Rigor and resistance to stretch in vertebrate smooth muscle. Depletion of the APT content of the rabbit taenia coli muscle to 0.07 mumol/g caused an increase in force equal to 11% of maximum active tension (Po) when the muscle was bathed in a calcium-containing Krebs solution at 21 degrees C, but no increase in force in a calcium-free solution. Stimulation of the muscle in calcium-containing medium during the loss of ATP increased the force maintained and permitted demonstration of an increased stiffness by shortening of the muscle. There was no increase in resistance to stretch in the ATP-depleted state compared with the resting state. There was, however, a calcium-dependent resistance to stretch with properties that suggested the presence of attached crossbridges in the resting state. Bathing of the resting muscle in a calcium-free medium decreased the resting resistance to stretch and permitted demonstration of an increased resistance to stretch in the rigor state. It is concluded that the rigor state exists in vertebrate smooth muscle.


Blood flow to respiratory, cardiac, and limb muscles in dogs during graded exercise. The distribution of cardiac output was analyzed in six dogs, with the animals at rest and running on a level treadmill for 3 min at 3-4 mph (mild exercise) and 3 min at 6-8 mph (moderate exercise). Organ flows were measured using 25-mug-diam radioactive microspheres. Cardiac output averaged 2.5, 4.6, and 5.7 liters/min, for rest, mild exercise, and moderate exercise, respectively. The greatest change was in diaphragmatic flow which increased by 275% with mild exercise and 500% with moderate exercise. Flow to intercostal muscles increased by 160 and 186%, to the exercising gastrocnemius muscle by 153 and 224%, and to cardiac muscle by 57 and 109% during mild and moderate exercise, respectively. Renal and cerebral flows did not change significantly. Significant decreases in flow occurred in the small and large intestines during moderate exercise. It is concluded that the increase in cardiac output during submaximal exercise was redistributed in a manner which limited flow to the brain, intestines, and kidneys and increased flow flow to the diaphragm, heart, and limb muscles.


Pentose cycle activity of the isolated perfused rat lung. Pentose cycle activity was estimated in isolated rat lungs under varying conditions of glucose oxidation. Lungs were perfused for 100-120 min with a Krebs-Ringer-bicarbonate buffer, pH 7.4, containing 1-14C- or 6-14C-labeled glucose and ventilated with 95% O2:5% CO2. Based on 14C specific yields in either 14CO2 or perfusate lactate plus pyruvate, pentose cycle flux in control lungs was 5.3 mumol of glucose per hour per gram dry weight (11-12% of glucose utilization). Pentose cycle activity was unaltered by perfusion with 0.8 mM 2,4-dinitrophenol. Perfusion with phenazine methosulfate, an artificial hydrogen acceptor, resulations of the pentose cycle based on 14C yields in tissue lipids (both the fatty acid and deacylated fractions) gave values 2-3 times higher than measurements based on 14CO2. This study indicates that pentose cycle activity in the lung accounts for a significant fraction of glucose utilization and this pathway readily responds to metabolic perturbation.


Regulation of plasma calcium in rats: age-related roles of PTH and calcitonin. To determine the influence of aging on the relative roles of parathyroid hormone (PTH) and calcitonin in the control of calcium homeostasis during fasting, we assessed changes in plasma calcium in fasted rats following simultaneous removal of the glands that secrete both hormones. Animals ranging in age from 3 to 34.7 wk were thyroparathyroidectomized or sham operated and bled by orbital puncture prior to and 1.5, 3, and 6 h after surgery. After thyroparathyroidectomy (TPTX), plasma calcium fell immediately and progressively in very young rats (3-6 wk old); in young animals (6.5-9.4 wk old), there was a delay of about 1.5 h pceded by a rise, which persisted for at least 3 h. Since the rise and fall in plasma calcium after TPTX are most likely due to calcitonin and PTH deficiencies, respectively, our observations are consistent with the following hypothesis; in the fasting state, the relative importance of calcitonin and PTH in the regulation of plasma calcium varies with age; PTH appears to play the dominant role in young rats; however, during maturation the importance of calcitonin appears to increase progressively.


Effect of methionine sulfoximine on glutathione and amino acid levels in the nephron. The effect of L-methionine-DL-sulfoximine (MSO) on renal glutathione concentration and aspartic acid transport has been studied by analyses of parts of individual freeze-dried glomeruli, early and late proximal convoluted, early and late proximal straight, and distal straight and convoluted tubules, and patches from thinlimb and papilla areas. Glutathione normally varies threefold along the kidney nephron, being highest in the convoluted and early straight proximal tubule, lowest in the distal straight tubule. Large loads of aspartate cause 20% diminution of glutathione in outer cortex, due entirely to changes in proximal tubule segments. MSO alone lowers glutathione 90% in all parts of the proximal tubule, with no change elsewhere. MSO does not affect the large increase in aspartate in proximal tubules caused by saturating aspartate loads, suggesting that glutathione is not directly involved in transport of this amino acid. Aspartate loads cause a large increase in renal glutamine, which is especially marked in the proximal straight tubule. MSO effectively blocks this increase and depresses tissue glutamine below normal levels.


Effect of acetylcholine on Cl- and Na+ fluxes across dog tracheal epithelium in vitro. Electrical potential difference is generated across canine tracheal epithelium by active transport of Cl- toward and Na+ away from the lumen. The present study examines the effects of acetylcholine on short-circuit current, potential difference, resistance, and fluxes of 36Cl and 24Na measured across pieces of canine tracheal epithelium mounted in Ussing-type chambers. Under short-circuit conditions, acetylcholine (5 X 10(-5) M) increased significantly net ion flux toward the lumen of Cl- (n equals 7) from +1.7 +/- SE 0.5 TO +3.3 +/- SE 0.5 mueq/cm2 - h, and of Na+ (n equals 7) from -0.8 +/- SE 0.2 to +0.5 +/- SE 0.2 mueq/cm2 - h. Under open-circuit conditions, acetylcholine (5 X 10(-5) M) increased significantly the unidirectional flux of Cl- (n equals 6) toward the lumen from 4.7 +/- SE 1.3 to 5.9 +/- SE 1.4 mueq/cm2 - h, while the other measured fluxes did not change significantly, suggesting that net Cl- flux had increased toward the lumen. Atropine sulfate (10(-8) M) prevented the response to acetylcholine (5 X 10(-5) M). The increased ion flux due to acetylcholine may mediate water secretion into the airway lumen, and this secretion may have important effects on the physical properties of the liquid through which the respiratory cilia beat.


