Factors governing insulin and glucagon responses during normal meals. An experimental model is described which can be used to study substrate and hormone responses to normal meals administered in very near normal circumstances. After 500, 300 and 125 calorie meals, the relative proportion of fat or protein content did not influence the plasma glucose except for minor differences between the high protein-high fat meals. The insulin response to such meals was correlated positively with the increment in glucose but reduction of protein content below 8 g caused a signficant reduction in the increment in plasma insulin per unit increase in plasma glucose. Alterations in protein content above 8 g made no difference. Fat content of the meal did not significantly alter the insulin response. No evidence was obtained for a major component of insulin release attributable to either bulk or preabsorption phenomena such as sight or smell. It is concluded that a significant accentuation of the insulin response to meals is dependent on a minimum amount of protein and that this is probably mediated by one of the gastro-intestinal hormones. Glucagon release is dependent on protein and carbohydrate content of the meal and is independent of the fat content. There may also be an early stimulation of glucagon release, regardless of content, which may also be hormonally mediated.


Partial hypopituitarism in a patient with a pituitary stone. A case of sexual infantilism was found to have calcification within the sella turcica. Endocrine evaluation revealed partial hypopituitarism involving gonadotrophin and growth hormone secretion.


Antibody dependent cellular cytotoxicity (ADCC) in acute hepatitis B and in chronic active hepatitis. Antibody-dependent cellular cytotoxicity (ADCC) of peripheral blood lymphocytes against chicken red blood cells (ChRBC) in the presence of specific antiserum has been studied in normal subjects and in patients with acute hepatitis B and with chronic active hepatitis (CAH). ADCC was significantly reduced in patients with acute hepatitis B studied three weeks after the onset of jaundice and in patients with CAH showing clinical, biochemical and histological features of activity. On the other hand, lymphocytes from patients with CAH in histological remission or in clinical and biochemical resolution, showed a significantly increased cytotoxicity. The effect of serum factors on ADCC of normal lymphocytes was investigated using serial serum samples from five patients with acute hepatitis B and five with CAH. Our data suggest that serum factors may be responsible for the impairment of ADCC in our patients, although other mechanisms may also be implied. Sera obtained at the time when ADCC of patients' lymphocytes was reduced, significantly inhibited ADCC of normal lymphocytes when compared with sera obtained at the time when ADCC of patients' lymphocytes was normal or increased. In all cases with CAH, the disappearance or reduction of inhibiting activity correlated with histological remission. In patients with CAH the study of serum factors inhibiting ADCC of normal lymphocytes may be a useful parameter in assessing disease activity.


Induction of a stable hapten-specific immunosuppression by a hapten conjugated to poly(N-vinylpyrrolidone) (PVP). The ability of a hapten coupled to a clinically permissive synthetic polymer (NIP-PVP) to induce suppression was investigated. NIP coupled to the low molecular weight non-immunogenic form of poly(N-vinylpyrrolidone) (PVP) was found to be capable of inducing a hapten-specific longlasting suppression of both primary and secondary responses. The previous use of PVP as a plasma expander in humans makes this polymer a potentially suitable tool for the induction of specific immunosuppression to a variety of clinically important drug and tissue specific epitopes. The possible use of low molecular weight PVP for that purpose will be investigated further, specifically with larger antigenic components.


Spontaneous cell-mediated cytotoxicity in humans. Distribution and characterization of the effector cell. When lymphocytes from healthy donors were tested as effector cells, the cytotoxic activities observed in spontaneous and in antibody-dependent cell-mediated cytotoxicity were positively correlated. However, with lymphocyte preparations obtained from renal patients, a dissociation between the two activities was occasionally observed. Human natural killer cells are lymphocytes, with receptors for the Fc fragment of IgG molecules, but with no surface immunoglobulin. Their cytotoxicity is reduced by the presence of granulocytes or monocytes. After separation of rosetting and non-rosetting cells with AET- (2-aminoethylisothiouronium bromide hydrobromide) or neuraminidase-treated sheep erythrocytes, the majority of the activity was recovered in the non-rosetting fraction, but a portion of it was present consistently in the rosetting cell fraction. Cells in the latter fraction also displayed receptors for the Fc fragment of immunoglobulin G.


Exacerbation of murine malaria by concurrent infection with lactic dehydrogenase-elevating virus. The simultaneous infection of mice with lactic dehydrogenase-elevating virus (LDV) and Plasmodium yoelii resulted in an exacerbated attack of malaria. Peak parasitaemia was higher and the patent infection more prolonged in doubly infected mice. The results indicate that contamination with LDV must be considered when a change in parasite virulence is observed, particularly when the parasite is maintained by blood passage in mice.


Blood flow and relative tissue oxygenation of normal and partially ischaemic myocardium: effect of CO2. 1. Ischaemia of a portion of the myocardium in the dog heart was produced by tying off a small branch of a coronary artery: flow in the occluded region was reduced from 5 to 82% of the initial value. 2. The effect of inhalation of 5% CO2 in air on relative tissue PO2 and perfusion in normal and partially ischaemic myocardium was determined. 3. After 10 min inhalation of 5% CO2, there was an increase in tissue perfusion as measured by hydrogen desaturation; the increase was inversely proportional to the degree of flow reduction. 4. Relative intramyocardial PO2 measured polarographically, decreased with occlusion and increased after CO2 inhalation; the changes were inversely proportional to the degree of reduction in PO2. 5. The increase in flow after CO2 inhalation suggests that partially ischaemic myocardial tissue is capable of further vasodilation.


Haemodynamic effects of isometric handgrip exercise in patients convalescent from myocardial infarction. 1. Cardiac performance in response to 30% maximal isometric handgrip exercise was studied in fourteen patients convalescing uneventfully from a first myocardial infarction. In each patient, heart rate, mean arterial blood pressure and cardiac index were measured, and total peripheral resistance was calculated. The covariance of changes in the mean arterial blood pressure and cardiac index in these patients was matched against tolerance limits calculated from published data for normal subjects. 2. All patients had normal haemodynamic values at rest, and showed the usual rise of heart rate and mean arterial pressure during handgrip exercise. However, in six patients (group 1) the rise in mean arterial pressure was, as in normal subjects, accounted for mainly by a rise in cardiac index, with no consistent change in peripheral resistance. In eight patients (group 2), the mean arterial pressure rose to the same level as in group 1, but with a consistent increase in peripheral resistance and a smaller rise in the cardiac index. 3. It is suggested that in a substantial proportion of patients who are making a seemingly uncomplicated recovery from myocardial infarction, it may be possible to unmask an impairment of left ventricular function by means of isometric handgrip exercise.


Pressure-volume relationships in the left atria of anaesthetized dogs. 1. Pressure-volume relationships of the left atria were studied in thoracotomized dogs anaesthetized with sodium pentobarbitone and ventilated artificially. Controlled volumes of saline were injected into the left atrium using a method by which the injections were triggered by the R wave of the normal ECG, during the period of the V wave of the left atrial pressure waveform. 2. The change in the amplitude of the V wave was found to be linearly related to the injected volume. Similar observations made while the pulmonary artery was occluded revealed that this linearity in the pressure-volume relationship of the atrium extended down to small volumes.


Myeloid bodies in the renal tubules of humans: relationship to gentamicin therapy. Ultrastructural changes in renal proximal tubule lysosomes, including the formation of myeloid bodies, occur reliably with gentamicin administration in experimental animals. The present study reviewed the electron microscopic tubular morphology of renal biopsies and nephrectomies performed in our institution over a 2-year period. The frequency of myeloid bodies and their relation to drug therapy and selected clinical features were determined. Myeloid bodies were found in the proximal tubules of 19 of 109 cases that were judged adequate for study. On review of the drug histories of these 19 patients, 15 had received gentamicin within 6 weeks of biopsy or nephrectomy. None of the 90 patients without myeloid bodies had received the drug within 6 weeks of tissue examination. Of 4 patients with myeloid bodies who had not received gentamicin, 1 had received chloroquin and 3 had received drugs with no known or suspected capacity to induce myeloid bodies. The presence of myeloid bodies in proximal tubules did not appear to be related to the total dose of gentamicin, duration of therapy, or serum drug concentration. Clinical evidence of gentamicin nephrotoxicity was present in only 1 case.


The antagonism by propranolol and alpha-methylpropranolol (ICI 77602) of vascular and cardiac responses to isoprenaline in anaesthetized dogs. 1. In anaesthetized dogs, alpha-methylpropranolol was less potent than propranolol in antagonizing both vascular (hind limb perfusion pressure) and cardiac heart rate) responses to isoprenaline. 2. alpha-Methylpropranolol was more potent in antagonizing vascular than cardiac responses to isoprenaline, but this selectivity was no greater than that seen also with propranolol. 3. Isoprenaline sensitivity was greater in the hind limb than the heart and vascular-selective antagonism was more pronounced in those dogs in which this differential sensitivity was the greatest. 4. Introduction of an alpha-methyl group into propranolol decreases its beta-adrenoceptor antagonist potency but does not enhance vascular selectivity.


The measurement of glomerular blood flow in the rat kidney: influence of microsphere size. 1. Radioactively labelled microspheres were used to determine glomerular blood flow in glomerular populations with distinct vascular characteristics. Two batches of microspheres (15 +/- 5.0 micrometer diameter and 7.0--10 micrometer diameter) were utilized. 2. The results show that the larger microspheres overestimate the superficial glomerular blood flow (414 +/- 61 nl/min, mean +/- s.e.m.) and underestimate the deep glomerular blood flow (98 +/- 10 nl/min), when compared with the data obtained with 7.0--10 micrometer diameter microspheres (317 +/- 30 nl/min and 209 +/- 23 nl/min, respectively). 3. The rheological artefact associated with the use of larger microspheres is confirmed by finding an uneven size distribution of microspheres lodged in the glomeruli. In each of three experiments, the mean diameter of 200 microspheres lodged in the superficial glomeruli (16.43 +/- 0.27 micrometer, 15.87 +/- 0.23 micrometer and 16.58 +/- 0.27 micrometer) was significantly greater than that found in the deep glomeruli (15.36 +/- 0.15 micrometer, 15.25 +/- 0.21 micrometer and 15.73 +/- 0.24 micrometer; P less than 0.01, less than 0.05 and less than 0.01, respectively). No such difference was detected when the 7.0--10 micrometer spheres were used. 4. Glomerular blood flow can be measured at all depths of the rat's cortex and the demonstrated rheological artefact associated with use of the larger spheres is circumvented with the use of 7.0--10 micrometer microspheres.


