[Current radionuclear methods in the diagnosis of regional myocardial circulation disorders]. Among nuclear medical diagnostic procedures a distinction can be made between non-invasive and invasive methods. The non-invasive methods serve either to image the still viable myocardium ("cold spot" technique) or for direct visualization of recently infarcted myocardial tissue ("hot spot" technique). These methods have the advantage of simple handling and good reproducibility. Side effects and risks are thus far unknown. Improvement of local dissolution should be aimed at in the future and wound greatly increase diagnostic and topographic security. The invasive procedures always require catheterization of the coronary arteries. This is the reason why they can be performed only with coronary arteriography. The Xenon "wash out" technique permits, with some restrictions, quantitative measurement of the regional flow rate. The "inflow technique" permits determination of perfusion distribution. The possibilities of the "double-radionuclide" scintigramm are discussed. For measurement of activity distribution, sationary detectors are generally preferred. In the case of the time-activity curves with the Xenon "wash out" technique, single detectors offer certain advantages.


[A physician's everyday life in the Engadin around the year 1700]. Jachiam Elias Frizzun (1657-1714), a barber-surgeon who practised in his native mountain village of Celerina (Grisons, Switzerland) from 1693 to 1713, has left a case-book written in Rhaeto-Romanic and covering the whole period of his professional activity. This unique source shows, among other things, that this village surgeon treated both medical and surgical conditions, though obstetrics was obviously the exclusive domain of the midwife. In chronic disease leading to death Frizzun was not called for, and only exceptionally did he attend smallpox patients. Some characteristic case histories are quoted in German translation. Frizzun's case-book was at the same time an account-book. The entries prompt the conclusion that he and his family depended for their living on his medical practice and on agiculture, while his barber's trade was of minor economic importance. Furthermore, at least half of the accounts were not settled in cash but by supply of goods or work.


[Cellular reactions in the lungs after inhalation of cotton dust and of endotoxin]. The free lung cell count has been studied in guinea pigs after exposure to extracts of various cotton dusts. A good correlation was found between the increase in leukocyte count in the airways and the number of gram-negative bacteria in the different dusts. The importance of endotoxin in the acute effects following exposure to cotton dust is discussed.


[Respiratory allergy to trichophyton].

[Respiratory allergy to trichophyton]. In 8 cases of rhinitis and asthma, the Trichophytons - of which the patient is often unaware as a cutaneous affection - were found to be responsible for the attacks by converging positive cutaneous tests, positive respiratory provocation tests and persevering dermatologic treatment. This infection is on the increase, due to faulty hygiene and use of mass swimming facilities.


Group B streptococcal endocarditis.

Group B streptococcal endocarditis. A retrospective study of group B streptococcal endocarditis during 1965-74 in Aberdeen General Hospitals revealed that group B streptococci how principally affect patients in the older age groups with or without a history of antecedent heart disease. Despite recent reports of increased group G infections in obstetric and perinatal practice there were no cases of post-puerperal endocarditis. Although aortic valve involvement would appear to be increasing, group B streptococci still show a marked predilection for the mitral valve.


The biologic bases for using hair and nail for analyses of trace elements. Sampling of human beings for trace element content can be a complex and costly procedure. The use of hair and nails simplifies the process and it is for this reason that such samples are extensively used. The primary consideration, however, is not how easily the samples can be collected nor even how accurately trace elements can be measured in hair and nails; rather, it is what do the values mean, i.e., to what extent does the measured level reflect the concentration and/or activity of the element in other parts of the body? The structure and histogenesis of hair and nails are discussed in relation to mechanisms by which trace elements are incorporated into these tissues. Problems of contamination in vivo are also considered. A résumé of current literature is presented, considering the trace elements that are appropriate for measurement in samples of human hair and nail and some of the problems involved in analysis.


Phenolic plant compounds functioning as reproductive inhibitors in Microtus montanus. Naturally occurring cinnamic acids and their related vinylphenols were found to inhibit reproductive function in Microtus montanus. When fed on these compounds, the rodents exhibited decreased uterine weight, inhibition of follicular development, and a cessation of breeding activity. It is suggested that these animals utilize plant compounds as a cue to terminate their reproductive effort in natural populations.


Lithium: effects on subjective functioning and morphine-induced euphoria. The therapeutic usefulness of lithium in decreasing the euphoria and other symptoms associated with manic behavior and the hypothesis of a common final mechanism for elevations in mood have led to speculation that lithium may block the euphoria induced by drugs of abuse. In this study, lithium alone was antieuphoric in drug-free opiate addicts and, further, did not block morphine-induced euphoria.


Experimental approaches to myocardial function studies: C15 O2 and 81m Kr. The role of short-lived gaseous radiotracers in myocardial function studies is reviewed. The evaluation of shunts and ejection fractions characterizing individual chambers is best performed with tracers restricted to those chambers. Classic examples include the C15 O2 inhalation radiocardiogram for probing the left-heart performance, with the right heart illuminated by intravenous 133Xe in saline. A more elegant utilization of rapid physical decay to unravel flow patterns is seen in the use of 81m Kr. Krypton-81m is swept from its parent 81Rb, either confined to an extracorporeal generator or an in vivo rubidium distribution. The steady-state images that result contain a wealth of dynamic information distilled into its most lucid format.


Thallium-201 as a myocardial imaging agent. The field of myocardial perfusion imaging has made many advances but still is in its infancy. The limitations in the technology at this time include limited instrument resolution of 6-9 mm, intrinsic at the energy of the mercury x-ray; significant Rayleigh scatter, which is particularly distrubing because this scatter cannot be removed by pulse-height analysis; and an effective half-life of thallium in the myocardium, which makes repeated imaging over a short period of time very difficult. Although hopes for the development of a technetium-labeled myocardial imaging tracer have burnt brightly, no new agents are presently in sight. Resolution with a technetium-labeled tracer would almost double that of thallium, and the dose that could be administered to the patient would increase by at least a factor of 4. The effective half-life of the tracer in the myocardium would permit multiple images to be obtained at least in the same day. Even with the limitations of the current techniques, however, myocardial perfusion imaging can make a real contribution to the care of the patients with heart disease. Thallium is now produced commercially and reasonably easily obtained. Extraction of thallium by the myocardium is probably somewhat, but not exactly, analogous to potassium. The tracer has major applications in defining shape and size of the heart, thickness of muscle, and especially myocardial ischemia and infarction. This review is aimed at providing a current perspective of these uses.


Observations on the diagnosis and treatment of schistosomiasis in an endemic area. This article attempts to evaluate the criteria used in the diagnosis of schistosomiasis in an endemic bilharzial area. The discussion deals with the possible value of criteria such as egg recovery, rectal biopsy specimens, eosinophilia, hepatomegaly, and serological and skin tests. A rational approach to the treatment of patients with schistosomiasis is proposed and features such as probability of re-infection are taken into account.


Studies on a naturally occurring R factor harbouring a chromosomal nutritional marker. A naturally occurring R factor which carried resistance determinants to tetracycline and chloramphenicol as well as a marker for lactose fermentation was found in a strain of Klebsiella pneumoniae isolated from sewage. The TcCmlac+ factor was transferred by conjugation to E. coli K12. It showed no recombination or stable coexistence with R factors of the fi- class. Studies in recombination-deficient (rec-) strains of E. coli K12 showed that the TcCmlac+ factor is an autonomously replicating plasmid. Preparative ultracentrifugation and electron microscopic studies revealed the presence of more than one molecular species. Average contour lengths for two of these species were 11,20 +/- 1,55 mum and 16,14 +/- 1,45 mum, which correspond to molecular weights of about 23,18 X 10(6) and 34,63 X 10(6) daltons, respectively.


South African multicentre study of metoprolol and propranolol in essential hypertension. Ninety-three patients diagnosed as essential hypertensives, WHO stage I or II, entered this double-blind trial comparing 2 dose levels of CGP 2175-H 93/26 (metoprolol) with 2 doses of propranolol. Treatment on active medication was maintained for 6 weeks and was started after a 2-week washout and a 2-week placebo period. Twelve patients dropped out of the trial for reasons not related to the drugs and 1 patient was regarded as a therapeutic failure. Efficacy was assessed by measuring the diastolic and systolic blood pressure, pulse rate and by noting any significant ECG changes. All treatments reduced and maintained a lower blood pressure. However, a reduction with 360 mg propranolol per day was not statistically significant. Metoprolol 120 mg/d was significantly superior to propranolol 240 mg/d in holding the diastolic supine blood pressure at less than or equal to 90 mmHg. Metoprolol 120 mg/d and 210 mg/d pooled results were significantly superior to the propranolol 240 mg/d and 360 mg/d pooled data in maintaining a diastolic blood pressure of less than or equal to 90 mmHg. All treatments were well tolerated and in no case was it necessary to withdraw owing to adverse effects. No significant difference was detected between the treatments with respect to therapeutic emergent symptoms and signs. Laboratory results remained normal with all treatments.


Renal revascularization in patients with severe atherosclerosis of the abdominal aorta or a previous operation on the abdominal aorta. Renal revascularization has been performed in six patients in whom severe atherosclerosis or previous operative procedures on the abdominal aorta precluded the performance of a standard aortorenal bypass graft. Splenorenal anastomoses were performed in three patients, superior mesenterorenal anastomosis in one patient, long saphenous vein iliorenal anastomosis in one patient, and renal autotransplantation in one patient. Successful renal revascularization with preservation of renal function was accomplished in all patients. The natural history of severe atherosclerotic renovascular disease has demonstrated the relatively frequent occurrence of arterial thrombosis and renal failure in patients with solitary kidneys. Occasionally, the presence of severe aortic disease precludes the use of standard aortorenal bypass grafting. Fortunately, as reported herein, alternate methods of revascularization are available whereby renovascular hypertension can be corrected and renal function preserved, with minimal operative risk.


Microvascular anastomosis using a blood product sealant-adhesive. In this experimental model, we have shown that a four suture repair with a biologic sealant adhesive significantly reduces hemorrhage and reduces operative time, while allowing a flap survival comparable to that obtained with standard techniques in rats undergoing a microvascular anastomosis. In heparinized rats undergoing the same procedure, the sealant adhesive significantly decreases hemorrhage and increases flap survival. Of significance is the fact that the platelet-fibrinogen-thrombin adhesive is biodegradable and does not induce a tissue reaction. We believe that this physiologic adhesive may become a useful adjunct in digital reimplantation. It appears to reduce operative time and heparin-induced bleeding.


