Studies in cholestasis of pregnancy. IV. Serum lipids and lipoproteins in relation to duration of symptoms and severity of the disease, and fatty acid composition of lecithin in relation to duration of symptoms. Pregnant women with pruritus and with cholestasis of pregnancy verified from the medical history and by the presence of lipoprotein-X in serum have been studied. Thirty-nine patients were investigated for serum lipids (cholesterol, phospholipids, and triglycerides), serum lipoproteins (high-density-lipoproteins cholesterol and estimated low-density-lipoproteins cholesterol), and for hematological data (serum iron and serum iron binding capacity), in relation to duration of pruritus. In 28 patients the serum lecithin concentrations and fatty acid compositions were also analysed. Severity and duration of the disease appeared to influence the lipid/lipoprotein metabolism. The results support the hypothesis of an abnormal reaction of liver metabolism to estrogens in the initial stage of cholestasis of pregnancy.


Influence of copper intrauterine contraceptive devices (Cu-7-IUD) on the menstrual blood-loss. In a series of 43 healthy women menstrual blood loss was determined before and after insertion of copper IUD (Gravigard). The menstrual blood loss before insertion was compared with the blood loss 1, 2, 3, 4, 5, 6, 7 and 12 months after insertion. An increase amounting to approximately 20 ml per period without significant variations during the study was recorded. No significant influence upon serum iron and TIBC was found in 15 of the subjects selected by random. Compared with plastic IUD's the tested copper IUD causes a less pronounced increase of the menstrual blood loss. The menstrual blood loss in a small group of women with menorrhagia was determined before and up to 5 months after insertion of copper IUD. No aggravation of the menorrhagia was however recorded in this group.


The relationship between the cephalo-pedal progress of clinical icterus and the serum bilirubin concentration in newborn infants without blood type sensitization. The correlation between the cephalo-pedal progress of clinical icterus and the serum bilirubin concentration was examined in newborn infants without blood type sensitization. In daylight, 374 observations were made, 290 on 121 mature infants and 84 on 24 premature infants. The investigation showed that a caudad progress of icterus corresponded with an increasing serum bilirubin concentration, and repeated observations can demonstrate whether icterus progresses, showing that the concentration is increasing. The same relationship was found in respect of all the infants with the exception of the two smallest (birth weight less than or equal to 1000 g). They were icteric on the feet at lower concentrations than in the other infants. Furthermore, the relationship did not depend on which day the observations were made. It was not necessary to determine the bilirubin concentration until icterus had progressed to below the knees, as a concentration less than or equal to 110 mg/1 corresponded to all observations in which the lower limit of icterus was found proximal to the knees. However, in the small premature infants it would have been reasonable to measure the concentration when icterus had reached the area below umbilicus.


Treatment of pruritus in cholestasis of pregnancy with a new anion exchange resin (Secholex). Anion exchange resins form a non-absorbable complex with bile acids in the intestine, thus removing bile acids from the enterohepatic circulation and facilitating bile acid excretion in the faeces. A new bile acid sequestrant (PDX chloride, Secholex) was evaluated for the relief of pruritus in cholestasis of pregnancy (CP) in 31 women. CP was verified by the presence of the abnormal lipoprotein X in serum and the clinical series was divided into two degrees of severity, pruritus gravidarum (PG) and hepatosis of pregnancy (HP) based on liver function tests. Eleven of 31 women discontinued treatment because of gastro-intestinal side effects. Of the 20 women continuing the study for more than one week, all with a milder form of cholestasis, PG (n=8), experienced relief of pruritus, while some relief was obtained in 75% of the women with HP. After up to 4 weeks administration of Secholex, no obvious interference with fat absorption was evident judging from the serum lecithin content of linoleic and arachidonic acids. A reduction in serum folic acid might indicate an interaction in folic acid absorption. An expected reduction in serum cholesterol levels which are characteristically increased in CP, was not achieved by the administration of Secholex.


Correlation between human chorionic somatomammotropin and placental weight. Human chorionic somatomammotropin concentration in serum (S-HCS) during the latter half of pregnancy was measured by radioimmunoassay and correlated to the placental weight, in two groups of normal, healthy, pregnant women. In one group, 228 samples from 47 women were examined, which gives a longitudinal series. In the other group, single samples from each of 346 pregnant women were examined, which gives a cross-sectional series. Both groups were randomized on the basis of a prospective selection. The mean values of S-HCS in each week of gestation were almost identical in the two groups, showing a steady increase until 37-38 weeks and a subsequent decrease. In the longitudinal series there was a positive correlation between the S-HCS and placental weight after 37 weeks' gestation, but not before that time. Before 37 weeks gestation the ratio S-HCS/placental weight was significantly higher with small placentae than with large placentae. This difference between small and large placentae disappeared after 37 weeks. These results point to the existence of some regulatory mechanism tending to keep the S-HCS concentration within certain limits, independent of placental weight. This mechanism appears to be lost after 37 weeks of gestation when the S-HCS concentration starts to correlate with placental weight.


Patterns of free fatty acids, glycerol, D-beta-hydroxybutyrate and insulin in pregnant women and their newborn infants. Effects of a low and a high insulin response to glucose in the mothers. Twenty-eight healthy women, 17 with high and 11 with low insulin response to glucose but with normal glucose tolerance, were followed throughout pregnancy. Plasma FFA, glycerol and D-beta-hydroxybutyrate as well as plasma insulin and glucose in blood were determined before and during a glucose infusion test (GIT) in each trimester and after pregnancy. In 13 infants of high insulin responders (IHR) and 10 infants of low responders (ILR) an intravenous glucose tolerance test (IVGTT) was performed, and the above lipid parameters were studied at birth and during the IVGTT. The low responder group was postulated to consist mainly of prediabetic individuals (8). Their infants have previously been shown to have an increased glucose assimilation rate at IVGTT (12, 13), as has been shown for infants of diabetic mothers. There was little difference between the two groups of mothers except for the insulin levels during the GIT in non-pregnant and early pregnant subjects, which were considerably lower in the low responders. They all had decreased fasting levels of FFA, glycerol, and D-beta-hydroxybutyrate in mid-pregnancy and normal values in late pregnancy. The ILR showed the same changes in FFA and glycerol as the IHR, but their D-beta-hydroxybutyrate levels were higher at birth than those of the IHR and lower after birth. Another difference found, was the correlation between birth weight and fasting insulin (and to some extent the insulin level at birth) in the ILR group, which was not found in the IHR. Apart from those differences the ILR and the IHR seemed to handle their fat metabolism in a similar way in the early neonatal perinatal period.


The frequency of fetal bradycardia during selective epidural anaesthesia. The frequency of marked fetal bradycardia (FB) during selective lumbar epidural anaesthesia with 0.25% or 0.5% bupivacaine (Marcain, Bofors) without adrenaline in doses of 5 ml to 8 ml is reported. 35 patients were monitored by means of the Hewlett-Packard Cardiotocograph with Hon's spiral scalp electrode and a transcervical catheter connected to a Hewlett-Packard (1280 B/C) physiological pressure transducer. Only patients with a normal cardiotocogram (CTG) before anaesthesia are included. During the second stage pathological fetal heart rate (FHR) patterns and technical artefacts are common, therefore the CTGs recorded in this period were not considered. In the 35 patients the total time of intrauterine monitoring was 119 hours. During this period 125 doses of 0.25% and 23 doses of 0.5% bupivacaine were given. In 33 parturients the FHR changes observed were insignificant. In one case a period of marked FB was seen. One parturient developed acute hypotension with a synchronous FB while lying in the supine position. It is concluded that continuous lumbar epidural anaesthesia with bupivacaine without adrenaline does not precipitate FB during the first stage when care is taken to avoid maternal hypotension.


The use of electro-analgesia in obstetrics and gynecology. A survey by invitation. The newly-developed method of electroanalgesia is based on the employment of low-intensity impulse currents with extended frequency range and electrode application in the region of the forehead and mastoid processes. Electro-analgesia has been successfully used in preparing the pregnant woman for labour, in controlling abnormal uterine contractility, in preventing and treating toxaemia of pregnancy. It produces favourable effects on the mother and the fetus. Electro-analgesia has also been successfully used in labour anaesthesia, and as part of a combined method of general anaesthesia in 200 obstetrical and gynaecologic operations and the postoperative period.


Bone mineral in patients with osteoarthrosis of the hip. A series of 29 patients with primary osteoarthrosis of the hip were studied to evaluate their bone mineral status. A comparison was made with a series of persons with healthy bones. The bone mineral content of the osteoarthrotics, as measured either by gamma ray attenuation in the forearm bones, or as cortical indexes, or obtained from the combined cortical thicknesses of the second metacarpals from the radiographs, was not higher than in the control series. These findings do not support the concept that patients with osteoarthrosis tend to have a higher "mineral density" than healthy people.


Early changes in the composition of rabbit articular cartilage following experimentally produced intra-articular fractures. A histological and thermoanalytical study. Intra-articular fractures were produced in rabbit knee joints. The articular cartilage of the injured joints was processed histologically and analysed by a complex thermoanalytical method. It was demonstrated that intra-articular fractures in the early stages have essentially no irreversible damaging effects on the composition of articular cartilage of injured joints.


Management of fractured scaphoid bone. A prospective study of 100 fractures. One hundred fractured carpal scaphoids were immobilised alternatively in above-elbow and below-elbow casts. Preventing the pronation and supination of the forearm did not reduce the immobilisation time, which, with either type of cast, averaged 7 weeks, after exclusion of the fractures with delayed union. These eight fractures, which did not unite in 3 months, were operated on using a lag screw fixation, whereafter consolidation was achieved.


Synovectomy of the elbow in rheumatoid arthritis. The results of 105 synovectomies + resection of the radial head in 84 patients with rheumatoid arthritis are shown. Pain was the main indication for surgery, and 1 1/4-6 2/4 years later about 80 per cent had pain relief at work, 90 per cent pain relief at rest. About 60 per cent of the elbows gained in rotation movement; about 40 per cent gained in hinge movement. Thirteen elbows had to be reoperated. In all cases there was only radial approach to the joint, which the authors find gives adequate exposure, few complications, and easy postoperative treatment.