Comparison of the anorectic and motor activity effects of some aminoindanes, 2-aminotetralin and amphetamine in the rat. 1. The anorectic and motor activity effects of 1-aminoindane, 2-aminoindane, some N-substituted 2-aminoindanes, 2-aminotetralin, amphetamine and fenfluramine were determined in rats. 2. The two compounds with structures most like the extended conformation of amphetamine, 2-aminotetralin and 2-aminoindane, were potent anorectics. At dosages which halved the intake of food over 1 h, amphetamine increased motor activity, 2-aminotetralin had no effect, and 2-aminoindane reduced motor activity. 3. Both the anorectic and central stimulant actions of 2-aminoindane were absent in N-ethyl- and N-isopropyl-2-aminoindane. 4. 1-Aminoindane, whose structure is like the folded conformation of amphetamine, produced a small anorectic effect and depressed motor activity.


Cardiac effects of salbutamol-induced hypokalaemia in the conscious dog. 1. Infusion of salbutamol (3.0 microgram/min after a bolus injection of 100 microgram) produced hypokalaemia in conscious dogs. 2. Measurement of arterial and coronary sinus potassium differences revealed no significant potassium loss from the heart with established hypokalaemia. 3. Shortly after the initial salbutamol bolus and before steady-state hypokalaemia had been achieved during salbutamol infusion, a prolongation of QTc occurred; this corresponded to a significant myocardial potassium of -0.12 mmol/l plasma. 4. Urinary electrolyte excretions indicated that the hypokalaemia was not due to urinary potassium loss. 5. It was deduced that potassium had moved intracellularly. No change in hydrogen ion status occurred to account for this. Pronounced rises in plasma insulin immunoreactivities during salbutamol infusions suggested this as one mechanism for potassium shifts.


Interactions between methaqualone and ethanol in rats and mice during acute and chronic states. 1. The effects of acute and chronic treatment of methaqualone on ethanol preference, the rate of disappearance of ethanol and on toxicity were studied in mice and rats. 2. Acute treatment with methaqualone showed a dose-dependent suppression in the voluntary intake of ethanol in C57Bl/6J mice in rats. No significant change in ethanol intake was observed during chronic methaqualone treatment and withdrawal. 3. Methaqualone pretreatment significantly (P less than 0.005) delayed the disappearance of ethanol in the blood and brain over a period of 50 and 200 min after a loading dose of 2.0 g/kg, i.p., of ethanol. 4. Methaqualone pretreatment at doses of 140 and 200 mg/kg significantly increased ethanol toxicity by 11% and 28%, respectively. Co-administration of ethanol using 6.0, 7.0 and 8.0 g/kg also reduced the LD50 of methaqualone by 19%, 24% and 40%, respectively. 5. Chronic administration with ethanol decreased the toxicity due to methaqualone. Potentiation of ethanol toxicity by methaqualone may be of clinical importance in view of the narrow range of safety margin of ethanol.


Free choline concentration and cephalin-N-methyltransferase activity in the maternal and foetal liver and placenta of pregnant rats. 1. The concentration of free choline and cephalin-N-methyltransferase activity of the maternal and foetal liver and placenta of rats in late pregnancy were determined. 2. The choline concentration of the liver fell from a mean of 130 nmol/g in adult non-pregnant rats to 38 nmol/g in late pregnancy. 3. The choline concentrations of the foetal liver and placenta had mean values of 135 and 442 nmol/g, respectively. 4. There was a significant 24% increase in the cephalin-N-methyltransferase activity of the liver during pregnancy. The enzyme activity in the foetal liver was 7% that of the maternal liver, and activity was undetectable in the placenta. 5. The results suggest that, during pregnancy, the maternal liver supplies choline to the placenta and foetal organs, like the liver, and that the demand for maternal liver choline far exceeds the supply available.


Patency evaluation of a LeVeen shunt using 99mTc-sulfur colloid. The LeVeen shunt has proved valuable in relieving intractable ascites. It is however subject to failure in about 5--8% of cases. To our knowledge there are only three reports in the literature describing the use of nuclides to assess patency; two using 99mTc-sulfur colloid and one using 99mTc-albumin. The purpose of this paper is to add our experience to the data currently published and stress that late liver visualization may occur with an obstructed shunt.


The effect of some centrally active drugs on corticosterone secretion and metabolism in rats. 1. Male rats were treated with morphine sulphate (10 mg/kg), methadone (10 mg/kg) and chlorpromazine (8.0 mg/kg) respectively, for 2 weeks. 2. At the end of this period, the adrenal glands of treated rats had increased in weight. 3. The concentration of corticosterone in the peripheral plasma was significantly lowered in the chlorpromazine-treated rats, increased in the methadone-treated rats and was unchanged in the morphine-treated rats. 4. The metabolic clearance rate of [1,2-3H]corticosterone decreased in the chlorpromazine-treated rats, while only a slight reduction was observed with methadone treatment. 5. These results showed that chronic treatment with either morphine or methadone did not suppress the adrenal function. The possible site of action of chlorpromazine in suppressing corticosterone secretion is discussed.


Scintigram in cortical blindness (Anton's syndrome). Anton's syndrome or cortical blindness consists of blindness, denial of blindness and at times confabulation. Despite the fact that the patient is completely blind, a persistent denial of inability to see is noted and is sometimes accompanied by visual hallucinations. We present a case report and scintigraphic study.


The sacral tubercle--a cause for hot spots on bone scan. The sacral tubercle, S1 posterior spinous process, can appear as intense as the sacroiliac joints on posterior bone scan in 4% of normal adult male patients. Due to sexual differences in anatomy, the scan appearance of the sacrum can cause false-positive readings. The converse, false-negative readings, can occur if the sacral intensity is taken as a constant when comparing ratios of sacroiliac joint intensities and sacral intensities on bone scans of patients with sacroiliac disease. This study demonstrates the normal anatomy of the sacrum and presents a sequence of tests to diagnose disease in the sacrum.


Bone scintigraphy of osteoid osteoma: a clinical review. Osteoid osteoma is a painful osteoblastic process. The pre-operative diagnosis is usually made by roentgenogram. Four surgically confirmed cases are examined where the preoperative diagnosis was clarified by bone scintigraphy. The clinical indications, the diseases process, the literature are reviewed.


Analysis of wall motion abnormalities of the heart and great vessels by computer generated cine-radionuclide-equilibrium study. Cardiac wall motion was evaluated in 54 patients by ECG-gated blood pool scintigraphy (GBPS) and computer assisted cine-radionuclide-equilibrium study (CRES). The cine format in CRES enhances the subtle aspects of great vessel and cardiac chamber motion and volume abnormalities. An off-line system using a general purpose computer permitted CRES to be initiated in smaller nuclear medicine facilities without large financial investiments.


Positive 67Ga-citrate scans in patients receiving Corynebacterium parvum. Gallium-67 citrate imaging for the staging of lymphomas was performed in three patients receiving Corynebacterium parvum (C. parvum) immunotherapy. Unexpected uptake at the site of C. parvum injections was identified and although the mechanism of localization is not determined by this study, similarities between C. parvum's known actions and the postulated mechanism of 67Ga-citrate localization are compared.


Gallium activity in the normal colon at six hours: a case report. Early 67Ga-citrate scintigraphy is commonly performed in the search for occult abdominal abscess. In addition to providing a more immediate answer in a clinically pressing situation, a six hour view can serve to clarify later images complicated by normal colonic activity. Although bowel visualization is thought to be unusual on the early study, we have frequently observed intense cecal activity that may have been misinterpreted as right abdominal pathology.


Unilateral increased radioactivity in the lower extremities on routine 99mTc-pyrophosphate bone imaging. Unilateral increased activity in the lower extremities was noted in 5 patients who underwent routine 99mTc-pyrophosphate bone imaging for metastatic evaluation. In three patients a large pelvic mass or retroperitoneal hematoma was noted on the affected side. Clinical evidence of lymphatic obstruction was apparent in two cases with pelvic mass. In the fourth case, venous disease (thrombophlebitis) was noted and the fifth case showed osteomyelitis. The possible mechanism for this phenomenon may include obstruction of the lymphatic or venous circulation and inflammation. Other causes of soft tissue uptake of 99mTc-PYP are reviewed. The above mentioned conditions must be excluded when asymmetrical activity of 99mTc-PYP is seen on routine bone imaging.


Tuberous sclerosis. Report of nine cases and a review. Tuberous sclerosis is characterized by epilepsy, mental retardation and adenoma sebaceum. Seizures and mental retardation were the presenting complaints in the nine cases presented here; however, a variety of clinical manifestations of the disease exist. Early diagnosis facilitates genetic counseling.


Computerized axial tomography in family members of patients with tuberous sclerosis. The diagnosis of unsuspected TS has been reached with the aid of computerized axial tomography. Most cases are sporadic, but incomplete forms of the disease may be difficult to detect. We have, therefore, studied nine immediate family members of four cases with TS. The results were negative in all of them, confirming the earlier notions that, in the absence of adenoma sebaceum in either parent, the disease is most probably sporadic.


What makes adolescent girls flee from their homes? An analysis of 50 such girls studied at Boston Juvenile Court. Fifty girls who were arrested in Boston on a charge of running away and their parents were studied via psychiatric interviews, rating schedules and psychotherapeutic data. There was an absence of psychosis and mental retardation in this group. A diversity of factors leading to running away episodes were elicited. Sexual factors were common. Family disturbances were usually found, reflecting in part the urban areas from which this group came. The girls showed a remarkable uniformity of behavior while on the run. Treatment of the whole family was often necessary for success in dealing with the runaway problem. The importance of intervention promptly is demonstrated by the associated self-destructive behavior of the girls, the frequency of severe family disturbances and the later histories of these youngsters.


Acute transverse myelopathy in childhood. A study of four cases. Four cases and a literature survey show acute transverse myelopathy to be a dramatic but rare pediatric problem. Neurologic deficits can be significant but generally improve with the passage of time. The prognosis for complete recovery, however, is poor.


