineffective when infused IV. Both IV and IVT Saralasin increased MAP in DOC hypertension. In spontaneously hypertensive (SH) rats, IV Saralasin increased MAP; IVT injection decreased MAP. The effect of IVT Saralasin in SH rats persisted 15-20 h after nephrectomy. We conclude that plasma AII may contribute to peripheral and central mechanisms of blood pressure regulation. The dissociation of the effects of IV and IVT Saralasin and the persistance of blood pressure decrease in nephrectomized SH rats following IVT Saralasin further support a role for locally formed brain angiotensin.


Microbubble elimination during priming improves biocompatibility of membrane oxygenators. We tested the hypothesis that platelet loss following blood contact with foreign materials is partly related to the presence of microbubbles of gas (gas nuclei) trapped in surface defects on the membrane material. Extracorporeal membrane oxygenator perfusions were conducted in two groups of sheep, with use of standard priming techniques for the oxygenator in one group and a new vacuum priming technique in the other group. The vacuum priming technique was developed to eliminate gas nuclei from the oxygenator surface. With denucleation priming, platelet loss during perfusion was markedly reduced, as was thrombus formation on the membrane surface. The platelet particle-size distribution curve showed a shift consistent with platelet aggregation with the standard priming technique but not with the vacuum priming technique. We conclude that the elimination of trapped gas nuclei from the membrane surface during priming reduces the initial interaction between blood elements and the foreign surface.


Temperature dynamics of the fertile chicken egg. Two thermistor temperature probes were mounted in fertile chicken eggs, one at the position normally occupied by an early embryo and the other in the center of the yolk. Temperature changes were constantly monitored while the eggs were removed from holding refrigerator to incubator, incubator to room temperature, or room temperature to incubator. Computer analysis was used to develop a mathematical model of heat fluxes in the egg. Graphs derived from this model are presented which permit any investigator to predict approximate time and temperature variables under conditions commonly encountered when using the chicken egg in biological research. We found that when the egg is moved from an incubator (38 degrees C) to laboratory bench (25 degrees C), there was a very rapid initial heat loss (over 8 degrees C in 10 min) at a site in the egg which would be occupied by an early embryo. Conversely, when the egg is moved from the bench back to the incubator, nearly 2 h is required for the egg to recover 90% of the heat that it had lost while cooling to 25 degrees C.


Oxygen exchange and vascular resistance in the totally perfused rainbow trout. A whole trout preparation (Salmo gairdneri) externally ventilated with water and internally perfused with artificial medium via a cardiac pump is discribed for the study of O2 exchange and vascular resistance. As cardiac output (Q) was raised, ventral and dorsal aortic pressures increased while branchial (Rg) and systemic (Rs) vascular resistances fell, reflecting considerable passive distensibility. Arterial oxygenation was negative at low Qs due to significant internal O2 demand by the gill tissue, but increased to zero or positive values at intermediate Qs, and eventually declined at high Qs because of transit time limitation. O2 uptake from the ventilatory flow rose with increasing Q. Epinephrine (10(-5) M) decreased Rg, increased Rs, and enhanced arterial oxygenation. Artificial elevation of dorsal aortic pressure decreased Rg but did not affect arterial oxygenation. A 10-fold elevation of ventilatory flow increased arterial oxygenation but did not alter Rg or Rs. Endogenous metabolism of branchial tissue accounted for 11.7% of resting O2 uptake in vivo, and comprised an internal component taking O2 from perfusion flow and an external component drawing O2 from ventilatory flow.


Cerebral blood flow and oxygen consumption in the newborn dog. Cerebral blood flow (CBF), CBF responses to changes in arterial CO2 tension, and cerebral metabolic rate for oxygen (CMRO2) were measured in newborn dogs, by means of a modification of the Kety and Schmidt technique employing 133Xe. Mongrel dogs of 1-7 days of age were paralyzed and passively ventilated with 70% N2O and 30% O2. CBF was derived by analysis of paired serial 20-microliter samples of arterial and of cerebral venous blood from the superior sagittal sinus. At an arterial PCO2 of 36.9 +/- 3.7 Torr and a mean arterial blood pressure of 62 +/- 10 Torr, CBF was 23 +/- 8 ml/min per 100 g. The arteriovenous oxygen content difference averaged 5.6 vol%, and CMRO2 was 1.13 +/- 0.30 ml O2/min per 100 g. CBF increased or decreased by 0.58 ml/min/100 g per Torr change in PCO2. Our results suggest that in the newborn, basal CBF and CBF responses to CO2 are considerably lower than in the adult and parallel the lower metabolic needs of the newborn brain.


Micropuncture studies of the osmoregulation in the nauplius of Artemia salina. The osmoregulation of the nauplius of the brine shrimp, Artemia salina, was investigated using micropuncture and microanalytical techniques. The naupliar body fluid, hemolymph was hyposmotic to and had lower Na concentrations than the suspending medium for the range of medium salinities from 80 to 4,900 mM NaCl. In medium containing 20 mM NaCl, the hemolymph was hyperosmotic to the medium, with osmolarity of 101 +/- 8 mosmol/1 and with [Na] of 49 +/- 11 meq/1. Whereas the maximal observed NaCl concentration gradient between hemolymph and medium was 4,785 mM, during the incubation of nauplii in artificial seawater (osmolarity: 932 mosmol/1; and [Na]: 502 meq/1) the osmolarity and [Na] of the naupliar hemolymph were 161 +/- SD 16 mosmol/1 and 86 +/- 14 meq/1, respectively. The influx and efflux of Na between medium and hemolymph were measured using 22Na. The fluxes of this ion were temperature dependent. The main site of efflux of 22Na was the neck organ as was shown by experiments of differential recovery of 22Na introduced in the hemolymph. These studies demonstrate that the nauplius of A. salina has the ability to osmoregulate not only against high environmental salinities but also against low salinities approaching those of freshwater.


Parabrachial pons mediates hypothalamically induced renal vasoconstriction. The role of the parabrachial region of the dorsal rostral pons (PB) in mediating control of renal blood flow and of systemic arterial blood pressure was investigated in nine cats anesthetized with chloralose-urethan. Electrical stimulation through electrodes placed stereotaxically in lateral and medial positions in the hypothalamus (LH and MH) in PB and in ventrolateral reticular formation (VLRF) of each cat elicited pronounced systemic arterial pressor responses and renal vasoconstrictions. Stimulation parameters were adjusted so that renal flow responses elicited from each site were equal. Following a unilateral lesion in the PB, responses of renal vasoconstriction induced by hypothalamic stimulation were attenuated, but responses of arterial pressure were not altered. Stimulation of the VLRF, posterior to the lesion, consistently produced undiminished systemic pressor responses and renal vasoconstriction throughout the durations of the experiments excluding decay of renal vascular responsiveness. Thus, the data suggest that pathways mediating renal vasoconstriction in response to hypothalamic stimulation was discrete and pass through the parabrachial region, whereas pathways mediating systemic vasoconstriction in response to hypothalamic stimulation are distinct or less compact.


Maladaptive cognitive structures in depression. According to the cognitive view, the individual's negative and distorted thinking is the basic psychological problem in the depressive syndrome. The distorted cognitions are supported by maladaptive cognitive schemata, which involve immature "either-or" rules of conduct or inflexible and unattainable self-expectations. These schemata are probably acquired early in development and, if uncritically carried into adulthood, serve to predispose the individual to depression. Since these schemata are long-term identifiable psychological patterns that influence attitude and behavioral responses, they may constitute a cognitive dimension of the depression-prone individual's personality. The authors discuss the treatment implications of the cognitive approach to depression.


The cardiac effects of therapeutic plasma concentrations of imipramine. The authors studied the effects of imipramine hydrochloride at plasma concentrations associated with antidepressant activity in seven patients hospitalized for severe depressive illness. They found that the drug usually produced prolongation of intraventricular cardiac conduction. Although this was generally well tolerated, the authors suggest that patients with preexisting conduction system disease may be at increased risk when taking tricyclic antidepressants. They feel that the orthostatic hypotension seen in all seven patients represents a potentially serious problem with tricyclic antidepressants. They discuss the antiarrhythmic properties associated with imipramine and significant interactions between imipramine and drugs taken by patients with cardiovascular disease.


Use of the extended family in the treatment of multiple personality. The author describes a patient with the diagnosis of multiple personality who was treated by several therapists with different theoretical perspectives, including psychoanalysis and family systems theory. The latter approaches to the patient's illness are compared, a new methodology of treatment is reported, and the impact of different ways of thinking about the patient is discussed.


Psychosocial aspects of mastectomy: II. the man's perspective. In order to assess factors related to men's adjustment to mastectomy and its aftermath the authors administered a questionnaire to 31 men whose wives or partners had had mastectomies. Most men reported a good overall adjustment, but a subgroup remained distressed and reported adverse effects on their relationships with wives or lovers. The data indicate that the nodal points in the process are the involvement of partners in the decision-making process, the frequency of hospital visits, resumption of the sexual relationship, and the man looking at his partner's body after surgery. These findings have implications for counseling couples who face this emotionally stressful procedure.


Obesity and psychoanalysis.

Obesity and psychoanalysis. Seventy-two psychoanalysts collected information on 84 obese patients and on a control sample of 63 of their patients of normal weight. Despite the fact that obesity was the chief complaint of only 6% of the obese patients, weight losses at 42 months of psychoanalytic treatment compared favorably with those after traditional medical efforts: 47% of the obese psychoanalytic patients lost more than 9 kg, and 19% lost more than 18 kg. There was also a striking decrease in the percentage of obese patients suffering from body image disparagement--from 44% to 12%, an unexpectedly good result for this chronic and intractable disorder.