Changes in renal hemodynamics and renin release caused by increased plasma oncotic pressure. The effect of increased plasma oncotic pressure on renal blood flow (RBF), glomerular filtration rate (GFR), electrolyte excretion, and renin secretion rate (RSR) was studied in dogs anesthetized with sodium pentobarbital. Renal artery infusions of hyperoncotic dextran or human serum albumin raised renal venous colloid osmotic pressure an average of 7.3 and 10.1 mmHg, respectively, and caused small but consistent increases in RBF, large increases in RSR, marked decreases in urine flow rate and electrolyte excretion, with either no change or small decreases in GFR, and no change in renal artery pressure. Renal vasodilation was confined primarily to afferent arterioles and was not measureable until approximately 45 s after the start of infusions. The renal responses to increased plasma oncotic pressure appeared to be an autoregulatory phenomenon, consistent with a tubular mechanism dependent on an altered distal tubular fluid flow and/or composition. The increased renin release during increased plasma oncotic pressure is not compatible with a renal baroreceptor mechanism that responds to decreases in afferent arteriolar pressure because calculated glomerular pressure increased during albumin and dextran infusions.


Water content of rat adipose tissue and isolated adipocytes in relation to cell size. Epididymal adipose tissue composition and adipocyte water content were studied in male rats during growth and development of spontaneous obesity. The data show that a highly significant positive correlation exists between fat-cell volume and intracellular water space (IWS) (r=.967, P less than .001). Intracellular water, expressed as picoliters per fat cell, varied from 1.5-2 in small fat cells (mean vol, 30-50 pl) to 9-10 in large cells (800-1,000 pl). When expressed as percent of fat-cell volume, IWS varied from 5-7% in the small fat cells to 1-1.3% in the large ones. Total adipose tissue water continued to increase with increasing adipose mass. Similarly, total adipocyte water increased with enlarging cell size and tissue mass. The contribution of total adipocyte water (as contrasted to that of nonadipocyte water) to total tissue water, however, was found to be limited (less than 23%) and to decline progressively with adipose mass expansion.


Effects of angiotensin, vasopressin, and methoxamine on cardiac function and blood flow distribution in conscious dogs. A comparison was made of the effects of vasopressin (ADH), methoxamine (MX), and angiotensin II (AN) on coronary and left ventricular dynamics, cardiac output, and regional blood flow distribution in intact, consci9us dogs. At an equal percent pressure elevation, ADH reduced cardiac output and cardiac rate the most, while AN had the least effect. After denervation of arterial baroreceptors, ADH still reduced heart rate, while AN increased it, suggesting nonbaroreceptor negative and positive chronotropic effects, respectively. A differential pattern on peak dP/dt was also observed, with ACH causing a greater reduction than MX while AN did not decrease dP/dt. With heart rate held constant, AN did not reduce dP/dt, suggesting a direct positive inotropic effect since dP/dt should have fallen slightly due to reflex mechanisms, as was observed with MX and ADH. ADH induced the greatest increase in coronary resistance (140%), while the least (46%) was observed with AN, which could be explained, in part, by the differential effects observed on cardiac rate and contractility. The greatest increase in resistance in the iliac bed occurred with ADH (30%), and the least with AN (34%). Conversely, the greatest constriction in the renal bed occurred with AN (95%), and lesser amounts were observed with ADH (36%) and MX (35%). Thus ADH, MX, and AN exert potent yet differential vasoconstricting actions on peripheral beds. In addition, while all three agents elicited coronary vasoconstriction, the differential effects on coronary vascular resistance appeared to be due predominantly to a difference in chronotropic and inotropic actions.


Absorption and exchange of water across rumen epithelium. The osmotic pressure of solutions in the ventral sac of the rumen of the conscious cow was varied with Na Cl or mannitol. The mucosal blood flow measured by HTO clearance was minimal when the lumen contained an isotonic solution and rose threefold when the rumen was hypo- or hypertonic to plasma by 150 mosmol/kg. Thus osmotic gradients actoss the rumen epithelium stimulated mucosal blood flow. Using osmotic gradients small enough to avoid blood flow stimulation, the net water flow could be enhanced by butyrate, a chemical stimulator of blood flow. Thus water movement was partially limited by blood flow. This implied an appreciable change in osmotic pressure of the capillary blood toward that of the rumen contents. The relative importance of blood flow, membrane permeability, and solute uptake on water transport was assessed. The osmotic pressure in the rumen was stationary when the rumen solution was distinctly hypotonic to plasma. The absorbate in the absence of an osmotic gradient was thus hypertonic. The net uptake of solute increased rapidly when the solution in the lumen was hypertonic to plasma. This gave rise to a more rapid rate of change of osmotic pressure in the rumen under this condition.


Basis for synchronization of sympathetic and phrenic nerve discharges. The basis for the relationship between the discharges in the external cartized cats that were vagotomized, paralyzed, and artificially ventilated. Ive discharge (with the period of the cycle of phrenic nerve activity) is extrinsically imposed on central sympathetic networks by elements of the brainstem respiratory oscillator. However, a number of observations made in the present study contradict this view. First, changes in respiratory rate were accompanied by dramatic shifts in the phase relations between sympathetic and phrenic nerve discharge. Second, slow oscillations of sympathetic and phrenic nerve discharge were not always locked in a 1:1 relation. Third, the slow sympathetic rhythm persisted when respiratory rhythmicity disappeic components of sympathetic and phrenic nerve activity are generated by in


PO2-modulated performance of cardiac muscle. An inverse linear relationship between normalized tension development (T/mm2) and muscle cross-sectional area (range 0.32-1.68 mm2) is seen in fully oxygenated rat papillary and columnar carnease muscles studied while contracting isometrically at the apex of the length-tension curve. The data demonstrate progressively poorer performance with thicker preparations, presumatic blockade) is added to fully oxygenated muscle preparations, no significant change in performance is seen even with the thickest preparations, suggesting that no portion of mechanical activity is supported by anaerobic glycolysis. With progressive lowering of the muscle bath PO2, the relative contributions of aerobic and glycolytic activity to mechanical performance are demonstrated. Viewed from the Hill model of oxygen and lactic acid distribution in a cylindrical section of muscle, the data that suggest the presence of a hypoxic core appear contrary to the evidence that indicates the absence of tension supported by glycolytic activity. A possible solution to this apparent contradiction is presented. The findings of these experiments emphasize limitations of isolated muscle studies and help define the relationship between oxygenation and mechanical activity of cardiac muscle.


Compensatory phosphaturia after unilateral nephrectomy in the rat. Within 24 hr after unilateral nephrectomy, fractional excretion of phosphate (FEp) by the remaining kidney is markedly increased. This increase in FEp occurs in throparathyroidectomized rats receiving fixed replacement doses of parathyroid hormone and, therefore, cannot be due to secondary hyperparathyroidism occurring in response to unilateral nephrectomy. In the avsence of any hormone replacement, the increase in FEp is much reduced, but still present. The increase in FEp cannot be ascribed to depression of overall tubular sodium reabsorption because it could be demonstrated in the absence of an increase in FENa. Phosphaturia following unilateral nephrectomy in the rat appears to be part of the complex of events that occur after acute reduction of renal mass; the exact mechanisms of its genesis are uncertain.