Analytical subcellular fractionation studies on different cell types isolated from normal rat liver. 1. Parenchymal, Kupffer and biliary tract cells were isolated from normal rat liver by perfusion with collagenase solution. 2. The specific activities (munits of enzyme activity/mg of protein) of marker enzymes for the principal subcellular organelles were determined in the isolated cell homogenates and compared with whole liver homogenates. 3. The cells were disrupted and the extracts subjected to analytical subcellular fractionation by sucrose-density-gradient centrifugation. Lysosomal integrity was determined by assaying latent beta-N-acetylglucosaminidase in the extracts. 4. Similar subcellular distributions were found for lysosomal, endoplasmic reticulum and plasma membrane marker enzymes in the whole liver and in parenchymal and biliary tract cells. In Kupffer cells, the proportion of these enzymes in the cytosol was significantly increased compared with the other fractions. In addition the equilibrium densities of the various organelles in these cells were lower than those from parenchymal cells.


The tubular reabsorption of phosphate in sickle-cell nephropathy. 1. In a series of patients with sickle-cell anaemia, serum phosphate and magnesium concentrations were elevated. Serum calcium concentrations were normal. Urinary excretion of calcium was decreased. 2. The maximum tubular reabsorption of phosphate per litre of glomerular filtrate (TmP/GFR) was significantly increased in these patients. 3. The increase in phosphate reabsorption explains the elevated serum phosphate observed in these patients.


The effects of prednisolone on the rat enterocyte at a subcellular level. 1. Enterocytes, isolated from the proximal jejunum and distal ileum of normal and prednisolone-treated rats, were homogenized and fractionated by isopycnic centrifugation on sucrose density gradients. The distributions of marker enzymes for the principal subcellular organelles, RNA and protein were determined and related to the activities per enterocyte. 2. In enterocytes fromthe jejunum and ileum of prednisolone-treated animals the activities of particulate brush-border enzymes and of both soluble and mitochondrial malate dehydrogenase were increased compared with those of the control system. The equilibrium density of the brush borders was enhanced in the prednisolone-treated jejunum. The modal densities of the other organelles were unaltered by prednisolone administration. 3. There was a large increase in the total RNA content of enterocytes from the jejunum and ileum of prednisolone-treated animals. This was predominantly associated with a distinct particulate component, indicative of a proliferation of the rough endoplasmic reticulum and consistent with an enhanced rate of protein synthesis. 4. Studies of latent brush-border enzyme activities, the mechanical fragility of isolated brush borders and electron microscopy suggest that steroid administration results in no marked alterations in the gross conformation of the brush-border membrane or in the orientation of the enzymes within the membrane.


Comparison of cardiac output determined by a carbon dioxide-rebreathing and direct Fick method at rest and during exercise. 1. To study the validity of a CO2-rebreathing method at rest and during graded exercise, cardiac output was measured simultaneously on 59 occasions in 16 subjects with normal pulmonary function with the CO2-rebreathing method and the direct Fick method for oxygen. The correlation coefficient between the results of both methods was significantly higher during exercise than at rest. 2. No systematic difference was shown between (a-v)CO2 content difference determined on whole blood and end-tidal gas, which justified the exclusion of a correction factor for blood to alveolar gas PCO2 gradients. 3. In the calculation of cardiac output by the direct Fick method for CO2 and by CO2 rebreathing, a standard CO2 dissociation curve was preferred to a synthetic CO2 dissociation curve, constructed by allowance for changes in haemoglobin concentration, pH and oxygen saturation. The latter curve tended to increase values for cardiac output and induced a large dispersion around the line of identity, when compared with simultaneous cardiac output estimates by the direct Fick method for oxygen.


The nature of hepatic cytochrone P-450 induced in hexachlorobenzene-fed rats. 1. The effect of feeding with a diet containing 0.2% (w/w) hexachlorobenzene on hepatic and urinary porphyrins and hepatic cytochrome P-450 was studied at various time intervals in female Wistar rats. 2. Hexachlorobenzene administration for 45 days resulted in the development of porphyria in rats, which biochemically closely resembles symptomatic porphyria in humans, with elevation of urinary uroporphyrin excretion, hepatic uroporphyrin content, and hepatic cytochrome P-450 content, in addition to appearance of porphyrins of the isocoproporphyrin (P1) series in the faeces. 3. Spectral studies of the induced hepatic cytochrone P-450 at 45 days with carbon monoxide and ethyl isocyanide as ligands indicated the presence of a greater admixture of a haemoprotein distinct from cytochrome P-450. 4. Study in vitro of the kinetics of two reactions, namely aminopyrine N-demethylation and 3,4-benzpyrene hydroxylation, catalysed by the hepatic microsomal cytochrom P-450-dependent enzyme system, suggested that hexachlorobenzene induced a form of cytochrome P-450-dependent enzyme system, suggested that hexachlorobenzene induced a form of cytochrome P-450 with different catalytic properties from those of forms induced by either phenobarbital or 3-methylcholanthrene.


The effect of vibration on blood flow in skeletal muscle in the rabbit. 1. The blood flow in rabbit gastrocnemius, as measured by photoelectric drop-counter, increased when the muscle was vibrated at frequencies of 22--62 Hz. 2. Blood flow increased rapidly within 1--2 s of the start of vibration, and lasted for the whole time vibration was applied. 3. The increase in blood flow was negatively correlated with the initial blood flow, being greater with lower flows. 4. The magnitude of increase was similar in both innervated and acutely denervated muscles. 5. The arterial blood pressure did not change apart from a very brief fall at the beginning of vibration. Venous pressure rose and, consequently, the perfusion pressure was lower. The increase in blood flow thus indicates a considerable dilatation in the resistance vessels of skeletal muscle.


The physcial properties of human pulmonary arteries and veins. 1. We have studied the extensibility of circumferential strips of main pulmonary artery and large pulmonary veins obtained at post mortem from patients of all ages, dying from conditions other than heart and lung disease. 2. The vessel strips were submitted to increasing loads in a tension balance. The pulmonary arteries were found to be readily extensible. This extensibility became less with increasing age. The pulmonary veins were virtually inextensible at all ages. 3. It is postulated that the large extraparenchymal pulmonary veins have a capacitative role in supplying blood from the lungs to the left atrium. This may be accomplished by their collapsible nature, as they have little capability of distension.


Haemodynamic variables during repeated exercise in chronic lung disease. 1. Pulmonary and systemic haemodynamics during repeated exercise were studied in 28 patients with chronic lung disease of various etiology, 16 of whom suffered from chronic bronchitis. They performed a moderate exercise repeated after a 20 min rest period. Ventilatory variables, blood gas tensions, cardiac output and vascular pressures (right ventricular end-diastolic, pulmonary arterial, wedge and systemic arterial) were measured at rest, during exercise and again at rest and during the same exercise. 2. Ventilation and blood gas tensions were similar during the two rest and exercise periods; there was, however, a slightly significant difference in oxygen consumption and hydrogen ion concentration between the first and the second exercise period. Pulmonary arterial and wedge pressures were lower during the second rest and exercise, right ventricular filling pressure was lower at rest, and systemic arterial pressure during the second exercise. Cardiac output and pulmonary vascular resistance were unchanged. 3. Changes in systemic arterial pressure were significantly different in a group of patients with arterial oxygen desaturation or perfusion defects, compared with those patients without such impairment.


Propranolol and the ventilatory response to hypoxia and hypercapnia in normal man. 1. The effect on respiration of a single dose of propranolol has been studied in normal subjects. 2. The degree of beta-adrenoreceptor blockade was assessed in terms of the impaired heart-rate response to progressive exercise and the plasma propranolol concentration. 3. No effect of propranolol was demonstrated on either the ventilatory response to rebreathing CO2 in hyperoxia, or the response to progressive isocapnic hypoxia. Simple indices of maximal expiratory flow (FEV 1.0% and PEFR) were also unchanged. 4. The absence of any effect of propranolol on the chemical control of breathing in man is discussed in relation to the conflicting literature.


Evidence for an hepatic anti-ketogenic effect of insulin in man. 1. Infusion of a triglyceride emulsion (Intralipid) into overnight fasted normal subjects produced a rise in plasma free fatty acids (FFA) and blood ketones. 2. Glucose given orally 60 min after the start of the Intralipid infusion produced a sharp fall in blood ketones without much change in plasma FFA. 3. An infusion of glucagon given together with Intralipid did not alter the reduction in blood ketones produced by oral glucose in normal subjects. 4. Oral glucose given 60 min after the start of the Intralipid infusion in three insulin-requiring diabetic subjects produced no fall in blood ketones. 5. The results suggest that glucose prevents the increase in blood ketones after Intralipid through an increase in insulin secretion rather than through a suppression of glucagon or as a direct effect of glucose. 6. It is most likely that the effect of insulin is to inhibit hepatic ketogenesis.


Protective effect of prostaglandin [PGE2] and in glycerol-induced acute renal failure in rats. 1. Acute renal failure was induced in female Sprague-Dawley rats by the subcutaneous injection of glycerol. 2. Four groups of rats were studied; all animals received a glycerol challenge. Group A (control) were sham-operated only, group B received an infusion of sodium chloride solution (150 mmol/l; saline) for 24 h, group C received an infusion containing prostaglandin E2 (PGE2, 1.7 micronmol/l) in saline and group D a solution containing PGE2 (3.4 micronmol/l) in saline. 3. All rats were killed 48 h after glycerol challenge. The degree of renal impairment was assessed by serum creatinine concentration, which did not differ in sham-operated animals and the group receiving saline alone. The group of rats receiving the lower dose  dose of PGE2 has a significantly lower mean serum creatinine concentration than the saline-infused control rats (P less than 0.0025). Creatinine concentration was further lowered by the higher dose of PGE2 but there was not a significant difference in the number of rats showing severe tubular necrosis histologically. 4. The study demonstrates that intravenous infusion of prostaglandin E2 has a protective influence on glycerol-induced renal failure in the rat; the protection afforded may be due to the vasodilator effect of PGE2 and/or an effect on glomerular permeability.


