Enrichment of B lymphocytes from human peripheral blood by sedimentation of E rosette stabilized with dextran. A simple method for the enrichment of B lymphocytes population from human peripheral blood by isolated of lymphocytes responsible for E rosette in presence of dextran is presented. Qualitative and quantitative results regarding the yield, the viability and the purity of the enriched population are discussed.


Peripheral blood T lymphocyte subpopulations in newborns. Monocyte-depleted lymphocyte suspensions from the peripheral blood of 36 healthy newborns and 23 adults were compared as to percent of cells forming rosettes with sheep erythrocytes (T lymphocytes) and proliferative responses after in vitro culture with various doses of Phytohemagglutinin, Concanavalin A and Pokeweed mitogen. No significant difference was found between the proportions of T lymphocytes of newborns and adults. Mitogen responsiveness of the newborn lymphocytes showed dramatic between-subject variability completely unrelated to the proportion of T lymphocytes. It is suggested that during neonatal life there is massive variable recirculation of T lymphocytes subsets (and/or stages of maturation) characterized by differential degrees of responsiveness to the mitogens tested.


[Effect of L-DOPA on repair of neurogenic dystrophic damage to the gastric mucosa of rats]. Neurogenic dystrophy of the gastric mucosa was induced by a 3-hour immobilization and electrostimulation. By the end of the stimulation there developed in the gastric mucosa hemorrhagic erosions which persisted for two days after the stimulation. According to the data of macro- and microscopic studies injections of 1-DOPA to rats in a dose of 10 mg/kg of body weight for a period of two days after the cessation of stimulation accelerated the healing of hemorrhagic erosions of the gastric mucosa.


Action of isoprenaline on the mechanical properties of lungs and airways in healthy people and patients with obstructive lung diseases. Lung volumes, maximal expiratory flows, pulmonary resistance and static recoil pressure-volume curves were measured before and after inhalation of isoprenaline in four groups of subjects: heqlthy patients with mild and severe chronic bronchitis and asthmatics. The observed changes were qualitatively similar in the four groups. Whereas total lung capacity and dynamic compliance were not influenced, there was an increase in vital capacity (not in healthy subjects and mild bronchitics), in FEV1, in maximal expiratory flows and a decrease in pulmonary resistance. The static recoil pressure-volume relationship was shifted to the left over its ascending part. The effect of isoprenaline tended to be larger in patients. Among the latter, the increase of vital capacity was especially pronounced  in the severe bronchitics, whereas the maximal flows increased most in asthmatics. We suggest that the influence of isoprenaline on maximal flows results from a bronchodilation, associated with an increased collapsibility of the central intrathoracic airways, whereas the influence of VC might reflect a delayed onset of small airway closure.


The renal handling of biologically active peptides. With the use of the protease inhibitor from bovine organs--Trasylol-- as a model, we studied the pinocytic transport of peptides in the kidney. Rats were injected with the 125I-labeled peptide and killed at different times thereafter. Kidney homogenates were subfractionated by differential and sucrose gradient centrifugation. Radioactivity was measured in the fractions in order to study the time-dependent fixation of the peptide to different cell organelles. With short survival periods, the protease inhibitor is recovered in the brush-border fraction, with longer periods, a shift towards the lysosome fraction takes place. Thus, the renal transport of the protease inhibitor consists of three steps: binding to the brush border, incorporation in micropinocytic vesicles and transport in phagolysosomes.


Sunscreen dermatitis due to glyceryl PABA: significance of cross-reactions to this PABA Ester. Glyceryl PABA (Escalol 106), present in many popular sunscreens, is a common sensitizer which invariably cross-reacts with benzocaine; it is present in over 400 over-the-counter products. Glyceryl PABA does not appear to cross-react with the sunscreening agents amyl (Escalol 506) and octyl (Escalol 507) dimethyl PABA. Glyceryl PABA, may, on occasion, cross-react with para-aminobenzoic acid (PABA), paraphenylenediamine, aniline, and sulfa drugs. Ironically, the sunscreening agent glyceryl PABA may, itself, act as a photosensitizing agent.


Lentiginosis profusa. III: Aesthetic and sanguineous aspects. Lentiginosis profusa syndrome and progressive cardiomyopathic lentiginosis are preferable terms to "leopard syndrome". Considerable cosmetic improvement followed facial dermabrasion and light electrodesiccation of lentigines on the exposed surfaces. Hematologic evaluation did not reveal hematopoietic defect in the patient studied.


Age, immunity and the skin.

Age, immunity and the skin. With advancing age there is a decrease in T-lymphocyte functions leading to defective cell-mediated immune responses and decreased levels of immunoglobulin G, which is produced by B cells under the influence of certain T lymphocytes. Decreased resistance to viruses as a result of the depression of T-cell function may lead to some clinical viral infections which trigger autoimmune diseases. The diminished T cell's immune response and its inability to eliminate ultraviolet-light-damaged epidermal cells may be in part responsible for the increased incidence of skin malignancies in elderly patients.


Quantitative scintigraphic display of myocardial blood flow. Technique and clinical evaluation. Immediately after coronarography 10 mCi 133Xenon were injected into the left or right coronary artery. A scintillation camera was placed above the thorax of the patient. A computer unit (KRUPP EPR 2500) with magnetic tapes and discs is available for data processing and data storage. Sequential images of the heart are taken over a period of 2 min in a two-second-frame mode and stored on magnetic tape. The total image was divided into 5 - 5 mm areas. From each area a functional curve was registered and the Myocardial Blood Flow (ml/min/100 g myocard) could be calculated from that. For a precise evaluation of the image of the Myocardial Blood Flow, any influences originating from other regions of the body had to be excluded. Therefore all curves are rejected which did not (a) reach their maximum value within 15s after injection, or (b) where the maximum was less than 10% of the highest maximum value of the reference curve. The values of the Myocardial Blood Flow calculated in this manner are displayed on a TV-screen. These values can be transformed into 10 colors or grey levels. This method has been proven to be useful in clinical practice for functional studies, especially for the judgement of the effectivity of pharmaceuticals. The quantitative display technique of the "Myocardial Blood Flow" improves the clinical statement in comparison to a scintigraphic picture.


Structure-activity relationship of some steroidal compounds in ocular inflammation. The structure-activity relationship of some topically applied 21-desoxy-substituted steroids as anti-inflammatory agents was investigated; the anti-inflammatory activity remained unaltered or increased on introducing a methyl group in position 6alpha and a hydroxyl group in position 11beta, even after eliminating the hydroxyl group in position 21. The activity of the molecule was further increased by the introduction of a hydroxyl group in position 17alpha and a fluorine atom in position 9alpha.


[Influence of atropine on the chronotropic effects of stimulating the parasympathetic innervation of the heart]. Changes of the positive chronotropic effect in the frog atrium during stimulation of the extracardiac pathways or of the central end of intracardiac innervation after application of atropin (10(-4)--10(-5) on the sinus node, were studied. The positive chronotropic effects were abolished by the atropin application. The postganglionic impulse activity of the intracardiac nervous pathways did not change. Atropin had no influence on the sympathetic acceleration of the heart rate due to stimulation of sympathetic pathways. Positive chronotropic effects induced by stimulation of the parasympathetic extra or intracardiac pathways, are of cholinergic nature.


[Effect of ATP on the sensitivity of the from heart to adrenaline]. Adenosinthreephosphoric acid (ATP) in concentration 1-10(-6)--1-10(-5) g/ml decreases sensitivity of the frog heart muscle to adrenaline by half. It is suggested that ATP present in the specific granules of adrenals, c. n. s. and adrenergic axons together with catecholamines and excreted with the mediator during excitation of adrenergic nerve, alters the sensitivity of postsynaptic membrane to adrenaline.


Ultrastructure of macrophage-lymphocyte interaction in purpura pigmentosa progressiva. Thin sections of pathologically changed skin lesions of patients suffering from purpura pigmentosa progressiva, a disorder which seems to be mediated by delayed type of allergy, were electron microscopically investigated. In 5 of the 7 cases we found cell infiltrates of the dermis consisting of many lymphocytes frequently in apposition to macrophages (histiocytes). The cell interactions observed occurred either by microvilli-like cytoplasmic protuberances or by local areas of the plasma membrane apposition. No submicroscopical alterations of the cytoplasm were found in the interacting cells although numerous macrophages show abundant microfilaments. The findings observed are interpreted as the ultrastructural substrate of cell cooperation for presenting and transfering antigens from macrophages to T lymphocytes. However, the question concerning the mechanism of the transfer remains open.


Inhibition of human platelet aggregation by the proteolytic effect of streptokinase. Role of the human factor-VIII-related protein. Defective ADP-induced aggregation was observed in in vitro streptokinases(SK)-treated normal platelet-rich plasma. Classic haemophilia and normal platelet poor plasma (PPP) treated with SK inhibit the aggregation of washed platelets; plasmin-treated normal human serum also shows an inhibitory effect on platelet aggregation. However, SK-treated von Willebrand plasmas do not inhibit the aggregation of washed platelets. This confirms the fact that the anti-aggregating effect is mainly linked to the digested factor VIII) but not to the digested fibrinogen. Defective ristocetin-induced platelet aggregation has also been observed in SK-treated plasmas. The presence of normal PPP does not modify the inhibition of the ADP-induced aggregation of washed platelets in SK-treated PPP. However, it does correct the ristocetin-induced aggregation. These results suggest that the inhibition of the ADP-induced aggregation is caused by the factor VIII degradation products, while the inhibition of the ristocetin-induced aggregation appears because of a defective von Willebrand activity of the factor VIII molecule.


Measurement of 5-hydroxyindole compounds during L-5-HTP treatment in depressed patients. L-5-hydroxytryptophan (L-5-HTP), an immediate serotonin precursor, was given to the hospitalized depressed patients in an open clinical trial of the Phase 2 study for antidepressive effects of the agent. A relatively small dose, 150mg orally for seven days, was employed, and seven of 14 patients responded to the treatment with mild or moderate emelioration of their depressive symptoms. Urinary excretion levels and plasma concentrations of three 5-hydroxyindole compounds, 5-HTP, 5-HT and 5-HIAA, were measured during the drug treatment. Approximately 70% of the orally administered dose of L-5-HTP was recovered from the urine of depressed patients. Major part of urinary indoleamine metabolites was free and conjugate 5-HIAA. Excretion levels of these compounds in urine were not consistenly altered in the depressed patients as compared to those in normal subjects. Clinical response to L-5-HTP treatment appeared to have some correlation with the biochemical measures in the depressed patients, that is, non-responders exhibited significantly lower excretion levels of 5-HT and 5-HIAA in urine, and lower plasma levels of 5-HT than responders. Administered L-5-HTP may not be fully utilized in the depressed patients who did not react to the agent.


