Plasma protein binding and distribution characteristics of drugs as indices of their hemodialyzability. The dialysis clearance, plasma protein binding, and distribution (expressed as volume of distribution) characteristics of a drug were evaluated as predictive indices of the efficiency of hemodialysis in removing drug from the body. Dialysis clearance correlated poorly with the fraction of drug in the body removed by hemodialysis. The best predictive measure of hemodialysis efficiency was obtained by a nonlinear model relating the ratio of the percent of free drug in the plasma and the volume of distribution of the drug to the fraction removed. Knowledge of the binding and distribution characteristics of a drug provides insight into the dialyzability of a drug which in turn may assist in coming to decisions on the necessity of dose adjustments for patients on chronic hemodialysis and the rational use of hemodialysis in the treatment of drug intoxication.


Spironolactone-induced changes in digoxin kinetics. Plasma clearance, volumes of distribution, and renal and extrarenal clearances of digoxin were calculated from plasma digoxin concentrations and urinary excretion of digoxin after intravenous injection of digoxin in 8 subjects. The investigation was repeated in the same subjects during long-term treatment with spironolactone. Increased plasma concentration of digoxin was detected during spironolactone treatment. Calculated plasma and renal clearances of digoxin and the volumes of distribution decreased statistically significant. Near maximal capacity for the tubular secretion of digoxin was found when normal digoxin dosage was used. It is suggested that unless spironolactone decreases the myocardial sensitivity for digoxin, the loading dose as well as the maintenance dose of digoxin should be reduced during treatment with spironolactone.


Influence of corticosteroid on hexobarbital and tolbutamide disposition. The influence of 10 days' prednisone treatment on the disposition of hexobarbital and tolbutamide was studied in 7 healthy male volunteers. No significant changes in the pharmacokinetic parameters of the two drugs became apparent, which indicates that prednisone pretreatment does not affect their metabolic activities.


Effect of human growth hormone on amobarbital metabolism in children. Drug metabolism changes during the course of growth and development. Hormones mediate somatic growth and may mediate other developmental changes. To determine the effect of human growth hormone (hGH) on human drug metabolism, 6 hGH-deficient children were given single oral doses of amobarbital before and 6 wk after beginning hGH replacement therapy. Amobarbital was selected as a marker of hepatic microsomal oxidation. Half-lives rose from 13.89 +/- 2.78 hr to 22.75 +/- 3.97 hr, volume of distribution was unchanged, and clearance fell from 62.2 +/- 15.2 ml/kg/hr to 31.2 +/- 11.4 ml/kg/hr. Results indicate that hGH slows the metabolism of amobarbital, probably through an effect on the hepatic microsomal drug-oxidizing system.


Effects of an oral contraceptive on hepatic size and antipyrine metabolism in premenopausal women. Liver volume and antipyrine disposition have been investigated in healthy premenopausal women who received 30 microgram ethinyl oestradiol + 500 microgram dl-norgesterol as an oral contraceptive. Six months' treatment was associated with a 17% increase in liver volume while no change occurred in age-matched control subjects. In the same subjects the contraceptive decreased antipyrine clearance by 21%. Thus the contraceptive markedly reduced drug-metabolizing activity per unit volume of liver by 33%. In additional subjects, discontinuation of the contraceptive resulted in a 30% increase in antipyrine clearance. These observations confirm that conventional oral contraceptive therapy to premenopausal women increases hepatic size and that it is a potent inhibitor of drug-metabolizing activity.


Microvascular grafting.

Microvascular grafting. In microvascular replantation and transplantation surgery, vascular repairs must be performed on undamaged vessels without tension. Meticulous inspection under the microscope will enable the microsurgeon to delineate th proper level of vascular débridement. The resultant defect, be it 2 or 20cm in length, can then be bridged with autogenous microvascular grafts. Forty-one microvascular grafts have been used on 17 patients, with survival of all but one transplant and replant.


Digit replantation. Analysis of 163 replantations in an 11 year period. From July 1965 to June 1976, 163 digits in 107 patients were replanted, and 145 digits survived-an 89 per cent success rate. Critical analyses were made of the causes of failures, complications, bone union, sensory recovery, secondary reconstructive procedures, and the final outcome. The majority of the patients were satisfied with their replanted digits, and no reamputation because of uselessness or causalgic pain of the replanted part has been necessary.


Reconstruction of the hypopharynx and cervical esophagus with microvascular jejunal transplant. A method of replacement of the hypopharynx and cervical esophagus utilizing a microvascular jejunal transplant has been presented. This has been found to be a clinically acceptable and reliable method of repair. Its primary advantage compared with other methods of reconstruction is that it is a one-stage repair with a lower incidence of postoperative complications.


The chest film findings in 'Q' fever--a series of 35 cases. Thirty-five cases of 'Q' fever have been admitted and confirmed serologically over the past 20 years. Thirty-two of these cases had chest films on admission, and lung changes were present in 87%. The lung changes were: 1. Multiple round segmental consolidations, 5--10 cm in diameter, of ground glass density and usually situated in the lower lobes. 2. Linear atelectasis. 3. Lobar or partial lobar consolidation, with some loss of volume in the affected lobe. 4. A slight pleural reaction in a few cases. 5. Some cases had background emphysema of the lungs. All the lesions tended to be slow to clear. The resolution time was from 10 to 70 days, with an average time fo 30 days. Some of the segmental lesions became small, round and dense during resolution. The 35 cases were almost exclusively in males. The finding of a single or multiple round segmental opacities of ground glass density, as described, especially with linear atelectasis, was found to be good evidence that the patient had 'Q' fever. The point is made that the admission chest film is in some cases a very useful early pointer to the diagnosis. This allows specific chemotherapy to be started before the serological results have come back. Plate atelectasis was helpful as a distinguishing feature from primary atypical pneumonia.


Pleural effusion aspiration with ultrasound. This paper describes how pulsed ultrasound applied through a combined transducer-aspirator aids in the location and complete aspiration of pleural exudates, particularly loculated ones, which may be difficult to assess fully using clinical techniques alone.


The role of echocardiography in suspected infective endocarditis. In 14 of 15 patients initially suspected of having infective endocarditis echocardiography accurately predicted the final diagnosis. Echocardiography is particularly valuable in culture negative cases and in excluding patients with other conditions whose clinical features mimic those of infective endocarditis. The presence of fibrosed aortic valve cusps resulted in one false positive diagnosis of valvular vegetations.


The epinephrine effect in renal angiography revisited. The effect of various doses of epinephrine on the renal vessels was studied angiographically in 15 kidneys including three renal tumours. Commonly used doses (10--25 microgram) are often too high as demonstrated in this study. Our findings indicate that the optimal dose for pharmacoangiography of renal masses should be 2--5 microgram of epinephrine. The time interval between drug administration and angiography should be less than 1 min and optimally in the range of 10--30s.


Smooth muscle tumours of the upper gastrointestinal tract. The clinical and radiological features and endoscopic findings in 13 patients with smooth muscle tumours of the upper gastrointestinal tract are reviewed. The study emphasises the non-specific nature of the symptomatology and exemplifies a number of aspects of the radiological picture of these disorders. It also illustrates some of the problems that can arise in their investigation, by radiological and endoscopic methods, and gives some indication of the favourable prognosis that may obtain when complete surgical removal of the tumour is possible.


Synovial rupture of the knee joint: confusion with deep vein thrombosis. Four patients were admitted to hospital with a provisional diagnosis of deep vein thrombosis. Arthrography of the knee joint subsequently demonstrated the presence of synovial cysts in all four patients with rupture into the tissues of the calf in two cases. These conditions are difficult to distinguish clincally and radiological investigation may be required to provide the correct diagnosis. Synovial rupture should be suspected in patients with knee effusions who develop acute pain and swelling of the calf, particularly if the patient has rheumatoid arthritis.


Paget's diseases of bone: some observations on the relation of the skeletal distribution to pathogenesis. A survey of the prevalence of Paget's disease in the United Kingdom (Barker et al., 1977) revealed 1225 patients with Paget's disease, detected in films of the lumbar spine, pelvis and femoral heads. These films and others obtained in these patients, have been analysed; 100 of the patients received full skeletal surveys. In these, the order of frequency of involvement was pelvis, lumbar spine, sacrum, femur, skull and dorsal spine. A similar distribution was found in those with incomplete surveys, with lower frequencies elsewhere in the skeleton. The extent of disease tended to increase with age. In the pelivs, the femora and the clavicles there was a right-sided bias; in the spine there were well-defined distributional differences. Of the patients with full skeletal surveys, 90% showed the disease in films covering the lumbar spine, pelvis and upper ends of femora and 31% had monostotic disease. The geographical and anatomical findings suggest that environment and stress are factors in the development of Paget's disease.


A radiological study of vertebral and rib malformations in children with myelomeningocele. Postmortem radiographs from 112 infants with thoracolumbosacral or lumbosacral myelomeningoceles were surveyed for associated vertebral and rib malformations. Sixty-four exhibited a variety of anomalies including hemivertebrae, fused vertebral bodies, fused vertebral arches, fused ribs, absence of ribs and absence of vertebral bodies. Anomalies were commonly associated with the cranial end of a dysraphic spina bifida region; in addition hemivertebrae and rib fusion exhibited peak incidences centred around the seventh cervical and fourth thoracic vertebra respectively. Fusion of vertebral arch elements increased in frequency throughout the thoracic region towards T10. The twelfth pair of ribs were absent in 20% of cases. Apparent absence of vertebral bodies from the caudal end of the vertebral column was seen in 24% of the radiographs.


Radiological aspects of posterior dislocation of the hip. Ninety-six cases of traumatic dislocation of the hip were admitted to one general hospital over a 10-year period. Eighty of these (83.3%) were posterior dislocations, usually with associated acetabular fractures (81.25%). The aetiology and various complications of posterior hip dislocation are described adn discussed, together with the radiographic management. Radiologists should take special care to exclude associated femoral and pelvic fractures both within and beyond the acetabulum. Fractures of the ipsilateral femur associated with posterior hip dislocation usually involve the femoral head and the radiological appearances and assessment of this injury is important. Ipsilateral femoral shaft fractures are less frequent, but it may be the hip dislocation which is then overlooked unless there is an awareness of the combined injury.