Small-intestinal changes induced by an elemental diet (Vivonex) in normal rats. 1. Rats were fed with the elemental diet Vivonex for 1 or 3 months and their jejunal histology was compared with that of an equal number of rats fed on a normal diet. 2. After 1 month of Vivonex feeding a significant reduction in the ratio of crypt height: villus height (CH:VH) was found in the Vivonex-fed rats (n = 4) compared with the control rats (n = 4) (P less than 0.05). 3. After 3 months the CH:VH ratio was also reduced in the Vivonex-fed rats (n = 18) compared with control rats (n = 18) (P less than 0.002). Villus height was significantly increased (P less than 0.002) and crypt height decreased (P less than 0.05). 4. Jejunal protein content, alkaline phosphatase and disaccharidase activity were also determined in 12 control and 12 Vivonex-fed rats from the 3 months study. 5. Alkaline phosphatase activity was increased from a control value of 201 +/- 8 to 243 +/- 15 munits/cm in the Vivonex-fed rats (n = 12) (P less than 0.05) but no significant changes in lactase, sucrase or maltase activites were found. The observed decrease in the CH:VH ratio suggested an improved survival of the mature enterocyte population during elemental diet feeding.


Sex and the cardiac patient.

Sex and the cardiac patient. Unfounded fears and misconceptions about postcoronary sex can cause much anxiety in an individual and his partner. Hypertension may complicate the clinical picture, and fear of a catastrophic episode may haunt partner as well as patient. Needed medications may further confuse them both by causing chemical impotence or ejaculatory problems in some cases. A good precoronary sexual history can lead to an open dialogue on plans, modifications, and concerns about resuming the patient's sexual exchange upon leaving the hospital. For holistic rehabilitation, good sex information is essential.


Myocardial damage following infarction.

Myocardial damage following infarction. It is likely that the size of the infarct is the main determinant of survival in acute MI. Infarct size can be judged effectively by using simple bedside techniques coupled with accurate interpretation of the chest radiograph. A more sensitive indicator of the patient's hemodynamic status can be gained by using the Swan-Ganz thermodilution catheter. Much more research is required for the development of methods for accurate measurement of infarct size. At present none of these is entirely satisfactory, although the measurement of metabolic substances released into the bloodstream from the infarct, particulary CK enzyme, appears to be the most promising.


Bedside management of acute myocardial infarction. Management of AMI is greatly aided by appreciation of the consequent hemodynamic derangements, which produce the clinical signs of power failure. These can be assessed accurately at the bedside either by clinical evaluation or direct measurement using the pulmonary artery balloon catheter. This evaluation establishes both a short-term prognosis and a direction for therapy. Primary therapeutic alternatives include sedation, propranolol, diuretics, vasodilators, volume infusion, cardiac pacing, pressor agents, mechanical circulatory assistance, and emergency bypass surgery. From this formidable array of potential therapies, a reasonable and consistent choice can almost always be selected, based on our current knowledge of cardiac hemodynamics.


Vitamin E status of young women on combined-type oral contraceptives. Differences in vitamin E status between young Caucasian women using oral contraceptives (OCs) for 1 yr or more and control females were obtained with regard to the following parameters: 1) hemolysis, 2) plasma total tocopherols by spectrophotometric analysis, 3) individual tocopherols by a thin-layer gas-liquid chromatographic (TLC-GLC) technique, and 4) dietary intakes of vitamin E, polyunsaturated and saturated lipids, cholesterol and kilocalories. Ten subjects were on Ortho-Novum- or Norinyl-1/50, 8 on Ortho-Novum- or Norinyl-1/80, and 10 had never taken OCs. Analyses of 24-hr recalls and 7-day dietary records revealed no significant differences among groups for intakes of nutrients listed above. No significant differences among groups were observed from hemolytic values. Plasma total tocopherol concentrations measured by spectrophotometric and TLC-GLC techniques revealed that OC-1/80 subjects had significantly lower values than controls. Marginally inadequate vitamin E status as assessed by the various techniques was observed in approximately one subject in the control and OC-1/50 groups and in 2 of the OC-1/80 women. Large individual variations in vitamin E status were observed for subjects in all groups on similar estimated vitamin E intakes. TLC-GLC measurements of total tocopherols in plasma seemed to be perhaps a more sensitive indicator of vitamin E status of subjects than spectrophotometric analysis of tocopherols.


Phospholipid analysis in testis-epididymis complex after alpha-chlorohydrin administration. alpha-Chlorohydrin, 6.5 mg/kg body weight for 14 days, did not alter total phospholipids, phosphatidyl choline, phosphatidyl ethanolamine, phosphatidyl serine, phosphatidyl inositol and sphingomyelin in rat testis and caput and corpus epididymis. However, marked decrease in total phospholipids, phosphatidyl choline, phosphatidyl ethanolamine and phosphatidyl inositol in cauda epididymis and vas deferens was observed. p32 incorporation also showed similar changes in phospholipids.


No increase of the fibrinolytic activity of the human endometrium by progesterone-releasing IUD (ProgestasertR). An increase in menstrual blood loss  is one of the most common side effects of plastic IUDs and, though less often, also of copper IUDs. This has been explained by the observation that IUD enhances the fibrinolytic activity of the endometrium. A progesterone-releasing IUD (ProgestasertR) does not increase menstrual bleeding. The fibrinolytic activity of the endometrium was studied in 17 women before and after insertion of a progesterone-releasing IUD. It did not enhance the histochemically determined fibrinolytic activity in the endometrium.


Pregnant mare's serum gonadotropin: V. Indomethacin or cortisone and the reversal of antifertility efficacy of pregnant mare's serum gonadotropin. Pregnant mare's serum gonadotropin (PMSG) of 10 IU on day 5 of pregnancy induced luteal demise and consequently an absolute resorption of fetuses and placentae resulted on day 16 of pregnancy. Simultaneous regimen of PMSG and indomethacin or cortisone was found to be consistently effective in preventing the luteolytic effect of PMSG. The growth of the fetuses, placentae as well as corpora lutea was found to be parallel to controls. Similarly, shortening of the duration of pseudopregnancy to 10--12 days in the bilaterally hysterectomized rat by PMSG and its retaining the normal duration of 18--20 days in the presence of indomethacin tempt us to propose that the PMSG-induced luteolysis is possibly reflected through the release of prostaglandin at the ovarian level.


Is development of pelvic inflammatory disease in women using intra-uterine device equal regardless of parity? A one year follow-up study. Seven hundred and fifty women using IUD(TCu 200) were observed for one year after insertion. Sixteen (2.1%) of the women were hospitalized for salpingitis (PID), and the diagnosis was always confirmed by laparascopy. Of these 16 women, 8 belonged to the nulliparous group and 8 to the parous group. In the high-risk age-group (16--25 years), the incidence of salpingitis was 47/1000 women-year in the nulliparous group, and 42/1000 women-year in the parous group. Thus, the rate of development of salpingitis is equal regardless of parity.


Determination of plasma concentrations of d-norgestrel during a one year follow-up in women with a d-norgestrel-releasing IUD. Eight healthy women had a d-norgestrel-releasing intrauterine device inserted postmenstrually and maintained in the uterine cavity for a one year period. Plasma concentrations of d-norgestrel were measured by radioimmunoassay during the one year treatment period. d-Norgestrel could be detected in the plasma of all the subjects within a fairly narrow range during the whole period. The release rate of d-norgestrel was calculated from two IUDs removed after the treatment.


Pituitary and gonadal function during the use of norgestrelestradiol vaginal rings. Four women used polysiloxane contraceptive rings (CVR) impregnated with d-Norgestrel and estradiol for contraceptive purposes. The treatment was given in three-week cycles, leaving one treatment-free week between the cycles. Subjects were followed by blood sampling twice a week for three or four treatment cycles. Plasma concentrations of d-Norgestrel, estradiol, progesterone, and gonadotropins were determined by radioimmunoassay. The bleeding patterns were very acceptable. One subject experienced acne and weight gain, but no other side-effects were observed. Furthermore, no local irritation was found during the follow-up period of six or seven months. The individual variation in the mean plasma concentrations of d-norgestrel was between 3.2 and 1.1 ng/ml. Apart from one case, the highest individual levels were observed at the beginning of the first treatment cycle. Plasma estradiol was low during the treatment, but in some cases low post-insertion peaks were observed. No ovulatory progesterone values were found. Plasma LH was generally suppressed, but FSH was not. During the treatment-free week increasing concentrations of both LH and FSH were found, indicating an activation of pituitary function.


The possible mode of action of prostaglandins: XIV. Evidence of an involvement of progesterone in the initiation of prostaglandin F2a-induced premature labor in rats. Prostaglandin F2a (PGF2a) at a dose of 2 mg/kg (sc) on day 18 of pregnancy induced premature emptying of gravid uteri by day 21 in the rat. Bilateral spaying or luteectomy on day 18 of pregnancy induced a refractoriness to respond to the abortifacient action of PGF2a. Injection of progesterone in the spayed or luteectomized pregnant rats, however, restored the sensitivity of the surgically manipulated animals to PGF2a. Premature parturition resulted in all of the animals so far tested. The importance of progesterone in terms of the abortifacient action of PGF2a is discussed.


Intravas device studies in rabbits: II. Effects on sperm output, fertility and histology of the reproductive tract. Solid (rod) and open (tube) prototype gole-platinum intravas device housings of three different surface designs were surgically inserted into the vasa deferentia of rabbits to test the feasibility of controlling male fertility. The devices were inserted through a short longitudinal slit in each vas deferens, secured with 4-0 silk suture and remained in situ for various periods ranging from 56--426 days. The solid devices completely inhibited the fertility of 6 rabbits in 20 of 21 matings. The fertile mating resulted after the loss of a device in one animal. In contrast, 7 of 9 rabbits receiving identical, but open (i.d. 0.8 mm), devices were fertile in numerous matings. Reduced sperm numbers or sperm-free ejaculates were usually obtained for 2--3 weeks after surgery, but returned to normal following this period. However, sperm blockage due to connective tissue infiltration and eventual encapsulation of the open devices was subsequently observed in about 50% of the animals. Histological changes of the vas deferens at the sites of some of the devices included occasional sperm granulomas, mild focal submucosal edema, mucosal erosion and mild mucosal hyperplasia due to fibroblastic proliferation.


Vitamin and trace mineral metabolism in medroxyprogesterone acetate users. The effect of one year's continual use of medroxyprogesterone acetate as an injectable contraceptive (150 mg I.M. every 90 days) on vitamin (A, B-carotene, E, B-1, B-2, B-6, oral tryptophan load test, folate and B-12) and trace mineral metabolism (Na, K, Ca, Mg, Cu, Zn and phosphorus) were assessed before and at the 3rd week, 3rd, 6th, 9th and 12th months after initiation of daily treatment with a vitamin-mineral supplement, in 12 non-lactating helathy Thai women. Neither vitamin nor trace mineral metabolism changed significantly as a result of treatment when compared to the pre-treatment control, suggesting that this form of hormonal contraceptive did not interfere with any of the parameters studied.