Does accommodative micropsia exist?

Does accommodative micropsia exist? Subjects matched the size of a test target seen under various conditions of accommodation and convergence to the size of a reference target seen under constant conditions. Convergence, as expected, had a substantial effect on perceived size, while accommodation by itself had little or none.


Recognition thresholds as a function of word length. Several experiments investigated the effect of word length on recognition thresholds for both familiar English words and unfamiliar pseudowords, the thresholds measured both with and without a stimulus mask. For familiar English words, length had no effect either with or without a mask. For unfamiliar pseudowords, length had a dramatic effect both with and without a mask.


Gonadoblastoma: an ovarian tumor with characteristic pelvic calcifications. Typical circumscribed mottled calcifications in the pelvis are a frequent finding in gonadoblastomas. Six patients with this tumor are reviewed. Radiologically visible calcifying gonadoblastomas were found in three cases.


Calcified intraperitoneal metastases from ovarian carcinoma. Three cases of calcified ovarian metastatic carcinoma are reported in order to illustrate their principal forms and distribution. These cases also demonstrate unusual features of serosal, colonic, and gastric invasion; ureteral obstruction by a calcified metastasis; and active uptake of technetium diphosphonate by the metastatic lesions. Plain films often simulate retained colonic barium.


Sonographic-radiographic correlations of renal and perirenal infections. Sonograms of 43 patients with intrinsic and perirenal infectious processes are reviewed. Fourteen had acute pyelonephritis; three, suppurative pyelonephritis; two, focal pyelonephritis; six, renal abscesses; three, infected cysts; six, perinephric abscesses; six, pyonephrosis; and three, chronic pyelonephritis. Sonography had little diagnostic value except for the patients with perinephric abscess. However, it proved valuable as a guide for a percutaneous approach to obtain cells for histologic diagnosis, to obtain fluid to determine chemotherapy, and to perform antegrade pyelography and percutaneous nephrostomy.


An approach to cardiac malposition and the heterotaxy syndrome using 99mTc sulfur colloid imaging. A diagnostic approach to cardiac malposition and the heterotaxy syndrome is outlined. The 99mTc sulfur colloid intravenous forward angiocardiogram and plain chest radiograph are used to determine the two key diagnostic points: position of the venous atrium and stomach. If located on the opposite sides of the body, four basic situs configurations are possible, and the presence of associated cardiac anomalies may be predicted. For the two configurations in which the cardiac apex is on the same side as the stomach, the incidence of associated cardiac anomalies is low; when on opposite sides, the indicence is high. If the venous atrium and stomach are on the same side, then abdominal heterotaxy with associated splenic abnormality is present. Dynamic 99mTc sulfur colloid imaging will usually show interruption of the inferior vena cava, if present, and multiple or absent spleens.


ARS Presidential Address: Estrogen therapy: a causal role in endometrial cancer? Publicity associated with recent reports of a greater frequency of adenocarcinoma of the endometrium among women who take exogenous estrogens has created confusion among physicians and fear among patients. An objective review of available data on estrogen effects and current epidemiologic evidence suggests that estrogen may play an indirect role in the development of endometrial carcinoma. Until definitive data are available, physicians should exercise caution in prescribing estrogens, monitoring the status of the endometrium at regular intervals by sampling and pathologic analysis.


Initial accuracy of esophagograms in detection of small esophageal carcinoma. Esophagograms of 35 patients were interpreted without knowledge of clinical history by four diagnostic radiologists. Six esophagograms were of normal esophagi, 16 were of various benign disorders, and 13 were examples of small (less than 3.5 cm) esophageal carcinomas. Overall diagnostic accuracy averaged 58%. Small esophageal carcinomas were initially diagnosed accurately in 73% of cases. Of the 27% false negative diagnoses, 6% were interpreted as normal and 21% as benign abnormalities. Esophageal lesions in the form of ulceration surrounded by mass were most often diagnosed correctly as carcinoma. The most common error was interpretation of esophagitis, stricture, and ulcerated benign lesions as carcinoma. Esophagography was found to be a good screening procedure for detection of esophageal disease but not for accurate diagnosis of small carcinomas.


Gastrointestinal perforation without intraperitoneal air-fluid level in neonatal pneumoperitoneum. Twenty-one cases of neonatal pneumoperitoneum seen at the C.S. Mott Children's Hospital between 1970 and 1974 were reviewed. Of 14 cases with autopsy or surgically proven gastrointestinal perforation, six did not have an intraperitoneal air-fluid level on the initial cross-table lateral roentgenogram while eight did. Four cases of pneumoperitoneum secondary to mechanically assisted ventilation and air leak phenomenon had no air-fluid level. A postmortem study in one premature infant cadaver suggests that the air-fluid level may not be reliably demonstrated when the amount of intraperitoneal fluid is small. These data support the contention that an intraperitoneal air-fluid level does not uniformly occur in perforated viscus and that its absence, even in the presence of mechanically assisted ventilation, does not exclude the necessity for surgical intervention. In some cases, water-soluble contrast examination of the gastrointestinal tract appears to be a more reliable diagnostic adjunct to document a perforated viscus, when a definite intraperitoneal air-fluid level is not present.


Absent mesosternum in congenital heart disease. The association of developmental abnormalities of the sternum with congenital heart disease is well known. These abnormalities include hypoplasia, multiple centers, and premature fusion. The absence of the sternal bodies in patients with congenital heart disease unrelated to a specific syndrome complex has not been previously described. Possible association with congenital pulmonary vascular disease was noted.


Frontometaphyseal dysplasia: evidence for autosomal dominant inheritance. Frontometaphyseal dysplasia is a syndrome that encompasses cranial hyperostosis, abnormal tubulation of cylindrical bones, and other skeletal and extraskeletal abnormalities. The most striking features are overgrowth of the supraorbital ridges which results in a Mephistophelian facial appearance and a radiographic configuration of the skull that has been likened to a soldier's helmet. Most patients have severe hearing loss, defective dentition, poorly developed musculature, and joint contractures. Dominant inheritance has been suggested in previous reports, but an appropriate pedigree has been documented in only one family. This paper describes three additional patients in two unrelated families: (1) an 8-year-old boy whose mother has mild metaphyseal dysplasia and several minor skeletal abnormalities that have occurred in patients with the syndrome; and (2) two maternal half-brothers. These cases provide additional evidence that frontometaphyseal dysplasia is an autosomal dominant trait with variable penetrance.


Effects of radiation therapy on growing long bones. Characteristic radiographic changes were seen in six of 14 children who received radiation therapy to the epiphyseal plate of a long bone. These changes, which include metaphyseal sclerosis, metaphyseal fraying, and epiphyseal plate widening, resemble rickets. In three patients, these changes were followed by development of a broad metaphyseal band of increased density. The absence of metaphyseal changes may indicate sterilization of cartilage cells and may be predictive of significant limb shortening.