The relationship between microcalcification and in situ carcinoma of the breast. The relationship of microcalcification to lobulo-ductal dysplasia and non-invasive carcinoma was studied in 20 women with in situ carcinoma of the breast. All had microcalcification on the mammogram and in half there was also mammographic evidence of disruption of the breast structure. Three-quarters of the women presented with breast symptoms. Multifocal carcinoma was found in seven patients and the histology suggested that not all foci may progess to extensive duct infiltration or invasion. Calcification was found to occur both in carcinoma and in adjacent benign breast lesions and in three cases no evidence of calcification was found in the carcinoma, but was present in adjacent epitheliosis. The origin and distribution of microcalcification appears to be the same in epithelial hyperplasia, non-invasive carcinoma and invasive carcinoma and there may be a relationship between the amount of calcification and the activity of the epithelial cells. Microcalcification is not specific to breast cancer, but is a product of increased cellular activity in the lobulo-ductal complex and may be extruded into the surrounding interstitial tissue. This implies that microcalcification on the mammogram, particularly if sparse, demonstrates a high risk area of breast rather than a certainty of the presence of carcinoma.


Internal mammary lymphoscintigraphy: a rational adjunct to the staging and management of breast carcinoma. Radionuclide lymphoscintigraphy utilising the bilateral subcostal introduction into the posterior rectus sheath of a small volume of radiocolloid of suitable particle size (99mTc antimony colloid) has provided scintigraphic images of diagnostic quality of the parasternal nodes in 2328 patients with malignant disease. An evaluation of the use of this technique in 1072 patients with breast carcinoma underlines the value of a procedure which, utilised routinely, should alter conventional staging criteria and provide a more rational basis for the management of patients with breast carcinoma and assessment of end results.


Sustained tumour opacification in infants during cerebral angiography. Total body opacification in infants following the intravenous injection of a large dose of water soluble contrast medium has long been recognised, but no example of increased radiodensity of abdominal or intracranial tumours has been reported using this technique. This paper reports the sustained opacification of intracranial tumours in three infants during cerebral angiography. Two of the tumours were papillomas of the choroid plexus of the lateral ventricle and the third a medulloblastoma of the fourth ventricle. Three possible explanations of this phenomenon are briefly considered: 1. That the amount of contrast medium was sufficient to cause total body opacification and the visibility of the tumours was due to a combination of their vascularity and the iodine concentration in the circulation blood. 2. That the observed phenomenon is peculiar to these tumours. 3. That the sustained opacity of these these tumours is due to the same cause or causes as the density enhancement of some intracranial tumours demonstrated by computerised tomography after intravenous injection of contrast medium.


Thermographic assessment of synovial haemangioma. Three patients with synovial haemangioma of the knee were examined by thermography. This technique disclosed extensive subcutaneous distribution of haemangiomata which had been unsuspected clinically. Localised and diffuse lesions can be differentiated by this method. This information is important in planning surgery and in assessment of prognosis.


Biphasic changes in thymus structure during evolving renal hypertension. 1. Structural changes in the thymus during the evolution experimental renal hypertension were investigated to determine their possible role in the genesis of hypertensive vascular disease. 2. The thymus, adrenal glands and the progression of hypertensive vascular lesions were investigated in rats during the first 30 days after occlusion of the aorta between the two renal arteries. 3. Hypertension was initially accompanied by marked atrophy of the thymus, most pronounced 9 days after operation. During this time, the adrenal glands doubled in size and the heart became enlarged. 4. After 21 days the thymus regenerated and became hypertrophic. Histological features of hyperactivity accompanied by infiltration of plasma cells were evident, while the adrenal glands remained enlarged. 5. The observed structural changes of the regenerated thymus in the presence of sustained adrenal hypertrophy indicate that the thymus may contribute to the production of hypertensive vascular disease.


Lack of effect of isometric handgrip exercise on the responses of the carotid sinus baroreceptor reflex in man. 1. The change in arterial pressure and heart rate resulting from alteration of carotid sinus transmural pressure by a median--34 mmHg and +33 mmHg by means of a variable-pressure neck chamber was tested in seven male volunteer subjects, at rest and during exertion of 35, 45 and 65% of maximum voluntary handgrip. 2. During 60 s of 35 and 45%, and during 30 s of 65%, of maximal voluntary handgrip there was virtually no alteration of the response of blood pressure to alteration carotid sinus transmural pressure. 3. The bradycardic response to increase in carotid sinus transmural pressure was reduced at various times after the commencement of handgrip at 45 and 65% of maximum voluntary contraction. 4. It is concluded that a reduction in arterial baroreceptor reflex sensitivy does not play an important role in the initiation of the increase in arterial blood pressure and heart rate caused by isometric exercise. 5. The hypothesis is advanced that some of the cardiovascular changes in exercise may result from elevation of the central 'set point' for blood pressure.


Intestinal absorption and tissue retention of cadmium and calcium in normal adult rats and rats given an active metabolite of vitamin D (1,25-dihydroxycholecalciferol). 1. Nine-months-old male rats were divided into a normal control group and one experimental group which received eight daily intraperitoneal injections 15 pmol of 1,25-dihydroxycholecalciferol/100 g body weight. After 5 days, 20 muCi of 109CdCl2 or 20muCi of 45CaCl2 was administered by stomach tube. The intestinal absorption and tissue retention of the radioisotopes were analysed during the next 3 days, the animals being kept in metabolic cages. 2. The administration of 1,25-dihydroxycholecalciferol caused significantly increased net absorption of intestinal calcium, hypercalcaemia and increased incorporation of calcium into bone. In comparison, there was no significant effect on the intestinal absorption of trace doses of cadmium or upon the accumulation of cadmium in the liver and kidneys.


Galactose and hepatic metabolism in malnutrition and sepsis in man. 1. Hepatic carbohydrate metabolism was studied by an intravenous galactose test in control patients, malnourished non-septic patients, patients with prolonged severe sepsis and patients after recovery from sepsis. 2. Blood galactose half-life was not significantly increased in the septic group despite abnormal liver-function tests, whereas it was approximately doubled in the malnourished patients. 3. The rise in blood glucose after galactose injection was less in both the septic and malnourished groups, as compared with that in the control subjects. 4. Fasting blood glucose, lactate and pyruvate concentrations were similar in all groups, whereas blood ketone bodies were increased in the malnourished and septic groups, and blood alanine was decreased only in the septic group. 5. The changes in hepatic metabolism and function were reversible on recovery from sepsis. 6. It is suggested that alterations in hepatic blood flow and the metabolic fate of galactose within the liver may explain the changes in the metabolic response to galactose observed in malnourished or septic patients.


Peptide excretion in experimental Fanconi syndrome in the rat. A study has been made of urinary peptide output in rats before and after production of a Fanconi syndrome induced by a single injection of sodium maleate. There was an unequivocal increase of urinary peptides on the first and second days after the injection, without any detectable change in the concentration of plasma peptides. 2. Similar results were obtained in osteolathyritic rats in which skeletal lesions had been produced by ingestion of beta-aminopropionitrile. 3. The fractional amino acid content of urinary peptides after maleate and beta-aminopropionitrile is shown to be significantly different from that in control animals. 4. Evidence is presented that the increased output of peptides is mainly due to increased renal clearance similar to that previously described for amino acids, glucose and several electrolytes in this type of experimental Fanconi syndrome.


Post-mortem migration of bone-seeking radionuclides in the rat and rabbit and its effect on estimates of bone uptake. 1. The continued uptake of 18F, 85Sr and 47Ca by bone after death has been studied in rats and rabbits after aortic injection followed by quick killing, a period of recirculation of tracer before death, and perfusion of the carcase. In each case an approximately linear increase of bone radioactivity was observed during a period of 1 h at about the same rate. The proportionate increase depended on the initial concentration of bone-seeking nuclide, ranging from a factor of 1.5 to 4.5. Boiling the carcase did not increase the migration rate. 2. Delay between death and dissection may therefore lead to spuriously high bone concentrations of these radionuclides, leading to over-estimates of bone uptake, extraction ratio or bone blood flow.


Interference by tannic acid with the effectiveness of activated charcoal in "universal antidote". Evidence is presented to show that tannic acid is responsible for the reduced effectiveness of "universal antidote" as compared with activated charcoal alone. Adsorption isotherm data indicate that tannic acid binds strongly to charcoal and hence uses up part of the adsorption capacity that would otherwise be available for binding of a drug or poison. Data on sodium salicylate adsorption from simulated gastric fluid, both with and without the presence of tannic acid, are presented that illustrate clearly that tannic acid interferes significantly with the adsorption of salicylate. Magnesium oxide, another component of "universal antidote," was found to offer no interference to salicylate adsorption, presumably because it does not adsorb to charcoal to any significant extent.


Reduction of pheniramine toxicity using activated charcoal. Pheniramine is efficiently adsorbed by Norit Medicinal Activated Charcoal in vitro. Administration of activated charcoal after pheniramine ingestion in dogs resulted in significantly lower blood levels. Norit or another proven effective activated charcoal would be of value in first-aid treatment of pheniramine poisoning.


Evaluation of sodium hypochlorite as a screening reagent for the identification of cocaine. The effectiveness of sodium hypochlorite, or commercial household bleach, as a screening test for the presence of cocaine in illicit drug specimens was evaluated. The advantages of using this reagent in an undercover situation are described, and the experience of undercover agents and law enforcement officers indicate that the test is simply and reliably interpreted. Chemical analyses of the sodium hypochlorite reaction product demonstrated the utility of this test as an adjunct in the identification of cocaine for forensic purposes.


