The use of instructor-patients to teach physical examination techniques. The increasing difficulty in obtaining appropriate hospitalized patients to give enlarging classes of medical students their first exposure to abnormal physical findings has led to the development of an instructor-patient program. Sixteen community residents with relatively stable respiratory, cardiovascular, musculoskeletal, or neurological findings were recruited and trained as instructor-patients to teach the technical elements of the examination of the affected organ system. Evaluation of the technical skills of 46 second-year students trained by instructor-patients and those of 41 randomly selected students trained in these skills by physician instructors demonstrated that the two have comparable technical skills five to eight weeks after the training sessions. Faculty recruitment, instructor-patient recruitment and training, and evaluation are discussed.


Evaluation of training in school health for pediatricians. There is a growing emphasis on the behavioral and psychological aspects of health and illness in pediatric practice. If physicians are to be effective deliverers of health services, they must be knowledgeable in these areas. Training programs, therefore, must expose future primary care providers to behavioral and developmental issues. Evaluating reactions of participants in a school health elective to program content and the effects of such a program on current professional activities is one way to assess the success of programmatic goals and educational techniques used.


Study of U.S. medical school applicants, 1976--77. This annual study contains descriptive statistics on applicants to the 1976--77 freshman classes of U.S. medical schools. In contrast to the growth rates of the early 1970s, the total number of applicants declined slightly for the second successive year. However, comparisons with past applicant pools show a continued increase in the annual number of women applying and a modest increment over the previous year in applicants from minority groups. For the first time in the annual series the 1976--77 study includes data on applicants' size of hometown and summarizes information collected on marital status, country of citizenship, and undergraduate degree level.


Developing an academic administration clerkship for upper-division medical students. It is increasingly apparent that there exists a need for academic administrators and an interest in that field on the part of physicians and medical students. In many academic medical centers physicians are called upon to assume administrative responsibilities or have a desire to pursue an administrative career. Medical students also play an important role in their university's governance through their representation on medical school and university committees as well as their participation in various national organizations. In addition, there continues to be a general lack of understanding regarding the nature of the internal and external variables affecting medical education. The course described in this paper is intended to provide students with an understanding of the administrative responsibilities inherent in academic management positions.


Coping styles of women medical students. As a student health psychiatrist in a medical school setting, the author has had experience in treating women students who present with various psychiatric complaints, ranging from mild depression and anxiety to psychosis. The concept of role strain will be illustrated as it occurs in the context of the presenting complaint and the subsequent treatment course. Issues of feminine sexuality and sex-role adjustment in single and married students will be discussed. Medical schools can increase their awareness of how sex bias and institutional sexism affect the mental health and well-being of women students and can take appropriate steps to lessen the detrimental effects for women in medical school.


Enriching personal and professional development: the experience of a support group for interns. A pilot support group for interns was established at Boston City Hospital early in the internship year to deal with the personal and professional issues arising out of the stresses of the internship. This report describes the functioning of this group, including a statement of goals, content of weekly meetings, and evaluation by group members. In general, the interns felt that the experience was positive and especially valuable in terms of providing support for personal/professional role conflict.


Practice meets theory: a new approach to medical sex education. In the past three years an elective clinical practicum in sex education has been added to the existing human sexuality program at the Howard University College of Medicine. Staff from the Washington, D.C., Department of Human Resources and Planned Parenthood of Metropolitan Washington have trained 84 third- and fourth-year medical students in sex education techniques and supervised their work with 2,100 public school children, mostly fifth- and sixth-grade pupils. Results indicate several advantages to the program: the public schools receive a needed service; the health agencies and the medical school are able to expand their work in the community; the public school students find ready models for identification while learning about sexual issues; and the medical students move from the role of passive learner to that of active teacher.


Decision to enter pulmonology: motives and implications. A study was undertaken to determine at what time American-trained pulmonary disease specialists in two California counties made their subspecialty choices and the factors which influenced their decision. Responses to 281 questionnaires were received and analyzed from 171 fellows, faculty members, and practitioners (60.8 percent). Subspecialty decisions for pulmonology were usually made during residency, motivated by pulmonary rotations and exposure to stimulating faculty members. Although this subspecialty has recently developed into an established, growing field, the survey data confirmed that the amount of pulmonary interaction during medical school remains minimal.


White-noise analysis of biological systems. The linear and nonlinear operations of a biological system can be represented by a set of functions called Wiener kernels. This type of analysis is becoming increasingly important in the field of biological systems analysis. This paper reviews the theoretical and practical aspects of testing a biological system with white-noise and provides a guide for interpreting Wiener kernels which result from such studies. A study of the human electroretinogram is presented as an example.


Digital ultrasonic imaging with microprocessor manipulation. The author describes the development of a digital scan converter system which accepts ultrasonic B-scans in "oscilloscope" format and displays them in video format. The system involves the use of a microprocessor, the function of which is outlined in the paper. A brief comparison with a system employing a scan converter tube is given.


The development of a fibre optic catheter tip pressure transducer. There has been much discussion on the distortion of intracardiac pressure waveforms measured by catheter methods. Tip transducers, which can eliminate this waveform distortion, have several problems. There are manufacturing difficulties with the mechano-electric transducing element. The devices also do not remain stable over variations in temperature and with long term clinical use. Safety problems may also be experienced due to the direct connection between external electronic devices and the heart. In order to overcome these difficulties, the application of fibre optics to the measurement of intracardiac pressure has been proposed. In this paper, the design, construction, and evaluation of a side-hole optic catheter, intended for intracardiac pressure measurement, is described.


Electronic analysis of foetal breathing movements: a practical application of phase-lock-loop principles. Measurement of foetal breathing movements is becoming more common as a means of monitoring processes occurring in the human foetus. Conventional time-period analysis of breathing movements is prone to error owing to their complexity, and it is laborious to decipher any frequency pattern. The described apparatus has been designed to give an on-line visual indication of the instantaneous frequency of foetal breathing movements when measured by a time-distance recorder connected to an echoscope. It is affected insignificantly by spurious signals, and can be build cheaply with easily-available components. Practical trials suggest that frequency analysis by this device can be of value for examining episodes of continuous breathing movements in the foetus.


The resocialization of single-caged chimpanzees and the establishment of an island colony. Single-caged chimpanzees used in medical experimentation were resocialized in the laboratory setting and subsequently established as a socially integrated island colony. The dynamics of their behavioral pathology are described.


The establishment of a chimpanzee breeding colony for hepatitis research. The chimpanzee is the most appropriate animal model for hepatitis B research. Because these primates are scarce and expensive it is important that optimum use be made of available animals and facilities. The establishment of a chimpanzee breeding colony is described and a model for providing primates for research is outlined.


Voltage-induced reflectivity relaxation of bilayer lipid membranes: on changes of bilayer thickness. Temporal and voltage-induced changes of reflectivity (R), the optical phase difference in transmitted polarized light, of tension and total capacity of bilayer lipid membrane (BLM) were studied. The membranes were mainly formed from total brain phospholipids (TP) in n-alkanes. 1) Reflectivity of "black" regions of films made of TP in decane and hexadecane decreases by several percent with a time constant (tauR) of about 30 min, whereas that of membranes with hexane and heptane does not depend on time (with an accuracy up to 1--2%). The BLM tension decreases appreciably in the course of time and reaches its steady-state value in tens of minutes after complete blackening of the membrane. 2) Under prolonged (up to tens of minutes) action of voltage (V) no R changes of BLMs with hexane, heptane, and hexadecane were revealed at a noise level of 0.2%. Blms with decane usually respond to voltage application, first by a rapid (jump-like) and then by a slow decrease of R with a value spread from 0.2% to 3%. 3) With higher amplitude and temporal resolutions of the signal (signal averaging method) it can be seen that after voltage jump R decreases down to a new steady-state value: at V = 100 mV, deltaR/R = -(2--4) . 10(-4) and tauR approximately 0.1 msec for BLMs from TP in heptane, and deltaR/R = -(3--6) . 10(-2) and tauR approximately 2 msec for BLMs from oxidized cholesterol in decane. It is shown in the latter case that the great value of deltaR/R is due to the contribution of invisible microlenses. In all the cases deltaR approximately V2. 4) It is concluded that at voltage jump a bilayer first becomes thinner due to volumic compression of its hydrocarbon core; then it spreads with a time constant of the order of 0.1 msec, getting thinner until a new equilibrium state is reached. Complete change of bilayer thickness is detah/h approximately -10(-4) at 100 mV.


On the physico-chemical basis of voltage-dependent molecular gating mechanisms in biological membranes. The possible nature and theoretical treatment of electric field-induced molecular processes in a membrane are examined. Special attention is given to fairly fast switching phenomena as reflected by asymmetry currents as well as ionic gating in squid axon and similar systems. The apparent charge displacement associated with the underlying mechanisms is argued to be brought about by conformational transitions of integral macromolecular structures. Under these circumstances, voltage changes can actaully control the functional state of membranes by direct interference with conformational equilibria. A basic model is quantitatively discussed and shown to account for certain observed asymmetry currents. Effects due to temperature, pressure, or chemical interactions can be readily described. It is indicated how more complicated voltage-dependent membrane processes may be approached along these lines.


Quantitative analysis of activation and inactivation of asymmetry currents in biological membranes, based on a conformational transition model. A basic voltage-dependent conformational transition mechanism is proposed. It comprises one relatively fast conversion between two individual states which are comparatively slowly coupled with a third state. Having introduced voltage as an additional parameter of state, standard methods of thermodynamics and rate theory are employed to describe the equilibrium and kinetic behavior of the system. In particular, a quantitative discussion is given regarding the asymmetrical displacement currents generated by switching on and off a voltage pulse. Effects of temperature, pulse duration, and application of a conditioning prepulse are examined. The results provide a comprehensive basis for a quantitative analysis of pertinent experimental work. The so far presented measuring data can indeed by very well described along these lines.