Reduction of blood platelet serotonin levels in manic and depressed patients. Blood platelet serotonin levels were measured in unmedicated 12 manic and 74 depressive patients with 118 normal control subjects employed. Blood platelets were separated by multiple contrifugation in the medium of Na2-EDTA solution, and the loss of serotonin during collecting procedures was about 11%. The mean value of blood platelet serotonin levels in depressed patients was 594+/-288ng/mg platelet protein (+/- S.D.), which was significantly lower than that for normal controls, 780 +/- 253ng/mg protein (p less than 0.001). Age does not account for the reduction of serotonin levels both in depressed and in normal population. Unipolar and involutional depressed patients exhibited to have the most pronounced reduced levels of serotonin of various subtypes of depression, while bipolar depressed patients, neurotic and chronic characterological depressed patients as well as patients with first-episode depression had the values which were comparable with those in normal controls. Manic patients did not show enhancement but did reduction of serotonin levels, the mean being 580+/-152ng/mg protein, which made a contrast with their clinical manifestations of exhilaration and hyperactivity. Changes in blood platelet serotonin levels were determined before, during and after administration of L-5-HTP with a maintenance dose of 300mg daily in nine depressed patients. Serotonin levels in all subjects were lifted to normal levels during the L-5-HTP treatment, while clinical symptoms were not improved with the treatment. Reduction of blood platelet serotonin levels in depressed patients may be due to their psychobiological distinction, which involves abnormal biogenic amine metabolism in the brain.


[Intracellular endobiosis as a basic factor in acquired immunity in man (author's transl)]. An attempt is made to explain the significance of intracellular endobiosis for the human acquisition of immunity against cyclic infections diseases. It is pointed out that, taking into account the temporally limited reduplication of an immune-potent cell clone, a species-specific induction of immunity against infections and other diseases is sustained for a sufficiently long period of time only by a microorganism which is still living.


5-bromodeoxyuridine-light inactivation of human lymphocytes stimulated mitogens and allogeneic cells: evidence for distinct T-lymphocyte subsets. The study of human peripheral blood currently permits enumeration of circulating B and T lymphocytes as well as the analysis of functional responses in vitro following stimulation with mitogens, antigens or allogeneic cells. In the present experiments, subsets of these major lymphocyte populations were analyzed by dissecting in vitro responses using an ablative technique. After an initial culture period of lymphocytes with a mitogen, the proliferating cells were inactivated with 5-bromodeoxyuridine and light, then the capacity of the remaining lymphocytes to respond to the same or a different mitogenic influence was tested. Responsiveness to a different stimulant in the presence of no further response to the first stimulant was taken as evidence for a different responding cell population. A large subset of peripheral blood lymphocytes was responsive to both phytohemagglutinin (PHA) and concanavalin A (Con A); ablation of the cells responsive to one left little or no cells responsive to the other. Pokeweed mitogen (PWM) stimulated a portion of the PHA-Con A-responsive subset and an approximately equal subset unresponsive to PHA or Con A. Other evidence indicates that with each of these mitogens (especially with PHA and Con A in a soluble form), most of the proliferative response of peripheral blood B lymphocytes is indirectly triggered and is dependent on T cell stimulation. The population of PHA-Con A-responsive cells is, therefore, interpreted to represent a major T cell subset plus recruited cells; the PWM-responsive population would include a T cell subset having also PHA and Con A responsiveness, and another subset of T (or perhaps B) cells. The mitogen-sensitive population showed no overlap with cells responsive to allogeneic stimulation in mixed leukocyte culture. Ablation of the mitogen-responsive cells potentiated the mixed leukocyte reaction, suggesting that a suppressive influence was removed with the inactivation of the mitogen-responsive cells. It appears, therefore, that distinct subsets of T lymphocytes differentially responsive to PHA-Con A, to PWM and to allogeneic stimulation are present in the human peripheral blood.


Cellular requirements for simulation by the purified streptococcal antigen DSR. Delayed skin reactor (DSR) was prepared from streptokinase-streptodornase. Peripheral blood mononuclear cells, were collected from a Ficoll-Hypaque gradient and subsequently subdivided into T cell-, B cell-, or monocyte-depleted populations. Mononuclear cells with complement receptors (B cells) were removed by a nylon-wool column adsorption. Sheep erythrocyte rosette forming cells (T cells) were removed by centrifugation on a second gradient. Populations of cells which did not adhere to plastic and/or ingest iron filings were monocyte-depleted. While response to DSR as measured by incorporation of tritiated thymidine into DNA was not affected by removing B lymphocytes, it was significantly diminished by removing T lymphocytes. Monocyte-depleted cells incorporated less tritiated thymidine into DNA in both antigen stimulated and control cells, but the stimulation index was not significantly altered.


Occurrence of suppressor cells in lymph nodes and spleen at later times after immunization with contact-sensitizing agent picryl chloride. The lymph node and spleen cells of mice painted on the skin with the contact sensitizing agent, picryl chloride, transfer contact sensitivity. Their ability to transfer reaches a peak 4 days after immunization and is absent by day 6 providing the recipient mice are challenged shortly after transfer (Chase type transfer). In contrast, when challenge of the recipients is delayed for 6 days (adoptive transfer), lymph node and spleen cells show the greatest ability to transfer 8-12 days after immunization. When cells taken 4 days after immunization (which transfer contact sensitivity) are mixed with cells taken at 6-11 days (which fail to transfer), the mixture shows little ability to transfer. This provides evidence for the occurrence of suppressor cells. Lymph node and spleen, and thymus cells show suppressor activity. The suppression is specific and cells from donors immunized with the contact-sensitizing agent oxazolone will not suppress passive transfer of contuse of the loss of ability of lymph node and spleen cells in transfer later than day 6 after immunization. Experiments on the loss of radioactivity from lymph nodes labelled with 125I-iododeoxyuridine (IUDR) suggest that loss of cells from the lymph nodes may be a contributory factor.


T and B lymphocyte populations in human normal lymph node, regional tumour lymph node and inflammatory lymph node. We have determined the T and B lymphocyte subpopulations in normal human lymph nodes. The lymphocyte profile was the same irrespective of the anatomical distribution and was similar to that found in peripheral blood with identical T and B cell values but with a lower Fc and a higher C3-receptor-bearing lymphocyte subpopulation. This pattern showed a marked change in the regional nodes of patients with mammary carcinoma and nodes draining a variety of other solid tumours, with a fall in T and pronounced elevation of B, Fc and C3 cells but with a persistence of C3 predominance. The lymphocyte profile found in tonsils and nodes draining inflammatory foci was a similar but further exaggeration of the tumour node pattern, with reversal of T and B cell ratios. The T and B lymphocyte percentages in the peripheral blood of patients with clinically localized breast cancer are identical to those of the healthy controls. Different Fc/C3 subsets exist in peripheral blood and lymphoid structures and probably represent a differential functional heterogeneity. Proximity of tumour to the draining node modified this profile.


Characterization of K-cell activity by use of depletion experiments. Normal human blood lymphocytes with affinity for ox red cells sensitized with IgG antibody, for normal or papain-treated sheep red cells and for ox red cells coated with mouse complement were used for rosette formation and the rosetting cells separated by density gradient centrifugation on Ficoll/hypaque. The non-rosetting cells at the interface were collected and compared with cell suspensions before treatment for direct and antibody-dependent cytotoxicity of human target cells. Depletion of Fc-receptor-bearing lymphocytes strongly decreased antibody-dependent cell-mediated cytotoxicity; reduction in the number (or depletion) of T cells and cells with C'3 receptor had no effect, showing the same or enhanced K-cell activity. It is concluded that one type of K or killer cell has Fc receptors but lacks C'3 receptors.


E and EAC rosette-forming cells in healthy donors and cancer patients. The influence of age and sex on the lymphocyte count and numbers of E and EAC rosette-forming cells (RFC) was investigated using peripheral blood of healthy donors. In the female donors we found a lower total lymphocyte count and percentage of EAC RFC than in male donors. The percentage and total number of E RFC appeared to be low in younger donors. Total lymphocyte count and numbers of E and EAC RFC were investigated in untreated and treated patients with advanced solid tumors and in patients with untreated malignant lymphomas. The lymphocyte count in all these groups was decreased, but the E/EAC RFC ratio was normal, except in the group with untreated solid tumors, where we found an increased percentage of E RFC. It is suggested that in these patients a nonspecific impairment of bone marrow function might be expressed in numbers of peripheral T and B cells.


Studies on immune responses to parasite antigens in mice. I. Ascaris suum larvae numbers and antiphosphorylcholine responses in infected mice of various strains and in hypothymic nu/nu mice. In terms of day 7 lung larvae numbers, mice vary markedly in their suscepibility to a first infection with the nematode worms, Ascaris suum, and the highly susceptible strain, C57Bl, is resistant to second infection. Time course studies suggested that the period of residence in the liver or migration to, or into, the lungs are stages of the life cycle in which natural or acquired resistance of the host is expressed. The traits, susceptibility and resistance to first infection, were under polygenic control and no linkage of susceptibility to the major histocompatibility complex of C57Bl mice (H-2b) was observed. Acquired resistance (to second infection) has not been dissected because of our inability to show adoptive transfer of resistance to naive recipeints. Studies in hypothymic BALB/c. nu/nu mice indicate that natural resistance (to first infection) is not affected by a lack of T cells. The T cell dependence of acquired resistance in C57Bl mice remains in doubt although in the relatively resistant strain BALB/c, hypothymic nu/nu mice after second infection contain as many larvae in their lungs and liver as are present after first infection. An eosinophilia is observed in infected intact mice but not in infected T cell-deficient mice. Partially T cell-dependent serum antibodies and plaque-forming cells to phosphorylcholine (PC) were present in mice infected with A. suum but no evidence was obtained that this anti-PC antibody response was in any way protective for the host. The cell membrane-acitive properties of PC and related molecules suggest that PC-containing parasite antigens may be tolerogens for certain of the B cells with specificity for parasite antigens. A state of partial tolerance involving high affinity antibody production may be one means whereby parasites survive in natural or unnatural hosts.