Prediction of antidepressant responses to lithium. The authors studied 53 patients hospitalized for depression to evaluate possible associations between pretreatment responses to the Minnesota Multiphasic Personality Inventory and behaviorally rated responses to lithium. Patients were randomly assigned to two groups (A and B) in which responders and nonresponders were balanced for sex. For the 18 women in group A, a lithium response scale discriminated responders with 89% accuracy. For the 9 males, a separate scale discriminated responders with 100% accuracy. In a cross-validation, the two scales discriminated responders and nonresponders with 100% accuracy in group B. The empirical methodology of this study suggests an alternative to the theoretical-rational approach of predicting response to antidepressant drugs based on pretreatment depressive symptoms.


MAO activity, csf amine metabolites, and drug-free improvement in schizophrenia. Platelet monoamine oxidase (MAO) activity and amine metabolites in cerebrospinal fluid were compared in 22 schizophrenic patients, 8 of whom improved during a 30-day drug-free period. CSF 5-hydroxyindoleacetic acid and homovanillic acid did not distinguish between drug-free improvers and nonimprovers. However, drug-free improvers had lower platelet MAO activities than did normal controls. The authors suggest that looking at clinical variables in patients with low MAO activity might provide a means of biologically subtyping schizophrenic patients.


Minor physical anomalies in young psychotic children. The authors examined three groups of children for minor physical anomalies: 52 autistic children, 34 nonautistic siblings of these patients, and 29 normal controls. The total number of anomalies and the weighted score were significantly higher in the autistic children. The formation of these anomalies in the first three months of fetal life may concur with the developmental deviation of the central nervous system in some of these individuals.


Self-destructive behavior in battered children. Fifty-nine physically abused children demonstrated a significantly higher incidence of self-destructive behavior than two control groups of nonabused children, one neglected and one normal. The self-destructive behavior, including suicide attempts and self-mutilation, was potentiated by interrelated variables operating in the abused child and his environment. Often enhanced by the ego deficits and impaired impulse control of the abused children, this behavior seemed to represent a learned pattern originating in early traumatic experiences with hostile primary objects.


Concurrent validity of the Depression Adjective Check List in a normal population. A random sample of 309 employees of a state mental hospital completed form E of the Depression Adjective Check List (DACL), the Beck Depression Inventory, the Zung Self-Rating Depression Scale, and the Crowne-Marlowe Social Desirability Scale. Two psychiatrists then interviewed and independently rated all subjects on a 5-point scale. Most of the correlations between the DACL and the other measurements were significant and of sufficient magnitude to warrant interpretation as support for the concurrent validity of the DACL.


The "relief effect": a sociobiological model for neurotic distress and large-group therapy. The author discusses the new discipline of sociobiology. He develops the hypothesis that relief of neurotic distress may be associated with experiencing social affiliation and presents data that demonstrate a decline in neurotic symptom intensity in individuals who joined a cohesive religious sect. Anthropological and ethological evidence for the adaptive value of this "relief effect" provides a basis for the evolution of this trait. The author proposes a corresponding model for psychotherapy in large groups.


The psychiatric house call.

The psychiatric house call. Although caregivers in many disciplines have provided home visits as part of their services, psychiatrists have rarely made house calls. The author discusses some of the practical and emotional issues that have traditionally caused both patient and psychiatrist sufficient discomfort to limit this model of therapeutic intervention. Special emphasis is made in support of the psychiatric house call for elderly persons.


Day hospital treatment of borderline patients: a clinical perspective. The authors suggest that day hospitalization can provide a useful therapeutic framework for patients with borderline personality organization without creating the ego regression often seen in such patients during 24-hour hospitalization. The lack of room and board facilities and of contact with patients who need 24-hour hospitalization plus the maintenance of contact with the people in the patient's nonhospital life facilitate treatment in this setting.


Oral contraceptive use: association with frequency of hospitalization and chronic disease risk indicators. A questionnaire was mailed to 97,364 married women, aged 26--50, resident in Greater Boston in 1970, requesting information on lifetime oral contraceptive (OC) use, reproductive history, education, and hospitalization experience in 1969; 65,843 women responded. In 1973 a second questionnaire was mailed to 37,292 of these women, including all OC users and an equal number of non-users matched on age, parity, education, and town of residence. This questionnaire related to use of OCs, other female hormones, and the menopause. OC use was most strongly related to age, with a sixfold increase in use from the oldest women (of whom 10 per cent had used OCs at some time) to the youngest. Use was directly related to education and mobility and inversely related to parity. Reasons for beginning and ceasing use differed for women of different ages and educational attainment. Thus, use of OCs varies with social and reproductive characteristics that are risk indicators for many diseases. OC use was associated with increased risk of hospitalization for thromboembolic disease (risk ratio = 1.5, 95 per cent confidence limits 1.2, 3.2) and for mental illness, hyperthyroidism, hypertension, and cancer of the cervix. OC users were hospitalized for many non-life threatening conditions 20 to 40 per cent more frequently than were non-users.


Socioeconomic differentials in selected causes of death. The areal approach utilized in mortality analysis for cities in the past is argued to be fruitful for suburban mortality analysis as well. Through factor analysis of four Census Tract indicators, weighted scores were computed and socioeconomic groups were constructed for each central city and each suburban area for three selected metropolitan areas: Birmingham, AL, Buffalo, NY, and Indianapolis, IN. Mortality rates from Heart Diseases, Malignant Neoplasms, and All Other Causes of death were found to be inversely associated with socioeconomic status in both the central cities and the suburban communities of these selected metropolitan areas. Evidence points to increasing socioeconomic differentials between 1960 and 1970 especially for males for the central cities and for suburban rings in spite of reductions in mortality during this period.


Improvement in infant and perinatal mortality in the United States, 1965--1973: I. Priorities for intervention. Changes in United States infant and perinatal mortality in the period 1965--1973 were examined by race, age at death or length of gestation, and degree of urbanization. The decline of postneonatal mortality rates was greater than the declines of fetal and neonatal mortality rates. Other-than white infant and fetal mortality rates improved more than the white rates, except in the first day of life. Postneonatal mortality rates improved more in rural than in urban areas, while neonatal and perinatal mortality rates improved more in urban areas than in rural. These improvements in mortality rates have occurred at the same time as changes in medical techniques and the organization and availability of health services, improvements in economic conditions and standards of living, and changes in the demographic characteristics of the child-bearing population of the United States. Each of these changes was in a direction expected to have a favorable effect on infant and perinatal mortality. Nevertheless, the improvement of infant mortality rates has not changed the relative position of the United States in comparison with other countries. Programs to improve infant and perinatal mortality can use the data in this study to define high priority target groups using a method based on the size of the problem in the target group, the severity of the problem, and the amount and direction of change.


The incidence of sudden infant death syndrome in North Carolina's cities and counties: 1972--1974. Between January 1, 1972 and December 31, 1974, 534 Sudden Infant Death Syndrome cases were reported in North Carolina. All but the out-of-state cases were mapped by county and city locations to determine if urban or rural cases predominated. The mapping was also undertaken to see if significant spatial variabilities could be detected between the county and city populations of infants at risk. The state had an overall SIDS rate of 2.06 per thousand live births. The mapping revealed that counties had a range from zero to a high of 6.6 and that cities with populations of over 10,000 had SIDS rates which ranged from zero to a high of 10.6. The proportions of SIDS cases occurring in either urban or rural locations roughly approximated the distribution of the state's population, with neither location accounting for disproportionately more cases. The larger cities, however, reported more cases than did their suburbs and the immediately surrounding rural areas. The largest and smallest cities, when grouped accordingly, had the lowest urban SIDS rates. The summary SIDS rates for whites was 1.23 per thousant live births, for blacks it was 3.75, and for Indians it was 6.56 per thousand live births.


Health services needs of children in day care centers. In order to assess health services needs of children in day care centers, interviews were carried out with health coordinators or directors of 52 licensed day care centers in Berkeley, California. Over one-third of the centers lacked a designated health coordinator; one-fourth of the centers lacked written health guidelines and/or emergency guidelines; almost one-half lacked nutrition education services; and over two-thirds lacked a dental health education program. Only one out of five centers was willing to admit mildly ill children. Health coordinators and directors showed strong preference for care of mildly ill children at home by a trained worker. The presence of a designated health coordinator and of state funds was highly associated with the content and scope of health services provided.


Audience interest in mass media messages about lung disease in Vermont. This study pretested audience interest in 25 potential message concepts to be used in a mass media campaign designed to change knowledge, attitudes, and behavior regarding lung disease. A group of 150 respondents reflecting specific target audiences (smokers, older persons, etc.) rated each concept on the basis of a two-sentence description using Haskins' 0--100 scale. Results indicated that older persons were most interested in message concepts suggesting ways to deal with various lung disease symptoms, and smokers showed highest interest in concepts offering positive and straightforward advice on how to quit smoking, rather than concepts that were negative, cute, or satirical in approach. Recommendations based on audience interest were made for the design of future lung disease media campaigns.


Problems in suicide statistics for whites and blacks. The accuracy of suicide statistics was assessed by comparing published Health Department suicide rates for an area of New York City with Medical Examiner records. For the period 1968--1979, records from the Medical Examiner's Office were searched to determine all deaths classified as definite suicides. Another group of deaths was considered suicide by the Medical Examiner but never classified as such. These deaths we labeled "assigned suicides." When definite suicides were compared with all deaths considered suicide by the Medical Examiner (definite and assigned suicides), black suicide was underestimated by 80 per cent and white suicide by 42 per cent. Underestimation was the same for males and females but varied by age group. In 1968, when the seventh revision of the International Classification of Deaths (ICD) was used, Health Department suicide rates for blacks were almost identical to Medical Examiner rates, while white rates were underestimated by 25 per cent. In 1969--1970, when the eighth revision was used, Health Department statistics underestimated black suicides by 82 per cent and white suicides by 66 per cent. Reasons for the underestimations were related to the methods used in committing suicide by the two ethnic groups and to the ways that suicide classification has changed from the seventh to eighth revision. Implications for research using official death certificate reports are discussed.


