Internal pancreatic fistulas: pancreatic ascites and pleural effusions. Thirty-four patients seen over a 10-year period with internal pancreatic fistulas are reported. In 22 patients the fistula was into the peritoneal cavity and they presented with pancreatic ascits. In 7 patients the fistula tracked up through the mediastinum into a pleural cavity, and they presented with pancreatic pleural effusions. Five patients presented with both pancreatic ascites and pancreatic pleural effusions. Diagnosis was made by finding a markedly elevated amylase and protein content in the ascitic and pleural fluids. Serum amylase was usually, but not always, elevated. Over one half of the patients had no history of inflammatory pancreatic disease. Initial treatment was non-operative using nasogastric suction, diamox, atropine, and multiple paracenteses or thoracenteses. This was successful in 48% (12/25). If non-operative therapy failed, surgery was performed to drain or resect the internal fistula. Surgery was successful in 82% (14/17). The internal pancreatic fistula was successfully demontrated in most instances by preoperative, operative, or postmortem pancreatography, or by gross observation at the time of surgery.


Perforations and foreign bodies of the rectum: report of 28 cases. A series comprised of 28 patients (five with perforations of the recto-sigmoid colon and 23 with lodged rectal foreign bodies) is presented. The symptomatology, physical, laboratory and x-ray findings are described. Methods of management are discussed, with emphasis on the operative management of perforations and the conservative approach to retained foreign bodies. It is felt that these protocols will be useful to physicians who see this practice less frequently. X-rays of two more unusual cases are depicted. A thorough review of the literature is also presented. This is the largest reported series of patients with retained rectal foreign bodies and/or perforations. The series includes two female patients, a heretofore unreported occurrence.


Effect of irradiation on the canine exocrine pancreas. Effects of irradiation on the pancreas was studied in 6 dogs receiving a dose equivalent to the biologic effect of 4000 R/6 weeks (with a nominal stnadard dose of 1175 rets) given to patients with Hodgkins disease. After control secretory, histologic and pancreatographic studies, 6 Thomas fistula dogs were subjected to 2400 R tumor dose over two weeks. There was a biphasic response to secretin alone or secretin with cholecystokininpancreozymin. An initial hypersecretion occurred at 2 weeks --volume was increased, but bicarbonate and enzyme output remained unchanged. Thereafter there was a progressive reduction in volume, bicarbonate and enzyme outputs ( greater than 90% after 3 months). Histology showed early ductal reduplication but with progressive fibrosis, features compatible with chronic pancreatitis. Pancreatic insufficiency may contribute to post-irradiation gastrointestinal symptomatology. Close field irradiation of the pancreas results in actual destruction of the parenchyma.


A simple test to identify coarctation of the aorta. Despite the widespread recognition of coartation of the aorta there are still many patients in whome the diagnosis is not made. A simple clinical test which is useful in making the diagnosis in infants and adults, is described. It depends upon the differential color changes between fingers and toes after releasing a manual compression of feet and hands in the elevated position.


Acute bacterial endocarditis: a silent source of sepsis in the burn patient. In the past six years, 35 patients with thermal injuries have died with a diagnosis of endocarditis. The cause of death in 21 of the 22 patients with acute bacterial endocarditis (ABE) was directly related to complications arising from the ongoing sepsis. In only three cases was the diagnosis considered pre-mortem. The endocarditis was located in the right heart in 18, left heart in 9, and both sides in 8 cases. Associated venous thrombi were present in 14 instances, and 10 of these were septic thrombi. Staphylococcus was the primary organism in the blood in 17 of 22 patients with ABE. Clinically audible murmurs were present in only two patients. In no instance was ABE superimposed upon previously existing valvular disease. ABE can serve as a silent source of sepsis in the burn patient. The diagnosis should be suspected with persistantly positive blood cultures, especially for Staphylococcus aureus, in any burn patient in whom no other foci of sepsis can be identified. Vigorous methods of diagnosis and specific treatment are recommended.


Use of an arteriovenous fistula for treatment of the severely ischemic extremity: experimental evaluation. Experiments were performed on obligatory bipeds to study the effects of an arteriovenous fistula on a devascularized ischemic limb. Retrograde flow of arterial blood entering the venous system by way of an arteriovenous fistula was demonstrated. Venous valves appeared not to interfere with retrograde arterial flow. The data from these experiments indicate that a "Y" type arteriovenous fistula can lead to functional revascularization in the ischemic limb with arterial obstruction. The dual mechanism of retrograde arterial flow in venous channels and the stimulation of collateral flow adjacent to the fistula seemed to be critical factors. Since a peripheral arteriovenous fistula is a potent stimulus to arterial collateralization in the extremity, its application is worthy of consideration in certain selected patients with advanced and otherwise inoperable arterial occlusive disease.


A clinical and anatomical study of anomalous terminations of the common bile duct into the duodenum. Termination of the common bile duct into the duodenum was studied in 1000 patients by operative cholangiograms obtained from 5 different San Francisco Bay Area hospitals. The results indicate the strong probability that the duodenal biliary papilla is anomalously placed in at least 13% of the 1000 patients studied. Comments relative to the importance of this fact to surgeons and radiologists are made, and suggestion of a possible causative factor for the anomalies is proposed.


Clinical and laboratory experience with heparin-impregnated silicone shunts for carotid endarterectomy. Our experience with use of a Silastic shunt for carotid endarterectomy is reviewed briefly, and the complication of shunt thrombosis despite intraoperative administration of heparin is noted. Of obvious importance are the reduction of blood flow and the possibility of embolization caused by accumulating thrombus. Shunt thrombosis has been abolished by the use of heparin-impregnated Silastic shunts. In experiments in dogs, such heparin-treated shunts showed greater thromboresistance than did untreated shunts.


The effect that time, touch and environment have upon bacterial contamination of instruments during surgery. Hemostats were evaluated for frequency of contamination and such contamination was correlated with increasing operating room exposure time. The studies were performed under surgical conditions in operating rooms with and without laminar air flow. The study was also designed to show whether contamination of hemostats were influenced by the scrub nurse's handling. Hemostats were more frequently contaminated in the conventional operating room without laminar air flow (P less than 0.001). Handling by the scrub nurse's gloved hand statistically increased the number of contaminated hemostats (P less than 0.01). Laminar air flow reduced the frequency of contamination statistically (P less than 0.001) to a point where time and touch by a gloved hand of the scrub nurse were not important factors.


Retrograde venous cardiac perfusion for myocardial revascularization: an experimental evaluation. This study evaluates cardiac function in dogs during retrograde perfusion through the coronary sinus. Five hearts perfused retrograde in an ex vivo apparatus demonstrated rapid and marked increases in weight and perfusion pressure, became hemorrhagic, and contracted poorly within one hour. Five similarly perfused hearts treated with phenoxybenzamine experienced no increase in weight or perfusion pressure and maintained good color and contractions for up to one hour. Five additional hearts treated with phenoxybenzamine did not develop hemorrhage, edema, increased weight, or increased perfusion pressure but could maintain the systemic circulation for only brief periods after 15 minutes of intermittent cardiopulmonary bypass support. We conclude that cardiac viability can be maintained with retrograde perfusion enhanced with alpha blocking agents. However, hearts so perfused cannot maintain adequate systemic pressure. The data suggests that extensive myocardial revascularization through the retrograde venous route would be ineffective.


Comparison of patients with coronary artery or valve disease: intraoperative differences in blood volume and observations of vasomotor response. A review of 296 patients undergoing cardiac operations has shown that those with coronary artery disease have a blood volume deficit. The 148 patients with valve disease had a normal blood volume of 78 ml/kg (normal range, 68--88 ml/kg), while the 148 coronary artery disease had a blood volume of 69 ml/kg (p less than 0.001). Infusion of plasma prior to cardiopulmonary bypass as well as the total transfusion required afterward to maintain blood pressure indicated an important clinical difference in these two groups. Another finding was that the requirement for a drug to control blood pressure prior to use of cardiopulmonary bypass was greater in the coronary patients (p less than 0.01). Comparison of the requirement for a hypotensive agent before and after bypass showed a greater predictability in the valve group. This experience leads us to conclude that patients with coronary artery disease and angina not only have a low blood volume, but they also have a marked vasoactive lability which shows up in their hemodynamic response to the conduct of an operation and to anesthesia.


Constant-pressure coronary artery perfusion during aortic valve operations. We considered the theoretical differences between the normal relationships of coronary blood flow and perfusion pressure in the working heart and those obtained with continuous, steady-flow perfusion by a roller pump during aortic valve replacement. Steady pump perfusion should deliver less blood flow to the endocardium because: 1. For the same mean artery perfusion pressure, the average coronary blood flow is less with constant-flow pump perfusion. 2. With constant pump perfusion, pressure would be excessively high during systole, and during diastole it would be significantly lower than the mean perfusion pressure. Instantaneous pressure and flow were measured in the left coronary artery in 8 patients undergoing aortic valve replacement, employing either roller pump perfusion or a gravity flow system to provide a steady pressure source. Although we did not attempt to demonstrate improved endocardial flow, the mean left coronary flow was always greater with gravity perfusion (297 versus 153 ml/min), lending support to the theoretically proposed differences between the two perfusion methods.


Method of managing the small aortic annulus during valve replacement. In a series of 130 patients undergoing aortic valve replacement, 20 had the ascending aorta enlarged with a Dacron patch. Eight of these required division of the annulus with extension of the incision inferiorly to the anterior leaflet of the mitral valve. The resulting separation of the annulus allowed a larger size valve to be inserted. Glutaraldehyde-fixed procine heterografts were used in all patients having the annulus enlarged. No deaths occurred in those patients having annular enlargement, and the post-operative studies show no evidence of mitral valve dysfunction.


The superior approach for correction of the supracardiac type of total anomalous pulmonary venous return. An alternative approach for correction of supracardiac (type I) total anomalous pulmonary venous return is described. A median sternotomy is used. The posterior wall of the left atrium and the common pulmonary venous trunk are exposed through the transverse sinus. A direct anastomosis between these structures, ligation of the systemic-venous connection (vertical vein), and closure of the interatrial septal defect results in a one-stage repair. In our experience with the supracardiac anomaly in 20 patients, we have found that this approach consistently affords better exposure than other techniques currently in use for surgical correction of this anomaly.