Studies on immune responses to parasite antigens in mice. II. Aspects of the T cell dependence of circulating reagin production to Ascaris suum antigens. Heat-labile, rat skin-fixing antibodies were detected readily in the sera of young female mice dosed intranasally with the body fluid of Ascaris suum (ABF) and the adjuvant, Bordetella pertussis vaccine (BPV). In addition, washed cell suspensions prepared from spleen and the lymph nodes regional to the lungs were positive in an adoptive cutaneous anaphylaxis assay, an assay which may detect activities of reagins associated with mast cells rather than reaginic antibody-secreting cells. The intraperitoneal route was a poor means of inducing circulating anti-ABF reagins and an intraperitoneal injection of ABF + BPV delayed the appearance of circulating reagins in mice dosed at the same time with ABF + BPV intranasally. Hypothymic female BALB/c. nu/nu ('nude') mice failed to produce circulating reagins to ABF but an injection of normal thymocytes or cortisone-resistant thymocytes from syngeneic female mice led to higher titers of circulating reagins than found in normal female BALB/c. nu/+ littermates. Using cells from young male or female syngeneic donors and male and female BALB/c. nu/mu recpiients, evidence was obtained for a defect in the thymus of young male mice and conceivably this defect may extend to the peripheral T cell population in such mice. Cyclophosphamide pretreatment or adrenalectomy increased circulating reagin titers in normal mice dosed intranasally with ABF + BPV, and pretreatment with lipopolysaccharide intranasally markedly reduced titers of circulating anti-ABF reagins. In the discussion, emphasis is given to the hypothesis that potent allergens are T cell-stimulating, relatively persistent antigens which, when located in submucosal lymphoid sites and under conditions of limited antibody production as a result of limited recruitment of 'helper' T cells systemically, lead to the induction and sustained production of IgE by resident Bxi cells and their progeny.


Studies on immune responses to parasite antigens in mice. III. Nippostrongylus brasiliensis infections in hypothymic nu/nu mice. Normal mice of several strains reject the nematode worm Nippostronglyus brasiliensis from the intestine within 14 days (and most often within 10 days) of injection of high numbers of infective third stage larvae (L3). Previously-infected mice are markedly resistant to a second infection. Hypothymic, nu/nu ('nude') mice continue to harbor worms long after intact mice have rejected the worm burden and an inoculum of T cells at the time of, or several days after L3 injection, leads to worm elimination within 14 days in nu/nu mice. As yet no evidence is available to indicate whether or not T cells with specificity for parasite antigens are required in a reconstitutive inoculum in nu/nu mice. Pretreatment of normal mice with cyclophosphamide, at doses reported to lead to temporary B cell hypofunction, does not result in delayed rejection of worms but the participation of B cell products (antibodies) cannot be discounted on the basis of this result. The nu/nu mouse - N. brasiliensis system will be useful in the search for, and characterization of, parasite antigens which gain access to the lymphoid organs and circulation of parasitized mice and in the analysis of T cell subtypes (both functional and surface Thy and Ly alloantigenic subtypes) involved in worm elimination.


Unusual combination of immune and endocrine deficiencies. A possible case of early-onset Louis-Bar syndrome. Immunodeficiency functionally limited to the B-cell system together with mild hypothyroidism and severe growth hormone deficiency was found in a 6 1/2-month-old female infant with recurrent infections and growth retardation. A lymph node biopsy and post mortem examination of the lymphoid organs surprisingly revealed severe deficiency of both thymus-dependent and bursa-equivalent systems. The unusual combination of immune and endocrine deficiencies posed a difficult diagnostic problem. The hypothesis of an early-onset Louis-Bar syndrome was suggested and apparently corroborated by the autopsy findings of ovarian dysgenesis and cerebellar degeneration. The dissociation between functional and morphological findings as regards the immunodeficiency, and the possible links between immune and endocrine derangements are discussed.


A comparative study of histochemical mapping on the distribution of acid phosphatase and 5-nucleotidase in the forebrain of frog (Rana tigrina). The four well defined dorsal, lateral, medial and intermediate olfactory tracts of the frog have been studied. During their courses they become intermingled with fibers related to the primordial septum, the primordial hippocampus, the primordial dorsal pallium and the primordial piriform areas. In acid phosphatase preparations all these tracts are completely negative, and, therefore, are not identifiable. However, these tracts have intense staining reaction to 5-nucleotidase throughout their courses. Differences in the distribution of acid phosphatase and 5-nucleotidase are apparent in the hippocampal and anterior commissures. These are negative for acid phosphatase. In 5-nucleotidase preparations the anterior commissure has an intensely positive whereas the hippocampal commissure has a completely negative reaction. The medial septal nucleus is intensely positive for 5-nucleotidase at the anterior hemisphere level. There is a gradual decrease in intensity of staining in this nucleus towards the posterior hemisphere levels so that in the last few sections of the forebrain of the frog the medial septal nucleus is completely unstained or negative. In the acid phosphatase preparations at all levels the medial septal nucleus presents a moderately positive reaction. In 5-nucleotidase preparations, the dorsomedial part of primordial hippocampus is intensely positive whereas the dorsal part of the hippocampus is completely negative. In acid phosphatase preparations, both dorsal and dorsomedial parts of hippocampus are intensely positive. The striatal complex and the lateral septal nucleus are positive for acid phosphatase and negative for 5-nucleotidase. The possible significance of some of these similarities and differences in tracts and nuclei has been considered with reference to the functioning of the various parts. The present histoenzymological preparations have revealed distinct nerve pathways. In some instances clear-cut connections, which had hitherto been unrevealed by neuroanotomical methods, have been demonstrated.


Histiocytosis X: a case report.

Histiocytosis X: a case report. The rare disease entity of histocytosis X is presented. Features of unusual interests in the present case were the bilateral exophthalmus as the presenting sign, fever, ottorhoea and involvement of lung and long bones.


Corneal electroretinograms in children without sedation. Many physicians assume that general anesthesia or sedation is necessary to perform electroretinograms (ERGs) on children and for this reason are reluctant to request the test. To challenge this assumption, routine contact lens ERGs, using topical anesthesia only, were attempted on 30 consecutively referred children (aged five months to six years). Mild restraint was sometimes needed, but successful oscilloscopic ERGs were obtained from all 30 children. The records were less stable than those from adults, but the response amplitude, wave-form and timing could always be evaluated and the cone and rod systems could be clearly differentiated.


An evaluation of the membrane constants and the potassium conductance in metabolically exhausted muscle fibres. 1. The membrane characteristics of metabolically poisoned and mechanically exhausted frog skeletal muscle fibres were investigated with intracellular micro-electrodes. 2. When cyanide plus iodoacetate were applied as metabolic poisons twitch tension declined towards zero after 150-300 stimuli (0-3 Hz; temperature = 0 degrees C). At the beginning of stimulation the mean resting potenial fell from -75 to -69 mV; it rose subsequently to -83 mV. The membrane resistance decreased during this stimulation period along a sigmoid time course to 4-6% of the original value. 3. In completely exhausted fibres the following membrane constants were estimated (23 degrees C): length constant, 0-31 mm; input resistance, 31 komega; membrane resistance, 58 omega.cm2. These values were calculated under the assumption of a constant internal resistivity of 170 omega. cm. The Q10 values of these constants were similar to those in normal fibres. Afew experiments revealed that the membrane capacity remained roughly constant under these conditions. 4. The current-voltage relation of exhausted fibres was approximately linear in the range between -60 and -100 mV. At less negative potentials the conductance increased slightly while at more negative potentials it decreased. The latter, in particular, became more evident when the imput current was converted into membrane current density by applying Cole's theorem. 5TEA+ and Rb+ in the external solution increased the membrane resistance of exhausted fibres by more than one order of magnitude. The major part of the membrane conductance induced by exhaustion, however, could not be blocked by these ions or Zn2+. 6. Chloride-free test solutions were used to measure the relative contributions of potassium and chloride ions to the membrane conductance. The relation GK:GC1 changed from 2:3 in normal fibres to 5:1 in exhausted ones. In absolute terms GK rose from ca. 130 to 14,300 mumho/cm2 and GC1 from ca. 200 to 2900 mumho/cm2. The discrimination between K+ and Na+ by the resting membrane in exhausted fibres was probably equal to or even higher than that under normal conditions. 7. In normal fibres the input resistance decreased by up to 20% after the external application of 1-2 mM caffeine, which is known to release calcium ions from internal stores. The elevation in internal Ca2+ by direct injection caused a small and, as a rule, irreversible decrease in input resistance which was probably partly due to local damage to the surface membrane. 8. It is concluded that in metabolically exhausted muscle fibres the surface and tubular membranes are still intact and that the observed decrease in membrane resistance is mainly due to an increase in potassium conductance. In addition, the results indicate that the gating mechanism of the potassium channels (presumably those with the characteristics of the slow component) is affected when energy reserves diminish.


An analysis of the influence of membrane potential and metabolic poisoning with azide on the sodium pump in skeletal muscle. 1. Activation of the Na pump in muscle by the external K concentration, [K]O, is independent of the membrane potential (Em) as shown by experiments in which Em was either stabilized during variation of [K]O or varied by application of azide at constant or zero [K]O. 2. Application of azide to Na-enriched muscles causes a  transient increase in 22Na efflux which occurs either in the presence or in the absence of external K. 3. The increased 22Na efflux induced by azide is abolished by addition of ouabain and is greatly reduced by removal of almost all of the external Na concentration, [Na]o. 4. Azide-treated muscles show a rather normal K sensitivity of 22Na efflux and [K]O induces a net Na extrusion from Na-enriched muscles in the presence of azide. 5. Azide reduces ouabain-sensitive K influx to low values thus interfering with K pump but not with the ability of K to activate the Na pump. 6. The experiments provide evidence that azide promotes a ouabainsensitive Na-Na exchange in Na-enriched muscles and that it partially uncouples the Na-K exchange normally observed.