Planning and developing a prehospital mobile intensive care system in an urban setting. A suggested model for the development of an urban based prehospital emergency care system is described. Factors considered in the planning and development include: 1) demand for services, projected and actual; 2) analysis of costs; 3) design and maintenance of the delivery system; and 4) establishment of the evaluation mechanisms. Over one year's experience and 1,144 mobile intensive care unit (MICU) calls in a densely populated urban setting with over 500,000 persons are reported. During the peak 8-hour period, predetermined dispatch categories were employed to activate one MICU operating in conjunction with three conventional ambulances. This partial conversion imparted MICU capability to the entire system at an 11 per cent increase in the ambulance budget. MICU calls averaged 4.5 per 8-hour peak shift and took 45 minutes each.


Dental examinations for quality control: peer review versus self-assessment. This paper reports the dental care norms for restorative dentistry collected from examinations of 1,466 patients in 105 dental offices in Washington State during 1976. These results are part of a larger study, "Assessment of Care and Continuing Dental Education," being conducted by the University of Washington with the endorsement and cooperation of the Washington State Dental Association. Treatments in volunteer offices were evaluated either by colleagues (peer review) or by the practitioner himself (self-assessment). Two hundred twenty-four of 1,196 eligible dentists volunteered for the study. Patients from the practitioners' offices were randomly selected from office files by project staff. The study tests the proposition that, using standardized clinical evaluation procedures and comparable samples of treatment, dentists will be more critical of their own work than that of others. Results suggest a generally high level of care provided by volunteer practitioners and that self-assessments were significantly more critical than peer review.


Psychiatry and general health care.

Psychiatry and general health care. The paper presents a study of psychiatric morbidity in the general health care program of a Health Maintenance Organization. Mental health services are built into the program as an integral component of primary care teams in internal medicine and pediatrics. The following were some of the findings: 15.7% of patients visiting the Health Center over a two-year period presented emotional problems; 72% were treated by primary care clinicians alone and 28% by mental health clinicians. Treatment by primary and mental health clinicians is broken down by diagnostic categories. A study of patients with chronic emotional problems revealed that they tended to be high utilizers of all Health Center services for both physical and emotional difficulties. Chronic patients represented 2% of all patients who visited in 1974; of these, 54% were seen by mental health clinicians and 46% by primary care clinicians. In the case of patients with non-chronic emotional problems, over a two-year period, there was an increase in the per cent seen by primary clinicians. The use of psychoactive drugs by primary physicians and the advantages and difficulties of developing a program of integrated health-mental services are described.


Health status indices and access to medical care. This paper examines the uses of some health status indices in measuring equity of access to medical care. Empirical examples are provided using data from national surveys of the U.S. population conducted from 1964 through 1976. A simple indicator, mean number of physician visits, suggests that between 1963 and 1976 the poor improved their position relative to the rest of the population and, indeed, currently enjoy the highest level of access. However, a second measure, the use-disability ratio indicates that the poor may still receive less care relative to their need. A third measure, the symptoms-response ratio suggests how norms of appropriate behavior might be incorporated into an access measure.


A method for selecting criteria to evaluate medical care. This study tests a questionnaire method for eliciting process criteria for medical care appraisal. The questionnaire was sent to national samples of family physicians, pediatricians, and pediatricians specializing in infectious diseases asking their opinions about various clinical actions in 125 clinical situations concerning respiratory infection in infants. Five hundred twenty-four (54%) physicians returned completed questionnaires. Questionnaire responses favored the performance of a majority of actions and opposed very few. Opinions concerning individual actions, particularly diagnostic tests and treatments, varied widely depending upon the clinical situation presented. A second questionnaire sent one year later indicated that the opinions expressed in the first questionnaire remained stable over time, especially if the initial opinion favored performance of the action. Comparison of the questionnaire responses and medical records of a group of practitioners demonstrated that only 55% of actions favored in a practitioner's questionnaire appeared in his records. Although the questionnaire method appears to be a feasible, specific, and reliable means of identifying clinical opinion, there remains considerable discordance between opinion as expressed in the questionnaire and recorded clinical practice.


Impact of a rural preventive care outreach program on children's health. A "treatment-control" research design incorporating a modified "tracer disease" methodology for measuring health outcomes has been applied to the evaluation of a rural pediatric outreach preventive health care program in Appalachia. The primary research objective was to assess the general level of effectiveness of the health services provided by the program in preventing and/or reducing illness due to common childhood diseases among children receiving these services, when compared to similar (i.e., "matched") children receiving standard pediatric outpatient care but without such outreach services. The research findings indicate that prevalence rates for the selected tracer diseases were generally comparable among program children and their controls. However, evidence of effective identification and treatment of an increased prevalence of iron deficiency anemia by the program was demonstrated. Comparison of the program and control children on their sociocultural characteristics also suggests that the comparable health outcomes for the two groups may have been achieved in the case of the program children despite their somewhat disadvantaged socioeconomic and environmental circumstances relative to the controls; and apparently with lower outpatient services utilization and lower overall costs.


Considerations in the design of mental health benefits under National Health Insurance. The existing insurance coverage for mental health benefits provides incentives for hospital as compared with community care and reinforces a medical approach to psychological disability. Moreover, the structure of benefits favors the affluent as compared with the disadvantaged and provides little assistance for the community integration of the chronic mental patient. In considering mental health benefits under National Health Insurance we must be careful to  avoid reinforcing these patterns. It is suggested that NHI include a mental health resource development fund intended for building a stronger network of community mental health care and that the pattern of insurance benefits under NHI be consistent with developing psychiatric services on a capitation basis.


Health input into land use planning experiences in a land use program. The experiences of a health professional in a land use program in a California County are described: providing health input into the land use planning process by counseling elected and appointed government officials, individual developers, and citizen groups; interpreting existing standards and evaluating proposed ordinances and land use proposals. The significance of such input and the need for guiding standards are emphasized.


Thoracic outlet compression in athletes a report of four cases. Four cases of thoracic outlet compression have been presented. The occurrence of this syndrome in athletes has not to our knowledge been previously reported. We do not feel eliminating athletic participation is a viable option for our patients. We have been satisfied with nonoperative treatment but would not hestitate offering surgery if indicated, since most authors have had good results in those who have failed conservative care. Thoracic outlet compression should be considered in all patients with upper extremity pain including athletes.


An analysis of 100 symptomatic baseball players. The management of baseball elbow injuries, both operative and nonoperative, was usually successful, permitting continued high-level athletic participation. Surgery was particularly effective in those cases with loose bodies. In the shoulder, symptoms occurred in the anterior and posterior regions. Each area presented difficulties in accurate diagnosis. The management of anterior symptoms was primarily nonoperative, surgery being reserved as a salvage procedure. In the posterior capsular syndrome, the source of pain is still unclear.


Protective immunity to Naegleria fowleri in experimental amebic meningoencephalitis. Naegleria fowleri, a free-living ameboflagellate, is the causative organism of primary amebic meningoencephalitis. Intranasal inoculation of N. fowleri in mice produces an infection similar to human disease. Mice immunized with live N. fowleri by intraperitoneal injection were found to be more resistant to subsequent intranasal challenge. These results may provide a lead to the development of immunotherapy for this virulent disease for which satisfactory chemotherapy is presently unavailable.


Further experience with mebendazole in the treatment of symptomatic trichuriasis in children. Mebendazole (methyl-5-benzoylbenzimidazole-2-carbamate: Vermox), a broad spectrum anthelmintic, cured 22 (88%) children with symptomatic trichuriasis when given as a single 6-day course in a dosage of 100 mg twice daily. A further 3 (12%) were cured after a repeat 6-day course of therapy. Thus complete parasite eradication was achieved in all. The administration of an antidiarrheal agent, loperamide hydrochloride (Imodium), appeared to enhance the efficacy of mebendazole. Both drugs were well tolerated and completely free of any toxic effects.


Scanning electron microscope observations on tegument maturation in Schistosoma mansoni grown in permissive and non-permissive hosts. Observations were made on details of tegument development of schistosomes grown in mouse, hamster, and rat hosts. In permissive hosts (mouse and hamster) the surface of the worm alters rapidly during early maturity and is characterized by fusing of a highly undulate surface network into smooth folds and spine-covered tubercles. In non-permissive hosts maturation of the tegument is both delayed and incomplete, and the tubercles are aspinous. Scanning views of the oral cavity and the gynegophoral canal, both sites of transitional tegumental organization, are also shown. The gynecophoral canal tegument seems to be a site of active lipid secretion.


Tissue eosinophil proliferation and maturation in schistosome-infected mice and hamsters. Extramedullary eosinophilopoiesis is described as a regular pathological feature of murine and cricetine schistosome infections. Using the Dominici staining technique, colonies of developing eosinophils were commonly found in certain tissue sites of dense oviposition, particularly in the liver, and in associated lymphoreticular tissues. The relationship of these observations to the role of eosinophilic leukocytes in schistosomiasis is discussed.