Minilaparotomy as a primary interval sterilization procedure in a high risk population. 200 cases of interval sterilization, using suprapubic minilaparotomy and the Osathanondh uterine elevation technique, were performed. A large number of patients was overweight (58.5%), and some had major medical problems (20%) or had prveious pelvic surgery (4%). All procedures were done under intravenous sedation and local anesthesia on an out-patient basis. The follow-up rate was 97%. Total complication rate was 6%. Neither serious complications nor readmissions to the hospital were found. The overall results were interpreted as demonstrating that the original Osathanondh minilaparotomy technique, with minor modifications, is suitable for use in high risk patients requiring permanent sterilization.


Effects of quinestrol on hepatic function in the rat. Hepatic function in female rats given 200 microgram of quinestrol every 15 days for up to 210 days was studied. Prolonged treatment with quinestrol affected liver weight, serum cholestrol levels, biliar flux, and bromosulphthalein test, but these parameters tended toward control levels after 30 days of treatment. Quinestrol failed to affect alkaline phosphatase, oxalacetic and pyruvic transaminases and the concentration of bilirubin in serum and bile. The effects of quinestrol on hepatic function are similar to the effects of other estrogen derivatives.


Detection of ovulation by a method of change in finger-finger electropotential readings. The purpose of this study was to determine whether ovulation can be detected by using a device (OvultronR) that measures electropotential differences in finger-to-finger contact. Daily basal body temperatures and five consecutive readings on the OvultronR were obtained each morning in 34 women for a three-month period. During one cycle an endometrial biopsy was taken and dated to document the time of ovulation. Our results showed that in only five out of 104 cycles did the device show an isolated change at the time of ovulation. This device is not a reliable method either for prediction of or the detection of ovulation. Therefore, one cannot effectively use this device alone as a basis for a rhythm method of contraception.


Release of contraceptive steroids from sustained release dosage forms and resulting plasma levels. The correlations of plasma levels of levonorgestrel, megestrol acetate and norgestrienone with the doses delivered from subdermal implants and contraceptive rings have been examined. Differences in plasma levels as large as three-fold between different subjects receiving nearly identical doses were observed with all three steroids. The relative plasma levels seen from one subject to another showed high consistency over time. Part of the explanation may lie in differing levels of sex hormone binding globulin, but additional factors must be operative since megestrol acetate binds only weakly with this carrier.


Clinical experience with implant contraception. Subdermal implants of polysiloxane (Silastic) capsules containing a number of synthetic progestagens have been studied in clinical trials to determine their contraceptive effectiveness and acceptability. The steroids studied include norgestrienone (R2010), gestrigone (R2323), megestrol acetate, d-norgestrel, norethindrone, ST-1435, lynestrenol and R-1364. With some of these steroids, studies have been undertaken with a varying number of implanted capsules. The estimated duration of use varies from 6 months to 6 years depending on dose and release rate of the individual steroid. The results of these studies involving about 5000 women in 8 years, indicate in general a high rate of effectiveness, as well as acceptability. Continuation rates at one year were generally 80% or greater. Abnormal bleeding patterns are the major disadvantage. Studies with implatns containing a combination of estrogen and progestogen are being undertaken in an attempt to improve the bleeding pattern.


Clinical trial with subdermal implants containing norgestrienone. Norgestrienone implants delivering approximately 225 microgram/ day were tested clinically for contraceptive effectiveness and acceptability in 145 women. Five pregnancies occurred in 2259 woman-months of use, one in the 11th month, one in the 15th and three in the 16th month of use. Continuation rate at 12 months was 86.7. The number of bleeding runs and bleeding days was increased in approximately 12% of the subjects. Ten percent of the patients had no bleeding in the first 90 days of treatment. Changes in bleeding pattern led to closures in four cases. Headache and signs of mild androgenicity were among the leading side effects. Blood and urine analysis throughout the study showed normal values of 17 different parameters, but a tendency to lower cholesterolemia not associated with changes in thyroid hormone levels, was observed in several patients. Cortisol was found slightly under the lower normal range in one subject without clinical manifestations of hypoadrenalism. It is concluded that norgestrienone implants should be replaced every twelve months for maximal contraceptive effect and because of their efficacy and good acceptability, evaluation of their long term use is warranted.


Clinical chemistry in women treated with progestogen implants. Effects on metabolic parameters of six subdermal implants of d-norgestrel, norgestrienone (R2010) and methylnorgestrienone (R2323) were studied in women. In general, tests remained within the normal range. An exception was increases in serum transaminase levels in several subjects on R2323 implants. Average cortisol values showed a tendency to decrease on all three regimens, but remained within the significance only with R2323 at six months and R2010 at 12 months. Serum cholesterol levels showed significant decreases on R2010 implants.


Sustained intrauterine release of d-norgestrel. Clinical experience with seventy-two first insertions of a d-norgestrel-releasing IUD is reported. Plasma d-norgestrel concentrations were measured in twelve subjects. No pregnancies occurred in the 522 woman-months of use (averaging 7.3 months/subject) that have been accumulated. Removals were performed in six subjects for medical reasons and in seven subjects for personal reasons. Plasma concentrations of d-norgestrel were highest during the first two weeks of use. A decline in the plasma concentration of d-norgestrel occurred and was only 0.05 ng/ml between 30 and 90 days after insertion.


Acute renal failure: clinical aspects and pathophysiology. Acute renal failure may be caused by multiple conditions including those which are due to some direct hemodynamic or nephrotoxic insult. In considering the pathophysiology of these entities, it seems appropriate to differentiate between the initiating and the maintenance phase of the disorder. In the former, renal ischemia and/or a direct effect of a given nephrotoxic agent seems to be the basis for the underlying renal damage. In the maintenance phase, renal functional impairment is maintained by a number of factors which include persistent renal vasoconstriction, tubular obstruction, a leakage of filtrate across damaged tubular epithelium, and a reduction in glomerular capillary permeability. The therapy and possible preventive aspects of these entities are discussed.


Prostaglandins: renin release and renal function. Renal prostaglandins have several potential functions in renal physiology. Perhaps their best documented role is the maintenance of renal blood flow during renal ischemia, although they are apparently not essential to blood flow autoregulation in the absence of ischemia. Alterations in sodium excretion parallel the hemodynamic changes induced by prostaglandin infusions and prostaglandin inhibition with indomethacin. A direct action on sodium balance is unproven. Numerous studies, in vivo and in vitro, have convincingly demonstrated that prostaglandins or their precursors stimulate renin release and prostaglandin inhibition blunts renin release independent of hemodynamic and electrolyte balance. These functions of prostaglandins have implicated them in the manifestations of Bartter's syndrome, the nephropathy of liver cirrhosis, renovascular hypertension, and other nephropathies.


Brain lactate uptake in coma secondary to acute cerebrovascular accident. Relative distribution of lactate, pyruvate, and glucose in cerebrospinal fluid, arterial blood, and jugular blood has been determined in patients in status of coma following cerebrovascular accidents and compared with values obtained in patients without CNS disorders. Ratios of lactate/pyruvate and arteriovenous differences were calculated. In the cerebrospinal fluid of these patients a significant increase of lactate concentration and of the lactate/pyruvate ratio was observed.


Cerebral energy metabolite levels and survival following exposure to low inspired oxygen concentration. To determine the relationship between brain energy metabolites and neurologic status after ischemia-hypoxia, we measured cortical tissue levels of adenosine triphosphate (ATP), phosphocreatine, and lactate. Rats with permanent unilateral carotid occlusion were exposed to 5, 10, and 15 min of hypoxic atmosphere (FIO2 0.048) and, to examine metabolic restitution, 60 min after recovery in rats exposed to the same hypoxic mixture for 15 min. At 5 and 10 min of hypoxia, there were significant reductions in phosphocreatinine and elevations in tissue lactate, but only after 15 min of hypoxia, did ATP levels significantly decrease. By 60 min after recovery, phosphocreatinine values returned to the normal range, ATP values to 15% less than normal, and tissue lactate toward normal. In parallel survival studies, neurological status was examined following hypoxic exposure (PaO2 18 to 19 torr) for 5 an 10 min. Evidence for neurological injury in the form of posthypoxic seizures occurred at a point in time preceding significant changes in brain tissue ATP level. Since injury occurs prior to ATP reduction, changes in brain tissue ATP level may not be an appropirate endpoint for determining brain tissue injury in hypoxia.


Arterial versus venous potassium: clinical implications. A difference between potassium concentrations in arterial plasma and venous serum was evaluated. The difference was 0.5 mM/litre, with a range of 0.1 to 1.1 mM/liter. Multiple factors operating primarily upon the venous sample are responsible for this difference. The value for arterial plasma potassium is stable and preferable, but a revised normal for arterial plasma K+ is necessary.


Aberrant position of a central venous catheter: a cause for inadequate fluid replacement in septic shock. An unusual placement of a "central" venous catheter in the porto-hemiazygous system of a cirrhotic patient in septic shock is described. The catheter was misinterpreted as being located in a central vein and served initially as a guide for volume replacement. The high central venous pressure recorded (22 cm H2O) in spite of signs of hypovolemia led to the introduction of a Swan-Ganz catheter which confirmed the presence of hypovolemia. The proper position of the central venous catheter, especially in cirrhotic patients, should not only be confirmed by plain chest x-ray but also by injection of contrast medium.


