Reduced DNA synthesis in zinc deficiency: regional differences in embryonic rats. Zinc deficiency during prenatal life results in a high incidence of gross malformations especially of CNS. Reduced 3H-thymidine incorporation into rat embryos has previously been reported in zinc deficient rats. The effect of zinc deficiency on regional DNA synthesis in the 12 day rat embryo was therefore investigated. Zinc deficiency was achieved by feeding normal pregnant rats a diet containing 0.4 ppm zinc from day 0 to day 12. Pair-fed controls received a diet containing 100 ppm zinc. Dams were injected with 3H-thymidine on day 12 and embryos removed 1 hour later. In embryos from zinc deficient dams, there was a lower incorporation of 3H-thymidine into DNA in the head regions than in comparable regions from ad libitum and pair-fed controls. Total DNA and RNA contents in the head and body regions of embryos from zinc deficient dams were lower than respective regions of pair-fed controls, but the greatest deficit occurred in the head region. Replacement of zinc 28 hours prior to injection of the label increased the low incorporation of 3H-thymidine/DNA in the head region of zinc deficient embryos. Autoradiographs of the head region indicated that reduced uptake of 3H-thymidine and reversal by zinc replacement occurred mainly in the developing CNS. These results demonstrate that the reduction in DNA synthesis resulting from zinc deficiency can be reversed by zinc alone, and that zinc deficiency in the mammalian system does not result in a general reduction in DNA synthesis in all tissues, but the head region is more vulnerable to reductions in zinc than the body region. The observation that DNA synthesis in the head region is reduced by zinc deficiency more than is the rest of the body may explain the increased vulnerability of the CNS to prenatal zinc deficiency.


Abnormal prenatal lung development resulting from maternal zinc deficiency in rats. The effect of maternal zinc deficiency during gestation on fetal lung development was studied. Sprague-Dawley rats were fed from the day of mating (day zero) a zinc deficient diet (0.4 +/- 0.1 ppm zinc) ad libitum, or a zinc supplemented control diet (100 ppm zinc) either ad libitum or with restricted intake. Fetuses were removed by cesarean section on days 17 to 21 of gestation. Fetuses of zinc deficient dams had smaller lungs both in absolute weight and relative to body weight on all days than did either ad libitum-fed or restricted-intake controls. On days 20 and 21 of gestation, concentration of fetal lung lecithin and phosphatidylethanolamine was lower in zinc deficient fetuses than in control groups, indicating a reduced production of pulmonary surfactant. The lecithin to sphingomyelin ratio of amniotic fluid was lower in zinc deficient rats than in controls on days 19, 20, and 21 of gestation. On days 18 through 21 of gestation, fetal lung DNA concentration in zinc deficient fetuses was lower than in controls, but there were no differences in fetal lung zinc concentration. Histological examination of lungs from zinc deficient fetuses at term showed air spaces that were slightly collapsed with smaller lumina of the alveolar ducts than in controls.


Effects of branched-chain amino acid antagonism in the rat on tissue amino acid and keto acid concentrations. Growth rate, plasma amino acid, and alpha-keto acid concentrations and activities of the branched-chain amino acid degradative enzymes of rats were measured. Effects of ingestion of excessive amounts of branched-chain amino acids on these variables were determined. Excessive intake of a single branched-chain amino acid led rapidly to elevated plasma concentration of both the amino acid administered and its corresponding alpha-keto acid and, if the rats had previously been fed a low protein diet, to an increase in liver branched-chain alpha-keto acid dehydrogenase activity. Only leucine caused, in addition, marked growth and food intake depression and decreased plasma isoleucine, valine, alpha-keto-beta-methylvaleric acid and alpha-keto isovaleric acid concentrations. The growth depression was associated food intake depression and could be moderated by addition of isoleucine and valine to the diet. The decreases in plasma isoleucine, valine, alpha-keto-beta-methylvaleric acid and alpha-keto isovaleric acid were not caused by increased degradation of these metabolites to carbon dioxide as branched-chain amino acid oxidation rates in vivo were unchanged by leucine loading and the degradative enzymes were unchanged in adequately fed rats. The decreased concentrations of these amino and keto acids may be the result of decreased protein degradation or increased protein synthesis, possibly mediated by insulin.


Methotrexate hepatotoxicity in children with leukemia. Percutaneous liver biopsy was performed on seven children with acute lymphocytic leukemia who had received maintanance chemotherapy with high-dose intravenous methotrexate for 1 1/2 to 2 1/2 years. Portal fibrosis was found in four of the seven children and in an additional patient treated with oral methotrexate. Serial tests of liver function and 99mtechnetium-sulfur-colloid scans did not accurately identify children with hepatic fibrosis. Clinical evidence of liver disease was not seen.


PKU as a factor in the development of self-esteem. Self-esteem of ten children with phenylketonuria was compared with that of seven unaffected siblings of children with PKU in a total of 11 families. Ages of the nine girls and eight boys ranged from 8 to 15 years. The study examined several variables that might affect self-esteem. From this study, it appears that PKU status and lowered IQ together contribute to lowered self-concept and that PKU status alone (i.e. with the effects of IQ removed) has a strong tendency to influence self-esteem.


The association of familial liver disease, subepidermal immunoproteins, and membranoproliferative glomerulonephritis. Herein we report a new familial form of hepatic disease. Each of the four patients had splenomegaly, hypersplenism, a small liver, biochemical evidence of hepatic excretory dysfunction and hepatocellular damage, kidneys without demonstrable cysts, and normal blood pressue. An evaluation of serum immunoproteins, autoantibodies, histocompatibility antigens, and mixed lymphocyte reactivity further defined the immunologic features of this syndrome. Extrahepatic manifestations included a papulosquamous dermatitis with deposition of immunoglobulins and complement in both normal and abnormal skin, a membranoproliferative glomerulonephritis with subendothelial deposits, arthritis, and pericardial, pleural, and synovial effusions.


Severe glomerulonephritis complicated by coagulopathy: treatment with anticoaguland and immunosuppresive drugs. Serial determinations, using plasma fibrinogen gel chromatography as well as standard methodology, demonstrated that six children with severe glomerulonephritis, characterized on renal biopsy by glomerular necrosis and crescent formation, had persistent evidence of intravascular coagulation. Based on these observations, therapy with anticoagulants and azathicoagulants and azathioprine was instituted for one year; treatment with anticoagulants was continued for a second year. Anticoagulant therapy was initiated with heparin, followed by oral anticoagulation with phenindione and dipyridamole. In contrast to our earlier experience with similar patients, each of the present patients improved. Urinalyses returned to normal and glomerular filtration rates to near normal values in all patients at the end of the treatment period and have remained so for up to 3.9 years since treatment has been completed. Post-treatment biopsies showed remarkable improvement, with virtually no glomerulosclerosis even in patients who had had a high incidence of glomerular crescents before treatment. It is suggested that the therapeutic regimen favorably influenced the natural history of disease and that plasma fibrinogen chromatographic findings may be helpful in selecting patients likely to benefit from the use of anticoagulant therapy.


The dysmature infant. Associated factors and outcome at 7 years of age. Dysmaturity, diagnosed according to the Clifford criteria, was studied for the first time in a black population. The infants and matched control subjects were participants in the Collaborative Perinatal Study in Philadelphia from birth to 7 years of age. The incidence of dysmaturity was 25/1,000 live births; more boys than girls were born dysmature, reversing the normal male/female ratio found among black infants in the Collaborative Study as a whole. The condition was more common among post-term infants but did occur in earlier gestational weeks. The overall characteristics of the condition among this black population did not differ from those previously reported among white populations of various races. Surviving infants developed mentally and physically as well as control subjects. No prenatal or environmental characteristics were found that distinguished mothers of dysmature infants from those of nondysmature infants.


Respiratory depression at birth--value of Apgar score and ventilatory measurements in its detection. The purpose of this investigation was to determine the value of ventilatory measurements and Apgar score in the diagnosis of respiratory depression in the newborn infant. The following were the results of the determinations made in 24 neonates whose mothers had received meperidine in a total dose up to 3 mg/kg within three hours prior to delivery; Respiratory rate, 51+/-3.7/minute; tidal volume, 21.4 +/- 1.5 ml; minute ventilation, 339 +/- 24 ml/kg X minute; end tidal CO2, 40.8 +/- 1.3 mm Hg; ventilatory response to CO2, 21.8 +/- 2.7 ML/KG X minute X mm Hg PACO2. The mean Apgar score was 7.1 and 9.0 at 1 and 5 minutes, respectively. None of the determinations were indicative of respiratory depression with the exception of the slope of the CO2 response curve; it was considered to be below the normal range. No correlations existed between the CO2 response curve and any other values. It is concluded that meperidine administered to mothers in labor in the described dose will not significantly alter Apgar score, VE, VT, RR, AND PAco2 in the newborn infant. The extent of respiratory center depression could be determined only by the decreased ventilatory response to CO2.


Glucocorticoid treatment of girls with congenital adrenal hyperplasia: effects on height, sexual maturation, and fertility. Ninety-eight females with congenital adrenal hyperplasia due to a defect in either the 21-hydroxylase or the 11 beta-hydroxylase enzyme were evaluated to determine the effects of glucocorticoid treatment on growth, pubertal development, and fertility. When treatment was begun prior to one year of age, mean final height was 157.4 +/- 7.3 com, well within the normal adult female range, and significantly (p less than 0.001) greater than the mean final height of 150.9 +/- 4.3 cm found in untreated patients. The mean age of menarche in patients treated prior to the age of six years was 13.8 +/- 3.7 years which is significantly (p less than 0.01) delayed compared to that in the normal population of the United States. However, 92% of patients with menstrual delay had inadequate suppression  of adrenal androgens and urinary excretion of 17 ketosteroids larger than 7.0 mg/24hours. The increased production of adrenal androgens was the result of poor compliance or an insufficient prescribed dose of glucocorticoids. The fertility rate in patients first treated between six and 20 years of age was 64%. The excretion of urinary 17 KS at the  time of pregnancy was 2.5 to 5.3 mg/24 hours. All of the patients who delivered term infants required delivery by cesarean section because of cephalopelvic disproportion. The major problems encountered in the management of adolescent patients were patient noncompliance and physician failure to increase the glucocorticoid dose as the patient's body size increased.