Experimental studies on the long term fate of the vein and artery grafts and its choice in aortocoronary bypass surgery. Experimental studies of aorto-coronary bypass were performed using the technique of distal coronary artery perfusion in 47 dogs to ellucidate the flow characteristics at various grafts and long term fate of grafts up to 440 days after operation. On short term results, early graft occlusion seems to occur within 2 weeks with 6.5 days of mean in Group I and II (free grafts) when inflammatory reaction is most prominent. After 2 weeks patency rate was 65% in Group I and II, more than 80% of patency rate were obtained in Group III. In Group IV (prosthetic grafts), all but few (3 cases) could survive for more than 24 hours. In flow characteristic, artery and vein graft of which diameter is larger than that of the coronary artery can maintain enough the basal flow after ligation of the proximal coronary artery. In Group III (IMA-Circumflex anastomosis group), the internal mammary artery must be large enough to carry the blood to coronary artery lest the graft flow becomes below the basal flow. In Group IV, grafts can carry full flow but long term studies were not done because of early graft occlusion. There are much differences between free artery and vein grafts. In artery graft except IMA proper arterial structure is being kept until 440 days but has arteriosclerotic wall changes similar to human being. On the contrary, almost all free vein grafts have subintimal hyperplasia with collagen deposit and fibrous tissue and still progress after one year. These findings demonstrate that ischemia and hydrauiic effect in the graft must be important factor for the irreversible graft wall changes.


Rod monochromatism -- an incomplete form. An incomplete form of rod monochromatism is described in a young man with normal visual acuity and absence of nystagmus or photophobia. ERG showed normal threshold sensitivity in white and blue lights but virtual absence of the first portion of response in red light. The sensory threshold curve lacked the typical rod-cone discontinuity, whereas the curve after full dark adaptation was normal. It is suggested that the condition is due to atypical disfunction of the cones.


Transition in the character of immunological memory in mice after immunization. II. Memory in T and B cell populations. Teh immunological memory in antibody response of mice to bovine serum albumin (BSA) was investigated at the level of antibody-producing cells or their precursor B cells and thymus-dependent helper T cells. Spleen cells obtained from mice previously primed with alum-precipitated BSA at various times were transferred to irradiated syngeneic mice. Spleen cells from mice immunized 8 days or 64 days before presented a high degree of adoptive secondary response, whereas the adoptive response of cells from mice immunized 2 days previously was found to be inferior even to that of unprimed spleen cells. Primed spleen cells treated with anti-mouse thymocyte rabbit serum plus complement were supplemented with normal thymus cells and the restoration of the responsiveness was examined. It was suggested that the memory was carried mainly by T cells in the earlier phases of the immunological memory (2 days or 8 days after the primary immunization). On the other hand, the immunological memory in the B-cell population was shown to grow gradually toward the later phase (later than 40 days).


[Primary hereditary band-shaped corneal dystrophy and its association with other hereditary corneal lesions (author's transl)]. The results of examinations of members of a large Tyrolian family tree with primary band-shaped corneal dystrophy and other hereditary corneal leasons are reported. Corneal lesions occurred in 16 family members. In three male members, the primary band-shaped corneal dystrophy is associated either with parenchymal opacification and endo-epithelial dystrophy or epithelial dystrophy or with parenchymal opacification and epithelial dystrophy. In some cases, various corneal dystrophies (parenchymal opacification, endo-epithelial dystrophy, cornea guttata, epithelial dystrophy, band-shaped nasal corneal dystrophy) exist without band-shaped corneal dystrophy. A polyphenic gene is responsible for the manifestation of the various corneal lesions. The occurrence of typical primary band-shaped corneal dystrophy only in male family members can be explained by sex-linked inheritance. Because of some flutuations in the expression, the primary band-shaped corneal dystrophy can only be manifested slightly on the nasal border. The hereditary character of the occurrence of the primary band-shaped corneal dystrophy and of the closely related other corneal dystrophies together with the already in 1974 observed association with keratokonus is stressed. Our observations show the variety of the manifestations of a polyphenic gene in the corneal region.


Fertilization and development of frog eggs after repeated spermiation induced by human chorionic gonadotropin. Sperm released into the urine of adult male frogs, Rana pipiens, after intraperitoneal injection of human chorionic gonadotropin, were used to fertilize freshly ovulated eggs. Repeated spermiations from the same animal were induced with repeated injections of the hormone at intervals of four to 11 days. Individual frogs were induced to spermiate up to four times, with fertile sperm ensuing each time. Development of zygotes produced by this method did not differ from the development of ova fertilized by conventional methods.


[Endoscopical findings and therapeutic decision in osteomyelosclerosis associated with portal hypertension and bleeding from esophageal varices (author's transl)]. Portal hypertension with hemorrhage from esophageal varices is a rare complication of osteomyelosclerosis; therapy is controversial. Hemostasis could be achieved in two patients by sclerozising the esophageal wall. In one of these cases hemorrhage could not be stopped on several occasions in the past by medical means; in the other patient the spleen had been removed. The patient without surgery did rather well and was in a better clinical condition than the other one; we therefore recommend to use splenectomy and splenorenal shunting in this disease rather cautiously.


[Vaginal flora in women from Gevgelija]. The author gives data on the vaginal flora of women aged 20--64 in the commune of Gevgelia obtained in the course of an early mass detection of the carcinoma of the uterine cervix in this area. The action covered 70.5% of women from urban areas and 85.3% of women from rural areas. The microbiological analysis of vaginal flora was made in two ways: first, by taking smears and by vital staining and classifying them after Jirovec, Peter, and Malik; another preparation was sent to the cytologist and, after fixing and staining, was interpreted microbiologically. The results of both methods are shown in tabular form, according to women's age and residence. They do not differ much between themselves. The purity of vaginal secretion in women from rural areas is higher than that in women from urban areas. The occurrence of Trichomonas vaginalis is twice as frequent in women from rural than from urban areas. There is a significant difference in the existence of Döderlein's bacillus in the postmenopausal period between women from urban and from rural parts of the commune. In women from urban areas over 60 Döderlein's bacillus was present only in 39.28% and in those from rural areas in as many as 63.07% of this group of women.


Transbronchial lung biopsy via the fiberoptic bronchoscope in the diagnosis of diffuse pulmonary infiltrates in the immunosuppressed host. The differential diagnosis of diffuse pulmonary infiltrates in the immunosuppressed patient is broad. Many of the etiologies are amenable to specific therapy. Although endobronchial brush biopsy has been used to identify many infections, including Pneumocystis carinii, it was less effective in the diagnosis of noinfectious infiltrates. Transbronchial lung biopsy via the fiberoptic bronchoscope provided lung tissue that could be studied histologically, which increased the diagnostic yield without the morbidity and mortality of open or percutaneous lung biopsies.-


Percutaneos pulmonary needle diagnosis of Pneumocystis carinii pneumonitis. Percutaneous pulmonary needle aspiration (PC-A) is one of several diagnostic techniques capable of providing material in which Pneumocystis carinii organisms can be identified. This simple procedure, readily performed by most physicians, can be rapidly done under local anesthesia, requiring no sedation, general anesthetic, or multiple support personnel. When the chest roentgenographic evidence suggests diffuse involvement, PC-A may be performed at the bedside; if more patchy in distribution, under fluoroscopic guidance. Diagnostic yield approximates 80% or more on on the first attempt and approaches 100% if repeat PC-A is done after an initially negative PC-A procedure. Underlying severe bleeding disorders may lead to serious hemorrhage. Pneumothorax is not uncommon but is usually of no clinical significance and, if necessary,, is readily controlled. Percutaneous pulmonary needle biopsy with cutting or coring needles is not recommended because of a higher complication rate.


Open lung biopsy in the diagnosis of Pneumocystis carinii pneumonia. Lung biopsy remains the essential cornerstone in the diagnosis of pneumocystis pneumonia. Whatever technique can establish this diagnosis safely and early in order to get treatment started quickly should be used. Open lung biopsy remains a candidate for the diagnostic method of choice because if offers some advantages over percutaneous needle biopsy. There is a greater supply of competent thoracic surgeons in most hospitals than of physicians who are proficient with needle biopsy. The direct vision afforded by thoracotomy enables selective biopsy of grossly involved lung that can be appreciated by direct vision and palpation; needle biopsy is random and blind in its sampling. A more generous tissue specimen can be obtained for pathologic examination; the pathologic diagnosis of an "unsatisfactory specimen" is unlikely to result from open biopsy. Open lung biopsy achieves a higher diagnostic yield earlier in the pneumonitis when pneumocystis pneumonia is confined to the perihilar regions inaccessible to percutaneous needle biopsy. Better control of hemostasis is achieved by direct vision and ligature in a group of patients characteristically at high risk for bleeding tendencies, and pneumothorax is controlled in open biopsy; thoracostomy prevents the later, uncontroled collapse of the lung when the patient returns to the ward where there may be some diagnostic and therapeutic delay in the treatment of pneumothorax in a patient who can tolerate little further respiratory compromise.


Pneumocystis carinii infection: diagnosis and pathogenesis. The methods of diagnosis of Pneumocystis carinii infection are reviewed; a high index of suspicion of the disease, particularly in the immunodeficient patient, is stressed and the classic morphology of the organism is described. Discussed are the known immunologic features gleaned from clinical and pathologic data from the literature and the reported cases from the University of Minnesota Hospitals. The importance of the complete investigation of the immune status of every patient who develops pneumocystis infection is stressed.


Pulmonary and extrapulmonary support for patients with Pneumocystis carinii pneumonia. Temporary extrapulmonary oxygenation may benefit selected patients with Pneumocystis carinii pneumonia who exhibit severe respiratory insufficiency. Four persons were considered candidates for extrapulmonary oxygenation with a membrane lung while under treatment for pneumocystis pneumonia. In one patient, attempts to institute membrane lung circulation were postponed until his condition was terminal. In another individual, membrane lung support was discontinued prematurely because of complications of anticoagulation. A third patient died of cardiac failure even though her oxygenation had improved during respiratory assistance. In the fourth, the membrane lung was used successfully to maintain the patient through therapy until lung recovery was adequate to resume vital function. The four cases presented are examples of the immunosuppression that creates susceptibility to pneumocystis pneumonia: In two patients, immunodeficiency was caused by lymphoma and combination chemotherapy for the underlying disease; in two others, immunosuppression was induced for the purposes of transplantation. Two patients underwent veno-venous perfusion for prepulmonary oxygenation, and one underwent venoarterial bypass with the membrane lung. Indications for, and techniques of, membrane lung bypass are reviewed. This method of extrapulmonary membrane lung support may save some patients with transient severe pulmonary insufficiency due to P, carinii pneumonia, and the membrane lung may be an adjunct to antimicrobial therapy.