Intraoperative placement of central venous pressure monitoring cannulas. A method for placement of central venous pressure monitoring and fluid administration catheters is described which we have found quite useful in our practice for the past three years in patients undergoing sternotomy incisions, most commonly for cardiac procedures.


Left ventricular wall rupture after mitral valve replacement: report of successful repair in 2 patients. Left ventricular wall rupture after mitral valve replacement, though uncommon, is a disastrous complication when it does occur. We have experienced this problem in 2 separate instances. Successful treatment was accomplished by suturing a large prosthetic patch over the entire area of laceration and hematoma.


Giant fibrovascular polyp of the esophagus. A case of giant fibrovascular polyp of the esophagus with a review of the literature is presented. The lesion is benign and pedunculated and may attain giant proportions. Symptoms are related to esophageal obstruction. Death by asphyxia can occur. Small lesions can be removed endoscopically with a snare. Larger lesions should be excised using a formal surgical approach.


Failure of the Jatene procedure in a patient with D-transposition and intact ventricular septum. Anatomical correction by arterial "switch" procedure was performed in a patient with transposition of the great arteries, intact ventricular septum, and left ventricular hypertension due to distal pulmonary stenosis. The patient died from left ventricular failure. The reasons for the failure of this procedure are discussed.


[Observations on varions electrovectocardiographic aspects of the W-P-W syndrome]. The  purpose of this study was to clarify certain electrovectorcardiographic aspects suggestive of heart disease associated with W-P-W syndrome. Seventy-six vectorcardiograms with W-P-W features were analyzed. The curves were obtained by Grishman's cube system and in 8 cases by Frank's method, as well. In addition, the conventional electrocardiograms corresponding to 55 vectorcardiograms, were studied. Not all the electrocardiographic and vectorcardiographic tracings were recorded simultaneously. The W-P-W syndrome was classified as type A when the electrical records suggested a pre-excitation phenomenon in the left postero-superior septal mass, probably with a partial "wave jumping" toward the right anterior septal mass. The W-P-W syndrome was judged to be of type B when the electrical tracings showed a pre-excitation in the right anterior septal mass, probably with a partial "wave jumping" toward the left posterior septal mass. The results of this study permit the following conclusions: 1. It seems justified to assert that the calssification of the W-P-W syndrome must be realized deductively on the basis of the sequence of the ventricular activation and of the heart position. 2. An interval of 30 msec. or more between the end of initial slurring and the vertex or middle point of the R loop permits inferring the coexistence of left ventricle hypertrophy. 3. The presence of an inactivable zone due to myocardial infarction should be suspected on the basis of segmentary irregularities or distortions of the electrical curves, while extensive deformations are more suggestive of myocardiopathy. 4. The duration of terminal slurrings does not depend on that of the initial ones. However, when the initial slurrings are very prolonged, the terminal ones are relatively short. 5. In the presence of W-P-W syndrome, the primary ventricular repolarization changes cannot be considered as pathognomonic of any associated cardiopathy because they are often provoked by drugs.


[Modifications of the left ventricular function as the result of severe and chronic reduction of the preload]. In order to evaluate the effect which the cronic, severe, and constant decrease of the preload of the left ventricle has on the contractile function of this chamber, 15 cases, with the strict technical conditions and permitted the planned measurements, were taken from 86 studies of ventricular function in patients with tight mitral stenosis. The following parameters were calculated; the ejection fraction, the maximum DP/dt, the zero point diastolic pressure, the final diastolic pressure, the diastolic AP, the mid-diastolic pressure, the diastolic compliance index, and the passive elastic module of the left ventricle, the pulmonary pressure, the cardiac output, systolic output, and the changes produced by the infusion of Isopropilaminoetanol. It was concluded that the effects of cronic and severe pre-load decrease are: 1. Moderate decrease of the cardiac output with low systolic output and high cardiac frequency. 2. Conserved inotropic reserve. 3. Normal ejection fraction. 4. Normal diastolic tension behavior. 5. Increased compliance and special behavior of the passive elastic module.


[Hemodynamic evaluation in acute myocardial infarct. Application to the treatment of contractile insufficiency syndromes of the left ventricle]. Even though the coronary care units have reduced to a minimum the mortality due to arrhythmias, the syndromes of left ventricular failure are responsible for the greatest part of hospital deaths in patients with acute myocardial infarction. The poor results depend upon the extensive destruction of left ventricular mass. The management in these cases should be directed to improve the performance of viable muscle as well as to preserve thejeopardized ischemic myocardium that is potentially viable. These goals may be adequately pursued by continuous hemodynamic characterization of left ventricular function. The experience of the Coronary Care Unit of the Instituto Nacional de Cardiología de México in the study of 30 of these patients is presented. Hemodynamic evaluations were performed by means of a Swan-Ganz catheter and cardiac output determinations by the thermodilution technique. The studies may be performed with a minimum of risk. Central venous pressure measurements do not adequately indicate the status of the left ventricle. Its function may be evaluated by the use of end diastolic pulmonary artery pressure which reflects, quite accurately, the left ventricular filling pressure in these patients. Continuous hemodynamic monitorization facilitates the proper manipulation of the determinants of ventricular performance (preload, afterload, cardiac rate and contractility) and permits an attempt to improve the balance between available oxygen and myocardial oxygen requirements. Hemodynamic studies and ventricular function curves are presented in selected patients with acute myocardial infarction. The mortality due to left ventricular failure and cardiogenic shock in patients with acute myocardial infarction remains extremely high. However, it is only through the early recognition by continuous hemodynamic monitorization and the aggressive management of the patient with incipient left ventricular failure that the number of survivors may be increased.


Further investigations on the effects of ergometrine and other ergot derivatives following injection into the nucleus accumbens of the rat. The influence of different pretreatments upon locomotor stimulation, induced by injection of ergometrine into the nucleus accumbens of rats, was investigated. The noradrenergic antagonists phenoxybenzamine and propranolol and the serotonin antagonist methysergide produced no clear changes. Reserpine, alone or in combination with alpha-MPT, considerably shortened the delay between injection of ergometrine and start of locomotor stimulation. Ro-DOPA, but not Ro-5-HTP, clearly antagonized the locomotor stimulation. The effect of ergometrine was strongly diminished following injection of haloperidol directly into the nucleus accumbens. A strong inhibition was also observedfollowing intracerebral administration of the imidazoline derivative (3,4-dihydroxy-phenylamino)-2-imidazoline (DPI), but not after injection of the structurally related compound clonidine. DPI by itself and also the ergot derivatives ergocornine, bromocryptine, LSD, dihydroergotamine and methysergide in doses 5--10 times as high as that of ergometrine failed to produce locomotor stimulation following injection into the nucleus accumbens. The results are discussed, especially with regard to the role of dopamine.


[Systolic intervals in disorders of intraventricular conduction]. The duration of the systolic intervals in 50 patients was studied. They were divided into the following groups of 10 each: 1) with normal intraventricular conduction; 2) with advanced right bundle branch block; 3) with advanced left bundle branch block; 4) with left anterior fascicular block, and 5) endocardial pacemaker in the right ventricle. The systolic intervals do not suffer modification in the presence of a right bundle branch block or a left anterior fasicular block. The left bundle branch block produces changes fundamentally in the preejection period at the expense of its two components. There also exists elevation of the systolic quotient. If the results obtained in various studies in the same patient are compared, it is possible to follow the evolution of ventricular alteration, but it is not valid, to make a comparison with the ideal values obtained in subjects with normal conduction. For those patients with a pacemaker in the right ventricular endocardium, the same criteria are applied as for the left bundle branch block. The shortening of the ejection period suggests a decrease in the volume of ventricular ejection.


Anaphylactic hypersensitivity in sheep lung in vitro: (vascular Schultz-Dale response and bioamine liberation). Two aspects of anaphylactic hypersensitivity in sheep lung were studied. Isolated pulmonary vein constricted in response to histamine, acetylcholine, dopamine and bradykinin, whereas serotonin or specific antigen in sensitized tissue caused relaxation of the vessel. Tryptaminergic antagonists did not inhibit vessel relaxation caused by either serotonin or antigen. Antigenic challenge of chopped sheep lung caused significant liberation of serotonin and dopamine but not of histamine. It is suggested that anaphylactic release of serotonin may counteract the inflammatory response in sheep lung; which may explain the relative resistance of sheep to pulmonary hypersensitivity and tryptamine toxicity compared with other species.


Echocardiography of ventricular septal movement in Wolff-Parkinson-White syndrome. Four patients, three with type B Wolff-Parkinson-White Syndrome and right ventricular preexcitation and one with type A Wolff-Parkinson-White Syndrome with left ventricular preexcitation, were studied echocardiographically. One of the patients with type B Wolff-Parkinson-White Syndrome was also studied while in intermittent normal conduction and right ventricular posterior preexcitation. Three patients with right ventricular preexcitation demonstrated early posterior systolic ventricular septal motion shortly after the on set of the delta wave of the QRS complex and later systolic paradoxic ventricular septal motion. During normal conduction in the patient with  intermitten right ventricular preexcitation the early systolic posterior septal movement disappeared and the later systolic septal movement became posterior; ventricular septal systolic movement became normal. The type a Wolff-Parkinson-White Syndrome patient demonstrated normal systolic ventricular septal movement while in preexcitation.


[Gammagraphy of the carotid glomus].

[Gammagraphy of the carotid glomus]. Using the colorant proteic complex labell with Tc-99 m. we visualize--by the first time--the carotideal glomus in the human in 6 volunteers and one patient with tumor. The results are very encorageous: the method was simple and safe (one single dose endovenously) and hardless (no radiotoxicity presents in 3 months of clinical and laboratory controls) and there is a good visualization by scan of carotideal bodies "in vivo", in human being. We think this new method and labell compound could be useful in research and medical diagnoses.


Neurotoxicity and CSF level of three penicillins. The electrocortical activity and the antibiotic concentration in serum and CSF were investigated in rabbits after i.v. administration of benzylpenicillin, ampicillin and oxacillin. In contrast to ampicillin and oxacillin, benzylpenicillin induced a pronounced epileptogenic activity. The different epileptogenic activity of the three penicillins cannot be explained by the difference in the CSF level of these agents only. The intensity of the epileptogenic activity and the CSF level after benzylpenicillin administration were markedly influenced by the experimental procedure in that curarized animals exhibited both higher CSF levels and more intense seizure activities than non-curarized animals. Factors are discussed which may be responsible for the different neurotoxic potency of the three penicillins and for the dependence of the benzylpenicillin-induced seizure intensity on the experimental procedure.