A potassium conductance activated by hyperpolarization in paramecium. Voltage clamp studies show that the wild-type membrane of Paramecium tetraurelia contains a conductance component which is sensitive to hyperpolarization. This component manifests itself as "anomalous", or "inward going", rectification of membrane voltage in response to applied constant current pulses and as a "hyperpolarizing spike" when no K is added to the external solution (Y. Satow, C. Kung, 1977. J. Comp. Physiol. 119:99). Like the conductances which underlie anomalous rectification in other cells, the hyperpolarization-sensitive conductance in Paramecium is specific for K, and the magnitude of the voltage-dependent conductance change depends not only on voltage but also on external potassium concentration. The internal potassium ion concentration of Paramecium is calculated to be between 17 and 18mM.


Fatty acid and alcohol partitioning with intestinal brush border and erythrocyte membranes. Relative partition coefficients of fatty acids and alcohols between aqueous buffers and biological membranes have been determined from the linear relationship between isotope content of sedimented membranes and aqueous concentration. This technique allows study of highly lipid soluble compounds such as long-chain saturated fatty acids. Rat intestinal brush border membranes and erythrocyte ghost membranes were studied by using homologous series of saturated fatty acids, mono-unsaturated fatty acids and 10, 12, and 14 carbon normal alcohols. The influence of chain length on partitioning was similar in the three series with an incremental free energy of -820 cal/mole per methylene group in brush borders for the saturated fatty acids. Incremental enthalpy and entropy were -1331 cal/mole and -1.64 cal/mole, degrees K respectively. Decrease in the partition coefficient due to the double bond (monounsaturated relative to saturated) had an incremental free energy of +1178 cal/mole, incremental enthalpy of -3453 cal/mole, and incremental entropy of -7.34 cal/mole, degrees K, while substitution of the hydroxyl for the ionized carboxyl group (pH 7.4) increased the partition coefficient by 72-fold. From these data it must be concluded that the lipid phase of the membrane bilayer is extremely hydrophobic, similar to heptane or polyethylene in polarity.


Electrical resistance of rabbit submaxillary main duct: a tight epithelium with leaky cell membranes. The electrical resistance of rabbit salivary main duct epithelium has been measured. A small axial electrode, which passed current and measured potential simultaneously, was placed inside the ductal lumen. A cylindrical spiral was wound around the main duct and served as outside current electrode. The instantaneous current voltage relations were linearly up to current densities of 1.5 mA/cm2, independently of the Cl concentration in the bathing solutions. Strong polarization effects were observed in low Cl solutions. There was a significant inverse correlation between the spontaneous potential difference across the epithelium and the epithelial resistance in solutions with either high or low Cl concentrations. In high Cl solutions the epithelial resistance was 12.2 + 1.8 (n = 7) omegacm2. The resistance increased when the mucosal Na and Cl concentrations decreased. After addition of ouabain the resistance always decreased. The temperature dependence of the resistance was determined, and apparent activation energies were calculated. Values for activation energies ranged from 3.2 to 6.5 kcal/mol, depending on the ionic composition of the bathing solutions. Addition of amiloride to the mucosal solution led to an increase in resistance by a factor of 2.1 in high Cl solutions and of 4.1 in low Cl solutions. When ouabain was applied before amiloride, there was no effect on the resistance in high Cl solutions and a smaller increase in the resistance in low Cl solutions. The results of this study support the conclusion that the low resistance of main duct epithelium resides in the cell membranes and is not due to a paracellular pathway.


Magnesium influx in dialyzed squid axons. The influx of magnesium from seawater into squid giant axons has been measured under conditions where internal solute control in the axon was maintained by dialysis. Mg influx is smallest (1 pmol/cm2 sec) when both Na and ATP have been removed from the axoplasm by dialysis. The addition of 3 mM ATP to the dialysis fluid gives a Mg influx of 2.5 pmol/cm2 sec while the addition of [Na]i and [ATP]i gives 3 pmol/cm2 sec as a value for Mg influx; this corresponds well with fluxes measured in intact squid giant axons. The Mg content of squid axons is 6 mmol/kg axoplasm; this is unaffected by soaking axons in Li or Na seawater for periods of up to 100 min.


Effects of ethacrynic acid on ion transport and energy metabolism in slices of avian salt gland and of mammalian liver and kidney cortex. Ethacrynic acid greatly inhibited net transport of ions and aerobic, energy-conserving metabolism in slices of avian salt gland, rat liver, and rat and guinea-pig kidney cortex. The effects of increasing concentrations of ethacrynic acid on the transport of Na+, K+ and Cl- ran closely parallel to its effects on tissue ATP levels and respiration. The concentration needed for maximal inhibition of transport reduced ATP levels by 80--90%. Respiration was reduced by 80--90% in salt gland and kidney cortex, and by a maximum of 30% in liver slices. The effects of low concentrations of ethacrynic acid required time to become fully manifest in some tissues, and the development of transport inhibition followed a similar course to decline of respiration and ATP levels. Ca2+ extrusion by liver cells was inhibited by ethacrynic acid. The concentration dependence of the inhibition was similar to that shown by the other transport systems inhibited. There was no distinction evident between the sensitivity of Na+ extrusion and of K+ accumulation to the diuretic. Lactate production increased as respiration decreased in the presence of increasing concentrations of ethacrynic acid. We conclude that ethacrynic acid acted primarily as an inhibitor of mitochondrial respiration and ATP synthesis in the tissue slices, and that inhibition of ion transport was a nonspecific consequence of the failure of the energy supply.


Comparative studies on the fine structure of purple membrane from Halobacterium Cutirubrum and Halobacterium Halobium. Direct comparison of the absorption and circular dichroic spectra of dark- and light-adapted purple membrane from Halobacterium cutirubrum and Halobacterium halobium indicated no apparent species differences. In addition, sequential bleaching and regeneration of the purple membrane with concomitant monitoring of the absorption and circular dichroic spectra showed no species differences as well. Furthermore, perturbation of the structure of the purple membrane from either species with a detergent, Triton X-100, yielded similar spectral changes. It was concluded: (i) no apparent differences exist in the molecular organization and protein fine structure of the two purple membranes, (ii) if exciton interaction among the retinal chromophores is a reasonable possibility in the case of the purple membrane from Halobacterium halobium, it must be similarly so for the membrane from Halobacterium cutirubrum, (iii) the effects of light adaptation on the membrane structure of both species are essentially the same, and (iv) the underlying molecular mechanisms for the bleaching and regenerative processes must be similar, if not identical, for the purple membranes of the two species.


X-ray microanalysis of epon sections after oxygen plasma microincineration. Dark-gold sections of osmium tetroxide-fixed, Epon-embedded brown adipose tissue before and after low-temperature oxygen plasma microincineration were examined using a high-resolution scanning transmission electron microscope and an energy-dispersive X-ray spectrometer. Microincineration produced ash patterns which were free of organic matrix, chlorine (from the Epon) and probably osmium (from the fixative). X-ray sensitivity was improved by a factor of 2-4 owing to decreased background, and sulphur, calcium and probably phosphorus were detected in the ash. Fidelity of the ash patterns permitted microanalytical spatial resolution of 0.1 micrometer or better. Oxygen plasma microincineration is thus shown to offer advantages for high resolution X-ray microanalysis of conventionally sectioned biological material. Its future application to shock-frozen, frozen-dried, unstained sections is indicated.


A perspicuous technique for directly visualizing radiation-damage artefacts in biological electron microscopy. Levels of impairment of electron-microscopic images of biological specimens stemming from radiation damage are assessed in a rapid visual procedure that involves taking a pair of low-fluence micrographs of a specimen area before and after a fraction of the picture area has been more seriously damaged by applying a measured electron fluence. The pair of micrographs is treated as a mock-stereo pair and is given contrasting colours. Lateral displacements of specimen details appear as false relief and changes in electron lucency as false colour.


Adverse drug reaction: implications for providers of health care. Adverse drug reactions are defined and examples are given. Four areas of concern are addressed, namely, defining drug reactions, identifying some of the factors contributing to the adverse drug reactions, implications of adverse drug reactions for health-care providers, and preventive measures which impact on the occurrence of adverse drug reactions. It is implied that increased knowledge and research are important factors in the control of these problems.


Self-medication.

Self-medication. Self-medication and drug interaction have been a problem in recent years. Pharmacists in ethical pharmacies and neighborhood establishments can best monitor these problems through use of patient profile records and consultations. The pharmacist should advise the public on over-the-counter (OTC) purchases. Auxiliary labels are recommended for use on containers to prevent drug interactions. Members of the black community have some specific problems with respect to self medications. These are addressed in this article. Self-medication, under supervision, is proper and can be controlled.


Noncompliance and drug toxicity in black, poor, and aged patients. Drug toxicity is a common medical problem. Continued increases in drug toxicity are related to the extensive, indiscriminate use of drugs. This is a national health problem which is caused partly by gaps in pharmacology as a basic and clinical science and partly by the rapid proliferation of drugs (the drug explosion) in the past 30 years. Socioeconomically disadvantaged (black, poor, and aged) patients are particularly vulnerable to compliance problems and drug toxicity. In this presentation we discuss the basis for this increased vulnerability and suggest strategies that practicing physicians can use to minimize both compliance problems and drug toxicity.


Drugs and nutrition.

Drugs and nutrition. The importance of a balanced diet with proper quantities of foods cannot be overemphasized. Consideration must be given also to food's digestion and absorption, transport to tissues, and utilization by cells. Interference during any stage of this process can result in nutritional deficiency. Certain foodstuffs can alter susceptibility to a drug, and certain drugs can affect the nutritional status of an individual.There are special considerations to be taken in giving drugs to patients with certain diseases in the treatment of which diet therapy plays an important role. Extra consideration and monitoring must be done when dispensing certain drugs to such patients because of their special nutritional requirements.


Drug therapy in children.

Drug therapy in children. Foolproof guidelines and rules for the administration of drug therapy to children are not available. In particular, the use of weight, height, and age as the basis for drug dose calculations can lead to serious errors in dosage. Extreme care must be used in the treatment of pregnant women as most drugs cross the placenta. The potential effects of a drug on the fetus must be weighed against the need for the drug in the mother.Special attention must be given to the lactating or breast-feeding mother since most drugs are excreted in breast milk and potentially can adversely affect the nursing infant. Where possible, drug therapy in children should be avoided. If drugs are specifically indicated, the dosage should be calculated after considerable scrutiny of the total management and the goals of the management regimen. Careful followup of every child on even the simplest drug is mandatory.


Drugs and alcohol.

