Effect of UV irradiation on the expression of vaccinia virus gene products synthesized in a cell-free system coupling transcription and translation. The effect of UV irradiation on the expression of the vaccinia virus genome was investigated in a cell-free system coupling transcription with translation. Exposure of vaccinia virus to an increasing dose of irradiation resulted in differential reduction in the syntheses of virus-specified polypeptides in the coupled system, with sensitivity being proportional to the size of the gene pro duct. This suggests that each translationally functional mRNA species produced in vitro by vaccinia virus cores is synthesized from an individual promoter site.


Adenovirus type 2 early proteins synthesized in vitro and in vivo: identification in infected cells of the 38,000- to 50,000- molecular-weight protein encoded by the left end of the adenovirus type 2 genome. Analysis by sodium dodecyl sulfate-polyacrylamide gel electrophoresis of protein synthesized early after injection of human cells with adenovirus type 2 (Ad2) showed that polypeptides of 11,000 (11K), 12K, 14K, 15K, 19K, 21K, 24K, and 72k molecular weight were present in infected but not in mock-infected cells. These polypeptides corresponded in electrophoretic mobility to the following polypeptides synthesized in vitro by using mRNA complementary to specific regions of the Ad2 genome: 11K, 19K, 21K (91.5 to 96.8 map units), 14K (78.2 to 83.4 map units), 72K (62.4 to 67.9 map units), and 15K (4.9 to 11.0 map units). Polypeptides of 25K, 17K, 15.5K, and 13K were also synthesized in vitro, but have not yet been detected in infected cells. In addition, six adeno-specific polypeptides of 38 to 50K molecular weight could be discerned in infected cells if two-dimensional isoelectric focusing-polyacrylamide gel electrophoresis was used to compare extracts from infected and mock-infected cells. Partial protease digestion showed these 38 to 50K polypeptides to be related in sequence to each other and to the 40 to 50K polypeptide made in vitro (1.3 to 4.0 map units).


Peptide mapping characterization of viral proteins generated in a cell-free coupled system for the transcription and translation of influenza virus mRNA. In a coupled cell-free system for the transcription and translation of the influenza mRNA's, containing detergent-disrupted purified NWS influenza virion and a micrococcal nuclease-preincubated rabbit reticulocyte lysate, five unglycosylated viral proteins (NS1, M, NP, P1, and P3) were easily produced and isolated. Their identification was based on the electrophoretic separation of peptide fragments resulting from their partial digestion with proteases of restricted specificity (D.W. Cleveland, S. G. Fisher, N. W. Kirschner, and U. K. Laemmli, J. Biol. Chem. 252:1102-1106, 1977).


Soluble endoribonuclease activity from vaccinia virus: specific cleavage of virion-associated high-molecular-weight RNA. A soluble endoribonuclease activity was extracted from purified vaccinia virus cores by treatment with sodium-deoxycholate and dithiothreitol. The soluble enzyme readily cleaved purified virion-associated high-molecular-weight RNA to limit-sized fragments sedimenting at 8 to 12S. Purified virion-released 8 to 12S polyadenylated mRNA was not degraded by the enzyme extract. The soluble endoribonuclease did not require the presence of ribonucleoside triphosphates for activity.


Adenovirus type 12 gene 401 function in transforming infection. The temperature-sensitive DNA-minus mutant, H12ts401, transformed two to eight times more hamster embryo cells than wild-type 12 adenovirus at 38.5 degrees C, but was unable to establish transformation of cultures of hamster embryo brain and rat 3Y1 cells at 41.5 and 40 degrees C, respectively. Another H12ts406 DNA-minus mutant was not defective in cell transformation at these restrictive temperatures. Both mutants, however, induced T-antigen and cell DNA synthesis after infection of 3Y1 cells at 40 degrees C.


Postoperative management of patients with pheochromocytoma. The optimal preoperative and postoperative management of patients with pheochromocytoma demands a multidisciplinary approach. We report on 5 recent patients to illustrate the large volumes of fluid needed in the early postoperative period. This large fluid requirement is owing to a combination of a change in vascular compliance after excision of a pheochromocytoma, the residual effects of specific preoperative medications (phenoxybenzamine and alpha-methyl-p-tyrosine) and the loss of fluid into the retroperitoneal compartment (third space) produced by extensive dissection. It takes 3 half-lives (36 hours) to dissipate the effects of phenoxybenzamine and alpha-methyl-p-tyrosine, which corresponds to the time in which these patients require large volumes of intravenous fluids.


Conservative surgery in solitary and bilateral renal carcinoma: indications and technical considerations. Seven patients presented with solitary or bilateral renal carcinoma. All 4 patients treated by partial nephrectomy are well and 3 are free of disease (followup of 24 to 32 months). A survey of similar series reveals a survival of 78 per cent in patients with solitary renal tumors undergoing partial nephrectomy (mean followup of 52 months). Since the projected survival in patients undergoing chronic hemodialysis for the same interval is only 65 per cent partial nephrectomy, when technically feasible, would appear to be the treatment of choice in solitary renal carcinoma. In cases involving bilateral lesions the survival rate after partial nephrectomy seems to be similar to that of cases on hemodialysis.


Radionuclide kidney function evaluation in the management of urolithiasis. Renal and ureteral stones may cause asymmetrical renal damage that is not measured accurately by serum creatinine and blood urea nitrogen studies, excretory urography, nephrotomography and arteriography. We evaluated with a renal scintillation camera study 77 patients who had renal or ureteral calculi. The radionuclide procedure provided an accurate measure of total effective renal plasma flow and differential effective renal plasma flow. It had the additional advantages of being a non-invasive procedure, causing no allergic reactions, requiring no patient preparation and producing low radiation exposure.


Renal vein renin concentration in the hypertension of unilateral reflux nephropathy. Hypertension is a frequent complication of reflux nephropathy. The cause of this hypertension is unknown. Our study was undertaken to assess the possible role of the renin-angiotensin system in the hypertension associated with unilateral reflux nephropathy. We selected for study 17 normotensive and 12 hypertensive patients with strictly unilateral reflux nephropathy. There were 3 normotensive and 2 hypertensive patients with a renal vein renin ratio exceeding 1.5. Of these 3 normotensive patients 1 had evidence from divided renal function studies to suggest functional renal ischemia. No consistent evidence was obtained to support the concept that the renin-angiotensin system has a primary role in the non-malignant hypertension of unilateral reflux nephropathy.


Extraperitoneal gas following nephrectomy: patterns and duration. The amount and duration of extraperitoneal gas in normal patients after major renal operations have not been documented. This air may be difficult to separate from that owing to abdominal abscess and, therefore, can be a potential source of diagnostic error in the febrile postoperative patient. A prospective study was performed on 41 postoperative patients to determine the incidence, duration and pattern of extraperitoneal gas in patients undergoing renal operations. No patient had an abscess. Of the abdominal films obtained between 1 and 4 days postoperatively 92 per cent demonstrated gas, 71 per cent were positive between 5 and 8 days and 61 per cent were positive between 9 and 12 days postoperatively. Over-all, 34 of 41 patients had extraperitoneal gas demonstrated on the postoperative abdominal radiographs. Linear and bubbly patterns were demonstrated and, in many cases, the appearance was indistinguishable from that of an abscess. It is important that the benign nature of this postoperative gas be appreciated and not mistaken for an abdominal abscess.


Surgery for renal cell carcinoma extending into the inferior vena cava. We have reviewed 26 patients with renal cell carcinoma extending into the inferior vena cava, 21 of whom underwent radical nephrectomy with either venacavotomy and tumor thrombectomy, or vena cava resection. Of 12 patients who presented with localized neoplasm 6 (50 per cent) are currently alive. Poor results were obtained in 9 patients who had preoperative metastatic disease. Over-all operative mortality was 14 per cent and morbidity was minimal, with no pulmonary emboli intraoperatively or postoperatively.


Ileal loop in the treatment of radiation-treated pelvic malignancies: a comparative review. Critical analysis of ureteroileal diversion in the treatment of pelvic tumors in which prior radiation therapy was administered has prompted us to review our experience with ileal loops after patients have been irradiated. Between 1970 and 1975, 136 adults underwent ureteroileal bypass. Of these patients 36 had preoperative irradiation for various pelvic malignancies, 44 had malignancies but no irradiation and 56 were operated upon for neurogenic bladders. Major morbidity in the irradiated group included wound infections (33 per cent), ureteroileal urinary leaks (19.4 per cent) and paralytic ileus (13.9 per cent). The average postoperative hospital stay for this group was 8 to 11 days longer than that of the other 2 groups. In contrast, however, the overall incidence of reoperations for various complications in the irradiated group was only 11 per cent, compared to 25 per cent in the group not given preoperative radiation and 30.4 per cent of those operated upon for neurogenic bladders. Most significantly, none of the patients in the irradiated group required re-exploration and surgical correction of ureteroileal urinary fistulae. Comparison of these results to those reported in the literature is favorable. The ileal loop remains a simple and viable operative technique in patients requiring urinary diversion for pelvic malignancies previously irradiated.


Non-refluxing colon conduit: experience with 70 cases. From 1969 through 1976, 70 non-refluxing colon conduit urinary diversions were performed on 30 adults and 40 children at the Massachusetts General Hospital. Although this is a longer and more complex operation to perform the rate of complications appears significantly less than that seen previously in patients with ileal loop diversions.


Closure of the bladder neck in patients undergoing continent vesicostomy for urinary incontinence. The continent vesicostomy has been done on 24 patients, 10 of whom had severe urinary incontinence requiring closure of the bladder neck or urethra as well. Therefore, the bladder was converted to a closed cavity and intermittent catheterization is done through an abdominal stoma. No dressings or appliances are necessary. Bladder neck (or urethral) closure was successful in 8 of the 10 patients. One of the failures had been incontinent and was rendered continent on attempted bladder neck closure and there is urethral leakage at night in the other patient. Intermittent catheterization through a vesicostomy stoma has been cleaner and more aesthetically pleasing to the patients. The bladder neck closure has resulted in a dry perineum with fewer skin problems.