The sporulated oocyst of Eimeria colini sp. n. from the bobwhite quail, Colinus virginianus. The sporulated oocyst of Eimeria colini sp. n. is described from the bobwhite quail, Colinus virginianus. The broadly ellipsoid oocysts measured 24.8 micronm (22.4 to 28.0) by 20.9 micronm (17.9 to 22.4). The L/W ratio was 1.2 (1.1 to 1.4). An inconspicuous micropyle was present while an oocyst residuum and polar granule were absent. The oocyst walls were 1.4 micronm thick and covered with small, evenly spaced elevations. The sporocysts measured 14.2 micronm (12.3 to 14.5) by 8.4 micronm (7.8 to 8.9). A sporocyst residuum, small Stieda body and large substieda body were present. Ooocysts first appeared in the feces between 84 to 96 hr. Freshly-passed oocysts were completely sporulated by 48 hr at 25 C.


The immunizing potential of sporulated oocysts of Eimeria nieschulzi exposed to heat and Co-60 gamma-radiation. Sporulated oocysts of Eimeria nieschulzi Dieben 1924, a rat coccidium, were exposed to radiation, heat, or both in an effort to attenuate the parasite. Moderate levels of each treatment or combination thereof attenuated the parasite, reduced pathogenesis (as judged by oocyst discharge during primary infection), and produced immunity to challenge when the oocysts were subsequently inoculated into rats. Thus, heat- and/or radiation-treated E. nieschulzi oocysts fed to rats could reduce pathogenesis during a primary infection and yet give good homologous protection.


Isolation and experimental infection of free-living amebae in freshwater fishes. Twenty-three species of fish from nine southeastern states were screened for the presence of small, free-living amebae. Organs from 11 species of fish contained amebae of the genera Acanthamoeba, Naegleria, and Vahlkampfia. Three strains of Acanthamoeba were injected into fish to determine infectivity and pathogenicity of the amebae. Strains used were an A. polyphaga MC-1 isolated from the spleen of a bass, the pathogenic A-5 strain of A. culbertsoni, and the pathogenic Lilly A-1 strain of A. culbertsoni. The MC-1 strain established systemic infections in many organs of the test fish. The 2 strains of A. culbertsoni did not produce any infection in fish under the laboratory conditions.


Characterization and isolation of concanavalin A binding sites from the epidermis of S. mansoni. Using concanavalin A labeled with tritium and fluorescein isothiocyanate we studied the binding properties of this plant lectin to adult paired schistosomes. Using concanavalin A coupled to a sepharose column we attempted to isolate and characterize concanavalin A binding molecules from the epidermis of adult schistosomes. Our results indicate the presence of specific concanavalin A binding sites on the surface of adult Schistosoma mansoni. A significant percentage of the concanavalin A was specifically bound and showed characteristics similar to that identical in other concanavalin A binding tissues. The parasite's concanavalin A binding sites appear to be 2 or 3 high molecular weight glycoproteins. There is some indication that glycoproteins associated with the worm's epidermis function as enzyme(s). The immunological significance of these glycoproteins has not been determined.


Effects of hycanthone on neuromuscular systems of Schistoma mansoni. Hycanthone has a variety of effects on muscular activity and neurotransmitter systems of schistosomes. These include interference with neuronal storage of 5-hydroxytryptamine (5-HT), an increase in the length of schistosomes, a weak stimulation of motor activity, and an inhibition of acetylcholinesterase activity. However, the findings reported in this paper indicate that none of these effects can be related to the mode of the antischistosomal action of hycanthone because (a) these effects are observable only after, but not prior to, the hepatic shift, (b) they are not demonstrable with anti-schistosomal strucutral analogs of hycanthone, or (c) the same effects are elicited in hycanthone-resistant schistosomes. Dansyl choline, under conditions recommended by others, does not stain selectively neuronal structures of schistosomes, but such structures can be visualized under different conditions. However, this stain lacks specificity for cholinergic neurons or receptors because no cholinergic drug can block binding of dansyl choline and because the same fluorescence staining effects are observed with dansic acid and dansyl chloride.


Textrema hopkinsi gen. et sp. n. (Digenea: Cryptogonimidae) from the largemouth bass of central Texas. Textrema hopkinsi gen. et sp. n. is described from Micropterus salmoides from central Texas. Textrema is most similar to the genus Multigonotylus but differs in having a single gomotyl. The new genus is placed in the family Cryptogonimidae.


New hemiurid trematodes from deep-sea benthic fishes in the western North Atlantic. Eight species of hemiurid trematodes, 6 of which are new, are reported from deep-sea fishes in the Hudson Canyon area of the western North Atlantic. New species include Dinosoma triangulata, D. sulca, Gonocerca haedrichi, G. minuta, Glomericirrus ulmeri, and Pseudolecithaster antimorae. The new genus, Pseudolecithaster, differs from Lecithaster Lühe 1901 by the presence of a sinus organ in Glomericirrus ulmeri sp. n., and G. amadai Yamaguti 1937, the type species, allows emendation of the description of that genus and supression of Glomericirrinae Yamaguti 1958. Gonocerca phycidis Manter 1925 and Lecithophyllum anteroporum Margolis 1958 are reported from new hosts and localities.


Asymphylodora atherinopsidis (Trematoda: Monorchiidae) from the California grunion, Leuresthes tenuis, including a redescription. Asymphylodora (Asymphylodoroides) atherinopsidis from the California grunion, Leuresthes tenuis, a new host record, and jacksmelt, Atherinopsis californiensis, the type host, is redescribed and illustrated using more symmetrical as well as larger and smaller specimens than the holotype. The geographic distribution is extended from the type locality of Stinson Beach, Marin Co., California to Estero Beach, 10 km south of Ensenada, Baja California Norte, Mexico. Two tubular externat seminal vesicles opening independently into the internal seminal vesicle are reported apparently for the first time in a trematode. The genital pore is at the left posterolateral margin of the acetabulum which is midway between the lateral margins. Worms may grow to a length of 5.6 mm but eggs were present in one specimen 1.3 mm long.


Freeze-fracture study of the tegument of larval Taenia crassiceps. The tegument of Taenia crassiceps cysticerus is composed of 2 layers, an outer microthrix border and an underlying vesicular syncytium. Each microthrix is a long slender structure that has 2 portions, a thick proximal portion and a thinner distal portion. The inner core of each microthrix contains a cylinder of microfilaments enclosing a central bundle of microfilaments. There are numerous particles on both the protoplasmic and extracellular fracture faces of the proximal portion of the microthrix membrane while there are few particles on the fracture faces of the distal portion. The vesicles that tightly pack the distal tegument are membrane-bound biconcave discs arranged in stacks.


Activation of complement by hydatid cyst fluid of Echinococcus granulosus. Factors present in hydatid cyst fluid of Echinococcus granulosus were found to interact with complement from several species. This nonimmunologic fixation resulted in the depletion of hemolytically active complement from fresh guinea pig serum, the conversion of human C3 to an electrophoretically faster species and the genration of smooth muscle contracting substances, analogous to anaphylatoxins, in normal rat serum in vitro. Vascular permeability changes were produced in vivo in rats and humans after intradermal inoculation of complement interacting fractions of hydatid fluid. It is suggested that these factors may contribute to the pathogenesis of the shock syndrome which follows intravenous administration of hydatid fluid in normal animals, and to the nonspecificity of immunodiagnostic skin tests for hydatid infection in man and animals.


Helminths of reptiles from Komodo and Flores Islands, Indonesia, with descriptions of two new nematode species. Helminths were examined from 12 different species of reptiles from Komodo and Flores Islands, Indonesia. Eight species of nematodes and 5 species of cestodes were identified. Spinicauda komodoensis sp. n. (Oxyurata) is characterized by a gubernaculum 295 micronm long. Trichoskrjabinia secundus sp. n. (Trichostrongylidae) differs from T. malayana (Baylis 1933) Travassos 1937, the only other species in the genus, by being shorter overall and having a shorter female esophagus and smaller eggs, spicules, and gubernaculum. Six new host records and 8 new geographical records are listed.


Utilization of propionic acid by the L4 and adult stages of Cooperia punctata (Nematoda: Trichostrongylidae) grown in vitro. Cultures of Cooperia punctata, a nematode parasitic in cattle, were studied in Ae medium at a pH of 7.2 to 7.3 under air. In fourth and fifth stages of development, they absorbed or otherwise took into their free pool and tissues, carbon derived from 14C-labeled sodium propionate and converted, by pathways not elucidated, a portion of this carbon into protein and lipid fractions. Thirty minutes postincubation in balanced slat solution was adequate to reduce the amount of isotope in the nematode gut to a constant level. Activity from specifically-labeled 14C-propionate was recovered (as glucose pentaacetate) from worm glucose and from CO2 evolved from cultures consisting of L4 and adult stages. Use of propionate by these worms, for whatever metabolic purpose, would result in depriving the ruminant host of some of its necessary glucogenic precursors, and could account for a specific pathogenic mechanism attendant to heavy infections with this parasite.


An epidemic of pediculosis capitis.

An epidemic of pediculosis capitis. An epidemic due to Pediculus humanus capitis occurred in the public schools of Buffalo, New York, in the winter of 1973. A survey at one elementary school showed that 20% of whites and no blacks were infested, and a city-wide prevalence survey during the academic year September 1972 to May 1973 showed that 7.2% of all pupils were infested. An epidemiological investigation showed that sex, age, race, socioeconomic status, crowding, method of closeting garments, and family size influenced the distribution of pediculosis but that hair length apparently was not a factor. Poverty and ignorance appeared to contribute to the persistence of infestation.