Antivascular endothelial cell antibody--its role in transplantation. Sera samples from eight different groups of patients were tested for the presence of circulating antibody (IgG) directed against vascular endothelial cell antigens. The indirect immunofluorescent method which used either whole blood vessels or single endothelial cells as targets was compared to lymphocytotoxicity panels. The indirect immunofluorescent antibody test (IFA) consistently detected antibody in sera samples which were negative for lymphocytotoxic activity, and the presence of IFA antibody to vascular endothelial cells had a much better correlation with both clinical course and renal allograft rejection than did the lymphocytotoxicity panels. Single vascular endothelial cells appeared to be a more sensitive target for the detection of IFA antibody than did whole vessels. Preliminary absorption studies suggest that cell-specific as well as HL-A antigens play a role in the immunological response to vascular endothelial cells.


Host presensitization and renal allograft success at a single institution: First transplants. From June, 1970, to January, 1975, 399 first transplants were performed at the University of Minnesota. Of these 399, 52 had performed antibodies against HLA antigens. When the results of transplantation to these recipients were compared with the results of transplantation to a recipient group matched for age, sex, presence of diabetes, time of transplant, and donor type, no differences were observed. Similarly, no differences were observed when either group of transplant recipients were compared with all first transplant recipients during this period of time. When the results were controlled for diabetes, related or cadaver donation, or degree of presensitization, no differences were observed. Four patients developed hyperacute rejection during this period of time. All four were found to have antibodies to the donor on retrospective analysis utilizing the most sensitive antiglobulin technique. In addition, 65 donor:recipient pairs negative by standard National Institutes of Health and cross-matching techniques proved to have positive prospective cross-matches utilizing the new antiglobulin technique. The correlation between the presence of anti-HL-A antibodies and negative antidonor cross-match and early kidney loss cannot be confirmed at a single institution. The results suggest that a highly sensitive antiglobulin cross-matching technique utilizing sera drawn just prior to the scheduled transplant and cross-matching utilizing the sera bearing the greatest number of anti-HL-A antibodies will eliminate correlation between anti-HL-A antibodies and early graft rejection in the presence of a negative cross-match.


The influence of presensitization on graft survival rate. Graft survival rate was evaluated in 61 recipients with greater than 50 percent frequency of performed antibodies to selected panel cells. This includes recipients of primary cadaver grafts, secondary cadaver grafts, and living related grafts. Graft survival rate also was evaluated in 199 recipients with pretransplant antibodies reacting with 10 to 50 percent of panel cells and in nonsensitized patients. The results show that good graft survival can be obtained in many hyperimmunized patients, particularly in recipients of primary renal allografts (66 percent cadaver graft survival rate at 2 years). However, sensitization following rejection of an allograft appears to confer a less favorable prognosis. The nature of recipient presensitization and the precise specificity of each reactivity cannot always be explained. This is exemplified in three patients in whom broadly reactive lymphocytotoxic antibodies were not directed against HL-A antigens. Since the number of sensitized patients who await renal transplantation is increasing, there should be no hesitation in proceeding with transplantation, particularly with primary grafts. Emphasis, however, must be placed on frequent prospective recipient serum sampling so that transient high levels of cytotoxins do not escape detection and therefore can be easily selected out for cross-matching against potential donors.


Prevention of transplant renal artery stenosis. Transplant renal artery stenosis occurred in 17 of 142 consecutive transplants (12 percent). All stenoses were in the renal artery distal to the anastomosis and two separate forms are recognized: angulation and segmental stenosis. Successful surgical correction in 12 of 17 patients relieved the hypertension and resulted in improved renal function. No patients receiving dipyridamole, a drug which inhibits platelet aggregation and intravascular fibrin deposition, developed segmental renal artery stenosis. No other factors could be identified which were important in either causing or preventing renal artery stenosis. Since intrarenal vascular changes are an integral aspect of rejection, the protection afforded by dipyridamole against segmental renal artery stenosis indicates that segmental stenosis is probably a manifestation of rejection.


Biliary complications after liver transplantation: with special reference to the biliary cast syndrome and techniques of secondary duct repair. In 93 consecutive cases of orthotopic liver transplantation, there were 24 example of biliary obstruction and eight of bile fistula formation. Six of the obstructed livers developed biliary cast formation so extensive that the smaller intrhepatic ducts became plugged to an extent that they could no longer have been treated by surgical mena. In each of the six cases, the most important causative factor was neglected obstruction of the large bile ducts with the intrahepatic lesions apparently being late and secondary. Stone and/or cast formation also occurred in other obstructed livers in the presence of bile fustulas, but these deposits were limited to the large ducts where they could have been or were removed. Although homograft bile undoubtedly has increased lithogenicity at certain posoperative times, the data from the present study have shown that biliary sludge formation essentially is always associated with defective bile duct reconstruction, and the observations have underscored the urgency with which reoperation must be considered. Techniques of secondary intervention have been described, with emphasis on conversion of cholecystojejunostomy to choledochojejunostomy. This operation has permitted salvage of homografts in eight of nine trials and the survival of seven patients.


The prevention of deep vein thrombosis, with particular reference to mechanical methods of prevention. Mechanical methods of preventing deep vein thrombosis have been surveyed. The best means of preventing venous stasis has been shown to be by intermittent compression of the legs. Use of intermittent compression will prevent isotopically detectable deep venous thrombosis in 82 percent of patients and in malignancy in 90 percent of patients. The only other prophylactic measure of comparable effectiveness is administration of low-dose subcutaneous heparin. Intermittent compression need only be applied during the operation and is cheap, foolproof, and safe. Intermittent compression acts by squeezing empty the soleal sinuses and large valve pockets in the major veins in which thrombi form while venous flow is slowed during operation. A combination of intermittent compression and administration of low-dose subcutaneous heparin has been found to be no more effective than is intermittent compression alone.


[Involvement of veterinary medicine in, and its responsibility for, the microbiological safety of foods of animal origin (author's transl)]. Epidemiological data indicate that, in the majority of outbreaks, the aetiology of diseases of microbial origin transmitted by foods is the "dual failure": poor sanitary handling in addition to storage of perishable items at temperatures allowing of microbial proliferation. For statistical reasons, sampling and examination of final products is completely ineffective as a means to obtain safe foods and meals. Dependable assurance of microbiological safety of foods should rather be attained by the application of Good Manufacturing Practices. The shared responsibility for reliable, uninterrupted preventive safeguarding of the food chain calls for cooperation between line workers of various disciplines. Microbiological examination of final product samples is still meaningful in order to monitor Good Manufacturing Practices. Reference values ("standards" with which data obtained can be compared are essential for this purpose. Theri establishment, based on product sample surveys of factories previously examined for reliable operation of approved procedures, is outlined.


Morphological and electrophysiological changes in cultured spinal ganglion cells during development. Morphological changes of partially dissociated chick spinal ganglion cells in culture and their intracellular responses were simultaneously observed in an attempt to investigate the correlation between cell structure and function during development in vitro. As the ganglion cells natured, their originally eccentric nuclei assumed more central positions and the surface area of cell body displayed a linear increase accompanied with an increase in cell diameter. Nissl bodies were distributed throughout the cytoplasm after 3 to 4 weeks and myelin was formed at the same period. The bioelectric properties of the ganglion cells changed in parallel with the morphological development. The passive membrane properties such as resting potentials and specific membrane resistance were increased. Action potentials could be elicited from neurons as early as 2 days in vitro, while the complete excitability was accomplished at 8 to 10 days. Moreover, the wave form of the action potenial itself was changed, that is, the amplitude and maximum rate of rise increased and the duration decreased. The alteration rates of these passive and active properties were maximum at 8 to 12 days in culture. Repetitive firing occurred after 3 to 4 weeks, though single responses were displayed by 3 weeks in culture. This changes seemed to correspond with myelin formation in vitro.


Some properties of rabbit anti-human thymus serum. A highly specific anti-human T lymphocyte serum (AHTS) was obtained by sequentially absorbing rabbit anti-human thymocyte serum (ATS) with human red cells, neutrophils, Burkitt's lymphoma cells (Daudi cells), liver, kidney and glutaraldehyde insolubilized human serum. The immunofluorescent staining revealed that the basement membrane of human renal glomeruli reacts with AHTS before being absorbed with kidney. Specificities of AHTS were studied by the cytotoxicity test, inhibition of PHA responses, inhibition of E-resulting and immunofluorescent staining.


Quantitative studies o the activities of anti-human tonsil sera and anti-human spleen sera against B lymphocyte. Anti-human B lymphocyte serum (AHBS) was obtained by absorbing rabbit anti-human tonsil serum (ATOS) or rabbit anti-human spleen serum (ASPS) with human red cells, liver, neutrophils, thymocytes and glutaraldehyde insolubilized human serum. Specificities of AHBS were checked by the cytotoxicity test, inhibition test of EAC-rosetting and inhibition of PWM responses. Raji cells of Burkitt's lymphoma originating from B-cells and acknowledged as non-immunoglobulin bearing on the cell surface were stained with AHBS according to the immunofluorescent technique. ATOS showed a higher cytotoxic titer against peripheral B-cells and inhibited EAC-rosetting stronger than ASPS did. On the other hand, macrophages in peripheral blood, Kupffer cells in the liver and certain cells of the thymus-medulla were stained with ASPA, but not with ATOS, even after intensively absorbing ASPS with thymocytes.


Immunohistochemical demonstration of somatostatin-positive cells in the canine gut. Somatostatin-immunoreactive cells in the canine gut were investigated by an indirect immunofluorescent technique. Somatostatin-positive cells were demonstrated in the neck portion of the pyloric gland and in the bottom of the intestinal crypt, and these cells were distinguished from those in other organs by the presence of a cytoplasmic process reaching the gut lumen (external environment). Possible functional meaning of this cytoplasmic process was discussed.