Drugs and alcohol. Millions of people in this country take medications, and millions drink alcohol. Both are drugs and have effects on the organs and systems with which they or their metabolites come in contact. This short article discusses some of the combined effects of prescribed drugs and alcohol on some systems, with special emphasis on the liver.


Altered states of consciousness.

Altered states of consciousness. Medicine, sex, and religion are presented as related areas of human thought and behavior in which people traditionally have sought temporary release from daily living. In essence, these areas represent a search for altered states of consciousness. The harmful way is through drug addiction.Five common characteristics are cited for the three areas. Examples of their universality are traceable by their omnipresence and their appearance in most childhood games-especially those taking on sexual nuances-which are usually hidden from adults.If Eastern knowledge and control of bodily processes were geared to Western technology, mankind would benefit.


Look at it this way: some aspects of the drug mix-up problem among black, poor, aged, and female patients. Black, poor, aged, and female patients are more susceptible to having to face problems of loneliness and stress, feelings offailure, sagging egos, and other psychological and emotional difficulties. Relief of these feelings is often found through artificial supports such as over-the-counter drugs. Because of the easy accessibility of such drugs as sleeping pills, weight control pills, and vitamins, an individual could have a bottle of almost any drug medication advertised in the media without physician supervision. Ignorance of the cumulative impact of mixing medications often leads to habit-forming results and significant side effects.A major step toward prevention of drug abuse is to know that someone cares and will reach out to patients before the problem drives them to seek relief from over-the-counter medications and drugs. A second major step is education about the hazards of mixing medicines without physician supervision.


Workshop conference management by objectives: a unique application. This report highlights some personal observations of the tasks involved in developing, managing, and evaluating the Drug Mix-up Workshop/Conference. It concludes with recommendations for success in future projects.


A new noninvasive method for the simultaneous determination of cardiac output, VA/QC disparity, and the magnitude of peripheral perfusion, suitable for use in the critically ill patient. A noninvasive technique for determining cardiac output, lung blood-tissue volume, and the volume of perfused body tissue in shock states has been developed from analysis of the pulmonary washout of several physiologically inert tracer gases. Canine preparations and a computer-based simulation were used to evaluate the accuracy and feasibility of the technique. The dogs were ventilated with 10% helium, 10% N2O, 0.45% C2H2, 39.5% N2, and 40% O2 mixture, and washed out with 60% N2 and 40% O2. End-tidal volume excretion differences between the three inert gases helium, N2O, and C2H2 resulted from differences in the blood/gas partition constants (lambda) of the test gases. Helium, which has a very low lambda, is contained in lung air space, whereas N2O and C2H2, with moderate lambda's, are distributed to lung air space, blood, and perfused tissues. Computer modeling of the cardiopulmonary and body perfusion gas transport permitted calculation of alveolar ventilation, VA/VA disparity, pulmonary blood-tissue volume, pulmonary blood flow, VAQć, and perfused body volume in the canine experiments. In experimental shock settings and in a variety of control situations over an eightfold range of flows the pulmonary blood flow calculated from the N2O and C2H2 washout was generally within +/- 15% of the cardiac output determined by the cardiogreen technique.


Fracture healing in weight-bearing and nonweight-bearing bones. Animal models demonstrated the differences in the process of fracture healing in weight-bearing and nonweight-bearing bones. Canine rib fractures regained strength properties rapidly; in canine radial fractures the return to normal stiffness levels was primary. The structural differences in fracture healing are probably functional and due more to biologic reorganization than to any measurable change in the biochemical components of the callus.


Tourniquet control of liver bleeding.

Tourniquet control of liver bleeding. Many methods have been described for control of bleeding from the liver. We have found that the technique of simply securing a 2 1/2 cm (1-in) Penrose drain as a tourniquet around the left or right lobe of the liver is a rapid and effective method of obtaining hemostasis. The tourniquet can be used to temporaily control bleeding so individual points can be secured, or tied down onto the liver and removed later. This method has been used without complications in five patients with severe liver trauma. Serial liver function studies obtained on all patients found no significant alterations in any.


Effect of nicotinic acid on vascular permeability after thermal trauma in the rat. Nicotinic acid has been suggested to decrease plasma volume loss after thermal injury. However, conflicting data have recently appeared, in reports of laboratory measurements of major derangements in cardiovascular function after large third-degree thermal injury. We investigated the microvascular effect of nicotinic acid on water and albumin leakage after a small second-degree thermal burn in the rat. No effect of nicotinic acid on albumin leakage was observed at 1/2 hour, 3 hours, or 6 hours; a minimal but significant (p less than 0.05) decrease in water content of burned tissue was observed 1/2 hour postinjury. Our studies confirm in rats previous work with sheep and dogs demonstrating that nicotinic acid has slight, if any, effect on fluid and protein loss after thermal injury.


Life-support training in high-density population centers. Death and disability from ischemic heart disease, trauma, and other medical emergencies may be reduced significantly by developing an Emergency Medical Services system based on training for the nonmedical population in basic life-support skills; this is particularly appropriate in high-density population centers where professional response time is complicated by confestion and traffic. A pilot project in New York City, which designed and implemented a first-response capability for medical emergencies in corporations, using employees in a system congruent with the fire warden plans in effect, was completed in May 1977. To obtain an initial assessment of the medical impact of such training and the effectiveness of such a medical emergency response system during the pilot phase, The Regional Emergency Medical Services Council of New York City, Inc., obtained reports from the 24 participating corporations on all reported medical and surgical emergencies occurring in the working environment. The authors conclude that this approach to development of a first response-capability can provide an effective community base for an effective Emergency Medical Services system in urban areas.


Rupture of the diaphragm in patients wearing seatbelts. Six diaphragmatic ruptures seen in a consecutive series of 435 cases of blunt abdominal trauma (1946-1976) are analyzed. All of the ruptures were sustained in car accidents, three of them with fatal outcome after severe trauma with multiple injuries. Four of the patients wore safety belts: in three of them a rather specific injury combination occurred--diaphragmatic rupture, multiple costal fractures, and pelvic or vertebral fracture. The role of the seatbelt in the pathogenetic mechanism of the rupture is discussed, and the possibility that the cause is the placement too high on the trunk, especially in short individuals, is raised.


The complementary uses of nuclear medicine and ultrasound in the kidney. Together, sonography and renal isotope techniques can provide greater information than either technique alone. These studies can replace excretory urography in the diagnosis of hydronephrosis and renal infarction. Arteriography is no longer necessary for the diagnosis of a pseudotumor, which has a specific isotope and a helpful sonographic appearance. The diagnosis of a renal abscess opposed to pyelonephritis can be made in a more definite fashion than is possible with other imaging techniques. We believe that the sonogram and isotope studies are particularly helpful in trauma because there is a more realistic assessment of the absence of renal function with isotopes than with the excretory urogram. One may detect hematoma within and around the kidney by ultrasonography.


Experimental and preliminary clinical experience with thermography for avascular nephrotomy. A simple method is presented for demarcation between different arterial areas, which allows the performance of nephrotomies with minimal bleeding and subsequent renal ischemia. The thermal gradient that exists between the segment with occluded blood supply and the adjacent ones retaining their blood supply is defined by a liquid cholesterol crystal sheet.


Renal cyst puncture: utilization of pediatric guide wire technique and upright radiographic changers. After puncture of a renal cyst with a polytetrafluoroethylene needle a pediatric 0.021-inch guide wire is inserted through a polytetrafluoroethylene sheath needle. The sheath is then advanced over the wire. The technique is controlled by fluoroscopy or performed under ultrasonography. Aspiration of the contrast material is performed, and then air and diatrizoate meglumine and diatrizoate sodium are injected to outline the borders of the cyst. The patient is then taken to an upright and lateral radiographic changer for routine radiography in the upright and decubitus positions.


Surgical treatment of renovascular hypertension associated with bilateral renal artery stenosis. We report on 15 patients operated upon for renovascular hypertension associated with bilateral renal artery stenosis. Followup has been for 1 to 12 years. Four of 5 patients with positive split renal function studies and 3 of 5 patients with positive renal vein renin assays underwent unilateral operations on the positive side. All of these patients were cured or improved. The guide for unilateral operations in hypertensive patients with bilateral renal artery stenosis by angiography was the physiological information obtained from the preoperative screening tests, especially the plasma renin activity ratios of the 3 different veins and the split renal function studies.


The treatment of renal cell carcinoma with solitary metastasis. Between 1950 and 1970, 44 patients (2.5 per cent) with renal cell carcinoma and a solitary metastatic lesion were treated at our clinic. Generally, treatment was aggressive, involving nephrectomy and excision of the metastatic lesion when possible. Patients presenting with the primary and metastatic lesion at the same time did not do as well as patients who presented with metastasis after nephrectomy. An operation for the metastatic lesion seemed to offer the best results in patients who presented with the solitary metastatic lesion after nephrectomy. The prognosis was uniformly poor in patients presenting with the primary and secondary lesion together, regardless of the mode of therapy. However, an operation seemed to be better marginally and did produce an occasional long-term survival.


Introduction of the Gibbons ureteral stent facilitated by antecedent percutaneous nephrostomy. Patients in whom retrograde catheterization of the ureters has failed can have the Gibbons catheter placed by a new technique that requires no regional or general anesthesia. This technique entails antecedent percutaneous nephrostomy and passage of an angiographic catheter down the ureter. The catheterizing apparatus is attached to the angiographic catheter and then pulled into position.


A plea for antireflux operations in adults: review of 50 cases. The results of antireflux operations in 41 cases of primary and 9 cases of secondary vesicoureteral reflux in adults are presented. Reflux was eliminated in all cases and there were no postoperative complications. Most patients had a long history of urinary tract infection preoperatively, which was eliminated in 64.1 per cent of the cases after surgical correction of the reflux. A relapse of infection occurred in 30.8 per cent of these cases. Chronic pyelonephritis remains active in 5.1 per cent of the cases. There were 6 patients with serum creatinine levels higher than 1.8 mg. per cent who underwent a successful antireflux procedure without an increase of serum creatinine levels. An antireflux operation should be preferred over long-term conservative management in most cases of symptomatic vesicoureteral reflux in adults less than 50 years old.