The single ectopic ureter.

The single ectopic ureter. A significant number of ureters with ectopic insertion occur in the single (nonduplex) collecting system. We have investigated 16 patients with this anomaly whose ureters were abnormal enough to cause problems. Characteristic symptoms at presentation included a pelvic mass, ureterovesical obstruction, a ureterocele, urinary dribbling, epididymitis, and infection of the urinary tract with or without reflux. Radiographic evaluation is usually possible using only intravenous urogarphy and voiding cystourethrography. Nonvisualization of one kidney in association with one of the above findings should suggest a single ectopic ureter. Particular attention should be paid to the site of ureteral insertion whenever reflux is seen.


Hepatic occlusion venography with a balloon catheter in patients with end-to side portacaval shunts. Hepatic occlusion venography with the aid of a Swan-Ganz balloon catheter represents a significant improvement in the radiographic demonstration of hepatic veins and their alteration in liver disease. It is simple to perform and can be combined with other hemodynamic examinations (e.g., hepatic vein pressure measurements). In this way the morphologic and hemodynamic changes in the pre- and postoperative evaluation of patients with portal hypertension can be investigated simultaneously. The method allows optimal demonstration of large branches of hepatic veins. Overloading of small areas of liver parenchyma with concentrated contrast medium, as in wedged hepatic venography, is avoided. Previously unknown portosplanchnic anastomoses developing after end-to-side portacaval shunt were demonstrated in seven of eight patients using this method. The frequency and size of these collaterals suggest possible hemodynamic and clinical significance.


Arteriographic evaluation of the femoral bifurcation value of the ipsilateral anterior oblique projection. Accurate preoperative evaluation of the proximal deep femoral artery is critical in proper surgical management of aortofemoral ischemic disease. A review of 116 femoral arteriograms demonstrated significant improvement in visualization of the femoral bifurcation and detection of proximal stenosis of the deep femoral artery when the ipsilateral anterior oblique projection was obtained in addition to the conventional anteroposterior projection.


Metrizamide cisternography with hypocycloidal tomography: preliminary results. Metrizamide (Amipaque), a nonionic water soluble contrast agent, has been shown to be safe and efficacious for lumbar myelography. Clinical trials of cervical, thoracic, and even intracranial examinations have  produced good results. Despite an inherent neurotoxicity, significant complications have been quite rare, and patient tolerance in general is remarkably good. Preliminary results of metrizamide cisternograms using hypocycloidal tomography are presented to illustrate the anatomic detail which can be demonstrated using this technique.


Fracture of the sella turcica.

Fracture of the sella turcica. Fracture involving the sella turcica is a rare complication of head trauma, but extremely important due to its strategic location adjacent to vital vascular and nervous structures. Of 14 cases reviewed, nine had at least one cranial nerve paralysis, with endocrine abnormalities and cerebrospinal fluid otorrhea seen to a lesser degree. The radiographic findings of sphenoid sinus fluid (13 of 14 cases), pneumocephalus, and unusual vascular occlusions are discussed.


Intracranial chondromas.

Intracranial chondromas. Intracranial chondromas are rare lesions. Four new cases are added to the previously recorded 122 cases. These tumors originate from rests of cartilaginous cells at sphenoethmoidal and sphenooccipital synchondroses. Clinically, the major symptom is lower cranial nerve palsy; proptosis and visual impairment can also occur. More than 60% of the lesions are calcified. Bone destruction is common. Angiography shows displacement of vessels but no tumor stain. Pneumoencephalography reveals displacement of basal cisterns and the ventricular system. A radionuclide brain scan may show abnormal uptake in the tumor. Computed tomography should prove useful in evaluating cerebral extension. Unusual features in our case material included the presence of associated aneurysms in one.


Arachnoid cysts on computed tomography.

Arachnoid cysts on computed tomography. The appearances of arachnoid cysts on computed tomography are presented. They are well defined lesions with the same density as cerebrospimal fluid and are not contrast enhanced. Superficial lesions are biconvex or semicircular and may have a characteristic straight inner margin. Deep lesions and cysts between the cerebellar hemispheres are spherical and some may be difficult to differentiate from cystic neoplasms. The etiology and clinical manifestations of arachnoid cysts are also briefly discussed.


Anterior mediastinal lymphadenopathy in sarcoidosis. Several lymph node chains in the anterior mediastinum lie between the sternum and the trachea. On a lateral chest radiograph they form two distinct groups separated by the superior vena cava. One group projects anterior to the trachea and is formed by overlapping nodes of the anterior paratracheal and the left anterior mediastinal (prearterial) chains. The other is in front of the superior vena cava, composed of the right anterior mediastinal (prevenous) and horizontal chains. The position of these chains prevents them, even when enlarged, from being seen on posteroanterior chest radiographs or tomography: frequently they may not be appreciated on lateral chest films. Therefore lateral chest tomography is the best method to evaluate anterior mediastinal lymphadenopathy. With this technique, anterior mediastinal lymphadenopathy in sarcoidosis should be found more frequently than indicated in the literature.


Differences between right and left lateral chest radiographs. Differences between 150 normal right lateral chest teleroentgenographs and 150 left laterals (infants, children, and adults) were evaluated and determined to be greater than has been generally appreciated. On the left lateral view the left leaf is distinguished from the right leaf by the following generalizations: anteriorly the left leaf is lower; posteriorly it is higher as is its costrophrenic sulcus; it intersects the relatively flattened right leaf near the posterior heart border; the stomach bubble and/or colon are immediately subjacent; there is no segmental obliteration by the inferior vena cava as there often is with the right leaf; in adults the outline of the left leaf is often sharper. When both major fissures can be identified, the left almost always intersects its diaphragmatic leaf posterior to and more vertically than the right fissure.


Community experience with small bowel bypass for morbid obesity. A comparison of small bowel bypass performed at university centers and by private practitioners in a large metropolitan area demonstrates definite stmilarities in terms of patient selection, mortality and morbidity, and weight loss results. The only aspect of small bowel bypass in the private sector that could be criticized would be the adequacy of follow-up. An operation with as many known and probably other unknown long-term complications as jejunoileal bypass necessitates prolonged careful patient follow-up. We belive the person most qualified to provide such follow-up is the surgeon who performed by bypass procedure.


Choledochoscopy.

Choledochoscopy. Experience has shown the rigid choledochoscope to be a valuable instrument in the exploration of the common bile duct. It has provided a means for removal of difficult to remove calculi from the common bile duct.


Cervical stenosis: a developmental anomaly with quadriparesis during football. As seen by the graphic depiction of F.M.'s sagittal diameter (Fig. 3) and by the photographs of his air myelogram, cervical sagittal stenosis should be looked for and thought of as an underlying anatomic anomaly in the athlete who has recurrent episodes of "pinched nerve" with flexion and hyperextension of his cervical spine during blocking or tackling. It is significant that the patient underwent two "normal" cervical spine x-rays before tomograms and air myelogram pointed out the sagittal stenosis of his cervical canal. Sagittal stenosis must be thought of and looked for strenously in the athlete competing in high velocity collision sports where recurrent neck and upper extremity complaints are too often attributed to the pinched nerve complex and a "horseshoe" collar is the remedy.