Heterogeneity of pig liver and pig brain mitochondrial monoamine oxidase. Pig liver and pig brain mitochondrial monoamine oxidase were inhibited by increasing concentrations of clorgyline (selective inhibitor for the "A" form of monoamine oxidase) and deprenil (selective inhibitor for the "B" form of the enzyme) and the activities were then estimated with serotonin, tyramine and beta-phenylethylamine as substrates. The results indicate that both the "A" and the "B" forms are present in these tissues. Serotonin and tyramine are shown to be oxidized by both the "A" and the "B" forms of the enzyme, whereas beta-phenylethylamine appears to be oxidized almost exclusively by the "B" form. Lipid-depletion of the mitochondrial preparation from these tissues by extraction with aqueous methyl ethyl ketone eliminated almost all of the "A" form activity while most of the "B" form activity remained.


An analysis of the postjunctional component of denervation supersensitivity in the isolated vas deferens of the guinea-pig. An attempt was made to devise evidences for a role of calcium ions in the postjunctional component of denervation supersensitivity. The evidences obtained are: chronic postganglionic denervation increases sensitivity and maximum response of the vas deferens to cumulative concentrations of calcium and alters the pattern of response to low-calcium, potassium-rich Krebs solution; denervation supersensitivity could not be demonstrated after depolarization, and in KC1-Ringer or in Ca2+/--free Krebs solution the rate of loss of responsiveness to acetylcholine was delayed after denervation whereas the rate of loss of responsiveness to noradrenaline was unaffected. It is suggested that the postjunctional component of denervation supersensitivity in the isolated vas deferens of the guinea-pig is due, at least partially, to an increased availability of a membrane-bound calcium store(s) associated to an enhanced cell membrane permeability to the ion.


[Aortic prosthesis, long-term results and evolution]. The results and evolution of 126 aortic prosthesis implanted from 1964 to 1971 were reported. The results are appraised according to the criteria of the NYHA. The hospital mortality in the first five years was 40%; in those operated on in the following 3 it fell to 21% and finally those treated in the last 2 years had 16%. The delayed mortality was 19%. Depending on the type of valvular lesion, the stenosis have the highest mortality (50%). The group II and II of the NYHA had less mortality. In the evolution of the survivors at ten years, the incidence of actual survivors shows that after the first two years of prosthetic change, the survival rate tends to stabilize staying at 77% at the end of 10 years; of which 75% evolve well and 17% badly. A separate analysis was made of the factors which modify the results and evolution such as calcifications, associated mitraltricuspid lesions, and myocardial damage. The most frequent complications were embolisms 14%, prosthetic dysfunction 12.8%, endocarditis 3.8%, and hemolysis 2.5%.


[Primary fibrosarcoma of the right ventricle]. Mexican literature has information of two fibrosarcomas in the atria. In the present work the first fibrosarcoma of the present work the first fibrosarcoma of the right ventricle found in Mexico is presented. This case behaved clinically, electrocardiographically, and phonomechanocardiographically like an Ebstein's disease, with the exception that in the phono a giant "a" wave was found. A review is mad of the clinical history, EKG, radiologic, and phono findings, as well as the laboratory analysis and data found in the autopsy.


[The action of tiadenol on compensatory hypertrophy of the liver in the rat]. The regenerating rat liver after partial hepatectomy was used as a model to study the effects of an hypolipidaemic drugs, tiadenol (bis hydroxyethylthio 1--10 decane). Seven days after partial hepatectomy, liver weight, DNA, RNA, total protein and cytochrome P-450 were increased in tiadenol treated rats, relative to hepatectomized controls. Tiadenol displaying similar effects on the intact liver, it is concluded that this hypolipidaemic drug maintains its hepatomegalic action on the regenerating rat liver.


F-461, 3-diethylamino-2,2-dimethylpropyl 5-(p-nitrophenyl)-2-furoate hydrochloride, a new non-anticholinergic spasmolytic and gastric acid inhibitor. Compound F-461, 3-diethylamino-2,2-dimethylpropyl 5-(p-nitrophenyl)-2-furoate hydrochloride, was evaluated pharmacologically and was found to exert non-anticholinergic smooth muscle spasmolytic activity along the gastrointestinal tract of animals. F-461 was additionally discovered to inhibit gastric acid secretion and to prevent cold + restraint stress-induced ulcers. Local anesthesia, both surface and infiltration, was also elicited by F-461. The pharmacologic properties of F-461, as revealed in this study, are indicative of potential usefulness of this drug in the therapy of spastic colon and/or peptic ulcers.


Dopamine receptors and dopaminergic nerves in the vas deferens of the rat. Phentolamine antagonized competitively the effects of noradrenaline (pA2 = 7.1), dopamine (pA2 = 8.0) and tyramine (pA2 = 8.2). Haloperidol had a pA2 value of 7.3 against dopamine and 6.5 against noradrenaline. Apomorphine antagonized competitively dopamine (pA 2 = 4.8) and tyramine (pA2 = 5.1) and noncompetitively antagonized noradrenaline (pD'2 = 3.6). From these data it is concluded that these antagonists interact with dopamine receptors and alpha-adrenergic receptors. Apomorphine (10-4 M) attenuated the maximal response to dopamine and field stimulation, whereas the same concentration of apomorphine potentiated the maximal response to noradrenaline. Assuming that tyramine and field stimulation release the naturally occurring neurohumoral transmitter from adrenergic nerve endings, it is concluded that dopamine is the physiologically functional neurohumoral transmitter in the rat vas deferens which, when released, stimulates specific dopamine receptors.


The effect of difenoxin on the lower esophageal sphincter pressure in man. Difenoxin, a new antidiarrheal agent, had no effect on lower esophageal sphincter pressure in man when given at an oral dose of 2 mg. Thus, this drug does not appear to cause or aggravate symptoms of gastro-esophageal reflux and may safely be used in reflux patients.


Effects of iodoacetate and anoxia on phosphate metabolism in isolated perfused rat hearts. When perfused with a solution equilibrated with 95% N2 and 5% CO2, the isolated rat heart was gradually depressed but continued to beat for longer than 30 min. Creatine phosphate content strikingly decreased, but lactate content was markedly elevated. When perfused with a fully oxygenated solution containing 0.5 mM of sodium iodoacetate (IAA) of the myocardial contractile force was almost unaltered and the heart rate decreased slightly within 10 min. Thereafter, the heart rate rapidly decreased, and soon cardiac arrest followed. Myocardial content of high-energy phosphates still remained at a considerably high level. The heart arrested by IAA responded to electrical stimulation, contracted and high-energy phosphates were well utilized. Addition of lactate to an oxygenated perfusate containing IAA improved myocardial performance. Citrate and palmitate did not restore the IAA-treated cardiac impairment. The results show that IAA disturbed cardiac conduction more markedly than contractility by blocking cytoplasmic glycolysis and that lactate, unlike citrate and palmitate, produced enough energy to recover cardiac activities in IAA-treated hearts.


Chronotropic effects of droperidol.

Chronotropic effects of droperidol. To study the mechanism of action by which droperidol exerts a negative chronotropic effect, 3 series of experiments were performed: a) on isolated right atria of rabbits, b) on the isolated vas deferens of guinea-pigs and c) by injecting the drug directly into the sinus node artery of anesthetized dogs. Isolated tissue results include: lack of cholinergic action or beta-adrenergic antagonism: a calcium ion flux interference could not be demonstrated. Alpha adrenergic antagonism of the drug (pA2) was ascertained in the vas deferens. Injections of droperidol in the sinus node artery caused a negative chrontropic effect proportional to the dose and arrest ensued with the largest dose followed by His escape rhythm. Droperidol could not inhibit isoproterenol or dopamine-induced tachycardia and showed similar negative chronotropism in vagotomized and atropinized dogs. Negative chronotropic effects of the drug appear to be caused by an exit blockade of sinus impulses.


The ability of pimozide to prevent inhibition by dopamine analogs of cardioaccelerator nerves in cat hearts. The dopamine receptor blocking agent, pimozide, antagonized inhibitory actions of apomorphine, N,N-dimethyldopamine and 5,6-dihydroxy-2-dimethyl-aminotetralin (M-7) on stimulation-induced positive chronotropic responses of cat hearts in both in vivo and in vitro experiments. Pimozide did not antagonize the inhibitory effect of clonidine in vitro experiments. Phentolamine, an alpha-adrenergic blocking agent, antagonized the inhibitory actions of dopamine analogs at 1.10 mug/ml concentration in in vitro experiments. Phentolamine, 0.3 mug/ml, only attenuated the response of N,  N-dimethyldopamine but did not antagonize the effects of apomorphine and M-7. Lower concentration of phentolamine, 0.1 mug/ml, showed marked inhibition to the inhibitory effect of clonidine. Both phentolamine and pimozide potentiated stimulation-induced positive chronotropic responses of cat right atria. Possibility of the presence of dopaminergic inhibitory system near the alpha-adrenergic inhibitory system in cardioaccelerator nerve terminal is discussed.


Betadrenoceptors in urinary bladder.

Betadrenoceptors in urinary bladder. In presence of dibenzyline, isoproterenol and adrenaline produced impairment of the responses of the guniea-pig urinary bladder to hypogastric nerve stimulation. Submaximal responses of isolated rat and guinea-pig urinary bladders to exogenous acytylcholine were similarly inhibited by these drugs. The inhibitory effects were reversed in presence of propranolol. The extent of maximal inhibition ranged between 60 and 80 per cent. The results provide evidence for the presence of inhibitory beta adrenoceptors in the urinary bladder of rats and guinea-pigs.