Hematologic abnormalities and pain during acute opiate abstinence syndrome. Opiate addicts receiving nonmethadone, symptomatic, chemotherapeutic treatment for the abstinence syndrome (at Terros' Opiate Detoxification Program), complained of pains that appeared unrelated to abstinence. The pains reported were primarily lumbosacral pains, joint pains, abdominal cramps, and muscle cramps in the lower extremities. Admission laboratory tests on 150 addicts were used in an attempt to correlate the blood chemistry with the type of pains described. Results of this preliminary screening indicate that a high uric acid level and a low blood urea nitrogen (BUN) may be related in females with joint pains and males with lumbrosacral pains. Values obtained from the nomogram indicate that all addicts have less than 50% of the total serum calcium in ionized form, and the low serum ionized calcium content is associated with abdominal and muscle pains, although 72% of all the addicts studied were within the 3.5 to 4.0 mg range. Hyperproteinemia, low BUN, high uric acid, and low serum ionized calcium were the most significant of the blood chemistry values. Blood glucose levels were not included due to the fact that test were not necessarily fasting results.


Mercury and selenium in cod-liver oil.

Mercury and selenium in cod-liver oil. Cod-liver oil preparations were analyzed for mercury and selenium. The conclusion can be drawn that the intake of mercury and selenium in the normal use of these preparations will be very low.


Fixatives and methods of fixation in selected tissues of the laboratory rat. The histologic appearances of tissues fixed by immersion and perfusion were compared, as well as the effects of these different fixatives: 10% neutral buffered formalin, Carnoy's fluid, and Bouin's fluid. Intravascular perfusion provided better tissue preservation than fixation by immersion. The quality of preservation by neutral buffered formalin was equal to that of Carnoy's fluid and Bouin's fluid, but the overall staining quality of the latter two was judged to be superior.


Anatomical and pathological study of the brain by CT scanner--II. Anatomical study of normal brain at various angles. Multiple angle examination. Having previously described the brain anatomy using traditional CT scanning methods, we will now present the advantages of examining the brain at various angles with representative cuts and descriptions. We propose the use of the multiple angle examination for a complete CT picture.


Improved visualization of subdural hematoma by use of coronal view in computerized tomography. Subdural hematoma may be difficult to visualize on standard axial views in computerized tomography (CT). There are a number of reasons for this. The hematoma may be too small to cause a significant shift of the midline. The content of hemoglobin in the clot may vary from case to case. The clot may appear isodense to the surrounding brain tissue in one patient, and in another patient it may be of increased density. We have noted that the use of the coronal view significantly improves the visualization of a subdural hematoma. Not only is the hematoma better visualized, but ventricular displacement in both lateral and downward direction is better appreciated. We are presenting five such consecutive cases studied by us.


Efficacy of computed tomography of the abdomen--early results. Our experience with 153 CT scans of the abdomen and pelvis over the first eight months of availability at our institution has been analyzed. The efficacy in terms of contribution to the diagnosis in each patient was assessed and accuracy determined. CT was found to have made a significant contribution to the diagnosis in patients with diseases of the pancreas, aorta, retroperitoneal structures, and in cases of abdominal and pelvic masses and abcesses. It has been somewhat less helpful in evaluation of liver and renal diseases. Overall, CT scanning appears to be a significant new diagnostic modality in the evaluation of patients with abdominal and pelvic diseases.


Computed tomography of the skeletal system. Because of its sensitivity to minor variations in radiographic density and its ability to eliminate overlapping because of the cross-sectional display, computed tomography (CT) of the skeletal system may yield valuable information that may not be apparent on plain film or radionclide examination of bone lesions. The authors present five case illustrations in which CT examination of bone was particularly helpful in the evaluation of the patient.


Heart imaging from computerized tomography. In vitro and in vivo animal experiments have demonstrated the potential for using computerized tomography in heart imaging. This paper summarizes some of the work done in our laboratory related to heart imaging of dogs, of cadavers, and of live subjects using the CT approach. We have also provided examples demonstrating a method for computing the heart volume from serial CT images.


Application of the apexcarotis diagram in ischaemic heart disease with angina pectoris and myocardial infarction. The apexcarotis diagram is a new mechanocardiographic method, uniting into a single diagram synchronous recordings of the carotidogram and apexcardiogram. Characteristic features of the apexcarotis diagram (ACD) in ischaemic heart disease with angina pectoris are the reduction of the area of ventricular ejection with a turn to the right toward the point S (p less than 0.001) and an extension of the diastolic subsegment A by more than 10% (p less than 0.001). In patients with myocardial infarction, in addition to the above changes, there occur a reduction of the area of ventricular filling (p less than 0.01) and an enlargement of the angle alpha (p less than 0.02). In 8 patients with angina pectoris and 7 patients with myocardial infarction, the coronary disease was established by coronary angiography as well as by catheterization of the right and left heart. In these patients, a reduction of the area of ventricular ejection was found, which was closely correlated with the elevation of left ventricular enddiastolic pressure (r = -0.72, p less than 0.001).


The sick sinus syndrome. Clinical and electrocardiographic spectrum of nine patients. The paper presents a report on the clinical and electrographic spectrum of nine patients with the sick sinus syndrome with severe symptoms of clinical disturbances and serious disorders of impulse formation and conduction. Seven patients had syncope associated with sinus bradycardia, sinoatrial block or atrial fibrillation with slow ventricular rate. Prolonged episodes of atrial and ventricular asystole occurred and were interrupted by junctional escape beats. Paroxysmal atrial fibrillation and flutter were foun in three patients and infrahisian block in four. Atropine induced a slight acceleration of the heart rate in all the patients studied while the post-suppression S-A node recovery time was prolonged in four.


Plasma renin activity in patients with renovascular hypertension. Changes of plasma renin activity (PRA) were studied in 45 patients with renovascular hypertension. Peripheral PRA was assayed by Serebovskaya's modification of Pickens' biological method; in 13 patients it was additionally assayed in blood samples taken from both renal veins. In some of the patients who were not surgically treated PRA was followed up over a period of 1 to 5 years. The interrelation between PRA and the sex and age of the patients, the duration and the severity of the disease, the clinical and the morphological type of renovascular hypertension, as well as uni- or bilateral involvement of the renal artery is discussed. PRA was increased during the early stage of renovascular hypertension, while later it became normal. PRA of renal vein blood samples, from the kidney with a constricted renal artery, reflects more exactly the dynamics of the changes in the pressor system of the kidney. The assay of PRA is of special importance in the evaluation of the indications for surgical treatment and of the effect of reconstructive surgery.


Post-exertion restitution of left ventricular systolic time intervals in healthy subjects. The left ventricular systolic function was studied in 123 healthy men aged 23-24 years under the influence of exercise and during a two-hour restitution period. Left ventricular systolic time intervals (LVSTI) were evaluated by means of the Blumberger method with Holldack's modification before the exercise, immediately after its termination and after 30, 60 and 120 minutes. After exercise, a decrease was found in the absolute values of LVSTI and of the diastolic stage. During two-hour restitution, the authors found a decrease of left ventricular ejection time, total mechanical systolic time, total electromechanical systolic time, total ventricular electrical stimulation time and of the diastolic stage. A statistically highly significant decrease of all mentioned intervals was related to persisting, still after 2 hours, increased heart rate with which these intervals significantly correlated. The share (in percent) of LVSTI in the total cardiac cycle increased after exercise and was still increased after 2 hours following its termination. The relative increase of systolic time intervals was accompanied by a decrease in the duration of the diastolic stage.


Contraction activity of right heart ventricle and pulmonary haemodynamics in cytotoxic cardiogenic shock. In the course of experimental cardiogenic shock in dogs it was found that in comparison with marked disturbances of heart function and haemodynamics in the systemic circulation, the changes in the right ventricular contractility were less conspicuous. The pulmonary arterial pressure kept at a level approaching the initial one. The pulmonary vascular resistance substantially rose at the same time, especially so in the arterioles. The left heart filling pressure did not increase. The authors assume that the changes in the pulmonary vascular resistance result from direct neurohumoral control of vascular resistance, and discuss possible mechanism of this control.


Angiometric assessment of coronary atherosclerosis in ischaemic heart disease in elderly and old patients. In 30 patients deceased because of various forms of ischaemic heart disease and in 10 control subjects who had died of other causes (age range in both groups, 60-89 years), the first proximal segments of the main coronary arteries were examined angiometrically. There were determined the circumference of the arterial lumen and the IM index, expressing the quotient intimal area/medial area. It was found that the magnitude of the IM index characterized, to a certain extent, the degree of severity of atherosclerosis: at IM values higher than the standard means there occurred complicated atherosclerotic lesions, and at lower IM values, only diffuse thickening of coronary arteries. The length of the circumference of the arterial lumen exhibited a positive correlation with the patients' age.


Incidence of circulatory arrest in patients with acute myocardial infarction in coronary unit. Mechanism of their genesis and factors conditioning successful resuscitation. The incidence, circumstances, and mechanism of development of cardiac arrest in 786 patients with myocardial infarction treated at a coronary care unit within a five-year period were studied and clinical factors are analysed with respect to success of resuscitation. One or more episodes of cardiac arrest occurred in a total of 156 patients (19.8%). Of these, 25 (16.0%) were successfully resuscitated and 131 (84.0%) died. At the clinical ward where the patients had been transferred after the acute stage, cardiac arrest occurred in additional 22 patients, of whom two were successfully resuscitated. Thus, the total number of successfully resuscitated patients throughout the five-year period was twenty-seven. The results of resuscitation were poorer in elderly patients, in those with anterior infarction, and above all in patients with severe symptoms of mechanical heart failure. Anamnestic factors (chronic angina pectoris, previous myocardial infarction, hypertension, diabetes mellitus, ischaemic disease of the lower limbs) were not significantly associated with the results of resuscitation. Primary ventricular fibrillation was the principal mechanism of cardiac arrest in 24 of the 27 patients successfully resuscitated, and its total incidence in the investigated group was 3%. The prognosis of resuscitation in patients with primary ventricular fibrillation was very good, and in all of them the resuscitation was successful and permanent.