Nitrosamine formation in bladder infections and its role in the etiology of bladder cancer. Dimethylnitrosamine, a powerful carcinogen, is produced in the urine of patients with urinary tract infections of Proteus mirabilis and Escherichia coli when nitrite is present. Treatment with tetracycline antibiotics does not enhance the concentration of this carcinogen but, rather, sharply reduces it. The results emphasize the importance of proper antibiotic therapy for the infections to reduce the possibility of the subsequent development of bladder cancer.


Pre-clinical cytological diagnosis of bladder cancer. The records of 100 recent urology service patients with bladder neoplasms were evaluated for correlation of cytological findings with clinical and histological diagnoses. At the time of diagnosis 83 patients had synchronous positive biopsies and cytologies, 3 had negative cytologies (even though urothelial cancer was present) and the remaining 14 had abnormal cytologies but clinical examination was negative. Of these 14 patients invasive cancer has been identified subsequently in 11, while 3 have not yet returned for clinical followup. Analysis of the 11 patients in whom cancer was proved eventually reveals 14 distinct periods, ranging from 1 to 37 months, in which cytologies were abnormal and concurrent clinical examinations and histological diagnoses were negative. Ten of these periods preceded tumor recurrence and the other 4 antedated the first occurrence of cancer. A relationship was found between a cytological diagnosis of carcinoma in situ or severe dysplasia and the presence or future appearance of low grade clinical cancer. Cytologies containing overtly malignant cells more commonly were associated with or preceded the appearance of high grade cancers. In these 11 patients the sensitivity of a single spontaneously voided urine specimen was 97 per cent but the sensitivity was 100 per cent when 2 or more specimens were submitted per patient. Bladder barbotages were 100 per cent sensitive.


Serial multiple-site biopsies in patients with bladder cancer. A prospective study was done on 52 patients with bladder cancer to determine the incidence of atypia, carcinoma in situ and carcinoma in selected site biopsies from normal-appearing mucosa at the time of initial and subsequent endoscopy. Biopsies at initial endoscopy revealed abnormalities in 33 per cent of the patients, while 77 per cent of 43 patients undergoing 3-month selected site biopsies had at least 1 abnormal biopsy during a 1-year period.


Studies in inhibitors of calcification and levels of urine saturation with calcium salts in recurrent stone patients. Studies have been done on patients with recurrent renal calculous disease, measuring in addition to the usual serum and urine constituents the inhibiting capacity of the urine and the activity products of calcium oxalate, octocalcium phosphate and brushite. Studies on the 24-hour urine calcium, phosphorus and uric acid and serum calcium indicate no essential differences between patients with calcium oxalate, mixed or uric acid stones and normal individuals. We were unable to demonstrate a difference in the inhibiting capacity of the urine between normal individuals and patients with calcium oxalate calculi, and levels of saturation of urine with calcium oxalate were identical in the calcium oxalate stone patients and normal individuals. The degree of saturation of urine with calcium phosphate is significantly greater in stone patients.


Phenoxybenzamine and sweating in the spinal cord injury patient. There were 10 patients with cervical spinal cord lesions and hyperhidrosis treated with the alpha-adrenergic blocking agent, phenoxybenzamine. Five of the 7 patients completing the study experienced marked diminution or elimination of the profuse sweating pattern.


Effects of bethanechol chloride on the external urethral sphincter in spinal cord injury patients. The neuropharmacodynamics of bethanechol chloride on the external urethral sphincter in male spinal cord injury patients with chronic lesions have been investigated. There were 90 cystosphincterometric and sphincteroperineal electromyographic studies conducted on 45 subjects in 4 different positions, showing varying urodynamic patterns. A gross postural cystophincteric discordant reflex was noted in the majority of patients with recent complete upper motor neuron bladders (less than 2 years in duration). The external sphincter tends to be coordinated in late cases of quadriplegics and in all paraplegics. With the administration of bethanechol chloride there was an increase in the striated sphincter pressure profile when the patient was in the sitting position, resulting in detrusor sphincter dyssnergia. This phenomenon seems to be dose-related. When the dose of bethanechol chloride is adjusted according to the types of vesicourethral dysfunctions or in combination with dantrolene sodium the most beneficial non-surgical rehabilitation of the urinary tract can be obtained in this particular group of patients.


The etiology of non-specific urethritis in active duty Marines. We studied patients with non-specific urethritis and control subjects at our dispensary. These patients and controls were matched for age, rank and sexual activity, and studied for the presence of bacteria, virus, Trichomonas and Mycoplasma. No significant bacteria were found in either group. No Trichomonas was identified, only 1 herpes II was recovered and no cytomegalovirus was found. Mycoplasma were cultured from patients and controls. The rate of colonization varied, depending upon several factors, but the significant factors seemed to be associated with the number of sexual partners. Those men with more than 1 sexual partner had a significantly increased colonization with Mycoplasma.


Staging profile of hypofertile male subjects. Thirty-four hypofertile male subjects with either oligospermia or azoospermia underwent infertility evaluation with assay of serum follicle-stimulating hormone, luteinizing hormone, testosterone and testicular biopsy. Cytogenetic analysis of testicular tissue and peripheral leukocytes was competed on 11 patients. Fifteen male subjects underwnet bilateral contrast vasography. These studies permitted segregation of the hypofertile male population from those with post-germinal hypofertility, primary germinal hypofertility or pre-germinal hypofertility. Retrospective analysis indicates that segregation of the hypofertile male population permits optimum selection for treatment intervention.


Vasovasostomy: the flap technique.

Vasovasostomy: the flap technique. The approximation of 2 pairs of broad, transverse vas flaps at right angles to the reanastomosis permanently widens the opening into each vas lumen. All patients undergoing this procedure had sperm in the ejaculates 5 weeks postoperatively and by 6 months there was a pregnancy rate of 64 per cent.


The accuracy of antimicrobial disk sensitivity testing in urinary tract infections. Fifty bacterial strains shown resistant to ampicillin, cephalothin or tetracycline by Kirby-Bauer disk diffusion susceptibility testing were isolated from patients with urinary infections. Inhibitory activity in urine of volunteers given these antimicrobial agents and tube dilution sensitivity testing indicated that agar disk diffusion gradients do not provide sufficiently high antimicrobial concentrations to predict accurately clinical efficacy.


Experience with measurement of bladder electrical activity. A series of patients is presented in whom the recording of bladder electrical activity was performed. There was a significant difference in frequency of the spike activity between patients with upper and lower motor neuron injury. This technique would seem to offer greater clinical application in areas of bladder dysfunction and evaluation of drugs on the bladder.


Ultrasonic evaluation of the prostatic nodule. Prostatic nodules detected on rectal examination of 50 patients were evaluated by the usual means and by prostatic ultrasonic scanning. Nodules were characterized as being either malignant, benign, inflammatory or stones. Those patients without evidence of calcification on radiography underwent prostatic biopsy and the histological findings were compared to the ultrasonic study. All histologically confirmed malignancies were diagnosed preoperatively and there were no instances of falsely negative ultrasonic studies.


Clinical and endocrinological evaluation of patients with congenital microphallus. Eight patients with congenital microphallus were investigated. Plasma luteinizing hormone, follicle-stimulating hormone, testosterone and androstenedione levels were obtained in all cases. In addition, the response to the administration of human chorionic gonadotropin, luteinizing horomone-releasing hormone and adrenocorticotropic hormone, the assessment of testicular histology by electron microscopy and the measurement of dihydrotestosterone formation by preputial skin were determined in some patients. The results of these studies were compared to similar studies in 6 normal prepubertal boys, 4 boys with bilateral cryptorchidism, 1 male infant with anorchia and 1 adult with hypogonadotropic hypogonadism. The clinical and endocrinological findings in the 8 patients with microphallus can be divided into 2 distinct categories. In 5 patients the disorder is familial, gonadotropin levels are low and there is a normal response to stimulation with chorionic gonadotropin. The data are compatible with the possibility that 3 (possibly 5) of the 8 patients with microphallus have hypogonadotropic hypogonadism. In the other group the cases are sporadic, serum luteinizing hormone and follicle-stimulating hormone levels are elevated and plasma testosterone failed to increase after short-term treatment with chorionic gonadotropin. In these patients a primary testicular disorder appears to be responsible. Experimental and clinical evidence suggests that microphallus results from defective testicular function during the second and third trimesters of pregnancy, either as the result of defective gonadotropin secretion or defective androgen synthesis.


99mTechnetium penicillamine scans: an index of differential renal function. The relative renal accumulation of 99mtechnetium penicillamine was evaluated as an index of differential renal function. Regions of interest were assigned over each kidney with a computer and the renal uptake of 99mtechnetium penicillamine was determined. A simple background correction was made by subtracting the renal activity at 10 minutes from that at 25 minutes. The percentage of 99mtechnetium penicillamine accumulation in the left kidney was correlated with the percentage of the total effective renal plasma flow to the left kidney. Effective renal plasma flow was determined after the intravenous injection of 131 I hippuran using a highly sophisticated computerized technique that has been validated in patients by comparison with traditional split renal function studies. The correlation coefficient between the 2 measurements was 0.97. In addition to its use as an index of differential effective renal plasma flow 99mtechnetium penicillamine is an excellent cortical imaging agent and the relative distribution of 99mtechnetium penicillamine between the 2 kidneys and within a single kidney can be assessed qualitatively by visual inspection of the scan.


Urine cytology findings in analgesic nephropathy. Urine cytology screening for neoplasm led to the detection of 3 urothelial carcinomas and 1 severe urothelial dysplasia in 98 patients with analgesic-induced papillary necrosis. A further 18 patients had changes suggesting that they were at risk of incurring malignancy in the near future. Routine urine cytology is recommended in all cases of analgesic nephropathy.


Percutaneous nephrostomy: indications, complications and clinical usefulness. Our experience with percutaneous nephrostomy in 22 patients is presented. This procedure can be accomplished readily and is safe, reliable and effective for short and long-term urinary diversion in various urologic conditions in children and adults.


Split cuff ileal stoma.