Cardiorespiratory and metabolic effects of profound hypothermia. At operation the body temperature of mechanically ventilated infants was initially decreased to 25--22 degrees C with surface cooling and further lowered to 16 degrees C by total body perfusion. During circulatory arrest, averaging 40 min, repair of complex intracardiac deformities was carried out. Rewarming to 36 degrees C was achieved by 35--65 min of total body perfusion. Of 29 infants, 23 under 10 kg survived their correction; normothermic ventilation without added CO2 was given throughout the cooling period. The following measurements were made: gas exchange, lung mechanics, heart rate, arterial pressure, right atrial pressure, cardiac output (Qt), ECG, core and nasopharyngeal temperature, as well as biochemical determinations. During surface cooling O2 consumption (VO2), CO2 production (VCO2), endtidal CO2 (PETCO2) and PaCO2 decreased proportionally and linearly with body temperature. Inspiratory resistance, total compliance, physiological dead space (VD/VT), and the single breath CO2 curve did not reveal disturbed lung function. Mean arterial pressure was 98, 90, and 70 mm Hg and heart rate was 141, 107, and 76 beat/min, at temperature 35, 30, and 25 degrees C, respectively. Cardiac index was 2.2 +/- 0.2 liter/min/m2 (mean +/- SEM, n = 25) 2 hours after surgery. Arterial lactate reached peak values of 4.1 +/- 0.3 mM/liter (n = 17), during rewarming but returned to normal. Respiratory alkalosis caused by hyperventilation during cooling caused no apparent harm. No neurological damage was observed. It is concluded that surface cooling performed with normothermic ventilation under guidance of core temperature, VO2, PETCO2, and VCO2, is a safe method.


A new controllable suction catheter for blind cannulation of the main stem bronchi. A new controllable suction catheter is described which was used for blind cannulation of the main stem bronchi. Cannulation of the right main stem bronchus was successful in 24 of 25 attempts (96%). Cannulation of the left main stem bronchus was successful in 22 of 25 attempts (88%). The use of a controllable tip suction catheter increases the rate of successful cannulation of the left main stem bronchus compared to previous reports in the literature.


Fulminant noncardiogenic pulmonary edema in the critically ill. The relationship between the serum colloid osmotic pressure (COPs), pulmonary artery wedge pressure (PWP), and pulmonary edema fluid colloid osmotic pressure was studied in six critically ill patients with fulminant noncardiogenic pulmonary edema. The relationship between COPs and PWP was also studied in 36 critically ill patients without pulmonary edema. The COPs-PWP gradient was normal in those patients without pulmonary edema. Three patients with noncardiogenic pulmonary edema had markedly reduced COPs-PWP gradients secondary to decreases in COPs. Their pulmonary edema fluid colloid osmotic pressure averaged 61% that of their serum colloid osmotic pressure. Three patients with noncardiogenic pulmonary edema had normal COPs-PWP gradients. Their pulmonary edema fluid colloid osmotic pressure averaged 92% that of their COPs. Noncardiogenic pulmonary edema in the critically ill patient may be caused by either a decrease of COPs-PWP gradient or an increase in capillary membrane permeability.


Unusual complications during pulmonary artery catheterization. Two unusual complications, encountered during pulmonary artery catheterization, are described. In both cases the catheter had been introduced percutaneously with the Seldinger technique. Inadvertent entry of the right pleural space occured in one case in which the catheter had been inserted into the internal jugular vein through a low cervical approach. The second complication was separation of the shaft of the introducer from the hub, with consequent risk of embolization. Possible means of preventing and treating these complications are discussed.


Lung mechanics in patients undergoing mitral valve replacement. The value of monitoring of compliance and resistance. Measurements of compliance, resistance of the respiratory system, and left atrial pressure were made before, during, and after mitral valve replacement in 30 patients. Postoperatively left atrial pressures decreased, resistance decreased and compliance increased significantly. Monitoring and recordkeeping of lung mechanics were found to be useful in predicting the feasibility for extubation and as indicators of impending disasters, e.g., due to bleeding in the thoracic cavity.


Automatic intracranial pressure regulation. This paper emphasizes our approach to control increased ventricular fluid volume and pressure; it utilizes an improved device based upon hydrostatic pressure principles. Intracranial pressure may be maintained at any preselected value, usually 25 cm H2O. Pressure increases beyond this value will result in a venting of fluid into a calibrated reservoir. The hydrostatic column will act to cushion the surrounding ventricular mass, helping to prevent ventricular collapse. The method overcomes the hazards of techniques, using intermittent withdrawal of fluid which requires human judgment. Ventricular pressure response curves performed on a number of patients showed a marked stability with a response less than 2 mm Hg/ml. This indicates a favorable influence on the intracranial compliance. The system is completely closed and its use in 52 neurosurgical patients in over 400 patient days has not been associated with any infection problem.


Multiple organ failure after near-hanging. A case report. Near-hanging and strangulation injuries can result in multiorgan failure. A 13-year-old male sustained an ischemic anoxic cerebral injury that was followed by an encephalopathy lasting approximately 30 hours and pulmonary edema lasting more than 48 hours. The patient was treated with continuous positive pressure ventilation followed by spontaneous breathing with continuous positive airway pressure by a mask; shock was reversed. The loss of cardiovascular competency and pulmonary insufficiency are problems frequently encountered in the patient who has sustained an hypoxic insult. Cerebral injury can result from hypoxemia related to tracheal compression, aspiration, and pulmonary edema; cerebral vascular engorgement secondary to venous compression; and ischemic anoxia related to arterial compression. Cerebral changes continue after circulatory and pulmonary competence has been restored. Multiorgan monitoring and control including intracranial pressure monitoring may be required to guide therapy. Respiratory distress syndrome may develop secondary to multiple factors including autonomic reflexes triggered by cerebral hypoxia and edema.


A closed system device for diagnosis and evaluation of neonatal pneumothoraces. A closed system device with teflon needle, sideholes, and attached stopcock was designed and evaluated for diagnosis and evacuation of neonatal pneumothoraces. Experience with this device has demonstrated specific advantages over existing needles and techniques. Since the system is airtight, diagnosis of pneumothorax can be performed without the risk of introducing air. In addition, the needle sideholes provide more complete and efficient evacuation of air and fluids from the pleural cavity.


A spring-loaded needle for emergency evacuation of pneumothorax. A tension pneumothorax requires immediate relief. Emergency evacuation of pneumothorax using a spring-loaded needle to prevent lung perforation is described. A case example is also presented. Over 3 years, this technique proved to be safe and easy to perform.


Acute life-threatening ventilation-perfusion inequality: an indication for independent lung ventilation. Although reports of independent lung ventilation are found in the literature more frequently, firm criteria for its use have not yet been established. It is probable that major ventilation-perfusion inequality, especially in cases in which the blood flow is primarily diverted to the less ventilated lung, could sometimes be corrected by this technique. The present report deals with such a case and describes the angiographic studies which convinced us that differential ventilation was necessary. By this means we were able to provide successful treatment for patients who had developed preterminal hypoxemia.


Comparison of computed tomography and ultrasound for abdominal aortic aneurysms: a preliminary study. Computed tomography (CT) and ultrasound were equally effective in measuring the external diameter of atherosclerotic abdominal aortic aneurysms in 20 patients. Ultrasound was superior for determining the true lumen caliber and detecting mural thrombi. CT was superior for demonstrating aortic wall calcifications, but no more so than a plain film abdominal radiograph. Ultrasound should be the method of choice in the diagnosis, serial evaluation and management of a patient with an abdominal aortic aneurysm.


Improved ear oximetry with a rubefacient ointment. Arterial blood oxygen saturation measurements were compared with those calculated from arterial blood samples in 51 adult cardiac surgery patients studied in the immediate postoperative period. Each patient's ears were arterialized on a random basis, either by 20 sec of brisk rubbing (control ear), or by the topical application of 0.05 ml of Finalgon Strong Ointment (Boehringer Ingelheim, West Germany) (experimental ear). Oximeter determined control ear measurements averaged 1.69% saturation lower than those calculated from arterial blood gases, whereas the difference averaged 0.38% higher on the ear treated with the rubefacient. A paired sample two-tailed Student's t-test showed significant difference between measurements made on the untreated ear and the calculated controls (p less than 0.001). No difference was found between measurements made on the treated ear and calculated controls (0.05 less than p less than 0.10). Thus, test ointment is useful for noninvasive oxygen saturation measurements with the Hewlett-Packard oximeter, particularly in cold or peripherally vasoconstricted patients in whom ear blood flow would be otherwise inadequate.


Computed tomography-guided biopsy. I. Overview. The authors are preparing a series of communications on CT-guided biopsy procedures to be published in future issues of this journal. The present article, which previously appeared in the Cleveland Clinic Quarterly, is intended to serve as an introduction to the concept of CT-guided biopsies. Because the principles of the biopsy procedure remain the same, we do not believe that a "rewrite" of the previously published article would be required. We hope that by presenting this article and subsequent articles concerning the use of CT-guided biopsies, the reader will acquire an appreciation of the proper role of this exciting new technique in comparison to the available imaging modalities. We believe that as individuals become more experienced with the imaging capabilities of these CT devices, they will want to develop the technique of obtaining biopsy confirmation of the imaging diagnosis.


Computed tomography of the skull base in the coronal plane. Coronal plane computed tomography (CT) is a valuable adjunct to standard transverse plane computed tomography in determining size and extension of intracerebral lesions. Extracerebral lesions at the skull base can also be evaluated by coronal plane CT. The appearances and diagnostic evaluations of these lesions, when used in conjunction with techniques to demonstrate bone detail, form the basis of this report.


Computed tomography of vertebrobasilar artery aneurysm. Review of computed tomographic as well as clinical and angiographic findings in 19 patients with vertebrobasilar artery aneurysms has revealed that there are two roentgenographically and clinically distinct types of aneurysms: saccular and fusiform. The saccular aneurysms often present with acute subarachnoid hemorrhage that differs in distribution from that seen with anterior circulation aneurysms. Small interpeduncular cisternal hematomas are helpful in localization of these aneurysms. Fusiform aneurysms of the basilar artery frequently present as posterior fossa mass lesions and have a fairly characteristic appearance on computed tomograms.


Computed tomography of pediatric craniofacial sarcoma. Review of the clinical and roentgenographic findings in 16 children with craniofacial sarcomas has revealed that CT is the most accurate method for delineation of the sarcomas and is indispensable for proper therapy planning and post therapy evaluation. The patients were examined and treated according to a protocol which required a CT examination before any type of therapy and after each mode of therapy, chemotherapy and radiotherapy. Chemotherapy alone was noted to produce marked reduction in tumor volume. The orbital sarcomas, which are most frequent, are small tumors without bone destruction. On the other hand, the nasopharyngeal, paranasal sinus and middle ear sarcomas are large tumors frequently associated with extensive bone destruction.