Field dependence and lateralization of verbal and configurational processing. With tachistoscopic presentation, relatively field-dependent 18- to 30-year-old males were found to show a significant right-visual-field advantage in reaction-time in a letter discrimination task, while relatively field-dependent subjects did not show a significant hemifield difference. In a second study, relatively field-independent 18- to 30-year-old males again showed a significant right-visual-field superiority in reaction time to letter discrimination, and in addition showed a significant left-visual-field superiority in tachistoscopic face discrimination, while relatively field-dependent subjects showed no significant hemifield difference on either task. The results are interpreted as indicating a link between Witkin's concept of psychological differentiation and differentiation at the neural level, as manifested by specialization of function of the cerebral hemispheres.


Lateral asymmetries in visual perception with and without eye movements. A signal detection analysis was made of single letter recognition in the right and left visual fields. When letters were presented 2 degrees 3' to the right or left of a central fixation there were no significant differences between the fields in perceptual accuracy independent of bias when the subject maintained a central fixation point. However, when subjects were free to move their eyes a right field advantage was found. The results were discussed in terms of attentional bias theories and hemispheric specialization theories.


The development of the right ear advantage in dichotic listening with focused attention. The influence of selective attention on cerebral asymmetry in 6, 8 and 10 year old children was studied using pre-cued dichotic recall of 1 to 4 pairs of digits. A constant right ear advantage for correct recall from the attended ear and intrusions from the unattended ear was found in all three age groups. The ear difference increased with set size and across serial position with a set size of 4 digit pairs. Thus the number of items in acoustic memory determined the degree of lateral asymmetry. The ability to focus attention on the left ear improved between 6 and 8 years. It was concluded that control of directed attention, which improves with development, and left hemisphere specialization for speech processing, which remains constant, both determine performance in dichotic verbal listening.


The effects of cuing on picture naming in aphasia. This study compared the facilitative values of six types of cue for eliciting picture naming responses from Brocas, Wernickes, and anomic aphasics. Degree of responsivity to cues was inversely related to severity of naming disorder. Type of cue, severity of naming disorder, and diagnostic category contributed significantly to the results obtained, though the diagnostic groups did not show differential patterns of response to the cues. First Sounds and Completion sentences were the most effective cues. The finding of diagnostic group differences in degree of responsivity to cues, without differential sensitivity to type of cue, was interpreted as indicating that a single factor might account for group differences in ability to benefit from cuing.


Dyscalculia and elements of the developmental Gerstmann syndrome in school children. Fourteen (14) dyscalculic school children were drawn from a larger population of learning-disabled children. The subjects were divided into two groups, those with normal-or-better reading ability and those with dyslexia equal in degree to their dyscalculia. Both groups showed a variety of behavioral deficits in addition to those comprising Gerstmann's syndrome and were notably poor in auditory and visual discrimination and motor coordination. Good readers showed severely-impaired ability to make right-left discriminations, while the poor readers were average in this ability. Poor readers showed marked impairment of word fluency and hand writing, while good readers were average in this regard. The dyscalculia and reading deficits reported here appear unrelated to central-language impairment. Subjects with all four elements of the developmental Gerstmann's syndrome did not constitute an homogeneous behavioral group and were found among samples of both good and poor readers. The pattern of behavioral deficits shown by these subjects suggests cerebral impairment rather than slow maturation as a probable etiology. While the DGS is not useful as a behavioral description, its value as a possible localizing neurological sign cannot yet be ruled out.


Inverted writing in right- and left-handers in relation to lateralization of face recognition. In a study with 157 right-handed and 69 left-handed college students, Gilbert's two-face choice task, which was used as an indicator of cerebral lateralization for face recognition, distinguished left-handers from right-handers. Right-handers primarily attended to the right side of the face (left visual field), while the group of left-handers had no visual field preference. Levy's hypothesis that inverted-writing left-handers are cortically lateralized like right-handers, and that inverted-writing right-handers are lateralized like left-handers found some support among the males. However, the females in both handedness groups performed in an opposite manner to that predicted by Levy's hypothesis.


Delayed auditory feedback and aphasia.

Delayed auditory feedback and aphasia. The effect of Delayed Auditory Feedback (DAF) was evaluated in three groups of subjects: 10 normal controls, 10 non-fluent aphasics, and 10 fluent aphasics. Speec production tasks consisted of (1) repeating sound and words; (2) naming objects; (3) producing sentences from given stimulus words; (4) answering questions; (5) reciting nursery rhymes; and (6) reading. Two delays were used, 180 and 360 msec. Two independent judges rated patients' responses for changes in intensity, duration, and quality of speech. Inter-judge reliability was considered satisfactory. Contrary to some previous reports, all subjects, including all the fluent aphasics, showed some DAF effect. Fluent aphasics, however, showed a significantly smaller DAF effect than non-fluent aphasics. Patient with conduction aphasia appeared to be the least impaired. Overall DAF effect was greater with 180 msec. than with 360 msec. The largest DAF effect occurred during answering question, followed by repeating, reading, nursery rhymes, sentence production, and naming, in that order. Repetition of a complex word produced a greater DAF effect than repetition of a simple sound. Finally, we found a differential effect of DAF on the three measures used in the study. We hypothesize that DAF effects result from changes in two separate monitoring systems. One systems is related to changes in the intensity of speech and does not appear to be affected by aphasia. The other is responsible for duration and qualitative changes in speech and is differentially affected in relation to pathology producing  aphasia.


Verbal and spatial encoding of visual stimuli: the effects of sex, hemisphere and yes-no judgements. Six male and six female subjects were given 112 trials on each of two tasks requiring a yes-no comparison of pairs of letters presented to the right and left hemispheres. One task was predominantly visual (detection of curved letter segments) and the other was predominantly verbal (detection of rhyming "ee" sounds). It was found that for "yes" decisions, females were faster in the right hemisphere than in the left, while the reverse was the case for males. Also for females "no" decisions were faster than "yes" decisions in the left hemisphere but "yes" decisions were faster than "no" decisions in the right hemiphere.


Dementia: the estimation of premorbid intelligence levels using the New Adult Reading Test. The NART is a new word-reading test which was specifically designed for use with adults: the 50 words were selected in order to assess familiarity with words rather than the ability to phonetically decode unfamilar words, i.e. for each word intelligent guesswork alone would not result in a correct response. The results from a group of patients with cortical atrophy and a control group demonstrated the superiority of the NART over the best previously available word list (the Schonell GWRT) in enabling higher and more accurate levels of intelligence to be predicted. The evidence implied that the reading of the NART words was not significantly affected by the dementing processes in the patients with cortical atrophy, and therefore that the NART reading score can provide an accurate estimate of premorbid intelligence levels in these patients.


Hemisphere differences in the recognition of nonsense shapes: cerebral dominance or strategy effects? A tachistoscopic visual half-field task involving delayed recognition of nonsense shapes did not prove to rely disproportionately on either cerebral hemisphere. However, subjects at either extreme of the laterality distribution were more accurate at recognition overall, relative to subjects displaying indeterminate laterality. These results are discussed in terms of subjects' preferred processing strategies and it is concluded that until we possess a detailed knowledge of task requirements and of subjects' strategies, the results of laterality studies will remain ambiguous.


Handedness effects in kinesthetic spatial location judgements. This experiment examines hemispheric assymetry in reproduction of spatial location in the kinesthetic modality. Using a dichotomous presentation technique, blindfolded, right-handed subjects moved both arms (arm positioning task) or the thumb (thumb positioning task) of each hand simultaneously to predetermined spatial locations and were subsequently asked to reproduce these locations. The results showed a marked left hand advantage only in the thumb positioning task suggesting that the right hemisphere was superior in performing this task. These data were discussed as they relate to other evidence pertaining to cerebral hemispheric specialization in motor activities.


A developmental study of hemisphere specialization for alphabetical stimuli. Three groups of normal female subjects (7 and 8 years of age, 13 and 14 years of age, and young adults) were tested on a choice reaction time task using a tachistoscopic presentation of single letters to either hemisphere. The two older groups of subjects were found to exhibit a significant right visual field (left hemisphere) superiority in reaction time to letters, but the 7 and 8 year old children did not show a hemisphere asymmetry. These reaction time results for the two older groups are consistent with Rizzolatti et al.'s (1971) finding of a right visual field superiority in reaction time to letters in male adults. The analyses of error rates for visual field differences were not significant for the children or the adolescents. In this study, in contrast to Rizzolatti et al.'s result with male adults, the female adults produced a significant visual field difference in error rate.


Processing of visual contour orientation information in normal and disabled reading children. Four experiments comparing the processing of contour orientation information in normal and specific reading disabled children were conducted. The first two experiments demonstrated that the reading disabled subjects had significantly longer visual information store durations than did the control subjects. In addition differences in visual information store durations for different orientations were found between the two groups. The final two experiments investigated processing of contour orientation information in the visual cortex. Results of Experiment IV suggested that the two groups differ in their processing of information in the visual cortex as well as in VIS. Because of the importance of feature detection in letter recognition, it is suggested that the present results may be important in understanding letter recognition is disabled readers.