Critical remarks on external cephalic version under tocolysis. Report on a case of antepartum fetal death. SALING and MULLER-HOLVE recently proposed an improved method of external cephalic version brought about a renewed interest in this obstetric procedure. In spite of the undisputed advantages in individual cases we posed the following questions: 1. The extent of the decreased cesaerean section rate 2. The fetal risk We estimate a decrease of cesarean sections by about 1.5% under the assumption that a breech presentation in primiparae is an indication of cesarean section and that 70% of the version attempts would be successful. The estimate includes some cases of multi-parae breech presentations which would have been operated without external version. The resulting decrease of the cesarean section rate is generally not very important and has a greater impact only in individual cases. We have some misgivings about the fetal risk. We report here on a case of intrauterine fetal death after failed external version. A 28 year-old primiparae without known pregnancy complications was admitted with a breech presentation in the 37th week of gestation. The biparietal diameter of the fetal head was appropriate and the placenta was posterior. Cardiotocogram before and after the unsuccessful version were in part misinterpreted. Seven hours after the version the fetal death was confirmed. Histological examination of the placenta showed a severe dissociated maturation disturbance in addition to a 10 X 8 cm large abruptio which had not been noted clinically. A prediabetes was suspected. The fetus itself showed no anomalies. This was interpreted as a severely placentogenically prestressed infant and prediabetes. The extent of the placental disturbance was unknown and had not been appreciated from the ultrasound examination. The placenta had acute infarcts and a circumscript abruption. The CTG was misinterpreted in part. In another case of version the postoperative cardiotocogram showed pathologic patterns. The birth occurred three weeks later without problems with a well child and an umbilical artery pH of 7.31...


[Acute reduction of uterine blood flow and fetal heart rate changes in pregnant sheep near term]. Five merino sheep near term were used for acute preparations to investigate the influence of basal uterine blood flow (UBF), basal fetal oxygenation and basal fetal heart rate (FHR) on FHR changes elicited by acute reduction of UBF. The ewes were anaesthesized with pentobarbital and Alloferin was given for relaxation. Ventilation was maintained via a tracheal tube by a Starling pump. Maternal heart rate, arterial pressure and intrauterine pressure as well as fetal heart rate and umbilical artery pressure were recorded continously. Initially blood flow was recorded by cuff flow meter sequentially in both uterine arteries for a short time in order to determine total UBF and the ratio of flows. During the UBF reduction sequence flow was recorded in the artery of the gravid horn continously and measurement was corrected according to the initial ratio of flows in both arteries, presuming that this ratio would remain constant throughout the course of the experiment. Repetitive and progressive acute reduction of UBF (approximately 25%, 50% and 100% from basal UBF value) was achieved three times, lasting 120 sec each and each approximatly 12 min apart, by flow meter controlled partial or total occlusion of the aorta abdominalis of the ewe with a balloon catheter inserted into the aorta. (In some cases the lateral abdominal section was left open and the aorta was compressed manually). Before, 90 sec after the beginning and 10 min after the end of UBF reduction blood samples were taken from the fetal catheters (Fig. 3). In two preparations this sequence was repeated once after complete recovery of FHR.


The effects of denervation, cocaine, 6-hydroxydopamine and reserpine on the characteristics of drug-induced contractions of the depolarized smooth muscle of the rat and guinea-pig vas deferens. Previous studies have suggested that postjunctional supersensitivity of the vas deferens is due in part to altered electrophysiological properties, the sensitivity of the muscle being increased to any agonist which initiates contraction by means of depolarizing the cell membrane. Results of the present study indicate that altered electrical properties are not the only postjunctional changes which can account for the enhanced response. Dose-response curves for stimulant agonists were obtained in isolated vasa deferentia which were depolarized by a K-rich, Na-free solution. Chronic denervation resulted in a 2- to 3-fold displacement of the dose-response curve for norepinephrine to the left of control. Cocaine (10-(5)M) did not potentiate the response to norepinephrine of the innervated, depolarized smooth muscle. Supporting the contention that the supersensitivity of the depolarized tissue is postjunctional in nature was the finding that the denervated vas deferens was supersensitive to methoxamine, an agent which is not taken up by the neuronal amine transport system. Pretreatment of rats with reserpine (1.0 mg/kg/day for 5-7 days) also produced supersensitivity of the depolarized vas deferens. The increased maximal response to drugs of the denervated rat vas deferens which is observed in normally polarized tissues is absent in depolarized tissues suggesting that the phenomenon of increased maximum requires the existence of a membrane potential in order to be manifest. The denervated vas deferens, but not the vas deferens from reserpine-pretreated animals, exhibits an increase in the duration of drug-induced contractions. This effect occurs in both normal and depolarizing salt solutions suggesting that the change which leads to this phenomenon differs from those alterations which lead to postjunctional supersensitivity and to the enhanced maximal response.


A calcium reversible action of barbiturates on the leech Retzius cell. The Na salts of phenobarbital, barbital, pentobarbital, secobarbital, methohexital and thiopental in concentrations of 1 to 5 mM all caused prolonged action potentials in leech Retzius cells. The prolongation was favored by low Ca and was reversible by elevation of Ca. Barbiturate-prolonged action potentials were not affected by 50 micronm tetrodotoxin or replacement of Cl by propionate, but they were dependent on external Na. Their amplitudes were increased by steady hyperpolarization and input resistance was reduced during them. They were of shorter duration when elicited at a rapid rate. They were sometimes shortened by intracellular iontophoresis of Ca and by use of the ionophore X537A, but technical factors complicated the interpretation of both kinds of experiments. The results are consistent with the hypothesis that the barbiturates used blocked a voltage-dependent inward Ca current which activates a K conductance necessary for normal repolarization.


Differential effects of reserpine and tetrabenazine on rat striatal synaptosomal dopamine biosynthesis and synaptosomal dopamine pools. Rat striatal dopamine (DA) levels and synaptosomal DA synthesis were determined after the administration of the catecholamine-depleting agents reserpine (RES) and tetrabenazine (TBZ). Striatal synaptosomal DA synthesis remained unchanged from control levels after Res administration over a wide range of doses (0.5-5 mg/kg) and times (up to 48 hour). In contrast, after TBZ administration, DA synthesis rapidly increased to values greater than 200% of control values, then returned to control levels. The changes in DA synthesis inversely paralleled the depletion of and recovery of striatal DA levels. The increased levels of DA synthesis did not appear to originate with alterations either in the kinetic properties of tyrosine hydroxylase or in the availability of exogenous or endogenous tyrosine. To assess the contribution of synaptosomal DA pools to the regulation of DA synthesis in tissue preparations from RES-or TBZ-pretreated animals, synaptosomal DA synthesis was assessed in the presence of DA releasing agents and compared with analogous experimental manipulations on tissue preparations from animals pretreated with alpha-methyltyrosine or the monoamine oxidase inhibitor, clorgyline. The data are consistent with a differential in vivo interaction of RES and TBZ with a nerve ending pool of DA which participates in end-product inhibition of tyrosine hydroxylase.


Prostaglandin and histamine involvement in the gastric vasodilator action of pentagastrin. Male mongrel dogs were anesthetized with 30 mg/kg of pentobarbital and left gastric arterial blood flow (GBF) was measured with electromagnetic flow probes. Pentagastrin, 1microng/kg i.v., produced an initial brief increase in flow followed by a prolonged secondary increase. Histamine, 1 microng/kg, and prostaglandin E2, 0.5 microng/kg, produced monophasic short-lived increases in GBF. The histamine H1 antagonist diphenhydramine and the H2 antagonist metiamide did not affect resting GBF. The prostaglandin synthesis inhibitor, indomethacin, reduced resting GBF by 46%. Responses to histamine were blocked by diphenhydramine by 81% and reduced by indomethacin by 21%. Responses to prostaglandin E2 were reduced by indomethacin by 21%. The primary pentagastrin response was blocked by diphenhydramine by 54%. The secondary pentagastrin response was blocked by both metiamide by 69% and indomethacin by 71%. We conclude that GBF is maintained by a basal production of vasodilatory prostaglandins. Furthermore, pentagastrin can release histamine which by acting on H2 receptors can enhance the production and/or release of prostaglandins to finally mediate an increase in GBF. These actions may partly explain the deleterious effect of indomethacin and the curative effect of prostaglandins on gastric mucosal ulcers.


Effects of alcohol on the hypothalamic-pituitary-gonadal axis in the male rat. The effects of acute and chronic alcohol administration on serum testosterone and luteinizing hormone (LH) levels were examined in the male rat. Chronic alcohol administration resulted in depressed serum testosterone and LH levels when alcohol-fed rats were compared with rats maintained, ad libitum, on rat chow and water. However, neither testosterone nor LH levels were significantly lower in alcohol-treated rats when comparisons were made to pair-fed control animals, indicating that the nutritional deficits imposed by the chronic alcohol-feeding regimen contributed heavily to the observed reductions in the two hormones. To avoid the problems associated with a chronic drug delivery model, we injected rats with a single acute injection of alcohol. LH levels dropped significantly within 2 hours after the injection of a 2.5 g/kg dose of alcohol and remained depressed, at a level between 25 and 30% of control values, from 2 to 4 hours. By 6 hours after the injection, LH levels had returned to base-line levels. Testosterone levels were also reduced by alcohol, but this drop was not significant until at least 3 hours after the injection. Testosterone levels did not return to control levels throughout the 6-hour course of the experiment. Dose-response determinations revealed that alcohol produced a biphasic effect on serum testosterone and LH: low doses of alcohol significantly increased testosterone and LH, whereas high doses decreased the levels of both hormones. The results of these studies suggest that the ability of alcohol to depress serum testosterone levels, and thus produce symptoms of hypogonadism in the male of several species, is due to a primary effect of alcohol on the hypothalamic-pituitary aspect of the hypothalamic-pituitary-gonadal axis.


Role of liver cytosolic aldehyde dehydrogenase isozymes in control of blood acetaldehyde concentrations. The role of various cytosolic aldehyde dehydrogenase (ALDH) isozymes in acetaldehyde metabolism was determined. Rats of known genotype (RR, reactor; rr, nonreactor) with respect to induction of a cytosolic enzyme by phenobarbital were used. Animals were treated with either phenobarbital (1.0 mg/ml in drinking water for 3 days) or 75 microng/kg (i.p.) of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) prior to ethanol treatment (2.5 g/kg). TCDD treatment is known to induce a second cytosolic ALDH isozyme in both RR and rr animals. Phenobarbital increased cytosolic ALDH activity 23-fold only in the RR animals, while TCDD increased activity 155-fold in both groups. Phenobarbital-treated RR rats maintained significantly lower blood acetaldehyde levels at 30, 90 and 150 minutes after ethanol injection compared to control RR animals. Blood acetaldehyde levels in phenobarbital-treated rr rats were not significantly different from rr controls. Administration of TCDD to RR or rr rats did not significantly alter blood acetaldehyde levels at 30, 90 or 150 minutes after ethanol treatment compared to appropriate controls. Similarly, phenobarbital significantly increased blood ethanol elimination rate (1.5 times greater than control) only in RR rats. Ethanol elimination rate was not significantly altered by TCDD in either group. Pargyline (100 mg/kg i.p.) did not significantly inhibit cytosolic ALDH activity, while total mitochondrial ALDH activity was inhibited by 28 and 57% in RR animals receiving TCDD and phenobarbital, respectively. Pargyline significantly increased blood acetaldehyde levels after ethanol administration. However, pretreatment with phenobarbital or TCDD significantly decreased elevated blood acetaldehyde levels resulting from pargyline treatment, with the greatest reduction in the phenobarbital-treated RR animals.