Surgical treatment of rupture of the rotator cuff tendon. A total of 55 tears of the rotator cuff tendon were surgically treated at the Department of Orthopaedics and Traumatology, Helsinki University Central Hospital, during the period 1960-1970. The rate of operative treatment was about 12 per cent. When more than half a year had elapsed since the accident, excision of the acromion was almost the only operative procedure carried out (10/12 patients). Excision of the acromion was performed as the only procedure in 16 cases and in connection with surgical repair of the rotator cuff tendon in 20 cases. This operation brings relief of nocturnal pain, but it is harmful in the treatment of large tears when used alone and sometimes also in connection with surgical repair of the rotator cuff tendon. Surgical repair of the lesion seems to give the best results, provided it is performed within 1 month of the injury.


Fracture of the scapular notch associated with lesion of the suprascapular nerve. In a material consisting of 18 patients with scapula fractures, the scapular notch was involved in two cases. In one of these cases injury of the suprascapular nerve function was proved. The value of X-ray examination with projections visualizing the scapular notch is pointed out. EMG examination in selected cases with the combination of reduced supraspinatus muscle function and a fracture of the scapular notch is recommended in order to diagnose injury of the suprascapular nerve.


A long term follow-up of Moore arthroplasty in femoral neck fractures. Moore arthroplasty was performed for medial femoral neck fractures in 169 patients. The mortality rate was 21.3 per cent within 3 months. The general postoperative complication rate (39.6 per cent) was dominated by cardiopulmonary (17.2 per cent) and thromboembolic (16.0 per cent) events. Of local complications, wound infection was found in 4.7 per cent and osteitis in 3.0 per cent of cases. A total of 60 patients were followed up with a mean observation time of 4.9 years. Of these, 8.3 per cent sustained femoral fractures during this period. The results classified according to the criteria of the American Academy of Orthopedic Surgeons showed 52 per cent excellent or good, 43 per cent fair and 5 per cent poor results. The roentgenological finding of settling or osteolysis along the prosthesis was significantly correlated to reduced hip mobility. Ossification in the prosthetic fenestres gave significantly diminished settling, and was correlated to better hip mobility and less pain. In our opinion, Moore arthroplasty has proved to be an acceptable method for the treatment of femoral neck fractures in elderly patients, as 73 per cent had an acceptable range of motion, 40 per cent managed walking distances of more than 500 m and 70 per cent had minimal or no pain. Although 25 per cent became nursing home patients, this reduction of vitality could be related to the hip arthroplasty in only two cases.


Classification of medial fractures of the femoral neck. In this study 444 consecutive cases of medial fracture of the femoral neck treated in the city of Turku are considered on the basis of the proposals of Garden (1961) and Pauwels (Leitz 1966) for the classification of fracture types. In order to find out what kind of classification is most practical and coherent a retrospective comparison of the progress of healing was made on the basis of the aforementioned classifications of fracture. Garden's classification proved to be far more logical and was much more reliable for the prognosis of recovery. For this reason and also because of the ease with which his criteria can be applied, the present authors recommend the general use of Garden's classification.


Early weightbearing after classical internal fixation of medial fractures of the femoral neck. This study is a survey of a series of 446 patients, treated in the city of Turku, Finland, between 1964 and 1971, for medial fractures of the femoral neck. Fractures were treated by means of the classical nailing method (nail placed along the central axis of the femoral neck, ad modum Smith-Petersen). An unselected group of patients were treated in such a way that they were already allowed to bear weight on the injured limb 2 weeks post-operatively (120 patients). The remaining patients were not allowed to bear weight on the injured limb until 12-14 weeks after nailing (261 patients). The progress of recovery was studied retrospectively, a comparison being made between the early and late weightbearers. Without reference to the type of fracture (according to the classifications of Garden or Pauwels) or to the method of fixing (Smith-Petersen nail, with or without side-plate) bone union was relatively more frequent and failures were relatively less frequent among early weightbearers than among late weightbearers. Early weightbearing had a beneficial effect upon the healing of the fracture and there was no evidence in the case of early weightbearers of any additional complications. A comparative study of the whole patient group on the basis of the time-lag between the accident and the operation--some were nailed 1-3 days, some 4-7 days and some more than a week after the fracture had taken place--revealed no significant differences.


Trochanteric femoral fractures treated with McLaughlin osteosynthesis. Of 317 patients with trochanteric femoral fractures, 305 were treated with McLaughlin osteosynthesis. The mortality rate was 14.5 per cent. The postoperative complication rate (35.6 per cent) was dominated by cardiopulmonary (10.6 per cent) and thromboembolic (10.6 per cent) events. Wound infection was found in 3.8 per cent and osteitis in 0.9 per cent. In all, 106 patients had stable fractures according to the Evans classification. Of these, four had to be re-operated due to penetration or a loose bolt. Two hundred and eleven patients (66.6 per cent) had unstable fractures. Follow-up of 169 patients showed two-thirds to have healed in unchanged position. Only 14.8 per cent of the 169 patients had significant fracture complications, particularly varus dislocation of more than 20 degrees (nine patients) and penetration of the nail (eight patients). A total of 10 patients (5.9 per cent) had to be re-operated because of varus dislocation, broken plate or development of pseudarthrosis after removal of the osteosynthesis material. McLaughlin osteosynthesis is concluded to be a suitable method for the treatment of trochanteric femoral fractures--also of the unstable type.


Femoral nerve compression syndrome with paresis of the quadriceps muscle caused by radiotherapy of malignant tumours. A report of four cases. Four patients showed signs of femoral nerve compression with subsequent paresis of the quadriceps muscle, after radiation therapy of malignant tumours. The compression was caused by scar tissue due to radiation treatment of the inguinal region. The first symptom was radiating pain in the front of the thigh and lower leg which appeared 12-16 months after X-ray treatment. A decrease in the strength of quadriceps muscle occurred some months later. In one case the femoral nerve was decompressed, another patient was treated by an intradural phenolglycerin injection and one patient was treated with cortisone and oxiphenbutazone. In these cases the pain decreased considerably, but in one case only the paresis of the quadriceps muscle improved after treatment.


Chondromalacia of the patella. Incidence, macroscopical and radiographical findings at autopsy. In a post-mortem series of 59 persons aged 10-50 years, 91 of the 118 patellae exhibited cartilaginous changes. These changes were most common in the older age groups and usually affected the medial articular facet where they were also most extensive and most profound. Clinical and radiological assessment showed this facet to be less suited to articulation with the femur because of its convex joint surface, central ridges, and prominences. Radiography using tangential views of the entire patella and of 2 mm thick slices of the patella showed in cases with macroscopically normal cartilage a less dense bony structure medially and a denser structure laterally. Even in the presence of distinct cartilaginous changes this difference in bone density did not alter essentially. In particular, there was no definite sclerosing medially, where the changes in the cartilage were most marked. Osteophyte formation was sparse, but most common in the older age groups, and laterally. Osteophytes were seen only on patellae with cartilaginous changes.


150 open fractures of the tibial shaft--the relation between necrosis of the skin and delayed union. In 150 open fractures of the tibial shaft a close relationship between the presence of skin necrosis and delayed union was found. The incidence of skin necrosis rose with the severity of trauma. It was high (22 per cent) among the fractures that were treated conservatively, but even higher (41 per cent) among those treated with primary osteosynthesis. Neither conventional conservative treatment nor osteosynthesis seems to be satisfactory as a primary treatment of the most severe cases. It is instead suggested that external fixation by the Hoffmann-Vidal technique should be combined with transposition of viable muscle tissue across denuded fractured bone areas according to the method of Ger.


Aneurysm of popliteal artery caused by cartilaginous exostosis. A case report. A case is reported of traumatic aneurysm in a young man, caused by cartilaginous exostosis distally in the femur. An analysis is given of 18 similar cases from the literature.


The neuropathic ulcer and loads on the foot in diabetic patients. Normal subjects and diabetic patients with and without food ulcers have been studied using an apparatus which measures the loads on the foot during walking. Diabetic patients have alterations in loading which show as a lateral shift of the highest maximum load on the forefoot and a decrease in the load carried by the toes. There is a significant progression of these changes between normal subjects, diabetic patients with deformity of the foot but no ulcer, and diabetic patients with foot ulcers. All the patients with ulcers exerted maximum loads at the site of the ulcer.


Congenital clubfoot. A follow-up of 95 persons treated in Sweden from 1940-1945 with special reference to their social adaption and subjective symptoms from the foot. A follow-up, with special reference to social adaptation and subjective symptoms, was done on 95 persons with congenital club feet treated in Sweden 1940-1945. At an age of 27-33 years the individuals managed themselves well and in spite of physical as well as psychological handicap they deviated relatively only a little from the normal population as regards work, sports and other social adaptibility.


Congenital metatarsus varus. On the advantages of early treatment. Among 212 infants with congenital metatarsus varus 84 (39.6 per cent) of the infants were treated. Only the treated group is considered in the analysis. Daily manipulative therapy was given followed by fixation in elastic bandage or splint. The manipulations aimed at correcting the adduction of the fore part of the foot, as well as the increased valgus of the heel. In 68 infants treatment was instituted before one year of age. The results were good in 65 of these patients and correspondingly good results were obtained in 15 out of 16 patients treated at more than one year of age. Subluxation in the fore- and midfoot and bony incongruity present at birth are offered as a possible explanation for lack of spontaneous recovery before weightbearing as well as the occurrence of resistant cases. Spontaneous improvement may take place during childhood and may be explained by the influence of the position of the heel during weightbearing.