The Reporter's Test: a sensitive test to detect expressive disturbances in aphasics. The Reporter's Test requires the patient to verbally report to a hypothetical third person the actions the examiner is performing on an array of tokens, so as to enable him to replicate them. These performances correspond for the most part to the commands of the Token Test. The aim is to have the patient produce connected sequences of words, the choice and order of which is determined in advance and can be easily scored. The test was given to 70 normal controls, 60 aphasics (selected for absence of severe expressive impairment), 20 non-aphasic left brain-damaged patients and 20 right brain-damaged patients. Years of schooling, but not age, were found to significantly influence and the scores were consequently corrected. The inferior 5% limit of the 90% tolerance interval around the controls' mean was choosen as the cutting score discriminating a normal from a pathological performance. The hit rate of the Reporter's Test was 92% in the aphasic group. The percentage of non-aphasic left brain-damaged patients and right brain-damaged patients who scored below the cutting point and would, therefore, be erroneously classified as aphasic, was 10% and 15%, respectively. The screening power of the Reporter's Test was clearly superior to that of other expressive tests that were given to aphasic and non-aphasic brain-damaged patients. Besides the pass or fail score, a wheighted score, which takes into account the number of correct words chosen in the first four parts of the test, was used. Although somewhat inferior as a screening device, it presents the advantage of allowing a more graded evaluation of aphasics' performance.


The involvement of the frontal lobes in cognitive estimation. Ninety-six patients with localised cerebral lesions were tested on a task of providing reasonable answers to Cognitive Estimate questions. These questions are ones that can be answered using general knowledge available to almost all subjects, but for which no immediately obvious strategy is available. It was found that patients with frontal lesions gave significantly more bizarre answers than patients with more posterior lesions. This effect is interpreted in terms of Luria's (1966) theory of the planning functions of the frontal lobes.


Handedness and intelligence.

Handedness and intelligence. The scores of 37 right and 30 left-handed subjects on tests of fluid and crystallized intelligence were compared. Consistent with the hypothesis, it was found that the left-handers were inferior to the right-handers on the Gf task. These data are consistent with those from three earlier studies and serve to question the assertion that there are no handedness related differences in ability.


Ageing of the female gamete. 2 Lactate dehydrogenase activity in fragmented oocytes and ova of the rat. LDH enzyme activities were determined in atretic and fragmented oocytes. The enzymatic activities in fragmented oocytes and ova were compared to those already known in early rat cleavage stages. Atretic oocytes are totally devoid of LDH activity. However, fragmented oocytes and ova exhibit nearly identical LDH activities to early cleavage stages. This result supports our earlier assumption that fragmentation and cleavage are homologus processes, induced by the same maternally transmitted factors in the oocyte cytoplasm.


Chromosome studies in Edentata.

Chromosome studies in Edentata. The karyotypes of three additional species of Edentata are described. The differences in karyotype between Tolypeutes matacus (2n = 38), and other species of armadillo is remarkable. Three species of Euphractini were compared through G- and C-banding patterns. Chaetophractus villosus appears to be much closer to Zaedyus pichiy than suggested by taxonomy. On the other hand, Tamandua tetradactyla and Tamandua longicaudata, two different species of anteater, possess the same karyotypes. The presence of an unusual Y-chromosome in Choloepus hoffmanni may be responsible for the peculiar sex-ratio reported in this species.


Interaction of microtubules and the mechanism of chromosome movement (zipper hypothesis). 3 Theoretical analysis of energy requirements and computer simulation of chromosome movement. A theoretical analysis of the energy requirements and a computer analysis of a special case (symmetrical pull in one plane during anaphase), of the zipper model for chromosome movement (Bajer, 1973a,b) is presented. The conclusions are general, however, and can be applied to any stage of mitosis. It is assumed that the movement is due to a series of short lateral interactions (called 'zips') between microtubules, and it is shown that a particular zip could begin if the bending energy requirement for two microtubules is met, and could terminate when a strain restriction is exceeded. The series of zips ends when the energy requirements for initiation of a particular zip are not met. In such conditions, certain predictions concerning the behaviour of microtubules in the spindle can be made (see Conclusions). It is shown that hydrolysis of ATP or GTP can yield sufficient energy to bend microtubules as specified by the model, that insignificant quantities of the triphosphate would be utilized, and that the linearity of chromosome movement predicted by the model is consistent with the linearity observed in vitro.


[Cultured cell isolates of the smooth muscle layer from the rat duodenum]. A culture obtained from rat duodenal smooth muscle layer is described. The cells were isolated by trypsinization (0.2%), and the medium used for culture was either MEM with glutamine and non-essential AA or RPMI, both containing 10% foetal calf serum. The cell culture contained both smooth muscle cells and fibroplasts in proportions varying with the age of the culture. At day 6, cell differentiation is important. At day 12, when the cells are confluent, the majority of the cells are fibroblasts. Although it is difficult, the transfer of cells is possible at least twice.


Variation in lateral asymmetry of human chromosome 1. Variations in lateral asymmetry of human chromosome 1 were studied in 17 amniotic cell samples and eight blood samples by the 5-bromodeoxyuridine (BrdU) quenching of 4'-6-diamidino-2-phenylindole (DAPI) fluorescence. The size and the relative proportion of the bright fluorescent spots on each chromatid in the heterochromatic region of chromosome 1 (1qh) are variable from different amniotic (or blood) samples after one cycle of BrdU incorporation. However, the particular pattern for a given chromosome 1 is consistent within the individual sample. Size variations were classified into three groups, and variations in the pattern (proportion) of bright fluorescence on each chromatid in the 1qh region were classified into four groups. A preliminary estimate of the type and frequency of lateral asymmetry variations was obtained. These results suggest a high frequency of variability of heterochromatin in the population. The BrdU-DAPI fluorescence technique was found to be very useful for characterizing variations in the 1qh region; variations in organization of heterochromatin DNA with the 1qh region can be detected, and a simple system of nomenclature is proposed for naming the variations in this region.


The chromosomes of cockerels (Gallus domesticus) during meiosis. The chromosomes in spermatogenic cells of 10 cockerels were examined. Prior to removing the testes, the birds had been injected with either 2.5 mg vinblastine sulfate or 5 mg colchicine, or were untreated. A cell suspension was made from small pieces of testis and slides were prepared using an air-drying technique. Pretreatments of the birds increased the numbers of spermatogonial and secondary spermatocyte cells at metaphase and rendered them more amenable to analysis. The modal number of macrochromosomes or bivalents was observed in 90.2% of spermatogonia, 98% of primary spermatocytes at diakinesis, and 94.2% of secondary spermatocytes. Polyploid cells at all stages were thought to be largely artifacts of the procedure. Aneuploidy was rare, being found in only 1% of secondary spermatocytes. It is estimated that between 56 and 66 chiasmata occur in the 39 bivalents; of these, an average of 28 are seen in the six macrobivalents. Average numbers were 8.1, 5.9, 4.6, 3.6, 2.4, and 3.5 for macrobivalents 1 through 5 and the Z respectively. The numbers of chiasmata differed significantly among birds but were not differentially affected by pretreatment of the birds.


The replicative life spans of euploid hybrids derived from short-lived and long-lived human skin fibroblast cultures. Two recent technical advances facilitate the derivation of proliferating hybrids from human diploid fibroblast strains without recourse to biochemical selection: (1) a new chemically-mediated method of somatic cell fusion (PEG-DMSO) yields hybrids at rates as high as 1 in 160 colonies after dilute plating of treated cell mixtures, and (2) a simple technology for assessment of DNA content (flow microfluorometry) permits rapid and highly sensitive monitoring of ploidy. Employing these techniques, we isolated 43 chromosomally stable hybrid clones from 12 crosses between seven different strains representing a wide range of longevities. Crosses between short-lived strains resulted in short-lived hybrid offspring, whereas hybrids derived from long-lived parents tended to be long-lived. Crosses between strains of contrasting longevities gave clones with intermediate growth potentials relative to the other types of hybrids. The failure to observe complementation (enhanced longevity) of hybrids argues against random recessive single-copy gene mutations as important determinants of clonal senescence.


Nongranulomatous interstitial pneumonitis in sarcoidosis. Relationship to development of epithelioid granulomas. Nongranulomatous, nonspecific interstitial pneumonitis was a predominating or prominent histopathologic finding in 62 percent of 128 granuloma-containing specimens from open lung biopsies obtained from patients with sarcoidosis. Data from this study, combined with observations by others on the evolution of experimentally induced granulomas, indicate that interstitial pneumonitis represents a very early lesion, possibly the initial lesion, in pulmonary sarcoidosis. Because of the relatively large error of sampling inherent in the currently increasing practice of obtaining small specimens for lung biopsy via the flexible fiberoptic bronchoscope, we anticipate that interstitial pneumonitis will be seen as the only histopathologic finding in these specimens with increasing frequency. It is therefore important to recognize that interstitial pneumonitis is a characteristic, although nondiagnostic, morphologic feature of pulmonary sarcoidosis.


Irreversibility of obstructive changes in severe asthma in childhood. The findings in three children with severe asthma are presented. Following intensive round-the-clock therapy with theophylline (the dosage of which maintained serum levels of theophylline between 10 microgram/ml and 20 microgram/ml) and therapy with prednisone (20 mg twice daily for three weeks or more), there were improvements in spirometric and body plethysmographic measurements. Despite this therapy, abnormalities in the forced expiratory volume in one second, the maximal midexpiratory flow, the residual volume, and specific airway conductance remained. These cases represent a subgroup of asthmatic children with reactive airways who have an irreversible component to their disease.


Intermittent severe mitral regurgitation. The findings in two patients with hemodynamic evidence of intermittent severe mitral regurgitation with cyclic variation in right and left ventricular pressures are presented. Both patients had aortic and mitral valvular regurgitation of unknown etiology without definite evidence of papillary muscle dysfunction. The basis for the variation in the degree of mitral regurgitation is unclear.


ST-segment elevation during recovery from exercise. A new manifestation of Prinzmetal's variant angina. Four patients underwent exercise testing because of a history of pain in the chest; all four developed marked elevation of the S-T segment only during recovery after exercise. Three of the four patients showed ST-segment depression during exercise, but ST-segment elevation was absent until two or more minutes after cessation of exercise. ST-segment elevation after exercise was accompanied by hypotension in three patients and by ventricular arrhythmias in one. Subsequent coronary angiographic studies revealed normal or minimally diseased coronary arteries in two patients and significant coronary lesions in the other two. Review of the literature shows that contrary to the prevailing belief, over half of the patients with Prinzmetal's variant angina have electrocardiographic changes diagnostic of ischemia during exercise testing. Over half of the patients with abnormal findings on tests during exercise display ST-segment elevation as a manifestation of ischemia; however, delayed ST-segment elevation of the type seen in these four patients is distinctly uncommon, having previously been described in only three individual case reports. The pathophysiology of this response is uncertain but may relate to rapid alterations in the autonomic balance during recovery after exercise.