Ureteroneocystostomy in the treatment of reflux in neurogenic bladders. There were 15 patients with neurogenic bladders, representing 23 renal units with reflux, who underwent reimplantation with the Politano-Leadbetter technique. The over-all success rate was 30 per cent. Failures, including persistent reflux or obstruction, were demonstrated on at least 1 side of all bilateral reimplantations and 3 of 7 unilateral procedures. These results are compared to those in the recent literature. We conclude that case selection, limiting the operation to only those patients with balanced bladders, will ensure uniformly good results. External sphincterotomy in patients with reflux may alter the clinical course, either obviating the need for reimplantation or creating a balanced bladder. Other forms of therapy, such as urinary diversion, are indicated only in those patients who persist with markedly abnormal bladders and renal deterioration.


Neurogenic bladder in the woman with multiple sclerosis. Fifty women with proved multiple sclerosis were grouped according to the severity of the disease (measured urodynamically) and followed for 5 years. All patients were asymptomatic initially. The symptoms, urodynamic results and therapy are discussed. As the disease progresses in a stepwise fashion bladder symptoms become more pronounced. With current methods of treatment and followup better control of the symptoms can be expected.


Percutaneous radiofrequency sacral rhizotomy in the treatment of the hyperreflexic bladder. Percutaneous radiofrequency rhizotomy was performed on 7 patients with a hyperreflexic bladder to augment bladder capacity and to make intermittent clean catheterization more feasible or stop precipitous micturition. Urodynamic evaluations were done before and after rhizotomy. A successful result was achieved in 6 patients. Patient selection and methodology are discussed and some of the previously reported series of rhizotomies are compared to the present study.


Biopsy of apparently normal urothelium in patients with bladder carcinoma. We obtained 246 cold cup biopsies from pre-selected sites of apparently non-tumor-bearing bladder urothelium from 82 patients who presented with bladder cancer for the first time. Of 75 patients with transitional cell carcinoma 32 (43 per cent) suffered coincidental urothelial abnormalities, the most common being atypia. Significant abnormalities occurred more commonly (77 per cent) in association with high grade tumors than with low grade tumors (15 per cent).


Squamous cell carcinoma of the bladder.

Squamous cell carcinoma of the bladder. Medical records were reviewed for 17 consecutive patients hospitalized with a diagnosis of squamous cell carcinoma of the bladder. This number represented 6.5 per cent of all patients with bladder cancer seen during the study period. All 4 patients who underwent cystectomy and urinary diversion are well 3 1/2 to 6 1/2 years after treatment. All 13 patients treated with various other modalities are dead, with an average survival from diagnosis to death of 9 months. It is concluded that cystectomy is the treatment of choice for patients with squamous cell carcinoma of the bladder that is not already stage D.


Spinal cord and nerve root lesions in children presenting with urinary dysfunction. Three cases of bladder dysfunction as the first indication of tumors involving the spinal cord and sacral nerve roots are presented. The correct diagnosis was delayed in each instance. The relationship of such tumors to bladder dysfunction is discussed and the need for careful history and physical examination is stressed. It is emphasized that neurologic disease may present with urinary dysfunction. Neurological symptoms, physical findings and radiographic abnormalities of the spine should be noted.


Voiding pattern abnormalities in normal children: results of pharmacologic manipulation. Urodynamic studies were done on 50 children with voiding pattern abnormalities, characterized by daytime incontinence, damp pants, nocturnal enuresis, frequency and recurrent urinary tract infections. These studies included cystometry, uroflowmetry and pelvic floor/external urethral sphincter electromyography. Of the 50 children studied 37 were treated with various pharmacological agents based on 8 recognized urodynamic patterns. Thirty-one children (84 per cent) became totally asymptomatic while on pharmacotherapy and 4 (11 per cent) demonstrated marked improvement in clinical symptoms during the course of this study. Appropriately directed urodynamic studies and treatment with specific pharmacological agents can treat (retrain) effectively children with voiding pattern abnormalities.


Cutaneous transureteroureterostomy as a form of diversion in children with a compromised urinary tract. Our experience with children who require supravesical diversion in the face of a compromised urinary tract indicates that in selected cases transureteroureterostomy with cutaneous ureterostomy will lead to a stabilized urinary tract that will be free from infection and postoperative complications.


The persisting mesonephric duct: high junction of vas deferens and ureter. We describe 9 examples of a rare congenital anomaly in which the unduplicated ureter joined the vas and exhibited long persisting mesonephric ducts that resembled the ureter rather than the vas. Some of the kidneys were unexpectedly well developed. It is proposed that a cranial ectopic ureteral bud may have induced a metanephric kidney in the region of the mesonephros or the ectopic bud and the metanephric blastema were displaced cranially.


Ectopic vas deferens.

Ectopic vas deferens. Two infants with ectopia of the vas deferens are described. To date 11 cases have been reported, comprising a total of 13 ectopic vas insertions, 2 of which are bilateral. A classification of 2 types of ectopic vas is presented with a discussion of their relationship to ureteral ectopias. An embryological hypothesis of a proximal vas precursor segment of the wolffian duct is related closely to Stephens' theory of ureteral development.


Urologic complications of neonatal umbilical arterial catheterization. Two cases are presented illustrating the emergent and potentially lethal complications of neonatal umbilical artery catheterization that may confront the pediatric urologist. Immediate aortography via the umbilical artery catheter usually will be diagnostic. Prompt surgical intervention is advocated if uncontrollable renovascular hypertension or a false aneurysm is found.


Anuria secondary to renal artery obstruction in a solitary kidney: 9-year followup. A patient with a prior nephrectomy for renovascular hypertension experienced complete anuria secondary to renal artery occlusion. Revascularization 75 hours later resulted in prompt diuresis, recovery of renal function and a 9-year survival. Serial preoperative renal function studies are presented. Deterioration of renal function and recurrent hypertension are believed to have heralded the onset of arterial obstruction to a solitary kidney. The literature concerning the etiology of renal artery occlusion and the rationale for therapy are reviewed.


Detrusor-sphincter dyssynergia and detrusor hyperreflexia leading to hydronephrosis during intermittent catheterization. Two cases of spinal cord injury with detrusor-sphincter dyssynergia and detrusor hyperreflexia are presented. In 1 patient bilateral hydronephrosis developed between 3 and 7 months after injury while he was on intermittent catheterization. In the other patient early sphincterotomy (3 1/2 months post-injury) was not followed by upper tract changes. Urodynamic evaluation should be done before intermittent catheterization is continued for more than 3 months after spinal cord injury. The importance of early diagnosis and appropriate management of detrusor-sphincter dyssynergia associated with detrusor hyperreflexia is discussed.


Extraction of ureteral calculi from patients with ileal loops: a new technique. A technique is described by which calculi can be removed from the distal ureters of patients with ileal conduit urinary diversions. A percutaneous nephrostomy is done and an angiogram catheter is manipulated down the ureter past the obstruction. After the angiogram catheter is retrieved from the loop with a Bumpus forceps a stone basket is attached, pulled up the ureter and opened. The stone can then be captured under fluoroscopic control and, by replacing the stone basket with a silicone splint, the ureteroileostomy also can be splinted. This may be important particularly if there is extravasation from the ureteroileostomy after stone manipulation or operation.


Long blind-ending ureteral duplications. Long blind-ending ureteral duplications can be symptomatic and require surgical intervention. Three patients with long blind-ending ureteral duplications had prominent reflux and required either resection of the blind ureter and ureteral reimplantation or nephroureterectomy.


Ureterolymphatic backflow.

Ureterolymphatic backflow. A case is reported of apparent radiologic demonstration of a communication between a completely obstructed distal ureter and its draining lymphatics in a patient with invasive bladder tumor involving the ureteral orifice.


Association of HLA-B27 antigen with retroperitoneal fibrosis. This is the second known case of retroperitoneal fibrosis in a middle-aged black man whose tissue type was HLA-B27 positive. The HLA-B27 antigen is present in only 4 per cent of black American male subjects and may be important in the diagnosis and management of patients with primary retroperitoneal fibrosis. A genetic predisposition is suggested for the development of idiopathic primary retroperitoneal fibrosis in patients who are HLA-B27 antigen positive.


Urethral valves as a cause of dilated Cowper's glands and perineal pain. Symptoms of lower urinary tract obstruction are the most frequent manifestation of congenital posterior valves. A case is presented in which the initial symptom was perineal pain. Diagnosis was delayed because of a false diagnosis of prostatitis. Urethrography and cystography showed posterior urethral valves and dilated Cowper's glands. Bilateral incisions of the valves with the knife electrode resulted in disapperance of the pain and regression of the dilated Cowper's glands.


Solitary leiomyoma of the prostate presenting as an encrusted intravesical mass. A leiomyoma of the prostate presented as an encrusted intravesical mass on excretory urography. A prostatic leiomyoma usually is benign and is relatively rare with only 41 cases reported previously. Surgical and pathological findings and differential diagnosis are presented.


Estrogen-induced porphyria cutanea tarda complicating treatment of prostatic carcinoma. A case of porphyria cutanea tarda secondary to stilbestrol in a man with carcinoma of the prostate is reported.


Symptomatic bacterial urinary tract infections in men: limitations of quantitative urine cultures. Occasionally, physicians have discarded the diagnosis of acute symptomatic bacterial urinary tract infection when the urine coutn failed to approach or exceed 100,000 organisms per ml. Previous studies done in women have established the fact that sole reliance cannot be placed on this value to exclude the diagnosis of symptomatic bacterial urinary tract infection. A retrospective analysis of the charts of male patients, with an unequivocal diagnosis of symptomatic bacterial urinary tract infection, demonstrates the limitations of the urine colony count as a diagnostic test in men.


Xenon ventilation-perfusion lung scans. The early diagnosis of inhalation injury. The use of xenon Xe 133 ventilation-perfusion lung scans for the early diagnosis of inhalation injury was evaluated in 67 patients with acute thermal burns. Study results were interpreted as normal if there was complete pulmonary clearance of the radioactive gas by 150 seconds. Thirty-two scans were normal, 32 abnormal, and three technically inadequate. There were three true false-positive study results and one false-negative study result. Good correlation was found between the scan results and various historical, physical, and laboratory values currently used to evaluate inhalation injury. The scans appeared to be the most sensitive method for the detection of early involvement, often being abnormal several days before the chest roentgenogram. Xenon lung scanning is a safe, easy, accurate, and sensitive method for the early diagnosis of inhalation injury and has important therapeutic and prognostic implications as well.