Light and electron microscopic studies of the bone marrow and blood cells in chronic panmyelosis including polycythemia vera and primary thrombocythemia. Both bone marrow and peripheral blood was investigated light and electron microscopically in 3 cases with polycythemia vera, 2 cases with primary thrombocythemia and 1 case with panmyelosis. In 5 cases the peripheral blood showed persistent increase in cells of two or three hematopoietic systems. Giant thrombocytes in the peripheral blood were seen in 3 cases. Erythroblasts, granulocytic young forms, and megakaryocytes were often observed in the blood. Histologic bone marrow examination showed prominent proliferation of all 3 hematopoietic cells in every case. Cytological and electron microscopical examinations of the bone marrow revealed many mitotic figures, morphological abnormalities, and unbalanced nucleocytoplasmic maturation in various hematopoietic cells. These findings suggested that the proliferation of all 3 hematopoietic cells in the bone marrow was not simply reactive in nature, but an idiopathic progressive process. It is considered that these disorders and primary myelosclerosis represent no separate entities and must be unified as "chronic panmyelosis".


Changes in vascular permeability in stroke-prone spontaneously hypertensive rats studied with peroxidase as a tracer. Cerebrovascular permeability in stroke-prone spontaneously hypertensive rats (SHR) at various ages was histologically studied using horseradish peroxidase as a tracer and such was related to the cerebrovascular lesions in the animals. An increase in permeability was demonstrated in the brain of SHR, particularly in those animals with an extremely high blood pressure. Increased cerebrovascular permeability occurred in some animals without any organic vascular change or severe parenchymal changes, although edema was present. Histologically, the SHR brain with an increase in permeability showed mild focal edema, rarefaction of tissue and necrosis with cyst formation. Thus a transitional progress was evident. Localization of the increase in permeability corresponded well with the predilection sites of cerebrovascular lesions in SHR. Constrictions and dilatations of intracerebral arterioles and small arteries were also demonstrated by the peroxidase method, and the dilated arterial walls did reveal a darker staining. From these results it is strongly suggested that certain cerebrovascular lesions, especially necrosis with cyst formation in SHR are sequelae of the increased cerebrovascular permeability caused by a chronic hypertensive state.


Giant mesenteric lymphoid tumor (Castleman's lymphoma) - a case report. An autopsy case of a giant mesenteric lymphoid tumor in a 57-year-old female was examined anatomo-biologically. A 17X15X6 cm3-sized pinkish gray-coloured medullary tumor occupying the mesenterium with no evident capsule, invaded the small intestine and pancrease head. Histologically, it was a lymphoid tissue consisting of hyalinized angiofollicular architecture having epithelioid cells and tingible body macrophages in the follicles. Some small-sized follicles showed typical Hassalloid architecture and other follicles consisted of monotonous growth of lymphocytes without a mantle zone, some of them fusing with each other. The histopathological appearance of the tumor was that of Castleman's lymphoma and of hyaline-vascular type of Keller's Classification. There was another 0.6X0.5X0.5 cm3-sized tumor having an angiofollicular architecture in the subserosa of the sigmoid colon. The present case was complicated with vertebral caries, hypogammaglobulinemia (1.2%), eosinophilia (50%) and panbronchobronchiolitis, the last one being responsible for her death.


Congenital muscular dystrophy associated with micropolygyria - report of two cases. This is a report on two autopsy cases of congenital muscular dystrophy associated with micropolygyria. The first case was that of an 11-year-old boy and the other of a 22-year-old male adult. Both cases had similar clinical features, very early onset of disease, diffuse and extensive wasting of skeletal muscles including facial muscles, contracture of joints, hypotonia and mental retardation. In the familial histories of these two cases, the parents of the boy were consanguineous, and a sister of the adult case suffered from muscle weakness and mental retardation. Both of these two cases were clinically diagnosed as congenital cerebromuscular dystrophy (Fukuyama's type). Autopsy revealed marked dystrophy of generalized skeletal muscles and widespread micropolygyria of the brain in both cases. Spinal cords and peripheral nerves were free from any prominent changes. It was concluded that so-called congenital cerebromuscular dystrophy may be caused by myogenic as well as neurogenic abnormalities during fetal period.


Hypophosphatasia-study on two autopsy cases. The autopsy findings of two cases of infantile hypophosphatasia are described and compared with those of 16 previously reported cases. Histochemical and biochemical tissue analysis for alkaline phosphatase showed a marked decrease in activity in liver, kidney, and bones. However, intestinal alkaline phosphatase possessed normal or slightly elevated activity. Nephrocalcinosis is a frequent complication and its development depends on hypercalcemia and length of survival of the patient. Electron microscopic findings are illustrated, and a mechanism for the development of nephrocalcinosis is proposed. For the first time, marked elevations of parathyroid hormone was detected. This finding, coupled with the extreme difficulty in locating the parathyroid glands in cases of hypophosphatasia, is enigmatic. Areas for furture investigation are suggested.


On the dynamics of the pulmonary stretch receptor. An attempt to describe mathematically the dynamic behavior of a slowly adapting pulmonary stretch receptor is presented. The elaborated formula makes it possible to assess both the dynamics of the receptor firing and the phenomenon of adaptation.


Effect of electrode implantation and electrical stimulation of hypothalamus of food intake in cats. Electrodes were implanted into HL in cats. Influence of implantation on daily food intake and alimentary preferences was investigated. Then, the particular sites were stimulated electrically and the general behavior of cats and their attitude towards the food was observed. Implantation effected food intake in different manner in particular individuals. All animals changed their preferences in the direction of raw meat. Electrical stimulation of sites producing alimentary behavior (10 from the 35 investigated) caused the same preference. Alimentary behavior occuring during the stimulation of these sites seems not to be related to the increase of hunger drive.


The effect of lesions of the dorsomedial thalamic nucleus on alimentary conditioned reflexes and food intake in dogs. The experiments have been carried out on 6 dogs with type II conditioned alimentary reaction. After achieving the criterion in all animals the dorsomedial thalamic nucleus was destroyed by means of electrocoagulation. After the operation hypophagia developed with a rise in the number of intertrial responses and disinhibition of the alimentary conditioned reaction not exceeding 6 days. The obtained results confirm in part the hypothesis of Brutkowski who regarded this nucleus as belonging to a system controlling feeding behavior.


The effect of a single intense effort on the activity of aminotransferases and concentration of free amino acids in the plasma of rats. Untrained rats were subjected to a single intense physical effort. In the plasma the activity of alanine aminotransferase, aspartate aminotransferase, and the concentrations of amino acids: glycine, cystine, alanine and leucine with isoleucine were measured. The results were compared with the data obtained in a control group. Despite lack of statistically significant differences in the activity of aminotransferases and concentration of amino acids between these groups a correlation was found between the activity of AIAT and alanine concentration in the animals after exercise. The concentration of alpha-amino nitrogen was decreased statistically significantly in the group of animals subjected to intensive exercise.


Investigations of erythropoiesis in newborn rats. Erythropoiesis in newborn rats in physiological conditions. Erythropoiesis was investigated in suckling rats from the 1st to the 19th day of life when the use of 59Fe. In 2-day and 5-day old rats it was less intensive than in later days. The haemopoietic processes were most intensive between the 7th and 14th day of life. Following this period the activity gradually decreased.


Investigations on erythropoiesis in newborn rats. Dependence of erythropoiesis in newborn rats on the intensity of the haemopoietic processes in the lactating mothers. The intensity of haemopoietic processes was investigated in 7, 9, 11, 14 and 19-day-old suckling rats in relation to the intensity of these processes in their mothers. The rate of the haemopoietic processes in newborn rats was determined on the basis of 59Fe incorporation into the blood and haemopoietic organs. The activity of the erythropoietic system in lactating rat females was stimulated by haemorrhage and inhibited by erythrocyte transfusion. Anaemization of lactating rats by haemorrhage did not stimulate erythropoiesis in the suckling rats. Posttransfusion polycythaemia in the lactating mothers inhibited erythropoiesis in the suckling rats beginning with the 9th day of life. This phenomenon became more pronounced with the age of the rats.


The influence of muscular contractions on acetylcholine effects on nutritive blood flow in the hindpaw of dog. In the earlier investigations it was shown that muscular exercise augmented the dilator effects of ACh in the vascular bed of the hind leg of dog. To get a closer insight into this phenonenon the effects of acetylcholine on the nutritive blood flow in contracting skeletal muscle in the dog were studied. It was found that i.a. acetylcholine administration raises the nutritive blood flow in the investigated vascular bed within about 30--36 minutes after muscular contractions. The nutritive blood flow during and following muscular contractions induced by stimuli of varying frequency was also investigated.


The effects on stretching and prostaglandin F2alpha on the contractile and bioelectric activity of the uterus in rat. The effects of stretching and of prostaglandin F2alpha on spontaneous and induced with local deformation contractile activity of rat uterus were studied. It was found that stretching the uterus up to the length of the decontracted organ in vivo increased the contractile and bioelectric activity. The rise in spontaneous uterine activity was a factor reducing induction of additional contractions. The fall in the level of endogenous prostaglandins in the uterus following administration of indomethacin inhibited the spontaneous contractile activity but was without effect on the contractions induced by local deformation of the myometrium. Prostaglandin F2alpha added to the bath in a concentration of 0.001 ng/ml exerted an inhibitory action on the different tested parameters of the contractile activity. After high doses stimulation of the uterine activity was observed.


The effects of indoleamines (serotonin and melatonin) on induction of ovulation in rabbits. Serotonin as well as melatonin introduced into the 3-rd cerebral ventricle in doses of 120 mug blocked induction of ovulation in rabbits; it was also observed that the ovulation-blocking effect of serotonin was much more effective than that of melatonin. The inhibitory effect of both indolamines on this process was more evident in summer than in spring. The role of serotonin and melatonin as mediators blocking the release of hypothalamic gonadotropin-releasing hormones (GRH) and the participation of these amines in the regulation of seasonal sexual rhythms are discussed.