Sympathomimetic drugs: evaluation for acute central hypotensive activity in alpha-chloralose-anesthetized dogs and cats intravertebral artery administration,. dl-Amphetamine, phentermine and their para-chloro derivatives were tested for acute central hypotensive activity after intra-vertebral artery (iva) infusions in alpha-chloralose-anesthetized cats and intact and carotid sinus denervated dogs. Iva clonidine (reference standard) caused immediate reductions in blood pressure and heart rate and carotid sinus denervation (CSD) enhanced the clonidine response. dl-Amphetamine and phentermine did not cause acute hypotensive responses in the dog or cat whereas their para-chloro derivatives did. The vasodepressor response to para-chloramphetamine was inconsistent and transient and not modified by CSD. The magnitude and duration of the chlorphentermine vasodepressor response was minimal in the intact and CSD dog compared to clonidine. In contrast, chlorphentermine in the cat (140-300 mug/kg) caused an acute hypotensive response comparable in magnitude to clonidine (0.6-1.0 mug/kg). The bradycardias observed after iva chlorphentermine were much less pronounced than those associated with iva clonidine at comparable vasodepressor doses. By the i.v. route, each drug caused only pressor responses in the dog and cat. Suppression of the pressor response (resulting from "spill-over" of these alpha-stimulants into the systemic circulation after iva dosing) in the dog with small doses of i.v. phenoxybenzamine did not unmask or enhance the vasodepressor or bradycardic actions to iva administration of drugs. Methysergide prevented the hypotensive response to chlorphentermine in the cat and partially suppressed the response to clonidine; the reverse was true after piperoxan. Lilly 110140 and para-chlorophenylalanine reduced or abolished the effects of iva chlorphentermine. In summary, (1) iva chlorphentermine and clonidine were the only alpha-sympathomimetics tested which were effective as hypotensive substances; (2) the cat was considerably more responsive to iva chlorphentermine than the intact or CSD dog; (3) iva clonidine was more bradycardic than iva chlorphentermine; and (4) both adrenergic and serotonergic components appear to be among the mechanisms involved in the acute iva hypotensive response to chlorphentermine in the cat.


Modification of venous stasis thrombosis in the rat by platelet-active drugs and by heparin. In rats, stasis thrombosis of a renal vein was produced by the occlusion of a vascular segment after induction of systemic hypercoagulability by i.v. injection of ellagic acid. Prostaglandin E1, at doses which reduced platelet retention by glass beads (6 mug/min/300 g i.v.) only slightly reduced the thrombus size. The platelet release inhibitors suprofen and indomethacin, at doses which prolonged tail bleeding time in rats (50 mg/kg i.v.) had no effect on the thrombus size. Heparin (10 and 20 U/kg i.v.) produced a marked, dose-related reduction of venous thrombosis. The platelet-active compound VK774, at the dose levels of 50 to 10 mg/kg i.v., also reduced the thrombus size to about half that of controls. Lower doses (5, 2.5 mg/kg i.v.) had a progressively weaker effect. Binding to ellagic acid or induction of coagulation changes by VK774 are proposed as possible mechanisms of action. It is concluded that, in comparison with the contribution of plasma coagulation, the participation of the aspects of platelet function we measured in the development of venous stasis thrombosis is comparatively small.


Effects of hypoxia and hypercapnia on non-esterified free fatty acid and cortisol levels. In the dog, FFA (free fatty acid) and cortisol levels in arterial blood plasma are lowered by anesthesia. Induced hypercapnia does not alter the cortisol levels but increases FFA levels. Hypoxia tends to raise the FFA levels. Possible causes of modifications in the FFA and cortisol levels are briefly discussed.


Effect of intraventricular administration of isoprenaline on urinary function in the goat. Intraventricular infusion of small doses of isoprenaline (ISO) in conscious non-hydrated goats produced a significant diuretic response, as well as a decrease in the excretion rate of Na+, K+ and Cl- in the urine; these effects were dose-dependent. An increase in free water clearance was observed as well. Pretreatment with propranolol, injected into the 3rd ventricle, completely abolished the ISO-induced diuretic effects, whereas phentolamine was ineffective. The data suggest that hypothalamic beta-adrenoreceptors are concerned with an inhibition of vasopressin release, inducing a diuretic response.


Acute central effects of 5,6-dihydroxytryptamine in fowl. In adult hens (Gallus domesticus) infusion into the IIIrd cerebral ventricle of 5,6-DHT (50, 75 and 100 mug) produced, after 5-10 min behavioural and electrocortical sedation and sleep lasting about 6-8 hr,and a monophasic or biphasic increase in body temperature for about 8 hr, Two and a half hr after 5,6-DHT administration, the histochemical picture showed a sustained decrease in yellow and green fluorescence in areas adjacent to the IIIrd ventricle, in the anterior hypothalamus and in the preoptic area, whereas no significant changes were detected in fluorescence of the tegmental cell-bodies. The present experiments suggest that behavioural and electrocortical effects evoked by 5,6-DHT seem to be due to a synergistic action of 5-HT and catecholamines displaced and released by this compound, whereas hyperthermic effects seem to be due to a more sustained release of 5-HT and/or to a direct action on 5-HT receptors and/or inhibition of 5-HT reuptake.


The effect of steroid contraceptives on the concentrations of brain monoamines in rats and mice. The effect of three estrogen-progestin combinations on biogenic amines in discrete brain areas of rats and mice has been investigated. With the exception of a significant decrease of brain 5-hydroxyindolacetic acid in the rats treated for 30 days with the combination norethynodrel + mestranol, no significant changes in the levels of serotonin, noradrenaline or dopamine in the rat brain were found following the administration of the compounds under study. On the other hand, in mice moderate but significant changes in the levels of serotonin, dopamine, noradrenaline and 5-hydroxyindolacetic acid were found in various brain areas depending on the estrogen-progestin combination used. The potential importance of these effects for the contraceptive as well as for some central actions of these compounds is discussed.


Drug metabolism and morphologic changes in the liver of nafenopin-treated rats. Nafenopin (2-methyl-2[p-(1,2,3,4-tetrahydro-1-naphthyl) phenoxy] propionic acid), a phenolic ether with hypolipidemic properties, given to rats of both sexes for 3 or 14 days, caused an increase in liver weight, peroxisome (microbody) proliferation and smooth endoplasmic reticulum accumulation in hepatocytes. In females, 3 days of nafenopin administration elicited a significant reduction of zoxazolamine paralysis time and an enhancement of its metabolism by the 9,000 g supernatant fraction of the liver. In contrast, treatment of males resulted in a prolongation of paralysis and a decrease of zoxazolamine hydroxylation. The serum cholesterol and triglyceride levels were not changed by short-term administration of the hypolipidemic drug to female rats, but there was a lowering of triglycerides in the males. Given for 14 days, nafenopin reduced paralysis time to the same extent in both sexes. The in vitro metabolism of zoxazolamine was similar to that observed after short-term nafenopin administration. A significant fall in serum triglycerides was noted in both females and males. The sex difference in zoxazolamine metabolism was not dependent on endogenous testosterone.


Blood levels in methaqualone in man following chronic therapeutic doses. Human serum was analyzed for methaqualone (MTQ) and hydroxylated metabolites by gas liquid chromatographic (GLC), ultraviolet spectrophotometric (UV) and spectrofluorimetric (SF) procedures. Intact methaqualone was found to be the major circulating drug component after administration of multiple 300 mg daily doses over a 28-day period. Hydroxylated methaqualone metabolites, if present, were estimated to be in extremely low concentrations. After acute ingestion of large quantities of methaqualone (2.4-3.0 g), at least one methaqualone metabolite, [2-methyl-3-(2' hydroxymethylphenyl)-4(3H)-quinazolinone] was present in serum obtained from subjects with a history of chronic drug abuse.


[Reversal by naloxone of the effects of morphine on the unanesthetized dog]. In unasthetized dogs naloxone induced effects opposed to those of morphine (tachycardia, agitation, hyperthermia, tachypnea) and mydriasis. These effects were moderate and transient; some of them were elicited with low doses being border-line after 0.03 mg.kg-1 s.c., statistically significant after 0.1 mg.kg-1 s.c.; they increased slightly with the dose. After repeated administrations, acute tolerance developed and some moderate morphine-like effects (miosis, sedation) were observed. The stimulatory effects described here may result from antagonism of a morphinomimetic natural ligand,and represent thus indirect arguments in favour of normal functions of this ligand; these functions would be to temper not only algesic but also other stimulant reactions. The limitation of the effects might result from the limited release of this ligand in normal dogs and (or) from interfering morphinomimetic properties of naloxone, which are apparently unmasked when administrations are repeated. Both, stimulatory and inhibitory effects of naloxone are not liable to represent noticeable side-effects of this drug, but they both might play some role in the mechanisms of precipitated abstinence.


Vitamin D metabolism in man. Effect of corticosteroids. This study evaluated the effects of acute intravenous calcium supplementation on vitamin D metabolism in nine patients maintained on long-term prednisone therapy for chronic obstructive lung disease. Vitamin D turnover studies, employing 1,2-(3)H,4(14)C vitamin D3, and coincident measurement of serum 25-hydroxycholecalciferol (25-OHCC) concentrations demonstration (P less than .05) and half-time (P less than .05) in the prednisone-treated patients when compared with the mean 25-OHCC concentration and half-time found in these patients prior to calcium infusion. However, there was no significant difference in the amounts of 24,25-(OH)2CC) or 1,25-dihydroxycholecalciferol (1,25-(OH)2CC) appearing after calcium infusion. The results of the study showed that the intravenous administration of calcium to corticosteroid-treated patients accelerated the disappearance of 25-OHCC from the plasma of these patients without parallel increases in the production of 1,25-(OH)2CC or 24-25-(OH)2CC.


Adult acute leukemia. The Rochester (NY) Experience. A ten-year retrospective study of adult acute leukemia was performed in nonieukemia-specialized centers to determine prognostic factors, length and quality of survival, cause of death, and response to different modes of therapy. Of 200 patients, 9.5% achieved complete remission, 14.0% obtained partial remission, and no response was present in 76.5%. Patients who were 50 years old or more (64.5%) had a significantly lower response rate (P less than .005) and survival (P less than .05) than the younger age group. Aggressive chemotherapy significantly improved the response rate, as well as survival (P less than .001). Quality of life was similar for responders and nonresponders, both spending only one fourth of their survival time in the hospital. Infection as the leading cause of death. The overall ten-year response rate of 23.5% represents a realistic rate in nonleukemia-specialized centers in which the treatment of adult acute leukemia is variable.