Treatment of Pneumocystis carinii pneumonia: current status of the regimens of pentamidine isethionate and pyrimethamine-sulfadiazine. A randomized clinical trial is under way comparing the relative merits of pentamidine isethionate and pyrimethamine-sulfadiazine in the management of patients with Pneumocystis carinii pneumonia. Twenty-one patients have entered the trial. Both regimens have produced at least one complete recovery in biopsy-proved pneumocystis pneumonia. Two patients have died from pneumocystis pneumonia after being treated with a combination of both regimens. Initial observations on comparative toxicity indicate pentamidine isethionate has more local toxicity, but pyrimethamine-sulfadiazine is difficult to administer to severely ill patients. Comparative merits of the two regimens will be analyzed at the completion of the present clinical trial.


Treatment of Pneumocystis carinii pneumonia in infancy. Pentamidine is recommended for the therapy of Pneumocystis carinii pneumonia either alone or, in severe cases, combined with pyrimethamine. Attention is drawn to the importance of supporting symptomatic treatment, particularly with the promethazine-Hydergine cocktail, and to the possibilities for general and drug prophylaxis.


Endemic infantile pneumocystis carinii infection: the Shiraz study. Orphanage epidemics of interstitial plasma cell pneumonia (IPCP) occur among premature infants whose passive immunity due to maternally transferred antibodies has lost its effectiveness before the infants' humoral immune systems have reached sufficient maturity to respond effectively to Pneumocystis carinii. IPCP occurs also among mature newborns receiving substandard care in understaffed and crowded orphanages. Infantile diarrhea in these institutions leads to marasmus and deficient immune response in infants 3-4 months after birth. The P. carinii organisms in the alveoli elicit a plasma cell response in the interstitial tissues of the lung, which may be so massive that it interferes with respiration and leads to death by asphyxiation. Such observations at the Shiraz Orphanage are discussed.


Pneumocystis pneumonia in patients with cancer: clinical setting. The most common clinical setting for the development of pneumocystis pneumonia in the United States is in a patient successfully treated with combination chemotherapy, usually including steroids, for a hematologic malignancy. The pneumonia is most likely to occur in the acute form during the reduction or withdrawal of chemotherapy and is the most common cause of infectious death in such cancer patients when they are in a clinical remission. The disease also develops in such patients on therapy who have uncontrolled growth of their tumor and occasionally in patients with other types of solid tumors. Given the appropriate clinical setting, all attempts should be made to establish the diagnosis histologically, but if this is not possible, empirical treatment with pentamidine isethionate is indicated.


Pneumocystis carinii pneumonia in the United States: epidemiologic, diagnostic, and clinical features. Analysis of 194 patients with confirmed Pneumocystis carinii pneumonia in the United States over a 3-year period revealed that P. carinii pneumonia occurred almost exclusively in the immunosuppressed host who had a serious underlying disease. The epidemiologic features of pneumocystis pneumonia primarily reflected those of the underlying disease. P. carinii was identified antermortem in 81% of the cases usually by biopsy or needle aspiration of the lung, procedures associated with considerable morbidity and morbidity and mortality. Laboratory identification of P. carinii was usually accurate, but errors resulting from fault staining tecnique occurred. Most patients had been ill less than 2 weeks with bilateral diffuse interstitial pneumonia. Leukopenia (white blood cell count less than or equal to 3,00/mm3) and probably severe hypoxia were negative prognostic factors. Although treatment with pentamidine was effective, the drug frequently cased adverse reactions, particularly impaired renal function, when given with other nephrotoxic agents.


Pneumocystis carinii pneumonia and primary immune deficiency diseases. During a 3-year period, 50 cases of Pneumocystis carinii pneumonia in children less than 5 years old were reported to the Parasitic Disease Drug Service, Center for disease Control. Primary immune deficiency diseses constituted the most frequent underlying diseases in patients less than 1 year old (24/29 cases, 83%), whereas acute lymphatic leukemia was the most common underlying diseases in children 1-4 years old (17/21 cases, 81%). Severe combined immunodeficiency was the most common type of immune deficiency disease (15/25 cases, 60%). Six (24%) of the immunodeficient patients each had a sibling who died during infancy of an immunologic deficiency disease and P. carinii penumonia. Although the pathogenesis of the association between immune deficiency and P. carinii pneumonia is poorly understood, defects in both humora and cellular immunity appear to be operative.--Natl Cancer lst Monogr 43: 65-72, 1976.


Atypical radiographic features in Pneumocystis carinii pneumonia. In a review of clinical, pathologic, and radiographic findings from 30 patients with confirmed pneumocystis pneumonia, the disease presented a typical radiographic picture of acute bilateral perihilar and basilar infiltrate progressing to diffuse alveolar consolidation within 3-5 days and unassociated with adenopathy or pleural changes in 13 patients. However, the incidence of atypical radiographic features was appreciable (17 of the 30 patients showed at least one atypical finding) and, in addition, few radiographic findings completely excluded the diagnosis of pneumocystis infection.


Roentgenologic diagnosis of interstitial plasma cell pneumonia in infancy. Sixt-two series of radiographs were analyzed. Interstitial plasma cell pneumonia (IPCP) was divided into six radiographic stages. A schematic description of these stages is given. The correlation between this scheme and the actual radiographs is illustrated with a series of nine antero-posterior and lateral radiographs from one infant. The patterns of the individual stages of the disease are then discussed with the aid of pulmonary radiographs of 12 infants and one 12-month-old child with dysgammaglobulinemia. From a prospective and retrospective analysis of these radiographs, we could delineate the development of the disease from the earliest radiologically recognizable lesions to resolution. The long incubation time of IPCP was established by a retograde analysis of several series of radiographs of proved cases; the time interval was determined between the earliest recognizable change and the full-blown picture of stage V, in which the interstitial infiltrative process may be accompained by various degrees of emphysema, edema (used synoymously with alveolar filling process), pneumothorax, and madiastinal emphysema. This scheme has proved its value during 20 years of radiographic diagnostic pactice with 30-35 annual consultations concerning IPCP; IT CORRELATES WELL WITH THE CLINICAL SYMPTOMATOLOGY AND THE RESPONSE TO THERAPY. Points of differential diagnostic importance concerning other interstitial infiltrative processes of the lungs are discussed for every stage of the disease.


[Placement of electrodes in transcutaneous stimulation for chronic pain]. Forty-six patients with chronic pain were treated with transcutaneous nerve stimulation (TNS). If there were any signs of sensory loss in the pain area, the electrodes were placed on the healthy side of the body. The effect of TNS was assessed quantitatively. After 9 months of repeated TNS, on average, the total pain score had improved by 39%. The subjective intensity of the pain, the frequency of pain and the need for analgesics had diminished by 46-47%. In those conditions in which total improvement was better than the mean (phantom limb pain, 65%; zoster neuralgia, 56%; thalamic pain, 45%), the healthy side of the body had been stimulated. In those in which the painful area had been stimulated (cancer pain, 32%; low back pain, 32%; brachialgia, 15%), the beneficial effect did not reach the mean for the whole series. This suggests that TNS of the healthy side of the body may give better long-term improvement than stimulation of the painful area. A theory of chronic pain and the mechanism of TNS is presented.


Varicose veins in New Zealand: prevalence and severity. Three categories (none, mild, and moderate) of varicose veins are studied, and the independent variables studied are race, age, sex, height, weight. Quetelet index and parity. In Maoris the age standarised prevalence rates of varicose veins are 36.3 percent in males and 47.4 percent in females. In Pakehas the rates are 21.6 percent in males and 40.4 percent in females. In both sexes Maoris have a significantly higher prevalence of the more severe category of varicose veins. All variables studied were associated with the prevalence of varicose veins although the relationships vary by race and sex. In the univariate analyses the only variable that distinguished the three categories of varicose veins was parity in Maori females. In the multivariate analyses only in Maori males was a significant discrimination between the three groups of varicose veins achieved although "suggestive" discriminations were also achieved for females of both races.


Gestational trophoblastic malignancy.

Gestational trophoblastic malignancy. Gestational trophoblastic malignancy, although rare, offers the clinician the opportunity of being able to cure a malignant disease with cytotoxic chemotherapy. Such an opportunity is fulfilled only when the progress of the post-molar patients is monitored and chemotherapy instituted as soon as the malignant transformation of the mole is documented. The management and treatment of nine cases is presented and discussed.


Enhanced tumor growth in chimeric mice.

Enhanced tumor growth in chimeric mice. Chimeras were produced by aggregation of B6D2F1 and SWA early embryos. Lewis lung tumor, syngeneic in B6D2F1, was used to study tumor growth and metastases in these chimeras. Enhanced tumor growth, low metastases rate and pronounced enlarged spleen could be observed in SWA equilibrium B6D2F1 chimeras 21 days after inoculation of tumor cells. Increased activity of suppressor T-cells which might be due to permanent allogeneic stimulation in chimeras is discussed as one of the possible mechanisms.


Aortocoronary bypass graft in dogs: late histological changes. Late histological changes occurring in aortocoronary bypass vein grafts were studied by lignt and electron microscopy in three dogs killed one, two and three years after grafting. The changes consisted of intimal thickening due to a proliferation of modified smooth muscle cells (myointimal hyperplasia) and replacement of most of the medial smooth muscle by fibrocytes. Serial angiography in the dogs did not reveal progression of the intimal thickening after one month.


Angina pectoris after aortic valve replacement. Angina pectoris after aortic valve replacement may be due to reduced myocardial blood flow (coronary artery stenosis or valvular dysfunction) or to increased myocardial oxygen demand (idiopathic hypertrophic subaortic stenosis or valvular dysfunction). If a patient does not do well after an aortic valve replacement, causes other than dysfunction of the prosthesis should be sought.