Arrhythmias from fiberoptic bronchoscopy. The electrocardiogram was monitored in 51 patients during fiberoptic bronchoscopic procedures and was compared to recordings made before premedication. Sixteen of the patients had heart disease. During the bronchoscopic procedure, the heart rate increased by 154 "/- 5 percent (+/- SE). The frequency of atrial ectopic beats was minimally increased, by an average 0.15 +/- 0.12 beats per minute (not significant). Ventricular ectopic beats became less frequent during the bronchoscopic procedure (-0.17 +/- 0.41 beats per minute; not significant), and there was no ventricular tachycardia. Frequent ventricular ectopic beats were seen mainly during bronchoscopic procedures in patients with coronary heart disease, but even in this group, ventricular ectopic beats became less frequent than at rest (-1.13 +/- 1.46 beats per minute; not significant). The nearly uniform sinus tachycardia that was observed was well tolerated but could predispose coronary patients to ischemia; however, the fiberoptic bronchoscopic procedure per se does not enhance prior ectopy.


Desmoid tumors of the chest wall.

Desmoid tumors of the chest wall. Twenty-six cases of desmoid tumors of the wall of the chest were reviewed. These are rare lesions, which nonetheless should be considered in the differential diagnosis of all tumors of the chest wall. Although the lesion is most often palpable, several of the tumors were detectable only by means of an x-ray film of the thorax. Definitive diagnosis could not be made clinically but was easily established by pathologic examination of widely excised tumor. Like all desmoid tumors, these were locally aggressive in their growth but nonmetastatic and generally carried a good prognosis. Ideally, treatment consisted of wide local excision, but if there was encroachment of the tumor on vital structures, excision with suboptimal tumor-free margins was required. Even in the latter instance, tumefaction could be well controlled for long periods. Recurrences after an initial attempted removal were common, but most of these responded to reexcision.


Surgical management of the small aortic annulus. Hemodynamic evaluation. Replacement of the aortic valve can be accomplished with ease and safety in most instances. The presence of a small aortic root, however, remains a problem in that both mechanical and stent-mounted tissue valves produce higher resting gradients in the smaller sizes. To avoid this, a technique has been developed to enlarge the aortic annulus. In a series of 253 patients undergoing aortic valve replacement, 22 required division of the aortic annulus. Extension of the incision inferiorly to the anterior leaflet of the mitral valve and a resulting separation of the annulus facilitated implantation of a larger valve. The resulting defect is obliterated with a woven Dacron patch. Hemodynamic data obtained on 12 patients who had recatheterization one to ten months postoperatively disclosed an average resting transvalvular gradient of 13.5 mm Hg. This procedure has been used successfully in combined aortic and mitral valve replacement and heart block has not occurred. Based upon encouraging follow-up studies of the Hancock glutaraldehyde-stabilized porcine heterograft, we use this prosthesis in patients with annular diameters of less than 25 mm. Our experience suggests that enlargement of the aortic annulus is necessary in a significant number of patients undergoing aortic valve replacement.


Pleural reaction to thoracotomy tube.

Pleural reaction to thoracotomy tube. Knowledge of the transitory pleural thickening seen around thoracotomy tubes can avoid confusion with more serious pleural and pulmonary conditions. In this study of 60 children treated with chest tubes, nine had a local pleural reaction severe enough to produce findings on x-ray films taken up to ten days after removal of the tube.


Pericardial effusion diagnosed by echocardiography. Clinical and electrocardiographic findings in 171 patients. Clinical and electrocardiographic findings in 171 patients with pericardial effusion diagnosed by echocardiographic studies were reviewed. In 70 patients the effusion was unsuspected. There were 87 small, 50 moderate, and 31 large effusions. Cardiac tamponade was present in three patients. Congestive heart failure was the most common cause of pericardial effusion and occurred in 37 patients. Other frequently noted conditions included cardiac disease without congestive heart failure, neoplasms, acute nonspecific pericarditis, renal failure, and acute myocardial infarction. A pericardial friction rub was present in 23 patients, two-thirds of whom had moderate or large effusions. Atrial arrhythmias were common. Low voltage occurred in 31 of 136 patients and was more common with large effusions. The ability to distinguish between a small effusion and the quantity of pericardial fluid present normally is a problem requiring further clarification.


Experimental myocardial infarction. 14. Accelerated myocardial stiffening related to coronary reperfusion following ischemia. In six dogs with surgically opened chests, segmental mechanical function was determined by measuring segment length using mercury-in-Silastic gauges attached to the epicardial surface of the left ventricular wall. Following coronary arterial occlusion the amplitude of the resulting paradoxical systolic bulge was quantitated in terms of "muscle lengths", defined as the ratio of the amplitude of the segment length over the end-diastolic segment length (EDSL). From an excursion of 0.176 +/- 0.029 muscle lengths at six hours of ischemia, the amplitude of the bulge decreased abruptly to 0.125 +/- 0.024 muscle lengths after 15 minutes of coronary reperfusion (P less than 0.05) but maintained paradoxical expansion in systole. Segmental "effective stiffness", calculated at the same periods of time from end-diastolic pressure-length relationships during transient pressure loading of the left ventricle, showed a reciprocal change, increasing from 1.416 +/- 0.161 to 2.051 +/- 0.238 mm Hg/% deltaEDSL (P less than 0.05). These data indicate that the degree of paradoxical bulging of an ischemic segment is affected by its pressure-length characteristics (distensibility) and that a rapid decrease both in the amplitude of the bulge and in distensibility occurs during reperfusion. The mechanism is uncertain but may relate to either myocardial edema or myofibrillar contracture.


The effect of glucagon on the pulmonary transvascular fluid filtration rate. Administration of glucagon has been shown to decrease pulmonary vascular resistance, but its primary site of action is undetermined. Whether this is on the arterial or venous side of the capillary would be reflected in the microvascular hydrostatic pressure. We used the pulmonary flow of lymph, a sensitive index of the transvascular fluid filtration rate, to monitor the microvascular hydrostatic pressure. Eight unanesthetized sheep with a surgically created long-term fistula for monitoring pulmonary lymph were given a 3-mg bolus of glucagon after a baseline period. We found no change in pulmonary arterial or left atrial pressures but noted a significant increase in cardiac output and a decrease in pulmonary resistance. The flow of pulmonary lymph increased by 50 percent for 30 minutes after administration of glucagon, and the protein content of the lymph decreased by 15 percent, indicating a large increase in the microvascular hydrostatic pressure. From these data, we calculated a decrease in arterial resistance from 60 percent to 30 percent of the total and, subsequently, an increase of 6 cm H2O in the microvascular hydrostatic pressure. Administration of glucagon, therefore, decreases the arterial resistance while increasing microvascular pressure in the process.


Profound first-degree atrioventricular block. A 30-year study. We report the findings in a 60-year-old patient with a 30-year history of profound first-degree heart block with no associated cardiac abnormalities. The sinus node and the His-Purkinje system were normal. The time for atrioventricular nodal conduction was prolonged, with normal refractoriness both before and after administration of atropine, suggesting that the atrioventricular node may be lengthened, although electrically normal.


Fascicular block within the His bundle.

Fascicular block within the His bundle. The findings in a patient with complete atrioventricular block and normal morphology and duration of the QRS complex are presented. A His bundle electrogram was obtained, which led to the location of the atrioventricular block within the His bundle. A careful review of the electrocardiograms obtained during the seven years preceding the onset of complete atrioventricular block showed a QRS complex with the features of left anterior hemiblock and a progressive impairment of atrioventricular conduction. From these data, we inferred that the different degrees of atrioventricular block and the left anterior hemiblock were caused by lesions within the His bundle involving the fibers destined for the left anterior division of the left branch. After the onset of complete atrioventricular block, with the subsidiary pacemaker located in the His bundle distal to the lesions, the QRS complex became normal, indicating the integrity of the bundle branches and fasciculi. The atrial and proximal His potential intervals and those between distal His and ventricular potentials were normal.


Recurrent mediastinal bronchogenic cyst. Cause of bronchial obstruction and compression of superior vena cava and pulmonary artery. The recurrence of a benign mediastinal bronchogenic cyst 20 years after partial excision precipitated potentially serious vascular and pulmonary complications. Aggressive total surgical excision should be feasible in the majority of cases. An approach via a median sternotomy offers distinct advantages in certain cases and should be considered. Computerized axial tomographic scanning promises to provide improved definition of mediastinal anatomic features and should be a valuable noninvasive diagnostic method in selected cases.


Legionnaires' disease. Clinical and pulmonary histopathologic features of a sporadic case. The pulmonary histopathologic features in a sporadic case of Legionnaires' disease are shown. The changes include acute bronchitis with focal ulceration and diffuse acute interstitial pneumonitis. These changes are not those seen with typical bacterial pneumonia but are similar to changes seen when viruses, rickettsiae, chlamydiae, or Mycoplasma pneumoniae organisms are the infecting agents.


Treatment of pulmonary melioidosis with combination of trimethoprim and sulfamethoxazole. Treatment with a combination of trimethoprim and sulfamethoxazole proved lifesaving in a patient with pulmonary melioidosis after therapeutic failure occurred with other antibiotics to which the organisms were sensitive in vitro. Antagonistic interaction of drugs occurred when the combination of trimethoprim and sulfamethoxazole was given along with other antibiotics. The combination of trimethoprim and sulfamethoxazole should be considered a major addition to the pharmacologic armamentarium for the treatment of pulmonary melioidosis.