[Radiation therapy and mode of propagation of non-Hodgkin lymphomas (author's transl)]. Out of a total number of 123 patients with non-Hodgkin lymphomas the result of local radiation therapy from 65 patients with lymphosarcomas or reticulosarcomas stage I or II are reported. In stage I, the tumor still being localized, there are good chances for recovery (3 or 4 years of survival without recurrenced in 75%). Already in stage II the percentages of a three-year survival without recurrences are reduced to 40% with lymphosarcomas and to 19% with recitulosarcomas. This most probably is due to an early, occult, already advanced cancerous spread, not having been recognized. More aggressive diagnostic measures for the staging, therefore, are recommandable. There are significant differences between lymphosarcomas and recitulosarcomas concerning their mode of propagation. Lymphosarcomas prefer the propagation into contiguous lymph node stations. With reticulosarcomas the generalisation to stage IV predominates at the first recurrence. For an improvement of the therapeutic results an irradiation is recommended which encompasses the adjacent lymphatics not yet being involved, the so-called "extended field technic". Early cytostatic therapy in stage II additionally has to be discussed, particularly for reticulosarcomas.


Utility of protease-digested human peripheral blood lymphocytes for the detection of lymphocyte-reactive alloantibodies by indirect immunofluorescence. Human peripheral blood lymphocytes were digested briefly with protease prior to application of indirect immunofluorescence techniques for detecting alloantibodies in sera of patients with chronic renal failure on maintenance hemodialysis. Background staining of intrinsic surface IgM and cytophilic IgG bound to Fc receptors was eliminated or greatly reduced, enabling detection of B cell specific antibodies, including cold-reactive types not demonstrable by conventional immunofluorescence or complement-dependent lymphocytotoxicity. The antigenicity of HLA and other surface membrane determinants was not decreased by protease, although reactivity with certain sera was enhanced. In experiments comparing indirect immunofluorescence using protease-treated cells with complement-dependent lymphocytotoxicity and antibody-dependent, lymphocyte-mediated cytotoxicity assays, indirect immunofluorescence was more sensitive and comprehensive, but not less specific, in defining alloantibodies of a variety of types.


Prolonged allograft survival with niridazole, azathioprine, and prednisolone. The immunosuppressive properties of niridazole, an antihelminthic drug, have been investigated in rats. When given orally in a dose of 50 mg/kg, it extended the median survival of cardiac allografts from 7 to 20 days. The immunosuppressive effect was not increased by giving either azathioprine or prednisolone concurrently but when all three drugs were combined, immunosuppression was profound and only two of eight grafts were rejected. Drug combinations incorporating niridazole at a lower dosage or for a shorter period were less effective, and azathioprine and prednisolone on their own or used together prolonged graft survival only marginally in this model. It is concluded that niridazole is a powerful immunosuppressive drug in this species and a synergistic effect can be obtained by using it in combination with azathioprine and prednisolone.


Antilymphocytic antibodies and marrow transplantation. V. Suppression of secondary disease by host-versus-theta-graft reaction. An approach to block secondary disease was investigated in mice sensitized against the Th-1.1 (theta-AKR) alloantigen on the marrow donor's T cells. To avoid a concomitant sensitization against the donor's histocompatibility antigens, prospective marrow recipients were sensitized against thymocytes of a third-party strain sharing the donor's Th-1 alloantigen but not his histocompatibility antigens. Advantage was taken of the fact that rats carry a Th-1.1-like theta-antigen which induces anti-Th-1.1 antibodies in Th-1.2 mice. CBA/J and (C57BL/6 x CBA)F1 Th-1.2 mice were sensitized against rat thymocytes and tranfused with spleen and bone marrow of AKR/J Th-1.1 after irradiation with 800 to 900 R. Although unsensitized recipients died within 3 weeks of acute secondary disease, sensitized mice survived the observation period of 50 days as chimaeras. Sensitized recipients were killed by the transplantation of spleen cells from congenic AKR/Cum carrying the Th-1.2 antigen. The host-versus-theta-graft approach suppressed secondary disease following H-2-compatible and -incompatible marrow grafts. Its hemopoietic and Tcell chimaeras tolerated skin grafts of the donor strain while rejecting third-party skin grafts.


The effect of antidonor serum and antigen-antibody complexes on the survival of heart allografts in rats presensitized with donor blood. Preimmunization of BN recipients with 1 ml of WAG/Rij blood 7 days before grafting led to accelerated rejection of WAG/Rij hearts in 5 days (normal, 8 to 9 days) and of (WAG/Rij X BN)F1 hearts in 7 to 11 days (normal, 9 to 11 days). Preimmunization with mixtures of 1 ml of WAG/Rij blood and 0.25 ml of BN anti-WAG/Rij serum (antidonor serum) prevented the accelerated rejection in the WAG/Rij to BN combination and even led to prolonged graft survival. However, using the (WAG/Rij X BN)F1 as donor, this pretreatment led to accelerated rejection as well as prolonged graft survival. Preimmunization of BN recipients with 1 ml of WAG/Rij blood and antigen-antibody (Ag-Ab) complexes gave more consistent results; WAG/Rij hearts were normally rejected, whereas (WAG/Rij X BN)F1 grafts survived for 13 to 16 days. Treatment of preimmunized BN rats with antidonor serum or Ag-Ab complexes after grafting did not abolish the effect of sensitization in the WAG/Rij leads to BN combination. In the (WAG/Rij X BN)F1 to BN combination, these treatments resulted in graft survival times of 4 to 13 and 11 to greater than 50 days, respectively. In most experimental groups, Ag-Ab complexes were more potent as an immunoregulatory agent than was antidonor serum.


Humoral antibody response in rat renal allotransplantation. Female inbred Fischer (F344) rats were grafted with kidneys from female BN rats. Humoral antibodies in some of the recipients were demonstrated as early as 3 days after transplantation: (1) antibodies bound to the graft were detected by mixed agglutination tests with graft sections and erythrocytes of the donor as indicator cells; (2) lytic and agglutinating antibodies against donor strain erythrocytes were demonstrated in the recipients' sera by hemolysis in agar gel and dextran hemagglutination tests; and (3) similar antibodies secreted by a significant number of cells were detected in the recipients' spleens by plaque assay. The antibody response of the recipients was directed against a single antigen, designated N, which was shown to be present on erythrocytes of 57% of Fischer strain rats and was shared by erythrocytes of all rat strains tested (BN, Lewis, Wistar, ACI, MAXX, and Buffalo). The N antigen did not seem to belong to any known rat histocompatibility antigen system. Segregation of the gene coding for this antigen within the Fischer strain would indicate residual genetic heterogeneity. Evidence was presented that this antigen is present not only on erythrocytes, but also on other cells including splenocytes.


Surgical repair of cleft soft palate in the horse. A technique for the surgical repair of a cleft soft palate in the horse is described. A symphysiotomy approach was employed to repair the anterior end of the cleft palate, and the posterior part was approached via a pharyingotomy incision.


Anaesthesia of pigs sensitive to malignant hyperthermia. During general anaesthesia some pigs develop a hyperthermic response which is often fatal. The syndrome is most common in pigs which are susceptible to stress and have a low proportion of body fat. On the basis of an experimental investigation in Pietrain pigs recommendations are presented for the clinical management and treatment of susceptible animals.


[Complement system and lymphocytotoxic antibodies in presensitized dogs after homologous lung transplantation ]. Left side orthotopic homotransplantation of the lung was performed in 8 mongrel dogs pre-sensitized by full-thickness skin transplants. The degree of sensitization was assessed by control of the lymphocytotoxic antibody titre. The behaviour of haemolytic complement activity, as well as the alterations in antibody titre were recorded up to 60 minutes after opening of the anastomoses. Evaluation was performed by analyses of significance. A significant decrease in lymphocytotoxic antibody titre (p less than 0.001), as well as a significant diminution in complement activity (p less than 0.01) was observed in blood  samples from the pulmonary vein of the graft during the first five minutes following recirculation. This resulted from an interaction of both systems in the immune reaction. The further complement consumption by the graft in contrast to the constancy of the lymphocytotoxic antibody titre in the subsequent post-transplantation period can be explained by antibody-independent complement activation. Vena cava-- pulmonary vein differences in the lymphocytotoxic antibody titre and complement activity are correlated only five minutes after opening of the anastomoses (r = 0.75), which confirms the independence of both systems during later course of the reaction.


[Hyperacute rejection of an HL-A identical renal allograft (author's transl)]. Hyperacute renal allograft rejection is described in a patient suffering from mesangio-proliferative glomerulonephritis. The transplanted kidney was HL-A identical and the direct cytotoxic cross-match between the recipient's serum and donor lymphocytes was negative. Intrarenal consumption of C 3, but not of C 1 q, C 4, total haemolytic complement, IgG or Igm was demonstrated. Immunofluorescence studies exhibited dense granular deposits of C 3, but not of IgG, IgM C 1q or C 4. These findings together with the observation of beta 1 C-beta 1A converting activity in the patient's serum, raised the possibility that the alternative pathway of complement activation induced by nephritic factor could have operated in this case. Further studies will be necessary to clarify the question whether hyperacute rejection of renal allografts is only antibody mediated or not.


[Modern trends in the treatment of diabetic retinopathy (author's transl)]. Adequate control of diabetic patients may not only delay the appearance of diabetic retinopathy, but may, moreover, effect the regression of fundus changes at the pre-retinopathic stage and in cases of commencing non-proliferative retinopathy. Medical treatment is based on the achievement of a decrease in vascular permeability and a lowering of the blood lipid level; a diet enriched with phosphates may influence retinal hypoxia by increasing the 2,3 diphosphoglycerate level in the erythrocytes, thereby leading to an improved free oxygen supply to the tissue. Complete medical and dietetic compensation of hyper-permeability of the retinal capillaries, of the intraretinal exudation of lipoproteins, and of retinal hypoxia belong still today to utopia; hence, conservative treatment is only of auxiliary character. Hypophysectomy has largely been abandoned in view of the mutilation involved and the poor results of this procedure. The most effective active treatment is photocoagulation. The best results are obtained by a combination of generalized unselective coagulation of the peripheral retina by means of a xenon coagulator and the selective elimination of progressive vascular changes seen in the fluorescein angiogram with argon laser.