Chromosomal proteins in human B and T lymphocytes. Histones and non-histone chromosomal proteins were characterized in B and T human lymphocytes by means of polyacrylamide disc gel electrophoresis. It was found that while histones do not present appreciable differences in the two examined populations, non-histone chromosomal proteins exhibit distinct electrophoretic profiles. Low molecular weight proteins predominate in B lymphocytes whereas high and intermediate proteins are largely represented in T lymphocytes. The latter proteins may be related to the capability of these resting cells to proliferate under appropriate antigenic stimuli.


Isolation of kallikrein from mammary gland of cows. Small amounts of kallikrein were isolated from bovine mammary tissue. Immediately after slaughter, the udder was removed, perfused with ice-cold xylocaine-Rheomacrodex solution, and homogenized in ice-cold acetic acid solution. Kallikrein-like substances were adsorbed on DEAE-cellulose, eluted with ammonium formate and fractionated by acetone precipitation. The 40-70% acetone fraction was separated on a Shephadex-G 75 column and aliquots of each fraction were incubated for 1 or 2 hr with kininogen. After incubation, extracts were tested for kinin activity on the isolated rat uterus, the rat duodenum, blood flow through the femoral artery of dogs and by intramammary pressure assay in sheep. Release of kinins was demonstrated by all these techniques, highest kallikrein activity being detected in the molecular weight range 50,000 to 60,000. Direct injection of the enzyme into the udder artery of sheep, without prior incubation with kinninogen, resulted in vasodilation and a rise in intramammary pressure. The kallikrein activity was strongly inhibited by aprotinin, but not by soybean trypsin inhibitor or ovomucoid. Kallikrein activity was always associated with esterase activity.


Chromosomal abnormalities in angio-immunoblastic lymphadenopathy. Chromosomal studies have been performed in 2 patients with angio-immunoblastic lymphadenopathy. In both the cases the presence of abnormal cell lines characterized by marker chromosomes has been detected. Application of banding techniques allowed to detect the structural composition of the marker chromosome in 1 of the cases and to show a clonal evolutive pattern of the rearranged chromosomal set; In the same patient a consistent Y loss observed in the major fraction of the investigated metaphases did not appear to be related to any defined rearrangement of the karyotype. Longitudinal chromosomal studies are stressed in order to better correlate th cytogenetic abnormalities and the immunoreactive picture of the lymph nodes along the course of the disease.


Membrane cell markers in human leukemias and lymphomas. The availability of B- and T-cell membrane markers has provided new approaches and concepts in the study of lymphoproliferative diseases; The present status of knowledge in monoclonal B-cell proliferations, T-cell proliferations such as the Sézary syndrome and chronic lymphocytic leukemia of T-cell origin, acute lymphoblastic leukemias and non-Hodgkin lymphomas is briefly reviewed.


Studies on the ability to taste phenylthiocarbamide; red-green colour blindness and the age at menarche in Johannesburg Chinese school children. The sample, although small, represents the total number of children attending the Johannesburg Chinese Kuo Ting Primary and High School in 1972 to 1974. The frequency of the non-taster gene was found to be 0,167 in the combined male and female sample. The gene for red-green colour blindness is present in the Johannesburg Chinese population but at low frequnecy, 0,012. The mean age at menarche was found to be 12,8+/-1,23 years and is younger than the mean ages recorded for a number of Caucasoid populations. It is suggested that this difference in mean age reflects possibly varying genetic rather than varying socio-economic factors.


Defect in IgA secretion and in IgA specific suppressor cells in patients with selective IgA deficiency. The nature of the defect in patients with selective IgA deficiency was investigated using a technique established to study terminal differentiation of B lymphocytes into immunoglobulin synthesizing and secreting cells. The peripheral blood lymphocytes from normal individuals had geometric mean synthetic rates of 4910 ng for IgM, 1625 ng for IgG and 1270 ng for IgA per 2 x 10(6) cells in culture for 7 days in the presence of pokeweed mitogen. The cultured lymphocytes from each of the 14 patients with selective IgA deficiency studied synthesized normal quantities of IgG and IgM but secreted less than 100 ng of IgA into the media. However, 11 of the 14 patients studied synthesized IgA by the 7th day in PWM stimulated cultures as assessed by staining for cytoplasmic IgA using fluorescein-labeled anti-IgA antisera. Synthesis and secretion of IgA by normal cells was not suppressed when they were co-cultured with lymphocytes from these patients that synthesize but do not secrete IgA. Three of the 14 patients did not have lymphocytes with IgA demonstrable in their cytoplasm following culture. When the lymphocytes from these 3 patients were co-cultured with normal lymphocytes and pokeweed mitogen the synthesis of IgA by the normal cells was depressed by 80 to 100%. Synthesis of IgG and IgM was not depressed. These studies suggest that lymphocytes cultured with pokeweed mitogen from the majority of patients with selective IgA deficiency can synthesize IgA but have a defect in IgA secretion. A smaller group of the patients do not synthesize IgA and have IgA specific suppressor cells that prevent B cells from maturing into IgA synthesizing and secreting cells.


[Presentation of 25 cases of post-irradiation lesions of the brachial plexus and their treatment]. A study was carried out on a series of 25 patients who were operated on for breast cancer and who submitted to postoperative radiotherapy, in which lesions of the brachial nervous plexus from ionizing radiations were obtained. In almost all the cases, 24 out of 25, various symptoms such as paresthesiae, pain, and motorial disturbances, were observed even one year after the completion of the treatment. Motorial troubles, which in 13 cases were not detected at the moment of the diagnosis of the other lesions, always occurred later. Etiopathogenesis and diagnosis of these lesions have been considered, as well as the possibility of lowering the incidence of such troubles. The conclusion can be drawn that useful results can be obtained, to a certain extent, only if therapeutic treatment is performed early: in most cases, however, the lesions showed a progressive evolution.


Iridocorneal adhesions in posterior polymorphous dystrophy. The variability of clinical expression in posterior polymorphous dystrophy is illustrated with emphasis on the occurrence of iridocorneal adhesions. These are believed to be synechiae and not Rieger's anomaly. The occurrence of glass-membrane-like material extending onto the iris from the cornea, causing synechiae and pupillary ectropion, is documented.


[Study of cellular immunity in patients with testicular teratoblastoma by the method of rosette formation]. In 23 patients with teratoblastomas of the testes the authors studied nonspecific reactivity of T-lymphocytes by means of the reaction of spontaneous rosette-formation. A definite correlation was shown between the reaction indices, chorionic gonadotropin, the Abelev reaction and clinical course of the disease. It is concluded that the complex therapy should be conducted under the control of the corresponding immunological indices.


[Endoscopy and biopsy of the esophagus]. Since glass fibre instruments are used, the number of oesophagoscopies very much increased. The complication rate is small. The oesophagus can be inspected without any gaps in all sections. Our knowledge on pathogenesis and distribution of certain diseases of the oesophagus has considerably been enlarged by modern biopsy and endoscopy. In the urgent clarification of acute causes of haemorrhage in the upper alimentary tract endoscopy stands in the first place compared with all other diagnostic methods. The interpretation of the findings in the oesophagus demands an experienced and critical examinator, as the bioptic particles frequently are very small.


[Diagnostic value of bulboscopy].

[Diagnostic value of bulboscopy]. Bulboscopy is a proved routine examination in radiological suspicion of changes in the duodenum, in duodenal ulcers, haemorrhages from the superior gastrointestinal tract, also as emergency endoscopy, and in unclear epigastric complaints. The endoscopy of the duodenal bulb is better than the radiological examination, especially when a cicatricial bulb is present. Flat ulcers often cannot be proved by radiological examination. Nevertheless the radiological examination should always be carried out, as also endoscopically in the cicatricial bulb ulcers may be overseen. Endoscopically the florid duodenal ulcer can be differentiated in several groups. Some a prognostic importance is ascribed.


[Emergency endoscopy in upper gastrointestinal tract hemorrhages]. The urgent endoscopy of the superior gastrointestinal haemorrhage carefully and quickly helps in clarifying the following questions: Is the patient going on bleeding? Is conservative approach allowed? Must be operated? It is without danger in the hand of the experienced. In 95.20% we could get a positive evidence. In this the advantage compared with other methods is shown. The examination should possibly be done only by means of a glass fibre endoscope and may be performed only after combat against shock. It is reported on own results of 125 endoscopies in haemorrhage of the superior gastrointestinal tract.


[Hemorrhagic erosion as a cause for gastrointestinal hemorrhages]. It is necessary in clinical diagnosis more than hitherto done to take into consideration haemorrhagic erosions as the most frequent cause of gastrointestinal haemorrhages. They are found as concomitant diseases of certain basic diseases, whereby the spectre of causes deviates in adults and children. In adults dominate heart insufficiency and cerebral diseases including skull-brain trauma, in children, however, infections of the respiratory and digestive tract, followed by cerebral affections and haemoblastoses. A differentiation concerning age and sex cannot be proved.


[Influence of homologous n-alkanoic acids on functional properties of isolated skeletal muscles. I. Muscle contraction]. 1. The contractility of isolated muscles of the frog (and in some instances of the rat) was investigated at room temperature in Ringer's solutions containing homologous alkanoic acids (100 mM C4 to 0.4 mM C10). 2. Free fatty acids decrease the contraction amplitudes evoked by direct stimulation. The effects increase with concentration, exposure, and chain length of the fatty acids. In Ringer's solution the changes are totally or partly reversible. 3. The depression of contraction amplitude induced by free fatty acids is removed by small concentrations of caffeine (2--5 mM) in Ringer's solution. 4. Interactions of fatty acids with different structures of skeletal muscle (mitochondria, sarcolemma and membranes of sarcoplasmic vesicles) are discussed. The distinct effect of fatty acids on stimulated muscles and the importance of membranes in the regulation of the calcium ion concentration in the cytoplasm suggest that fatty acids interact with membrane lipids.


Reversal of acute myocardial ischemia in closed chest animals by retrograde perfusion of the coronary sinus with arterial blood. The fundamental objective of this study was to develop a technique for salvaging aco the ischemic muscle segment is the coronary venous system. We have been able to ration) in closed chest dogs by placing a double lumen balloon catheter in the coronary sinus, and perfusing it with blood derived from a peripheral artery. We have been able to partially reverse these same manifestations in similar dogs with an ischemic period of 30-60 minutes.