Continuous precordial murmur due to congenital fistula between the femoral artery and the superior vena cava. An unusual case of arteriovenous communication between the left inferior epigastric artery, a branch of the femoral artery, and the superior vena cava is presented. The communication caused a continuous murmur at the lower parasternal area and was responsible for a significant left-to-right shunt. Surgical treatment, which consisted of ligation of the aberrant artery at its origin, was followed by disappearance of the precordial murmur.


Pneumomediastinum. An unusual complication of needle biopsy of the lung. Pneumomediastinum without pneumothorax is an unusual and apparently benign complication of needle biopsy of the lung.


Procainamide-induced left anterior hemiblock of the 2:1 type (pseudoelectrical alternans). A selective defect in cardiac conduction in the anterior division of the left bundle branch was induced in a patient by therapy with procainamide hydrochloride. The defect in conduction, when intermittent, resulted in 2:1 Wencklebach sequences and produced a pattern similar to classic electrical alternans. The prognosis in drug-induced alternans is good, and it is important to differentiate it from true electrical alternans.


Brain edema in immature animals. An experimental study in rats. Applying several procedures to produce brian edema, the authors examined electron microscopically immature rat brains, and the findings were compared with those in adult rat brains. Using Na-fluorescein and ferritin as tracers, the authors also examined the blood brain barrier (BBB) functionally. It was clarified that immature rat brains showed resistance to the brain edema of the vasogenic type in spite of breakdown of the BBB. On the basis of these results the authors discussed on genesis of brain edema of the vasogenic type.


Gangliogliomas in children. A clinicopathological study. 14 children with central nervous system gangliogliomas are reviewed. The tumors were most frequently located in the cerebral hemisphere and often were cystic and calcified. Total removal was performed in only 1 patient. A well-defined plane of cleavage could not obtained in the majority of tumors at surgery. All patients are alive on follow-up and only 1 is neurologically disabled. Radiation therapy was given to 4 patients postoperatively. The clinical course of patients given postoperative radiation therapy was not different from that of those who were not irradiated. The histological aspects of the tumors are described.


Myeloschisis in early human embryos.

Myeloschisis in early human embryos. Four early human embryos with open myeloschisis are reported. These are a thoracolumbar myeloschisis in Carnegie developmental stage 12, a cervical myeloschisis in stage 13, and two lumbosacral myeloschisis in stage 14. All of them are the smallest human embryos with this type of malformation ever reported. In these embryos, the neuroectodermal junction is smooth and there is no microscopic evidence that the neural tube is forced open after its proper closure. The presence of the lesion in such early embryos, especially in one of stage 12, implies that the lesion evolved from the neural plate which never closed. Cellular polarity and the limiting membrane in the lesion are generally well preserved in spite of apparent overgrowth of the neural tissue. These findings do not support the hypothesis of LEMIRE et al. that the defective external limiting membrane predisposes to a loss of cellular polarity and resultant neural overgrowth.


Hydrocephalus in children treated with the one-piece shunt. The results of the surgical treatment of 50 children with hydrocephalus with a new one-piece shunt are presented. The advantages and disadvantages of this shunt are discussed.


Infant recognition of the invariant form of objects. The developing ability to abstract and recognize the invariant form of an object was studied in 6- to 9-month-old infants. It was found that 9-month-olds were capable of recognizing the invariant form of objects. They demonstrated this ability by differentiating a variation of a familiarized object from a configurationally novel object after a period of familiarization involving other variations of the familiar object. The forms of some objects were more difficult to recognize than others, but recognition of the more difficult forms was enhanced by allowing simultaneous comparison of variations during familiarization. 6-month-olds, on the other hand, did not demonstrate recognition of the invariant form of the experimental objects.


Memory factors in vowel discrimination of normal and at-risk infants. The role of memory factors in infant vowel discrimination was examined by studying the categorical versus continuous discrimination of very brief vowels and the effect on discrimination of the silent delay interval between the last familiar and the first novel stimulus. 8-week-old infants of normal and at-risk medical histories were presented in a nonnutritive sucking paradigm with either a between-category or a within-category vowel shift. The results revealed reliable between-category but not within-category discrimination. In addition, the magnitude of the recovery in the between-category shift was related inversely to the duration of the shift delay interval. Finally, differences were observed between normal and at-risk infants in their initial attention to, discrimination of, and memory for short vowels. These findings were discussed in terms of the relative contributions of auditory and phonetic short-term memory in infant and adult vowel perception.


Criteria for same and different judgments and visual comparison strategies of four-year-olds. 4-year-olds made same and different judgments about pairs of stimuli requiring detailed comparison in 2 conditions: a judgment-only condition and a justification condition in which children explained the reasons for their judgments. The systematic comparison strategies revealed in the justifications indicated that all children had definite criteria for "same" and "different" although about two-thirds of the children used a criterion that differed from the adult criterion. Judgments were more accurate in the justification than in the judgment-only condition, suggesting that overt verbalizations and gestures may provide a beneficial external support for completion of a child's own visual comparison strategy.


Visually elicited finger movements in infants. The relationship between visual stimulus intensity and finger movements was examined in infants from 10 to 15 weeks of age and from 20 to 25 weeks of age who were shown a cone that varied in size, brightness, and distance from them. 2 hypotheses derived from Schneirla's approach-withdrawal theory were examined; (1) that responses of the younger infants would be directly related to stimulus intensity, with finger extension (approach) movements elicited by weak stimuli and flexion (withdrawal) movements elicited by more intense stimuli; and (2) that stimulus dimensions such as distance, size, and brightness would make additive contributions to stimulus intensity, so that combinations of weak intensity would elicit finger extension and combinations of strong intensity would elicit flexion. Analyses of variance indicated no significant main effects of distance, size, or brightness, but significant age, intensity, and age x intensity effects. Older infants tended to extend their fingers more than younger infants. However, as intensity increased, the younger infants' responses showed decreases in extension and increases in flexion, while the older infants' responses indicated no clear relationship between intensity and response direction. That younger infants were responsive to the quantitative rather than the qualitative aspects of stimulation has important implications for understanding how various stimulus dimensions affect infant responses.


The development of cognitive gender constancy and sex role preferences. The chief purpose of this study was to examine the development of stable concepts of "boy" and "girl" (gender identity constancy) in kindergartners and first and second graders. Gender constancy was explored in relation to cognitive level (assessed both by grade and conservation measures); whether the concept was applied to the subject himself or to another child; whether the concept was applied to live children or pictorial representations; and sex role preferences (games, television characters, peer preferences). In support of a cognitive-developmental position, gender constancy was found to be related to cognitive level, and most children conformed to a developmental sequence (Guttman scalogram) in which conservation preceded gender constancy. Gender constancy performance was better when the concept was applied to the self versus another child and when applied to pictorial representations versus live forms. Gender constancy was not related to sex role preferences.


Sex role concepts of two- and three-year-olds. An instrument was developed to assess beliefs about males and females in very young children. Use of the instrument with 72 2- and 3-year-old subjects indicated that children as young as 2 years of age possess substantial knowledge of sex role stereotypes prevailing in the adult culture. Knowledge of sex role stereotypes was highly correlated (.85) with comprehension of gender identity as an irreversible characteristic. Subjects who indicated actual or ideal identity with the opposite sex, however, showed a level of stereotyping no greater than chance. While there were no differences in amount of stereotyping as a function of subjects' age or sex, an analysis of the content of subjects' stereotypes revealed that boys' and girls' beliefs were only partially overlapping. In particular, girls tended to ascribe positive characteristics to their own sex and negative characteristics to males, while boys did the reverse. Explanations for these findings in terms of self-valuation processes were suggested.


Sex role stereotypes and children's memory for story content. This investigation examined children's memory for stereotypic and reverse-stereotypic sex role content in their reading material. In experiment 1, lists of traits and behaviors deemed typical of boys and girls were obtained from 2 classrooms of fifth-grade students. 4 experimental stories were developed from these lists of stereotypic items, each depicting a male and female character who exhibited an equal number of masculine and feminine characteristics. In experiment 2, 24 fifth-grade students of each sex read 2 experimental stories and were administered a choice-recognition test. Results revealed that both sexes remembered more of the masculine sex typed characteristics of male characters and more of the feminine sex-typed characteristics of female characters. Moreover, the subjects were less proficient in remembering trait than behavioral descriptions and were particularly unlikely to remember the feminine traits of male characters. On the basis of these findings, it was speculated that children use the sex role stereotype as an organizational framework in reading comprehension. Possible implications of this research for children's reading programs were discussed.


The effects of extraneous speech on visual vigilance performance of children. First-grade males performed a 30-min visual vigilance task under 5 conditions of auditory background stimulation. The 5 conditions consisted of (1) continuous conversation, in which subjects listened to a tape of conversation spliced so that there were no intervals of silence lasting longer than 3 sec; (2) continuous reverse, in which subjects heard the continuous conversation tape played in reverse; (3) intermittent conversation, in which subjects heard alternating segments of conversation and silence; (4) intermittent reverse, in which subjects heard alternating segments of reverse conversation and silence; and (5) silence control. Compared with silence or continuous stimulation, intermittent stimulation produced better detection regardless of whether or not it was meaningful. High achievers made more correct detections than low achievers, but only in the second and third time periods. Few subjects made errors of commission.


Locus of control and generosity in learning disabled, normal achieving, and gifted children. Locus of control and generosity were investigated in 3 groups of children varying in academic achievement, namely, the learning disabled, normal achieving, and gifted. 34 9- and 10-year-old males were administered in dividually the shortened Nowicki-Strickland Locus of Control Scale and a donation task. An analysis of covariance and subsequent t tests for adjusted means revealed significant differences between all the groups, with learning disabled the most, and gifted the least, externally oriented. In addition, generosity was found to correlate significantly with internal-external control. The implications for special education, and resulting research priorities, are discussed.