Red cell and total blood volumes during sexual excitement and copulation in the boar. Measurements of hematocrit, total plasma protein and red cell volume were made during sexual excitement and copulation in boars. Red cell volume (RCV) was determined by isotope dilution technique using endogenous 51Cr-tagged red cells. Basing on these data changes in the total blood volume (TBV) and plasma volume (PV) were calculated by 2 indirect methods. RCV increased by 12% to 16% in the intial phase of ejaculation and remained increased during ejaculation and 40 minutes after copulation. TBV and PV decreased during copulation, greatest drop being found in the final phase of ejaculation. After ejaculation the TBV was increasing, first to the resting value before copulation (about 20 minutes after copulation), thereafter it became markedly higher than during the resting period. Depending on the method used for calculation significant differences were found in the quantity of TBV and PV drop during ejaculation.


The effect of stable strontium on the incorporation and metabolism of radioactive strontium in young and adult rabbit bones. The experiments were performed on 5-, 8-, 12- and 14 months old rabbits. The effect of stable strontium enriched diet on the bone tissue formation (apposition) and on physiocochemical processes consisting in ion exchange were studied using radioactive isotopes: Sr-85 and Ra-226 and tetracycline. The results of kinetic and autoradiographic studies and micoscopical analysis of bone preparations suggest that stable strontium inhibits the mineralization of newly formed bone tissue without affecting the physico-chemical processes related to ion exchange.


Relationship between the changes in the concentration of endoxan and the activity of kininforming enzymes within the Guérin tumor in rat. The activity of rat kininforming system and endoxan level in certain organs and in the neoplastic tissue was studied. It was found that trypsin increases markedly the kininforming activity and endoxan level in the Guérin tumor, and slightly in the liver. A direct correlation between the level of endoxan when given with trypsin and the kinin activity were observed. The authors suppose that the selective accumulation of endoxan in the tumor depends on the trypsin -- induced activation of kininforming system within the neoplastic tissue.


The effect of hypertonic urea solution on Na+ and K+ transport through the smooth muscle membrane. The aim of this work was to examine the effect of a hypertonic solution (Krebs solution + 290 mM urea) on K+ and Na+ transport. The experiments were carried out on the guinea-pig taenia coli preparations using the method of Na-24 and K-24 loading and washout. The efflux curves were analysed by means of the digital computer technique. The following parameters were determined: efflux rate constant k2, influx rate constant k1, intracellular ion concentration C1 ion flux M and permeability P. Any significant difference between PNa/PK ratio in hypertonic urea and isotonic Krebs solutions was found.


Therapeutic attempts with lithium in young drug addicts. On the hypothesis that drug addiction may be due to "masked depression", lithium was administered to 20 opiate addicts. Only nine patients took the lithium carbonate tablets for more than a few weeks; during this period they seemed to abstain from taking opiates. After 1 year, all the patients were off lithium and most of them again took opiates. Due to lack of cooperation on the part of the patients, the observations can neither confirm nor refute our hypothesis. The study shows that psychological and socio-environmental factors make trials on drug treatment of opiate addicts almost impossible to carry out.


Marital status and schizophrenia.

Marital status and schizophrenia. The finding that married persons are more likely to be hospitalized schizophrenics is reviewed. Three interpretations of the finding are discussed: causation, selection, and differential utilization. A strategy to separate the three hypotheses is presented which uses data on rates of admission and duration of hospitalization and which concentrates on the widowed category. Data from the Maryland Psychiatric Case Register are used to test the hypotheses. Evidence of selection and differential utilization is found, but none in favor of the causation hypothesis. It is shown that selection operates less powerfully in rural areas.


Changes of associative performance in hospitalized schizophrenics: a 16-year follow-up. After a mean test-retest interval of 16.6 years a sample of 72 initially acute/subacute as well as chronic schizophrenic patients showed a significant normalisation of performance with respect to associative commonality, idiosyncratic responses, and response latency. The findings are attributed chiefly to effects of psychotropic drugs and improved psychiatric treatment.


The psychopathology of anancastic endogenous depression. From a sample of 1,005 patients admitted to the Psychiatric Hospital in Aarhus for the first time during the period 1950-1959 and diagnosed as suffering from manic-depressive psychosis or endogenous depression (affective psychoses), a subsample of 104 manic-depressive patients with anancastic symptoms in the history was selected. The 104 probands were individually matched with 104 non-anancastic probands with affective psychoses. The study was designed as a follow-up study, and the patients who were still living were seen personally. In the search for factors which could be used to distinguish affective psychoses with anancastic symptoms from affective psychoses without these traits, the incidence of a number of psychopathological features was evaluated based on the case histories and the information given by the patients at the follow-up. There was no difference as far as atypical, schizophrenia-like symptoms were concerned between the anancastic probands and the controls. Manic and hypomanic features were more frequent among the controls, corresponding to a greater number of bipolar psychoses among them. At the same time, the controls showed a significant preponderance of decidedly psychotic symptoms such as disturbances of consciousness, delusions and delusion-like ideas and hallucinations. Furthermore, retardation was more frequent among the controls. There was no difference in the suicidal behaviour of the two groups. Symptoms which were more often met among the anancastic depressives were: anxiety, agitation, diurnal variation of mood and early awakening. Seasonal variation in symptomatology was also more frequent among the anancastic probands. The same held true for depersonalization. The anancastic probands showed a significant preponderance of anancastic premorbid personality features. A positive correlation was found between the number of anancastic personality features and the following symptoms: agitation, anxiety, diurnal fluctuation, seasonal variation, hypochondriacal attitude and depersonalization. On the other hand, objective retardation or flight of ideas showed a significant negative correlation. The pattern of the anancastic symptoms was rather uniform; aggressive obsessions, mostly in the form of suicidal and homicidal obsessions, were present in more than two thirds of the cases. The anancastic depressions were often less severe than non-anancastic depressions in that the latter were more often complicated by decidedly psychotic symptoms. It is possible to interpret the symptomatology of anancastic depressions as a pathoplastic influence of the anancastic personality, but it cannot be excluded that some of the symptoms like anxiety and agitation are linked to the presence of anancastic symptoms as such.


Myelography with the non-ionic water-soluble contrast medium metrizamide. Technical problems in myelography with the water-soluble contrast medium, metrizamide are analysed and a technique used for examination of the entire spinal subarachnoid space is described. The choice of gas or water-soluble contrast medium for myelography is also discussed.


Multidirectional tomography in reconstructive middle ear surgery. The tomographic demonstration of essential structural details before reconstructive middle ear surgery with osseous auto- and homografts is described, and the preoperative information requirements are briefly discussed. The tomographic appearance of the different types of reconstruction is presented. The halfaxial and true lateral projections are to be preferred, if necessary complemented by the axial-pyramidal projection. Tomography may disclose obvious morphologic causes of absence of postoperative hearing improvement or secondary hearing impairment.


Side effects after lumbar myelography with dimeglumine iocarmate (Dimer-X). Further experiences. Lumbar myelography with dimeglumine iocarmate was performed in 90 cases premedicated with diazepam (Valium). EEG was performed before, as well as 3 and 24 hours after myelography. The use of diazepam interfered to some extent with the interpretation of the EEG. In 3 cases EEG abnormalities occurred 3 hours after myelography, most probably ascribable to Dimer-X. No further changes were found in the 24-hour recording. Immediate side effects were few and mild and seizures did not appear. The EEG abnormalities were equally distributed among patients with and without side effects.


Psoriatic lesion of the sternal synchondrosis. Radiography of the synchondrosis between the manubrium and the sternal body was performed in 29 patients with clinically certain psoriatic arthropathy. Tomography proved necessary for a detailed analysis. Erosive inflammatory lesions were detected in 18 cases; in 61 per cent of cases with a history of more than 5 years and in 71 per cent of cases with typical hand and feet arthropathy. It is concluded that the sternum is frequently involved in cases with roentgenologically typical psoriatic arthropathy.


Angiography in epidemic nephropathy.

Angiography in epidemic nephropathy. Nephroangiography has been performed in 35 patients with epidemic nephropathy during the course of the renal lesion phase. In addition to enlarged kidney with thickened cortex, generalized renal vasodilatation was demonstrated in the majority of the cases, frequently combined with rapid circulation. Thus, contrary to previous assumptions, acute oliguric renal insufficiency may also occur in cases with peripheral renal vasodilatation. The angiographic appearance of epidemic nephropathy was characteristic and most evident in the oliguric and anuric phases. Nephroangiography in acute oliguric renal failure may thus be of value for the differential diagnosis and thereby influence the clinical management of the patient.


Circulatory disturbances following missile wounding of soft tissue. The early circulatory changes following high velocity missile wounding to soft tissue of an extremity were analysed by hemodynamic methods and serial angiography. The extent of the tissue injury and the functional disturbances were mapped out and the time-course of the alterations in blood flow was registered. Possible mechanisms for the observed abnormalities are discussed.


Perception of simulated lesions in the lung. The detectability of phi 20 mm, disk-shaped objects on a normal chest film was investigated at viewing distances of 0.3, 1.0 and 3.0 m. Objects with a tapered border were found to be best perceived at longer distances. The photpgraphic density difference between object and background yielding a 50% detection probability was found to increase from 0.025 to 0.060 when the outer gradient zone of the object increased from 0.8 to 4.0 mm.


Relative flow measured by roentgen videodensitometry in hydrodynamic model. The behaviour of injected iodine contrast medium in a pulsative hydrodynamic model was recorded on videotape in television fluoroscopy and measured by roentgen videodensitometry. By a simple relationship between the integrated densitometric area, the amount of injected contrast medium, and the flow at the site of the injection, it was possible to compare the flow in two different cross-sections of the circulatory system with high accuracy.


Influence of secondary radiation on image quality. On the basis of observations concerning non-screen films and xerox plates a theory is proposed as to how the image quality is impaired by secondary radiation. The theory includes an explanation of why xerox plates and industrial roentgen films of a high silver content are less affected by secondary radiation than conventional roentgen films.