Abdominal epilepsy. A cause of abdominal pain in adults. Four patients, aged 17 to 47 years, had paroxysmal abdominal pain associated with symptoms suggestive of a CNS disturbance. None had a discernible primary gastrointestinal process, but each had EEG abnormalities and a striking response to anticonvulsant medication. These findings suggest that abdominal epilepsy should be considered in the differential diagnosis of unexplained paroxysmal abdominal pain.


Hospital costs and mortality attributed to nosocomial bacteremias. Hospital patients with nosocomial bacteremia and matched hospital control patients without this infection were used to determine the excess hospital costs and mortality attributed to nosocomial bacteremias. Mortality was 14 times greater in patients with nosocomial bacteremia than in matched members of the control group with the same primary diagnoses. An itemized cost analysis, based on 81 case-control pairs, showed an average excess of approximately $3,600 in direct hospital costs for patients who had nosocomial bacteremias. It is estimated that only 24% of the total excess costs to these hospital patients are preventable. Patients with nosocomial bacteremia had an average hospitalization period that was 14 days longer than the average hospital stay for members of the control group.


Electroconvulsive therapy in patients with pacemakers. A patient with an R-wave inhibited permanent pacemaker required electroconvulsive therapy (ECT). Possible interference by this therapy with pacer functioning through external interference or internal interference by inhibitory myopotentials was eliminated by temporary conversion to fixed rate pacing before ECT.


Disseminated Cryptococcus treated with transfer factor. Cardiac toxic reactions and pulmonary consolidation in the left lower lobe developed in a patient who was receiving amphotericin B therapy for cryptococcal meningitis. Following surgical resection of the lobe, multiple subcutaneous cryptococcal abscesses appeared. Flucytosine administered intravenously failed to eradicate the lesions. Transfer factor therapy and multiple drainage procedures elimniated the skin abscesses. Transfer factor therapy was administered for one year; the patient was asymptomatic 16 months after therapy was discontinued.


Undetected tuberculosis in prison. Source of infection for community at large. Discovery of two cases of infectious tuberculosis in a state prison in 1976 prompted a careful study of the entire population of 1,500. Eight more cases were found, giving a morbidity of 670/100,000 (arkansas rate, 21.1). The epidemic was aborted by the use of isoniazid and the establishment of a program for screening and periodic retesting. Clear evidence was found for intramural spread of the infection, and eight of 16 persons with clinical tuberculosis from 1975 to 1977 had entered the prison uninfected. Nine percent of 800 men with tuberculosis in Arkansas from 1972 through 1977 had "done time" in this particular prison. In January 1978 a child died of tuberculosis transmitted from a former inmate who had been infected while incarcerated in 1976 but released without therapy. Tuberculosis morbidity was 6.5 times greater in state prisons than in the general population.


Myocardial infarction and other vascular diseases in young women. Role of estrogens and other factors. We studied 83 women younger than 46 years with acute myocardial infarction (MI) and 154 controls. There was a strong positive association between MI and the following: (1) age, (2) both oral contraceptive and noncontraceptive estrogen use, (3) cigarette smoking, and (4) the presence of predisposing medical conditions, eg, past MI, hypertension, and diabetes. ABO blood type and family history of arterial disease were also positively associated with MI. Whereas the risks for idiopathic stroke and venous thromboembolism have also been shown to be increased among oral contraceptive users, there is comparatively little correlation between these two illnesses and age or smoking in young women. The present study, taken together with previously published work, provides reasonable estimates of the vascular risks associated with oral contraceptive use.


Fatal compulsive water drinking.

Fatal compulsive water drinking. In two cases of psychogenic polydipsia, water intoxication developed and contributed to the patient's death. The treatment of the patient with psychogenic polydipsia has been based on the presumed reversibility of the condition. Treatment of such patients must be reconsidered in light of these deaths.


Rubella-vaccinated students. Follow-up in a public school system. In a 7 1/2-year follow-up evaluation of the duration of rubella-vaccine-induced immunity of students who received either HPV-77 DK-12 or Cendehill vaccine, both groups showed a continous decline in hemagglutination-inhibition antibody from seven weeks after vaccination but a lower decline between 4 1/2 and 7 1/2 years after vaccination. However, at 7 1/2 years only 16 students (8%) receiving the Cendehill vaccine and one student (0.5%) receiving the HPV-77 DK-12 vaccine lacked detectable antibody. Despite the persistence of antibody titers, there was evidence of subclinical rubella among both groups of vaccinated students. These results emphasize the importance of continued evaluation of the conditions of persons receiving rubella vaccine.


Aarskog syndrome. New findings and genetic analysis. A patient had several unusual findings that, to our knowledge, have not previously been reported in the Aarskog syndrome (facio-digital-genital syndrome). On the basis of published pedigrees, the data strongly support an X-linked recessive mode of inheritance.


Megavitamins for minimal brain dysfunction. A placebo-controlled study. Preliminary to a stimulant comparison study, 31 children with minimal brain dysfunction randomly received either placebo or a megavitamin combination. During a two-week trial, only two children responded so well that stiumlants were not considered necessary; both were in the placebo group. Change scores from pretest to posttest on four blind ratings by teachers and parents did not show a significant difference between the placebo and vitamin groups.


Tamoxifen flare in advanced breast cancer. The antiestrogen tamoxifen citrate is an effective antitumor agent in postmenopausal women with advanced breast cancer. The drug has produced relatively few and generally mild side effects. However, a not uncommon clinical phenomenon that may falsely suggest premature discontinuation of tamoxifen therapy has become evident to us and has not yet been sufficiently emphasized in the literature. We have designated this phenomenon as the tamoxifen flare. It consists of transient, at times severe, increase in pain with an apparent worsening of the patient's clinical status occurring within the first few weeks of therapy. In each of six patients experiencing this flare (45 patients treated) pain subsided despite continuation of tamoxifen therapy, followed by a partial remission lasting from six to 20 months.


Rural health care. Medical issues.

Rural health care. Medical issues. Problems in the provision of health care to rural areas in the United States include the distribution of health workers, health care facilities, preventive services, quality of care, and economics. The problems must be clearly identified and defined if solutions are to be effective, and the cooperation of several sectors of the community is required. Community organization and political activity are often necessary to convince legislators and medical schools to assist rural communities in a solution of their major problems.


Inaccuracy of house staff in reading throat cultures. The low prevalence of streptococcal pharyngitis in our pediatric clinic during a normally high-prevalence period encouraged us to examine the accuracy of throat culture readings made by the house staff. Six pediatric residents processed 256 cultures, which were then reinterpreted by a microbiologist. The residents consistently underread the cultures, failing to identify 68 (60%) of 112 with beta-hemolysis and 23 (58%) of 40 with a zone of bacitracin inhibition. This inaccuracy in interpretation of throat cultures emphasizes the physician's need to periodically reassess these skills.


Aortic insufficiency with mild ankylosing spondylitis in black men. Two black male patients with aortic insufficiency were later found to have mild, asymptomatic ankylosing spondylitis, evident from roentgenograms and from the presence of HLA-B27 antigen. The two cases emphasize the even "subclinical" ankylosing spondylitis may have aortic insufficiency, and that the uncommon occurrence of ankylosing spondylitis in black patients may also be associated with this extra-articular manifestation.


Hemoperfusion in the management of digoxin toxicity. Resin hemoperfusion was used in a long-term dialysis patient who inadvertently ingested a quadruple dose of digoxin for five days. Severe gastrointestinal symptoms improved, and impressive plasma digoxin clearances were observed. Cellulose-coated activated charcoal was used in another patient who had ingested a massive dose of digoxin. Gastrointestinal and CNS symptoms improved, and second-degree heart block with life-threatening bradycardia cleared during hemoperfusion. Digoxin toxicity may be added to the list of conditions that can be treated by this method.


Prognostic importance of pruritus in Hodgkin's disease. In 1971 participants in the Ann Arbor Conference on Hodgkin's disease thought that pruritus had no independent prognostic importance. We reviewed our series of patients with Hodgkin's disease and found six patients in whom severe itching was a major clinical problem. When compared with similarly treated patients without pruritus, these patients appeared to have more-aggressive disease. Severe itching, alone or with B symptoms, needs further study, since it may presage a poor prognosis.


Metastatic non-oat-cell bronchogenic carcinoma. Therapy with cyclophosphamide, doxorubicin, methotrexate, and procarbazine (CAMP). Fifty-four patients with metastatic non-oat-cell bronchogenic carcinoma were treated with cyclophosphamide, doxorubicin hydrochloride (Adriamycin), methotrexate, and procarbazine hydrochloride (CAMP). Eighteen of 51 of these patients with measurable disease showed an objective response to CAMP chemotherapy, with a median survival of 12.6 months. Eight of the 18 patients are still alive, and two have been in continuous remission for 20 and 26 months. Survival for patients with stable disease was 12 months, similar to that for patients demonstrating objective regression in response to CAMP treatment. Weight loss, performance status, and dominant site of metastases proved to be important prognostic factors. The CAMP regimen was well tolerated; there were only two drug-related deaths, both secondary to infectious complications.


Routine chest roentgenography in pregnancy. In an effort to determine if routine prenatal chest roentgenograms were of practical value, the records of 12,109 consecutive deliveries at the Mayo Clinic were reviewed retrospectively. The roentgenograms were obtained during the first or second prenatal visit and additionally when warranted by notable symptoms or physical findings in subsequent prenatal visits. Forty-eight patients had appreciable roentgenographic abnormalities. The findings of the general medical examination (which was routinely done at the first prenatal visit) were reviewed to determine if the chest abnormalities would have been suspected from the results of physical examination alone. In every case, a positive history or abnormal physical finding would have suggested the presence of the major abnormality or of the need for roentgenography to be performed.