Split cuff ileal stoma. Long-term patient comfort after an ileal conduit urinary diversion depends on the conduit stoma. The problem of leak-proof urine collection of the flush stoma can be overcome by using a spout stoma but this could become stenotic unless everted. Eversion is a technically difficult procedure and produces a bulky spout that tends to prolapse. The use of carefully placed myotomies in the split cuff stoma described herein facilitates eversion and produces a slim stoma that accepts a compact, leak-proof appliance and is, at the same time, free of the complications of stenosis and prolapse in the long-term management.


Experiences with colocystoplasties, cecocystoplasties and ileocystoplasties in urologic surgery: 40 patients. During the last 16 years (1960 to 1976) we have treated 78 patients with a contracted bladder syndrome, 40 of whom have been treated surgically by replacing part or all of the bladder with an isolated segment of rectosigmoid, cecum or ileum. The series is a combination of 30 patients treated by Shirley in the United States and 10 patients by Mirelman in South America. Chronic interstitial cystitis (26 cases) and chronic radiation cystitis (4 cases) have been the primary causes for surgical treatment of the contracted bladder in the United States, whereas tuberculosis of the urinary tract was the primary etiologic factor for those treated in South America. The results have been gratifying, with 50 per cent excellent and 30 per cent good. Only 3 patients have had to be diverted to and outside colon or ileal conduit. Generally, our results with each type segment of large and small bowel have been satisfactory by the choice of segment must depend on the degree of bladder disease, and the medical and urologic condition of the patient.


Cystitis cystica (cystosis) with bladder cancer. The term cystitis cystica is a misnomer and reflects the unfortunate habit of labeling obscure bladder conditions as cystitis. Cystosis of the bladder would be a more correct term. Cystitis cystica is a derivative of the focal epithelial proliferation, the associated tumors tend to be non-infiltrating papillary and the prognosis is good.


Carcinoma of the bladder in patients less than 40 years old. The records were reviewed of 22 patients with bladder carcinoma before they were 40 years old to determine whether age alone influenced the course of the disease. There were 19 men and 3 women, reflecting a male predominance of 6 to 1. Of the 9 patients with superficial stage A/O disease 8 are alive 6 months to 28 years after diagnosis, the remaining patient being lost to followup. The other 13 patients with tumors invading muscle are dead, 11 as a direct result of the disease. No evidence was found to substantiate earlier reports that bladder carcinoma in young patients has a more benign behavior.


5-fluorouracil urethral suppositories for the eradication of condyloma accuminata. The formulation of a 5-fluorouracil urethral suppository is described. The suppositories have been found extremely successful in the eradication of intraurethral condylomas. They have provided better patient compliance and dosage monitoring, and have extended patient usefulness to male and female subjects.


Recanalization rate following methods of vasectomy using interposition of fascial sheath of vas deferens. A small but definite recanalization rate has followed the vas ligation method of partial vasectomy for sterilization. Interposition of the fascial sheath between the divided ends of the vas reduced the recanalization rate to 0. Fulguration of the lumen of the cut vas ends was used but was not the significant factor in this zero recanalization rate.


The nuclear uptake of androgen by human benign prostate in vitro: action of antiandrogens. An in vitro test system suitable to assess the potency of putative antiandrogens has been developed, using the human benign prostatic tissue obtained at operation. The system circumvents some problems associated with using human tissue, such as the presence of endogenous steroid and contamination with plasma proteins (particularly sex hormone binding globulin). Slices of tissue were incubated in the presence of 3H-testosterone and the uptake into nuclei was determined. The nature of the nuclear radioactivity and the steroid specificity indicates a mechanism similar to the established in the rat ventral prostate. The action of antiandrogens (cyproterone acetate, diethylstilbestrol, flutamide, hydroxylated flutamide and gestonorone capronate) has been studied at various concentrations.


Trimethoprium-sulfamethoxazole and minocycline- hydrochloride in the treatment of culture-proved bacterial prostatitis. Trimethoprim-sulfamethoxazole, 2 tablets twice daily for 90 days, or minocycline-hydrochloride, 100 mg. twice daily for 14 days, was given to 15 and 14 men, respectively, with culture-proved bacterial prostatitis. Given as prescribed both agents seemed equally effective in controlling symptomatic recurrence during the 12 months after cessation of therapy.


The use of prophylactic low dose heparin in transurethral prostatectomy. Low dose heparin prophylaxis has proved effective in reducing postoperative thromboembolic complications in a series combining multiple types of surgical procedures. Our series comfirms its safety for transurethral operations. We recommend its use in patients with predisposing factors to thromboembolic complications.


Extended total excision of prostatic adenocarcinoma. Cases of locally advanced prostatic adenocarcinoma (stages B and C) managed by exenteration or prostatocystectomy were reviewed. Local control and survival rates seem to justify this approach in selected cases, especially when conservative measures, such as hormonal therapy and irradiation, have been exhausted.


Evaluation of psychogenic urinary retention. Urinary retention may develop in the absence of significant organic disease. Patients with psychogenic retention range from those with episodic acute retention to those who have learned to inhibit urination and have retention with a large residual urine volume owing to myotonic detrusor degeneration. A combination of thorough medical, neurologic, psychiatric and urologic evaluation is indicated for all such patients. Management consists of the implementation of bladder training with or without intermittent catheterization, which generally may be accomplished on an outpatient basis.


Evaluation of a dip-slide in a university outpatient service. Initial and followup urine specimens from patients in an outpatient service of a university hospital with the diagnosis of presumptive urinary tract infection were processed by the dip-slide system and the conventional calibrated loop procedure. Evaluation of the dip-slide system included not only microbiological  comparison but also the feasibility  of the adaptation of this system to a clinic working area. Complete microbiological agreement between the 2 methods was approximately 50 per cent. Disagreement was caused largely by improper inoculation, quantitation and interpretation of the dip-slide. It has been our experience that the dip-slide cannot be used effectively as a screening tool in a population with a high incidence of urinary tract infection. The use of laboratory personnel along with proper specimen collecting instructions increased the reliability of the dip-slide system. Our data suggest that the results obtained should be evaluated carefully along with the clinical impression in complicated cases of urinary tract infections.


Cinoxacin in the treatment of acute urinary tract infections: an evaluation of efficacy and a comparison of dosage schedules. Fifty-one women with acute urinary tract infections have been treated with cinoxacin, a new synthetic compound that is similar chemically and in antimicrobial activity to nalidixic acid. Urine cultures were made before treatment was started, midway through the 7 to 10-day course of therapy, 1 week after therapy and 4 to 6 weeks after therapy, if possible. Pre-treatment , mid-therapy and post-therapy evaluations of renal and liver function along with a complete blood count were done. All patients were believed to have lower urinary tract infections. Urine cultures in 48 of the 51 patients (94 per cent) became sterile during therapy and 47 patients (92 per cent) maintained sterile urine 1 week after therapy. Of those patients undergoing followup cultures 4 to 6 weeks after therapy 72 per cent had sterile urine. No significant hematological, renal, hepatic or gastroenterologic toxicity was noted. Cinoxacin seems to be a safe and useful drug in the treatment of urinary tract infections caused by the common gram-negative organisms and there does not seem to be any difference in efficacy between the dosage schedules tested.


Urological applications of computerized axial tomography: a preliminary report. Computerized tomography scanning of the chest and abdomen has been used as a diagnostic technique in more than 4,500 patients since 1974,  190 of whom had histologically proved disorders of the genitourinary system and retroperitoneum. On the basis of this experience computerized tomography scanning has been found to be safe and effective, and offers certain advantages over conventional techniques. The number, extent and content of renal mass lesions can be determined with relatively great accuracy. The presence and extent of metastases into the retroperitoneum, liver and chest can often be shown by computerized tomography scanning when other tests are negative. Placement of needles for aspiration, biopsy, injection of contrast medium or insertion of drainage tubes can be done more accurately under computerized tomography control. Computerized tomography in itself is non-invasive, carries a low radiation exposure comparable to other radiographic procedures and therefore, can be valuable in following the course of patients with various diseases during and after therapy. While scanning will not replace other diagnostic procedures it should lead to a more judicious selection of potentially hazardous tests in selected cases, such as angiography, aspiration and open biopsy.


The reproducibility and interpretation of carbon dioxide cystometry. The day-to-day and same-day variability of carbon dioxide cystometry was examined in a population of men. Considerable variability was observed in each parameter monitored. The implications of such variability, and the validity and significance of certain cystometric events are discussed.


Urethral pressure profile in children: a comparison between perfused catheters and micro-transducers, and a study of the usefulness of urethral pressure profile measurements in children. Urethral pressure profiles were done on 46 children by the  classical open-end perfused catheter and by a micro-transducer mounted on the tip of a catheter. A comparative study of the results obtained using the 2 methods demonstrates clearly the superiority of the micro-transducer over the perfused catheter. There are so many limitations of precison with the perfused catheter method that its usefulness for clinical studies seems questionable. With both methods the urethral pressure profile alone was not sufficient for distinguishing betweeen obstructed and non-obstructed bladder outlets.


The Lich-Gregoir antireflux plasty: experiences with 371 children. The Lich-Gregoir antireflux procedure is a simple and safe method for the treatment of primary reflux of all grades if the ureter is not grossly dilated on the excretory urogram. Reflux was cured in 97.7 per cent of 429 ureters in 371 children. A stenosis of the terminal ureter requiring reimplantation occurred in 0.5 per cent. The over-all rate of reinterventions was 3.7 per cent. This low complication rate makes surgical correction of reflux advisable if urinary tract infection and primary reflux cannot be eradicated by continuous antimicrobial therapy within 6 months.


Reflux in complete duplication in children. Reflux is the most common abnormality associated with complete ureteral duplication. Several authors have emphasized early surgical correction of reflux when it occurs in duplicated systems. because of a negligible success rate in non-operative therapy. Our practice has been to judge an orifice with reflux on its own merit, that is position, appearance and submucosal tunnel length. Realizing that this philosophy is not in total agreement with most of the literature on reflux in ureteral duplication we have reviewed 59 cases to ascertain whether our non-operative approach has justification. In this study early operation was elected in 61 per cent of those patients with reflux in association with total duplication. However, in 48 per cent of patients followed with non-operative surveillance reflux has either stopped spontaneously or is medically stable.