The continuous kinetic determination of p-nitroanisole O-demethylation in hemoglobin-free perfused rat liver. P-Nitroanisole O-demethylation by perfused rat liver based on the spectral properties of the product, p-nitrophenolate, was determined continuously. Rates of p-nitrophenol production in this system were sensitive to inhibition by CO. p-Nitrophenolate production by livers of normal animals was linear for up to 30 minutes; however, rates were only linear for 1 to 2 minutes followed by a steady decline in induced (6-fold) livers from phenobarbital-treated rats. Only a small portion (24%) of this steady decline could be accounted for by the formation of conjugation products. Additionally, infusion of p-nitrophenol (14 micronM) was not associated with a decline in rate. The decline in rate in induced livers was reversed by glucose, suggesting that an intimate relationship may exist between drug and carbohydrate metabolism in the intact liver. Alteration in rates of p-nitroanisole metabolism with various inducing agents of the mixed-function oxidation system (phenobarbital; ethanol) produced parallel changes in rates of hepatic lactate production, most likely reflecting the aciton of p-nitrophenol to uncouple oxidative phosphorylation. The data support the hypothesis that the decline in rate in p-nitroanisole O-demethylation in livers from phenobarbital-treated rats is due to reduced availability of NADPH for mixed-function oxidation.


Effect of warfarin on the kinetics of the vitamin K-dependent clotting factors in rats. The objectives of this study were to compare the time course of activities and rates of synthesis of activities for the separate clotting factors II, VII, IX, and X and to relate the rate of synthesis of activity of each factor to the plasma concentration of warfarin in individual rats after acute and chronic dosing with warfarin. Sequences of blood samples were obtained from each rat for 50 to 70 hours after an acute dose of warfarin or for 120 hours after a chronic loading dose plus 12-hour maintenance doses of warfarin and assayed for factor activities and warfarin concentration. The half-lives for degradation of factor activities ranged from 2.6 to 9.0 hours for the four factors. During periods of changing warfarin concentration (acute dosing) factor VII and X activities and rates of synthesis of activity showed large rapid changes, while factors II and IX responded more slowly. As the warfarin concentration diminished, the factor X rate of synthesis of activity appeared to exceed predrug values in all rats. During chronic dosing with warfarin the factor II activity and rate of synthesis of activity was depressed the most. The percent depression of the rate of synthesis of activity for each factor was related linearly to the logarithm of the plasma concentration of warfarin for the range 0 to 80% depression with acute dosing. However, this relationship was not suitable to explain the apparent overshoot in factor X rate of synthesis of activity.


MacAndrew MMPI alcoholism scale: alcoholism and drug addictiveness. MMPI Form R answer sheets of 222 successive black and white male inpatients referred for psychological testing in a VA general medical and surgical hospital were scored on the MacAndrew Alcoholism and the Cavior Heroin Addiction Scales. The MacAndrew Scale with 74% accuracy provided a practical screening device for identifying alcoholics. It did not significantly differentiate patients with a history of drug abuse from patients with a history of alcoholism. The Cavior He Scale was not so valid a screening device for identifying drug addicted patients in our total population. Each scale in a special way seems to be measuring a "general addictive propensity."


Number of children wanted and expected by American physicians. Seven hundred thrity-five male and 93 female physicians indicated the number of children they would like to have; 713 and 89 indicated the number they expected to have. These questionnaire responses were related to demographic, educational, and personality test data gathered while the physicians were in medical school. The strongest predictor of both number of children wanted and expected was the size of the physician's own family of origin. Specialists in obstetrics and gynecology wanted and expected more children than those in other specialties.


[Abdominal tomometry. Application to study of the liver. Experimental study, initial clinical results and perspectives in the exploration of tumour pathology (author's transl)]. Over a period of two months, 120 patients were studied using an Acta-Scanner tomometer for various hepatic disorders. In parallel, comparative tomometric and pathological studies were carried out in cadavers and isolated livers. These made possible the recognition of normal structures in tomometry and the identification of certain hepatic images which might be potential sources of error. Serial axial transverse sections were used to reconstruct the volume of the liver in space, thus making in possible to eliminate certain forms of pseudo-tumoural hepatomegaly. Systematic densitometric analysis was made by radiological anatomical study and in hepatic pathology. This new type of analysis led to a quantified diagnosis of certain diffuse hepatic diseases and a histological approach to tumour lesions. Hepatography using liposoluble agents in very low dosage was used in hepatic tomometry after animal experimentation. The method, free of untoward effects, makes possible the diagnosis of hepato-splenic tumor lesions less than one centimetre in diameter.


[Absorbed dose by the crystalline in middle ear tomography (author's transl)]. Measurements of the incident dose on the eye have been taken during the tomographic examinations of the middle ear. These measurements have been effectuated without any protection of the eye, and with a Pb-diaphragm protection, thickness 2mm. The tomograph which has been used is an Italian one (Eurostrator-Zuder, Genoa) provided with complex radiation movements (circular, spiral) and which gives technical resutlts such as the Polytom (generally used for these researches) but which has a focus film distance of 1m instead of 1.40 m. The average incident dose on the erystalline lens is high (11.7 R): the use of the Pb-diaphragm reduces the dose considerably (0.65 R) without any significant imperfections on the radiological image.


[Early gastric carcinoma. 20 cases. Radioclinical, endoscopic and histopathological study (author's transl)]. The authors report twenty cases of early gastric carcinoma: superficial and with limited infiltration. The histological appearances varied, related to the macroscopic type of the tumour: protuberant, ulcerated, flat. The slightest clinical symptoms justify the most careful radiological study. Protuberant types result in a filling defect. Ulcerated types have a characteristic appearance of superficial ulcer, the folds involved being nodular or widely spread. Deeper regressive ulcerations are sometimes seen in association. Flat forms after the folds of a localised area of mucosa. The differential diagnosis is difficult. It is particularly important to eliminate the possibility of a benign ulcer, polypoid gastritis, lymphoid superficial ulcer, atrophic gastritis, well healed benign ulcer. Combined radiological and endoscopic studies are essential at all stages.


Exogenous estrogens and endometrial carcinoma: review and comments for the clinician. It is justifiable to have reservations about the significance of the data available at this time on a possible increase in the risk of a patient's developing endometrial cancer if estrogen replacement therapy has been prescribed for her. Hopefully, additional studies currently being conducted will help to clarify the issue further. In the meantime, clinicians need guidelines on the use of estrogen replacement therapy. Estrogen is indicated in the premenopausal woman who has had surgical or radiation castration for treatment of disease. Menopausal women with severe vasomotor instability or atrophic vaginitis should also be considered for estrogen replacement therapy. In the latter situation, topical administration may be adequate. Contraindications to estrogen replacement include undiagnosed vaginal bleeding, breast cancer history of thromboembolic disease, liver disease, uterine leiomyomata, hypertension, diabetes, migraine headaches or gall bladder disease. In patients for whom estrogens are contraindicated, atrophic vaginitis can be treated with local estrogens and vasomotor symptoms with sedatives such as phenobarbital and belladonna. Before estrogen treatment is begun, a medical history and physical examination that look for possible contraindications are required. Obviously, any woman with abnormal uterine bleeding in the menopausal age group requires a procedure that provides tissue for histopathologic examination. Although postmenopausal women taking estrogen may have uterine bleeding related to the hormone, such bleeding cannot be assumed to be due to the therapy and always requires evaluation. The lowest dose effective in controlling a patient's symptoms should be administered, preferably in cyclic fashion. Whether the addition of a progestational compound at cyclic intervals has a beneficial effect on the endometrium is a matter of conjecture at this time. Requirement for continuing therapy should be reevaluated at least on an annual basis and preferably more often. In conclusion, a quote from Graber and Barber is appropriate: "The entire picture of routine postmenopausal estrogen therapy is in a state of complete confusion. We must proceed with circumspection and caution. We need less passion, fewer hypotheses, and more facts."


Medical humanities: an aid to ethical discussions. 'The ethical landscape', the title given to part of a course devised by Mr. Moore, is described in full in this paper. The whole course is a new adventure in medical education designed to help students to explore the ethical problems in the practice of medicine. The 'ethical landscape' is seen through discussion based on passages from literature depicting doctors' and patients' dilemmas. As the results summarized in the tables show, the students found the course well worth while, and thought that they had gained a new insight into the problems with which they would be confronted and also into their own personalities and those of their fellow students whom previously they had only known superficially. The Chairman of the course, Mr. Moore, was also subjected to assessment from his students, because on the skill of the Chairman such a course would fail or succeed.


'The implications of medical ethics'.

'The implications of medical ethics'. Professor Goldworth takes up the cudgels in defence of the contemporary moral philosopher, who, he says, should indeed have a role in helping doctors to make clinical decisions based on philosophical theory; Mr. Thompson in his reply says that Professor Goldworth has misinterpreted his earlier argument. Mr. Thompson reiterates his view that the practice of medical ethics must begin with the professionals -- the doctors and nurses--although the philosopher could perhaps find himself part of a medical team. In these circumstances Professor Goldworth and Mr. Thompson would be in complete agreement. Both writers seem to be reflecting very clearly the ideas current in American and British climates of opinion.


A Rhesus dilemma.