A family study of gender identification. Self-reports about 70 masculine and feminine behaviors were collected from 177 undergraduates and their families. These self-report scores were correlated within family pairs to assess family resemblances in masculine or feminine preferences. The obtained family correlations were compared with those predicted by a simple additive-genetic theory, an X- linkage model, and a same-sex identification theory of gender-identity acquisition. The obtained pattern of correlations (mother x daughter=.26, sister x sister=.28, father x son=.33, and brother x brother=.23, all other family correlations near 0) strongly rejects the X-linkage and simple additive-genetic models of gender-identity acquisition. On the other hand, the obtained family correlations are quite consistent with a same-sex theory of gender identification, although, of course, within-family correlations only suggest causal relations, they do not prove them. Other factors such as social class could affect sex role identification as well.


[The multiple stomach carcinoid].

[The multiple stomach carcinoid]. Carcinoid tumors can be found in the entire alimentary tract. Stomach carcinoids make up about 3% of all carcinoids; 0.39% of all stomach tumors are carcinoids. Multiple stomach carcinoid is a medical rarity. In spite of an invasive growth, carcinoids with a diameter of less than 1 cm are considered semimalignant, those with a diameter of more than 1 cm are considered sure malignant. There are 8 cases of multiple gastric carcinoids described in the literature. In our case we found macroscopically 31 polyps with a diameter of between 0.4 and 2 cm in the stomach. Histologically they were growing invasively with small tumor groups in the lymph ducts. Therapeutically total gastrectomy was necessary.


[Treatment of meconium ileus equivalent]. A 12-year old boy with mucoviscidosis developed a mechanical obstruction of the small intestine. The diagnosis of a meconium ileus equivalent was made and a conservative treatment was started. After this treatment failed, a laparotomy was performed which verified the diagnosis of a meconium ileus equivalent. It was possible to move the inspissated feces inside the terminal ileum into the ascending colon. The postoperative course was uneventful. The etiology, differential diagnosis, and both conservative and operative treatment of this complication of the mucoviscidosis are discussed.


[The meso-caval shunt--a future standard operation?]. As a result of several retrospective and prospective studies, there have been remarkable changes in surgery for portal hypertension, namely the limitation of surgical interventions to an asymptomatic time interval (without bleeding), and the preference for distal shunt operations, aiming at a lasting reduction of the portal hypertension with minimal reduction of portal liver perfusion. These requirements are best met by the mesocaval (H-) shunt, using a vascular prosthesis with sufficient wall stability and a negatively charged inner surface, such as, for example, the expanded PTFE graft (Gore-TEX). In contrast to several types of splenorenal shunt, the H-shunt in mesocaval position is characterized by the following advantages: (a) minimal operative stress, even in high-risk patients, (b) technical ease of use, (c) reduced operative mortality, especially for interval operations, (d) minimal risk of recurrent bleeding and encephalopathy. From this preliminary report it may be expected that the technique of mesocaval expanded PTFE shunt here presented is likely to become the method of choice in both elective and emergency interventions.


[Choice of procedure in the surgical treatment of liver injuries]. We give an analysis of liver-rupture cases among our own patients and discuss the problems of diagnosis and surgical therapy. Total lethality is 29%; this is dependent on quick diagnostic procedure, the number and severity of accompanying traumas, and the type of liver rupture. The main diagnostic feature seems to be peritoneal lavage, Operative procedure depends on the type and severity of the liver rupture. We therefore propose a classification of the types of liver ruptures, together with their adequate surgical therapy. Some postoperative complications can also be avoided.


[Neuroma of the cystic nerve stump. No explanation for post-cholecystectomy pain]. The investigation of 20 clinical patients and the autopsy material of 15 cases showed that neuromas of the cystic duct stump following cholecystectomy represent a regular pathomorphologic condition and have no correlation with any postoperative symptoms. Identical morphologic alterations can also be found on arterial stumps after resection of abdominal organs. Therefore, we suggest eliminating the cystic duct neuroma from the list of possible causes of symptoms after cholecystectomy.


[The elimination of the excretory pancreatic parenchyma by means of intraductal injection of a rapidly hardening solution of aminoacids]. The effect of the occlusion of the pancreatic duct system uith a new alcoholic solution of aminoacids has been studied in animal experiments. The solution solidifies in the duct system, is microbiologically indifferent, and becomes disintegrated within 11 days. The development of fistulas following exploratory excision is prevented by the filling of the duct system. The solution could be suitable for a therapeutic acceleration of the "burning-out" of the chronic pancreatitis.


[Local gastric fibrinolysis].

[Local gastric fibrinolysis]. Local fibrinolytic activity was studied in normal and hemorrhagic gastric juice and in the gastric wall of men and pigs. This activity was definitely higher in hemorrhagic juice than in normal gastric juice, and its probably released from hemolyzed erythrocytes and mucosal lesions of the gastric wall.


[Late results after extra-anatomical shunt surgery in vascular surgery]. Alternative procedures were applied in high-risk patients or, in cases in which it was necessary, to bypass infected vascular beds. Some of our 113 procedures, especially the carotid-subclavian and the femoro-femoral grafts, showed excellent long-term results and wider application of these operations thus appears justified. Infected areas in the groin may be bypassed by the lateral iliaco-femoral graft as an alternative to the obturator bypass.


[Effect of exogenous collagen on the metabolism of rat burns]. Standardized burns on rats were treated with 14C-labeled collagen from guinea pig skin. Collagen fractions of different solubility were extracted from the wounds during healing and the incorporation rates were measured. In the neutral salt-soluble fraction, maximal specific activity was found on day 7 after application of the burns; 1,65% of the applied label was incoporated, and it was calculated that 11,8% of the total neutral salt-soluble collagen of the wounds originated from the applied exogenous collagen. In the citric acid soluble collagen, maximal specific activity was observed on day 9; 1,48% of the applied label was incorporated; 6,0% of total citric acid-soluble collagen of the wounds was derived from the exogenous collagen. In the insoluble collagen, no significant increase in radioactivity was observed before day 14 after burning. The results support the opinion that exogenous collagen is used for substitution in connection with endogenous collagen synthesis.


Circadian rhythm in murine reticuloendothelial function. Six separate groups, each composed of 15 comparable inbred female CBA mice, standardized in light daily from 0700 to 1900, alternating with darkness, maintained with food and water available ad libitum, were tested at 4-h intervals for a 24-h span for the phagocytic index, determined 3, 6, 9 and 12 min after the injection of a carbon suspension. By an analysis of variance and the single cosinor method applied to these data a circadian rhythm was demonstrated, with a double amplitude of 20% and an acrophase during the second half of the daily light span. These results extend the scope of immunologic circadian rhythms to the reticuloendothelial system as a feature of a bioperiodic defense mechanism, most active during the habitual rest light span of nocturnally active mice.


Chronobiologic study in the domestic duck. II. Physiological mechanism of the chronobiologic action of visible light on the gonads of the male duck. 1. The physiological mechanism of the gonad-stimulant effect of light rays on the pre-pubertal duck testis, is the basis of any chronobiolgical study of this effect. 2. The light stimulates the chain formed by the retina, the optic nerve, the hypothalamus and the anterior part of the pituitary. This chain includes 2 photo-receptors, a superficial one, the retina and a deep one, the hypothalamus. The retina is here only sensitive to orange and red rays. Consequently an autonomic retina intervenes instead of the visual retina. The hypothalamus, on the other hand, is sensitive to all visible rays when they are  brought directly in contact with it through a quartz rod placed in the orbit which has been previously emptied. 3. The hypothalamus, which is thus enlightened directly is more than a hundred times more sensitive than the retina. This great sensitivity allows normal stimulation by the most penetrating rays in the orbital region. 4. Ultra-violet and infra-red rays are inactive on the autonomic retina and on the hypothalamus. 5. The neuro-secretory cells of the latter, stimulated directly or indirectly, secrete hormones which via the axones reach a capillary network covering the median eminence, then, by series of portal veins, the anterior part of the pituitary, the corresponding cells of which secrete various hormones, which through the systemic circulation reach the corresponding target organs and in particular the gonads. It is thus a neuro-hormonal mechanism which the external factor light, brings into play to stimulate various functions of the autonomic life of the organism.


[Low-dose x-ray treatment of 44 haemangiomas of the lid (author's transl)]. An extent knowledge of different haemangioma forms is the prerequisite of any treatment of haemangioma. Only the blastomatous haemangioma, because of its histological substrate, has a marked sensitivity to x-radiation. The tendency towards spontaneous regression among haemangiomas is an important factor which must be taken into consideration in any treatment plan. The blastomatous haemangiomas are most radiation-sensitive during the growth phase. For this reason such treatment should be undertaken in the first two years of life and under quite specific indications. The results of low-dose radiotherapy was assessed five years after the end of treatment on 157 patients with haemangiomas (of these, 44 were of the lid). Very good to satisfactory results had been achieved in 95.5% of blastomatous haemangiomas. Radiotherapy was only little effective in juveniles and adults. These results indicate that radiotherapy is the treatment of choice for blastomatous haemangiomas.


[New aspects of pathogenesis and treatment of dysmenorrhoea (author's transl)]. Menstrual blood of 5 dysmenorrhoeic women was collected in tampons during two menstrual cycles without and four cycles with intrauterine progesterone treatment (Progestasert). Three eumenorrhoeic women served as controls. Progesterone was assayed radioimmunologically after purification and extraction. Total progesterone excretion in the menstrual blood was the same in eumenorrhoeic and dysmenorrhoeic women without treatment. An increase of menstrual progesterone excretion by the factor 13 was found during the first bleeding after insertion of progesterone T. After 12 months of treatment with Progestasert only 41.7% (2 alpha less than or equal to 0.001) of the initial progesterone amount per menstruation was found. The progesterone concentration per ml menstrual blood had decreased in the same way but was still clearly higher than eumenorrhoeic values. The results indicate that progesterone controls intrauterine prostaglandin F2alpha formation indirectly.