Calciphylaxis in man. A syndrome of tissue necrosis and vascular calcification in 11 patients with chronic renal failure. Eleven patients with chronic renal failure and presumed secondary hyperparathyroidism developed a syndrome of medial calcinosis of the arteries and painful ischemic ulcers of the fingers, legs, or thighs, or any combination of the three. Five patients required maintenance hemodialysis; six had functioning renal homografts. Severe hyperphosphatemia had existed in each; seven showed roentgenographic evidence of subperiosteal resorption. Similarities are evident between the lesions and experimentally produced calciphylaxix. The lesions demonstrated a relentless, progressive course, with serious morbidity and mortality. Hyperplastic or adenomatours parathyroid tissue was removed from ten of 11 patients unergoing surgical procedures; healing followed in seven patients. Treatment with phosphate-binding antacids to lower serum phosphorus levels may prevent this syndrome. Total or subtotal parathyroidectomy should be considered when ischemic skin lesions appear in uremic patients or in renal transplant recipients.


Spontaneous pseudocystogastrostomy associated with pancreatitis. Detection by endoscopy. A pseudocystogastrostomy complicating the course of acute hemorrhagic pancreatitis was detected by upper endoscopy. Aspiration of the cyst contents during endoscopy showed greatly elevated amylase values confirming the diagnosis. Peritoneal lavage therapy was used in the acute phase of the patient's illness with dramatic clearing of the peritoneal fluid, reduction of ascitic fluid amylase values, and subjective clinical improvement.


Segmental renin sampling and partial nephrectomy in renal hypertension. Selective renin sampling from renal vein tributaries identified a high-renin source in the lower pole of the left kidney in a 16-year-old boy who had gradually developed hypertension after blunt left renal trauma. Localized renin secretion from the ischemic pole was associated with suppression of renin secretion from both the contralateral kidney and the normal part of the affected kidney. Removal of ischemic tissue by partial nephrectomy produced sustained correction of hypertension. The findings indicate that segmental renin sampling can define indications for partial nephrectomy in renal hypertension.


Myeloma-like lesions of the kidney. Occurrence in a case of acinic cell adenocarcinoma of the pancreas. A 54-year-old man with acinic cell adenocarcinoma of the pancreas died of oliguric renal failure associated with myeloma-like renal lesions. Electron microscopical study of the tumor cells disclosed rich rough-surfaced endoplasmic reticulum and membrane-bound secretory granules, which indicated active protein synthesis and suggested that abnormal proteins produced by the tumor cells were the underlying cause of the renal lesions. Rapid deterioration of renal function ensued after intravenous pyelography, as is usual in the syndrome of myeloma-like lesions of the kidneys. This case presents further evidence for the occurrence of "myeloma kidney" in association with tumors other than plasma cell myeloma.


Hemodialysis of acute arsenic intoxication with transient renal failure. A striking reduction in serum arsenic level was achieved after four hours of hemodialysis in a patient with acute arsenic intoxication and transient renal failure. Quantitative dialysance of arsenic and a comparison of daily urinary excretion of arsenic with amount removed by dialysis suggested that hemodialysis is indicated in the treatment of acute arsenic intoxication if there is concomitant renal failure. In the presence of normal renal function, supportive measures, including dimercaprol (BAL in Oil) therapy, constitute the best available treatment.


Yersinia enterocolitica septicemia with septic arthritis. We report a case of Yersinia enterocolitica septicemia with septic arthritis. Gentamicin administration controlled the septicemia but failed to eradicate the organisms in the joint, in spite of a synovial fluid level four times its minimal inhibitory concentration after four days of therapy. Development of azotemia necessitated change of antibiotic therapy to chloramphenicol, which eradicated the infection. While Y enterocolitica infection in the United States is uncommon, it must be added to the list of organisms causing suppurative arthritis and septicemia in susceptible hosts. Septic arthritis must be distinguished from the much more common reactive theumatic polyarthritis associated with Y enterocolimica infection, for which antibiotic therapy is neither needed nor helpful.


Regulation of amino acid transport in growing cells of Streptomyces hydrogenans. I. Modulation of transport capacity and amino acid pool composition during the growth cycle. (1) The active uptake of different amino acids by growing cells of Streptomyces hydrogenans was shown to be correlated with the physiological age of the cells. During the lag phase of growth the transport capacity increased and attained its highest level when the growth rate was maximum. During further growth the transport capacity declined progressively. The lowest transport activity was observed when the culture shifted into the stationary growth phase. (2) Such modulation of transport capacity was independent on the presence or absence of amino acids in the growth medium of the cells. (3) The size and the composition of the pool of free intracellular amino acids was also undergoing substantial variations during the growth cycle of the culture. In the lag phase, the levels of all amino acids decreased markedly and attained their lowest values at the end of this phase. During further growth the pool size was slowly replenished. (4) Removal of the pool resulted in a considerable gain of transport capacity. Therefore, it was concluded that active amino acid transport in growing Streptomyces hydrogenans is under feedback control by intracellular amino acids. (5) Quantitatively, the modulation of the pool size could not fully account for the variation of the transport capacity. Since a pool-independent stimulation of transport was found to be correlated with the increase of the growth rate of the cells, the possibility is discussed that the stimulation of transport is either due to increased levels of distinct RNA species, which might provide positive feedback signals for transport, or by increased rates of de novo synthesis of transport limiting proteins.


The development patterns of lysosomal enzyme activities during Ca2+-induced sporangium formation in Achyla bisexualis. III. Ribonucleases. The present paper describes intracellular changes in ribonuclease specific activity during Ca2+-induced sporangium formation in the water mold Achyla bisexualis. The enzymes undergo a decrease in activity prior to crosswall formation followed by an increase in activity during spore cleavage. As spore discharge occurs the RNase activity again decreases. A large percentage of the nuclease activity is associated with a lysosomal-like fraction of the cell, but there is also considerably activity associated with nuclear and microsomal fractions. Addition of cycloheximide or actinomycin D at various times during development prevents further decrease or increase in the enzyme activity. Mixing of cell extracts from different developmental stages provides evidence that inhibitors or activators of the enzyme activity are not responsible for the activity levels evident at the different stages. There is a change in the total levels of presumptive mRNA during Ca2+-induced sporangial formation which appears to be associated with the patterns of RNase activity. Utilizing total cellular RNA and Poly(A)+ RNA with the crude ribonuclease preparations, no substrate specificity could be ascertained.


On the possible role of respiratory activity of Acholeplasma laidlawii cells in sugar transport. 1. Out of 20 exogeneous substrates only ethanol and, to a much lesser extent, lactate and pyruvate were shown to be capable of stimulating the respiration of Acholeplasma laidlawii cells. However, none of these substrates changed the initial rate of active transport of 3-O-methyl-D-glucose (3-O-MG). 2. From inhibitory analyses and spectroscopic data, it is apparent that the respiratory chain of A. laidlawii has no cytochromes and is probably not responsible for oxidative phosphorylation. 3. Valinomycin and nigericin stimulated cell respiration only in the presence of K+-ions, while monensin stimulated it in the presence of Na+-ions. 4. 3-O-MG transport was shown to be sensitive to uncouplers, ATPase inhibitors and arsenate are resistant to a majority of respiratory inhibitors tested. This suggested that there was no relationship between respiration and carbohydrate transport in the A. laidlawii cells. Further evidence was provided by the absence of respiratory stimulation during the transport of non-metabolizing carbohydrates.


The use of stable sulfur isotope labelling to elucidate sulfur metabolism by Clostridium pasteurianum. An unique isotope labelling experiment was conducted whereby mixtures of sulfate and sulfite of different isotopic compositions were metabolized by Clostridium pasteurianum. The results showed during reduction of 1 mM SO3= plus 1 mM SO4=, essentially all evolved H2S arose from the sulfite whereas in the case of cellular sulfur, 85% was derived from sulfite and the remainder from sulfate.


[On the essential oil of green algae. III. The oils of some Chlorella mutants (author's transl)]. The stability against mutation of essential oil formation in the genus Chlorella is similar to that of hydrogenase. Both characters are therefore of special value in Chlorella taxonomy. All the 21 mutants of C. fusca C-1.1.10 produce essential oils, but only a few of them produce proazulenes. Two mutants of C. kessleri C-1.1.12 produce essential oils and proazulenes like the wild type.


[Histological studies on the capillarization of various muscles in industrially raised rabbits]. The longissimus dorsi, semitendinosus, psoas major and biceps femoris muscles of 40 industrially kept rabbits were studied in regard to their numbers of capillaries per square mm. The relation between the number of capillaries and muscle fibres is narrower in a red muscle than in a white one. The total body mass is of more influence on the number of capillaries per square mm than the age.


[Studies on endocrine and spermiogenic testis function. III. Relationships between the quality of dietary proteins, testosterone content of the testes and cell nucleus volume of the Leydig cells during postnatal developme-t of rats]. Male Wistar rats, aged 15 days, received different qualities of feed proteins through 80 days (absorbable crude protein-rRP = ten per cent). For experimentation, the animals were subdivded into four groups. The first group was given casein plus four per cent methionine (K), the second maize gluten with amino acid added (M + As), the third maize gluten only (M), and the fourth casein plus four per cent methionine mixed one to three with gelatin (K/G). Live weight increases after ten days of feeding were 34+/-13.9 g (K), 24+/-8.5 g (M + As), 8+/-5.7 g (M), and 0+/-3.6 g (K/G). The same trend was recorded from testicular weight which was measured as well in ten-day intervals. The eight cyclic phases of the germinal epithelium were completely developed as of the 45th day of age in animals on K and M+/-As rations and as rations and as the 95th day of age in animals on K/G ration (followed improvement to 2:3). Spermatide transformation still was a bit differentiated by histological examination of animals on M diet on the 95th day of experimentation. The testosterone levels in testicular tissue were about 220 ng/100 g live weight after 80 days of K or M + As diets, but only 100 ng/100 g live weight after K/G or M feeding. The nuclear volumes of the interstitial cells of Leydig exhibited significant variation (p less than 0.01) between the 35th and 45th days of age, but went stable to approximately 50 mum3, independent of feed protein quality, at the onset of suxual maturity, on the 95th day of age. Complete formation of all eight cyclic phases of the germinal epithelium seems to depend on limiting values relating to testosterone per gram of testis, testicular weight nuclear volume of the interstitial cells of Leydig and live weight.


[Haptoglobin in domestic mammals. V. Plasma haptoglobin level in cattle under pathological conditions]. The haptoglobine concentration in the blood plasma of cattle tends to rise to more than 10 mg/100 ml in the presence of acute inflammation anywhere in the organism. They were 40 mg/100 ml and above in the presence of traumatic reticuloperitonitis. The absence of haptoglobin multiplication in the plasma is a high-probability indicator to the absence of that inflammatory process. chronic inflammation will only in exceptional cases entail plasma-haptoglobin multiplication. Concentrations will not be pathologically increased in cattle with positive reaction to haematological testing for leucosis.