Endoscopic retrograde cholangiopancreatography in the diagnosis of jaundice. Endoscopic retrograde cholangiopancreatography (ERCP) was successfully accomplished in 395 patients or 97 per cent of the patients in whom it was attempted. Of 157 patients with cholestatic type jaundice, satisfactory endoscopic retrograde cholangiography or cholangiopancreatography was accomplished in 145 (92 per cent), with only one complication. ERCP excluded extrahepatic biliary ductal obstruction and thus avoided unnecessary surgical exploration in forty-nine patients with cholestatic jaundice. ERCP established the diagnosis of obstructive jaundice in ninety-six patients and delineated the site of ductal obstruction and probable cause. ERCP revealed additional significant previously undiagnosed upper gastrointestinal pathologic changes in 25 per cent of jaundiced patients.


Iliac apophysitis and stress fractures in adolescent runners. Twenty-one cases of overuse injury to the iliac crest apophysis is presented. It can be a significant cause of disability to the adolescent middle and long distance runner. All cases resolved with 4 to 6 weeks of rest.


Primary carcinoma of the gallbladder. The role of adjunctive therapy in its treatment. Of forty-three patients with carcinoma of the gallbladder discovered ih a twenty-five year period (during which 10,349 patients were diagnosed as having cholelithiasis), eighteen patients (42 per cent) had no obvious tumor outside of the gallbladder at the time of operation, nineteen patients (44 per cent) had local spread of the disease, and six patients (14 per cent) had abdominal carcinomatosis or distant metastasis. In the twenty-one patients who underwent surgical therapy for cure of their disease, the five year survival rate was 33 per cent. The more extensive surgical procedures (other than cholecystectomy alone) did not significantly increase survival. Neither the duration of the symptoms nor the pathologic type of the tumor altered the eventual outcome. No patients with tumor outside the gallbladder at the time of operation survived longer than two years. Compared to those who did not receive it, the fifteen patients treated postoperatively with adjunctive therapy (radiation therapy or chemotherapy or both) lived longer and also were significantly better palliated when tumor outside of the gallbladder was found at the time of operation. From these findings, the routine use of adjunctive therapy is recommended in all patients with disease outside of the gallbladder and serious consideration should be given to its use in all patients found to have carcinoma of the gallbladder.


Limb salvage procedures for lower extremity ischemia. Limb salvage procedures were performed in ninety patients during the period from 1965 to 1975. Sixteen different procedures were performed with an associated complication rate of 8.9 per cent and a mortality rate of 8.9 per cent. The patency rates were 79.7 per cent at thirty days and 72.9 per cent at last follow-up.


Little League survey: the Houston study. 1. In a study of 595 Little League pitchers, approximately 17% had a history of elbow symptoms: only 1% had elbow symptoms which had ever excluded them from pitching. There was no correlation between the presence of symptoms and years of pitching experience. 2. Some limitation of active extension of the elbow was seen in 12% of the pitchers; however, there was no correlation between elbow flexion contractures and years of pitching experience, symptoms, or roentgenographic pathology. No normal child had an elbow flexion contracture greater than 15 degrees. 3. A slight valgus carrying angle is considered a normal anatomic variant in the dominant arm. There was no correlation between valgus carrying angle and years of pitching experience or symptoms or roentgenographic pathology. 4. No roentgenographic evidence of avascular necrosis of the capitellum, radial head, or both was seen in this population. 5. Roentgenographic findings such as bony hypertrophy, enlargement of the medial epicondyle, and secondary ossification centers are normal anatomic variants not related to symptoms. Undisplaced stress fractures of the medial epicondyle respond well to conservative treatment, with no functional residual.


Little League survey: the Eugene study.

Little League survey: the Eugene study. In a clinical and radiographic survey of the elbows of 120 pitchers ages 11 and 12, 20% were found to have symptoms, 10% flexion contractures, and 23% roentgenographic changes related to traction stresses on the medial side of the elbow. Five per cent had more serious lateral compression findings related to the radial head or capitellum, but none of these had symptoms. Although this represents a definite incidence of abnormal occurrence, there were no statistically significant correlations or interrelations found relating to pitching experience, valgus elbow deformities, symptoms, flexion contractures, or x-ray findings.


Follow-up on hang gliding injuries in Colorado. In a period extending from July 1973 to December 1975, seven fatal hang glider accidents were recorded in Colorado, all among experienced pilots. In addition, 11 serious nonfatal injuries were reported, which may represent only a fraction of those occurring. Accidents were noted to be multifactorial, caused by (1) pilot error, (2) equipment failure, (3) terrain hazards, and (4) possible design shortcomings. Accidents can be expected to decline in frequency with improved pilot training programs, grading and regulation of sites, and standardized safety clothing. No doubt over time, the less safe standard Rogallo wing will be replaced by the more stable Superkites and controlled collapsibles, which offer a higher safety margin. In the last analysis, this sport will remain a popular yet high risk endeavor (Figs. 2 through 5).


The role of profundaplasty in revascularization of the lower extremity. Profundaplasty has been performed on 112 limbs (88 primary and 24 secondary) in eighty-five men. Seventy-six limbs had incapacitating claudication, twenty-three rest pain, and thirteen either gangrene or ischemic ulceration. In thirty-six limbs treated by profundaplasty alone there were no deaths but five subsequently had amputation for ischemic pain. In the seventy-six limbs treated by profundaplasty plus other operative augmentation there were three operative deaths and one late death; three required further operative surgery and in four amputation was necessary. Oblique arteriographic films of the femoral area are essential for evaluation of the profunda femoris artery. Both radionuclide and Doppler pressure studies confirmed physical and arteriographic findings. The latter would appear superior because of ease of availability and cost. After profundaplasty alone and aortofemoral bypass there was a moderate increase in calf blood flow, but in only those with a patent superficial femoral artery did blood flow and pressure studies return to within normal limits. Profundaplasty is an important addition to the armamentarium of the vascular surgeon in dealing with arteriosclerotic insufficiency of the lower extremities.


Clinical evaluation of 99mTc-pyridoxylideneglutamate for hepatobiliary scanning. Clinical evaluation of hepatobiliary scanning using 99mTc-PG was done in twenty normal volunteers and eighty-three patients with liver and biliary tract disease. Satisfactory images of the biliary tract were obtained using small dosages of this agent. In normal humans, the agent reached the liver in 5 minutes, and the common bile duct, gallbladder, and duodenum in 10 to 20 minutes. The gallbladder was not visualized when the cystic duct was obstructed in patients with acute and chronic cholecystitis. In patients with partial common bile duct obstruction, a distended duct was visualized and there was delay in transit of radioactivity into the duodenum. With complete common bile duct obstruction, no radioactivity was seen in the biliary or gastrointestinal tracts up to 24 hours after injection. Hepatocellular disease was characterized by delayed liver clearance and delayed visualization of the biliary and gastrointestinal tracts. There were no toxic or other untoward effects in any patients.