Layer formation in narrow beam rotation radiography. The layer formation in rotation narrow beam radiography is analysed mathematically. It is shown that the blurring, and consequently the layer formation, is due primarily to the width of the beam; no blurring and no layer formation occur if the beam is of negligible width. The blurring is significantly affected by the magnification factor in the specific central projection typical of narrow beam rotation methods, where the rotation centre serves as an imaginary focus.


Injection device for pharmaco-angiography. A device for injections of vasoactive agents at angiography connected with an injector for contrast medium and a film changer is described. It enables the examination to be performed according to predetermined data with a high degree of reproducibility. It lends itself particularly to experimental investigations of pharmacologic effects within various vascular areas.


Treatment of sinoatrial syndrome with permanent cardiac pacing in 90 patients. Out of a pacemaker population of 392 patients, 90 (23%) have been found to have sinoatrial syndrome. Their ages ranged from 22 to 86 years, and averaged 66 for men and 70 for women. The male-to-female ratio was 1:1.6. Before pacemaker implantation, syncopal attacks had occurred in 54%, dizziness without syncope in 31% and tachyarrhythmias in 57%. Atrial or paroxysmal supraventricular tachycardia had been recorded in 33%, atrial fibrillation or flutter in 28%, and ventricular tachycardia in 11%. First and/or second degree AV block was found in 36%. Coronary heart disease was present in 61% and 20% had had myocardial infarction. Cardiomyopathy and previous carditis were other associated heart diseases. Sinoatrial syndrome was the only manifestation of heart disease in 20%. Follow-up time after pacemaker implantation ranged from 3 months to 7 years, mean 23 months. Syncopal attacks were stopped in 48 of 49 patients, dizziness was relieved in all 28 patients and tachyarrhythmias were controlled by combined drug treatment in 43 of 51 patients. Nineteen patients died during the follow-up, most of them of cerebrovascular events or myocardial infarction. Associated coronary heart disease was especially frequent in this group. The death of one patient was caused by a run-away pacemaker. Other pacing failures were due to electrode movement or premature battery exhaustion. There was no mortality associated with pacemaker implantations or replacements. These results strongly support the view that pacemaker treatment most effectively controls symptoms of sinoatrial syndrome when drug treatment fails.


Creatine phosphokinase following cardioversion. Serial estimations of total serum creatine phosphokinase (CPK) have been performed before and during 18-51 hours after cardioversion of supraventricular tachyarrhythmias in 12 patients without acute myocardial infarction (AMI). The maximal CPK rise was 78 mU/ml (110%) and the CPK did not exceed the upper normal limit (130 mU/ml) in more than two patients (149 respectively 156 mU/ml). The CPK rise we have observed in a series of AMI patients varied between 101 (133%) and 2 260 mU/ml (3 780%), mean 900 mU/ml (1 184%). Therefore, cardioversion performed as described seldom seems to interfere with diagnosing AMI by serial estimations of serum CPK during the next 24 hours.


Deaths and non-fatal reinfarctions during two years' follow-up after myocardial infarction. Since 1968 special units for registering and following up all myocardial infarction patients have been in operation in Góteborg. The present paper reports on the deaths and non-fatal reinfarctions among 440 men and women below 67 years of age followed for two years after hospitalization for myocardial infarction. Of the 359 men, 299 had their first infarction and 60 a recurrent infarction. During two years 13% of men with a first infarction, and 37% of men with a recurrent infarction died. Deaths were significantly more common during the first than during the second year. There was no significant difference in mortality between men and women. The incidence of non-fatal reinfarctions was of similar magnitude and showed similar time relationships. Two thirds of the deaths were sudden (within 24 hours after onset of new symptoms) and half of the deaths occurred outside hospital. The autopsy rate was 92%. Two thirds of the deaths were caused by a fresh morphological infarct. In one fourth of the deaths where no cause was found at autopsy, death was ascribed to malignant arrhythmias. Heart weights were higher among patients dying after recurrent infarction at entry to the study. No distinctive pattern was found when autopsy findings were correlated to the interval between the onset of symptoms and death. Deaths due to fresh infarction and without an identifiable cause were more common among those who died within 24 hours of onset of symptoms compared to those dying after longer intervals.


Diazoxide in the management of severe hypertension. Fourteen patients with severe hypertension have been given i.v. diazoxide in a dosage of 5 mg/kg b.wt. The material comprised 2 patients with malignant nephrosclerosis, 4 with chronic nephropathy and severe reduction of renal function, 1 patient with chronic pyelonephritis, 1 with renovascular hypertension and 6 patients with essential hypertension and in malignant phase. All patients attained a controllable blood pressure. Eight patients remaining needed only one injection, while the remaining patients required 2-5 injections, and concomitant furosemide therapy. The retinopathy improved in most patients and renal function was unchanged in the azotemic patients. No serious adverse effects were seen, except one hypotensive episode. Diazoxide is easy to handle, dosage can be predetermined, monitoring is simple and we find diazoxide to be a valuable drug in severe hypertension.


Glomerular filtration rate and renal plasma flow in patients with essential hypertension before and after treatment with alprenolol. In 25 patients with essential hypertension, the renal plasma flow RPF), glomerular filtration rate (GFR) and BP have been measured before and after one month's treatment with alprenolol. The patients were divided into two groups according to age. Group 1 consisted of 10 patients with mild hypertension under 35 years of age, group 2 of 15 patients over the age of 35 with moderate hypertension. A markedly greater lowering of BP was measured in group 1 than in group 2. There were no changes in RPF or GFR after alprenolol treatment and no differences in these parameters were observed between the two groups either before or after treatment. Group 1 displayed significantly lower renal vascular resistance (RVR) than group 2 both before and after treatment, and alprenolol treatment resulted in a slight reduction of RVR in group 1, but not in group 2. The difference between the two groups with respect to the antihypertensive effect of alprenolol and the RVR may possibly be due to the fact that the patients in group 2 had more pronounced structural vascular alterations than those in group 1.


Catecholamines in plasma and urine in patients with essential hypertension determined by double-isotope derivative techniques. Employing double-isotope derivative techniques, noradrenaline and adrenaline have been determined in plasma and in urine and dopamine in urine in 21 patients with essential hypertension as well as in 32 controls. Plasma noradrenaline rose with age in both groups of subjects. No differences were observed in plasma noradrenaline and plasma adrenaline in the resting supine position and in urinary excretion of noradrenaline and dopamine in hypertensive patients as compared to control subjects. Urinary excretion of adrenaline was somewhat lower in the hypertensives than in the controls. Treatment with alprenolol, a beta-adrenergic blocking agent, did not influence noradrenaline and adrenaline in plasma in the basal state or the urinary excretion of the three catecholamines. The combined treatment with alprenolol and hydralazine was followed by a significant rise in plasma noradrenaline. It is concluded that the adrenergic activity evaluated by circulating catecholamines is normal in most patients with essential hypertension.


Effect of alprenolol and hydralazine on plasma renin concentration in patients with arterial hypertension. The effect of alprenolol alone and in combination with hydralazine on plasma renin concentration has been studied in 25 patients with arterial hypertension. Alprenolol caused a significant fall in plasma renin concentration and in BP but the two falls were not intercorrelated. Addition of hydralazine to the treatment regimen produced a further reduction of BP. Changes in plasma renin concentration varied greatly during combination therapy. A modest, non-significant increase in plasma renin concentration was measured compared with the level after treatment with alprenolol. It is concluded that mechanisms other than suppression of plasma renin concentration are important for the reduction of BP during beta-adrenergic blockade and that the plasma renin concentration probably has no clinical significance with regard to forecasting the antihypertensive effect of alprenolol. Even though a significant correlation was found between the fall in plasma renin concentration and the fall in diastolic BP during combination therapy, it is uncertain whether changes in the renin-angiotensin system are of primary importance for BP regulation during this therapy.


A 3-year follow-up of middle-aged men with borderline blood pressure. Ninety-eight middle-aged men with untreated borderline raised blood pressure (BP) have been reexamined after three years. Twenty-five subjects were considered to be hypertensive, motivating a shorter interval for rescreening. Systolic BP had decreased in 23%, diastolic BP in 46% and both pressures in 15%. Those who developed hypertension had higher systolic BP at the initial examination. A family history of hypertension was more common in this group.


Intestinal decarboxylation of orally administered L-dopa. Influence of pharmacological preparations, dose magnitude, dose sequence and food intake. The intestinal decarboxylation and the absorption of orally administered L-dopa have been studied in 20 parkinsonian patients in different conditions. The decarboxylation generally amounted to 50-70% of the dose given, i.e. only 30-50% of orally administered L-dopa reached the general circulation. The shape of the plasma concentration curve varied individually and with the resolvation time of the type of pharmacological preparation given. No obvious difference in the degree of intestinal decarboxylation was observed when tablets with different resolvation times were given but the net absorption of L-dopa was somewhat greater when it was given as a solution. The decarboxylation in the intestinal organs was found to be rather constant at different times of the day. Isocaloric meals, whether rich in protein or carbohydrate, caused a delay in absorption of L-dopa, but did not change the degree of decarboxylation. Diurnal variations in the clinical response to L-dopa, could, thus, not be related to diurnal variations in the decarboxylation in the intestinal organs. The delay in L-dopa absorption after meals may be misinterpreted as lack of response. At dosage with short intervals, the delay may cause an additive effect of two doses.


Adolescent-adult interaction and peer-group involvement. The principle purpose of this paper has been to assess the importance of the quality of adolescent-adult interaction in explaining differentials in adolescent peer-group involvement. The analysis indicated that quality of adolescent-adult interaction is inversely related to peer-group involvement and that the relationship is statistically significant beyond the .001 level. This holds true for each dimension of peer-group involvement included in the analysis. Thus, the analysis supports the hypothesis.