Free autogenous muscle transplantation in the treatment of urinary incontinence in children: background, surgical technique and preliminary results. Urinary incontinence owing to epispadias or bladder exstrophy is a difficult therapeutic problem. To improve the results a new method, including free autogenous muscle transplantation, was developed. Before transplantation a skeletal muscle (extensor brevis of the foot) is denervated and, 2 weeks later, it is transplanted and placed as a U-sling around the urethra in close contact with normally innervated muscles, which act as reinnervation sources. Two patients showed improvement of continence and increasing bladder capacity from 6 weeks after transplantation. Postoperative cine-studies of micturition demonstrated clearly the functional properties of the transplanted muscle.


Anuria in infants and children.

Anuria in infants and children. The urologist may be involved in the initial evaluation of a child with anuria. In our experience the most common cause of anuria in neonates was perinatal hypoxia and in older children it was the hemolytic uremic syndrome. Obstructive uropathy as a cause of anuria in infants and children appears to be uncommon.


Etiologic considerations in penoscrotal hypospadias repair. Superficial location of fivrous bands causing chordee in patients with penoscrotal hypospadias has been demonstrated by microscopic and gross photographs. Our technique to manage this problem is similar to that described by Allen and Spence and by King for distal hypospadias and has been used in 120 patients. The technique involves the repair of the embryologic penile defect by advancing the closure of the urethral groove and transposing the scrotum to its appropriate caudal position. The repair is applicable in patients with failure of fusion rather than failure of the development of the urethral groove as in perineal hypospadias.


Gallium-67 scintigraphy in the diagnosis of renal cortical abscess. Clinical and radiologic diagnosis of a renal cortical abscess is difficult. A plain x-ray of the kidneys, ureters and bladder, an excretory urogram with nephrotomography, nephrosonography and renal angiography may not be helpful in the diagnosis. A case is presented of bilateral polycystic kidneys with a renal cortical abscess of the lower pole of the left kidney. An abscess could not be localized by the routine radiologic procedures. Gallium-67 scintigraphy demonstrated a renal cortical abscess of the left kidney, which was treated successfully by operation.


Solitary crossed renal ectopia and its associated congenital anomalies. Solitary crossed renal ectopia is one of the rarest congenital renal anomalies, with only 21 previously reported cases. It is often accompanied by multisystem congenital anomalies, mainly skeletal and genital in type. The twenty-second such case of this rare congenital anomaly is reported in association with a severe congenital scoliosis of the lumbosacral spine. The embryogenesis and the significance of its associated congenital anomalies are discussed.


Small renal pelvic carcinomas: value of epinephrine magnification angiography. We studied 3 cases of small renal pelvic transitional cell carcinoma with 2-fold direct serial magnification renal angiography in conjunction with epinephrine pharmacoangiography. In 2 cases we found that this technique resulted in visualizing abnormal vessels that were not apparent on routine magnification angiograms.


An approach to the control of massive hemorrhage in cyclophosphamide-induced cystitis by intravenous vasopressin: a case report. Massive bleeding owing to cyclophosphamide-induced hemorrhagic cystitis was not affected by intravesical instillation of 4 per cent formalin or 1 per cent silver nitrate. After initiation of a continuous systemic infusion of vasopressin hematuria and  transfusion requirements diminished markedly. Adverse reactions were mild. Intravenous vasopressin was a safe and effective means to control temporarily life-threatening hemorrhagic cystitis.


Vesicoperineal accessory urethra.

Vesicoperineal accessory urethra. A previously undescribed form of accessory urethra was found in 2 boys. In each the supernumerary urethra originated from the bladder, just anterior to the vesical neck, passed anterior to the prostate and crossed the normal urethra. In 1 case the channel ended blindly and in the other it opened on the posterior aspect of the scrotum.


Bilateral testicular rupture: report of a case with an unusual presentation. A case of bilateral testicular rupture after blunt trauma is presented. It is unusual in that the patient presented with a unilateral retractile testis with pain. The contralateral testis was asymptomatic but was found to be ruptured at exploration. The objectives of preservation of testicular function and prevention of misdiagnosis and undiagnosed cases are reiterated. Early exploration of all blunt trauma to the scrotum and testis is advocated. The surgical management of the ruptured testis is reviewed with regard to orchiectomy, primary closure, closure with portion of tunica vaginalis and decompression of the contused testis.


Diagnosis and management of hydrometrocolpos in infancy. Three cases of hydrometrocolpos in infants are presented, which demonstrate that despite thorough documentation of the clinical findings, the misdiagnosis and the ensuing mismanagement of this condition remain a problem. The presence of other genitourinary abnormalities and the association with anomalies of the anorectal area make it imperative that these infants be evaluated, treated and followed by clinicians who are skilled in these areas. Introital revision may proceed at an early age to avoid the necessity of repeated drainage procedures and allow normal voiding but close followup is necessary.


Interaction between quinidine and digoxin. The serum digoxin concentration increased in 25 of 27 study patients (93%), and the mean serum digoxin concentration rose from 1.4 ng/ml to 3.2 ng/ml during quinidine therapy. Anorexia, nausea, or vomiting developed in 16 patients (59%) but disappeared in all ten patients for whom the digoxin dose alone was reduced, suggesting that digoxin excess caused these symptoms. Ventricular premature depolarizations developed in three patients after starting quinidine therapy; ventricular tachycardia developed in one patient, and another died suddenly. When starting quinidine therapy in patients who are taking digoxin, the clinical course, ECG, and serum digoxin level should be followed closely.


Minimal genetic findings and their cancer control implications. A family with the cancer family syndrome. A kindred in which five first-degree relatives were initially known to exhibit colorectal, endometrial, and unspecified carcinoma for two generations, occurring at an early age and including three cases of multiple primary cancer, is consistent with criteria for the cancer family syndrome. Follow-up included a diligent surveillance program that led to the early diagnosis of colon cancer in a young member of the third generation who had been considered at high risk for this lesion. Manifestly, hereditary cancer syndrome identification may be expedited through longitudinal study of apparently cancer-prone kindreds, given limited historical information about tumor expression. However, cancer surveillance measures can and should be instituted early and predicated on clues that suggest, but need not be diagnostic of, such a hereditary cancer predisposing disorder.


Atypical mycobacterial infection complicating mineral oil pneumonia. Two patients had pulmonary infections with atypical mycobacteria superimposed on mineral oil pneumonia. In both cases, long-standing laxative use and neurological disorders led to development of the lipid pneumonia. The pathogenicity of the rapidly growing mycobacteria causing infection in the two patients is apparently enhanced by the presence of mineral oil, a relationship supported by experimental studies. The clinical diagnosis of both atypical mycobacterial infection and mineral oil pneumonia may be difficult, but the presence of one should suggest the possibility of occurrence of the other.


Intramuscular injection-site complications. Among 26,294 hospitalized medical patients monitored by the Boston Collaborative Drug Surveillance Program, 46% received at least one intramuscular (IM) injection. Drugs for which IM injection was the route of administration in more than 80% of all exposures included penicillin G procaine, mercurial diuretics, cyanocobalamin, streptomycin sulfate, colistimethate sodium, meperidine hydrochloride, cephaloridine, scopolamine hydrobromide, kanamycin sulfate, and iron dextran injection. Local complications of IM injection were reported in a total of only 48 patients (0.4% of all IM recipients). Local complications were most commonly associated with IM injection of cephalothin sodium. Clinically important local complications are uncommonly associated with IM injections in general. However, certain drugs, eg, cephalothin, produce injection-site complications with relatively high frequency; the clinical role of IM injection of such drugs should be reevaluated.


Amyotrophic lateral sclerosis. No increase among US construction workers in Guam. The rate of amyotrophic lateral sclerosis (ALS) among stateside construction workers on Guam was similar to that of US resident white men. Of 12,601 men who worked on Guam for one year or more from 1945 to 1954, we were able to follow up 10,049 until 1970 through the Social Security Administration. Of these workers, 1,958 had died, and the cause of death was recorded for all but 335. There were three deaths from ALS. Residence on Guam as an adult did not predispose to a high rate of ALS.


Levodopa therapy and malignant melanoma. Concern has been voiced over a role for levodopa in the induction or stimulation of growth of cutaneous malignant melanoma. Prospective query of 1,099 patients of the Melanoma Clinical Cooperative Group at the time of presentation of their primary melanoma showed only one patient who had been taking levodopa. It was concluded that levodopa, if a factor in the induction of melanoma, must be playing an inconsequential role in the rapid rise in incidence observed for this tumor over the past decade.


External cardiac compression. A randomized comparison of mechanical and manual techniques. To compare the effectiveness of manual and mechanical chest compression during cardiopulmonary resuscitation, 50 patients who suffered cardiac arrest were randomly allocated to receive manual or mechanical chest compression. Randomization was performed after failure of initial resuscitative measures but within ten minutes after the onset of cardiac arrest (mean, 6.4 +/- 1.2 min). Ten patients from each group survived longer than one hour following resuscitation. Three from the mechanical group and two from the manual group were eventually able to leave the hospital. Thus mechanical compression appears comparable with manual compression when manual compression is performed under ideal conditions. Mechanical chest compression may be employed when trained personnel are not readily available or where manual compression is technically difficult to perform.


Physician opnions on the use of antibiotics in respiratory infections. To investigate the feasibility of establishing standards of care based on a broad consensus, a questionnaire concerning the management of signs and symptoms of common respiratory infections in infants was given to a national sample of pediatric infectious disease specialists, general pediatricians, and family physicians. There was significant disagreement (p less than .01) among the three groups of physicians in 15 of the 18 clinical situations concerning the appropriateness of prescribing antibiotics. Whenever there was disagreement, the family physician group was most inclined and the infectious disease group least inclined to favor antibiotics therapy. More than 75% of each group favored antibiotics in the same situation in only three instances. These results suggest that it may be difficult to set widely accepted standards for the evaluation of medical care where there are such differences of opinion.