Telemedicine in pediatric primary care. Favorable experience in nurse-staffed inner-city clinic. Off-site pediatric consultation via bidirectional cable television (TV) was instituted to provide backup for nurse practitioners treating sick and well children in a small primary-care clinic. During a year of study of the system, there were 2,161 clinic visits and 285 TV consultations. When both TV and telephone consultation were available, TV was used for 10.8% of the visits, and telephone was used for 9.6% of visits. Staff reactions, though initially skeptical, were ultimately favorable. The system allowed pediatric nurse practitioners to function without on-site physician coverage 40% of the time. The main disadvantages were technical. Further work is needed to assess the reliability and validity of TV consultation and its acceptability in other settings.


Prazosin in the diagnosis and treatment of pheochromocytoma. In a patient with paraganglioma, severe hypertension due to high levels of plasma norepinephrine was easily controlled with prazosin hydrochloride, 6 to 8 mg/day for 19 days before surgery. A prolonged antihypertensive response to the first two 1-mg doses suggested the presence of pheochromocytoma. This experience dramatizes the remarkable effectiveness of prazosin as a postsynaptic alpha-adrenergic receptor blocker and invites further trials of the drug for both the diagnosis and treatment of pheochromocytoma.


Clinical evaluation of new office spirometer. The accuracy of a simple, pneumatic, direct-recording spirometer suitable for office use was evaluated by comparing spirometry on a water-sealed, 13.5-liter, water-filled spirometer for 120 patients. Good correlation between the two spirometers was seen through a wide range of values for forced vital capacity, forced expiratory volume in one second, and forced expiratory flow during 25% to 75% of forced vital capacity, with coefficients of correlation being .988, .988, and .948, respectively. All correlations were significant. The pneumatic spirometer is accurate, simple to operate, and suitable for spirometry in the office and clinic.


A temporal profile of changes in myocardial copper after isoproterenol induced cardiac necrosis. The changes in myocardial copper were studied over a period of five days after producing myocardial necrosis in albino rats by subcutaneous injection of isoproterenol. Two different doses of isoproterenol (85 mg/kg & 42.5 mg/kg) were used to study the effect of variation in the extent of myocardial damage on the behaviour of myocardial copper. It was interesting to note that there was mainly an increase in myocardial copper with the lower dose of isoproterenol whereas there was mainly a fall in myocardial copper with the higher dose of isoproterenol. It has been hypothesized that this difference in behaviour of myocardial copper with respect to the different doses of isoproterenol is related to the extent of the myocardial tissue which escapes injury. Confirmation of myocardial necrosis was done by ECG, enzymes (SGOT, SGPT & LDH) and histology. Estimation of myocardial copper was done by atomic absorption spectrophotometry (Perkin Elmer 303).


Effects of graded coronary constriction on regional oxygen and carbon dioxide tensions in outer and inner layers of the canine myocardium. This study was undertaken to investigate the effects of graded coronary constriction on regional gas tensions of the myocardium. In 12 open chest dogs, tissue carbon dioxide (PtCO2) and oxygen (PtO2) tensions were measured simultaneously in outer and inner layers of the myocardium using a mass spectrometer. In normal condition, higher PtO2 and lower PtCO2 were observed in outer layer than in inner layer. With application of coronary constriction, increase in PtCO2 and decrease in PtO2 were observed in both layers of the myocardium, but the response to the ischemic stimuli by applying coronary constriction in inner layer was different from that in outer layer. Severe coronary constriction, more than 90% in its diameter, was necessary to produce significant changes in both gas tensions in both layers of the myocardium. Decrease in PtO2 was found in the condition of less severe coronary constriction and to be greater in inner layer than in outer layer of the myocardium. In terms of the changes in PtCO2, inner layer was also more susceptible to the ischemic stimuli than outer layer. The greater and earlier elevation of PtCO2 in inner layer than in outer layer is regarded as one of the possible mechanisms of the reduction of myocardial contraction in the early stage of myocardial ischemia.


Studies on the QRS wave of the spatial magnitude electrocardiogram in ventricular septal defect. The QRS wave of the spatial magnitude electrocardiogram (ECG) was investigated in 86 cases of the ventricular septal defect (VSD). The relationship between the amplitude and the time interval of QRS wave of the spatial magnitude ECG and the various hemodynamic parameters obtained by the right heart catheterization and the defect area ascertained during the operations were evaluated.


Glucose tolerance in spontaneously hypertensive rats. In order to clarify the relationship between essential hypertension and glucose metabolism, and to approach the pathophysiology or the etiology of essential hypertension, we examined glucose tolerance test (GTT) using spontaneously hypertensive rats (SHR) as models. SHR, namely stroke-prone SHR (SHRSP) and stroke-resistant SHR (SHRSR) always had higher serum glucose levels at each GTT phase than normotensive control Wistar-Kyoto rats. They also tended to show higher levels in the young even at 5 weeks of age rather than in the adult. These results indicate that hyperglycemic tendency or lower glucose tolerance may be a characteristic of spontaneous hypertension and may be related to the mechanism of hypertension.


Hyperuricemia associated with hypertension. A 4-year follow-up study of hyperuricemic hypertensives. We investigated the prognosis of 153 hypertensive patients, whose initial concentration of serum uric acid had been evaluated. One hundred and seventeen subjects could be followed up after 4 years and 16 of them died during the follow-up period. Cerebrovascular disease was seen in 6 subjects, 4 of whom died from the disease. Myocardial infarction and heart failure occurred in 9 and 7 of them died as a result. The frequency of these diseases was greater among the hyperuricemic group and 8 of the 11 who died belonged to this group. Four men were struck by gouty attacks. They were all hyperuricemic and had been proven to have at least one family member with asymptomatic hyperuricemia and/or gout. It is reasonable to regard the presence of hyperuricemia as one of the poor risk factors for vascular diseases. I addition, we must investigate more closely personal and family histories of gout when we see hyperuricemic subjects, regardless of absence of gouty symptoms.


A-V block and A-V dissociation in electrocardiographic surveys of middle school students. (1) ECG surveys were performed on 12,523 middle school students. The incidence of A-V block was 0.04% (0.37% in males and 0.43% in females). The incidence of A-V dissociation was 0.11% (0.09% in males and0.13% in females). (2) There was no case of Mobitz type II or complete A-V block in this survey. (3) Sixty-four school students were picked at random from the students with A-V block who had been diagnosed by ECG surveys during the  last there years and were given the Master's two-step test. The following four types of response were recognized; Type 1, Type 2, Type 3A, B, C, and Type 4. (4) Elevation of ASLO and antistreptkinase (ASK) were found in 6.4% and 13.5%, respectively. The serum cold agglutinin titer was elevated in four of the 12 students tested. (5) Most students with A-V block or A-V  dissociation had no past history of severe disease or no major complaints.


Cytotoxicity assay against cultured heart cell in rheumatic heart disease. Non-specific cytotoxicity of peripheral lymphocytes from healthy subjects was observed by stimulation of PHA and PWM. Peripheral lymphocytes from patients with reheumatic fever and rheumatic heart disease was cytotoxic against 51Cr labelled cultured heart cells in vitro.


The metabolism of digitoxin in hepatic cirrhosis of human subjects. Digitoxin, 1 mg, was orally administered to 12 cirrhotic patients (the 6 in a clinically compensated and the 6 in a decompensated state) and their serum concentrations were measured at 6 hours and everyday through 7 days by radioimmunoassay. The serum half-life of digitoxin in these groups and normal subjects, determined from the serum concentrations, was as follows: 4.7 +/- 0.55 days for controls, 4.9 +/- 0.45 days for the compensated group and 5.3 +/- 0.35 days for the decompensated group. No statistically significant difference could be found in half-life among these groups. (P less than 0.2). The same dose of digitoxin was orally administered to 6 cirrhotic patients and 6 control subjects and their left ventricular systolic time intervals, LVET and QS2, were determined at 6 hours and every morning for 7 days. Cardiac responses, exhibited by decrease in the systolic time intervals, in both control subjects and cirrhotic patients dissipated in fair parallel during the ensuing 4 days and returned to base line level by 5 days. From these both biological half-life and physiological effect, it may be concluded that overall metabolism of digitoxin in cirrhotic patients is not disturbed.


Mitral insufficiency secondary to mucocutaneous lymph node syndrome. A case report of successful surgical treatment. A three-year-old girl with mitral regurgitation due to mucocutaneous lymph node syndrome (MCLS) but with normal coronary arteries was treated surgically. Although no definite pathologic lesions causing severe mitral regurgitation except for dilatation of the mitral annulus were found at operation, some minor changes implied focal ischemia of the posterior papillary muscle. A poster-medial annuloplasty was performed without significant residual regurgitation. This is the first patient successfully treated by surgery for mitral valve incompentence due to MCLS. However, additional clinical experiences will be needed to evaluate surgical treatment for this group patients.


[Effects of fosfomycin sodium upon renal functions (author's transl)]. Effects of fosfomycin-sodium (FOM-Na) upon renal functions were studied with male rats. 1) After fasting for 24 hours, 25 ml/kg body weight of physiological saline were orally administered and respectively 160 and 320 mg/kg of FOM-Na were intraperitoneally administered immediately thereafter. The subsequent urinations amounts at 4 hours' interval were determined to see no effect of FOM-Na upon the urination amount. 2) After suspending water supply for 2 days, 1,000 mg/kg of FOM-Na were intraperitoneally administered once a day for successive 2 days. On the 3rd day, 50 ml/kg of dextran were intraperitoneally administered, and one hour thereafter, 1,000 mg/kg of FOM-Na were intramuscularly administered to hind leg. Blood samples were collected the following day (suspension of water was continued until blood sample collection) to determine the BUN and UA in serum. FOM-Na was found exerting on reinforcing effect upon renal dysfunctions caused by dextran.


[Study on tobramycin concentration in bone marrow (author's transl)]. Tobramycin (TOB) concentration in the bone marrow of tibia was examined 1, 2, 3 and 4 hours after intramuscular injection of 60 mg: TOB concentration in the bone marrow of tibia 1 hour after injection was 2.8 +/- 0.578 microgram/ml. Ratio to serum was 87.5%. TOB concentration in the bone marrow of tibia 2 hours after injection was 1.6 +/- 0.480 microgram/ml. Ratio to serum was 94.1%. TOB concentration in the bone marrow of tibia 3 hours after injection was 1.1 +/- 0.337 microgram/ml. Ratio to serum was 84.6%. TOB concentration in the bone marrow of tibia 4 hours after injection was 0.8 +/- 0.372 microgram/ml. Ratio to serum was 80.0%. Penetration capacity of TOB into the bone marrow of tibia was excellent.