Patient inquiry into mental hospitalization: a quantitative analysis. In this section we have assembled a small collection of data concerned with the issue of whether or not adolescents would profit from reflective inquiry into the closed area of mental health care. We have analyzed, arranged and interpreted the data from our study and conclude it demonstrates that adolescent inpatients did profit substantially from a reflective inquiry into mental health care. The number of subjects involved in this experimental program was small. The subjects of the experimental program were not selected randomly. Moreover, the researcher could not control for a number of intervening variables. For this particular group the intervening variables were many: changes in the subjects' individual treatment program, level of tranquilizing medication, attitude of other staff toward the experimental program, relations with parents or relatives, et cetera. This list covers some of the more important weaknesses of the experimental design. In the account of the experiment we reported the influence of other significant intervening variables as they emerged during the course of the study. Even with these important limitations the total push of the results in the direction of our argument compels us to conclude that it is clearly profitable for adolescent inpatients to reflectively inquire into the closed area of mental health care. Although the data reported here are not of predictive value, we believe they indicate the importance of having adolescent inpatients reflectively examine their social situation.


Issues involved in the treatment of an adolescent group. At first we had a lot of information about what to expect from an adolescent group. But we quickly found an enormous gap between our information and the actual experience and gut feelings. It is important to anticipate many overwhelming feelings! It is also crucial for therapists to be open and honest with themselves and each other about their counter-transferences. Second, we discovered that it is not hopeless! However, it is essential to provide structure via firm, consistent limits and goals. Adolescents need to feel protected by therapists who can manage the group's turbulence. Third, creative techniques frequently provide ways of dealing with feelings. Four, a treatment group cannot survive with too many acters-out; one or two may add spice and give permission to others to recognize and express feelings. Also, despite the often chaotic atmosphere, serious treatment takes place. It has been helpful to have Mrs. Friedman as our supervisor. At critical points, when we were overwhelmed, she helped with her objectivity and support, offering a clearer vision of actual treatment issues when feelings were high. At times when we felt depleted, Mrs. Friedman's support replenished us and we were able to return to the group with enthusiasm. In conclusion, it has been fun working as co-therapists. We have found that the sharing and mutual confrontation contributed significantly to our professional growth.


Abortion attitudes among Catholic college students. The present study has explored the abortion attitudes of 200 students attending a midwestern liberal arts college affiliated with the Roman Catholic Church. The main findings were as follows: 1. Catholics in general tend to be more conservative in this area than Protestants. 2. There were no statistically significant differences between urban and rural residents and between single and engaged subjects. On the other hand, females, social science majors, and those having no plans for graduate studies were significantly more conservative than males, natural science majors, and those planning to do graduate work, respectively. 3. Abortion scores were correlated negatively and significantly with religious services attended, amount of Catholic education, and, to a limited extent, father's occupation, but nonsignificantly with age, number of siblings, birth order, college rank, parental education, and mother's occupation.


An approach to families of acting-out adolescents--a case study. Certain types of acting-out in the adolescent express the feelings of deprivation of the parental pair in a maladaptive aggressive way. Family therapists have attempted to convert the acting-out behavioral disorders into an effective state, i.e., make the family aware of their feelings of deprivation by focusing on the aggressive component. In many instances, the family becomes depressed and then interrupts or terminates treatment. The authors feel that this is due to the therapist's interpretations which bring about the depressive state via guilt provocation. The family understands the interpretations as meaning "You are bad to have your adolescent offspring behave in such a way". The therapist is thus seen as the family's collective super-ego. In order to prevent premature termination, the therapist should instead help the members of the family to become more conscious of their loving, "welfare" feelings for one another. In this way the self-esteem of the family is increased, which then permits more verbal action of aggressive feelings--thus a decrease in the acting-out, and ultimately an increase in the capacity to mourn. It should be pointed out, however, that in certain families, the technique described is not applicable. In these cases, although there is acting-out, the families are unable to draw on sufficient good experiences together which are necessary to elicit positive feeling for one another. The absence of readily available "welfare" feelings is of diagnostic and prognostic significance and differentiates the disorganized, sociopathic or schizophrenic family from the acting-out of parental deprivation as illustrated in this paper.


Catholic scaled values according to the Allport, Vernon and Lindzey Study of Values in relation to the 1970 national high school norms: grades 10-12. Utilizing the Allport, Vernon and Lindzey Scale of Values, six scale values: Theoretical, Economical, Aesthetic, Social Political and Religious were measured. The subjects were in grades 10-12 of seven Greater Cincinnati Catholic High Schools (N = 205) and one public high school (N = 43), tested as a potential control. The scores were compared to 1970 national norms (N = 12,616) with added intra-comparisons between male and female scores. It was shown that local Catholic subjects scored significantly higher than the national general norms on the Aesthetic and Social values and significantly lower on the Theoretical, Economic and Religious values. This pattern was identical for both the Catholic males and females. In addition, the local males scored significantly higher than the local females on the Theoretical value and significantly lower on the Aesthetic and Social values. And, the local public control high school scored significantly higher on the Aesthetic value and significantly lower on the Theoretical value.


Personal management of growth: productivity, decision-making, emotion, and social behavior in my senior year. The writer used self-recording and charting of his own behavior as a way to observe and manage changes during his senior year at high school. The method used has implications for the application of behavior modification technology to self-management, and to behaviors that occur inside an organism's skin. The results have implications for study of the Senior Slump", for college and career planning in high school, for clarifying interpersonal attitudes, and for keeping track of one's emotional well-being.


Sex-role development and parental expectations among disturbed adolescent males. Seventeen pre-delinquent, 17 mixed psychiatric, and 17 normal adolescents and their parents were compared for the possession of certain personality traits traditionally classified as masculine or feminine. The parents were also compared in regard to the characteristics they expected their sons to possess. The main findings centered around three personality traits that differentiated the adolescents, and also between the expectations of both the mothers and fathers. In general, the parents of the normal adolescents expected their sons to be more achieving, dominating, and enduring than the parents of the other adolescents, which is consistent in regard to the personality traits that differentiated the adolescents from each other. The results suggest that the possession of certain traits, such as dominance and endurance, appear to be important for adequate functioning in adolescent males.


The partial ileal bypass operation in treatment of the hyperlipidemias. Partial ileal bypass is, today, the single most effective means available for lowering the plasma lipids, in particular the plasma cholesterol concentration. The cholesterol lowering effect of this procedure is universally lasting; response escape or rebound of lipid levels has not occurred. The operation is safe. In addition, the obligatory benefits of this mode of therapy make it attractive as a therapeutic alternative, especially in a young and asymptomatic population. We do not advocate this operation as the treatment of choice for all hyperlipidemic individuals. It may be the treatment of choice for certain patients with hyperlipidemia.


New animal model for atherosclerosis research. Japanese quail were investigated for their utility as a model for the discovery and evaluation of anti-atherosclerosis compounds. Although they possessed suitable characteristics for a screening animal, their development of atherosclerosis was too variable to make them a practical model. A search was conducted to find a means to make quail uniformly atherosclerotic. To this end a line of quail susceptible to experimental atherosclerosis (SEA) were selectively bred. Thus, the SEA Japanese quail is a new animal model for atherosclerosis research.


Effects of various hypolipidemic drugs on fatty acid composition of liver and serum lipids. 1. Treatment of rats with hypolipidemic drugs elicited an increase in oleic and a decrease in linoleic acid content in cholesterol esters, triglycerides and phospholipids of serum and liver lipids. 2. The change was most pronounced in triglycerides followed by cholesterol esters and phospholipids. 3. The shift was dose-dependent, starting with doses eliciting hypolipidemic effects. 4. The shift became obvious immediately after beginning of treatment and reached after 4 days a new steady state. 5. This effect was shared by both drugs of aryloxy fatty acid structure, but was not seen with either L-thyroxine or nicotinic acid. 6. The mechanism underlying this phenomenon is thus far unknown, but in our view it merits further attention.


Protectins in Argentine mollusks: immunological and immunochemical aspects. Protectins and agglutinins in several organs, fluids and spawn from Argentine terrestrial and fresh-water gastropod species were examined. Differences or analogies with vertebrate immunoglobulin serological behaviour are summarized. Individual or group variability and the evolutionary meaning of the reproductive system-linked and the Ca++ ion-linked protectins are discussed.


Metastaseous adenocarcinoma in the oviduct of a great tit (Parus major L.) preventing laying. A female Great Tit was found to have an adenocarcinoma preventing the egg cells from reaching the ostium part of the oviduct. Metastases were found in the ovary, along the intestine, and in the pancreas, liver and kidney. The frequency of carcinomas among birds was discussed.


[Origin of the coelomic cavities and the heart in the polypterids (Pisces)]. In polypterus the mesodermal cavities appear quite late during embryonic life. They are generally small and they only get somewhat more voluminous in the anterior mesomeres (where they establish the pronephrie chambers) and in the ventral anterior mesoderm (where they become an embryonic pericardial cavity). The anlage of the heart appears in the anterior part of the tissue that is situated between the paired mesodermal cavities of these stages. It assumes some unawaited dispositions that are truly confusing in the case of a superficial inspection. It is only during larval life that a coelomic cavity appears all along the truncal part of the mesoderm. In the beginning this is a pericardio-peritoneal cavity. But because of the coalescence between several membranes an anterior cavity gets isolated and this one is the pericardial cavity of the adult specimens; this cavity is much more limited than its homonymic counterpart of the embryonic stages.


[Development of the cloaca and its ulterior transformations in the polypterids (Pisces)]. Generally spoken cloacae have been but little studied. In Polypterus, a brachiopterygian fish, a cloaca only exists during parts of the embryonal and larval life and it gets replaced by structures consisting of an anus and an urinary sinus. In the beginning of embryonal life the posterior opening of the body seems to be nothing else than the original blastoporus. The wall of this opening acquires evaginations; the anlagen of the excretory ducts come in contact with them, establishing in that way a structure, that merits the name of cloaca. During the elongation of the post-vitellin body, the latter gets shifted from the level of metamere XII to that of metamere XXX. Another migration of the cloaca occurs when the digestive system acquires its development. Finally the cloaca may be found under the 47th and 48th muscular segments (at least in the species Polypterus senegalus senegalus Cuvier). During these stages the excretory ducts have build up an urinary sinus that gets separated from the gut. In adults no communication exists any more between the gut and the urinary sinus; the latter is a very destinct organ that may have an impair or pair aspect according to its being filled up. Because of the establishing of a communication with the genital ducts the sinus becomes an uro-genital sinus in the adult.