[Late lesions in cerebrocortical necrosis (CCN) of cattle]. The brains of three young fattening bulls in which cerebrocortical necrosis had been cured by intensive vitamin-B1 treatment were histologically examined six, eight, and ten months after the clinical outbreak of the disease. Shrinkage foci were detected in the cerebral cortex, their localisation and extension depending on the course of the past disease. Part of the cerebrocortical centre was void, with differentiated amounts of fatty granular cells being scattered in regions of it. The findings were taken to indicate almost complete decomposition and resorption of the liquefied necrotic tissue. Glios cicatrisation occurred in places. A vacumn that had resulted from depression of the brain surface was filled up by proliferating loose connective tissue and vessels in the leptomeningeal region. The weight increase of fattening bulls with a case history of cerebrocortical nectosis was found to be much worse than that recordable from animals with no pathological record. Continued keeping of such cured animals, therefore, seems to be of poor economy.


[R and S-streptococcal infections in swine]. Some 115 R- and 143 S-streptococcal strains were isolated from 258 pigs that had died or been killed for disease, between 1969 and 1973. They were cultured and biochemically tested for sensitivity to chemotherapeutics. All R- and S-strains were of normal sensitivity to penicillin and, with few exceptions, to chloramphenicol and oxytetracycline as well. Most of the strains caused primary Sc.-infection, such as septicaemia, leptomeningitis, endocarditis, and arthritis. R-Sc.-infections were contracted mainly by store pigs and animals in advenced age, while S-Sc.-infections affected mainly piglets.


[Anatomical studies on the quantitative development of liver, heart and adrenal glands in white New Zealand rabbits]. Five male and five female pure-bred White New Zealanders, including newborns and young animals, one, two, and three months of age, were examined. No sex-dependent difference was established for the parameters tested (weight of liver, heart, and adrenal gland). Significant weight differences were found to exist between the age groups. The relative weights of the organs under review declined along with growing age. Correlations were found to exist between the weights of liver, heart, and adrenal gland.


[Electronmicroscopic findings in the skeletal muscles of newborn swine with congenital splayleg]. Pathomorphological studies were taken of 104 muscle samples (including M. longissimus dorsi, adductor, semimembranaceus) obtained from 26 piglets, aged between one and three days and received from six stocks (large whites, land race, hybrids), which exhibited symptoms of congenital splayleg. Presence of myofibrillar hypoplasia or disseminated necrotisation of fibre was established by light microscopy. Some of the piglets, however, failed to exhibit substantive changes at all. Four types of fibre were differentiated by electron microscopy: (1) the normal type (with intact fibrils, plenty of lipids etc.), (2) the hypoplastic type (inhibition of protein synthesis, lack and immaturity of fibrils, disorder of paraplasmatic substances), (3) the dystrophic type (variable defects of fibrils, decay), (4) the primitive type (myoplastlike cell elements with precipitate fibrillogenesis). While those types were of variegated intramuscular occurrence, some predominance was established of dystrophic changes. Hence, spraddle-legged piglets seem to be afflicted with disorder of muscular development accompanied by signs of myopathy. Outbreak and intensity of clinical symptoms are believed to depend  on exogenous factors.


An autoradiographic study of DNA synthesis in lymphoid cells of leucotic and healthy cattle. The present study on 3H-thymidine incorporation using the histouatoradiographic method showed that spontaneous DNA synthesis occurred, on average, in 0.526 (+/- 0.233) per cent of lymphoid cells in 19 cattle with the normal blood picture (6,355+/-1,866 leucocytes/cu. mm). In 17 leucotic cattle with persistent leuco- and lymphocytosis (19,138+/-8,817 leucocytes/cu. mm) the proportion of these cells was insignificantly different, hovering about 0.554 (+/-0.191) per cent. The present sample did not include cases with marked changes in the blood picture (50,000-600,000 leucocytes/cu. mm) which occur in only 5-10 per cent of leucotic animals. This fact, however, could not influence the conclusion that even when used in conjunction with other methods, the determination of spontaneous DNA synthesis in peripheral lymphocytes is not a useful tool for the detection of preclinical phases of bovine leucosis.


[Studies on biotechnical ovulation synchronization in young cows. 1. Ovulation periods, ovarian findings and fertilization results after use of Metallibur, 750 IE PMS and 250 or 500 IE HCG]. The following treatment was applied to 50 mature young sows in two experiments (22 and 28 animals) throughout 20 days: Turisynchron-Prämix (Turi.), 5 g/animal, and 750 IU PMS (Prolosan serum) 28 hours after Turi. In the first experiment. 250 IU HCG (Gonabion) were additionally injected to each of twelve animals 100 hours after Turi., while in the second experiment each of ten animals recieved 500 IU HCG 103 hours after Turi. The remaining animals of the two groups were used as controls. Inseminations took place 101 and 104 hours (fourth day) after Turi. in the first experiment and 125, 149, as well as 173 hours (fifth, sixth, and seventh days) after Turi. in the second. Onset of ovulation was brought forward to the sixth day after Turi. in response to 500 IU HCG by laparotomy performed in the mornings and evenings of the fourth through seventh days. Most of the controls and test animals with 250 IU HCG ovulated on the sixth or seventh day after Turi. Ovulation was stimulated by both HCG dosages, in comparison to the controls, which was established by slaughtering the animals between the seventh and twelfth days after Turi. The percentage of ovulations was higher among the test animals and that of ovarian cysts lower. Fertilisation of the second group was clearly better than that in the first where insemination had taken place two days prior to ovulation, that is too early. The latter results were secured by tubal douche and ovocyte tests.


[Studies on endocrine and spermiogenic testis function. IV. Relations between the testosterone content of the testes cell nucleus volume of the Leydig cells and rat spermatogenesis (deduced from studies on the effect of the dietary protein quality on the function of the testes)]. The following relations were derived from large-scale testing of feed protein quality and its bearings on testicular function in growing Wistar rats: testicle weights and live weights r = 0.77 for juvenile animals and r = 0.36 for adult animals; nuclear volumes of Leydig's cells to testicle weights r = 0.84 for juvenile animals and r = 0.43 for adult animals; testosterone in testicular tissue, ng/g, to testicle weights r = 0.55 for juvenile animals and r = 0.80 for adult animals; testosterone per live weight, ng/100 g, to nuclear volumes of Leydig's cells r = 0.76 for juvenile animals and r = 0.46 for adult animals. Critical thresholds above which complete spermatogenesis is always ensured may be established for testosterone (50+/-5 ng/100 g live weight) and for the nuclear volume of Leydig's cells (30 mum3). Another conclusions drawn from the above results is that high testosterone levels in the testes of adult animals were not attributable to high testosterone biogenesis of Leydig's cells, as might have been assumed from high activities of that kind recordable from some nuclear volumes.


[Culture media for Salmonella dublin on a chemically defined basis]. The nutrient demand of S-dublin strains was investigated. Media on chemically defined basis for culturing of S. dublin are recommended with reference to the above studies. The definition includes Na2HPO4, KH2PO4, NaCl, glucose, the amino acids L-asparaginic acid, L-cystine, L-glutamic acid, serine, and L-threonine, and nicotinamide as vitamin component. Such media will be quite favourable for certain culturing problems, but complex substrate (yeast extract, peptone, tryptone) should be added for high yields.


[The course of plasma concentrations of cathecholamines and corticosteroids and of plasma--bound iodine (PBJ) in swine under the effect of noise and of various methods of raising]. Plasma concentrations of 11-OHKS were transitorily increased with significance in pigs, 25 kg to 45 kg in live weight, exposed to short-time engine noise (120 dB, 60 to 8,000 Hz, 60 minutes). Intensity of noise application and duration did not cause significant variation of plasma concentrations in catecholamines nor in P.B.J. The catecholamines were on a rising trend. Those results supported the conclusion that both quality and quantity of applied noise are perceived by store pigs as factors of disturbance. Their noise nature is comparable to that perceived by man and laboratory animals. Decline in 11-OHKS after 55 minutes of exposure to noise was recorded also by other authors who had exposed other species to long-time noise. It seems to reflect adaptation mechanisms in the information-processing system. The reactivity to noise of the adrenal cortext of swine was found to depend on the form of keeping. Animals kept in groups responded to noise in the same way in which they would respond to acute cold, by significantly increasing rise of plasma concentrations of 11-OHKS. The above results were taken to support the conclusion that organic response to a specific stimulus depended on the level of each control circuit at the time of stimulation.


[Changes in various physiological parameters in chickens after entomoxan administration]. Eight weeks of Entomoxan administration to chickens (15 mg/kg live weight) were followed by significant change of certain physiological parameters relating to the blood, liver, suprarenal bodies, and sexual glands. Such variation was taken to indicate the presence of stress suffered by the animals' impairment of carbohydrate and fat metabolism, and defects of hormonal regulation.


[Quantitative-morphological studies on the Berlin miniature pig heart. 1. Report: absolute and relative heart weight]. Body dimensions, carcass weight, as well as absolute and relative heart weight of 29 Berlin miniature pigs were assessed and statistically evaluated. The correlations between all variables were checked. Significant correlation coefficients were established between absolute heart weight and live or carcass weight as well as between live and carcass weight. The trend towards a relationship between absolute heart and live weight is given by the major axis function. The mean value of relative heart weight was 0.314 per cent. The results are discussed.


[A contribution to the relationship between electric systole and hypocalcemia in cattle]. Strong correlations between electric systole (QT time) and calcium-serum concentration can be statistically secured. In this context, all-transistor direct-printing electrocardiographs were used for indirect determination of calcium concentrations with the view to assessing QT time. The approach is described with reference to the need for safe and independent diagnosis of hypocalcaemic hysteroparalysis in concomitance with parturition against the background of industrialised cattle farming.