A Rhesus dilemma. A family doctor encounters many problems, some of which are not strictly medical, but today he has become the first person to whom people turn when confronted with any personal difficulties which may be expressed medically. Pauline provides an example: she received good medical advice and counsel relating to her social and family context. Pauline took the advice as far as she was willing. However, the participants in the subsequent case conference thought that the problem of Rhesus incompatibility submitted to the doctor was not the crux of the matter but rather the way in which he handled it: the obvious question then to be asked is, Why did the patient consult her doctor and not some other counsellor as the problem proved not to be medical at all? Those taking part were Canon Derek Blows, counsellor and psychotherapist for the Southwark diocese and at University College Hospital, London; Bridget Greeves, Director of the Tottenham Advice Bureau; Dr. Anthony Thorley, honorary senior registrar in psychiatry, Maudsley Hospital, London; Kerstin Lindley-Jones, therapist; and Dr. Roger Higgs, general practitioner and organizer of this series, in the chair. Dr. Michael Courtney, general practitioner, London, was not able to be present but sent his commentary.


Do drug advertisements provide therapeutic information? In this study of advertisements appearing in medical periodicals and by direct mail advertising to general practitioners, Dr. Stimson, a sociologist, concludes that from what is intended to provide therapeutic information hardly any therapeutic information is provided. He reminds the reader of the safeguards which surround all drug advertising by law and by the code of practice of the Association of the British Pharmaceutical Industry but these safeguards do not appear to control real or potential sins of omission. Frequently in these advertisements the literature relating to the drug is quoted but Dr. Stimson found that it was difficult to trace all the papers quoted in different types of medical library. (Some references quoted were to unpublished papers but surely the blame should be shared in this situation?) Dr. Stimson also gives a vivid and fascinating glimpse of what he calls the 'images and stereotypes' of the patients who, it is claimed, would benefit from the drug being advertised. Certainly most general practitioners must be aware that when they prescribe that image is displaced by an individual but the portrait gallery is indeed depressing. However, to balance these advertisements drug companies issue data sheets which must be more informative than advertisements and conform to regulations in their format. Unfortunately data sheets are only issued every 15 months whereas the 'average general practitioner is potentially exposed to 1,300 advertisements every month'. In other words, the data sheet and not the advertisement should be the guideline but it arrives too infrequently to offset the lack of therapeutic information contained in advertisements.


Determination of muscle cable parameters from a single membrane voltage response. Computer techniques have been developed to achieve a least-squares fit of the Hodgkin and Rushton one time-constant cable equation to the recorded responses of muscle cells to the intracellular injection of square current pulses. In the rat diaphragm the response of the muscle fiber to square current pulses is well fit by a one time-constant model. This makes possible the estimation of the passive electrical properties of muscle sarcolemma using the response of the fiber to a single stimulus. A comparison of the results of this method and the older method of spatial decay in the rat diaphragm shows no significant differences. Average values obtained using the one-point method for estimating membrane resistance and capacitance are 520 omega cm2 and 4.6 micronF/cm2, respectively. An estimation of the average specific resistivity of the cytoplasm was made using this method, and it was found to be 213 omega cm. At levels of injected currents producing large membrane hyperpolarizations where delayed conductance changes make the spatial decay method useless, the one-point method continues to give consistent results since it utilizes only the early portion of the membrane response. Work with the frog sartorius muscle, which is known to display the characteristics of a two time-constant system, shows that this method is capable of estimating the slower components of this system by using only the later portion of the response curve. The immunity of this method to delayed conductance changes and its experimental facility make it useful in estimating the passive electrical properties of muscle fibers, particularly when working with tissues that are small and delicate or that have poor in vitro viability.


Mode of action of amiloride in toad urinary bladder. An electrophysiological study of the drug action on sodium permeability of the mucosal border. The effect of amiloride on the sensitivity to Na of the mucosal border of toad urinary bladder was investigated by recording Na concentration-dependent transepithelial potential difference (Vt) and the intracellular potential. When mucosal Na concentration was normal, amiloride added to the mucosal solution at 10(-4) M markedly reduced the mucosal membrane potential (Vm) and altered the potential profile from a two-step type to a well type. Similar changes were observed when Na was totally eliminated from the mucosal medium. The serosal membrane potential was insensitive to amiloride and elimination of mucosal Na. In the absence of amiloride, the Vt could be described by the Goldman-Hodgkin-Katz equation  in the range of mucosal Na concentration from 0 to 16 mM, and amiloride extended this concentration range. By using the Goldman-Hodgkin-Katz equation. Na permeability was calculated from the data of Vt's obtained in the allowed ranges of Na concentration and compared before and after the addition of amiloride. The results show that Na permeability decreases to 1/600 of control when the maximum dose of amiloride (10(-4) M) is applied. The relationship between Na permeability and amiloride concentration is well explained on the basis of assumptions that amiloride binds to the Na site of the mucosal border in one-to-one fashion and in a competitive manner with Na and that Na permeability reduces in proportion to increase in number of the sites bound with amiloride.


Mechanics of the syrinx in Gallus gallus. II. Electromyographic studies of ad libitum vocalizations. Records of electrical activity in the tracheal muscles of domestic chickens were obtained for a variety of ad libitum vocalizations. Primary attention was given to an analysis of events during the most complex call, crowing. Three pairs of muscles, Mm, tracheohyoideus, tracheolateralis, and sternotrachealis, can affect the configuration of a chicken's syrinx. The firing patterns of the three muscle pairs are related to their different abilities to affect the tension of the syringeal membranes. The influence of M. tracheohyoideus is most indirect and imprecise, and its role the least clearly defined. It appears to adjust the position of the trachea so that the syrinx is isolated from unpredictable and/or undesireable consequences of nuchal position and tracheal elasticity, and also helps draw the glottis caudad, thereby deepening the pharyngeal chamber. The other two muscles interact to control the tension of the vocal membranes. M. sternotrachealis relaxes the membranes by drawing the drum of the trachea caudad, or, via the syringeal ligament, by rotating the pessulus cranioventrad, or both. M. tracheolateralis tenses the membranes and/or prevents caudal movement of the orgin of M. sternotrachedalis, a necessity if the syringeal ligament is to rotate the pessulus. Vocalization depends on both syringeal configuration and appropriated air flow. Hence, tracheal muscles, syrinx, air sacs, and ventilatory muscles cooperate to form a vocal system. Cooperation elicits a surprising degree of redundancy. At least one call, a high pitched wail, may be produced by two very different techniques.


Applications of reconstructive craniofacial techniques to acute craniofacial trauma. Increasing familiarity with elective reconstructive approaches to craniofacial deformity has led to the application of a similar multispecialty approach to repair of selected cases of massive frontal and upper facial trauma. The fundamental steps in craniofacial reconstruction are outlined. The process of patient selection is emphasized. Illustrative case histories review the management of this type of injury. Contributions from anesthesiology, neurosurgery, ophthalmology, and plastic surgery are required. Specialized facilities for postoperative care are mandatory.


Dynamics of insulin secretion and resistance after burns. Alteration in the insulin regulation of carbohydrate metabolism following 20% surface burn injury in the rat was biphasic. At 4 hr after burn there was fasting hyperglycemia (92 +/- 6 (SE) mg/100 ml above controls) and a pronounced intolerance to 1 gm glucose/kg IV. Fasting serum insulin did not differ from controls and failed to rise appreciably following glucose administration. Two to four days after burn, the ability to cope with exogenous glucose was near normal or normal and the insulin response to standard glucose load was 41-69% higher than in the controls, indicating the presence of insulin resistance. This pattern was not altered by feeding the burned and control rats with glucose intragastrically, thus eliminating lower postburn food intake as the causal factor of exaggerated insulin response to IV glucose. Diaphragms from burned rats showed the same increase in glucose uptake in response to 0.1 U insulin/ml in vitro as those of controls, suggesting that the insulin resistance in vivo is not due to a decrease in the capacity of muscle to bind and respond to insulin.


Eyebrow reconstruction in the burn patient. Eyebrow reconstruction in burn patients has been effectively performed in nine eyebrows in six burn patients. The results were excellent in seven of the eyebrows and satisfactory in the remaining two. In the authors' experience, the free hair transplants have had marginal results because of the scarred recipient site, and we recommend the island pedicle graft as an alternative, in selected cases, for facial burn reconstruction. Case summaries, details of the operative procedure, and illustrations are presented.


Hand infections in patients with diabetes mellitus. In a study of diabetic patients with hand infections reviewed at Jackson Memorial Hospital, University of Miami School of Medicine, 20 such diabetic patients with hand infections were found. The most outstanding result was that seven of the 20 had amputation either to control infection or because the function of the extremity was impaired by the remaining ravaged part. Pathologic examination of tissue removed showed the same changes commonly seen in diabetic gangrene of the lower extremity. Electromyographic studies, when done, have been confirmatory of a peripheral neuropathy with delayed nerve conduction studies. The bacterial organisms of the infections were variable, but a predominance of Gram-negative organisms were cultured in twelve of the 20 patients. Early aggressive management, including surgical debridement and intravenous antibiotics, is recommended to prevent unnecessary amputations and improve residual function.


Post-traumatic cysts of soft tissue.

Post-traumatic cysts of soft tissue. Post-traumatic cysts of soft tissue, formed by crushing and shearing strains, usually occur at the junction of the subcutaneous fat and deep fascia. They become filled with serosanguinous fluid and lined with fibrous tissue. Chronic cysts may either remain stable or occasionally expand, much like a subdural hematoma.


Compression hepatic necrosis in a child. A child with compression ischemia of a segment of the liver is described. Such an insult may cause insignificant early abdominal findings and serious delay in the diagnosis may follow. An unusual colonization of the ischemic liver with Salmonella organisms caused sepsis, leading to the patient's demise.


Renal angiomyolipoma: a study of 13 cases. Arteriographic studies are valuable in the differentiation of angiomyolipoma from adenocarcinoma. Herein are described 13 cases of angiomyolipoma, in 10 of which angiographic studies were done. A correct preoperative diagnosis was made in 3 of the 10 cases and partial nephrectomy was done in 2. Since angiomyolipomas are benign tumors therapy differs greatly from that for adenocarcinoma. Early diagnosis of angiomyolipomas can prevent total or extensive nephrectomy and postoperative radiotherapy or cytostatic therapy, which are not necessary and are harmful to the patient.