Poisonous snakebite treatment in the United States. This is retrospective report of 107 cases of poisonous snakebites treated in south Georgia and north Florida. Sixty-seven percent of the cases required intensive treatment. Intravenous antivenin therapy, if indicated, should be given early and over a short time. Steroids are of use primarily for allergic phenomena. Fasciotomies were  not necessary unless cooling or inadequate antivenin had been administered. A grading system that matches the species of snake with the severity of the bite was used to classify the cases.


Screening and immunization of rubella-susceptible women. Experience in a large, prepaid medical group. Four hundred and fifty childbearing-aged women were screened for rubella hemagglutination inhibition (HI) antibody after a clinical history of susceptibility was obtained. One hundred and forty-nine (33%) were found to be susceptible (titers less than 1:8), pointing out the need for a move active immunization program for susceptible young women and for routine vaccination of children. Clinical history correlated poorly with the level of HI antibody. One hundred percent of the patients were vaccinated and protective antibody titres developed in 97%. Since titers are higher after infection than after vaccination, periodic reevaluation of the vaccinated group may be indicated if immunity is to be ensured.


Exercise tolerance test. Single-sample screening technique to rule out growth-hormone deficiency. Parent-directed vigorous exercise was evaluated as a screening test for adequacy of pituitary growth-hormone release in 57 short-statured children. This method obviated the need for pharmacologic provocative testing in all but the four children with growth-hormone deficiency. In 92% of the euendocrine children, the immediate postexercise venous sample demonstrated an adequate growth-hormone level. Vigorous physical exercise after an 8- to 12- hour fast with a single postexercise serum growth-hormone sample is a reliable, safe, and cost-effective screening test for growth-hormone deficiency.


Cooperative study of hospital frequency and character of transient ischemic attacks. VIII. Risk factors. A total of 969 (73%) of 1,328 patients with cases of suspected transient ischemic attacks (TIAs) who came to six institutions during a 21-month period were followed up. Factors were identified and prospectively analyzed for risk for further TIAs, stroke, and deatn. A history of multiple carotid artery TIAs was significantly related to further TIAs. A single TIA placed the patient at greater risk for early infarction. Older age, male sex, and unreliability to take dangerous medication were risk factors for cerebral infarction. Anticoagulant therapy, older age, male sex, diabetes mellitus, heart disease, abnormal ECG, and poor surgical risk were factors for death. The increased mortality associated with anticoagulants was confined to the older age group. While white patients treated with antiplatelet-aggregating agents had a lower mortality than those treated otherwise, this was not true amont black patients.


Symptom-producing interposition of the colon. Clinical syndrome in mentally deficient adults. Interposition of the colon between the liver and diaphragm, ie. Chilaiditi's syndrome, visible during roentgenographic examination, has been described as an asymptomatic finding in adults of no clinical importance: it is occasionally symptom-producing in children. In mentally retarded adults, however, a unique syndrome commonly occurs, characterized by nausea, pain, vomiting, anorexia, distension, audible bowel sounds, and constipation: all are associated with three roentgenographic features of interposition. The symptoms respond to simple treatment and can be prevented by routine prophylactic measures.


Rifampin therapy of Staphylococcus epidermidis. Use in infections from indwelling artificial devices. Rifampin was added to existing antibiotic regimens in two patients with Staphylococcus epidermidis infections; one patient had prosthetic valve endocarditis and the other had an infection of a CSF shunt. The addition of rifampin increased serum or CSF bactericidal titers 16-fold or greater and was correlated with a favorable clinical response. The results of tests for tube-dilution antibiotic susceptibility showed rifampin to be the most active of all antibiotics tested against the patients' organisms. The combinations of gentamicin sulfate, nafcillin sodium, or vancomycin hydrochloride with rifampin prevented the emergence of rifampin resistance in vitro and promoted enhanced killing when compared with either antibiotic alone.


Commercial national board review programs. A case study at the Medical College of Georgia. For a long period, students have been taking national board examination review programs offered by commercial firms. The one question to which faculty and students would like the answer is, "Do the national board review programs offered by these commercial firms do any good?" Events at the Medical College of Georgia have provided an opportunity to gather data toward an answer to this question. In 1976, thirty-three medical students at the Medical College of Georgia enrolled in a commercial national board review program. Performance of these students was compared with the predicted performance of these students had they not taken the national board review program. The results suggest that the commercial review program did not notably help these students.


Public beliefs about causes and prevention of heart attacks. Interviews with a probability sample of 617 adults in the Chicago area indicated widespread lack of information about major probable causes of heart attacks in persons younger than 60 years: 28% named cigarette smoking, 21% named high blood pressure, and 13% named cholesterol or fat in the diet or blood. Half did not name any of these risk factors, and only 1% named all three. Although three fourths believed that heart attacks are preventable, few named specific behaviors that would effectively reduce risk factors other than smoking. Sustained community-wide educational programs about reducing coronary risk factors are clearly needed and can be effective.


Ankylosing spondylitis and hyperparathyroidism. An attempt was made to determine whether a relationship exists between ankylosing spondylitis (AS) and hyperparathyroidism (HP). Twenty patients with definite AS, studied for biochemical evidence of HP, did not show consistent abnormalities in serum calcium, phosphorus, alkalinephosphatase, or parathyroid hormone levels or in bone-density measurements. Reviewing roentgenograms of 39 patients with HP showed one patient with sacroiliitis, and one of the 28 hyperparathyroid patients tissue-typed as HLA B27-positive. Both AS and HP are independent entities that have no causative or pathological relationship to each other.


Type A behavior pattern and coronary angiographic findings. One hundred forty-seven consecutive patients scheduled to undergo coronary angiography were classified according to the type-A behavior pattern. Statistically significant correlations were found between diseases severity and the physical risk factors cholesterol, smoking, hypertension, sex, and age. The correlation of the behavior pattern with angiographic disease severity was of the same magnitude as that of the other risk factors except cholesterol, which was greater. The association between the behavior pattern and severity persisted after adjustments had been made for the effects of five other major risk factors.


Septicemic melioidosis. Occurrence following acute influenza A six years after exposure in Vietnam. Septicemic melioidosis in association with acute influenza A was diagnosed in a Vietnam veteran. The case illustrates that activation of melioidosis can occur long after exposure to a known endemic area and may be precipitated by infections with other common pathogens. Hence, physicians must maintain a high index of suspicion of melioidosis when dealing with unexplained sepsis in Vietnam veterans. Prolonged therapy with appropriate antimicrobial agents is needed to eradicate this infection.


Treatment of acute intermittent porphyria with large doses of propranolol. A patient had an acute attack of intermittent porphyria with severe neurologic manifestations, hypertension, and tachycardia. Treatment with propranolol hydrochloride (Deralin [Israel]; Inderal, comparable US product) intravenously administered in a total dose of 284 mg during a period of 18 hours, was followed by clinical remission associated with a decline in urinary excretion of porphyrin precursors.


Insulin secretion in the diagnosis of adult-onset diabetes mellitus. The natural history of patients with glucose intolerance was observed in 334 patients during a period of 18 years. Glucose tolerance testing (100 g orally) was characterized by measurement of induced insulin secretion. Diabetic complications of retinopathy, sensory neuropathy, and renal disease developed only in the group of patients in whom the induced serum insulin peak fell below 60 mu U/ml. Preservation of an insulin secretory reserve that permitted serum insulin peaks of 60 muU/ml or greater was not associated with development of these complications or symptoms of insulin deficiency despite the presence of an equal degree of fasting hyperglycemia and glucose intolerance. A critical amount of insulin secretory reserve distinguishes between two qualitatively distinct clinical syndromes: true diabetes mellitus (the development of signs and symptoms of insulin deficiency) and the syndrome of pure resistance to insulin (signs and symptoms of hyperglycemia in the setting of adequate or excessive insulin secretion, frequently with obesity, but without diabetic complication).


Exogenous progestogen and estrogen implicated in birth defects. A five-year study of possible teratogenicity of exogenous female sex hormones included three case-control studies and one cohort study. The first case-control study disclosed an estimated relative risk of 8.41 and a highly significant difference in maternal hormonal exposure (P less than .001) between controls and infants with three major anomalies of the VACTERL group (V, vertebral; A, anal; C, cardiac; T, tracheal; E, esophageal; R, renal; and L,limb). Relative risk (RR) estimates of 5.58 (P = .017) and 3.35 (P less than .001) were found in two case-control studies involving maternal hormonal exposure and patients with congenital heart lesions without other malformations. A controlled, single-blind prospective study disclosed an excess of patients with major malformations (RR = 2.75), congenital heart anomalies (RR = 6), and neurological and neural tube disorders preponderant in the presence of a precipitously declining exposure rate during a three-year period in our referral area.


Bougienage is effective therapy for most benign esophageal strictures. Esophageal stricture is the most frequent serious complication of reflux esophagitis. Bougienage was used as the primary therapy of benign esophageal stricture in 92 patients, followed by institution of a medical antireflux program. Response to treatment was excellent, and 78% of patients required two or fewer subsequent dilations. Twenty patients were followed up for two years or longer, and 75% did not require more than one dilation annually. Primary therapy for most patients with peptic stenosis of the esophagus is recommended to be dilation; operative therapy should be reserved for those patients in whom a malignant neoplasm is suspected or those in whom frequent and rapid stricture recurrence makes medical therapy impractical.


A national study of medical and surgical specialties. I. Background purpose, and methodology. The University of Southern California is conducting a national survey of physicians involving the collection and analysis of detailed data on the activities and practice characteristics of generalists, medical specialists, and surgical specialists of different types. This is the first of a series of reports on the survey and provides an overview of the survey's background, purposes, and general research methods. Basic features of the research methods include the development of a survey instrument capable of obtaining different types of practice data from physicians in most specialties and practice arrangements, the sampling of physician population to ensure that sufficient data are obtained from physicians in most specialties and practice arrangements, and the creation and application of a scheme for classifying patient-care services provided by physicians along dimensions related to primary care.