[Metameric components of the occipital region of the polypterids (Pisces)]. Investigations into the development of the pronephros in Polypterus senegalus senegalus Cuvier have shown several details on the composition of the occipital region of this fish. It has been shown that the first six metotic metameres contribute to the structuring of the occipital region. These six metameres also are responsible for the existence of the pronephros. The epimeres of metamere I atrophies in the beginning of larval life. The muscular structures derived from the four following metameres become englobed in the occipital region. In the myoseptum between the previous metameres V and VI the post-occipital semi-vertebra, a pecularity of Polypterus, arises. The first vertebra of the column arises between structures that are derived from the previous metameres VI and VII. Such statements have been possible by a close examination of the disposition of the pectoral fin nerves in several larval stages. Because these nerves have been labelled with different names in several studies, a comparison of these names has been necessary.


Managing the individual and family in crisis. Thorough assessment of the crisis requires skilled use of interviewing techniques, such as facilitating the flow of verbalization, selective focusing, ventilation and catharsis. Family interviewing is especially challenging. Conveying interest and preserving neutrality are essential while deciphering relationships among family members. Treatment modalities include individual and family counseling, psychoactive drugs, environmental manipulation (hospitalization, vacation) and the use of community resources. Intervention at the appropriate time can break a vicious cycle of repetitive disorganization and crisis.


Intolerance to aspirin.

Intolerance to aspirin. The aspirin intolerance syndrome is characterized by rhinitis and/or sinusitis, nasal polyposis and asthma, with or without a history of adverse reactions, following aspirin ingestion. The frequency of this syndrome in a total population of patients with asthma and/or rhinitis has recently been estimated to be 2.4 percent. Aspirin-intolerant individuals can tolerate sodium salicylate and acetaminophen but indomethacin, morphine, codeine and certain pharmaceutical dyes may cause adverse reactions. The mechanism of aspirin intolerance is as yet unclear but does not appear to be on an immunologic basis. Treatment includes strict avoidance of aspirin and symptomatic therapy of rhinitis and asthma.


Kids vs. commercials.

Kids vs. commercials. A game show with fifth and sixth graders effectively demonstrated their ability to critically evaluate television commercials about health-related products. While the family physician is in a unique position to affect future drug utilization patterns of children by counseling parents, a more active role, such as this exercise in the evaluation of TV messages, may be even more effective.


Athletic injuries: Heat vs. cold.

Athletic injuries: Heat vs. cold. Cryotherapy is the treatment of choice in the management of acute athletic injuries. Ice is readily available and simple to apply. The rationale for its use is based on well-defined physiologic observations. The application of heat is not indicated in the immediate treatment of acute athletic injuries. If applied early and injudiciously, heat may adversely affect resolution of the trauma and prolong the rehabilitation of the athlete.


Injuries of the talus.

Injuries of the talus. Forced plantar flexion can result in tibiotalar dislocation, subtalar dislocation and total dislocation of the talus. Forced dorsal flexion can cause fracture of the neck of the talus, with or without subtalar dislocation, or dislocation of the body of the bone. Accurate diagnosis is important and sometimes difficult. Reduction must be prompt. Complications include osteomyelitis, malunion and avascular necrosis of the talar body. The last may be partial and revascularization can occur.


Twenty-four hour automatic monitoring of blood pressure and heart rate at work and at home. It proved feasible and practical to automatically record indirect blood pressure at 15 minute intervals with a 4 pound portable device throughout a 24 hour period in five subjects at work and at home, awake and asleep. Of the subjects, two were apparently healthy and three had coronary artery disease, mild essential hypertension, and emphysema, respectively. Most striking was the hypotension accompanying sleep, which was greatest in the hypertensive subject and least in the subject with emphysema. Activity, while mainly walking, resulted in only modest changes in pressure. There was a tendency toward slight pressure rises associated with eating and modest tachycardia while driving a car. There was a tendency in all five subjects to exhibit somewhat higher pressures during the first 4 to 5 hours after awakening.


Acute bacterial percarditis in children: report of 25 cases. Twenty-five patients, aged 5 months to 14 years, with acute bacterial pericarditis are reported. Thirteen (52 per cent) of the patients died. The presenting symptoms, associated illness and physical findings, bacteriology, and response to therapy are reviewed. Optimum therapy consists of intravenous administration of specific antibiotics combined with surgical drainage; 90 per cent of our patients treated in this fashion survived. Antibiotic therapy alone is usually inadequate, especially in the presence of significant effusion, and among our patients only three of 10 patients so treated survived. One patient developed constrictive pericarditis 1 month after the initial attack with meningococcal pericarditis and required pericardectomy.


Amplitude of the first heart sound at rest and during exercise in normal subjects and in patients with coronary heart disease. The response of S1 amplitude to exercise stress was investigated in patients with coronary heart disease. Phonocardiograms were recorded at rest and during a multistage bicycle ergometer exercise test in a group of 22 patients with angina pectoris and documented coronary disease, and in a normal control group comprised of 32 men. A symmetrical bandpass filter with 100-Hz center frequency and a 12 db per octave slope was used. Mean S1 amplitude increased approximately linearly with heart rate from rest to maximal exercise through several levels of submaximal effort in both control groups. An increase in heart rate of 40 beats above resting levels resulted in a mean increase in S1 amplitude of 281 per cent in the control group. There was a significantly smaller (p less than 0.01) mean increase in the patient group, 195 per cent. In 5 patients the S1 amplitude during exercise at the load precipitating angina was lower than at the highest load that could be tolerated without pain. S1 amplitude is easily measured and may provide a clinically useful method for evaluation of left ventricular function and documentation of an abnormal left ventricular response to exercise stress.


The effect of upright tilt on the volume of the failing human left ventricle. The effect of a passive change from supine to 25-degree head-up tilted position on left ventricular volume was studied by echocardiography and other noninvasive techniques in 18 normal subjects, 6 patients with compensated LV volume overloading, and 12 patients with LV failure. In normal subjects and patients with compensated LV volume overloading, 10 minutes of head-up tilt resulted in a significant decrease in the echocardiographic LV internal dimension equivalent to a decrease in the calculated LV end-diastolic volume of 27 and 16 per cent, respectively. In contrast, no change in LV end-diastolic dimension and volume was noted during tilt in the patients with LV failure. The response of heart rate, blood pressure, and LV ejection fraction to this intervention was insignificant in all groups. These data indicate that volume preload is unresponsive to postural changes in patients with LV failure but not in normal subjects or in those with compensated LV volume overloading. It is suggested that the effect of posture on LV volume and output is primarily determined by the absence or presence of LV failure and the consequences of it on the peripheral circulation.


The Wolff-Parkinson-White syndrome: pharmacologic effects of procaine amide. The effect of procaine amide, 10 mg. per kilogram via intravenous infusion, was studied in 13 patients with the WPW syndrome. The delta wave was eliminated by procaine amide in 10 and modified in three patients. This effect lasted between 30 minutes and 8 1/2 hours and was unrelated to the total dose administered. Anterograde A-V conduction was assessed by atrial pacing with increasing rates. More rapid atrial pacing rates with 1:1 A-V conduction were observed in patients who maintained rather than lost their delta wave during pacing. Ventriculoatrial conduction was assessed with ventricular pacing at increasing rates; ventricular conduction time was fixed regardless on the pacing rate. Procaine amide significantly prolonged V-A conduction time in six and blocked V-A conduction in one patient. In addition, A-V and V-A refractory periods were measured by the extrastimulus technique. Two types of responses were observed: (1) Type I or (2) line of identity. A-V nodal refractoriness was observed to be within the normal range. Procaine amide converted anterograde line of identity responses to Type I responses in all patients who had their delta waves eliminated. In this patient group, bypass refractoriness was shorter than A-V nodal refractoriness. Procaine amide was not observed to alter significantly normal A-V conduction as assessed by atrial pacing or A-V refractory period measurements. Furthermore, a significant disparity between the effects of procaine amide on anterograde and retrograde bypass refractoriness was observed. Tachycardias could be induced in nine of the 13 patients with a mean rate of 167.2 +/- 7.9 beats per minute; delta waves were abent during all episodes of tachycardia. Procaine amide prevented tachycardia induction in six of the none patients. Procaine amide therefore demonstrates electrophysiologic effects which would be beneficial for prevention or treatment of reciprocating tachycardias in the WPW syndrome. Moreover, procaine amide would be an ideal agent for the prevention of rapid ventricular rates in patients with the WPW syndrome and atrial fibrillation.


Effect of direct revascularization surgery on coronary collateral circulation in man. In 63 consecutive patients with significant coronary artery disease (more than 75 percent stenosis), the effects of direct myocardial revascularization on coronary collateral channels were studied 6 to 29 days (mean 13.4 days) after operation. Collateral vessels were identified preoperatively and their angiographic regression or reappearance after operation was noted. In 15 patients (23 percent), there was no evidence of collateral flow before or after operation. The remaining 48 patients had 186 collateral channels preoperatively. Postoperatively, 84 (45 percent) of these collateral vessels were no longer apparent, 75 (40 percent) were unchanged and 27 (15 percent) were identical with the preoperative vessels but the pattern of blood flow was reversed. The findings suggest that in the presence of established collateral channels, direct revascularization acutely alters existing flow and pressure gradients in a complex manner. Collateral channels disappear or remain unchanged when a gradient is decreased or maintained; collateral flow is reversed when a gradient is increased. These data may permit (1) objective preoperative estimation of distal vessel runoff in vessels with collateral channels, and (2) evaluation of the completeness of revascularization in assessing long-term postoperative results.