Neuropathologic basis of computed tomographic scan abnormalities: a correlative method. The accuracy of CT scan diagnosis can best be studied by comparing the postmortem scan to the corresponding pathologic specimen. To be valid, this comparison must be made in a precise manner: the CT image plane and the pathologic slice plane must correspond anatomically and must be juxtaposed in a specific point-to-point manner. A new method is described which correlates postmortem CT scans and postmortem pathologic specimens. Also considered are the utility and the limitations of matching CT absorption values to homogeneous pathologic lesions such as neoplasms, infarcts, hemorrhage and edema.


The overshoot artifact as an aid in differentiating low densities on the computed tomographic scan. This brief report describes an artifact that is seen as a thin, white rim outlining an air collection on the EMI 80 X 80 and 160 X 160 matrix CT scanners. This artifact is not associated with fat density and, therefore, its recognition allows presumptive differentiation between air and fat densities. The attenuation numbers of the lesion should then be obtained for confirmation.


Protocol for a computed tomography scanner performance repository. An argument is presented for organization of a Computed Tomography Scanner Performance Repository. Performance data on CT scanners would be distributed in statistical form to the radiological community. A Protocol is presented for the uniform collection of data. Results of exposure, resolution and visibility measurements made by the authors are presented for the EMI 5005/U, Pfizer 0200 FS and General Electric CT/T scanners.


Computed tomography in hydrocephalus.

Computed tomography in hydrocephalus. Computed tomography has changed the direction of the investigation of hydrocephalus. Alone or with ventriculography and radionuclide CSF flow studies the types and causes of hydrocephalus can usually be diagnosed. Atrophy with large ventricles, subdural hygromas and mild hydrocephalus may still be difficult to separate. Many of the complications of treatment, such as subdural hematoma, shunt blocks and ventricular isolation, are now visible with the use of computed tomography.


Don't excise--exorcise. Treatment for subungual and periungual warts. I offer yet another modality from that "bag of tricks" used in the management of the common wart, primarily the subungual and periungual varieties, where treatment can be painful, and where the undesirable sequelae of scarring and nail deformities may occur. My method is safe, easy, simple painless, inexpensive, and highly effective. It leaves no scarring or deformed nails. When there are multiple warts on different digits, occlusion of only one wart by this method often results in cure of all. The mystery remains: How and why does this method work? I cannot offer any reasonable or logical explanation. It cannot be all "hypnotic" or "suggestive." Could it be that the airtight occlusion and a chemical reaction set up by the adhesive in the tape might combine to release a chemical or "toxin" causing the formation of antibodies? Whatever it may be, it works. I recommend that you try it.


Urea ointment in the nonsurgical avulsion of nail dystrophies. A nonsurgical and atraumatic method for avulsing dystrophic nails is described. Thirty-five patients with a variety of nail abnormalities were successfully treated using urea preparations under occlusive dressings. The method has many advantages and appears ideal for patients with digital vascular insufficiency and increased susceptibility to infection.


Symptoms of adopted children presenting to a large mental health clinic. The intake records of a selected sample of children adopted in early infancy are reviewed and their presenting symptoms categorized. A majority of the children's symptoms fell into the first 5 of 15 categories: Oppositional Behavior, Aggressive Behavior, Anti-social Acting Out, Academic Problems and Problems with Peers. While these symptoms are not uncommon in non-adoptive clinic cases, the authors note an emphasis on the adoptive parents' disappointment and accusatory attitude to toward these children as well as high incidence of symptoms indicative of interpersonal difficulties and problems in developing solid parental attachments and self-control.


Equivocal neurological signs, child development, and learned behavior. Ten children were tested repeatedly for five motor tasks commonly labeled "soft signs." Finger approximation, walking hell to toe, and the equivocal Babinski improved significantly with practice. These results are interpreted as eliminating these tasks from evidence of "minimal brain damage" and questioning the validity of their inclusion in developmental tests.


Children's reactions to hospitalization and illness. The paper describes children's reactions to illness and hospitalizations from a developmental point of view. Taking the latter into account, it becomes easier to understand not only the child's reaction at different ages and the reasons for it, but the nature of the potential damage, that is, where and why it takes place, as well as the resources available to the child that may help, if wisely used, to minimize the potential traumas.


Expanding the role of supervision in child psychiatric education. Despite the burgeoning of available therapeutic interventions, the sparse literature devoted to child psychiatric supervision concentrates on individual psychotherapy. The non-cognitive aspects of the expanding supervisory challenge continues to converge on the clinician's personality, which is a focus of educational attention only in sequestered or haphazard parts of programs. The unidimensional supervisory literature addresses this issue by questioning the extent to which supervision should resemble traditional pedagogy or personal psychotherapy. In contrast to this emphasis on elusive unconscious influences on clinical work, scant attention has been devoted to other influences stemming from the clinician's current experiences, affiliations, identifications, aspirations and similar more easily modifiable factors that exert considerable leverage and tend to be more accessible to rational scrutiny in supervision. The latter half of this paper discusses these factors.


Sleep habits of children and the identification of pathologically sleepy children. Sleep disorders and daytime sleepiness have been investigated only minimally in children. The sleep habits of 218 children, ages 10-13 years, were surveyed by a sleep habits questionnaire (SHQ). Our results demonstrate that total night time sleep on school nights begins to fall in early adolescence, whereas it remains relatively stable on non-school nights. Daytime sleepiness is not a common problem in this age group, in contrast to a college age population. We conclude that in adolescence chronic sleep deficits begin to occur which cumulatively affect later functioning. The potential use of the SHQ for depicting pathological sleepiness is also discussed.


[Surgical diseases of the veriform appendix]. Various diseases can symptomatically resemble appendicitis. It has been proved that luminal obstruction is the most frequent cause of inflammation of the appendix. There are various causes of obstruction, such as scars, foreign bodies, tumors, granulomas, and dysfunction of coecocolon. Every appendix should therefore be histologically examined. The operative indication for appendectomy should not only include the time factor, but also anamnesis, complaints, and clinical presentation. It is inconsiderate to perform appendectomy as a prophylaxis against appendicitis. Finally, it is surprising that there have been almost no experimental studies on pathogenesis of appendicitis.


[Problems in congenital choledochus cysts]. Congenital choledochal cysts are classified into three types (type A = cystic dilatation, type B = diverticula, Type C = choledochocele). In addition, all cases of types A and B may have anomalies of the pancreaticobiliary duct system. In type I the pancreatic duct enters the common duct and in type II the common duct enters the pancreatic duct. These anomalies are considered etiological factors in the development of choledochal cysts and are important for prognosis and therapy. Types A and B should be mainly treated by choledochocystojejunostomy (Roux-en-Y), while in type C an endoscopic transpapillary splitting is recommended.


[Peritoneo-venous ascite drainage using the Le Veen shunt]. Ascites drainage by using the Le Veen shunt should be attempted after other treatments have failed. A silicon catheter connects the intraperitoneal space with the vena cava superior via a jugular vein. According to our own observations, misleading may occur during the insertion of the venous part of the catheter into the vena jugularis externa. Later, a thrombosis may occur. Intra- or postoperative roentgen controls for corrections or replacements seem advisable.


[Simultaneous occurrence of hyperthyreosis and thyroid carcinoma]. The authors report on the morphological and clinical features of occult thyroid carcinomas confirmed by detailed histological examinations following the surgical treatment of hyperthyreotic goiters recurrent after prolonged thyreostatic treatment, as well as on the follow-up data of the patients. Joint occurrence of hyperthyroidism and thyroid tumors was observed in five patients, two of whom showed progressive endocrine ophthalmopathy. In the surgical preparations of three patients, chronic lymphocytic thyroiditis was also diagnosed. On the grounds of postoperative care, the authors draw conclusions of practical clinical significance. They take a stand on the questions of surgical and adjuvant treatment favored by them in the case of the joint occurrence of the two diseases.


[Morphological aspects of parathyroid gland transplantation. Contribution on the clinical relevance of induced, invasive tissue growth]. The results of morphologic studies performed in 18 patients who had total parathyroidectomy and autotransplantation of parathyroid tissue into the forearm muscle are presented. All patients had long-standing renal disease with azotemia, hyperphosphatemia and high levels of parathyroid hormone. The histologic findings after total parathyroidectomy, before gland transplantation, are important for selection of parathyroid tissue for surgery. Diffuse hyperplasia with the development of multiple nodules of the parathyroids can possibly be adverse for the transplant. In one case, nine month after autotransplantation we found a tumor in the forearm, measuring 2.0 X 3.0 X 2.2 cm in diameter. Morphologic findings in this case before implantation showed diffuse hyperplasia with adenomatous nodules but no signs of carcinoma. The grafted parathyroid tissue after excision was seen with blood vessel invasion in the normal skeletal muscle. In the case of primary renal disease with secondary parathyroid hyperplasia, the light microscopic examination revealed an autonomous tumorlike adenomatous formation in the autografted parathyroid tissue, with graft-dependent hypercalcemia. The invasive growth with some signs of neoplasia following autotransplantation raises the question of the development of certain neoplasia.


[A new use for the freely transplanted omentum. Management of a late radiation injury of the brachial plexus using freely transplanted omentum and neurolysis]. A short review of the structural characteristics and the function of the greater omentum is presented. The results of treatment of secondary lymphedema by free transplantation of the omentum with microvascular anastomoses in the canine model and their relevance for clinical application are discussed. Clinical indications, operative technique, and results of omental transplantation and exoneurolysis of the brachial plexus in seven patients with constrictive, radiation induced brachial plexus paralysis, with and without secondary lymphedema, are reviewed. No effect of the grafted omentum on arm-lymphedema was observed over the entire observation period of 1 1/2--4 years. Minor degree reversion of neurodegenerative changes was found in two patients, in all other patients, these changes stopped. The most impressing result was the immediate and permanent disappearance of pain in all patients.


[Preoperative location of parathyroid adenomas using supraselective parathyroid hormone determination in the blood of the cervical veins]. After a short presentation of advances in biochemical and clinical analysis of primary hyperparathyroidism, the importance of superselective catheterization of the small jugular veins for PTH radioimmunoassay is shown as an improvement of the preoperative localization technique. Since May 1976, the diagnosis of pHPT could be established in 20 patients. Our own experiences with the method of small vein sampling combined with the radioimmunoassay demonstrate that a reliable localization of overactive parathyroid tumors is possible.