Splenectomy in children. A correlative review of indications and complications in fifty patients. We have reported our experience with splenectomy in fifty patients less than fourteen years old. The indications, results, and complications were enumerated. These data were then correlated with the recent literature regarding pediatric splenctomy. Of special note is the problem of immunologic incompetency associated with splenectomy in the patients less than five years old.


Expanded polytetrafluoroethylene as a small artery replacement. A preliminary report. Recent laboratory and clinical investigations have demonstrated a specific configuration of polytetrafluoroethylene (PTFE) to be a superior biocompatible material for small artery replacement. Twenty such vascular grafts have been implanted in eighteen patients. Grafts were placed in the femoropopliteal or femoral posterior tibial or anterior tibial positions in fifteen patients and in the aortorenal position in three patients. The early results have been satisfying as judged by follow-up angiography and/or clinical examination. There has been no aneurysmal formation in this series of Impragrafts. No infections have been noted. We believe that Impragraft may offer a logical substitute for the inadequate or surgically absent saphenous vein autograft.


Oculoplethysmography: an adjunct to arteriography in the diagnosis of extracranial carotid occlusive disease. A four and a half year study documents that oculoplethysmography, in conjunction with carotid phonoangiography, fulfills the criteria of an effective noninvasive adjunct to arteriography in the diagnosis of extracranial carotid occlusive disease. The risk and expense of unnecessary arteriographic studies can be reduced and accuracy of arteriographic technics and interpretations can be enhanced by routine application of oculoplethysmography.


Value of segmental limb blood pressures in predicting results of aortofemoral bypass. The efficacy of segmental limb blood pressure measurements, assessed noninvasively by Doppler ultrasound, in predicting the result of aortofemoral reconstruction was evaluated in fifty-two extremities with varying extent of aortoiliac and more distal arterial occlusive disease. Three prognostic correlates were analyzed: (1) preoperative proximal thigh/arm pressure index (TPI); (2) preoperative pressure gradient between adjacent leg segments (proximal thigh, above-knee, below-knee, and ankle), normally less than 30 mm Hg; and (3) early postoperative increase in the ankle/arm pressure index (API). After aortofemoral bypass, forty-one limbs (79 per cent) were asymptomatic or improved and eleven were unimproved. The mean TPI in extremities benefiting from aortofemoral bypass, 0.82 +/- 0.17 (+/-1SD) was significantly less than that of unimproved limbs, 1.01 +/- 0.09 (p less than 0.01). Aortofemoral bypass was beneficial in all twenty limbs with normal leg pressure gradients. Conversely, six of twenty-five legs with one abnormal gradient and five of seven with two abnormal gradients failed to improve. The postoperative increase in API was 0.1 or more in all forty-one improved extremities and was less than 0.1 in all eleven failures. Although eleven of thirty-two limbs (34 per cent) with arteriographic evidence of combined aortoiliac and subinguinal occlusive disease were not improved after proximal bypass, the result of operation could not be predicted from the angiographic pattern or severity of distal disease. Segmental limb blood pressures provide useful predictive indices of the efficacy of aortofemoral bypass and the potential need for more distal reconstruction in multisegmental disease.


Elastic compression in the prevention of venous stasis. A critical reevaluation. The effect of elastic compression on venous flow in the legs provided by carefully fitted stockings has been measured by a venographic technic. The stocking used provides a gradually decreasing compression from ankle to groin. Clearance of stagnant blood from behind venous valves is clearly improved and the differences observed are statistically highly significant. These data suggest that the routine use of carefully fitted compression stockings will result in a decreased incidence of deep vein thrombosis (DVT) and provide a singularly safe, convenient, and noninvasive method of prophylaxis. Evidence presented suggests that at least two investigators have failed to show a decreased incidence of DVT in limbs subjected to elastic compression because the method of compression was inadequate .


Congenital diaphragmatic hernia: Bochdalek type. Congenital Bochdalek hernias result in significant mortality in the newborn period. Forty-four cases over a nineteen year period are presented. The overall mortality is 34 per cent; however, it has decreased from 41 to 25 per cent in the last five years. The mortality of those patients less than 24 hours old remains high (33 per cent) but improved. We prefer the abdominal approach and believe that prolonged respiratory support will salvage a significant number of these critically ill infants.


Congenital anomalies of the diaphragm. Personal experience with thirty-five consecutive cases. A personal experience of thirty-five consecutive patients with congenital anomalies of the diaphragm is reported. The anomalies included twenty-five Bochdalek hernias, seven diaphragmatic eventrations, and three esophageal hiatal hernias. Except for the patients with esophageal hiatal hernias, virtually all patients presented with respiratory embarrassment, twenty-seven of the thirty-five within 24 hours of birth. An especially high mortality is associated with this early onset of symptoms. The treatment was surgical with a thoracic approach used for right Bochdalek defects and eventrations, and an abdominal approach used for left Bochdalek hernias. The importance of proper preoperative and postoperative management in a well equipped neonatal intensive care unit is emphasized.


Preperitoneal prosthetic inguinal herniorrhaphy without a relaxing incision. A consecutive series of 276 men had 317 inguinal hernias repaired by the preperitoneal approach. Of these, 162 (59 per cent) had 194 (61 per cent) "complete" repairs using Marlex prostheses. Fifty-five of 152 indirect hernias (36 per cent) were patched similarly. Seventeen of twenty-two mixed bilateral defects (77 per cent) had a prosthetic patch. Thrity-three of forty-eight repairs (68 per cent) for recurrent hernia in forty-five men also employed Marlex. Two patients died postoperatively. Four of 194 repairs using Marlex failed. These preliminary results indicate that the advantages of preperitoneal exposure can be complemented by an initially satisfactory technic of repair using a prosthesis instead of the classic relaxing incision, which is difficult to use with this posterior approach.


Intestinal necrosis and perforation in patients receiving immunosuppressive drugs. Immunosuppressive agents are frequently used in transplant recipients for prevention of homograft rejection and in patients with leukemia for treatment of their primary disease. From 1973 to 1975, fifty-nine patients undergoing renal transplantation and forty-one patients with leukemia were treated at the University of California (Davis) Medical Center. Intestinal necrosis and perforation developed in four (7 per cent) of those receiving transplants and in four (10 per cent) of the patients with leukemia. One transplant receipient and all four patients with leukemia had extensive necrosis of both the small and large intestines. Two transplant recipients had isolated sigmoid perforations, and one had splenic flexure colonic perforation. All died from septicemia with septic shock. The etiology of these intestinal complication appears related to immunosuppressive agents, particularly high dosages of steroids. Despite the grave prognosis, early surgical intervention is the only method of dealing with these complications. Early diagnosis as well as properly timed and selected operations are necessary for the successful management of these patients.