Studies on the fresh water cercariae in Leyte Island, Philippines. 6. Cercariae from Lymnaeidae and Bulinidae. In the previous paper of this series, the cercariae from Oncomelania quadrasi (Part 2), from the snails of Thiaridae (Part 3), from the snails of Viviparidae and Pilidae (Part 4), and from Planorbidae (Part 5) were reported continuously. In this paper the crecariae from Lymnaeidae and Bulinidae were dealt with. These studies were all carried on during the period of 1975 and 1976 in Leyte Island, Philippines. From the lymnaeid snails seven species of cercariae, comprising two echinostome cercariae, one fasciolid cercaria, and four xiphidiocercariae were detected. From the bulinid snails, only two xiphidiocercariae were found, both of which were identifiable with those from the lymnaeid snails. These seven species of cercariae are described and illustrated with a tentative name from Cercaria leyteensis no. 37 to Cercaria leyteensis no. 43, in addition with some remarks on their presumptive life histories.


Development of resistance to hepatotoxic effect of furylfuramide by pretreatment with its subnecrotic doses and carbon tetrachloride. Hepatotoxicity caused by furylfuramide in ddYS male mice was further investigated with following results. (1) Pretreatment with successive oral administration of non-toxic (non-necrotizing) dose (100 mg/day) of furylfuramide for 8 or 24 days alleviated the liver damage elicited by a necrotizing dose (250 mg/kg). The pretreatment resulted in the significant enhancement of the activity of aniline hydroxylase in the liver microsome, which was reduced markedly by a single administration of 250 mg/kg (without pretreatment). The result suggests that the acquired resistance to a toxic dose of furylfuramide is due to the acceleration of detoxication of the drug. (2) Simultaneous administration of CCl4, another hepatotoxic substance, with furylfuramide reduced the lethal effect of the latter. The LD50 values of furylfuramide were increased more than 2.4 times as compared with that of furylfuramide alone. Pretreatment with a small amount of CCl4 as short period as half an hour is more effective than simultaneous administration of both substances. This inhibitory effect of CCl4 on furylfuramide may be explained by an inhibition of the metabolic activation of the latter by the former.


[Effects of local vibration exposure on the cerebral blood flow--on the relation of brain and finger blood flow to vibration frequencies (author's transl)]. The healthy young men aged from 18 to 26 years were examined whether some vibrational stimuli may affect the vasoreaction in the brain and in a finger. The vasoreaction was observed on each subject after the exposure to vibration of frequencies 32, 64, 140 and 250 Hz with acceleration level at 98 m/sec2 and compression force at the vibrating grip of 5 kg, while in the control state the vibration was exactly the same except the vibrational stimuli. Vasodilation and vasoconstriction were observed when low frequency and high frequency vibrational stimuli were given respectively. Vasoreactive pattern of the brain was almost the same as that of the finger.


[On the structure of visual similarity (author's transl)]. The purpose of the present study is to investigate the structure of visual similarity. Stimuli were two series of geometric figures, one of them was 16 rectangles (series A) and the other 18 "apparent" cubes (series B). Each stimulus series was given to eleven adults and eleven infants (five years old). Kruskal's nonmetric MDS was applied to observed (subjects mean average) similarity data. The main results were as follows: (a) The Euclidean model was more suited to the data than the city block model. (b) The number of necessary dimensions was two (series A), or three (series B) in both groups of the subjects.


[Shift of visual laterality difference by loading of auditory discrimination tasks (author's transl)]. To investigate the functional relationship between the right and the left cerebral hemispheres in normal man, the effects of verbal and nonverbal auditory loads on the visual laterality difference in recognizing line orientation and Japanese letters were examined. The left visual field superiority in recognizing line orientation increased with nonverbal load, and disappeared with verbal load. On the other hand, the right visual field superiority in recognizing letters increased with verbal load, and disappeared with nonverbal load. The results were interpreted as indicating that when verbal or nonverbal auditory load was presented to both hemispheres through both ears, shift of functional dominance occurred between the two hemispheres which were connected by corpus callosum.


Comparison of the pharmacological effects of epinephrine administered by the intravenous and endotracheal routes. Epinephrine in various dosages was administered to anesthetized dogs by intravenous and endotracheal routes. Both methods produced measurable effects on heart rate, blood pressure, and respiration. Tachycardia occurred more rapidly after endotracheal administration than after intravenous administration. Respiration appeared to be supported more advantageously with the larger endotracheal dosages. The maximum blood pressure rise was delayed only 60 seconds by the endotracheal route. With an endotracheally administered dose of ten times the intravenous dose, equal responses in blood pressure were obtained. However, when equal doses are compared, there is only a two to three fold increase with the intravenous route. The endotracheal route may be less toxic at higher doses, affording greater safety when large amounts of epinephrine are used. It is concluded that endotracheally administered epinephrine produces significant pharmacologic effects in anesthetized dogs.


Hand injuries: incidence and epidemiology in an emergency service. During a four-month period, 1,164 patients presented to the surgical section of our Emergency Services (ES) with chief complaints involving the hand. Patient records were analyzed for several variables including demographics, diagnosis and therapeutic procedures. Lacerations were the most frequent injury, 61.5% (n=716) with deep structure injuries present in 6.1% (n=44). Of deep structure injuries, 36.4% were tendon lacerations, 27.2% were nerve injuries, and 36.4% were compound fractures. "Bites" accounted for 5.2% (37) of all lacerations, eight of which were human bites. Fractures were the second most frequent injury, (11.4%) and involved 143 separate bones. Infections were present in 7%; over half were paronychias. There were 42 (3.6%) thermal injuries.


The Baron revisited: a case report.

The Baron revisited: a case report. The Munchausen patient seeks hospital care to satisfy a masochistic streak and is willing to undergo operations and painful hospital procedures while at the same time being abusive and aggressive. He often uses an argument with hospital personnel as an excuse to leave against medical advice. The diagnosis is rarely made in the emergency department but might be made more frequently if lists of known "Munchausens" were circulated through emergency department and if emergency physicians were more aware of the problem. The physician in doubt, however, will do better to risk being fooled and manage the patient as if his complaints were real. One such case is reported.


"Cotton fever" in narcotic addicts.

"Cotton fever" in narcotic addicts. Two patients presented to the emergency department with acute onset of fever and myalgia after injecting heroin reclaimed from previously used cotton filters. Their histories and clinical courses are illustrative of the symptom complex known to drug users as "cotton fever." Although the causative mechanisms are unknown, the syndrome does appear to have a benign, self-limiting course.


A rubber band powered, piston-valve aspirator. A new valved surgical aspirator is described which overcomes the shortcomings of conventional, valve-less suction devices. The valve piston which controls the flow of fluid is retained in the valve body by an ordinary rubber band. When the valve is opened by depressing the piston, the rubber band is stretched. When the piston is released, the rubber band shortens, automatically returning the valve to the closed position. Occluding the flow of air through a surgical aspirator between actual usages reduces the risk of bacterial wound contamination and reduces noise levels in the operating room. The rubber band powered, piston-valve aspirator is simple and efficient, and therefore it is suitable for hospital use.


Disordered breathing and oxygen desaturation during daytime naps. Ten patients with and ten patients without chronic obstructive pulmonary disease (COPD) were monitored for the presence of disordered breathing and oxygen desaturation during daytime naps. Disordered breathing occurred commonly during naps in patients with COPD and often was associated with desaturation. Disordered breathing was also seen in patients without COPD, but desaturation was less frequent and less severe.


[Cardiac insufficiency and mortality after correction of the mitral valve defect, depending on the degree of cardiac output before the operation]. The course of the postoperative period was studied in 107 patients subjected to adequate correction of mitral valvular disease; 88 of them underwent open heart surgery. The cardiac output was measured by radiocardiography. Total postoperative mortality was 13%, cardiac insufficiency mortality 8.4%. Cardiac insufficiency was encountered in 42% of patients who had been operated on. Significant increase in the rate of cardiac insufficiency with the diminution of the cardiac index with "critical" value of 21/min/m2 was established: cardiac insufficiency was found in 76.3% of patients subjected to operation with cardiac index below 21/min/m2 and in 23.2% among those with cardiac index equal to or more than 21/min/m2. A similar regularity was revealed in analysis of cardiac insufficiency mortality:with cardiac index below 21/min/m2 it was 18.4%, with cardiac index of 21/min/m2 or more, it was 2.9%. No interrelationship was revealed between cardiac insufficiency incidence and mortality and the type of mitral valve lesion, extent of surgical intervention, and duration of extracorporeal circulation.


[Tolerance to physical exertion and energy expenditure as indicators of work capacity of patients with ischemic heart disease]. The character and severity of suffered infarction determine the tolerance to physical load, mainly in the early phase of the disease. Patients with a threshold capacity of 400 kgm/min and more may be pronounced capable of working irrespective of the character of the infarction suffered. Individuals over 55 years of age with a large oxygen deficit and relative cardiac insufficiency perform loads of 300 kgm/min and higher, which should be borne in mind in examination for determining their working capacity.


[Use of the esophageal electric countershock]. Transesophageal cardioversion was applied in 277 patients 296 times for arrest of cardiac arrhythmia. Paroxysmal fibrillation and flutter of the atria, and paroxysmal tachycardia were arrested in all cases, chronic atrial fibrillation in 92.4% and chronic irregular atrial flutter in 94.1% of cases. In the group of patients where transthoracic cardioversion at a voltage of 7 kV proved ineffective, the sinus rhythm was restored in 76.5% of cases with atrial fibrillation and 84.2% of cases with irregular atrial flutter when one of the electrodes was introduced into the esophagus. The mean defibrillating voltage in transesophageal cardioversion for chronic atrial fibrillation was by 53.8% lower than that in transthoracic cardioversion. The design of the esophageal electrode proposed provides for the continous recording of the ECG in the esophageal lead for the purpose of determining the optimum position of the electrode and identifying the character of disorders in the cardiac rhythm more precisely.