Counterimmunoelectrophoresis in the detection of antibodies to Schistosoma japonicum. Counterimmunoelectrophoresis (CIE) was used to detect antibodies to Schistosoma japonicum soluble egg antigen in 118 sera from people living in a schistosomiasis endemic area in the Philippines. The sera were also tested for antibodies by the circumoval precipitin test (COPT); 53% were found positive by CIE and 48% positive by COPT. No significant differences were found between the tests (P = 0.18 by McNemar's test). Cross-reactions with sera from patients with intestinal capillariasis and monkeys with experimental angiostrongyliasis were not found and no false reactions were detected with sera from "normal" controls. The CIE test as used in the present studies was found to be comparable to the COPT in sensitivity and specificity as related to cross-reactivity with sera from nematode infections such as intestinal capillariasis and angiostrongyliasis. Results are usually available quickly with nearly 70% of any reactions occurring within 1 h. The test should be of value in seroepidemiologic surveys in schistosomiasis-endemic areas.


Venezuelan encephalitis virus infection in neotropical bats. I. Natural infection in a Guatemalan enzootic focus. A serological survey of 939 Neotropical bats of 22 species from an enzootic focus of Venezuelan encephalitis (VE) virus on the Pacific lowlands of Guatemala during 1971--1975 revealed VE virus specific antibodies in seven species, three belonging to the genus Artibeus. VE virus was isolated from the blood of one Uroderma bilobatum. Antibody frequency was considerably lower in bats than in terrestrial mammals, and tended to vary within any given species from locality to locality and from year to year. At the village of La Avellana where VE virus was most active, antibody rates in the two best-sampled Artibeus species were 0.14 in 1971, 0.11 in 1972, 0.03 in 1973, and 0.11 in 1975. The positive rate of 0.10 over all years at La Avellana for the genus Artibeus suggests that these and possibly other bats regularly are infected by VE virus, and may possibly serve as alternate hosts to maintain virus circulation if most terrestrial animals become immune.


Venezuelan encephalitis virus infection in neotropical bats. II. Experimental infections. Eighty-nine Neotropical bats of five species were inoculated subcutaneously with epizootic or enzootic strains of Venezuelan encephalitis (VE) virus. Viremia was detected in 92.5% of all bats, but no illness attributable to virus infection was observed. Detectable viremias averaged slightly over 4 days in Artibeus jamaicensis and A. lituratus, and 2.8 days in Phyllostomus discolor, and maximal viremia titers in these three species averaged 6.9, 6.6, and 4.6 log10 SMicLD50 per ml of blood, respectively. In general Artibeus developed and maintained detectable levels of both hemagglutination-inhibition (HI) and neutralizing antibody for as long as tested (up to 506 days), although HI antibody to enzootic VE virus strains disappeared in some A. lituratus. The detectable antibody response of P. discolor was slower and of lower magnitude and shorter duration than that of Artibeus, although individual P. discolor which had lost detectable HI and N antibody resisted challenge. Vertical passage of antibody was observed in three A. lituratus offspring. Artibeus jamaicensis were found to be only slightly less susceptible to VE virus infection than a U.S. subspecies of the cotton rat (Sigmodon hispidus). No virus was recovered by mouse inoculation of organ pools of bats killed as early as 2 days and as late as 299 days after the last day of detectable viremia.


Venezuelan encephalitis virus infection in neotropical bats. III. Experimental studies on virus excretion and non-arthropod transmission. A total of 80 Neotropical bats of five species was inoculated with one of four strains of Venezuelan encephalitis (VE) virus. Virus was detected in the oropharynges of 56% of bats, and most regularly in Artibeus jamaicensis (75%). Titers of virus in oropharyngeal secretions were occasionally very high (8.5 log10 SMicLD50/ml in one A. jamaicensis). Only 2 of 123 urine samples from 50 bats and 2 of 86 fecal samples from 46 bats yielded VE virus. No contact or aerosol virus transmission from bat to bat was detected. VE virus passed transplacentally from two infected mothers to their fetuses, which were aborted. Virus did not pass from one infected mother to her nursing young.


Selection of a strain of Culex tarsalis highly resistant to infection following ingestion of western equine encephalomyelitis virus. After prolonged selection, two hybrid strains of Culex tarsalis were evolved that were highly resistant to infection following ingestion of western equine encephalomyelitis virus. These strains were greater than 25,000-fold more resistant than the most susceptible parental strain when fed on viremic chicks. Resistance was associated with a mesenteronal barrier since both refractory and parental strains were equally susceptible to infection by intrathoracic inoculation. Susceptibility was dominant, possibly incompletely dominant, over resistance. Inheritance was probably polyfactorial but this could not be determined with certainty since a small proportion of individuals appeared to become infected by nongenetic mechanisms.


Towards a quantitative understanding of the epidemiology of Keystone virus in the eastern United States. The implications of the Keystone virus--Aedes atlanticus transmission cycle are explored in the context of a quantitative model. Among the variables considered are the vertical transmission rate, the effect of the virus upon vector fertility and survival, vector densities and distributions, the proportion susceptible in the vertebrate population, the attractiveness of different vertebrates to the vector and vector survival rates. The logical relationships between these several variables are explored. It is concluded that the current view of Keystone virus maintenance is quantitatively feasible, and that certain predictions may be made as to the magnitude of several parameters which have not yet been measured. Such predictions allow direct testing of the model. The general structure of the model is such that it may prove useful in describing the epidemiology of other vector-borne infections in which vertical transmission is essential for infection maintenance at certain periods of the year.


Epizootiology of epidemic typhus (Rickettsia prowazekii) in flying squirrels. Vector transmission of Rickettsia prowazekii among wild flying squirrels, Glaucomys volans, was suggested by the occurrence of natural infection of squirrel lice and fleas. Lice, mostly Neohaematopinus sciuropteri Osburn, were found infected in the fall in each of 2 consecutive years; 4 of the 8 pools of this insect tested were infected. Fleas, Orchopeas howardii (Baker), were found infected on two occasions in 1 of the 2 consecutive years. However, only 2 of 14 flea pools were infected. No evidence of infection was found in mites, Haemogamasus reidi Ewing and Androlaelaps fahrenholzi (Berlese). These findings implicate the flying squirrel louse and flea as possible vectors in nature. Serologic tests of flying squirrel sera revealed a maximum incidence of seroconversions in the fall and early winter months, coincident with the maximum increase in abundance of the suspected arthropod vectors. The infection was found to persist form year to year in the same enzootic foci. Infection appeared to spread most rapidly in young, non-immune animals born in the preceding spring and summer after congregating in dense aggregations in the fall. No other animals in the same habitat were found to have been infected. Aspects of the ecology of the ectoparasites associated with the flying squirrels are described, especially seasonal activity and abundance in nests. The potential public health importance of this sylvan disease in flying squirrels and in its ectoparasites, particularly the non-host specific, wide ranging squirrel flea, is noted.


Inhibition of mitogen-induced lymphocyte proliferative responses by quinine. In vitro mitogen-induced proliferative responses of human lymphocytes were inhibited by concentrations of quinine normally attainable during therapy of malaria infections. The clinical implications of these findings are discussed.


Clinical and histological kidney involvement in human kala-azar. A 19-year-old women developed prolonged fever, weight loss, hepatosplenomegaly, anemia, leukopenia, and hyperglobulinemia. Appropriate tests indicated that she had visceral leishmaniasis (kala-azar). Urinalysis demonstrated significant proteinuria and microhematuria with the presence of red cell casts. A kidney biopsy was performed. Light microscopy showed a slight mesangial thickening and segmental mesangial proliferation. Immunofluorescence demonstrated deposits of immunoglobulins A and M, complement, and fibrinogen. Electron microscopy showed subendothelial and intramembranous deposits. After treatment with N-methylglucamine antimonate the proteinuria and microhematuria disappeared and the patient recovered uneventfully.


Seizures and electroencephalograph changes associated with oxamniquine therapy. A Tanzanian man with a known seizure disorder was admitted to hospital for treatment of schistosomiasis mansoni. He suffered a grand mal seizure soon after the second dose of oxamniquine. This is the first recorded seizured associated with use of this drug. Two other cases are reported in which transient electroencephalograph changes occurred during oxamniquine therapy. The central nervous system effects of oxamniquine are reviewed with respect to its possible epileptogenic effects.


Intradermal test with histamine in Schistosomiasis mansoni. Histamine diphosphate was injected intradermally, at dilutions of 10(-3), 10(-4), and 10(-5), into 25 boys (10--12 yr old), and 25 men (20--30 yr old) with active schistosomiasis mansoni. A linear relationship between the mean area of the wheals and the logarithm of histamine concentrations was determined. Both equations (men and boys) were significant (P less than 0.05) but showed no difference between their regression coefficients. These findings contrast with those obtained with the intradermal test performed with Schistosoma mansoni antigens, in which skin response in men is significantly greater than in boys.


Cholecystectomy with drainage. Factors influencing wound infection in 1,000 elective cases. A retrospective review of 1,000 elective cholecystectomies was undertaken to identify factors associated with wound infection. The technic of wound drainage appears to influence the incidence of infectious wound complications to a significant degree.


The web factor in cholangitis.

The web factor in cholangitis. Choledochoscopy demonstrates that stone-related suppurative cholangitis has the pathologic characteristics of a multiloculated intraductal abscess. The fibrin web compartmentalizes the duct, traps calculi, and limits spontaneous extrusion. The stones act as foreign bodies and stasis maintains the bacterobilia. This is the anatomic basis and rationale for early direct surgical drainage as the definite effective treatment.