[The effect of flying ash immissions on performance and health of broilers]. Up to 500 mg fly ash from a soft-coal based power station were intratracheally administered to 353 broilers in ten test series. No detrimental impact on the animals' performance was recorded measurements of live weight curves, feed consumption, and feed conversion. Dust contamination of the animals' lungs was a pathologico-anatomic finding made in differentiated degrees. Erythrocyte and leucocyte counts as well as staining indices were normal and did not show any statistically significant deviations from the values in animals that had not been treated with fly ash. In most of the experimental animals haemoglobin values were significantly below those recorded from the controls. No compensatory reactions were recordable from staining index 1, for example, no rise of erythrocytes and haemoglobin. The above experiments and their results seem to suggest that fly ash emission is not a factor to rule out close neighbourhood of industralised broiler units to large-scale power stations.


Influence of ethionine on the ultrastructural morphology of the porcine hepatocyte. In the present study the morphological alterations induced by ethionine poisoning in the porcine liver were examined by electron microscopy. It was found that the most prominent ultrastructural changes were: accumulation of fat drops in the cytoplasm, disappearance of polysomes, fragmentation and vesiculisation of the endoplasmic reticulum, altered glycogen distribution and mitochondrial swelling. These closely resembled the pathological changes found in rat parenchymal cells under the same circumstances. In addition, moreover fat deposits were found in the nucleoplasm. The microbodies showed an altered morphology.


[Degradation and elimination of the anthelminitic 131I-rafoxanid in cattle and sheep]. Rafoxanide, labelled by 131J, was applied orally in oily solution to cattle and sheep, 12 and 17 mg/kg bodymass, resp. The half time of 131J in blood in 12,5 and 10,5 d for sheep and cattle, resp., the compound is adsorbed to proteins in blood. In the milk a maximal level of 3-3,5 ppm (calculated as total 131J) after 4-6 d was measured. More detailed results regarding the metabolism of rafoxanide are hitherto not possible.


[Studies on biotechnical ovulation synchronization in young sows. 2. Report: effect of laparotomy on ovarian findings after Zn-metallibur, 750 IU PMS, with and without 500 IU HCG]. A group of 72 gilts, aged between eight and nine months, were treated 20 days each by administration of 5 g Suisynchronprämix (Zinc Metallibur/Sui), followed by 24-hour treatment with 750 IU PMS (Prolosanserum). Fifty per cent of the group received 500 IU per animal of HCG (Gonabion) at 11 a.m., on the fourth day after Sui. All animals were artificially inseminated at 3.30 p.m. on the fifth day after Sui. and at 7.30 a.m. on the sixth day after Sui. Laparotomy was performed on 50 per cent of the HCG-treated and untreated animals in the afternoon of the sixth day after Sui. Animals with no recordable ovulation had to undergo another laparotomy in the morning of the seventh day. The above approach resulted in regrouping by four therapeutic categories: 1. HCG with laparotomy, 2. No HCG, 3. HCG with no laparotomy, 4. No HCG and no laparotomy. In the afternoon of the sixth day after Sui (51-56 hours after HCG) ovulation had begun in all 17 measurable animals of the first group, but only in one of 18 animals of the second. The animals were slaughtered between the seventh and twelfth days after Sui, and the following ovulation percentages were established: 100 per cent in the first group, 83.3 per cent in the second, 55.6 per cent in the third, and 72.2 per cent in the fourth. The animals that had been given HCG treatment (Groups 1 and 3) were found to be superior in terms of percentual ovulation to the untreated animals (Groups 2 and 4). However, Group 2 was the only group that had been exposed to the extraordinary stress of two laparotomies, and this should be borne in mind for evaluation. Ovarian cysts (more than 10 mm) began to develop on the eighth day on the laparotomised groups (1 and 2) and on the tenth day on the non-laparotomized groups (3 and 4). Cysts developed in 41.1 per cent of all animals in Group 1, 38.9 per cent in Group 2, 27.8 per cent in Group 3, and 22.2 per cent in Group 4. Therefore, cyst formation is thought to have been stimulated by laparotomy. Ovocyte tests suggested fertilisation of all animals in the first group. The embryonation rates of the second, third, and fourth groups are discussed with reference to the dates of insemination.


[Studies on biotechnical ovulation synchronization in young sows. 3. Report: ovulation onset, ovarian findings and results of fertilization after metallibur, 750 IU PMS, with and without 500 IU HCG with varied treatment time]. Fourty-eight gilts were treated with Turisynchron-Prämix (Turi.) and PMS (750 IU; 24-hours a. Turi.). One-half of the animals receaved additionally 500 IU HCG (fourth day a. Turi.). Performing treatments (Turi., PMS, HCG) either between 8 and 9 a.m. or 3 and 4 p.m. resulted in 2 experimental (HCG) and 2 control (without HCG) groups, each consisting of 12 animals. Double insemination took place according to treatment times at the fifth or the fifth and sixth day a. Turi. The experimental animals underwent laparotomy at the sixth day between 9 and 12 a.m., the conerols between 1 and 4 p.m. at the sixth or 9 and 12 a.m., at the seventh day a. Turi. Oviducts were flushed either at laparatomy or on slaughter to establish fertilization. From 24 experimental animals 20 ones had ovulated between 42-53 h p. HCG, and at slaughter 22 did so. The period of ovulation is mainly assumed near and immediately after 42 h p. HCG. In controls ovulation could be established in 3 of 15 animals laparotomized up to 152 h a. Turi. and in 8 of 9 animals laparotomized up to 168 h a. Turi. At slaughter there were in all 22 animals of the 2 control groups which had ovulated. In the rate of ovarian cysts (25-33%) and fertilized ova no remarkable differences were found between the groups.


[Mannosidosis: a simple diagnosis].

[Mannosidosis: a simple diagnosis]. Mannosidosis is a new and rare disorder. The following clinical symptoms should evolve its diagnosis: facial dysmorphy with slight mental retardation; bone deformities with abnormal L2 vertebra and craniosynostosis; biological abnormalities with vacuolized lymphocytes and absence of urinary mucopolysaccharides. Definite diagnosis relies upon detection of mannose oligosaccharides in the urine and serum deficiency of alpha-D-mannosidase.


[Hazards and complications of pneumoencephalography in children]. In a series of 1334 consecutive pneumoencephalographies in children 0-15 years, there were 2 deaths, 3 severe apneas and 1 pneumomediastinum. Respiratory insufficiency, due to contention of the patient with resulting impairment of the motion of thoracic muscles was an important mechanism and pneumoencephalography is contra-indicated in children with respiratory difficulties prior to the examination. In 90 consecutive patients submitted to pneymoencephalography CSF changes and fundus oculi abnormalities were studied prospectively. Aseptic meningitis of a mild degree is common following the examination, whereas significant meningeal haemorrhage is rare. Haemorrhages in the fundi were noted in 10% of the patients. The general tolerance of the examination was good.


[Intravascular coagulation and severe hepatic failure in infants]. Diagnostic criteria for disseminated intravascular coagulation occurring in severe liver failure were reviewed by analyzing 11 pediatric cases. In this series, intravascular coagulation was often latent, but became overt following inconsiderate administration of procoagulant concentrates. Exchange-transfusion of infusion of fresh-frozen plasma, with or without addition of heparin, appeared to be the best mode for correcting potential bleeding tendencies.


[Attempt at potentiation of the action of L-dopa on the secretion of growth hormone by benserazide, disulfiram and propranolol]. Two tests of stimulation of growth hormone secretion were performed in 3 groups of normal children. In the first test L-Dopa was used on its own; in the second, L-Dopa was combined with Benserazide (group A), with Disulfirame (group B), or with Propranolol (group C). In group A the mean peak value after L-Dopa was 9.1 +/- 1.6 ng/ml; with the combination of L-Dopa and Benserazide it was 12.4 +/- 2.4 ng/ml. The difference between the means is not significant. In group B the mean peak value after L-Dopa was 8.9 +/- 3.6 ng/ml; with the combination of L-Dopa and Disulfirame it was 14.5 +/- 4.4 ng/ml. The difference is not significant. In group C the mean peak value after L-Dopa was 9.8 +/- 2.6 ng/ml; with the combination of L-Dopa and Propranolol, it was 10.1 +/- 1.9 ng/ml. Again the difference is not significant. These findings do not provide evidence in favour of the effect of L-Dopa on the secretion of growth hormone being facilitated by an inhibitor of L-Dopa decarboxylase (Benserazide) or of Dopamine beta hydroxylase (Disulfirame), or by a beta blocking agent (Propranolol). The mechanisms of action of L-Dopa and of the various combinations studied are discussed.


[Hypopituitarism with hypoplasia of the optic nerve (Kaplan, Grumbach and Hoyt syndrome]. Two new cases of the syndrome described by Kaplan, Grumbach and Hoyt are reported. The two children were hypopituitary dwarfs, with congenital nystagmus and small optic discs with double border. Pneumoencephalography showed malformations of the median structures, with trans-sphenoidal encephalocele in one case. The definition of this syndrome and its relation to De Morsier's septooptical dysplasia are briefly discussed.


[Intralobar sequestration causing heart failure in a new born infant. Surgical correction]. The authors report the occurrence of an intralobar pulmonary sequestration in a neonate with symptoms of congestive heart failure, due to a fistula effect in the sequestrated area. The venous drainage was directed mainly to the superior caval vein via azygos vein and accessorily to the left atrium. The patient became asymptomatic after lobectomy performed at the age of 11 days.


[Neonatal pneumothorax and urinary tract malformation. 3 cases]. Three newborn male infants are reported who presented with a tension pneumothorax in the first few hours of life. Early in one case and after intervals of one month and eight months in the others attention was drawn to the urinary tract. Radiological investigations revealed morphological abnormalities of the kidneys and the urinary tract itself. The pathogenesis is discussed and an intravenous pyelogram is recommended before the development of clinical features. In this way early diagnosis might allow treatment prior to renal involvement.


[Isovaleric acidemia. Study and treatment in 3 brothers]. The cases of 3 sibs presenting with isovaleric acidemia are reported. The first infant died when he was 9 day-old. The two others appear to have benefited from a controlled leucine diet which was introduced from the first days on of life. The clinical symptomatology, highly typical of the disease, is described. Diagnosis was not assessed on amino-acids chromatography but on the chromatography of volatile fatty acids. The mode of treatment is described: peritoneal dialysis, with the object of rounding a crucial cape, and overall controlled leucine diet, but supplemented by essential amino-acids.