[The value of imprint cytology in neurosurgical diagnosis (author's transl)]. Cytological smear techniques have been found valuable in obtaining a rapid histological diagnosis during neurosurgical biopsies, although their accuracy is questioned. This method is particularly appropriate in the case of small pieces of tissue which may be difficult to cut in the cryostat. A method developed to obtain multiple touch preparations was used in 332 consecutive neurosurgical biopsies; these were examined and compared with subsequent paraffin sections of the same biopsies. The correct diagnosis was obtained from the smears in 93.7% of the cases, while the diagnostic accuracy of paraffin sections was 98.2%. The imprints also allowed correct grading of gliomas. Most of the errors or inconclusive cytological diagnoses stemmed from failure to distinguish between primary and secondary anaplastic CNS tumours, between neurinomas and fibroplastic meningiomas, or between glial scar or normal brain tissue and isomorphic astrocytomas. The differentiation of these lesions is, however, often difficult even in paraffin sections. In accordance with the results of other authors it is suggested that the touch cytology is one of the most appropriate techniques available for rapid neurosurgical diagnosis.


Luteinizing hormone responses to luteinizing hormone releasing hormone, and growth hormone and cortisol responses to insulin induced hypoglycaemia in functional secondary amenorrhoea. Luteinizing hormone (LH) responses to luteinizing hormone releasing hormone (LHRH), and growth hormone (GH) and cortisol responses to insulin induced hypoglycaemia were studied in 56 women classified into 4 distinct groups of functional secondary amenorrhoea. The groups were: I, self-induced weight reduction (20 patients); II, post pill amenorrhoea (14 patients); III, anorexia nervosa (10 patients); and IV, idiopathic secondary amenorrhoea (12 patients). Only patients with no overlapping anamnestic factors were included. Group I patients had the most heavily impaired LHRH-LH responses, and the GH response to hypoglycaemia was smaller than in other groups. Cortisol responses were normal. Group II patients showed blunted LH responses and normal GH and cortisol responses. Group III patients showed normal or exaggerated LH responses in the recovery phase of anorexia nervosa, while those two patients who were in the static phase of the illness had impaired responses. GH responses varied greatly. Group IV patients had normal basal levels of LH and normal LH, GH and cortisol responses. The restoration of LH response is not solely correlated to body mass, since patients recovering from anorexia nervosa showed greater LHRH-LH responses with nutritional rehabilitation at 76% of ideal body weight than patients with self-induced weight reduction at 87% of ideal body weight. In idiopathic amenorrhoea the hypothalamic pituitary axis seems to be practically intact. The function of hypothalamic-pituitary axis may be impaired selectively in functional amenorrhoea. Corticotrophin releasing hormone function remains intact, and GH-response may be impaired or normal independently of the LH-response to LHRH. In self-induced weight reduction both functions were impaired. These tests are easily carried out with out-patients, and they give more information about the functional state of hypothalamic-pituitary axis than basal analyses of hypothalamic-pituitary axis than basal analyses of gonadotrophins and oestrogens. However, a single pathologic reading in the LH response is not specific enough to indicate to which group of amenorrhoea the patients belong, but these tests together elucidate the severity of lesion in hypothalamic pituitary axis.


Familial idiopathic hypogonadotrophic hypogonadism. A new case of familial idiopathic hypogonadotrophic hypogonadism is presented: 3 males and 2 females among 9 siblings are affected. Very low to non-detectable levels of plasma LH and FSH levels were found in each patient. LH-RH stimulation test gave in one male a slight increase in plasma LH levels while no change was observed in the others. Prolonged treatment with gonadotrophins or testosterone gave poor results in the males while evidence of ovulation was obtained in the two females during a unique induced artificial cycle with combined HMG and HCG treatment; rapid feminization was also obtained in the females with oestrogen therapy. The striking difference in the results of the substitution treatments between males and females suggest that some degree of acquired insensitivity of the testes to gonadotrophins and of peripheral tissues to male sex hormones are present in male hypogonadotrophic hypogonadism. This may be the consequence of a lack of hormonal stimulation or impregnation during infancy and childhood


A method for concentrating cerebrospinal fluid cells. The morphology of CSF cells changes in vitro rapidly. An optimal cytologic evaluation therefore requires special demands for the cell preparation. The cell concentration by means of the forced spontaneous sedimentation yields the best cytomorphologic results. A simple method for cell concentration has been described. Its application in two variations is determined by the cell content. In the first version the cells sediment spontaneously on the microscopic slide and in the second version on the membrane filter. The sedimentation is facilitated by the absorbent paper. This method is particularly suited for concentrating cultured cells and CSF cells, which have been incubated in the presence of tracer.


Response of the pituitary-testicular axis to luteinizing hormone-releasing hormone in the immature male rat. Follicle stimulating hormone (FSH), luteinizing hormone (LH), testosterone and androstenedione were measured by radioimmunoassays in the sera of immature male rats treated with luteinizing hormone-releasing hormone (LH-RH). A single dose of 10, 20, 40 or 80 ng of LH-RH produced a prompt increase in serum LH: signfiicant changes in FSH were found only with the two larger doses. Serum testosterone increased to peak levels in 20 to 40 min and returned to control level by 120 min. Changes in androstenedione were temporally similar but smaller in magnitude. Four doses of 20 or 40 ng LH-RH given at 20 min intervals did not increase serum LH or testosterone concentrations above those found with a single injection; FSH was slightly higher after the fourth dose. However, 40 ng LH-RH given every 20 min for 2 h produced a dramatic increase in serum LH and FSH: serum and testicular androgens were also much higher during the second hour. A 2 h stimulation with 80 ng LH-RH given ip at 30 min intervals did not alter the response to the same treatment given 24 h later; i.e., neither the pituitary nor the gonad was primed by previous exposure to increased levels of LH-RH or gonadotrophins. These results suggest that a single pulse of LH-RH produces a predictable response in the animal, but multiple episodic stimuli produce variable responses: testes, on the other hand, produce androgens as long as gonadotrophins are available.


Pituitary-gonadal function in male patients with myotonic dystrophy- serum luteinizing hormone, follicle stimulating hormone and testosterone levels and histological dmaage of the testis. Variations in serum levels of LH and FSH after administration of synthetic LH-RH, and basal levels of serum testosterone were studied in 9 male patients with myotonic dystrophy. The degree of testicular damage, as determined histologically on biopsy specimens, was also studied. Results were as follows: 1) it was observed that both the basal and stimulated (maximal) levels of serum LH and FSH were significantly higher than levels found in 9 sex- and age-matched normal controls. 2) The basal level of serum testosterone was consistently lower in the patient group. One patient, however, showed a low normal level, which represented a statistically significant reciprocal relation to both LH and FSH levels as expressed on a logarithmic scale. 3) There was a significant trend which indicated that the higher the serum LH, FSH levels, or the lower the basal levels of serum testosterone, the more extensive was the damage to the seminiferous tubules. From these findings it was concluded that hypogonadism in patients with myotonic dystrophy, is characterized by the development of lesions in the seminiferous tubules.


Fundamental study of automatic cyto-screening for uterine cancer. III. New system of automated apparatus (CYBEST) utilizing the pattern recognition method. An investigation was carried out, both from the point of view of combining features which are considered as being of the highest reliability based on pattern analysis of the nuclear structure and cytoplasm of cells, and the complexity of the apparatus. Several features such as "ambiguity" function were extracted by mathematical and statistical processing, and these were then made the parameters of a diagnostic logic. Also, a method in which a "differential histogram" and a "threshold value" are combined was developed for segmentation of cells. It became possible to operate an automatic scanning machine at a speed of about six minutes per slide using two-stage coarse and fine scanning of a flying spot scanner. The advantage of this system is flexibility of diagnostic program logic and speed of algorithms for a determined number of cellular features. An automatic focusing system was also developed and it functions satisfactorily at high speed on a fully extended regular object slide.


Osteonecrosis following renal allotransplantation. A quantitative histological study of iliac bone. Morphometric and dynamic studies of bone obtained by biopsy from a standard locality on the iliac crest were carried out in 10 patients with and 7 patients without radiological signs of osteonecrosis. All the patients had normally functioning kidney transplants. The results obtained in the two groups were compared and both groups were compared with a series of noraml subjects where the age and sex distribution was the same. In the group of patients with osteonecrosis, the reduction in the amount of cancellous bone was found to be highly significant as compared with that in normal subjects and with that in the other group of patients. Apart from the reduction in bone, changes in all patients were characterized by an increased amount of osteoid and a low rate of mineralization, determined by double labelling with tetracycline. As there were no changes in the width of osteoid seams indicating osteomalacia, it is suggested that these patients suffered from a severe corticosteroid osteopenia.


Hypercalcemia and parathyroid function after renal transplantation. Hypercalcemia after renal transplantation (post-T hypercalcemia) has been detected in 29 (16.7%) of 174 long-term survivors. The mean time of onset of hypercalcemia was 69 days after renal transplantation (range 3-210). In 18 patients the hypercalcemia was mild and resolved spontaneously (transient) from 2-65 months (mean 19) after onset. In 4 patients serum calcium normalized concurrently with rejection episodes. In 7 patients the hypercalcemia was more pronounced (permanent), being terminated by subtotal parathyroidectomy in 5 and persisting in 2 recipients. The hypercalcemia was asymptomatic except in one patient, who developed calculi in the graft and a fall in graft function, all of which disappeared after parathyroidectomy. At operation the parathyroid glands showed hyperplasia, except in one case with an adenoma in one of the hyperplastic glands. Serum phosphorus was markedly decreased, to the same extent in transiently and permanently hypercalcemic recipients. Serum parathyroid hormone (S-PTH) was increased in all of 5 patients with permanent and in 3 of 8 with transient post-T hypercalcemia. In normocalcemic and in transiently hypercalcemic recipients the mean S-PTH was identical, but significantly lower than in the permanently hypercalcemic recipients. S-PTH was suppressed to the same extent during an i.v. calcium infusion in patients with post-T hypercalcemia and with primary hyperparathyroidism.