Late occurrence of perineal wound abscess years after total colectomy. Seven patients presented with a large perineal abscess eight months to seven years after complete healing of the perineal wound following proctocolectomy. Six patients had had total proctocolectomies for ulcerative colitis and a seventh had undergone abdominoperineal resection for cancer. A typical clinical picture of perineal pain, fever, urinary tract complaints (including retention), and minimal local perineal findings was present. Prostatitis or a urinary tract infection was considered in five patients, but none of them responded to antibiotics. Ultrasound examination of the perineum may confirm the diagnosis; however, diagnostic and therapeutic surgical exploration of the healed perineum is recommended when this diagnosis is unclear.


An anterior transversalis fascia repair for adult inguinal hernias. During the eight year period from 1967 to 1975, 1,020 patients more than eighteen years old underwent 1,311 inguinal herniorrhaphies. Group I consisted of 723 inguinal herniorrhaphies in which either a Bassini or a Cooper's ligament repair was used. During a four to nine year follow-up period, the total recurrence rate was 11.5 per cent; the recurrence rate for the primary repair group was 7 per cent and for the recurrent group 32 per cent. The follow-up rate was 93.7 per cent. Group II consisted of 591 herniorrhaphies in which the repair was performed by an anterior transversalis fascia technic. During a two to five year follow-up period, the total recurrence rate was 2.7 per cent; 1.8 per cent for primary repairs and 8.0 per cent for recurrent hernias. The follow-up rate was 98 per cent (95 per cent by personal examination). Assuming that the recurrences in group II will occur with the same frequency as in group I, our projected four to nine year recurrence rate is 3.4 per cent. This suggests that the anterior transversalis fascia repair results in a lower recurrence rate than either the Bassini or Cooper's ligament repairs.


Mechanisms of late recurrence after radical surgery for gastric carcinoma. Factors involved in late recurrence of gastric carcinoma were investigated in 25 patients with late recurrence who died five or more years after radical surgery and 129 with early recurrence who died within two years after surgery. In the patients with late recurrence, the important routes of cancer spread in the initial phase of the recurrence were contiguous invasion and lymphatic spread. Whether early or late recurrence occurred had a high correlation with the following four conditions: (1) the amount of residual cancer left at the time of surgery; (2) the spread of the residual cancer; (3) the rate of cancer proliferation; and (4) the resistance of the host. To prevent late recurrence, it is necessary not to leave any cancer tissue in these routes at the time of gastrectomy, as well as to employ adjuvant chemo- and immunotherapy for the inhibition of cancer proliferation and elevation of the host resistance.


The cost of misadventures in colonic surgery. A model for the analysis of adverse outcomes in standard procedures. Analysis revealed an impressive number of patients transferred to intensive care at the Peter Bent Brigham Hospital after misadventures in standard medical and surgical procedures. The model explored here is that of colon surgery, a therapy standardized for decades. The courses of sixteen patients were studied, wherein adverse outcomes appeared to have been preventable. Failure to diagnose colonic leakage and failure to provide colostomy (or to do so safely) were the major underlying causes. Nephrotoxic antibiotics and immunosuppression were sometimes in the background. Nine patients died, all with severe sepsis. Multiple organ failure occurred in the majority of cases. The mortality was tenfold, the cost sevenfold, and the length of hospitalization fourfold that expected after uneventful operation. Current interest in cost-benefit analysis should be broadened standard medical and surgical procedures. Litigious potential should not be allowed to impede such analyses.


The use of stroma-free hemoglobin solution for partial exchange transfusion in aortic resection in dogs. Vascular surgery involves multiple transfusions with their concomitant hazards. At the start of each vascular procedure, 20 per cent of each patient's blood (approximately 1,000 of 5,600 ml) is removed and replaced with colloid and crystalloid and the withdrawn blood returned at the end of surgery. Theoretically, if 40 per cent of the blood volume (2,000+ ml) could be withdrawn, essentially no banked blood would be required for a major vascular procedure. Therefore, 40 per cent (900+ ml) of the blood volume of twenty greyhounds was withdrawn under anesthesia and replaced with stroma-free hemoglobin solution (SFHS). Abdominal aortic resection and graft replacement was performed, and any blood lost during the procedure was replaced with SFHS. After surgery the withdrawn blood was returned to the dog and excess volume removed with postoperative hemodilution diuresis. The study included a battery of twenty tests for monitoring during the procedure and at intervals from this project that in greyhounds 40 per cent or more of the blood volume may be removed and replaced with SFHS and major vascular surgery done without undue risk and with unaltered kidney function.


Evaluation of tracheal incisions for tracheostomy. Three standard tracheostomy incisions in dogs were compared to determine whether any were more likely associated with stomal stenosis. Each incision resulted in an average reduction in tracheal lumen of 25 per cent, with a 50 per cent maximum. The incision selected should depend on the conditions present.


Experimental retained antrum. Diagnostic technics and histopathologic correlations. Retained gastric antrum was evaluated in six dogs, and diagnostic methods correlated with histopathology. Secretin and calcium infusion did not significantly alter circulating gastrin levels. 99 mTc scanning was uniformly positive and did not depend on the presence of parietal cells. The failure to consistently develop hypergastrinemia and the absence of gastrin cell hyperplasia suggest that factors other than gastrin may be implicated in the recurrent ulceration seen with retained antrum.


Systemic anaphylaxis secondary to the use of 5 per cent plasma protein fractions. A severe anaphylactic reaction developed in a twenty-six year old female after the administration of only 40 ml of 5 per cent plasma protein fractions (Plasmanate). The reaction was characterized by generalized tingling, chest pain, sudden severe hypotension, and urticaria. The patient responded to intravenous fluid, epinephrine, diphenylhydramine, and steroid administration.


Carcinoid tumors of the rectum.

Carcinoid tumors of the rectum. Carcinoid tumors of the rectum are not uncommon. However, multiple rectal carcinoids are very rare but can occur. The behavior of the rectal carcinoids is different than that of carcinoid tumors in other areas of the gastrointestinal tract. All carcinoids are malignant, and management is based on size and depth of invasion.


Ileostomy of the distal end of the bypassed intestine in a patient with jejunoileal bypass for obesity. Ileostomy of the distal end of the bypassed segment of small intestine was done twenty-three months after a 28 to 20 cm (12 to 8 inch) end-to-end jejunoileal bypass for obesity (Scott operation) in a forty-eight year old white female, thus creating a Thiry fistula. Weight prior to jejunoileal bypass was 130 kg (287 pounds). Before ileostomy it had stabilized at 80.3 kg (177 pounds). Indications for ileostomy were three episodes of blind loop syndrome and three episodes of severe bleeding from the ileotransverse colostomy anastomotic site. Culture of the bypassed segment at laparotomy revealed bacteroides, clostridia, and other anaerobes as well as the usual aerobic large bowel flora. After ileostomy the bypassed segment contained no anaerobic bacteria. Daily fluid output from the ileostomy has decreased with time, averaging 436 ml per day for the first postileostomy month and 50 ml per day for the ninth month. Beneficial effects of the ileostomy include: (1) better sense of well being; (2) no further episodes of blind loop syndrome or intestinal bleeding; and (3) cessation of anal itching. Nine months after ileostomy, hyperoxaluria and acquired megacolon were present. Weight was 5.9 kg (13 pounds) greater than before ileostomy.


Mediastinal parathyroid cyst. Report of a case and review of the literature. A case of mediastinal parathyroid cyst is presented, including a review of the world literature and a discussion of the etiology, diagnosis, and management.


A simple method for percutaneous cannulation of the internal jugular vein. A safe and rapid technic for internal jugular vein cannulation is described. The success rate is almost as high and the serious complication rate is much lower than subclavian vein cannulation.


Surgical technic for the resection of internal carotid aneurysms using an internal shunt. A technic for reconstruction of the internal carotid artery after resection of carotid aneurysms is presented. Reconstruction is performed over an internal shunt using a vein or Dacron patch. Total interruption of cerebral circulation is usually less than three minutes. The technic is described in detail. Oculoplethysmographic and phonoangiographic follow-up studies demonstrate normal carotid flow.


Transdiaphragmatic approach to the descending thoracic aorta for proximal control during surgery on the abdominal aorta. A technic of mobilizing and clamping the lower descending thoracic aorta from the abdomen through the incision in the diaphragm is described. This technic is simple and may be useful when it is difficult to obtain proximal control of the abdominal aorta during surgery. In addition, certain surgical procedures on the upper abdominal aorta may be facilitated by the use of this technic.


Isolation and partial characterization of three allergens of timothy pollen. Three allergens, antigen Nos. 3, 25, and 30, were isolated from freeze-dried aqueous extract of timothy pollen by various combinations of anionic and cationic exchange and gel chromatography. The allergens were all of protein nature and contained less than 2% (w/w) immunochem;cally detectable impurities. Molecular weights and pI's were determined to less than 10 X 10(3), 15 X 10(3) and 3.9, 4.5, 9.4, respectively, and antigen 25 was determined as the major component of the earlier isolated antigen B. amino acid analyses performed an antigens 3 and 30 revealed large variation s in the amino acid composition. The allergenic activities were verified by means of RAST inhibition and pick tests and proved antigen 25 to be quantitatively the most important allergen of timothy pollen.


Lysosomal enzyme release from the lungs after cardiopulmonary bypass. The activity of some lysosomal enzymes has been investigated in venous and arterial blood collected from patients undergoing cardiopulmonary bypass. Before bypass, there is no arterio-venous difference in the activity of n-acetyl-beta glucosaminidase, beta-glucuronidase or lysozyme. After operation, the activity of n-acetyl-beta-glucosaminidase is greater in arterial than in superior caval blood within the first 24 h after bypass, and a small arterio-venous increment in the activity of beta-glucuronidase can also be detected towards the end of the first day. The site of enzyme release has not been identified with certainty but may lie within the pulmonary circulation.