[Physiological properties of the blood vessel smooth muscles in experimental atherosclerosis]. The contraction of smooth muscle cells in response to the effect of catecholamines and potassium chloride was studied in experiments on isolated ring segments of the rabbit aorta under normal conditions and in experimental cholesterol atherosclerosis at its early developmental stages. It was found that at the early stages of atherosclerosis development the character of the contractile reactions was marked by changes which may be considered from the standpoint of disorder in the ion mechanisms of the interrelationships of sodium and calcium both on the membrane and within the smooth muscle cell, and from the standpoint of increased reactivity of chemically sensitive calcium channels of the membrane. The cause of these changes may be the accumulation of cholesterol, lipoproteins and acid mucopolysaccharides in the vascular wall at the early stages of atherosclerosis development.


[Indications for electric stimulation of the heart in disorders of atrioventricular conductivity]. The authors analyse the indications for electric stimulation of the heart in disorders of atrioventricular conduction on the basis of personal experience (1000 odd electric stimulations). Two main factors, the frequency and severity of Morgangni-Adams-Stokes attacks and the state of hemodynamics, should be taken into account when the indications for electric cardiac stimulation are considered. In choosing the therapeutical measures and methods, due consideration should also be given to the etiology of the block. Morgagni-Adams-Stokes attacks are an absolute indication for permanent electric stimulation. The authors believe that as a method for the management of atrioventricular block electric stimulation of the heart has no absolute contraindications.


[Use of the electric defibrillation for increasing electric stability of the myocardium under normal conditions and in myocardial infarct (experimental-clinical study)]. On the basis of animal experiments and analysis of clinical data it is concluded that the electric discharge used in cardioversion and defibrillation increases the threshold of ventricular fibrilllation and that the effect of repeated electric discharges accumulates.


[Relationship between the spike potentials of "local" intra-atrial and esophageal electrocardiograms of the atria and notched P wave of ECG from the body surface]. The interrelationship of spike potentials of "local" intraatrial and esophageal electrograms and notched P wave of an intensified ECG recorded from the body surface was studied. It was found that the process of excitation in the region of the sinus node is reflected in the slow deviation of the P wave of intensified ECG, preceding the appearance of the P wave of an ordinary ECG recorded from the body surface. The A1 spike of a "local" electrogram reflecting the penetration of excitation into the right atrium is manifested in the form of the first notch of the P wave on an intensified ECG. The A2 spike reflecting the arrival of the excitation to the atrioventricular node is manifested in the form of a notch--the first peak of the P wave. The A1(2)) spike reflecting the arrival of the excitation to the left atrium along Bachmann's bundle is manifested as the second peak of the P wave (A1(2)). The A3 spike of the "local" electrogram reflecting the arrival of the excitation from the left atrium to the orifice of the coronary sinus is manifested in the form of the second notch of the P wave (A3).


[Atrial tachycardia with atrioventricular block]. A clinico-electrocardiographic analysis of 25 cases with atrial tachycardia and atrioventricular block was conducted. Confirmation was established of the connection between the development of atrial tachycardia with atrioventricular block and changes in the myocardium, circulatory insufficiency, acute coronary failure and toxicosis with cardiac glucosides. Such signs of atrial tachycardia with atrioventricular block as the rate of atrial rhythm of 150 to 250 per minute, the possibility of fluctuations in the P-P interval, the presence of an isoelectric PP segment, and atrioventricular block of various degree were found to be of the highest diagnostic value. It is presumed that the development of atrioventricular block in atrial tachycardia is linked with changes in the conducting system of the heart.


[Variants of development of complete atrioventricular block. Prognosis in disorders of intraventricular conduction]. In a group of patients with complete atrioventricular block admitted for implantation of a cardiac stimulant, 15 out of 74 patients (20.3%) had normal intraventricular conduction before the block, while 59 (79.7%) had disorders of intraventricular conduction. A combination of right bundle-branch block with block of the anterior limb of the left branch was the most frequent occurrence (37.8%). Comparison of the QRS complexes in maintained atrioventricular conduction with those in complete antrioventricular block showed that among patients with disorders of intraventricular conduction complete atrioventricular block was of a proximal character in 45.5% and of a distal character in 54.5% of cases. There was a high risk of development of complete atrioventricular block in patients with right bundle-branch block combined with block of the anterior limb of the left branch; it was found to be 41.2% at an average follow-up period of 23 months.


[Dynamics of myocardial contraction in patients with auricular fibrillation after restoration of sinus rhythm by means of electric countershock]. The dynamics of left ventricular contraction was studied in 107 patients with cardiac fibrillation 1 and 6-8 days after restoration of sinus rhythm by electroimpulsive therapy. It has been found that contraction of the left ventricle improves markedly 24 hours after the sinus rhythm is restored and practically does not change by the 6th -8th day after that. On the grounds of such dynamics of left ventricular contraction it is concluded that it is quite sufficient to observe complete bedrest after successful defibrillation for 24 hours, since the risk of normalization embolisms and pulmonary edema sharply diminishes beginning 24 hours after the sinus rhythm has been restored. It is shown that the dynamics of myocardial contration following restoration of the sinus rhythm cannot serve for the prognostication of the remote results of electroimpulsive therapy.


[Anti-arrhythmic properties of ethmosine (clinico-experimental study)]. The antiarrhythmic activity of some acyl derivatives of phenothiazine was studied. Ethmozine proved to be the most effective among them. It produced a marked antiarrhythmic effect both in experiments and in the clinic. The effect of ethmozine is similar to that of quinidine, but it has a wider therapeutic range and is less toxic. The drug has practically no effect or arterial pressure, myocardial conduction and myocardial contraction. These properties of ethmozine as well as its ability to prolong the refractory period and reduce myocardial excitability allow it to be recommened for the management of tachyarrhythmic a-rhythmia.


[Prevention of ventricular fibrillation in animal experiments]. The precursors of ventricular fibrillation and asystole developing after ligation of a branch of the coronary artery and adrenalin injection were studied in 30 albino rats. The comparative efficacy of antiarrhythmic agents (ajmalin, lidocaine, isoptin, visken) in the prevention of ventricular fibrillation induced by electric current was determined in 40 rats. Ventricular extrasystole and tachysystole as well as the block of the bundle of His branch were the most common precursors of ventricular fibrillation. In some experiments fibrillation was preceded by complete atrioventricular block, cardiac fibrillation, sinus bradycardia, nonparoxysmal ventricular tachycardia, and excaped ventricular contractions. Ventricular asystole was most frequently preceded by complete atrioventricular block and the bundle of His branch block. Among the antiarrhythmic agents studied, ajmalin proved most effective in prevention of ventricular fibrillation; it raised the fibrillation threshold in all animals. Lidocaine, which produced a prophylactic effect in 50% of experiments, was second in effectiveness. Changes in the ventricular fibrillation threshold due to the effect of these agents were statistically significant on the average. Isoptin and visken proved to be less effective.


[Prevention of ventricular fibrillation with the aid of protopine in animal experiments]. The anti-arrhythmic activity of protopin, quinidine and novocainamide infused intravenously as a preventive and relieving measure was studied in acute experiments on rats with calcium chloride and aconitic arrhythmia. In myocardial fibrillation induced by calcium chloride the contents in the rat heart of adrenalin, noradrenaline, dopa and dopamine were studied by spectrofluorimetry before and after the use of protopin. It was established that in the size of its minimum effective doses which arrest or prevent calcium chloride and aconitic arrhythmias in rats protopin is two to three times more potent than quinidine and novocainamide. The mechanism of the anti-arrhythmic effect of protopin in calcium chloride and aconitic arrhythmias is complex and is due to the suppression of the foci of heterotopic stimulation, decrease in excitability of the myocardial cells and normalization of the catecholamine content in the myocardium.


[Effect of propranolol on the fibrillation threshold and the period of vulnerability of cardiac ventricles under normal conditions and during acute coronary occlusion]. Experiments on anesthetized dogs have shown that intravenous infusion of 1 mg/kg of propranolol has no essential effect on the threshold of ventricular fibrillation, but considerably reduces the duration of the vulnerable period. Ligation of the coronary artery during propranolol infusion does not cause a reduction in the fibrillation threshold or prolongation of the period of vulnerability; propranolol inhibits the fibrillatory effect of ligation of the vessel. Infusion of propranolol after ligation of the coronary artery leads to the return of the fibrillation threshold and the duration of the period of vulnerability to the initial values. Prolongation of the period of vulnerability after ligation of the coronary artery and its reduction after propranolol infusion occur due to shifts in the internal boundary of the period. There is a direct correlative relationship between the duration of the vulnerable period and the body mass of the dogs: the greater the mass of the animal, the longer the duration of the period of vulnerability.


[Anti-arrhythmic activity of trimecaine under experimental and clinical conditions]. The antiarrhythmic properties of trimecaine, a local anesthetic, were studied. Tests on cats and rats with arrhythmia induced by stimulation with electric current and injection of aconitine, barium chloride, and calcium chloride as well as on a cell model of aconitine arrhythmia have shown that trimecaine possesses marked antiarrhythmic properties. It is more active and less toxic than procainamide hydrochloride or quinidine. Oral administration of 0.35% trimecaine solution had a favourable therapeutic effect in extrasystole in patients with complex heart valvular diseases and circulatory disorders. It is presumed that parenteral injection will produce a more rapid and prolonged antiarrhythmic effect.


[Assessment of early arrhythmias in acute experimental myocardial infarct in rabbits]. Arrhythmias were studied at the early stage after rapid ligation of the left ventricular artery on an experimental model of arrhythmia in rabbits. The rabbits were subjected to thoractomy and ligation of the left ventricular artery under direct visualization. The electrocardiographic and hemodynamic parameters were recorded. Electrocardiographic signs of infarction and changes in rhythm were recorded in 60% of the animals. The rate of cardiac contractions and the arterial pressure decreased after the ligation. In the group in which practolol was applied the rate of arrhythmias dropped to 25%. The effect of adrenergic beta-block on acute occlusion of the coronary artery is discussed.


[Cardiac arrhythmias of hypothalamic origin]. It was established in chronic rabbit experiments that periodical prolonged electric stimulation of the hypothalamic ventrolateral nucleus may induce, besides tachycardia and ventricular extrasystole, episodes of cardiac fibrillation and sudden death from ventricular fibrillation. The development of cardiac fibrillation is associated with increased content of catecholamines in the blood and myocardium. It was also found that the energy-producing activity of the mitochondria and active ion transportation were impaired in the myocardium, the intracellular content of potassium and sodium was changed, and the ultrastructure of the heart muscle was markedly altered. It was shown that the predominance of parasympathetic effects over sympathetic was one of the factors determining the resistance of the heart to the development of cardiac fibrillation of hypothalamic origin.