A new clinical taxonomy for rating change in functional activities of patients with angina pectoris. The treatment of patients with angina pectoris is commonly evaluated according to such indexes as the frequency of anginal attacks, quantity of supplemental nitroglycerin, and exercise performance in an ergometric laboratory test. None of these indexes demonstrates the clinical change in ordinary functional limitations that may have been the major reason why a patient sought medical help. The New York Heart Association ratings of functional capacity do not refer to different types of activity and the four categories of the scale are too coarse to show distinct changes that can occur while a patient retains the same rating. A new taxonomy has been devised for rating transitions in functional capacity as noted in three different kinds of functional performance: occupation, customary activities, and sporadic activities. The ratings of change in these three activities can be combined into single global rating. When applied to conventional questionaire data for 309 patients in a randomized double-blind therapeutic trial, the new classifications showed a statistically significant superiority, in each type of functional transition and in the global ratings, for patients receiving timolol maleate rather than placebo. By augmenting the conventional information used for therapeutic evaluation, the new taxonomic indexes can expand the scientific scope of antianginal treatment. Data derived from history-taking can be just as statistically significant as "harder" forms of information, while simultaneously being more pertinent for the clinical challenge of choosing and evaluating the agents used in patient care.


The effects of oral propranolol, digoxin and combination therapy on the resting and exercise electrocardiogram. The effects of propranolol, digoxin and combination therapy (/D) on the resting and exercise ECG were studied in ten normal subjects and 20 patients with coronary artery disease (CAD) given a sequence of oral placebo, propranolol, P/D, digoxin and placebo, for two week periods. Digoxin produced a significant decrease in T-wave amplitude and often resulted in ST segment depression in the resting ECG. Propranolol, digoxin, and P/D tended to decrease the QTc interval and prolong the PR interval. However, CAD patients were more sensitive to PR prolongation than normals while receiving propranolol or digoxin alone. Propranolol therapy did not significantly affect the ST segment of the exercise ECG in the normal subjects or the CAD patients without an ischemic control exercise ECG. By contrast, 50 per cent of the normal subjects developed "false-positive" ischemic ST segment responses to exercise while receiving digoxin of P/D and three of eight CAD patients without ischemic control exercise ST segments had a similar response to digoxin or P/D. In 12 CAD patients with ischemic control exercise ST segments, propranolol did not affect the amount of ST segment depression at the onset of angina or the maximum amount of ST segment depression. Digoxin or P/D both uniformly increased the maximum amount of ST segment depression which was greater with digoxin than P/D. However, the maximum heart rate on P/D was significantly reduced as compared to that on digoxin. It is concluded that (1) CAD patients are more sensitive to propranolol or digoxin-induced AV block than normals, (2) propranolol does not change the magnitude of ischemic exercise ST segment depression, (3) digoxin increases ischemic exercise ST segment depression and results in a high incidence of false-positive exercise tests, and (4) the addition of propranolol to digoxin attenuates the effects of digoxin on the exercise ST segment.


Detection of pulmonary edema in acute myocardial infarction. To evaluate methods for detecting pulmonary edema, pulmonary extravascular water volume was measured at 24 hour intervals (total 72 hours) in 25 patients with acute myocardial infarction. Measured lung water was compared with results of clinical, blood gas, X-ray and hemodynamic methods for detecting pulmonary edema. Increased pulmonary extravascular water volume on one or more measurements was observed in 18 of the 25 patients and was associated with an abnormal chest radiograph and increased pulmonary arterial wedge, pulmonary arterial diastolic and right atrial pressures. It was associated less well with clinical, blood gas and other hemodynamic measurements. Pulmonary arterial diastolic or pulmonary wedge pressure was a significant predictor of lung water 24 hours later. Both "preclinical pulmonary edema" and the "therapeutic phase lag" could be predicted from the pulmonary wedge pressure. Clinical, blood gas, radiographic and other hemodynamic measurements were not predictive.


Permanent pacing of the heart: 1952 to 1976. The theory and science of electrical pacing of the heart is scarcely 2 decades old, but developments in these areas have in a way revolutionized modern cardiology. This report, basically a review of the major developments during that time, describes the present state of the art, and calls attention to the many people who have brought us to this point. Results of a recent national survey reveal that about 156,000 patients in the United States are living with implanted pacemakers or about 1 in every 1,300 persons. The rate of new implants is 270/million each year, the highest in the world. The impact of such a volume is considerable, affecting industrial growth, federal legislation and control, insurance plans and a multitude of medical programs. New power sources, some touted to last a lifetime, will have a great impact but will not change the current state of the art materially because 30 percent or more of pacemaker operations are for problems other than routine battery exhaustion. The need for improvements in other pacemaker components is emphasized.


Effect of citrus pectin on blood lipids and fecal steroid excretion in man. Citrus pectin (15 g/day) was added for 3 weeks to metabolically controlled diets in nine subjects. Pectin was consumed with fruit and sugar as a gel in divided doses with meals. Plasma cholesterol concentrations were reduced by a mean of 13% (P less than 0.001). Fecal fat excretion increased by 44% (P less than 0.001); neutral steroids by 17% (P less than 0.001) and fecal bile acids by 33% (P less than 0.02). Plasma triglyceride levels did not change.


Urinary cytodiagnosis of acute renal allograft rejection using the cytocentrifuge. The clinical diagnosis of acute renal allograft rejection in immunosuppressed recipients can often be predicted or confirmed on the basis of characteristic urinary cytologic findings. Use of cytocentrifugation permits a simple, rapid, reproducible and semiquantitative means of preparing cytologic urinary specimens of diagnostic quality from small quantities of urine. The cytodiagnosis of acute renal rejection was established before or on the same day a clinical diagnosis of rejection was made in the majority of renal transplant cases studied over a 12-month period. Renal tubular cells were found to be the exfoliated cells of greatest value in predicting an acute rejection episode, and their persistence has prognostic importance.


Quantitative counterimmunoelectrophoresis for urinary fibrinogen-related antigens. A quantitative procedure for urinary fibrinogen-related antigens, applying counterimmunoelectrophoresis to serial dilutions of concentrated samples against standards of known fibrinogen concentrations, is described. It is fast, convenient, sensitive enough (r = 0.8729, p less than 0.001), and can be easily incorporated into routine laboratory work.


Postmortem bacteriology and pneumonia in a mentally retarded population. Postmortem pathologic and bacteriologic reports were analyzed for 237 deaths occurring at a large institution for the mentally retarded from 1958 to 1973. Bronchopneumonia, aspiration pneumonia, and lipid pneumonia were frequently reported at autopsy, and in a total of 146 cases (61.6%) at least one type of pneumonia was reported. Postmortem bacteriologic cultures in a smaller group revealed high recovery rates of staphylococci (coagulase-positive), hemolytic streptococci, and gram-negative bacilli in throat and lung cultures. Enteric aerobic gram-negative bacilli were particularly frequent along with yeast (Candida albicans). The institutionalized retarded appear similar to other hospitalized populations, in that a large proportion of hospital-acquired respiratory infections is related to aerobic gram-negative bacilli. The high frequency of aspiration and its sequelae in this population is unusual, however, and post-mortem bacteriologic findings appear consistent with those of antemortem studies of cases of aspiration pneumonia.


Oxolinic acid therapy for urinary tract infections in children. Thirty hospitalized children with Gram-negative bacillary urinary tract infections were treated with oxolinic acid for 14 to 21 dyas. Fifteen of 17 patients with uncomplicated and 11 of 13 with complicated urinary infections had favorable bacteriologic responses. Resistant organisms developed in four treatment failures. Oxolinic acid urine concentrations were well above the minimal inhibitory concentration for most strains of Escherichia coli, Klebsiella, Enterobacter, Proteus mirabilis, P vulgaris, P morganii, and P rettgeri. Approximately half of these patients experienced mild symptoms possibly related to oxolinic acid therapy; in no instance did they require cessation of therapy. Our experience indicates that if the urine is not sterile by the end of five days of treatment, bacterial resistance to oxolinic acid is likely to have developed, and therapy with another agent should be considered and antibiotic susceptibility tests repeated.


Group B beta-hemolytic streptococcal colonization. Acquisition, persistence, and effect of umbilical cord treatment with triple dye. Following an outbreak of group B beta-hemolytic streptococcal neonatal infection (GBS), a prevalence survey of GBS colonization was performed on 238 infants. No important differences were noted in the prevalence of colonization when the infants were grouped according to age. Follow-up of 24 colonized babies for three months disclosed that most had persistence of GBS at the rectum and pharynx. Local umbilical cord care with triple dye (TD) or hexachlorophene skin cleanser was compared with untreated controls with respect to rates of GBS colonization. At birth the colonization rates of the three groups were similar. The rate of acquisition of colonization with GBS was 1.0% in the TD group, 6.3% in the hexachlorophene group, and 8.3% in the control group. Triple dye was much more effective than no specific cord care or hexachlorophene in preventing acquisition of GBS colonization.


Intellectual and perceptual-motor characteristics of treated myelomeningocele children. We studied 173 children with myelomeningocele, 133 of whom developed hydrocephalus (and had shunt procedures) and 40 of whom did not. Eighty siblings were tested as a control group. Sixty-three percent of children with hydrocephalus had IQs above 80; 87% of those without hydrocephalus had IQs above 80. Children who had associated hydrocephalus were significantly less intelligent than their siblings, whereas those without hydrocephalus were not. When patients and siblings were not. When patients and siblings were matched by age and IQ, the former scored significantly lower on a perceptual-motor functioning test. When patients with and without hydrocephalus were similarly matched, those with hydrocephalus scored lower. Inverse relationships between sac location and IQ, and sensory level and IQ, were found to be dependent on the association of higher sac levels and of sensory loss with hydrocephalus. Patient IQ was related to family income and education.


Meningitis due to two serotypes of Escherichia coli. An infant who recovered. A newborn infant with hyaline membrane disease and aspiration pneumonia developed purulent meningitis on day 19, three days after discontinuation of ampicillin sodium and gentamicin sulfate therapy. Therapy with gentamicin, both systemically and intrathecally, for two weeks was ineffective. During this time each of four specimens of cerebrospinal fluid contained two serotypes of Escherichia coli, namely, O83:H4 and O75:H5. The antibiograms of the two strains were identical, both being susceptible to gentamicin and ampicillin. Treatment with ampicillin resulted in prompt disappearance of the infecting microorganisms and recovery from the infection. One of the strains (O75:H5) produced an antigen cross-reacting with the capsular antigen of Haemophilus influenzae type B; the other did not. The patient developed O antibodies in substantial titers against E coli O83 but not against E coli O75.