Contemporary views of negative effects in psychotherapy. An integrated account. As part of a larger investigation into negative effects in psychotherapy, we conducted a survey of researchers and practitioners in psychotherapy. We now present an integrated account of the consensus of these experts on the following issues: (1) Is there a problem of negative effects? (2) What constitutes a negative effect? (3) What factors are prominently associated with negative effects? There was an overwhelming affirmation of the reality of negative effects among the respondents. Furthermore, they urged that negative effects be subjected to systematic research scrutiny, a strategy made more feasible by the identifying criteria and possible causative factors cited by these experts. It is suggested that there is need for research into therapeutic actions and psychotherapy outcomes in general, with special reference to negative effects.


Group psychotherapy. A long-term follow-up study. Forty-two randomly selected patients were interviewed 2 to 14 years after termination of psychoanalytic group therapy. Comparison of psychodynamic changes in patients who stayed less than six months with those in patients who stayed more than two years gave a null result. The majority of patients were highly dissatisfied with their group experiences. However, there was a very strong positive correlation between favorable outcome and previous individual psychotherapy. Thirteen patients were then studied who were selected by their group therapists as having done well. These patients gave strong evidence of beneficial therapeutic effects, but such patients appear to be rare. These results (1) suggest how this form of treatment might be improved, and (2) raise questions about the appropriateness of transferring to group treatment the strictly psychoanalytic approach as used with individuals.


Clinical effectiveness of "short" vs "long" psychiatric hospitalization. I. Inpatient results. To evaluate the clinical effectiveness of short-term (three month maximum length of stay) and long-term (discharge based on clinical judgement) hospitalization, the inhospital course of 68 "short-" and 58 "long-term" psychiatric patients was studied. The results indicate that patients assigned without bias to short-term patterns, however, indicated that these results could be entirely accounted for by the significantly greater use of group therapy as an additional treatment modality in the short-term units. The need for a more systematic exploration of the effect of restricted hospital stay on the treatment patterns of the clinician and the effect of these differential treatment patterns on inhospital improvement is emphasized. The necessity for follow-up data to gain a complete picture of these treatment contrasts is clear.


Illness in a therapist--loss of omnipotence. This article describes one psychotherapist's discovery through his own acute illness, of his use of omnipotence as an unconscious defense mechanism while working with patients. It includes his patients' reactions to his "loss of omnipotence" and the insights he gained from the experience.


Postcombat violent behavior in psychiatrically maladjusting soldiers. Thirty-one psychiatrically maladjusting combat veterans, referred for psychiatric evaluation either for administrative reasons or because of specific psychiatric symptoms, were interviewed while still on active duty two months to 1 1/2 years after returning from Vietnam. Thirteen of the 31 reported at least one act of violence against another person since returning from combat. The soldiers with postcombat violence more frequently than the nonviolent had a history of fighting in childhood or adolescence, of volunteering for Vietnam, of reporting thay they had killed four or more persons, and of reenlisting for additional tours of duty in Vietnam. Maladjusting soldiers who are violent following combat may as a group be more violence-prone both before and during combat than soldiers who are not, but definitive studies are lacking.


Stress films, emotion, and cognitive response. The clinical theory of the repetition compulsion is sometimes taken to mean that neurotic persons, when traumatized, will develop compulsive repetitions of the trauma. Our experiment suggests that there is a more general effect--that various types of persons, after a variety of stressful events, will tend to develop intrusive and stimulus-repetitive thought; the stress itself does not necessarily have to have a negative valence. Equivalent effects were noted after stimuli that aroused  positive emotions and after those stimuli that aroused dysphoric affects.


The double-bind theory and hemodialysis. A review of the literature on the psychosocial problems attending hemodialysis provides no coherent theory or approach to explain the high incidence of psychiatric morbidity in this medical population. The literature is characterized in the main by the assumption that the problems lie either in the patients or in the stresses consequent to the treatment. Little recognition is given the fact that hemodialysis patients, unlike patients in other medical categories, are involved in intense, ongoing, and in many cases permanent, interpersonal relationships with medical professionals. Instead of looking at the personalities, predispositions, or capacities of patients, or how these responded to handicap and stress, the focus here is on the structure or pattern of the staff-patient relationships in this context.


Linguistic analysis of speech in affective disorders. Various aspects of speech and language were compared, using psycholinguistic techniques, in a group of 15 depressed patients and 16 manic patients: lexical diversity, syntactical complexity, syntactical elements, and content analysis. Contrary to anticipation, the manic patients did not show more varied word choice or complexity of sentence structure than the depressives. In particular, they did not differ significantly in type-token ratio. The greatest difference was in syntactical elements, with manics using more action verbs, adjectives, and concrete nouns, while the depressed patients used more state of being verbs, modifying adverbs, first-person pronouns, and personal pronouns. When compared by content analysis, the manics used more words reflecting a concern with power and achievement. These results imply that depressive speech tends to be more vague and qualified and to show considerable self-preoccupation, while manic speech tends to be colorful and concrete and to show more concern with things than with people.


Platelet monamine oxidase in chronic schizophrenia. Some enzyme characteristics relevant to reduced activity. To evaluate further the basis for the reduced activity of platelet monoamine oxidase (MAO) found in chronic schizophrenic patients, a number of characteristics of the enzyme were compared between patients and controls. Equivalent and statistically significant reductions in activity of the enzyme were found in the patients when tyramine and benzylamine were used as the substrates in comparison to previously reported reductions with tryptamine as the substrate. Michaelis constants for platelet MAO from chronic schizophrenic patients with reduced enzyme activity were not different from controls. Dialysis of the enzyme from patients and controls yielded no changes in activity. Studies of other platelet enzymes, including succinate dehydrogenase, cytochrome C reductase, and lactate dehydrogenase in patients, normal controls, and a subgroup of normal controls with reduced MAO activity, showed no parallel reductions in activity in patients or controls with low MAO activity. These findings suggest that the reduced MAO activity found in chronic schizophrenic patients is apparently not accounted for by nonspecific changes in platelets or platelet mitochondria.


Potentiation of the antidepressant action of clomipramine by tryptophan. In a double-blind study of 24 patients with endogenous depressiona group treated with clomipramine hydrochloride (chlorimipramine) plus tryptophan was compared with a group treated with clomipramine plus placebo. The sum of the ratings for depressed mood, suicidal intent, depressive thought content, and anxiety showed a more rapid improvement in the former group, the difference being already significant after 12 days of treatment. On the other hand, the ratings for retardation decreased about equally in both groups during the three-week treatment period. Side-effect ratings showed no significant increase but seemed to be partly influenced by the improvement of depressive symptoms. Plasma levels of clomipramine appeared to reach a plateau within a few days, whereas the monodesmethylated metabolite continued to rise for a longer period of time, and reached considerably higher values than the parent compound. In the tryptophan group the degree of improvement seemed to be positively correlated to these levels, suggesting that further improvement might have been reached in some patients by increasing the dose of clomipramine. The levels of 5-hydroxyindoleacetic acid in the cerebrospinal fluid appeared to be reduced by clomipramine administration. This effect was prevented by the additional treatment with tryptophan.


Undergraduate education in rehabilitation medicine: trends in curriculum development and the impact on specialty manpower and delivery of service. One hundred thirteen medical schools which offered full degree programs were identified and surveyed by questionnaires to obtain information which identified the existence, characteristics and involvement of physical medicine or rehabilitation medicine programs. The survey also attempted to identify specific changes which have occurred in undergraduate medical education in rehabilitation medicine since the Commission of Education and Rehabilitation Medicine survey of 1963-64. The results suggest that growth of the programs has not followed the expansion in the number of medical schools nor in the number of students enrolled. The programs have however, improved their administrative standing and involvement in medical schools. The impact on the undergraduate medical student is not satisfactory as judged by elective enrollment and recruiting of residents. Lack of funding was found to be one of the major obstacles to curriculum development, along with a marked shortage of academic physiatrists. The impact of the changes in undergraduate medical school curricula on rehabilitation medicine has produced considerable conjoint teaching in conjunction with a large number of basic science and clinical departments.


Team care in chronic illness: a critical review of the literature of the past 25 years. Accumulated literature over the past 25 years about the team approach to chronic disease can be divided into three broad categories: (1) the opinion base which reflects statements of belief and faith, (2) the descriptive base which contains details and personal testimony of programs using team concepts and (3) the study base which includes serious research efforts to investigate the effectiveness of team care in various settings. An analysis of the articles in the last category provides a useful insight into the problems and possibilities associated with this neglected area of health care research. The populations studied include patients with heart disease, hypertension, stroke, hip fracture, rheumatoid arthritis, diabetes and groups referred for comprehensive rehabilitation. The majority of the studies demonstrated improved outcomes in one or more areas for patients receiving coordinated team care when compared with control groups. Although these studies serve as a useful guide, the extent to which the findings can be generalized is open to serious question. In the absence of additional research, team care will remain as it is today, largely a matter of faith and the subject of many platitudes. An outline is proposed of the major methodological features which should be considered in the planning and/or evaluation of future studies in this area.


[Significance of sibling constellations for the origin of systematic schizophrenias (author's transl)]. In previous examinations of twins the author found that, surprisingly, "systematic schizophrenias" did not occur in identical twins, whereas they did in binovular twins. Even though the term systematic schizophrenia may not be accepted, the results, in any case, remain valid because they are based on a classification that had been defined and described prior to the present investigation. From the findings in twins the question arised as to whether the constellation of siblings who are not twins might also be significant in preventing the outbreak of systematic schizophrenias. Therefore, in a sample of 500 patients examined earlier we stated how many siblings, older siblings, younger siblings, brothers, sisters were to be found in systematic schizophrenias and their special types. There were many findings, in part being statistically significant, in part suggesting, at least, that they be taken into consideration. As a result of the findings it seems clear that sibling constellations are important for the origin of systematic schizophrenias. Thus, whereas psychosocial factors proved prominent, we found the heredity rate especially low in these forms of schizophrenia.


Prevention of paraplegia associated with resection of extensive thoracic aneurysms. A review of the literature suggests that paraplegia associated with thoracic aortic surgery is preventable if intraoperative hypotension is eliminated, the distal aorta perfused adequately, and the intercostal arteries below T-8 level preserved. A surgical technique has been developed that leaves the posterior aortic wall, preserving the intercostal arteries below the level of T-8, and interspersing a diagonally tailored prosthesis with the aid of left atrial-to-femoral arterial bypass without heparinization. Seven patients with extensive aneurysms involving the entire descending thoracic aorta were operated on successfully by this technique without neurological complications.