Unblocked segments in obstetric epidural blocks. The influence of previous regional block on obstetric patients receiving lumbar epidural analgesia during labour. Two hundred and six patients were studied to discover if previous regional analgesia influenced the incidence of unblocked segments and unilateral analgesia during lumbar epidural block in labour. Previous lumbar epidural or subarachnoid or sacral epidural blocks alone did not appear to influence the incidence of unilateral block or of unblocked segments. The practice of using epidural analgesia to facilitate the insertion of cervical circumsuture during pregnancy did not appear to be contra-indicated.


Pricing of anaesthetic techniques.

Pricing of anaesthetic techniques. The costs of various anaesthetic techniques have been measured using the costs of the various anaesthetic drugs supplied to one hospital in the National Health Service. These costs have been used as a basis for a discussion of the economies that might be practised in the conduct of anaesthesia.


Vascular surgery in an anephric patient. A 33-year-old man with chronic renal failure underwent repair of an expanding aortic aneurysm. The management of the case is described and the anaesthetic problems discussed.


Anaesthesia with ketamine and thiopentone for short surgical procedures: with reference to anaesthesia in developing countries. A technique of general anaesthesia using small doses of intravenous ketamine and thiopentone is described. The method provides satisfactory operating conditions combined with cardiovascular stability and an apparently safe airway at little more than half the cost of a comparable technique using ketamine alone.


[Clinical and laboratory aspects of malignant hyperthermia in children with special reference to creatine kinase isoenzymes (author's transl)]. The clinical and laboratory findings in 4 children with signs of malignant hyperthermia are reported. In all cases an extraordinary elevation of creatine kinase activity in serum was observed. By investigation of the creatine kinase isoenzyme activities we tried to determine the origin of creatine kinase. In contrast to other reports, creatine kinase BB derived from brain was found to be absent in all cases, although creatine kinase MM and MB showed remarkable alterations. A certificate for all patients who have survived malignant hyperthermia is suggested.


[Microaggregates in stored blood: comparative evaluation of whole blood and buffycoat-free red cell concentrates (author's transl)]. Routine preparation of red cell concentrates in our institute removes 90% of platelets and 70% of leucocytes in whole blood. Microaggregate formation in whole blood and red cell concentrates was comparatively evaluated by blood passage through a membrane filter with a pore size of 12 micron. Dry weight residues on the filter due to microaggregates were 5 to 10 times lower in red cell concentrates as compared to whole blood at any point of a 20 day storage period. In addition, the decrease in flow rate with increasing storage time was much more marked for whole blood than for red cell concentrates.


[Emergencies and aspiration. Can the usual methods for the prophylaxis of aspiration be further developed? (author's transl)]. There are two prerequisites for aspiration of gastric contents, namely material near the larynx and the possibility for an influx into the tracheobronchial system. We discussed the value of common measures in protecting against aspiration. To take notice of the normal emptying time of the stomach, suction of liquid gastric contents by a stomach tube, evacuation of the stomach by inducing vomiting (large bore stomach tube or apomorphine), mechanical blockade of the oesophagus or of the gastrooesophageal junction, modification of general anaesthesia (induction with an inhalation anaesthetic or intravenous agents), cricoid pressure, foot-down, lateral or horizontal position are not able to prevent the passage of gastric contents into the oro- and nasopharynx. Aspiration is unavoidable if there is a possibility of influx into the tracheobronchial system. Induction of anaesthesia with the patient lying on his left side in the head-down position gives the maximum protection against the danger of aspiration. An easy method of enabling a patient to be placed in the left lateral, head-down position, when only two persons are present, is highly desirable.


[A rare cumulation of vena cava catheter complications in the same patient (author's transl)]. Two complications that occurred in connection with the use of CVP catheters in the SVC and IVC in one patient are described: 1. Extravascular injection in the superior mediastinum and in the extrapleural space. 2. Massive thrombosis of the IVC. The differential diagnosis of a wedening of superior mediastinum is discussed. Recommendations are made to prevent these complications.


[The catheterembolisation for permanent occlusion of the renal artery--anaesthesiologic views (author's transl)]. Experiences with a new radiological technique, namely embolisation of the renal artery with a spiral from Gianturco, are reported. Continuous epidural block has been found to be the best method of anaesthetic management. The technique of embolisation was used in 17 patients. As a preoperative measure it facilitates tumournephrectomy, saves blood and reduces the danger of dissemination of tumour-cells during operation.


[A new method to avoid aspirations (author's transl)]. When treating accident victims and other high-risk patients there is always the danger of aspiration until intubation has been completed. An ancillary unit is described that can be connected to any type of tracheal aspirator, working on the principle of increasing the suction. Thus liquids and solid particles can always be sucked out quickly and effectively. In this way the danger of aspiration is considerably reduced or avoided altogether.


[A new CO2 analyzer for monitoring of artificial ventilation (author's transl)]. A new CO2-Analyzer for continuous measurement of CO2 content during artificial respiration is described. Based on infra red absorption, this device may be used for measuring the carbon dioxide content of expiration in anaesthesia and intensive care. Carbon dioxide infrared absorption is affected by nitrous oxide. This side effect can be compensated by a single switch, if the sample contans N2O.


[Data processing in the blood gas laboratory (author's transl)]. A computer-assisted system for the calculation of derived blood-gas and acid-base parameters, consisting of an analysator (AVL 937) desk calculator (HP 9825A) and external printer (HP 5150A) is described. For the calculation of the derived parameters corrections were made for patient temperature, plasma protein, reduced haemoglobin and CO2-carbamino haemoglobin. The time needed for calculating and feed back was shortened.


Morphological changes in cooked longissimus dorsi muscle of pig, buffalo, sheep, goat and poultry. In an effort to establish the morphological differences between the cooked muscles of pig, buffalo, sheep, goat and poultry longissimus dorsi were examined. Cooking at 100 degrees C produced shrinkage of muscle fibres in all species. The demarcation of the fascicles was also lost. Cooking at 121 degrees C destroyed even the granulated structure of collagen, reducing it to an amorphous state. The transverse striations were lost and the muscle fibres showed cracking, breaking and splitting. In relation to the control the per cent values of the cross-sectional area of the muscle fibre after treatment at 100 degrees C decreased by 28.6% in pig, 17.8% in buffalo, 20.4% in sheep, 24.3% in goat and 34.8% in poultry, whereas the respective values after cooking at 121 degrees C were 38.3%, 28.6%, 32%, 33.9% and 44.1%. Besides, the muscle fibre diameter in all species was also reduced after cooking. The number of muscle fibres and fascicles per mm2 were found to increase after cooking at 100 degrees C and 121 degrees C.


A note on the limb nerves of the frog (Rana tigrina). In the frog (Rana tigrina) the mean length of the brain was 17.5 mm and that of the spinal cord 61 mm. The weight of the brain and spinal cord (together) was 389 mg. The fascicular number, fascicular area, total number of fibres and their density were studied in the left and right brachial nerves, left and right sciatic nerves and the sympathetic trunk (nerve). The largest number of nerve fascicles (12) was noticed in the sympathetic trunk while the right brachial nerve comprised of only one nerve fascicle. As for the mean fascicular area, the left brachial nerve had the greatest area (0.7963 mm2) while the least (0.1312 mm2) was noticed in the sympathetic trunk. The sympathetic trunk revealed the highest number (mean value 2176) of myelinated fibres. The least value in this regard (598) was noticed in the left sciatic nerve. As for the external diameter of the nerve fibres, more than 50% of the fibres in all the nerves were of the order 6--8 micrometer. The histograms confirmed this trend. The greatest density of myelinated nerve fibres was noted in the left brachial nerve (288/mm2). Based on the retrograde degeneration, the ventral horn neurons giving origin to the motor fibres in the brachial nerves were traced to spinal cord segments 2 (Preponderantly) and 3. The ventral horn neurons of spinal cord segments 7 and 8 appear to contribute motor fibres to the sciatic nerves.


Intramammary lymph nodes in cow in early fetal period. The analysis of serial sections of 4 fetal mammary glands of cattle revealed that the intramammary lymph nodes occurred in these glands. In two cases they were present in both halves of the gland and the number of nodes was 1 to 3 in one half. The nodes were of ovoid shape and their length  ranged from 170 to 920 micrometer. The nodes were situated within the mesenchymal primordium of the mammary gland in the neighbourhood of the ramification of the primary epithelial bud into the secondary ones. The microstructure of node was rather primitive. Their capsulae consisted of condensed adjacent mesenchyme and passed over without septa in the supporting nodal reticulum. The lymphoid tissue was not differentiated into the cortex and medulla and consisted of clusters of immature lymphocytes


Hematology of the common Indian frog Rana tigrina. III. Hemoglobin and hematocrit. The hemoglobin and hematocrit values studied in two years averaged 6.22 and 3.87 g/100 ml and 31.8 and 19.5 percent in female and male Rana tigrina respectively. The peak values in females and males are observed in May and June respectively. The breeding season is characterized by low hemoglobin and hematocrit values. The starvation upto 28 days is observed to cause a decrease in hemoglobin level.