Choosing a vessel for aortocoronary bypass. In practice, the surgeon is left with few choices of the proper ACB graft. His options are limited entirely to autologous tissues, of which the best is the great saphenous vein from the calf (Table 3). Actually, once leg veins and the internal mammary artery are no longer available there are few other choices worth considering. Small calibre allografts, however preserved, and synthetic grafts, are uniformly doomed to failure. The great saphenous vein from the calf is usually a single tube, of suitable diameter and strength for arterial replacement. Most of its tributaries lie in the upper third of the calf; this makes the lower segment preferable for the patient who requires only one or two bypasses. Variations in the normal anatomy have been illustrated.


The contribution of right ventricular angiocardiography to the diagnosis of tricuspid valvular stenosis (Observations made on 3 patients). The right ventricular angiocardiographic findings, in the anterioposterior projection, are described on three patients with tricuspid valvular stenosis. During diastole, the tricuspid valve was delineated as an arcline contour, placed between the non opacified right atrium and the opacified right ventricle, and it was displaced to the left of the spine. Its mobility was diminished. Right ventricular angiocardiography seems to be a useful method for the diagnosis of the tricuspid valvular stenosis and the estimation of the pathology and the functional condition of the tricuspid valve. The method is recommended for further evaluation.


[Action potentials of the heart atria and ventricles of Rana temporaria frogs and Cyprinus carpio carp]. Using microelectrode technique, studies have been made on electrophysiological indices (amplitude of AP, amplitude of the plateau, latent period of AP, duration of maximal depolarization, duration of repolarization at different levels) of cells of isolated atrium and ventricles of the carp during both the spontaneous activity and electrical stimulation. The obtained amplitude-temporal parameters were compared to those of the heart in the frog R. temporaria. It was found that the amplitude of AP, the amplitude of the plateau and the duration of the latent period of AP in both the atrium and ventricles of the carp significantly (p less than 0.01) differ from the corresponding indices of the frog. On the contrary, the duration of maximal depolarization and repolarization in cells from homologous parts of the heart is very close in the species investigated.


Surgical versus medical treatment of coronary artery disease: long-term survival. In an attempt to answer the question as to whether or not aortocoronary bypass (ACB) does increase life expectancy of patients with coronary artery occlusive disease (CAOD), 4,766 consecutive patients undergoing ACB at the Texas Heart Institute from October, 1969 through June, 1975, were reviewed and followed for five and one half years. Overall early mortality was reduced from 9.7 percent during the first full year (1970) of the study to 3.3 percent during the last full year (1974). Early mortality in males (86.5 percent) was reduced to 3 percent during 1975, but in females only to 8.4 percent. However, late mortality in females was only 2.6 percent as compared to 3.4 percent in males. Long-term survival was similar for both males and females at five and one-half years when early mortality was considered. Males also experienced better symptomatic results than females with 90.3 percent of males remaining asymptomatic, while only 86.6 percent of females remained in this category. Early mortality increased as more vessels were bypassed, but late mortality decreased and symptomatic results improved as more complete revascularization was performed. Only 55 percent of late deaths were cardiac related. Actuarial comparison of this surgical series with the most comparable series in the literature of patients treated medically, demonstrated significant (P less than 0.001) increased survival in the surgical group as compared to medically treated patients at every year up to five and one-half years, for patients with double and triple vessel disease and for the entire series. In those patients with single vessel disease, the survival curves were similar to four years, following which survival was increased in the surgical patients at the end of the fifth and sixth reporting years. In summary, these data appear to suggest that surgical treatment of coronary artery occlusive disease does provide a favorable effect upon life expectancy.


Polycardiographic study of atrial flutter. The modifications that atrial flutter determines on the phonocardiogram, apexcardiogram, carotid pulse tracing, jugular venous pulse tracing, and indirect (esophageal) left atrial pulse tracing were studied. On the basis of the data here presented and that of the literature, a polygraphic profile of atrial flutter has been constructed as follows: notable variability of the intensity and of the richness of the vibratory components of the first and second heart sound; regularly alternating intervals between successive atrial sounds, each one of which consists of two groups of vibrations; deformations of all mechanographic tracings corresponding with "F" waves of the ECG. The interpretation of various polygraphic reports contributes to the understanding of the physiopathogenesis of atrial flutter.


Serum magnesium concentrations in atrial fibrillation. Serum magnesium and digoxin levels were obtained in 13 nontoxic patients with atrial fibrillation due to chronic rheumatic heart disease receiving digoxin for the control of ventricular rate and heart failure. Fairly good correlations were made between serum digoxin levels and ventricular rates. Hypomagnesemia was quite common (7 out of 13) and mean magnesium serum levels were significantly lowered in total as well in 7 hypomagnesemic patients, as compared to in healthy controls. Magnesium sulphate was successfully used in patients with magnesium deficiency to control the ventricular rates.


Haemodynamic diversity and plasma renin activity in labile arterial hypertension. Haemodynamic studies were made on 31 patients with labile hypertension at rest and during exercise. Plasma renin activity (PRA) was measured in 8 of them. Five haemodynamic types could be recognised and they could be arranged into two groups. The first was characterised by an increase of calculated peripheral resistance, sometimes permanent, sometimes revealed by effort, sometimes in relation to an increased cardiac output; this would appear to predict the development of permanent hypertension. The second group was characterised by normal systemic resistances, adapted to the cardiac output which was either normal or increased; the significance of labile hypertension in these cases was uncertain; from the haemodynamic studies one was unable to distinguish a transient emotive hypertension from potential permanent hypertension. The PRA was raised in the supine position and greatly increased by an orthostatic posture in the 8 patients tested, suggesting therefore an underlying neuro-adrenergic mechanism. In some patients with labile hypertension the haemodynamic tests were normal at rest and during effort. Others had different responses, which may be the result of varieties of hyper-sympathetic activity, either pure or predominantly beta-adrenergic (increased cardiac output, peripheral resistance adapted to the output) or combined beta and alpha (increased cardiac output with raised peripheral resistance) or mainly alpha-adrenergic (normal cardiac output, increased peripheral resistance).


[Daily form of rest in the catfish Ictalurus nebulosus and the frog Rana temporaria]. By means of recording the cardiac rhythm, respiration rate and motor activity in unrestrained animals, studies have been made on the dynamics of formation of cataleptic-like immobilization in the teleost I. nebulosus. Rhythmic illumination at a rate 3/min. (10 sec light on - 10 sec light off) in the daytime gradually caused the onset of immobilization in the fish. This immobilization is characterized by the specific heart rate, type of respiration and the degree of plastic tone. Under the same experimental conditions, the formation of photogenic catalepsy in the frog Rana temporaria was confirmed. Typical heart rate, respiration pattern and the degree of plastic tone were determined as well. The role of illumination rhythm in the onset of all conditions which are characteristic for the "awakefulness-rest" cycle is discussed.


Late spontaneous closure of a large ventricular septal defect. The authors report a case of a large ventricular septal defect with pulmonary hypertension, cardiomegaly and heart failure in early infancy, exhibiting marked improvement at five years of age. Subsequent followup, revealed spontaneous closure of the defect demonstrated by hemodynamic studies between 7 and 8 years of age, at which time the patient became completely asymptomatic with disappearance of all abnormal physical findings.


Double atrial parasystole. Case report.

Double atrial parasystole. Case report. A 62 year-old man with hiatal hernia and complex atrial arrhythmia is reported. On the standard electrocardiogram a double atrial parasystole is found, with reversed coupling. During carotid sinus massage only one of the parasystolic foci is not influenced, and assumes the atrial activity, regularizing the cardiac rhythm.


Severe coarctation with similar pressure at four limbs. Clinical, catheterization, angiographic and surgical data of one case. In patient with severe coarctation of the aorta, arterial pressures were similar at the four limbs due to departure of both subclavian arteries from the descending aorta. The clinical clues to the diagnosis and the hemodynamic, angiocardiographic and surgical data are presented.


Arthritis and heart lesions. A study of 25 cases with pericarditis or valvular lesions associated to inflammatory joint disease. Clinical and laboratory data of 25 patients with inflammatory joint disease and pericarditis or valvular heart disease are reviewed. The patients were divided in two groups: 11 presented pericarditis and 14 valvular heart disease. The patients studied presented a spectrum of diseases ranging from classical sero-positive rheumatoid arthritis to ankylosing spondylitis. Acute rheumatic fever was in no case the actual joint disease. In contrast to the patients with valvular heart disease nearly all patients with pericarditis were rheumatoid arthritis factor positive and signs of a generalized systemic disease with vasculitis were also more frequent. In the pericarditis group there was no sex difference in contrast to the valvular group where females were more often affected. The heart lesions were usually detected late in the course of the chronic joint disease. Valvular heart disease occurs not only in ankylosing spondylitis but also in rheumatoid arthritis, usually the sero-negative type. In the light of a survey of the literature, the pertinent findings are discussed.


[Immediate and long-term results of surgery of the tricuspid valve. APropos of 62 operated cases]. Operative and late results in a series of patients operated on the tricuspid valve (replacement or annuloplasty) at the moment of surgery upon mitral and aortic valves are reported. Functional tricuspid insufficiency carries a greater risk than organic tricuspid disease. Considering the duration of the underlying mitral disease, four grades are set up for the mitro-tricuspid patient allowing for prognosis and indication of the type of surgery to be done on the tricuspid valve.


The angiocardiographic appearance of the endocardial cushion defect in selected transposition and malposition complexes. Although the angiocardiographic features of the endocardial cushion defect (ECD) have been well described in the patient with two normally related ventricles (D-ventricular loop in situs solitus) and normally related great arteries, little attention has been focused on the angiocardiographic appearance of the ECD in patients with complex cardiovascular disease. Because of recent surgical advances in the treatment of single ventricle and double outlet right ventricle complexes, it has become increasingly important to document the status of the atrioventricular valves in these patients. The angiocardiographic features of the ECD are therefore described in two patients, one with D-loop, single left ventricle and outlet chamber, D-transposition of the great arteries, bilateral conus and pulmonary stenosis and the other with dextrocardia, situs inversus, double outlet right ventricle, common atrioventricular canal and pulmonary stenosis. In both patients, the left ventricular outflow tract, despite aortic-mitral discontinuity, is characterized by elongation, scalloping and serration, and the classic appearance of the "gooseneck" deformity is observed on left ventricular angiography. It thus appears that aortic-mitral continuity and two well-formed, normally related ventricles and great arteries are not invariable necessary to the manifestation of the "gooseneck" deformity in the patient with complex cardiovascular disease and associated endocardial cushion defect.