Ascites following renal transplantation. Idiopathic ascites has been described in patients on maintenance peritoneal dialysis and hemodialysis. The mechanism responsible for ascites formation in these patients is unknown, and therapy has been generaly unsuccessful. However, renal transplantation has been associated with resolution of this form of ascites. We describe a patient who was free of ascites during maintenance dialysis, in whom ascites developed following renal transplantation associated with transient impairment of renal function. No specific cause of the ascites was found. Resolution of ascited occurred as renal function improved. This experience extends the spectrum of idiopathic ascites in uremic patients to the transplant recipient.


Long-term effects of highly selective vagotomy (HSV) in dogs on acid and pepsin secretion. Gastric H+ and pepsin studies before and at intervals for 4o months after fundic vagotomy (HSV) in 3 fistula dogs were done with the vagal stimulant 2-deoxyglucose (2-DG), and blocked the secretory response to 2-DG, but secretion began to recover by 5-6 months, and from 16 months on stabilized at 60% H+ and 13-17% pepsin (preoperative = 100%). After HSV the stomach showed hypersensitivity to urecholine with a lower threshold and lower Km, but unchanged Vm, while with histamine the curves were shifted to the right, with Vm unchanged and Km increased. With pentagastrin there was also a small decrease in Vm. Pepsin responses to urecholine recovered and exceeded control by 16 months, but remained relatively unresponsive to histamine or pentagastrin. A cholinergic background provided by urecholine at subthreshold doses (less than 10 mug/kg-hr) restored both pentagastrin and histamine responses to prevagotomy levels. Gastrin release from the innervated antrum by 2-DG was several times greater than in controls and was atropine sensitive. The results indicate that denervation of the secretory mucosa, especially of the peptic cells, is never more than partially reversed even after 3 years. Even though the response to vagal stimulation is partial, the mucosa remains capable of normal response, ie, there is no atrophy, and therefore, the vagus is not directly trophic to the gastric fundus. Moreover, vagotomy was followed by some hypersensitivity to urecholine, indicating changes in cholinergic receptors like those seen in denervated muscle cells.


Kinetics of atropine inhibition of pentagastrin-stimulated H+, electrolyte, and pepsin secretion in the dog. The effects of atropine on pentagastrin-stimulated gastric secretion of water, H, Cl, Na, K, and pepsin were determined by kinetic analysis of dose-response studies in 5 dogs with esophagostomy and gastric cannula. First a dose-response study was done using 7 doses of pentagastrin (1-6 mug/kg hr), each dose given by I.V. infusion for 4 hr at a separate time. The same series of doses was used with atropine sulfate 10 mug/kg hr as background. Atropine inhibited pentagastrin-stimulated secretion competively with a dose ratio change of 20. In a third set of studies pentagastrin was infused alone for 4 hrs in the dose of 1.5 mug/kg hr and then with each of 7 doses of atropine (0.625-40 mug/kg hr), each dose used separately. Atropine competitively inhibited water, H, Cl, and K secretion, with Ki (dose of atropine giving 50% inhibition) of 1.0 mug/kg hr. Pepsin secretion was much more strongly inhibited than acid secretion by atropine with Ki 0.27 mug/kg hr and the inhibition was uncompetitive. Calculated maximal inhibition of H+ secretion by atropine was 89% and of pepsin 95%. Furthermore the shape of the response to pentagastrin was altered by atropine so that the peak response was delayed to the third and fourth hour of pentagastrin infusion.


Effect of swallowed isosorbide dinitrate on blood pressure, heart rate and exercise capacity in patients with coronary artery disease. Blood pressures and heart rates were measured with the patients supine and standing after a placebo and small (5 to 10 mg) and large (10 to 30 mg) doses of isosorbide dinitrate were given orally in double-blind fashion to six patients. Compared to the findings after the placebo, the blood pressure level fell and the heart rate increased after the ingestion of isosorbide dinitrate. The changes were more striking with the patients standing than with them supine, and the larger dose of the drug produced greater changes than the smaller dose. The hemodynamic effects were usually apparent at 15 minutes, peaked between 30 and 120 minutes, and were still present at 240 minutes. Two hours after swallowing a 7.5 to 20 mg dose of isosorbide dinitrate or placebo, administered in random fashion, 10 patients with coronary artery disease and angina pectoris underwent graded, treadmill, exercise testing designed to provoke angina only after 3 minutes or more. Nine of them exercised longer and achieved higher maximal heart rates after taking the isosorbide dinitrate. Thus, in man, swallowed isosorbide dinitrate has a dose-related, "long-acting," pharmacologic effect, and when tested by properly designed protocols, it improves exercise capacity. However, because the problems of nitrate tolerance and dependence have not been resolved, the place of oral nitrates in the management of patients with angina pectoris remains uncertain.


115 patients with first cadaver kidney transplants followed two to seven and a half years. A multifactorial analysis. One hundred fifteen consecutive patients received first transplants from cadaver donors at the University of Minnesota between January 1, 1968, and May 31, 1973. All patients have been followed for at least two years. The two-year survival rate is 70 per cent and the two-year transplant function rate is 58 per cent. Considerable improvement in both patient survival and transplant function has been noted since 1971. The success of transplantation appears to depend to a large degree on the age of the transplant recipient, the number of HLA antigens matched between donor and recipient, and the dose of antilymphoblast globulin (ALG) administered to the recipient during the first two weeks after transplantation. Each of these factors appears to be important even when the other factors are controlled, and when patients with diabetes, suffering technical failure or hyperacute rejection, are excluded. The results utilizing well-matched cadaver kidneys plus large doses of ALG appear to be equivalent to those obtained with the use of mismatched kidneys from relatives, but further analysis will be required to draw a definite conclusion. Patients receiving poorly-matched cadaver kidneys do far less well than patients receiving mismatched related grafts, however, even when ALG is utilized.


Routine processing of ophthalmic tissue for light microscopy. The techniques for processing ophthalmic tissue in our laboratory are described in detail. The procedure for grossing of specimens, and the different time tables for processing are given. We have been able to achieve easily reproducible results using the methods described.


The acute effect of hysterectomy on ovarian blood flow. Ovarian stromal blood flow was measured by 133xenon-clearance technique in five women before and immediately after abdominal hysterectomy preserving the adnexae. The interval  between the two measurements ranged from 35 to 76 minutes. The rate of xenon clearance was reduced by 52 to 89 percent in four of the women who were in the fertile age and by 29 percent in one postmenopausal subject. These findings indicate that acute reductions in ovarina blood flow may be responsible for the postoperative transient drop in ovarina steroid levels in peripheral plasma reported earlier.


Successful treatment of Candida endophthalmitis with a synergistic combination of amphotericin B and rifampin. Candida endophthalmitis, caused by transient candidemia, developed in a 14-year-old white girl receiving intravenous hyperalimentation. Antifungal synergism was established in vitro for the combination of amphotericin B and rifampin against the C. albicans isolate. A combined ten-day course of intravenous amphotericin B and oral rifampin was followed by the elimination of the infection and the preservation of good visual acuity.


A method to correct the contracted socket. In four patients, rotation of the inferior tarsus around the tarsal-tendon horizontal axis caused a contracted socket with loss of lower fornix and the inability to retain an artificial eye. Exposure of the lower border of the inferior tarsus through a skin incision, separating the tarsus from the overlying orbicularis oculi muscle, and suturing its lower margin to the skin corrected the abnormality.


Corneal endothelium under various storage conditions. Three rabbit corneas each were stored in McCarey-Kaufman (M-K) medium, rabbit serum, and in a moist chamber at 4 degrees C refrigeration for various lengths of observation. The endothelial cells appeared normal under all conditions for the first 24 hours as compared with control corneas processed concurrently with each experimental group. After 48 hours of storage the specimens in the moist chamber showed isolated endothelial cell damage. The endothelia in M-K medium or rabbit serum appeared viable up to six days without significant differences although those stored in rabbit serum showed a better preservation of microvilli on individual endothelial cells. Under all conditions a mild shrinkage of the cells seemed to have taken place as indicated by the more pronounced cell boundaries. We incubated an equal number of control rabbit corneas at 37 degrees C with 5% CO2 and moist air in M-K medium, serum, and minimal essential medium (MEM) with 10% fetal calf serum and 100 units/ml of a penicillin and streptomycin mixture. In serum, the endothelia showed rapid destruction with swelling of the entire cornea. Those stored in M-K medium maintained a normal endothelial covering of the cornea up to six days. At nine days of storage, marked cellular changes were observed with dehiscence of the cellular layer. When stored in the MEM mixture, the endothelial cells showed a normal layer without obvious cell damage when compared with those stored in M-K medium up to four days. However, after six and nine days of storage, cellular destruction was greater in these specimens than in those stored in M-K medium. In addition, there was considerable swelling of the whole cornea under this storage condition.


John Dewey: implications for schooling.

John Dewey: implications for schooling. Propositions, whether great and lasting or insignificant and passing, reside in the "guts of the living." Each age rediscovers its Plato, Dickens, Newton, or Dewey. Each age rewrites history, redefines science, develops its own theoretical perspectives. Propositions are tentative, conditional, or relative. They depend on contemporary priorities, and on a personal space and time context. At any future moment propositions may change, perspectives alter, new choices emerge. John Dewey provided for constructive innovation in schooling and the battles about his suggested criteria continue unabated. The purpose here, however, is only to examine some of Dewey's theoretical propositions and their probable implications (1).