[Dynamics of pre-hospital lethality in acute coronary insufficiency and myocardial infarct in Krasnoyarsk during 1963-1975]. The data on the dynamics of prehospital mortality in acute coronary failure (ACF) and myocardial infarction (MI) depending on the improvement in medical service in the prehospital stage of treatment are presented. The research showed that prehospital mortality in ACF and MI accounts for 75% of the total mortality. Among deaths registered in the prehospital stage 73.7% were sudden. As the result of improvements in prehospital medical service due to the training of physicians of the emergency medical service, the organization of cardiologic emergency aid teams, clinico-pathologic conferences held at the emergency medical service stations, etc. extrahospital mortality dropped from 45.6% (1963) to 26.2% (1975) with simultaneous drop in total mortality from 61.9% (1963) to 37.4% (1975).


[Morphogenesis of the "myxedematous heart" after experimental thyroidectomy in rabbits]. Electrocardiographic, biochemical, morphohistochemical and ultrastructural changes in the rabbit's heart were studied after thyroidectomy. The data obtained suggested that the changes in the heart of the test animals were characteristic of the "myxedematous heart". Certain regularities in the dynamics of the tissue and structure changes in the myocardium depending on the postoperative period were revealed.


[Cor pulmonale in various collagen diseases]. The early manifestations of cor pulmonale and their dependence on the functional and morphologic changes in the lungs as well as on the collagen disease were studied on 186 patients with various collagenoses. Besides undergoing routine methods of examination all patients were tested for the function of external respiration and subjected to X-ray examination of the lungs and heart and electro-, phono-, vector- and kinetocardiography. There was no parallelism between the clinical manifestations of respiratory insufficiency and the functional and X-ray signs of affection of the lungs. Despite the chronic changes in the lungs, the configuration of the heart is altered only in singular cases. In the diagnosis of the involvement into the process of the right parts of the heart kinetocardiography and changes in the PV1 angle on the ECG proved to be most informative. Instrumental methods of examination revealed that the right parts of the heart were already involved in the stage of functional changes in the lungs.


[Classification of non-coronarogenic myocardial damage]. A working classification of noncoronarogenic damage to the cardiac muscle is suggested in which 4 general-pathology groups are considered: myocardial dystrophies, myocarditis, cardiomyopathy, and neoplasms. The main principles are presented for grouping diseases of the myocardium not associated with ischemic heart disease, hypertension or rheumatic fever. Certain problems of the clinical picture and differential diagnosis of dystrophic, inflammatory, and idiopathic damages to the heart muscle are discussed.


[Toxoplasmosis-induced myocarditis].

[Toxoplasmosis-induced myocarditis]. The clinical picture of myocarditis was studied in 72 patients with toxoplasmic infection and in 44 patients not suffering from this infection. Comparison of the clinical signs of myocarditis in these two groups showed that myocarditis of toxoplasmic etiology has no characteristic features. The only distinction between these two groups was the different frequency of various symptoms. In view of this, methods of laboratory diagnosis of toxoplasmosis acquire much significance.


[Endomyocardial biopsy in the diagnosis of myocarditis and cardiomyopathies]. Fifty patients with the following suspected diseases were examined: examined: congenital heart disease (25), rheumatic heart disease (7), infectious-allergic myocarditis (12), fibroelastosis of the endocardium (3), alcoholic cardiomyopathy (2), drug cardiomyopathy (1). Catheterization biopsy of the endo- and myocardium was accomplished with a special bioptome after catheterization of the heart. No complications occurred during or after biopsy. The results of histologic and histochemical examination of the bioptates of the cardiac muscle are discussed. On the basis of the data in the literature and personal experience, it is concluded that biopsy of the endo- and myocardium may be undertaken to specify the etiology and pathogenesis of cardiomyopathy. The method is comparatively safe.


[Differential diagnosis and treatment of ischemic heart disease and dyshormonal myocardial dystrophy]. The informative value of functional tests (with inderal, potassium and bicycle ergometer), the state of central hemodynamics, and the effectiveness of the anabolic hormone retabolil were studied in young females with dyshormonal myocardial dystrophy. The group consisted of 33 females between the ages of 33 and 45 with maintained menstrual cycle. The presence of cardialgia, syndrome of negative T wave, aggravated gynecologic anamnesis and the absence of clinical and laboratory data testifying to coronarogenous, inflammatory or some other lesion of the heart muscle made it possible to make the diagnosis of dyshormonal myocardial dystrophy. Functional tests with inderal and potassium and bicycle ergometry are objective criteria in the differential diagnosis of ischemic heart disease and dyshormonal myocardial dystrophy. Negative drug tests in individuals with persistent signs of dyshormonal dystrophy of the myocardium are evidence in favour of the development of postdystrophic cardiosclerosis. According to the data of hemodynamics, the functional state of the myocardium in patients with diffuse myocardial dystrophy is impaired. The anabolic hormone retabolil is an agent of pathogenetic therapy in the group of patients studied.


[Characteristics of the sound symptomatology of the heart in functional cardiopathy]. Sixty persons with functional cardiopathy who had a systolic murmur were examined. The purpose of the study was the demonstration of the criteria for the positive diagnosis of a functional systolic murmur in this pathologic condition since hyperdiagnosis of valvular heart disease among these patients is a frequent occurrence. The auscultatory and phonocardiographic characteristics of the functional systolic murmur are described, a conclusion on the absence of any connection between this murmur and the valvular apparatus of the heart is drawn, an opinion on the mechanism of its formation is presented, and the data on the effect of beta-blocking agents on the systolic murmur (single dose and a course of treatment) are discussed.


[Circulatory changes in the neurocirculatory asthenia syndrome]. The results of a comprehensive study of central and cerebral hemodynamics in individuals with the syndrome of neurocirculatory dystonia by means of radionuclide diagnosis are discussed. The shifts revealed provide evidence that hypertonic type of the dystonia syndrome is characterized by increase in the minute cardiac volume, vascular resistance, and minute cardiac output with moderate decrease in the volumetric rate of the cerebral circulation. In hypotonic type of dystonia the volumetric rate of the cerebral circulation is considerably diminished, while central hemodynamics is normal. The study also showed that in the syndrome of neurocirculatory dystonia there was lack of coordination between the systemic and regional cerebral hemodynamics manifested by decrease in the cerebral fraction of the cardiac minute volume.


[Difficulties in diagnosis of infectious-allergic myocarditis]. The work is based on observations over 168 patients with infectious-allergic myocarditis. The principal clinical, instrumental-laboratory, and morphologic criteria of this disease are discussed. The contractile function of the myocardium and central hemodynamics were studied. Intravital puncture biopsy of the myocardium was employed for the first time in this disease. Clinico-morphologic variants of infectious-allergic myocarditis are distinguished.


[Mechanism of the cardiotoxic effect of various industrial poisons (metals)]. The effect of acute and repeated action of cobalt, lead, antimony on the metabolism of the heart muscle is shown. High doses of the metals of approximately 1/5 LD50 were studied in the acute experiment and doses one fifth these in the repeated experiment. The data obtained indicated that due to the effect of all the poisons studied changes developed early in catecholamine metabolism - the myocardial noradrenaline content decreased and the blood and urine monamine levels rose. Increase in the content of pyruvic acid, intensification of glycogenolysis processes (increase in phosphorylase a activity and decrease in the glycogen level), and diminished activity of lactate dehydrogenase in the myocardium attested to changes in its metabolism. High doses of the metals caused an increase in the free activity of the lysosome enzymes, cathepsins and of acid phosphatase, which indicated that the permeability of the membranes of these organelles was disturbed. The mechanism of the cardiotoxic effect of the metals is discussed.


[Echocardiography in the diagnosis of exudative pericarditis]. Echocardiography revealed pericardial effusion in 20 patients with various oncologic diseases. Chest X-ray showed effusion only in 5 patients, electrocardiographic signs of pericarditis were found in 12 patients. Echocardiography is an exact and simple method for the diagnosis of exudative pericarditis.


[Dynamics of the echocardiographic indicators in myocardial infarct]. Echocardiography was conducted on 22 patients with macrofocal myocardial infarction in the first 24 hours of the disease and in the three months following. Zones of asynergy of myocardial contraction were found in all patients. Segmental diminution of myocardial contraction was combined with hyperkinesia of areas of the intact heart muscle. Disturbance in regional myocardial contraction was attended with a decrease in functional capacity of the left ventricle. The left ventricular dysfunction in myocardial infarction is to a greater extent determined by the size and character of the asynergy rather than by the localization of infarction. In the period of recovery normalization of contraction was noted in the hypokinetic zones and to a lesser extent in the zones of akinesia. Zones of paradoxical movements of the wall which had developed in the acute period remained 3 months after the onset of the disease.


[Types of disorders of the contractile function of the heart in acute myocardial infarct]. Acute myocardial infarction is characterized by reduced contractile activity of the heart, which is manifested by pathological shifts in the phase structure of the left ventricular systole and parameters of hemodynamics corresponding to the syndrome of hypodynamia. The severity of the hypodynamia syndrome depends on the volume of the affected myocardium. On the basis of the degree of pathological shifts in the phase and hemodynamic indices, the authors distinguished several types of impaired cardiac contractility. In the course of stage-by-stage treatment applied on the principles of early activation, mobilization, and rehabilitation of patients, the dynamics differs with the type of the contractility disorder. In type I positive dynamics is revealed beginning with stage I, in type II beginning with stage II of treatment; in type III negative dynamics is noted in the early periods of the disease and positive dynamics in stage III of treatment. The differentiation of these types becomes very important in appraising the tactics, the prognosis, and the outcome of the disease. Close correlative relations were revealed between the phase indices and the indices of hemodynamics which allow more objective appraisal of the state of cardiac contractility in the acute period of myocardial infarction.