Ureterocele and pseudoureterocele: cobra versus cancer. The cobra-shaped distal ureter is not pathognomonic of a ureterocele. It may be seen with incomplete distal ureteral obstruction owing to tumor or calculus. The appearance of the wall surrounding the dilated distal ureteral segment is a more important finding to differentiate a ureterocele and a pseudoureterocele. The wall of a ureterocele is thin, while the lucency surrounding a pseudoureterocele is thicker and poorly defined.


Non-obstructive vesicoureteral reflux in adults: value of conservative treatment. Chronic or recurrent non-obstructive urinary tract infection was investigated in 158 adult patients, 39 of whom had vesicoureteral reflux. Conservative, long-term chemotherapy did not eradicate the reflux in these patients. The characteristics of reflux in adults were studied with cystograms, excretory urograms, cystoscopic findings of the ureteral orifices or trigones and the clinical histories of the patients. These data were evaluated and compared to data obtained from adults with chronic or recurrent uncomplicated urinary tract infection and from children with vesicoureteral reflux who were referred to us during the same period. Non-obstructive vesicoureteral reflux in adults may be considered to be congenital in most cases, since the proportion of trigonal anomalies in adults with reflux is equal to that in children and the frequency of abnormalities at the ureteral orifice and trigonal region is significantly more than the frequency noted in control patients with uncomplicated pyelonephritis. Characteristically, excretory urography revealed caliceal scarring in adults with reflux in contrast to children, in whom a normal or dilated pattern of the upper tract was prominent. Recurring renal infection, for which this congenital defect of the ureterovesical valve must be responsible, produces progressive renal damage. Prolonged conservative treatment is of little use and is often destructive in adults with reflux.


The influence of bladder fullness on upper urinary tract dimensions and renal excretory function. Nearly full bladders (375 ml.) produced significantly greater dimensions of the renal calices, pelves and ureters on excretory urograms compared to nearly empty bladders. These dimensions were frequently to the point of being considered pathological dilatations. On planimetry the urographic areas of the pelviocaliceal systems decreased by 43 per cent on the right side and 38 per cent on the left side when the nearly full bladder was compared to the nearly empty bladder in 10 patients. Renal excretory function also was affected by nearly full bladders. Urea clearances after 1 hour were 24 per cent lower and creatinine clearances were 9 per cent lower when starting with a nearly full bladder as compared to starting with an empty bladder. The implications of these findings are of potential significance with respect to 1) interpretation of excretory urograms and 2) chronic urine holding in patients with recurrent urinary tract infections, impaired renal function and/or urolithiasis.


Experience with primary carcinoma of the male urethra. We reviewed 23 cases of primary carcinoma of the male urethra and compared the clinical findings, treatment and results to the experiences previously reported. Patients with lesions of the pendulous urethra managed by appropriate amputation of the penis with ilio-inguinal node dissection for groin metastases had a good prognosis, whereas patients with lesions of the bulbo-membranous or prostatic urethra had a poor prognosis. Despite occasional successful results with conservative surgical excision and over-all poor results with radical excision the generally extensive nature of such tumors necessarily makes radical excision the treatment of choice.


Surgical treatment of Peyronie's disease: a new approach. We treated 12 patients with intractable Peyronie's disease with a new approach based on simple incision of the fibrotic plaque(s) and stenting of the corpora with penile implants. Infection in 1 case necessitated removal of the prostheses, while the remaining 11 patients had satisfactory functional and anatomical results. The procedure is indicated for patients with 1) Peyronie's disease and impotency, 2) normal potency and extensive disease and 3) normal potency and localized disease in selective cases. In this series insertion of the penile prostheses did not change sexual prowess in previously potent patients.


Considerations for management of large retroperitoneal tumors: use of the modified thoracoabdominal approach. Massive retroperitoneal tumors have been resected successfully from 20 patients by means of the modified thoracoabdominal approach. Of these 20 patients 19 had primary non-seminomatous testicular cancer and 1 had a primary leiomyosarcoma. Fourteen patients are currently free of tumor. Salient features of the successful management of these patients have been the use of intensive chemotherapy before attempted surgical resection, aggressive surgical efforts that may necessitate major vascular resections and, in particular, use of the modified thoracoabdominal approach, which is described and illustrated in detail.


High dose cyclophosphamide as an adjunct to radiotherapy for advanced seminoma. Two patients with far-advanced seminoma of the testis were given single intravenous injections of high dose (1.5 and 2.0 gm. per m.) cyclophosphamide. Both patients experienced prompt, dramatic objective regressions without severe toxicity. Definitive radiotherapy, deemed technically unfeasible before cyclophosphamide administration, was administered subsequently. Long-term complete remissions (more than 16 and 28 months) have been attained in both patients. High dose cyclophosphamide may prove useful in selected patients with disseminated seminoma.


Followup of irradiated prostatic carcinoma by aspiration biopsy. Of 66 patients with irradiated prostatic carcinoma 53 were controlled regularly by repeat aspiration biopsy every 6 months. Local sterilization was achieved in 43 per cent but the results of combined radiotherapy (endocrine therapy plus irradiation) were only 8 per cent more favorable than those in patients treated by radiotherapy alone. Thus, endocrine therapy is not warranted before the radiation effect is evaluated. Post-radiation treatment should be determined by the clinical and bioptic findings.


Large prostatic hematomas associated with carcinoma of the prostate. Two cases are presented of large prostatic hematomas secondary to adenocarcinoma of the prostate. The similarity of these cases at examination to prostatic abscesses complicated diagnosis and delayed treatment. To avoid diagnostic error it is important to remain alert to this atypical presentation and to remember the necessity to obtain adequate biopsies.


Mercaptopropionylglycine: a progress in cystine stone therapy. During a 4-year period 9 cases of severe recurrent cystine stones and cystinuria were treated with mercaptopropionylglycine. The oral long-term administration revealed the high effectiveness of the drug and resulted in no further stone formation. Mercaptopropionylglycine is free of side effects and more effective than D-penicillamine.


Oxalate stone disease after intestinal resection. There have been 543 jejuno-ileal bypass patients screened for the presence of urinary calculi 1 to 6 years postoperatively. Of these patients 9 per cent have had 1 to 2 calculi during the followup and 3 per cent have had multiple calculi. Ninety-four per cent of the recovered calculi consisted entirely of calcium oxalate. Seven patients had a history of stones before the bypass, 6 of whom have had additional stones postoperatively. To define the conditions associated with stone formation in these patients measurements of serum and urinary oxalate concentration, urinary calcium oxalate saturation, urinary crystal size distribution, and the rates of intestinal oxalate absorption and urinary crystallization have been performed on patients who did and did not have stones postoperatively. On the basis of these studies it appears that the patients in whom stones formed differ from those in whom they did not form only in the rate of urinary crystallization and in the number of large crystal particles present in the urine. Evaluation of current therapeutic modalities in terms of the capability to correct these stone-forming characteristics and to reduce actual calculus formation reveals that the only successful regimen is that which includes an extreme reduction of oxalate ingestion.


Self-retaining loop nephrostomy.

Self-retaining loop nephrostomy. A self-retaining loop nephrostomy with an inflated balloon in the renal pelvis to prevent accidental extraction or displacement is described. An additional feature of this tube is a plug that may be positioned to promote maximal irrigation of the kidney with a stone solvent or to allow urine to flow from 1 or both ends of the loop.


A new operative fiberpyeloscope.

A new operative fiberpyeloscope. We describe a flexible fiberpyeloscope with which it is possible to extract renal pelvic and caliceal stones easily. The tip of the fiberpyeloscope can be deflected 90 degrees up or down from the basic position with a hand-manipulated angle deflector know on the fiberpyeloscope grip. This flexibility allows the inside of the renal pelvis to be observed clearly from every direction. Specially designed stone forceps can be inserted through the channel of the fiberpyeloscope into the renal pelvis to grasp pelvic stones under direct visual observation. The fiberpyeloscope has been used in 4 cases of renal pelvic stones in which the pelvis was exposed by a subcostal flank incision. The stones were extracted successfully with the fiberpyeloscope, which was introduced through a small incision on the pelvis.


Surgical treatment of the massively dilated ureter in children. Part I. management by cutaneous ureterostomy. One of the major therapeutic challenges facing the pediatric urologist is the massively dilated ureter. When conservative measures, such as relief of obstruction or treatment of infection, have failed or are likely to fail, surgical treatment must be directed at the massive dilatation itself. These circumstances were encountered in 366 massively dilated ureters in 244 children during a 10-year period. Loop and/or terminal cutaneous ureterostomy was used to manage 125 of these ureters in 74 children. Indications for temporary non-intubated proximal urinary diversion included uncontrolled infection, sepsis, azotemia, significant ureteral redundancy and tortuosity, and questionable over-all renal function. Advantages of loop ureterostomy included more proximal drainage and less stomal problems but terminal ureterostomy required a significantly lesser number of surgical procedures in reconstructing the urinary tract. Temporary splinting of the ureter in dry ureteral reimplantations has diminished markedly the incidence of ureterovesical complications. No instances of permanent vesical contracture were noted after long periods of defunctionalization. After initial reconstruction of 47 cutaneous ureterostomies good results by all parameters were obtained in 68 per cent. Additional surgical procedures in selected initial failures have resulted in a final success rate of 85 per cent.


Carcinoma in the defunctionalized bladder: report of a case and review of the literature. There are few reports in the literature of carcinoma developing in the post-diversionary bladder. The sixth such case is reported and the pertinent literature is reviewed. All cases of carcinoma in defunctionalized bladders have been associated with chronic inflammation of the bladder and all tumors became apparent within 4 years of diversion. Simple cystectomy at the time of diversion should be considered for patients with a long history of bladder inflammation.