Morphogenesis and histogenesis of the cartilaginous tracheal rings in the domestic fowl (gallus domesticus). The morphogenesis, histogenesis and growth pattern of the tracheal rings were studied in chick embryos and in chickens up to 4 months of age. The blastemas representing the earliest ring primordia are seen to arise in the embryo in the cranial portion of the tracheal tube on the 10th day of incubation, and to extend rapidly caudalwards. They form first in the anterior wall of the tracheal tube and expand successively laterally and posteriorly. The mesenchymal blastemas that have acquired the shape of complete rings differentiate into precartilage and then into typical hyaline cartilage. During growth, the tracheal rings undergo striking changes in both shape and position. In the embryo, an active growth rate in a craniocaudal direction prevails, and after hatching each ring outstretches cranially and caudally into two long expansions (winglike projections). Moreover, these rings, which in early embryos were regularly aligned in a longitudinal row, are seen to become alternately located with their higher halves on an inner plane and their lower halves on a more superficial plane. Such a peculiar ring displacement on two different planes may reasonably be assumed to obey spatial requirements, since ring growth rate according to a craniocaudal direction is far more vigorous than growth, in the same direction, of the tracheal wall housing them.


Caudal neurosecretory system and the neurohemal organ of Tor tor (Ham.). The Caudal neurosecretory system and the neurohemal organ of a fresh water fish, Tor tor, is described. In this fish the neurosecretory system is well developed which extends upon an stretch of the last 6--7 caudal vertebrae. This region of the spinal cord is characterised by the presence of large Dahlgren cells. These cells send off long processes into a ventrally situated storage release centre, "the neurohemal organ" termed as "urophysis". In Tor tor the urophysis is a distinct, whitish, unpaired and ventral prominence of typical teleostean type. It remains located in a shallow concavity formed at the urostyle and communicates with the spinal cord broadly. Gross morphology of this system provides the evidence that the caudal spinal cord is composed of Dahlgren cells, glial cells, ependymal cells, blood capillaries, ordinary nerve fibres and the central with Reisnner's fibres. The Dahlgren cells are recognized to be of two types--small and large. These cells are polymorphic and usually multinucleated. Polymorphic and lobulated nuclei have also been encountered. Histologically the urophysis can be divided into two regions--an outer cortex and inner medulla. The cortex is composed of epedymal cells, glial cells, connective tissue and the blood capillaries while the medulla consists of the neurosecretory processes of the Dahlgren cells, connective tissue fibres, secretory droplets including large size herring bodies and abundantly present blood capillaries. A few of the herring bodies are also observed with vacuoles, a feature suggesting them to be in the functional state.


[The mechanisms of fracture in the human skull under static loads while still covered by tissue (author's transl)]. Static compression tests were undertaken on 40 human skulls while still covered by tissue. The compression tests were performed on the median sagittal part of the calotte. It was found that the skull, like the tubular bones, is fully elastic. Dissection revealed considerably more fractures, particularly in the basal region, than were shown on x-ray pictures (50%). With regard to the mechanisms of fracture, Fig. 2 shows that fractures occur only while the last third of the load is being applied. The following parameters were determined: maximum stress upon fracture, strain, elongation, elasticity module and elasticity coefficient.


[Contribution to three-dimensional consideration of surfaces of joints of condyli femoris (author's transl)]. There were laid sections in a difference of 1 cm across the condyli femoris of 5 human formalin-fixed femora and was looked for the curvature of the areas of joints at their marks. In comparing with literature was to be seen that corresponding dats failed at the orientation of the bone. Model conceptions used in case of compensation can't be accepted. Exact calculations of the three-dimensional curvature of surface are presumed for taking into account the mechanism of transfer of forces in the knee joint.


Light and scanning electron microscopic observations of the effects of sublethal doses of methotrexate on the rat small intestine. The small intestines of adult rats were examined by light and scanning-electron microscopy after sublethal doses of methotrexate were injected at 5, 3 and 1 mg, respectively, per rat per day, for three days. Methotrexate inhibited mitosis and thereby disrupted the steady state system of the epithelium. Villi and crypts progressively diminished up to about four and one-half days after the initial injection. Thereafter, recovery began and, by day 7, relatively normal morphology was restored. In the degenerative phase, the loss of crypt-villus continuum was frequently observed, the former crypts forming cyst-like structures. The columnar cells became flat and pleomorphic but epithelial continuity was maintained. Goblet cells apparently decreased in number. Paneth cells, especially in the ileum, appreciably increased in size and number. During the recovery phase, the cystic crypts apparently re-established continuity with the villus epithelium. Size and proportion of all epithelial cell types returned to normal. Scanning electron microscopy showed villus fusion and the cellular pleomorphism and loss of microvilli during the degenerative phase. During recovery of the villi some alteration in orientation and shape remained as shown by scanning electron microscopy.


Fenestrae in the rough endoplasmic reticulum of Xenopus laevis hepatocytes. The rough endoplasmic reticulum (RER) of Xenopus laevis hepatocytes was examined by freeze-fracture and by conventional thin section electron microscopy. Much of the RER was present as stacks of cisternae at the cell periphery but, in addition, large whorls of cisternae were seen in the cytoplasm in most sections. Freeze-fracture replicas revealed fenestrae in both stacked and whorled cisternae, although the fenestrae were more numerous in the whorls. The role of these fenestrae is unknown, but such structures would facilitate access of precursors to the protein synthetic machinery in this highly metabolically active cell type. This would be particularly important in RER whorls, where the innermost cisternae would otherwise be isolated from the rest of the cytoplasm.


Embryologic origin of the various epithelial cell types in the second kind of thyroid follicle in the C3H mouse. The thyroid gland of the C3H mouse is composed largely of the usual follicle but it also contains a second kind of follicle. To ascertain the embryologic origin of the cell types in each of these follicles, ventral pharyngeal outpocketings and ultimobranchial outpocketings were isolated (before they fused to form the thyroid gland) from the 12-day-old fetus of the C3H mouse. The outpocketings were implanted into different kidney capsules of adult C3H mice and were allowed to grow for several months. Transplants were then excised and examined by electron microscopy. The ventral contribution formed large aggregates of follicles and was recognized as a distinct bump on the surface of the kidney. It formed only typical thyroid ultimobranchial contribution usually formed only a small number of follicles, generally of small size. It was readily located because the follicles occurred next to a white plaque of bone or cartilage at the site of implantation. The ultimobranchial contribution formed follicles containing four cell types: a ciliated cell, a cell with abundant agranular reticulum, a cell with many free ribosomes and fiber and occasional hemidesmosomes, and the C cell which was the most frequent cell type. No typical thyroid epithelium was observed in the ultimobranchial transplant. These observations suggest that the C cell in the usual follicle is derived from the ultimobranchial contribution, and that the second kind of follicle is largely an ultimobranchial contribution but the typical thyroid epithelium in it is largely or entirely a ventral contribution.


Autoradiographic analysis of altered glycosaminoglycan synthesis in the epiphyseal cartilage of neonatal brachymorphic mice. Brachymorphic (bm/bm) mice are disproportionately short in stature. Past biochemical studies on neonatal mice (Orkin et al., '76) demonstrated that epiphyseal cartilage from these mutants synthesizes glycosaminoglycans (GAG) that are undersulfated. In this study, synthesis of GAG, as determined autoradiographically with Na2 35SO4 and 3H-glucosamine was reduced in all areas of bm/bm epiphyses both in vivo and in vitro as compared to normal C57BL/6J mice. Incorporation of both isotopic precursors into GAG of the brachymorphic proliferative zone was reduced to a greater extent than in the reserve zone. In addition, incorporation of these precursors into GAG of epiphyseal cartilages in vitro, as determined biochemically, was reduced by 40%. In contrast, the incorporation of 3H-leucine and 3H-proline into protein did not show differences between mutant and normal epiphyses. These results suggest that alterations in GAG synthesis in bm/bm epiphyseal growth plates are not exclusive to any one zone, but do appear to be most pronounced in the proliferative zone.


Synergistic effects of prolactin and testosterone in the restoration of rat prostatic epithelium following castration. Prolactin is known to enhance the uptake and metabolism of testosterone in male accessory sex organs and to increase the weight of accessory sex organs from castrated rats over those from controls treated with testosterone alone. The present study was directed toward defining fine structural changes detectable with scanning and transmission electron microscopy which might accompany such responses. Accordingly, rat ventral prostate gland was examined from castrated animals which had received testosterone propionate and ovine prolactin singly or together, or which had received vehicle only. Unoperated animals served as additional controls. Post-castration glandular atrophy was not influenced by prolactin treatment alone. Testosterone restored epithelial height, secretory product, Golgi complexes and rough endoplasmic reticulum, such that cellular and tissue morphology was generally indistinguishable from that of unoperated controls. Prostatic tissue from animals given testosterone and prolactin simultaneously exhibited pleomorphic, cytoplasmic apical projections which extended into the acinar lumen. Transmission electron microscopy demonstrated that these blebs were devoid of organelles and microvilli; scanning electron microscopy revealed that the blebs were highly wrinkled and more numerous than were the projections observed in tissue from animals treated with testosterone alone, or in tissue from unoperated controls. It is suggested that such blebbing may reflect enhanced apocrine secretion in prolactin/testosterone stimulated restoration of the prostate gland in castrated rats.


The effects of vitamin B6 deficiency on the bone marrow of the rat. Bone marrow from adult rats fed a vitamin B6 deficient diet for two weeks was found to have reduced numbers of neutrophils, erythroid cells and small lymphocytes. The numbers of transitional cells were not reduced. Since the small lymphocyte population in the bone marrow consists of B cells and null cells in approximately the same proportion, it was concluded that both cell types were reduced as a result of the deficiency. A complete recovery in the cellularity of the bone marrow was brought about by returning the vitamin B6 deficient animals to a normal diet for four weeks. Other effects of the two-week vitamin B6 deficient diet included a failure to gain weight, a decrease in thymus weight and a reduction in the numbers of white blood cells in the peripheral blood. All of these defects were corrected after the animals had been fed a normal diet for four weeks.