[A study on serum level and urinary excretion of fosfomycin-Na in man with special reference to pharmacokinetic analysis (author's transl)]. FOM-Na was investigated on its distribution after a continuous intravenous drip infusion in 3 healthy adult volunteers, and its serum levels and urinary excretion were pharmacokinetically analyzed, while the excreted substance into urine was also analyzed with GC/MS. The results obtained are summarized as follows: 1. The distribution volume of FOM-Na in one-compartment open model was 0.183 L/kg, half life in human body 1.66 hours and renal clearance 0.0737 L/hr/kg. 2. With these pharmacokinetic constants, the mean values following various doses demonstrated almost equal irrespective of its dosage schedule, keeping an almost constant level in each individual tested. 3. The area under serum level-time curve was approximately 216 microgram.hr/ml per 1 g (potency), and increased in proportion to an infused dose within the range of 1 approximately 6 g (potency). Three consecutive administrations showed no trend of accumulation of the agent in the serum. 4. Urinary excretion of the agent was found to be very fast, and its recovery rate from urine within 10 approximately 11 hours after the completion of an i. v. drip infusion was approximately 95 approximately 99%. 5. As a result of GC/MS on the substance excreted into urine, it was noted that FOM-Na was not metabolized in human body and excreted into urine in its original form. 6. There was seen no specific change in electrocardiogram during and/or after an intravenous drip infusion in 1 hour of 2 g (potency) FOM-Na dissolved in a 300 ml 5% glucose solution.


Acute toxic effects of chaetoglobosin A, a new cytochalasan compound produced by Chaetomium globosum, on mice and rats. A new cytochalasan compound, chaetoglobosin A produced by Chaetomium globosum, was studied for its toxicity to animals. By subcutaneous injection, 2 mg/kg body weight of chaetoglobosin A killed young Wistar rats acutely, and in the mouse of DDD strain, LD50 values of chaetoglobosin A were estimated 6.5 and 17.8 mg/kg for male and female, respectively. By oral administration, 400 mg/kg of chaetoglobosin A caused little adverse effect on mice and rats. Pathological examination of the mice, injected subcutaneously with 5 mg/kg of the toxin, revealed marked edema at the injection site which appeared in several hours after injection and subsided in a week. In other tissues necrosis of the thymus and spleen and degeneration of the spermatocytes in the testicles were noticeable. With characteristic cytotoxic effects like cytochalasin B, chaetoglobosin A is an interesting mycotoxin, although it may be of little significance as a food- or feed-borne toxin.


Studies on the adjuvant effect of water-in-oil-in-water (w/o/w) emulsion of sesame oil. 1. Enhanced and persistent antibody formation by antigen incorporated into the water-in-oil-in-water emulsion. Water-in-oil-in-water (w/o/w) emulsion developed in our laboratory is as effective as water-in-oil (w/o) emulsion of Freund's incomplete adjuvant (FIA) in the stimulation of antibody formation. The emulsion is prepared by redispersion of water-in-sesame oil emulsion of an antigen solution in phosphate buffered saline with emulsifier, Tween 80. The emulsion can be stored at 4 degrees C for at least 3 months without any evidence of change in the adjuvanticity and in the w/o/w state. Even a single injection of bovine serum albumin (BSA) in the w/o/w emulsion elicited a high antibody response in mice over the period of almost whole lifespan. 10 microgram BSA in w/o/w could stimulate antibody formation up to 2(12) in hemagglutination titer, while the same dose in free solution did not elicit any detectable antibody. The tissue reactions caused by the w/o/w emulsion at the injected site and in the regional lymph nodes were much less prominent than those by FIA.


Mouse peritoneal macrophage reaction to gutta percha in vivo and in vitro. Mouse peritoneal macrophages were reacted with gutta percha, a kind of  natural rubber, widely used as a root canal filling material in endodontic therapy. Fine gutta percha particles were phagocytized by mouse peritoneal macrophages in vitro. Gutta percha particles injected intraperitoneally stimulated peritoneal macrophages and accumulated in milky spots on the omentum. Pure gutta percha membranes implanted intraperitoneally were covered and penetrated by macrophages. Gutta percha point membranes were partly digested in the same environment. Thus, evidence was obtained that gutta percha is not biologically inert in the strict sense, but can activate the body's defensive mechanisms.


Thymus-dependent cytokinetics in transplantable leukemia of AKR mice. Perinatally thymectomized AKR mice inoculated i.v. with acute lymphoblastic T-cell leukemia (TAL) demonstrated, as compared to controls, an accelerated passage of injected cells through the lungs. Later in disease they also exhibited an especially intense infiltration of liver and spleen by leukemic blasts proliferating at a slow rate the big majority of cells being in the G0 + G1-phase. The thymus controls the proliferation and the traffic of leukemic cells in the recipient.


Toxic effects of rice culture of Aspergillus candidus and its metabolite, xanthoascin, on Japanese quails. Laying Japanese quails were fed on diet of 1:1 mixture of basal diet and rice cultures of 2 strains of Aspergillus candidus. During 20 days of feeding, egg production was significantly reduced in these groups compared with the birds fed unmolded rice. The liver of the quails sacrificed at 20 days showed fatty degeneration of hepatic cells. Following withdrawal of the moldy rice, rate of egg production recovered in 5 days. The suppressive effect of egg production seems to be secondary to hepatic injury. In the other experiment, xanthoascin, a purified mycotoxin of A. candidus, was given subcutaneously between 2 to 5 mg/g body weight. In all groups mortality was about 80%. Survivors produced no eggs 10 days following the injection. The liver of quails that died in 1 to 4 days showed focal necrosis, fine droplet fatty degeneration and bile thrombosis of bile ductules. The features are similar to those observed previously in mice and rats, but the quail is far more sensitive to injected xanthoascin than rodents.


Augmented mitotic response of human peripheral lymphocytes in the presence of lymphocytes from nude mice: detection of a small number of functional human lymphocytes in the explanted host. In the present paper, authors showed a method to detect a small number of functional human peripheral lymphocytes (HPL) in the presence of lymphoid cells of nude mouse (n-ML). HPL was mixed with n-ML to give a total number of 5 X 10(4) cells and cultured in vitro in the presence of PHA for 5 days. HPL responded will to PHA while n-ML did not, as assessed by 3H-TdR incorporation in the presence of the mitogen. Synergistic response between these two cell population was observed. Five--ten folds enhancement was shown by mixing 5 X 10(3) HPL and 4.5 X 10(4) n-ML (10% of HPL) and 500 HPL became detectable by comixing with n-ML, while 5,000 HPL was the lowest limit to be detected in a single cell culture with this mitogen. The results seem to indicate that this method could detect functional HPL as small number as one percent of the cell mixture. On the other hand, xenogeneic mixed lymphocyte reaction was observed when the percentage of HPL exceeded 40%. Mitomycin-C treatment of either HPL or n-ML revealed that a major part of cells incorporating 3H-TdR was HPL which could be activated by the stimulation with xenogeneic murine nucleated cells and that a smaller part of murien B cells were also stimulated by the HPL.


Bacteriological investigation on biopsy specimens from patients with sarcoidosis. Biopsy specimens, mostly lymph nodes, removed under aseptic conditions, were emulsified and the homogenate was inoculated in various media, which were incubated aerobically or anaerobically. Only Propionibacterium acnes was isolated in high incidence and the highest concentration of bacteria was 6.5 X 10(5) per g tissue: 28 and 31 out of 40 lymph nodes were positive on solid and on liquid media, respectively. P.acnes was also isolated from control non-sarcoidosis lymph nodes: 4 and 8 out of 14 were positive on solid and on liquid media, respectively. The highest concentration of bacteria was 1 X 10(4). A bacterial component derived from P. acnes was used for the passive hemagglutination test to estimate antibodies against the bacterium and also for skin test on patients. These results showed only slight differences between patients with sarcoidosis and control patients. No other bacteria or fungi were isolated.


Carcinogenesis in tissue culture. 29: Neoplastic transformation of a normal human diploid cell strain, WI-38, with Co-60 gamma rays. WI-38 normal human diploid fibroblasts were exposed to Co-60 gamma rays 4 times at a total dose of 1400 rads and transformed into neoplastic cells in culture. The transformed WI-38 cells which are growing steadily without showing aging phenomena at the present time showed epithelial-like morphology, abnormal karyology, B-type isoenzyme pattern of glucose-6-phosphate dehydrogenase (G6PD), and produced sarcomas when transplanted into cheek pouches of hamsters treated with anti-hamster thymocyte serum.


Effect of strain differences on heat-susceptibility of L-asparaginase in the guinea pig. Effect of urea on the activity of serum L-asparaginase in outbred guinea pigs (Hartley) was examined for comparison between heat-resistant and heat-sensitive types. The heat-resistant serum L-asparaginase was much more stable to urea-treatment than the heat-sensitive serum enzyme, and the urea-inactivation of the serum enzyme was protected by Na+ or K+. Liver L-asparaginase of the guinea pig, in which the serum enzyme was resistant to heat, was also resistant to heat, and vice versa, although liver enzyme was much more sensitive to heat than serum enzyme. The heat inactivation of liver enzyme was also protected by Na+. Similar results were also demonstrated on purified serum L-asparaginase, although the amino acid compositions between the two purified enzyme preparations were slightly different. When the animal having heat-resistant serum L-asparaginase were crossed with each other, serum enzyme of the resultant progenies was also resistant to heat, and vice versa. The serum enzyme of two inbred strains (JY-1, Hartley/F) was thermostable and the enzyme of the other (Strain 2, Strain 13) was thermolabile.