Long-term results with the combined operation for duodenal ulcer disease. During the twenty year span from 1951 to 1970, the combined operation was selected as the procedure of choice 663 times in the surgical management of duodenal ulcer disease. A retrospective study of these cases represents a 70 per cent follow-up rate; thirty-two additional patients expired during this period of causes unrelated to peptic ulcer disease or the procedure, bringing the crude follow-up rate to 77 per cent. The known recurrence rate was 0.85 per cent and the mortality 0.6 per cent. None of the deaths were due to the operative procedure itself. Diarrhea (11 per cent) and dumping (24 per cent) were the principle postoperative sequelae, neither of which represented a significant problem after twelve to fourteen months. Their incidence after 1960 in this series was decreased due to improved technic, better overall total surgical care, and reduction of the extent of resection from 75 to 50 per cent. The results, as interpreted by surgeon, patients, and gastroenterologist, have been reviewed.


The management of flail chest. A comparison of ventilatory and nonventilatory treatment. Retrospective analysis of forty-two consecutive patients with flail chest injuries admitted to the Trauma Research Unit of the Naval Regional Medical Center, San Deigo from June 1972 to July 1975 compared ventilatory and nonventilatory management. The actual need for ventilatory support in these patients was determined by analyzing their records for evidence of significant pulmonary dysfunction. This allowed division of patients into three groups: "appropriately" ventilated; "inappropriately" ventilated; and nonventilated. Admission PO2 in the "appropriately" ventilated patients was significantly lower than in the other two groups because the former were admitted with respiratory distress and hypoxemia. Significantly more complications occurred in the ventilated groups than in the nonventilated. Treatment-associated complications were more frequent in the ventilated groups. Because of these findings, we belive that mechanical ventilation should be used in the treatment of flail chest injuries only for significant pulmonary dysfunction and not for the purpose of stabilizing the chest wall. If respiratory support is required, it should be discontinued when normal gas exchange has been restored.


"Prohibitive" lung function and major surgical procedures. Sixteen patients with preoperative pulmonary function testing data placing them in the "prohibitive" range underwent major surgical procedures with one mortality (6 per cent) and three major pulmonary complications (19 per cent). All complications were after pulmonary resections in patients with marked muscular weakness. Patients should not be denied necessary operative procedures on the basis of pulmonary function testing placing them in the "prohibitive" range of the Miller quadrant diagram alone. This term should be changed to "increased risk."


Detection and management of hypercoagulability. Patients at high risk of having thromboses can be identified not only on the basis of clinical criteria but also on the basis of laboratory studies. With use of a condensed coagulation profile consisting of six laboratory tests, the clinical impression of hypercoagulability can be confirmed in approximately 90 per cent of cases. Therapy directed to correct specific laboratory abnormalities may be more efficacious than nonspecific therapy.


Congenital anomalies associated with thoracic outlet syndrome. Anatomy, symptoms, diagnosis, and treatment. Personal evaluation of more than 2,300 patients for possible thoracic outlet syndrome (TOS) and knowledge gained from 980 TOS operations in 766 patients (operative incidence of 33.7 per cent of the patients examined) have shown that most patients with TOS have anomalous fibrous muscular bands near the brachial plexus that predispose them to neurologic irritation or compression involving the plexus. Anatomic analysis during operations for TOS, plus cadaver dissections, have disclosed seven distinct types of fibromuscular bands in addition to the less frequent bony anomalies long associated with neurovascular compression. One third of fifty-eight cadaver thoracic outlets dissected showed at least one of the seven muscular anomalies recognized at operations. These anomalies can be accurately related to the patients' symptoms, which are neurologic complaints in 99 per cent of the patients examined who ultimately have the diagnosis of TOS established. Neurologic symptoms are clearly explained by the anomalous bands irritating or compressing the brachial plexus and rarely have any effect on the subclavian vessels. These studies, and others before, have shown no correlation with impairment of circulation or positional radial pulse changes in almost all patients with true TOS. Also, arteriograms and nerve conduction studies generally have failed to be of value in establishing the accurate diagnosis. Reasons for these conclusions are explained, and the most reliable tests are described. The most effective means of relief of severe symptoms of TOS is to alter the mechanical irritation or compression of the brachial plexus by completely resecting the first throacic rib and all anomalous fibromuscular tissue around the plexus and subclavian vessels. If patients are are throughly evaluated with appropriate tests and highly selected for surgical treatment, gratifying relief will result in more than 90 per cent of patients, if the correct operation is performed with meticulous technic.


Intramural hematoma of the duodenum.

Intramural hematoma of the duodenum. Five new cases of intramural duodenal hematoma are reviewed with 174 cases derived from the literature. Operative therapy with simple evacuation of the hematoma is advocated as the procedure of choice. Bypass procedures and resection should be reserved for selected cases.


The VIPoma: further confirmation of VIP as the hormonal agent in the WDHA syndrome. The WDHA syndrome characterized by watery diarrhea, hypokalemia, and achlorhydria is being diagnosed with increasing frequency. The diagnosis has been made to date only due to severe clinical symptomatology. In a review of the literature gastrin, secretin, glucagon, enteroglucagon, gastric inhibitory peptide (GIP), vasoactive intestinal peptide (VIP), and prostaglandins have been variously suggested as a possible etiologic agent for this syndrome. A case of the WDHA syndrome is reported in which hormonal assays of the serum preoperatively and two years postoperatively and tumor for many of the proposed agents is performed. A discussion of possible cross-reactivity among these similary structured polypeptides in the radioimmunoassays systems is used to explain the multitude of possible hormonal agents presented in the literature. Standardization of the VIP assays will result in increasing diagnosis of this diseases state prior to its fulminant clinical presentation.


The esophageal anastomotic leak.

The esophageal anastomotic leak. Sixty-three esophageal anastomoses were performed on adult patients with esophageal or gastric cancer. A total of thirteen anastomotic leaks occurred, resulting in death in seven patients and serious morbidity in an additional patients. Twelve patients had esophagocolostomy, with five anastomotic leaks. Four leaks occurred in the cervical region and were easily managed by local drainage and irrigation, while the other patient had an intrapleural leak resulting in sepsis and death. Twenty-eight patients had esophagogastrostomy, with a total of five leaks. All anastomoses were intrapleurally located, and death ensued in four patients. Fourteen Roux-en-Y and three loop esophagojejunostomies were performed, with no leaks. Two additional deaths occurred from leakage in the pleural cavity and left upper abdomen after jejunal interposition (3 patients) and esophagoduodenostomy (3 patients). In this study, impaired blood supply of the anastomotic end appeared to be the major cause of anastomotic failure. In addition, postoperative shock appeared to predispose to anastomotic leakage, whereas microscopic tumor at the lineof resection, duration of operation and operations for palliation did not appear to increase the leakage rate. The high mortality with esophageal anastomotic leak occurs when diagnosis is delayed and when the site of leakage is in the pleural cavity or left upper abdomen. Conservative treatment is uniformly fatal, whereas operative intervention offers the only chance for survival.