Studies on the role of sympathetic nervous system in the mechanism of essential hypertension. In order to investigate a role of sympathetic nervous system in the mechanism of blood-pressure elevation in essential hypertension, urinary catecholamines, serum dopamine-beta-hydroxylase (DBH) activity and a pressor response to infused noradrenaline (noradrenaline response) were measured, in the patients with essential hypertension, before and 2 weeks-rest after hospitalization or following salt restriction. In addition, plasma renin activity (PRA) and water-sodium contents were determined and a correlation between these variables and noradrenaline excretion, serum DBH or noradrenaline response was observed. A blood pressure fall after hospitalization was associated with a decrease of urinary noradrenaline and serum DBH, and there was a significantly positive correlation between the changes in blood pressure and those in urinary noradrenaline or in serum DBH. A significantly adverse correlation was found between plasma volume and the amounts of urinary noradrenaline excretion. The changes in noradrenaline response was negatively correlated with those in urinary noradrenaline excretion. In addition, noradrenaline response was correlated positively with plasma volume, extracellular fluid volume and total exchangeable sodium and negatively with PRA. Following salt restriction, a fall of the blood pressure was associated with an elevation of urinary noradrenaline excretion. The patients with more marked blood pressure fall showed a higher increase of urinary noradrenaline, and a significant correlation was found between the changes in these two variables. Noradrenaline response was significantly reduced, although it was not correlated significantly with noradrenaline excretion. In these experiments, adrenaline, unlike noradrenaline, did not show any obvious changes. These findings suggested that an excessive sympathetic nerve activity caused an elevation of blood pressure in the labile type of essential hypertension. It was demonstrated that a sympathetic nervous function was dependent on sodium intake and that there exisited a close relationship between noradrenaline response and water-sodium contents or PRA.


Comparisons of body fluid volumes, plasma renin activity, hemodynamics and pressor responsiveness between juvenile and aged patients with essential hypertension. Body fluid volumes, cardiac output, PRA and pressor responses to angiotensin II (AT) and norepinephrine (NE) were compared between untreated patients with essential hypertension aged younger than 35 (EH-I) and those aged older than 36 years (EH-II). Men blood volume, total body water and extracellular volume were not significantly different between the patients with essential hypertension and normotensive subjects. There were no difinite differences in each volume between the EH-I and EH-II patients either. However, the distribution of blood volume was significantly larger in the essential hypertensive patients than in the normotensive subjects, suggesting that the changes in blood volume might not be homogenous in essential hypertension. In addition, blood volume was noted to have a significant inverse correlation with PRA. Cardiac output at rest was slightly but not significantly less in the EH-I and EH-II groups than in the normotensive group. A decline in blood pressure following 'bed-rest' was accompanied by a decrease in total peripheral resistance index (TPRI). Thus, elevated peripheral vascular resistance seems to be responsible for the mild to moderate hypertension even in the younger patients. PRA and its increases in response to standing or furosemide were normal in the EH-I patients, while they were markedly suppressed in the EH-II patients as compared to the age-matched normotensive subjects. In addition, PRA had a significant inverse correlation with the blood pressure and the scores of the severity of hypertension in the patients with essential hypertension. Thus, it seems likely that low renin in essential hypertension is secondary to long-lasting hypertension. Pressor response to AT significantly correlated with mean blood pressure and that to NE did so with 24 hours' urinary sodium excretion in essential hypertensive patients. The influence of aging on the pressor responses were obscure: the relationships of the pressore responses to blood pressure or to urinary sodium excretion were not different between the EH-I and EH-II groups. The examinations were repeated in 16 patients with essential hypertension (16 to 48 year-old) in 11 to 30 days after the initial study. Twelve of the 16 patients had declines in blood pressure and TPRI at the second study. In 7 of the patients whose blood pressure declined following 'bed-rest', there were significant decreases in pressor response to AT and in blood volume and a significant increase in PRA (group A). The other 5 patients showed a significant decrease in PRA and an enhanced pressor response to NE (group B). The blood volume in the group A was significantly larger than that in the group B at the initial study. It is suggested that the cause of essential hypertension is not homogeneous in that the increased vascular resistance may have been attributed to sodium excess in some patients and to an increased sympathetic activity in others. Some additional factors remain to be taken into account to clarify the complicated aspects of essential hypertension.


Pathogenesis of spontaneous hypertension as a model for essential hypertension. Hypertension in spontaneously hypertensive rats (SHR) develops initially without any obvious organic lesions, and mainly with hemodynamic alteration due to increased peripheral vascular resistance. It is then followed later by various cardiovascular complications such as stroke. These facts indicate that this spontaneous hypertension is very similar to essential hypertension in man. Studies on the pathogenic mechanisms of spontaneous hypertension up to the present have revealed the following points. (1) This hypertension is genetically transmitted to the offspring in an additive mode by a relatively small number of major genes; (2) Environmental factors such as stress and salt-loading accelerate the hypertension; (3) Parabiosis between SHR and normotensive rats offered no positive evidence indicating the involvement of any strong humoral factors; (4) Assays on adrenal and thyroid hormones have suggested that this hypertension is not a simple endocrine hypertension; (5) The destruction of the central nervous system or sympathectomy on blood pressure or peripheral vascular resistance, as well as the recording of spontaneous sympathetic discharge, etc. have indicated the positive involvement of the autonomic nervous system in the development of this hypertension; (6) Changes in the enzyme activities of the central nervous system and in the central responses to various candidates of central neurotransmitters suggested that 'noradrenergic inhibitory mechanisms for blood pressure regulation in the brainstem' (Yamori, Lovenberg and Sjoerdsma, 1970) might be insufficient and result in the initial enhancement of peripheral vasomotor tone causing labile hypertension; (7) Noradrenalin turnover study of the heart and hindlimb perfusion experiments indicated that the neural factor was mainly involved in the development or the early stage of hypertension; this finding was further supported by the increased noradrenalin level or dopamine-beta-hydroxylase activity in the blood; (8) Histometrical studies indicated that the structural component of the peripheral vascular resistance stabilized the hypertension; (9) The initial neurogenic factors and successive involvement of nonneurogenic factors are relayed by the acceleration of protein metabolism of the vascular wall ('adaptive metabolic change', Yamori, 1974). This acceleration is commonly detected by amino acid incorporation study in both spontaneous and other experimental hypertension; (10) Increased lysine incorporation into the noncollagenous protein of the mesenteric arteries detected in the prehypertensive SHR was experimentally confirmed to be influenced by neural innervation. This confirmation indicated the importance of such a trophic effect of the nervous system on the structural alteration of blood vessels in the development of hypertension (neurovascular linkage, Yamori, 1975)...


The role of the left atrium in the development of pulmonary hypertension -- experiment with dogs --. The experiments were performed on dogs to confirm the hypothesis that the left atrium plays an important role in raising the pulmonary arterial pressure through the autonomic nervous system. In Experiment I, the left auricular resection of dogs resulted in elevated pulmonary arterial pressure. In Experiment 2, 6% Dextran infusion was performed on four groups of dogs: (1) intact dogs (2) dogs with the left auricular resection (3) with the cardiac denervation (4) with both the left auricular resection and the cardiac denervation. The pulmonary arterial resistance increased after the infusion in the dogs with simple left auricular resection, but was relatively unchanged in all others. The result shows that cardiac denervation prevents the increase of the pulmonary arterial resistance due to the left auricular resection. From this we can conclude that the left auricular resection causes an increase in the pulmonary arterial resistance through the autonomic nervous system.


A study on sinoatrial conduction in the aged. Sinus node response to premature atrial stimulation (PAS) was studied in 30 aged patients (group I:21 cases without sinus node dysfunction, group II:9 cases with sick sinus syndrome). Sinoatrial conduction time (SACT) was calculated according to the method reported by Strauss et al. As coupling interval of PAS decreased, there noted 5 patterns of sinus node response. In Type A, return cycle length (RC) initially increased (fully compensatory pause) and then became constant; RC progressively increased either along the compensatory reference line (Type B1) or along the less-than-compensatory line (Type B2) without being constant. In 2 other cases, RC showed similar pattern as in Type A up to 32-37% of sinus cycle length where they showed abrupt prolongation below or above the compensatory reference line (Types C and D, respectively). The incidence of abnormal response (Types B1, B2, C, and D) was high both in group I (38.0%) and group II (33.3%). The calculated SACT in group I showed a high correlation with basic sinus cycle length, while no correlation was observed in group II. The possible factors influencing return cycle length and significance of frequent observation of abnormal sinus nodal responses in the aged subjects were discussed.


A clinicopathological study on mitral ring calcification. The incidence, the size of mitral ring calcification (MRC) and its relation to the mitral valve disease were examined in a total of 600 consecutive autopsy cases of over 60 years of age. (1) The incidence of MRC was 10% (60 cases among 600), and the sex difference was statistically significant with 6.7% in male and 13.3% in female (p less than 0.01). The age was 82 years in average, and an increase of its incidence with aging was significant only in female (p less than 0.005). (2) MRC was found in the annulus of the posterior mitral leaflet. The length of MRC was 12.5 +/- 10.3 mm in male, and 31.8 +/- 23.5 mm in female (p less than 0.01). Large MRC more than 30 mm were found in 1 man and 19 women. (3) The relationship between the length and cross sectional diameter of the MRC showed a positive correlation (r=0.75). Three cases of mitral stenosis or combined stenosis and regurgitation belonged to the extremely large MRC group. (4) There were 27 cases with systolic murmur; 3 holosystolic and 24 ejection type. In large and small MRC groups, systolic murmurs were found in 70% and 33% (p less than 0.05), MRC extending to the anterior leaflet in 65% and 2.5% (p less than 0.005), moderate to severe calcification of the aortic valve in 40% and 20% (n.s.), respectively. (5) X-ray films were examined retrospectively, and large MRC was diagnosed in 85%, and incidence of calcification in the other soft tissues (trachea, bronchi, costal cartilage, aortic arch, thoracic and abdominal aorta) was higher in large MRC group than in the control group (87 cases) without MRC (p less than 0.005).


Observer variations in the diagnosis of stroke. WHO collaborative study on the control of stroke in the community. Validity and consistency of the diagnosis of stroke and its types were tested with 60 case reports including 15 diguised duplicates, drawn at random from community-based stroke registers. Seven European, 5 Japanese, and 5 other centers participated the test. The diagnosis of stroke as such (regardless of its type) seems to have been established accurately in all the 3 groups of centers; this leads to the conclusion that the incidence rates of stroke as registered in the participating centers were comparable. The diagnosis of the types of stroke was less reliable, since intra-and inter-observer bias was found in the diagnosis of the identical sample of test cases. In some European centers, the type of stroke was rarely determined, unless objective and definitive evidences were available. The Japanese centers appeared to have diagnosed the type of stroke in a relatively more uniform way between centers, however, the consistency of the diagnosis at separate times was lower. Subarachnoid hemorrhage, when diagnosed, was generally based on firmer gounds. These observations were confirmed in a small number of autopsy-verified cases. These varying diagnostic attitudes introduce false differences. Such "softness" of type-diagnosis must be borne in mind when comparison of type of stroke at different times or between populations is attempted.