Solubilization of the H-2 antigen from hybrid cells of mouse mammary ascites tumor and mouse L cells at high cell concentrations in detergent. Radioiodinated membrane components of L-FM3ANo.2 cells, which were hybrid cells of C3H/He mouse mammary ascites tumor and mouse L cells, were solubilized with non-ionic detergent Nonidet P-40 and immunoprecipitated with anti-H-2k sera. The immune complexes were reduced and subjected to SDS-polyacrylamide gel electrophoresis. When the cells were lysed at a concentration of 2 X 10(7) cells/ml in 0.5% NP-40 buffer, only H-2 molecules including beta2-microglobulin were precipitated, but when the cells were lysed at a concentration of 8 X 10(7) cells/ml in 0.5% NP-40 buffer, two labeled components corresponding to molecules of 105,000 daltons and 85,000 daltons, respectively, were observed in addition to the characteristic radioactive peaks of the H-2 antigen. Dilution of the latter detergent lysate with phosphate buffered saline exhibited no effect on the detection of the two additional components, while further treatment of the lysate with NP-40 buffer abrogated them to be detected. The results indicate that the H-2 molecules were solubilized as physical complexes with certain membrane components of L-FM3ANo.2 cells when the cells were lysed at high cell concentrations in detergent, and suggest that the H-2 molecules and certain membrane components may be physically associated with each other on the cell surface of L-FM3ANo.2 cells.


A preliminary serologic study of hepatitis A virus infection in Japan. Ninety-eight acute non-B hepatitis cases recently observed in Japan and household contacts with these cases were subjected to serologic examinations for hepatitis A; 400 serum specimens obtained in 1971 from healthy individuals living in areas near Tokyo and 16 preparations of human immunoglobulin produced in Japan in 1975 and 1976 were examined for antibody to hepatitis A antigen. Hepatitis A virus infection was confirmed in all 25 patients and in 8 of 26 household contacts found in association with non-B hepatitis outbreaks, and also in 11 of 60 sporadic non-B hepatitis patients, but in none of 13 non-B hepatitis patients found in association with blood transfusion. There was no difference between males and females in the prevalence of antibody to hepatitis A antigen among healthy individuals, however, there was a strong relationship to age. Rates of antibody positives were only 2.5% in the groups younger than 20 years of age. An ample amount of antibody to hepatitis A antigen was detected in the preparations of human immunoglobulin. Hepatitis A virus was thus found to be endemic in Japan, but considered not popular during at least these 20 years. Infection with non-A non-B hepatitis virus(es) seems to be common in Japan especially in such cases as sporadic non-B hepatitis or post-transfusion non-B hepatitis.


A ten-year follow-up study on measles vaccination in Japan: evaluation of the efficacy analyzed on a computer system. A long-term surveillance system using a computer system was established for the follow-up study on the protective effect of measles vaccination. More than 3,000 children, 3 to 6 years of age, who were immunized with measles vaccines by various methods have been registered in the system since 1971, and their outcomes with regard to measles have been followed up every year. The subjects were divided into three groups by the vaccination method: live vaccine alone (L), further attenuated live vaccine alone (FL), and the combined use of live and killed vaccines (KL). From comparative studies with these groups, the following results were obtained: (1) Annual measles incidence rates were found to be the lowest in L group followed by FL and KL. (2) Accumulated incidence rates of measles for 10 years in L, FL and KL groups calculated were 1.90, 2.49 and 17.84%, respectively. A linear regression was observed only from 0 to 3 years after vaccination in L and FL groups, and from 0 to 9 years in KL group. KL group showed a significantly larger regression coefficient than did the former two groups. (3) Protection rates against close contact with measles in families calculated were 97% in L and FL and 80% in KL group, respectively. (4) Low but detectable levels of antibody titers were observed in the sera for at least 4--6 years after vaccination.


Adjuvant effect of cationic surface-active lipid, dimethyl dioctadecyl ammonium bromide, on the induction of delayed-type hypersensitivity to sheep red blood cells in mice. The authors investigated the adjuvant effect of a cationic surface active lipid, dimethyl dioctadecyl ammonium bromide (DDA), on the inducation of delayed-type hypersensitivity (DTH) to sheep red blood cells (SRBC) in mice. Markedly enhanced DTH to SRBC was induced by subcutaneous injection of 2X10(8) SRBC suspended in saline containing DDA as compared to DTH responses in control animals sensitized with the same doses of SRBC without DDA. The enhancement of DTH responses seemed to be closely related to the delayed appearance of circulating antibody to SRBC and not to depend on the strain or the age of mice.


Hyperpolarization caused by external high potassium in snail neurons. Two-thirds of the tested subesophageal ganglion cells of Japanese snail, Euhadra peliomphala, was hyperpolarized when they were perfused by high K-Ringer. This hyperpolarization was accompanied with a marked decrease in membrane resistance and was independent of cell types classified by ACh-induced response. Pentobarbital was found to convert high K-induced hyperpolarization into depolarization, or to augment K-depolarization. The high K-induced hyperpolarization was considered as the result of summated IPSP's elicited by the presynaptic inhibitory fibers which were primarily depolarized by high K. Pentobarbital may remove this synaptic inhibition and disclose the original K-depolarization underlying the cell. In Cl-free media, high K caused a marked depolarization instead of hyperpolarization, or augmented the depolarization observed in normal Ringer. This suggested that the subsynaptic membrane became permeable to Cl ions during the inhibitory presynaptic activity when high K was applied. ACh was found not to be responsible for this synaptic inhibition, because d-tubocurarine, which is known to block the Cl-dependent ACh response of the snail neurons, did not affect the high K-induced hyperpolarization. The possibility of indirect action of high K on the membrane potential through synaptically mediated inhibition was discussed as a cause of its hyperpolarizing effect.


Body colour response of the carp (Cyprinus carpio) during asphyxia. The body colour of immobilized carp was photoelectrically measured simultaneously with heart rate in order to examine one of the effects of asphyxia on autonomic functions of the cutaneous region. 1) Asphyxia induced marked body colour darkening and bradycardia. 2) Adequate increase in cardiac vagal activity was recorded during asphyxic bradycardia. 3) After atropine injection, body colour darkening, as in intact fish, was observed during asphyxia while heart rate was not changed. 4) After transection of anterior spinal cord, asphyxic stimulation did not induce body colour darkening. It is concluded that body colour darkening mediated by nervous pathways was observed during asphyxia simultaneously with the definite bradycardia. This response of body colour has provided the first indication for responses in cutaneous autonomic systems within the responses of the fish co-ordinated as a whole to asphyxia.


Influences of extracellular calcium and potassium concentrations on adrenaline release and membrane potential in the perfused adrenal medulla of the rat. Prolonged perfusion of isolated rat adrenal glands with high K produced a transient increase in adrenaline release that reached a maximum within 1 min and then declined with a half-time of about 5 min. The higher the [K]o used, the larger was the release of adrenaline elicited. There was a linear relation between the mean rate of adrenaline release in the initial 5 min of continuous stimulation with excess K and logarithmic increase in the [K]o. The higher the [Ca]o used, the steeper was relation obtained: the slope determined in the presence of 5 mM-Ca was nearly twice as much as that obtained in the presence of 0.5 mM-Ca. The release of adrenaline in response to excess K was virtually abolished by the omission of [ca]o. The chromaffin cells were depolarized in proportion to logarithmic increase in the [K]o. Linear relations were thus obtained between the mean rates of adrenaline release and the membrane potential of chromaffin cells in the presence of different [Ca]o. Application of high K revived secretory response of a gland after prolonged exposure to acetylcholine in the presence of tetrodotoxin, when adrenaline release had declined below a half of the maximum response. Application of acetylcholine also revived secretory response after prolonged exposure to high K. These results support the view that the mechanism of Ca influx activated by high K may differ from that activated by acetylcholine.


The temporal relationship between basilar membrane motion and nerve impulse initiation in auditory nerve fibers of guinea pigs. When the helicotrema was obstructed in guinea pigs, trapezoidal displacement of the round window membrane produced a trapezoidal microphonic which indicated a unidirectional displacement of the entire length of the basilar membrane. Responses of single auditory nerve fibers to the trapezoidal displacement of the round window membrane were recorded after obstruction of the helicotrema. About 39% of the 424 fibers showed tonic responses which demonstrated directional sensitivity. More than 90% of these fibers increased their discharge rate during displacement of the basilar membrane toward the scala tympani and decreased their discharge rate during oppositely directed displacement. Less than 5% of the tonic fibers responded in the reverse manner. About 23% of the auditory nerve fibers responded to onset and/or cessation of trapezoidal motion of the basilar membrane. About 28% showed a combination of the tonic and phasic responses. However it is probably that all phasic responses we observed do not arise from velocity-sensitive fibers but some may represent artifacts. Both possibilities remain open until further studies are performed. The transduction mechanism of the cochlea is discussed on the basis of our data obtained by unidirectional displacement of the basilar membrane.


A study of sensory projection from jaw muscles to the cerebral cortex in the rat. The sensory projection from jaw muscles to the cerebral cortex have been studied in rats by electrophysiological and histochemical methods. Electrical stimulation of individual masticatory muscles elicited bilateral responses in the cortical areas 8, 10, 2, and 2a. The following pathway was postulated to mediate these cortical responses; impulses of muscle origin are conducted in turn to the trigeminal mesencephalic tract nucleus (TMT), the contralateral thalamic nucleus ventralis posteromedialis (VPM), the cerebral cortex and finally to the other cerebral cortex which is ipsilateral to the side of stimulation. The ipsilateral cortical response appeared about 5 msec later than the contralateral one and was abolished by sectioning the corpus callosum. By stimulating the cerebral cortex antidromically, the conduction time to the VPM was found to be as long as 6 msec. The conduction from the TMT to the contralateral VPM consumed a period of more than 10 msec. It was presumed to be multisynaptic, being based on the finding that horseradish peroxidase injected into the VPM could not be recovered in the contralateral TMT.


Blood volume and plasma constituent changes in splenectomized dogs consequent to exercise. To assess the effects of submaximal exercise on fluid balance and blood constituents, changes in plasma volume, hematocrit, hemoglobin, plasma protein, serum osmolality, and serum electrolytes were measured in splenectomized dogs during treadmill work and recovery. During exercise approximating 32 and 50% of Vo2max, plasma volume did not significantly change. During recovery, plasma volume tended to increase by the same amount at both levels of exercise. Both total circulating plasma protein content and protein concentration increased during exercise. Serum osmolality increased abruptly during exercise and returned to the pre-exercise level immediately after cessation of work. Plasma volume changes calculated from both hematocrit and hemoglobin concentrations correlated well with direct measurements using labelled erythrocytes, but values calculated from hematocrit alone averaged 12% higher.