The electromechanical interval in normal subjects and after myocardial infarction. The electromechanical interval (EMI) was measured in 25 normal males, 56 male patients with a myocardial infarction and 6 patients with a ventricular aneurysm. In the normal subjects the EMI was found to be unrelated to the heart rate but the isovolumic contraction time was inversely related to the heart rate. The EMI was increased after myocardial infarction but this increase did not occur in patientswho had a non-transmural infarction when they had not had any previous myocardial infarction. The increase was more marked in the patients with a ventricular aneurysm. It is suggested that the prolongation of EMI is due to areas of abnormal left ventricular wall movement and that this effect may be a useful aid to the diagnosis of ventricular aneurysm.


Haemodynamic alterations of the left ventricle during right atrial pacing. The left ventricular haemodynamic alterations during right atrial pacing were studied in 12 cases. Cardiac index varied little: during maximal rate however, its mean value was slightly lower than the resting one. Stroke index decreased inversely to the heart rate. The course of these indices did not separate the normal from abnormal cases. Ventricular function curves (VFCs) were constructed by relating the changes of left ventricular (LV) end-diastolic pressure (EDP) to those of stroke index (SI). In 4 normal cases the curves were steep, showing a fall of EDP with relatively large decrease of SI; in 3 cases of congestive myocardiopathy they were flat, showing fall of EDP in two and increase in one, with relatively small decrease of SI; in 5 patients with effort angina LVEDP initially decreased. This initial fall of VFCs was steep in two with normal and flattened in three with impaired resting LV function. Increase of EDP, evidently due to development of ischaemia, followed in all; it exceeded resting EDP in two out of three cases developing angina and in one out of two not developing angina. Our findings support the view that the increase of LVEDP is due to decrease of both myocardial contractility and compliance.


Anomalous coronary arterial pattern.

Anomalous coronary arterial pattern. The clinical history of an adult patient with anginal-like pain is described. A coronary angiography revealed the existence of a hypoplastic left coronary artery, a right coronary artery which passed around the posterior surface of the heart and continued into the anterior surface of the heart to give off an anterior descending artery and the presence of a "conus" artery. The embryonic genesis of hypoplastic coronary artery and of a similar aberration, single coronary artery, are discussed.


Multiple coronary arteriovenous fistulae. A case with multiple congenital coronary arteriovenous fistulae is reported. The right coronary artery was communicating with the right ventricle. The left coronary artery was entering directly into the pulmonary trunk and two terminal branches of the anterior descending into the left ventricle. The direct communication of the left coronary artery without interposition of an accessory artery or a circoid plexus is met for the first time.


Pseudo-retrograde conduction in complete A-V heart block due to ectopic His bundle activity. A case with complete A-V heart block in whom retrograde P- waves following some of the ventricular complexes were due to an ectopic junctional activity with the characteristics of parasystole is reported. His bundle electrogram showed an infrahisian block. After administration of 1 mg atropine intravenously the retrograde P- waves were detached from the ventricular automatic complexes and an H' deflection preceded each inverted P- wave with an H'-A' interval of 40 msec.


Prenylamine inhibition of isoproterenol induced myocardial lesions. Histochemical and ultrastructural findings. Eighty Wistar rats were divided into 4 groups. All of them received 10 mg/kg i.p. isoproterenol (ISP). The animals were sacrificed at 5 min. (groups A and B) and 24 hours (groups C and D). Groups A and C served as control of group B and D. Group B also received 9 mg/kg prenylamine (P), 30 min before ISP and group D 9 mg/kg P, 1 hour before and 1 hour after ISP. Transversal slices of each heart underwent the following procedures: hematoxilineosin, Barbeito-Lopez trichromic, "ischemia stain", acid phosphatase stain and standard electron microscopy. Group A and C showed positivity for ischemic techniques; necrotic and ischemic zones represented, in average 25.1 +/- 1.4% of the myocardial volume. Group B and D (ISP + prenylamine) showed no significant lesions. Group D (ISP + prenylamine, sacrificed at 24 hours) presented complete absence of "infarct-like" lesions in 17 out of the 20 studied animals. No evident changes in acid-phosphatase enzymes were detected. Animals treated with ISP alone presented "contraction bands" at electron microscopy as well as myofibrillar fragmentation. Those receiving also P showed only light alterations, in the electron microscopy specimens. A primary action of ISP on the calcium pump might explain the infarct-like lesions found in our study. The inhibition of these above mentioned lesions by prenylamine, a drug which acts by slowing down the ca transport, also supports this interpretation.


Mechanical alterations of the left ventricle during right atrial pacing. The effect of increasing heart rate by right atrial pacing on the peak value of the first derivative of left ventricular (LV) pressure(dp/dt) and the maximal velocity of the contractile element (KVmax) was studied in 12 cases. Peak dp/dt was poor as regards its sensitivity in reflecting the changes of contractility, due to its strong dependence on LV end-diastolic (EDP) and systolic pressure. KVmax increased constantly in the 4 normals and in 2 cases of ischaemic heart disease which did not develop angina; the increase exceeded 90 ml sec-1 in the former and one of the latter cases in which resting LV function was normal. In contrast, it decreased during the development of ischaemia in two of the three cases which developed angina; in the third case, in which also resting LV function was seriously impaired, the course of KVmax was almost flat. A similar flat course was observed in the three cases of congestive myocardiopathy. the above alterations of KV max were independent of the EDP and proportional to the basic contractility and its anticipated changes during pacing.


[Electrophysiologic study of fenoxedil chlorhydrate]. Electrophysiologic studies were carried out on 10 patients before and during therapy by Fenoxedil Chlorhydrate a new anti-arrhythmic drug, to determine the effects on cardiac conduction. Fenoxedil Chlorhydrate produces a constant alteration of intra-nodal conduction. Modification of sinus function are less evident. Auricular and ventricular refractory periods are increased in the majority of cases. These results give a better understanding of mecanism of this drug, and helps in its prescription in clinical practice.


Magnesium and the heart.

Magnesium and the heart. Magnesium is a most important cation in the body mostly distributed in the skeleton, muscles and liver. The most important causes of magnesium deficiency in the body include wide range of gastrointestinal disorders, diuretic therapy, endocrine disorders, renal diseases, alcoholism, etc. The demonstration of hypomagnesemia in patients of digitalis toxicity is of great clinical significance since magnesium can be replaced among these patients and toxicity and mortality due to this drug can be minimised. In patients with low serum magnesium, the cellular content of this ion may be normal. Therefore, it is of great interest to study the myocardial level of this ion in cardiovascular diseases. The clinical features of magnesium deficit are related to neuromuscular disorders. However, ST and T waves changes are quite commonly seen in the electrocardiogram and cardiac arrhythmias rarely have also been described. Magnesium administration on the other hand causes hypotention, bradycardia, and conduction defects. Magnesium depresses central nervous system, neuromuscular transmission and conductivity of the heart. Magnesium therapy is indicated when clinical features of magnesium deficiency are present in association with low serum or tissue levels.


Left ventricular aneurysmectomy for refractory tachyarrhythmias: report in 11 postinfarction patients. Between January 1970 and August 1974, eleven postinfarction patients underwent left ventricular aneurysmectomy for refractory tachyarrhythmias. Ten suffered from ventricular tachycardias and one from supraventricular tachycardia. All had localized aneurysms and normal contractions of the surrounding myocardium on angiocardiography. None suffered from significant angina, congestive heart failure or papillary muscle dysfunction. The diagnosis was first suspected at fluoroscopy, the latter being in our opinion a most reliable screening method for the recognition of these cases. There was one hospital death after surgery. The remaining ten patients are now free from further arrhythmic attacks for a follow-up period between fourteen months to five and a half years. These results confirm that in some carefully selected postinfarction patients, left ventricular aneurysmectomy without concomittant aortocoronary bypass may result in the elimination of medically intractable tachyarrhythmias.


Prognostic value of intraventricular conduction blocks in acute myocardial infarction. An intraventricular conduction defect complicated 61 out of 765 cases of acute myocardial infarctions. The defect, with the exception of two cases, always developed in infarctions affecting the anterior wall of the heart. Compared with the other acute anterior myocardial infarctions in which the mortality in the Coronary Care Unit was 15%, infarctions complicated by intraventricular conduction defects have on the whole, presented a worse clinical course and a higher mortality rate (54%). It must be stressed that clinical course and mortality rate have been very different in the various conduction defects. The most innocuous conduction defects were the anterior fascicular block, and, with some reserve, the right bundle branch block too, defects in which the clinical course and the mortality rate were not significantly different from those of the other anterior myocardial infarctions not complicated by intraventricular conduction troubles. On the contrary clinical course was more serious and mortality rate higher (52%) in the cases in which the two defects were associated. Myocardial infarctions complicated by left bundle branch block, right bundle branch block with posterior fascicular block, alternating bundle branch block presented an extremely serious clinical course and a very high mortality rate (over 85%). These differences in the clinical course and in the mortality rate of the various intraventricular conduction defects are explained by the fact that they are associated with myocardial damage of different degree, which is clarified by knowledge of the blood supply of the intraventricular conduction system.


Surface maps and myocardial scanning at rest and during exercise: comparison with coronary angiography. The observations of surface electromaps recorded at rest and during exercise in two examplative cases are reported: the first one deals with a normal man while the second refers to a patient suffering from an old inferior myocardial infarction with bouts of angina pectoris; these surface maps are compared with myocardial scanning also performed at rest and during exercise. Special attention is devoted to the possible relation of the above described, non-invasive, techniques to the anatomical description of coronary lesions as demonstrated by coronary angiography. A close relationship is found between the surface potential distribution pattern and the area of hypofixation observed on the scan as far as the presumed location of ischemic myocardial tissue is concerned.


Polysplenia with left ventricular hypoplasia and partial anomalous pulmonary venous connection. A case is reported of left ventricular hypoplasia associated with anisosplenia. Even though congenital heart malformations are frequently found in cases of splenic anomalies, the association of polysplenia with hypoplastic left heart syndrome is extremely rare. The existence in addition of partial anomalous pulmonary venous connection of the right pulmonary veins to the right atrium, gave us the possibility of study the different changes in pulmonary arteries wall thickness in both lungs.