Intrahepatic distribution of nerves in the rat. The intrahepatic distribution of nerves in the rat was studied using neurohistochemical and electron microscopic methods. Innervation was restricted primarily to vessels in the portal space and hilus. Both adrenergic and cholinergic fibers were observed in the adventitia of hepatic arteries, and to a lesser extent adjacent to portal veins. Some of the cholinergic fibers, however, were not contiguous with the vasculature. Near the hilus many of these fibers were associated with ganglia while peripherally some coursed into the immediately adjacent parenchyma where end bulbs abutted on hepatocytes. Ultrastructurally, scattered small nerves, devoid of neurolemma, were found contiguous with the portal lamina of hepatocytes. Nerve fibers deeper within the lobule were not seen but numerous gap junctions were observed between contiguous hepatocytes. Central and sublobular hepatic veins lacked innervation but adrenergic nerves were demonstrated in the walls of larger hepatic veins. Innervation of the biliary system was sparse. While nerves were interposed between vessels and bile ducts, such nerves tended to be associated more closely with the vasculature.


A study of the structure of the papilla neglecta in the lizard, Anolis carolinensis. Scanning and transmission electron microscopy have been used to investigate the structure of the papilla neglecta in the lizard, Anolis carolinensis. Situated in the posterior part of the utricle, the receptor is innervated by a branch of the posterior ampullary nerve and is covered by an extracellular membrane that exhibits a tapering extension into the orifice of the utriculo-saccular duct. The neuroepithelium contains two populations of sensory cells within a matrix of sustentacular cells; one population (non-calyceal hair cells) is supplied primarily by boutons and clublike terminals, while the other (calyceal hair cells) is served by calycine terminals that invest from one to five sensory cells. The apices of calyceal hair cells bulge into the utricular lumen and have larger diameters and ciliary counts than non-calyceal cells, but other differences are not marked. Although the bases of calyceal hair cells are deeply indented by calyceal processes, both types show similar afferent synaptic structures confined to the nuclear and infranuclear regions. Efferent terminals synapse on afferent endings and hair cells in both cases; synapses directly on calyceal hair cells lie above the calyx, just beneath the apicolateral junctional complexes. Those complexes are basically similar throughout the receptor, except that a hemispheroidal gap junction between a supporting cell and adjacent hair cell was noted in several instances. Arrays of endoplasmic reticulum and specialized mitochondria occur adjacent to aggregations of afferent synaptic vesicles in both types of sensory cell; it is suggested that such arrays may participate in the production of the vesicles in a process involving membrane recycling similar to that at the neuromuscular junction. Differences between calycine units and the type I hair cell of mammals are discussed, and evidence that suggests an equilibratory function for the lacertilian papilla neglecta is presented.


Cephalexin concentration in the human ejaculate following oral and parenteral administration. Cephalexin levels in the ejaculates of 31 infection-free volunteers have been determined following the administration of 1 g of antibiotic. In 16 subjects the cephalexin was administered by intramuscular injection and in 15 by mouth. In each case the volunteers were divided into groups of five each of which received the drug, 1, 2 or 4 hours before the collection of semen. Antibiotic concentrations were determined microbiologically on agar plates using Sarcina lutea ATCC 9341. For selection purposes healthy subjects were considered to be those showing a normal anamnesis and physical exploration, an absence of leucocytes demonstrable by a cytomorphological evaluation of the semen, semen citric acid and fructose levels within normal limits and a qualitatively and quantitatively similar saprophytic flora to that seen in a culture of urine taken immediately before the collection of semen. Maximum concentrations were obtained 2 hours after the administration of the antibiotic and the concentration following intramuscular injection (6.9 microgram/ml) was significantly greater than that following oral administration (4.7 microgram/ml).


Proliferation of smooth endoplasmic reticulum and induction of microsomal drug-metabolizing enzymes after ether or halothane. Hepatic drug-metabolizing enzymes and hepatic ultrastructure were studied in rats after two hours of anesthesia with 1 MAC halothane or diethyl ether. Twelve hours after cessation of either anesthetic smooth endoplasmic reticulum was increased in centrilobular but not in periportal hepatocytes. This change persisted at 24- and 36-hour sampling times. Microsomal cytochrome P450 and cytochrome b5 decreased after halothane anesthesia (by 7 to 20 per cent of control). Diethyl ether caused increased cytochrome P450 and cytochrome b5 (27 and 18 per cent, respectively) at the 36-hour sampling time. NADPH cytochrome c reductase did not change significantly after either agent. The authors interpret these results to mean that both agents promote conversion of rough endoplasmic reticulum to smooth endoplasmic reticulum or, alternatively, that the anesthetics decrease degradation of smooth endoplasmic membranes. Since only ether caused an increase in the microsomal content of enzymes of the drug-metabolizing enzyme system, it is concluded that these two anesthetics act on hepatic cells by dissimilar mechanisms.


Microvascular responses to norepinephrine and vasopressin during halothane anesthesia in the rat. This experiment was designed to determine the microvascular responses to the two known naturally occurring vasoconstrictors, norepinephrine (NE) and vasopressin, at known levels of central vasomotor activity before, during and after halothane anesthesia. The responses to topical application of NE and vasopressin were studied in the microvasculature of the mesentery and cremaster muscle, using microscopic methods. Neural (CNS) stimulation was accomplished through electrodes chronically implanted in vasoactive sites of the forebrain and midbrain. The increase in blood pressure in response to CNS stimulation was decreased during halothane anesthesia (32.4 +/- 5.4 per cent before and 24.7 +/- 6.1 per cent during; P less than 0.001). There was no significant change in the steady-state diameter of the microvasculature under study during or after halothane anesthesia. Marked abatement of arteriolar vasoconstriction in response to CNS stimulation was seen prior to halothane. However, the same target vessel showed increased constriction in response to topically applied NE (from 32.3 +/- 4.7 to 53.2 +/- 7.8 per cent; P less than 0.01) during halothane anesthesia. By contrast, the response to vasopressin decreased (from 42.4 +/- 5.7 to 1.0 +/- 6 per cent; P less than 0.001) with halothane. The precise mechanism(s) underlying the described hypersensitivity to NE and hyposensitivity to vasopressin in the same vascular structure during halothane anesthesia remains undetermined.


Antispermatogenic effect of aspirin and its prevention by prostaglandin E2. Aspirin treatment causes a decrease in Leydig cell function, change in Sertoli cell morphology and a subsequent decrease in Spermatid count. Administration of Prostaglandin E2 prevents the effect of Aspirin on the Sertoli cell morphology and Spermatid degeneration without significant improvement of the Leydig cell function. On the basis of these findings, a possible relationship between Prostaglandin and testicular spermatogenesis has been discussed.


Demonstration of the reversibility of spermatozoa suppression by testosterone oenanthate. Long-term treatment with testosterone oenanthate in seven healthy young men was conducted with the aim of inducing reversible inhibition of spermatogenesis. During the observation period following discontinuation of the therapy spermatogenesis showed a gradual recovery. In three cases, however, the sperm counts did not reach pre-treatment levels. The subjects were re-examined 3 years after the start of the study, i.e. 2.5 years after the last injection of testosterone oenanthate. This examination confirmed that the testosterone treatment had had no recognizable negative influence on testicular function--on the contrary, in three cases analysis of the seminal fluid yielded higher sperm counts than previously.


Spermatozoa motility and fructolysis--comparative study of samples obtained by masturbation and with plastic collectors. A comparative study was made of spermatozoa motility and fructolysis with semen normal donors incubated in glass flasks and plastic collectors at room temperature (22 degrees to 25 degrees C). With the results obtained we came to the conclusion that poliethylene plastic collectors of low density, polimero 0.921, thickeness 20 to 30 mu, do not affect motility of fructose consumption of semen from normal donors. This material showed similar conditions to those in glass flasks.


Paternity cases.

Paternity cases. Through analysis of 350 expertises in suits, where the man was accused of paternity, was found that these examinees often lived in a sterile marriage. When examined they often try to influence negatively the result of spermiologic examination. Sterility was ascertained here in only about 10% of cases. In the material consisting of 98 expertises in suits for denial of paternity it was found that about one half of these men were either divorced or in the course of divorce proceedings and about one third of them stated the infidelity of the wife. In more than one third of these cases sterility was proved. The court expert must often express his opinion as to the fertility of the man two or more years previously. His conclusion is especially difficult, where the spermiologic findings repeatedly vary within the limits of severe oligozoospermia with less than 5 million spermatozoids per 1 ml and where the motility is poor.


Neurologic activity of infants following anesthesia for cesarean section. Elective cesarean section was performed in a consecutive series of 30 patients with full-term pregnancies who were not in labor. Epidural (lidocaine, 1.5 per cent, with epinephrine, 1:200,000) and general anesthesia (thiopental, nitrous oxide-oxygen, succinylcholine infusion) was used alternately. Neonatal acid-base values and Apgar scores showed no significant difference between the two anesthetic groups, and most infants were vigorous at birth. The neurologic recoveries of the infants showed no significant difference between the two groups. In the group receiving epidural anesthesia, there was a significant correlation between maternal hypotension and weak rooting and sucking reflexes of the infants during the first two days. All infants of high-risk obstetric patients in the series, independent of anesthetic technique used, had abnormal neurologic activity, as evidenced by either depression of muscle tone and the reflexes or all the tested variables. Neurologic assessment as followed in this series is a sensitive indicator of the effects of fetal stress factors acting during cesarean section.


[Drinking of eye secretion by malloghages]. The until now known facts on the phenomenon that biting lice may drink the eye-fluids of their hosts are listed. These data are supplemented by further relevant observations (own and from others). In this respect, the menoponid species Myrsidea (Wolfdietrichia) cornicis and Gallacanthus kaddoui are concerned.