[Extra-anatomical bypass in aorto-iliac obstruction]. Our report describes the results of 35 extra-anatomic bypass operations for the treatment of aortoiliac occlusion in high-risk patients. This operation is an alternative to amputation for the therapy of claudication intermittens or gangrene. Long-term results are difficult to obtain, as many patients in this group die early from other causes. The problem of iatrogenic steal phenomenon is discussed. We consider Doppler ultrasound assessment a very valuable method for excluding aortoiliac insufficiency of the donor limb, not detected by other means.


[Colorectal polyps. Pathologico-anatomical and statistical studies on 3037 polyps]. Report on 3037 colorectal polyps from the Deutsche Klinik für Diagnostik Wiesbaden that were observed within about 6 years and submitted to microscopic examination. The polyps were classified according to the WHO nomenclature, 1976. Adenomas and metaplastic (hyperplastic) polyps were the most frequenty types. The terms 'carcinoma in situ,' 'focal carcinoma,' 'adenoma with severe cellular atypia,' and 'malignant polyp' are explained and discussed in view of possible false interpretations by the surgeon. It is stressed that only the term 'adenoma with severe cellular atypia' (WHO classification) should be retained. In 286 cases, primary multiplicity of polyps was observed. There were recurrent polyp(s) in 154 cases (7%). Most frequently the recurrent polyp(s) corresponded to the type that had been found during the first examination. Finally, some remarks are made concerning the techniques of biopsy and of pathological examination.


[Chronic tendovaginitis in parasitic diseases]. A case of chronic tendovaginitis was found to be caused by parasites (filariae). The parasites had apparently been killed by the treatment of the disease. Histologic investigations showed that this pathologic process was a case of the granulomatous form of tendovaginitis. Differentiation from the other forms of tendovaginitis was clearly established by the morphologic picture.


Current state and future trends in the estimation of human genetic risk from environmental chemicals in the Czech Socialist Republic. The paper reviews results achieved in a pilot study about the effect of chemical mutagens on the Czech population. The method of non-work population studies revealed that the most significantly changing category was the frequency of birth defects. In a group of workers occupationally exposed to epichlorohydrin and haloethers, the suitability of cytogenetic analysis of peripheral lymphocytes as an indicator of occupational damage was tested. Current trends indicate that the late effects of genetic damage due to exposure to environmental factors are becoming a population problem. For this reason a program has been worked out for late effect studies to be conducted by the hygienic service and methods are recommended to be used for occupational and non-occupational exposure analyses. Their merits will be experimentally verified up to 1980. The objective of the program is to prove the practical applicability of the two methods and to obtain reliable data for preventive measures to be accepted to reduce the genetic risk to the population and the individual.


Toward a chronopsy: part I. A chronobiologic case report and a thermopsy complementing the biopsy. A prophylactic bilateral subcutaneous mastectomy, following a preoperative mammogram revealed clustered small calcifications in the left breast. In order to investigate the merits of thermorphythmometry, the patient self-measured surface temperature of each breast, above and below the nipple, while awake. In the case here presented, bilateral subcutaneous mastectomy followed by extensive histologic scrutiny of both breasts revealed no indication of malignancy. Bilateral fibrocystic disease with calcification and lobular hyperplasia was found. As compared to the contralateral sites, the atypical epithelial proliferation was more abundant in the mammographically and thermorhythmometrically 'abnormal' area of the left breast.


Role of the immune system in regulation of ovarian function-hypothesis. A hypothesis is presented on the interaction between the immune system and ovary in the regulation of the reproductive system and in the origin of some of its disorders. The cyclicity of ovarian function is considered to be primarily dependent on the induction of a specific cyclic immune response to the ovary. Similarly, the selection of a species-specific number of ovulating follicles during sexual maturity is thought to be ensured by immune mechanisms.


Circadian rhythms of electrolyte excretion in hypertensive patients and healthy subjects. Analysis of data of 10 practically healthy subjects and 43 patients with hypertensive disease has indicated that there are circadian rhythms of urine volume and excretion of calcium, potassium, sodium, magnesium and phosphorus in healthy subjects. In the earlier stages of hypertensive disease significant rhythms of sodium and magnesium excretion are not revealed. However, in patients in the IIA stage of hypertension, circadian rhythms of sodium and magnesium excretion are significant. Such a phenomenon shows that the regulation of sodium and magnesium rhythmostasis has been reestablished. But in the later stages of hypertensive disease breakdown of compensatory mechanisms and dysrhythmostasis are again observed, which are expressed by absence of significant rhythms of cations and urine excretion in patients in the IIB and IIIA stages of hypertensive disease.


Growth and determinism of pupal diapause in a lepidopter Pieris brassicae (L.): a possible role for pigmentary photoreception independent of the daylight rhythm. Facultative pupal insect diapause is induced by daylight rhythm and temperature furnished for the larval growth. Receptors of these factors are generally considered as larval eyes or brain. This work analyzes the possible role of pterobilin pigment of hemolymph and integument. This pigment seems to act independently and, sometimes with antagonistic actions, on the general physiology.


Competing circadian effects of methylprednisolone and rat weight, light chains, immunocytoma size and survival. Eighty-four singly housed LOU rats, 43 males and 41 females, were studied (under conditions standardized for rhythmometry) for the effect of methylprednisolone sodium succinate (MP) upon a transplantable immunocytoma. Body temperature was monitored as a host reference rhythm while light chain excretion and tumor size were monitored to determine an effect upon the tumor. The MP, dissolved in a sweet solution, was consumed by the rats without any statistically significant shift in acrophase of the circadian temperature rhythm. Time dependent effects of MP treatment were observed with respect to 1) tumor size decrement and 2) the survival of treated animals, as compared to untreated animals.


Iron metabolism: clinical chronobiological aspects. Some features of clinical chronobiology are suggested on the basis of studies on the function of time in relation to various parameters of iron metabolism and factors associated with iron metabolism. In particular, so-called normal values, loading tests and the administration of iron (Eryfer) and chelating agents are reviewed in chronobiological terms. Some changes in the rhythms of iron metabolism are also discussed.


Evaluation of patient's knowledge of diabetes self-care. A survey conducted at a Veterans Administration Hospital to evaluate patient capability for self-management found that over 35 per cent of the patients interviewed lacked any formal training. Seventeen patients had been placed on insulin without formal instruction. Almost one half the patients who claimed to have attended training programs could not demonstrate adequate knowledge or skills in any of the major areas of self-care: insulin administration, urine testing, diet, foot care, and management of hypoglycemia and hyperglycemia. While patients with training were more knowledgeable than patients without training, the difference was slight. The results indicate the need for systematic analysis of patient knowledge and the evaluation of training programs on a continuing basis.


Service and education for the insulin-dependent child. A pilot program of service and education was designed to actively involve the inner-city, insulin-dependent child in his own diabetes management. A telephone service for questions and advice, managed by a pediatric nurse specialist, was responsible for a significant reduction in hospital admissions. The project was enthausiastically received and utilized by inner-city residents and resulted in an increased referral rate from the entire metropolitan area.


Microbiology of deep tissue in diabetic gangrene. Information on the incidence and nature of the causative organisms in the infected tissues of patients with diabetic gangrene is scanty. Studies in which material for culture was obtained from the presenting lesion reveal multiple organisms in host isolates. No data are available regarding the bacterial flora of the deep infected tissue itself, uncontaminated by surface organisms. In this investigation 58 specimens from 52 patients were obtained utilizing aerobic and anaerobic culture techniques. In the surgical theater, material was obtained from the infected deep tissues using careful aseptic dissection techniques. All patients had been on antibiotic therapy from 2 to 10 days before the study. An average of 2.3 organisms per specimen was found. The predominant organisms were Proteus sp., Enterococcus, Staphylococcus aureus, and other enterobacteriacae in that order. Anaerobes were isolated in 27 per cent of cases, but never as the only organism. Prior antibiotic therapy did not eradicate infection in infected diabetic gangrene.


Composition of foods commonly used in diets for persons with diabetes. Information on the carbohydrate, protein, fat, kilocalorie, and plant fiber content of 152 common foods has been collated. These data are based on information currently available and will need to be modified and updated as more information emerges. These data are presented in six tables that follow the format of the commonly used Exchange Lists for Meal Planning for patients with diabetes mellitus.


On diabetic osteopathy: a radiographic study of 21 patients. Twenty-one diabetic patients with anesthetic peripheral neuropathy who never suffered a foot infection or local ulceration had roentgenograms of both feet to seek whether osseous changes characteristic of diabetic osteopathy were present. We found nine patients with vascular calcification (all 21 patients had palpable pedal pulses); four patients with ancient fractures; one patient with two phalangeal erosions; and two patients with equivocal osseous cystic lesions. No patient had findings typical of diabetic osteopathy. From this study, plus experience with other diabetic patients who had infected, ulcerated feet, we conclude that diabetic osteopathy represents healing or healed lesions of local osteomyelitis.


Birth of a clearinghouse.

Birth of a clearinghouse. In 1976 the National Commission on Diabetes recommended the establishment of a diabetes information and education clearinghouse on a national level. This undertaking was initiated by the Director, National Institute of Arthritis, Metabolism, and Digestive Diseases, National Institutes of Health, and plans were developed in 1977. Printed diabetes materials for patients, professionals, and the public are being gathered and will be annotated and then published as subject bibliographies. In addition, The Diabetes Clearinghouse will coordinate and encourage diabetes-related education and information activities and efforts throughout the United States.


Some social consequences of partial prohibition in Auckland, New Zealand. Information was gathered from two hospitals, Police, and Traffic Departments in Auckland, New Zealand, for a 4-week period during which beer supplies were erratic or stopped and compared with 4 weeks during normal beer production. Reductions occurred in the mean weekly numbers of accident and emergency admissions at one hospital, in the number of Friday road traffic accidents and injuries reported by the Traffic Department, and in the weekly number of arrests for drunkenness and other alcohol-related offences made by the Police. A larger effect might have been expected in this country, where beer drinking has become an important part of the male lifestyle.


Tilidine abuse and dependence.

Tilidine abuse and dependence. Tilidine (Valoron) is a new strong analgesic which was introduced into the market in West Germany in 1970. In February 1978 tilidine was placed under the regulations of the German Narcotics Act because it had rapidly become an easily acquired substitute for opiates on the drug scene. Cases have become known where tilidine dependence developed during the treatment of pain in patients without any preceding addiction to other drugs. The relevant literature on tilidine is reviewed in regard to pharmacological, epidemiological and clinical aspects of tilidine dependence and abuse.