A posttreatment evaluation of direct bonding in orthodontics. A long-term evaluation was made of results achieved in direct bonding of metal attachments with a chemically polymerized composite material. A total of 705 attachments were bonded to different teeth, including premolars and molars, in forty-six children. Slim bracket bases, small quantities of adhesive paste, and trimming of the excess material were used to improve esthetics and to benefit in respect of gingival condition. The same person bonded all brackets and performed the orthodontic treatment by a friction-free edgewise light-wire technique. Mean treatment time was 17 months. The clinical appearance before, during, and after treatment is shown in Figs. 3 to 5. The failure rates for the whole treatment period were 4 to 10 per cent for central and lateral incisors, canines, and first premolars in both dental arches. The second premolars, which were often in various stages of eruption at the time of bonding, and the molars had higher failure rates (Table I). An evident individual variation was noted, as a few children had a high number of loose brackets. Clinical and scanning electron microscopic studies of tooth surfaces following removal of the brackets demonstrated normal surface appearance when plain-cut tungsten carbide burs rotated at low speed were used to remove remnants of adhesive that could not easily be scraped off. Precoating etched enamel with sealant, in combination with daily fluoride mouth rinses and good oral hygiene, virtually eliminated the caries problem, but regular inspection for interproximal cavities was needed. There were no signs of enamel damage or discoloration for periods of up to 12 months subsequent to bracket removal. Further details of the technical operative procedure, failure analysis, bracket type and design, gingival health, and other aspects of direct bonding were also discussed.


On the meaning of increased fluctuating dental asymmetry: a cross populational study. Suarez reports a greater magnitude of fluctuating dental asymmetry for Neandertal sample when compared with a sample of modern Ohio whites. He postulates that this greater antimeric variance could be due to a greater degree of inbreeding in the Neandertal populations. In the present investigation, the magnitude of fluctuating dental asymmetry is evaluated for Eskimo and Pueblo populations. These populations were found to exhibit dental variance of equal magnitude to that of the Neandertal population. As these populations are not highly inbred, a stress related mechanism is suggested to explain these observations and the inbreeding hypothesis is rejected. The implications of this mechanism to Brace's Probable Mutation Effect are discussed.


A comparative study on the dental health status of five precolumbian Peruvian cultures. In a survey of dental health status of ancient Southern Peru, 101 skeletal remains were studied from five cultures: Paracas, Nazca, Tiahuanaco, Ica, and Inca. The Paracas and Ica cultures exhibited more missing antemortem teeth per mandible than the other cultures. Frequency of missing one or more third molars was less than expected and not as high as reported in peoples of Mongoloid heritage. The Paracas, Ica and Nazca, "coastal" cultures had a higher caries incidence than the "inland" cultures. Whether this relates to some difference in diet or water supply remains unresolved and warrants further investigation. Moderate attrition was noted in all the Precolumbian cultures but pulpal involvement was not observed. Osteitis, noted in all the cultures, was more pronounced in the Nazca, Paracas and Ica cultures. There appeared to be a direct relationship between caries involvement and the number of missing antemortem teeth to osteitis. Calculus was heavier in the Paracas and Ica cultures. In addition, the Paracas culture exhibited a dark brown stain on the teeth which may imply some difference between the cultures in either the food, water or social habits.


The Alto Salaverry child: a case of anemia from the Peruvian preceramic. Excavations during 1974 at the Peruvian Preceramic site of Alto Salaverry led to the discovery of a child's skeleton. The fragmentary skeleton exhibits cribra orbitalia, a pitting of the orbital roof associated with anemia. This specimen provides the first evidence of anemia in a population of the predominantly non-agricultural Peruvian Preceramic and extends the antiquity of the pathology among Precolumbian Peruvians.


Morphometrics of the Neandertal talus.

Morphometrics of the Neandertal talus. A number of morphometric analyses of Neandertal tali since the turn of the century have failed to reach a consensus on the functional affinities of these fossil foot bones. To clarify the problem a univariate and multivariate analysis of the available Neandertal and Skhūl tali in relation to those of modern humans was performed using nine linear dimensions and four angles. Our analysis indicates that Neandertal tali are indistinguishable from modern human tali in the implied locomotor capabilities and similar in overall size and proportions. The primary differences between the fossil and modern tali involve the greater articular robustness of the fossils, probably to compensate for higher levels of biomechanical stress.


Skeletal growth of the protohistoric Arikara. The longitudinal growth of the long bones and growth in breadth of the ilium are assessed for a population of protohistoric Arikara Indians from South Dakota through the correlation of skeletal measurements with estimates of chronological age at death. Comparison of the Arikara growth data with those from other Indian samples (Indian Knoll and Late Woodland, Illinois) reveals similar rates of bone growth, when compensation is made for methodological variation. As predicted from documented variation in adult statures, the Indian samples indicate slower growth rates than those of Whites but faster than those of Eskimos.


Task activity and anterior tooth grooving in prehistoric California indians. Abraded grooves have been observed on the anterior teeth of all the adults in a small population of prehistoric California Indians. These dental effects show considerable variety, appearing on maxillary and mandibular teeth, on approximal and occulusal surfaces, and either isolated or bilaterally aligned. Although many of the grooves are indistinguishable from those reported for other prehistoric populations, their variety illustrates the limited applicability of etiological hypotheses previously proposed to account for such effects. It is suggested that the grooves represent traces of a task activity involving the pulling of fibrous materials across the teeth.


Cardiovascular effects of increasing airway pressure in the dog. In paralyzed anesthetized dogs the cardiovascular effects of increasing positive end-expiratory pressure (PEEP) were explored under two conditions: a) end-expiratory lung volume increasing, b) end-expiratory lung volume kept nearly constant by matching pleural pressure rise to end-expiratory airway pressure rise. Two series of experiments were done: I) xenous return was allowed to fall, II) venous return was kept constant by infusion of volume. Right atrial pressure, pulmonary arterial pressure, and left atrial pressure increased under all conditions when measured relative to atmospheric pressure, but increased relative to pleural pressure only under condition a. The rise in left atrial relative to pleural pressure may indicate a degree of left ventricular dysfunction associated with increasing end-expiratory lung volume. Furthermore, when end-expiratory lung volume increased, inequality of the rise in pulmonary artery wedge pressure exceeded the rise in left atrial pressure in series I. From plots of cardiac output as a function of right atrial pressure it was possible to conclude that the decrease in venous return is partially offset by an increase in mean circulatory pressure.


An implantable semiconductor beta-radiation detector. An implantable beta-radiation detector suitable for the measurement of reginal blood flow in the experimental animal by the indicator clearance principle is described. A lithium-drifted silicon diode encapsulated in a stainless steel case is sutured over the site of interest. A suitable beta-emitting isotope, such as 85Kr in saline solution, is injected into the arterial supply and its calibrated against a mechanical system and showed excellent agreement up to 600 ml/100 g per min. At very high rates beyond the physiological range, flow was underestimated by a maximum of 10%. In vivo comparisons of myocardial blood flow assessed by the beta detector did not agree well with estimates of flow from a precordial counter or by the microsphere technique. Possible reasons are spatial heterogeneity of regional myocardial blood flow, the greatly different masses of tissue involved, or our inability to achieve sufficient numbers of spheres for accuracy in a 50-mg mass of tissue. The unit was still functional after 50 days in a chronic animal.


Total body water and the exchangeable hydrogen. I. Theoretical calculation of nonaqueous exchangeable hydrogen in man. A theoretical calculation of the total nonaqueous exchangeable hydrogen in protein, carbohydrates, and fat in man has been made. It shows that of the total exchangeable hydrogen in the body 5.22% is located in biochemical components, soluble in body water, containing hydrogen that is exchangeable with the isotope. This value represents a maximum upward distortion of total body water measurements by isotope dilution, due to the maximum possible exchangeability in these molecular conformations. From comparative measurements reported in the literature it is clear that this maximum is not achieved during the short period of time during which tritium-dilution studies are performed. It is the authors' belief that the hard-to-exchange amide hydrogens described by Blout in the protein conformations account for this failure of the isotope to achieve complete exchange in the short time allowed.


Total body water and the exchangeable hydrogen. II. A review of comparative data from animals based on isotope dilution and desiccation, with a report of new data from the rat. Total body water (TBW) determination by tritium space could be factitiously elevated by exchangeable H+ contained within water-soluble chemical configurations. Should this nonaqueous (molecular) exchangeable H+ turn out to be a large fraction of total exchangeable H+, TBW measurement by tritiated water (THO) dilution would display a systematic upward and non-random error. TBW was measured by THO dilution and subsequently by total body desiccation in 21 rats (weight 227+/-83 g, mean+/-SD). TBW was 71.38+/-2.4% by THO dilution and 70.20+/-1.5% by body desiccation. Analysis of variance of TBW vs. body weight showed a highly significant correlation both with desiccation (P less than 0.0005, r=-0.78) and dilution (P less than 0.03, r= -0.50). Convariance analysis of both methods showed no difference in slope (P greater than 0.9). There was a difference in variance (P less than 0.001) and means (P less than 0.03). Tritium space is 1.2% of body weight larger than TBW measured by desiccation. TBW measured by THO dilution gives a 1.71% overestimation of TBW as measured by desiccation. TBW measurement by THO dilution is accurate within less than 2% error. These findings have particular significance in the light of our theoretical model of the total nonaqueous exchangeable H+ in fat, protein, and carbodhydrate in the living vertebrate.


The crisis in mental health research.

The crisis in mental health research. The author states that the mental health research program of the United States is facing a threat to its survival as a force for public health. He describes the antecedents of this crisis, which include the separation of the National Institute of Mental Health from the National Institutes of Health and other organizational changes, the public's disappointment that overly great expectations were not met, and monetary inflation coupled with budgetary cutbacks. He concludes that, because research cannot be separated from the goals of service and training, the success of the total mental health program in the United States depends on resolving the research support crisis.


Whom to refer for group psychotherapy.

Whom to refer for group psychotherapy. The authors believe that group psychotherapy is a useful modality in terms of both economic use of resources and manpower and effective treatment for many common problems. Three major indications for group therapy are inappropriate patterns of interpersonal relationships, the tendency to act immediately on feelings, and the potential or existence of a transference that impedes individual therapy. Patients in these categories who are also in crisis or have a neurotic problem for which the development of a transference neurosis is indicated may require individual therapy instead of or in addition to group therapy. The attitude of the referring physician is crucial; he/she must provide support during the transition and must believe that group therapy can substantially benefit the patient.