Quantitative study of left bundle branch fibrosis in left anterior hemiblock: A stereologic approach. Serial sectioning of the interventricular septum was carried out in 16 hearts, 8 from elderly subjects with no conduction disturbance and 8 from patients with chronic left anterior hemiblock. The histologic slides were studied stereologically, and the relative density of fibrosis was quantitatively assessed by the point counting technique at various levels of the main subdivisions of the left bundle branch system. Statistical analysis revealed the following: (1) Although some fibrosis was found in the control hearts, the density of fibrosis was consistently and significantly greater throughout the conduction system in patients with left anterior hemiblock. (2) In the group with hemiblock, the relative density of fibrosis tended to increase significantly from the posterior ramification to the midseptal fibers and, finally, to the anterior fascicle. (3) Among the eight patients with hemiblock, fibrosis appeared to be evenly distributed throughout the conduction system in four. It was predominantly located in the anterior and midseptal fibers in one patient and showed an increasing severity from the posterior to the midseptal and anterior fibers in the remaining three patients. From this quantitative study, it is concluded that left anterior hemiblock is a reliable sign of left bundle branch disease but that the underlying lesions are more widely distributed than would be from the expected electrocardiographic terminology since they were found predominantly in the anterior ramifications in only half of the studied cases.


Alternating Wenckebach periodicity: A common electrophysiologic response. Alternating Wenckebach periods are defined as episodes of 2:1 atrioventricular (A-V) block in which conducted P-R intervals progressively prolong, terminating in two or three blocked P waves. In this study, His bundle recordings were obtained in 13 patients with pacing-induced alternating Wenckebach periods. Three patterns were noted: Pattern 1 (one patient with a narrow QRS complex) was characterized by 2:1 block distal to the H deflection (block in the His bundle) and Wenckebach periods proximal to the H deflection, terminating with two blocked P waves. Pattern 2 (four patients) was characterized by alternating Wenckebach periods proximal to the His bundle, terminating with three blocked P waves. Pattern 3 (eight patients) was characterized by alternating Wenckebach periods proximal to the His bundle, terminating with two blocked P waves. Alternating Wenckebach periods are best explained by postulating two levels of block. When alternating Wenckebach periods are terminated by three blocked P waves (pattern 2), the condition may be explained by postulating 2:1 block (proximal level) and type I block (distal level). When alternating Wenckebach periods are terminated by two blocked P waves (patterns 1 and 3), the condition may be explained by postulating type I block (proximal level) and 2:1 block (distal level). Pattern 1 reflects block at two levels, the A-V node and His bundle. Patterns 2 and 3 most likely reflect horizontal dissociation within the A-V node.


Biventricular dynamics during quantitated anteroseptal infarction in the porcine heart. The porcine heart has been shown to have close anatomic similarity to the human heart and was used as the experimental model in this study to gain further understanding of the early responses of both ventricles during acute anteroseptal myocardial infarction. High fidelity pressure and flow data were measured and multiple preejection and ejection variables were calculated for both ventricles. Infarct weight and distribution in both ventricles were quantitated. The standard infarction resulted from single stage ligation of the left anterior descending coronary artery just beyond its midpoint and second left ventricular branch. It comprised an average of 15.8 percent of total ventricular myocardium with an infarct/perfused ratio of 0.62 and a periinfarction transition zone of 7.5 mm, and involved significant portions of both ventricles and the interventricular septum. Performance characteristics of both ventricles were altered significantly by anteroseptal infarction and involved all phases of contraction--end-diastole, isovolumic systole and ventricular ejection. Although contractile alterations in the right ventricle were significant, they were somewhat delayed, yielding relatively low correlation coefficients with analogous left ventricular contractile indexes. These correlations became quite distinct during specific ventricular stresses. Comparison of anterolateral and anteroseptal infarction, matched in terms of infarct size, indicated that the right ventricular changes in the latter were related to direct involvement of the right ventricular free wall and septum rather than secondary to left ventricular alterations.


Vulnerability to ventricular fibrillation during acute coronary arterial occlusion and release. The effect of 10 minutes of occlusion, and release of occlusion, of the left anterior descending coronary artery on vulnerability to ventricular fibrillation was studied in 15 dogs. Ventricular fibrillation threshold was determined by inducing a sequence of three closely coupled extrasystoles (sequential R/T pulsing). Within 3 minutes of occlusion the current required to induce fibrillation decreased from a control value of 56 +/- 7 ma (mean +/- standard error) to 1.6 +/- 0.3 ma (P less than 0.001). It remained at this level for about 4 minutes and then rapidly returned to the control level in 8 of 10 dogs. Upon release of occlusion at 10 minutes, the ventricular fibrillation threshold was again greatly reduced; this period of reduction occurred shortly after reperfusion and was of brief duration. After both occlusion and release the duration of the ventricular vulnerable period was prolonged. The time course of change in cardiac vulnerability parallels the altered susceptibility to ventricular fibrillation after coronary arterial occlusion and release. These results recommend sequential R/T pulsing as a useful technique for probing changes in cardiac vulnerability under diverse experimental conditions.


Measurement of regional myocardial blood flow in man: description and critique of the method using xenon-133 and a scintillation camera. A method has been devised to measure regional myocardial blood flow in man. The approach consists of selective injection of xenon-133 into a coronary artery and the external monitoring of radioisotope washout curves from multiple areas of the myocardium with a multiple crystal scintillation camera. Rate constants of isotope washout are calculated using a monoexponential model, and the capillary blood flow rates in multiple regions of the heart are calculated by the Kety formula. The pattern of perfusion rates is related to the coronary arteriogram obtained in the same study. Myocardial perfusion patterns obtained in patients with and without coronary artery disease and during atrial pacing are given, as well as examples of results obtained in myocardial aneurysms, in regions of ischemic myocardium supplied by collateral vessels and after tracer injection into an aortocoronary bypass graft. Advantages of the method are discussed along with limitations related to the tracer, the scintillation camera, the form of mathematical analysis and the three dimensional nature of the heart.


Etiologic relations among categories of congenital heart malformations. Pairs of siblings with congenital heart malformations of different types were analyzed for evidence of nonrandom association of defects within families that might suggest a genetic predisposition common to two or more kinds of malformations. An excess of pairs was noted for tetralogy of Fallot and pulmonary stenosis, tetralogy of Fallot and transposition of the great vessels, and tetralogy of Fallot and ventricular septal defect, thus suggesting that there may be a developmental relation between these lesions. This finding is supported by a recent study in the Keeshond dog demonstrating a genetic predisposition common to tetralogy of Fallot, pulmonary stenosis and ventricular septal defect. Thus the method does seem capable of revealing etiologic relations, probably genetic, among different types of cardiac lesions. Data on risks of recurrence for siblings of children with these defects will now have to be refined to take into account the possible recurrence of related lesions.


Echocardiographic detection of aneurysms of the interventricular septum associated with ventricular septal defect. A method of noninvasive diagnosis and follow-up. Spontaneous closure of a ventricular septal defect is frequently accompanied by the formation of an aneurysm of the membranous septum. The exact anatomic basis for such an aneurysm varies. Some arise from redundant tissue from the endocardial cushions or from adherence of the tricuspid septal leaflet to the defect; the origin of others cannot be determined. Echocardiographic studies in 17 patients with the diagnosis of ventricular septal defect revealed in 7 an aneurysm of the membranous septum that was later confirmed by angiography. In no patient was an aneurysm missed or erroneously diagnosed in the echocardiographic study. Echocardiography can be a useful diagnostic and prognostic tool in the long-term management of patients with ventricular septal defect.


Cardiovascular management of pregnant women with a heart valve prosthesis. This study of 14 pregnancies in 11 patients with a Starr-Edwards valve prosthesis (nine mitral, two aortic) shows that cardiac functional capacity deteriorated to class III (New York Heart Association criteria) in only 1 woman. The deterioration occurred during the third trimester and the patient's condition improved with medical therapy. Careful medical control diminished the incidence of heart failure in these patients. Six of nine pregnant women with a mitral valve prosthesis were treated continuously with coumarin and three discontinued the therapy gradually before the third trimester of pregnancy. In five pregnant women (three with an aortic valve prosthesis, two with a mitral valve prosthesis) no anticoagulant agents were used. No embolic episodes or severe hemorrhagic complications were seen. One newborn whose mother received coumarin during the first trimester had bilateral hand polydactylia. There were no maternal deaths. One neonate died after fetal stress necessitating the only cesarean section. These results suggest that women with an artificial heart valve tolerate pregnancy well and that anticoagulant therapy is not mandatory in pregnant women with an aortic valve prosthesis, or in the few women with a mitral valve prosthesis not already receiving coumarin at the onset of pregnancy.


Atrioventricular block after reciprocating atrioventricular junctional tachycardia. Short runs of symptomatic atrioventricular (A-V) block occurred after spontaneous cessation of reciprocating A-V junctional tachycardia in a patient with right bundle branch block, normal H-V interval and sinus nodal dysfunction. These episodes were characterized by long (more than 1 sec) P-P intervals during which the A deflections were not followed by His bundle electrograms. Three possible explanations are: (1) a posttachycardia-induced period of abnormally prolonged A-V nodal refractoriness; (2) pseudo-A-V block produced by concealed A-V junctional tachycardia, or (3) bradycardia-dependent (phase 4) A-V block at the "upper" His bundle, above the site from which the H deflection was recorded.


Sinus and atrioventricular nodal reentrant tachycardia in the same patient. Sinus and atrioventricular (A-V) nodal reentry are shown to coexist in the same patient, and the following conclusions are drawn: (1) Reentry at one nodal site may mask reentry at the other nodal site, (2) concealed reentry at either site may become manifest reentry under the appropriate conditions, (3) manifest sinus nodal reentry may alternate with manifest A-V nodal reentry, and (4) a Wenckebach type phenomenon manifest in the A-V node and concealed in the sinus node may in some instances be the basis for coexistent sinus and A-V nodal reentry in man.