A clinicopathological study on the papillary muscle dysfunction. A total of 11 cases of papillary muscle dysfunction (PMD) was found among 600 consecutive autopsy (1.8%). There were 5 men and 6 women, with their ages ranging from 64 to 92 years. Auscultation and phonocardiograms revealed holosystolic murmurs in 9 cases and early systolic murmurs in 2. There were accentuated 1st sound in 8 cases, 3rd sound in 7, and 4th sound in 5. PMD was classified into 3 types according to the clinical course and pathologic examinations. In type A (6 cases), myocardial infarction (MI) preceded the occurence of mitral regurgitation (MR) by 3 or 4 years, with pathological verification of old MI. In type B (1 case), MR developed during acute MI. In type C (4 cases), pathological examinations disclosed various degrees of myocardial fibrosis, in which clinical diagnosis was MR of unknown etiology. In a total of 113 cases of MI, 36 cases (32%) showed papillary muscle infarction (PMI), which occurred with significantly high incidence in (1) male, (2) large MI, and (3) subendocardial or lateral MI. Among 36 cases of PMI, 9 cases developed PMD, which showed high incidence in inferior MI and in female. Various other factors concerning PMD and PMI were examined, and it was pointed out that not only PMI but also severe lesions in corresponding ventricular wall were necessary for the development of PMD.


A method for the estimation of peak serum LDH activity based on a single post-peak level after acute myocardial infarction. A new method was developed to estimate the peak serum lactic dehydrogenase (LDH) value in patients with acute myocardial infarction from a single determination of serum LDH activity in the post-peak period (3rd to 5th day after the onset of infarction) using nomogram method based on the monoexponential decay of serum LDH with a decay constant of 0.012 hours-1. To develop this nomogram, the serial changes in serum LDH activities were studied in 30 patients with acute myocardial infarction admitted to the coronary care unit within the pre-peak period. The mean errors in estimation from data of the 3rd, 4th, or 5th day after the onset were acceptably small, 10.5 +/- 1.9%, 14.5 +/- 2.8%, and 15.9 +/- 3.3%, respectively. Furthermore, a correction formula was obtained to improve the accuracy of estimation, since the peak values were underestimated in patients with actual peak values less than 300 units and overestimated in the case of more than 500 units. Estimation in 9 patients of an external sample group confirmed that this nomogram is useful clinically with mean errors of less than 25%.


Effects of salmon calcitonin on SA nodal pacemaker activity and contractility in isolated, blood-perfused atrial and papillary muscle preparations of dogs. Effects of salmon calcitonin on SA node pacemaker activity and contractility were investigated in isolated atrium and papillary muscle preparations which were perfused with arterial blood led from a carotid artery of the support dog. Calcitonin at a dose range from 0.005 to 0.16 units was injected into the cannulated sinus node artery, which dose-relatedly caused a negative chronotropic and inotropic effect in atrium preparations. This negative effect was not modified by treatment with atropine. On the other hand, in the isolated paillary muscle preparations, an intraarterial calcitonin caused little negative inotropic effect even at higher dose level of 0.16 units. From these results, it is concluded that 1) in chronotropy, calcitonin causes a negative chronotropic effect, and 2) in inotropy calcitonin causes a negative inotropic effect on the atrium but not on the ventricle.


Positive chronotropic and negative inotropic actions of vasopressin in isolated blood-perfused canine atrium. Effects of vasopressin on SA nodal pacemaker activity and atrial contractility were investigated, using 5 isolated, blood-perfused canine atrium preparations. Vasopressin produced a dose-related positive chronotropic and negative inotropic effect, which was not influenced by treatments with an adequate dose of atropine or an adrenergic beta-blocking agent, alprenolol. From these results, it is concluded that vasopressin has a direct stimulating property on SA nodal pacemaker activity and a direct suppressive property on atrial contractility.


Modified magnetorheography. Measurement of cardiac output by a catheter and an externally applied high magnetic field. This study is dealt with a design for measuring cardiac output using a catheter and an externally applied magnetic field with the most minimized trauma. Many trials have yielded the following results. When a high static magnetic field is applied externally to the body and a catheter carrying electrodes at the tip is inserted from the carotid artery cutdown, 2 sensing electrodes, across the lumen of the aortic arch, at a little larger electrode distance than the lumen can detect the greatest flow signal. Since the biggest noises in the signal are ECG, they can be cancelled to a great extent by the reversed deflection of the ECG which is detected with cancelling electrodes placed at the left chest surface point geometrically symmetrical to the ascending aorta with respect to the center of the heart. Clamping the flow signal to zero level during diastole leads to the remodulation of D-C level in the flow signal and to the reduction of zero drifts. The flow signal produced by giving known volume to the ascending aorta via a catheter can be used for the calibration of the flow measuring system.


Studies on the coronary circulation by a simulation method. Some aspects of the control mechanism in the coronary circulation were investigated by using analog simulation. The simulation is designed to separate passive or mechanical factor from entire influence on the change in coronary flow consisting of passive and active factors, under different hemodynamic conditions. Simulated waveform was very similar to the blood flow pattern of the left circumflex artery actually obtained by an electromagnetic flowmeter. Pressure flow relationship was almost linear. Coronary flow increased with rise of aortic pressure, with the influence of active factors exceeding greatly that of the passive factors. When the heart rate was increased, the decrease in coronary flow due to the passive factors themselves was found. After the occlusion of the coronary artery the slight reactive hyperemia due to only passive factors was observed in the simulated flow.


Prolongation of ventricular action potential due to sympathetic stimulation. The changes of monophasic action potential durations due to stellate stimulation for the period of 3 sec were studied in dogs with suction electrodes from the anterior surface of the right ventricle and the posterior surface of the left ventricle. Prolongation of monophasic action potential duration was observed from the period of 2 to 3 sec during stimulation to that of 10 to 20 sec after the termination of stimulation. Prolongation of monophasic action potential duration due to right stellate stimulation was predominant in the right ventricle and that due to left stellate stimulation was predominant in the left ventricle. The transient T wave change in the surface electrocardiogram occurring immediately after the beginning of stellate stimulation could be explained by this local difference in prolongation of ventricle repolarization. Since the onset of prolongation of monophasic action potential duration preceded increase in blood pressure following stellate stimulation, this prolongation of monophasic action potential duration did not result from the hemodynamic changes and could be a primary effect of the sympathetic nerve stimulation.


The use of silver-zinc-allantoin powder for the prehospital treatment of burns. We describe our experimental studies of a powder formulated to treat serious burn wounds on-the-scene. The wound powder comprises two parts silver-citro-allantoinate, two parts zinc allantoinate and 96 parts pure allantoin. The back skin of 62 rats was shaved and exposed to actively boiling water for ten seconds, resulting in third degree burns of 20% of the total body surface. Immediately, 1 ml of a culture containing 2 X 10(8) Pseudomonas aeruginosa was applied to the burn. The animals were isolated. Of the 30 control rats, six were powdered with allantoin only. Thirty-two rats were dusted with the silver-zinc-allantoin powder within 15 minutes of burning. Cultures were taken at 48 hour intervals. Eighty-seven percent of the control animals died an average of six days postburn. In the treated animals, the mortality was 15%. A mean of 27% of the applied silver (0.35 gm) became incorporated in the eschar. In all control rats, sepsis was detected under the eschar. In treated animals, bacterial concentration fell from an initial average of 5 X 10(4) at 4 hours postburn to 6 X 10(2) at 96 hours.


[Ultrastructural changes in the arterioles in hypertension in man]. Renal tissue obtained by means of biopsy or nephrectomy from 11 patients with various degrees of arterial hypertension was studied by electron microscopy. A distinct correlation was found between the level of arterial pressure and the degree of arteriolar lesions. According to the author, arteriolar damage in hypertension develops in two stages: 1. Hypertrophy of initmal and medial cells and hyperplasia of intracellular organelles. 2. Degeneration of the arteriolar wall with deposition of an electron dense material (hyaline) under the basal membrane and in the intercellular matrix of the media. The first stage may be regarded as an enhancement of the compensatory and adaptive processes in the arteriolar wall. The second stage is a manifestation of irreversible changes associated with the progression of the disease. The sequence is apparently common to all parts of the arteriolar system and to a certain extent it may be considered typical for the development of hyaline arteriolosclerosis. The penetration of blood plasma components and their deposition in the arteriolar wall depends, according to the author, on an increased intercellular and cellular permeability, and hypertension evidently enhances this process.


[Effect of the cholesterol breakdown rate in the body on the dynamics of the development of alimentary hypercholesterinemia in rabbits]. A mathematical equation of the shift of the dynamic balance of cholesterolemia to a new level is substantiated. A mathematical analysis of the results of experimental studies is presented. A correlation was established between the mechanism of the development of alimentary hypercholesterolemia in rabbits and the half-life period of cholesterol in the body (T1/2 per day). It is demonstrated that an equilibrium level of hypercholesterolemia (Xeqn,ch, mg%) is directly proportional to the speed of cholesterol accumulation in blood (Vch, mg%/day) and reciprocal to the constant rate of cholesterol decomposition in the body.


[Importance of heparin in thrombin-131I clearance and in the complex formation processes in animals under experimental restoration of the function of the anticoagulating system]. Thrombine-I131 infusion to animals receiving Linethol with vitamin A in the presence of both natural and atherogenic diets accelerated the clearance of thrombine-I131 and elevated the level of nonenzymatic fibrinolysis in the blood and tissue of the liver and lungs. In addition to the administration of thrombine-I131, intravenous heparin injections to animals kept for a long time on atherogenic diets and receiving Linethol with vitamin A provided for a still greater acceleration of thrombine-I131 clearance, which manifested itself in its faster absorption from blood by the liver in the form of a thrombine-I131 -- heparin complex, in an increasing total fibrinolytic activity and of its nonenzymatic fibrinolysis in blood plasma and tissues of the liver and lungs. This resulted in a partial restoration of the function of the anticoagulation system and an increase of the functional activity of the hepatic tissue directed at the consumption of the thrombine excess from the blood flow.