The effects of caffeine on reaction time in hyperkinetic and normal children. Using a double-blind design, the authors investigated 1) caffeine's effect in hyperkinetic children on a choice reaction time task, 2) whether caffeine has different effects on simple reaction time and choice reaction time, and 3) whether its effects in the hyperkinetic compared with the normal group of children are best described by the law of initial values or as a "paradoxical effect." The results indicate that caffeine produced an increase in the accuracy of stimulus identification and processing and a decrease in lapses of attention for the hyperkinetic group. The law of initial values best represented the phenomena observed.


Current status of pancreatojejunostomy in the management of chronic pancreatitis. Thirty patients with chronic pancreatitis were treated by pancreatojejunostomy, six caudal and twenty-four longitudinal anastomoses. Follow-up data up to twenty years are reported and the early and long-term results compared. There were no deaths. Long-term results with caudal pancreatojejunostomy were 50 per cent excellent or improved and with longitudinal pancreatojejunostomy, 70 per cent excellent or improved. The best results were obtained when intraductal calcification was present. Longitudinal pancreatojejunostomy is recommended as the initial treatment of choice for chronic pancreatitis in patients with ductal obstruction, particularly when calcification is present.


Hodgkin's disease in human renal transplantation. After transplantation Hodgkin's disease developed in two recipients of related donor renal allografts. Only one case of Hodgkin's disease had previously been reported in this specific patient population and these two cases demonstrate the very atypical biologic behavior of Hodgkin's disease in the immunosuppressed renal transplant patient.


Use of transcutaneous electrical stimulation in the control of postoperative pain. Perception and relief of pain were studied in a varied group of fifty patients who had undergone laparotomy with upper abdominal midline incisions. Twenty-six patients were supplied with functioning transcutaneous electrical stimulators. Twenty-four received nonfunctioning machines. The controls were randomized by a nurse not otherwise involved in this study. Only seventeen of the total study group were judged failures and six of the patients had been receiving preoperative narcotics. Patient response was very favorable and pain relief was good to excellent, especially in one group with working stimulators (p is less than 0.008). Patients with known malignant disease did not respond as well as those with benign disease although anxiety may have been an important factor here. Use of the transcutaneous electrical stimulator would seem particularly worthwhile for patients undergoing elective abdominal operations for benign disease with no history of narcotic usage. Briefing the patient preoperatively on the potential value of transcutaneous electrical stimulation as a method of pain relief may improve end-results.


Influence of subcuticular sutures on scar formation. The purpose of this study was to determine the influence of nonabsorbable and absorbable subcuticular sutures on the width of scars of the human skin. This study included seventeen patients undergoing partial laminectomy for radiculopathy secondary to herniated nucleus pulposis. The scar of each patient served as its only control with its superior and inferior portions being subjected to different closure technics. The most important determinant of scar width was the patient himself. The width of the scar varied from an almost imperceptible scar in one patient to a very wide scar in another. An additional determinant of scar width was the location of the scar. The width of the inferior half of the scar was wider than the width of the superior half of the scar. Subcuticular closure of the laminectomy scar did not alter the magnitude of scar formation.


A simple trocar tor transcutaneous interosseous wiring in limited exposure sites. A simple trocar with inner canula is used in limited exposure sites for transcutaneous drilling. The trocar has an outer cannula which allows the special "air-powered" drill tip to pass through for transcutaneous interosseous drilling. No complications have been encountered by its use on numerous occasions.


Intermittent positive pressure inflation during microscopic endolaryngeal surgery. We describe a technique of anaesthesia for microlaryngeal surgery which we have found satisfactory. Inflation of oxygen through a noso-tracheal catheter provided very satisfactory ventilation with high oxygen levels in contrast to other reports. The intratracheal pressure was intermittently monitored to ensure safety. Continuous infusion of Methohexitone and suxamethonium provided adequate safe anaesthesia, prompt recovery, and absence of awareness. The results of pulmonary function tests undertaken preoperatively and postoperatively were mainly identical, showing no gross deleterious effect with this method of anaesthesia.


Treatment of diffuse metastatic cancer pain by instillation of alcohol into the sella turcica. The technique of "chemical hypophysectomy" was modified for the management of pain due to metastatic cancer. Using stereotaxic control, a needle is introduced via the nose into the sella turcica. Absolute alcohol is then injected into the pituitary. Of 13 patients who had severe uncontrollable pain, 11 obtained marked symptomatic relief. The longest follow-up period to date is seven months, with results persisting. Sequelae are those associated with destruction of the pituitary gland, the most significant being diabetes insipidus. Several cerebrospinal fluid leaks prompted us routinely to instill alpha-ethyl cyanoacrylate to seal the sella floor. Three patients had slight extraocular nerve palsies. There was no death related to the procedure.


Improved oxygenation during thoractomy with selective PEEP to the dependent lung. In 22 patients during thoracotomy in the lateral position, the effects of selective positive end-expiratory pressure (PEEP) to the dependent lung while simultaneously ventilating the non-dependent lung at zero end-expiratory pressure (ZEEP) on (1) inspired O2 concentration required to maintain adequate Pao2 during thoractomy and 2) alveolar-arterial oxygen difference (AaO2D) while breathing 100 percent O2 at the end of thoractomy were examined and compared to ventilation of both lungs at ZEEP, Selective PEEP to the dependent lung resulted in adequate PaO2 with a lower inspired O2 concentration (44 +/- SD 6% versus 70 +/- SD 21%), and a smaller AsO2D while breathing 100 percent O2 189 +/- SD 31 versus 342 +/- SD 69 torr) at the end of thoracotomy.


The Bela Schick Memorial Lecture. Toward measurement of success: from diphtheria to allergy. Schick's skin test identifies persons immune to diphtheria and those successfully immunized. No test enables comparable judgment of hyposensitization (immunotherapy), long used for treatment of diseases of allergic origin. Efforts made to measure the successful immunologic conquest of diphtheria are compared and contrasted with efforts being made to conquer diseases of allergic origin.


Ventilatory pattern, intrapleural pressure, and cardiac output. Continuous positive-pressure ventilation may decrease cardiac output. However, a few reports have separated the effects of positive and end-expiratory pressure (PEEP) from those of mechanical ventilation. Ten surgical patients requiring mechanical ventilatory support had catheters inserted for measurement of right atrial pressure (RAP), pulmonary artery occlusion pressure (PAOP), intrapleural, radial artery, airway, and atrial filling pressures, and cardiac output. All patients breathed spontaneously between mechanical breaths delivered every 30 seconds by intermittent mandatory ventilation (IMV). Measurements were made with 0, 5, and 10 cm H2O PEEP, and during intermittent positive-pressure ventilation (IPPV) with 12 breaths/min without PEEP. Airway pressure (Paw), intrapleural pressure, RAP, and PAOP were increased by PEEP and IPPV. Intrapleural pressure increased most during IPPV (p less than 0.001). Atrial filling pressures and cardiac output were unaffected by PEEP but decreased during IPPV (p less than 0.001). Patients receiving IMV maintained negative intrapleural pressure, atrial filling pressure, cardiac output and, therefore, O2 delivery, regardless of PEEP level. The authors conclude that patients requiring mechanical respiratory support, with or without PEEP, may maintain better cardiopulmonary function when allowed some spontaneous ventilatory activity.


A comparative study of the aerosolized bronchodilators, isoproterenol, metaproterenol and terbutaline in asthma. Twenty-one patients with asthma were studied in a double-blind manner for the effects of three aerosolized bronchodilators (isoproterenol, metaproterenol and terbutaline) on small, large and mixed airways, blood pressure, heart rate and various blood chemistries. Favorable responses were measured within 30 seconds for each drug. However, only the newer, selective beta-2 agonists, metaproterenol and terbutaline, produced significantly prolonged action upon small as well as large airways and lung volumes. Of the two, terbutaline tended to have an earlier and higher peak activity and longer duration of action, especially on large airways. Such prolonged activity by the newer agents suggests a safer and more effective alternative to isoproterenol inhalation.


A computerized approach to closing volume determination. A computer program was designed to analyze the single-breath nitrogen curve and calculate closing volume. The program solved simultaneously the two regression equations of phases III and IV with the intersection representing the point of closing volume. Thirty volunteers were asked to perform three consecutive single-breath nitrogen tests, all administered by an experienced laboratory technician. The tracings were also analyzed independently by two experienced observers. Correlation between visual and computer determination was excellent (r = 0.84), indicating that the computer method is as accurate in its closing volume analysis as is the present day method of visual determination. The results of this study suggest that widespread use of such a program could prove timesaving and eliminate the problems of interobserver and intraobserver variation, which presently impair the reliability of the SB N2 test.


Autonomic blockade and the cardiovascular and catecholamine response to electroshock. From a study on the interrelationship between electroshock-induced convulsions, autonomic function, catecholamines, and cardiovascular homeostasis in dogs, the authors found that: (1) the asystole of electroshock (ES) was significnatly prolonged by high spinal anesthesia but not by relative alpha- or beta-adrenergic blockade; (2) increased levels of circulating catecholamines were solely responsible for the marked hypertensive response to ES, since the pressor effect could be blocked by preventing the release of catecholamines with high spinal anesthesia or by inhibiting alpha-adrenergic receptors with phenoxybenzamine; (3) the adrenal medulla appeared to be the source of most of the ES-induced increase in circulating catecholamines; (4) the asystole and arrhythmias of ES were a cholinergic effect, since they were blocked by atropine; (5) there was a dose-response relationship between the coulombs of electricity administered and the catecholamine and cardiovascular responses; and (6) that the adverse cardiovascular effects of ES therapy could be ameliorated pharmacologically.


Oral atropine in the treatment of chronic asthma. Six adult patients with chronic asthma were treated with oral atropine sulfate 0.5 mg or placebo four times a day in a double-blind, crossover trial lasting eight weeks. Subjects returned at weekly intervals for spirometry and clinical evaluation. The baseline pulmonary functions did not differ significantly between the atropine and placebo periods. The only side effects noted were slight dryness of the mouth in three patients. The three patients who complained of mouth dryness felt that they were better while they were taking oral atropine in that they had fewer acute episodes of asthma. The administration of 0.5 mg oral atropine four times a day is ineffective in improving baseline pulmonary functions in chronic asthmatics, although it may decrease the incidence and severity of acute asthmatic episodes.