Congenital dilatation of the bile ducts. Our experience with five cases of cystic dilatation of the extrahepatic bile ducts is reported and compared with the literature. The following conclusions have been reached: (1) The etiology of this anomaly is primarily congenital but may involve an acquired component. (2) Diagnosis should be suspected when any of the triad of abdominal pain, right upper quadrant mass, or jaundice is present. (3) The diagnosis can usually be made in infants based on the clinical picture and routine radiologic studies. (4) Retrograde cholangiopancreatography is a useful tool in making the diagnosis in older children and adults. (5) Roux-en-Y choledochocystojejunostomy is the procedure of choice for type I cysts, excision for type II, and choledochocystoduodenostomy for type III.


Experimental amniocentesis and teratogenesis. 1. Evaluation of the intra-amniotic route of treatment in teratological studies. Experiments were designed to evaluate the usefulness of the intra-amniotic route of administration of test-substances in teratological studies. Particular attention was given to the differences in fetal parameters of growth and development and the incidence of fetal mortality between treated and untreated offspring which might be induced as a result of the treatment. Amniocentesis on gestational days 14, 15 or 16 produced a high incidence of fetal mortality and a significant reduction in the weights and crown-rump lengths of treated offspring. With increasing gestational age at the time of treatment and by reducing the volume of solvent injected, fetal mortality was decreased.


Experimental amniocentesis and teratogenesis. 2. Control of teratogenicity. An attempt was made to ameliorate or eliminate the teratogenicity of experimental amniocentesis a) by reducing the calibre of the needle used to puncture the amniotic membranes, and b) by applying a surgical hemostatic sponge over the puncture site. It was found that although neither attempts altered the deleterious effects of amniocentesis on the fetal parameters of weight, crownrump length, and length-weight ratio, the incidence of fetal mortality decreased as the calibre of the needle was reduced. Evidence regarding the ability of the Gelfoam seal to ameliorate the teratogenicity of amniocentesis was conflicting and inconclusive.


[Asymmetry in artificially deformed skulls from a Protobulgarian mass grave of the 9th century]. A series of 18 skulls with pronounced asymmetry, picked up out of a total of 52 artificially deformed and accordingly restored skulls are studied. It is a matter of material discovered in a circular tomb near by the village of Devnja, dating back to the end of the 9th century. To obtain metrical determination of the asymmetry, the authors performed measurements of chords, resp. arches between the anthropological points sphenion and asterion, as well as of the distance from the latter and from the porion on either side up to the glabella, inion, bregma and lambda. Besides the 18 sizes directly recorded, 18 chords constructed on the craniograms (three per skull) mainly between the above mentioned points were also utilized. For each dimension the absolute differences between left and right, the mean value of the differences and the asymmetry index after Duncker were calculated. Using the method outlined, an accurate and quantitative determination was made of the asymmetry both in the occipito-parietal and temporo-clinoidal parts of the skull (compensatory and persisting asymmetry). It is demonstrated that the discrepancies between some of the size values established in individual skulls, and the skull asymmetry, recorded scopically with other measurements, are due to displacements of the anthropological points (sphenion, asterion, inion), produced by differences in growth rate and size of bones. The arrested development of bones and the resulting depressions along their surfaces under the effect of the artificial deformation dressing are of utmost importance for the processes developing within the deformed skulls.


Ultrastructural evidence for loss of the trophoblastic layer in the chorioallantoic placenta of Australian bandicoots (Marsupialia: Peramelidae). In most marsupials, placentation involves only the yolk sac; however, in the bandicoot family, Peramelidae, a functional chorioallantoic placentation develops in addition (Hill, 1895, 1897, 1900; Flynn, '22, '23). This duality is viewed as having evolutionary significance because most eutheria have both placentae. Furthermore, the bandicoot trophoblast was reported to vanish from the chorioallantoic site in late gestation (Hill, 1897; Flynn, '23); whereas, the eutherian trophoblast is identifiable throughout later pregnancy and may act as an immunological barrier between maternal and fetal genotypes (Kirby '68). Thus we have re-examined this singular chorioallantoic placenta of the bandicoot in plastic sections with light and electron microscopy. A distinctive feature of the bandicoot placentation is the transformation of the uterine simple columnar luminal epithelium into a highly vascular lining composed almost entirely of discrete syncytial masses (homokaryons). Endometrial blood vessels penetrate among the homokaryons to create a rich network of large diameter capillaries at extremely superficial locations near the maternal surface. In the chorioallantoic placenta (7 mm to 10-11 mm crown-rump embryos) the microvillous surface of the maternal homokaryons interdigitates with the microvillous border of the fetal trophoblast with desmosomal interaction. This trophoblast consists of a single layer of tall columnar undifferentiated cells rich in ribosomes-polysomes, poor in cytoplasmic membranes, and with large nuclei that have distinct clumps of heterochromatin and conspicuous nucleoli. It is thus remarkable that these undifferentiated cells disappear as a recognizable layer later in gestation (12 mm crown-rump embryos). Flynn's hypothesis that the trophoblastic cells disappear by fusing with maternal syncytia gains support from the existence of two populations of nuclei in the syncytial masses only at the chorioallantoic site. One population is comparable to that occurring in the homokaryons pf the yolk sac placenta, i.e., pale staining nuclei with little heterochromatin and small peripheral nucleoli. However, the other nuclei resemble those of the trophoblast cells. Since the trophoblastic cells before their disappearance as a layer possess properties associated with potential for further differentiation, the possibility of fusion between the maternal homokaryons and fetal trophoblastic cells to form heterokaryons composed of two genotypes merits fur


Morphological changes in the midpiece of wooly opossum spermatozoa during epididymal transit. Several ultrastructural changes were found to occur in the midpiece region of wooly opossum spermatozoa during epididymal maturation. The changes include alterations in mitochondrial morphology, development of structural specializations of the plasma membrane, and acquisition of a prominent extracellular coating. The lamellar membrane network which is wound about the periphery of the mitochondria becomes more densely packed during sperm development and the reticular network of membranes noted in the center of the mitochondria of immature sperm disappears leaving a homogeneous electron dense central zone. During epididymal transit the plasma membrane over the sperm midpiece region shows extensive structural modification. In cross sections of paired spermatozoa the plasma membrane of the midpiece regions shows a very regular, repetitive scalloping. In longitudinal sections the scalloping is observed as continuous parallel ridges which extend slightly obliquely to the flagellar long axis. Each ridge appears to be greater in density than the interridge areas. In the epididymis a prominent extracellular coating of dense material is deposited over the midpiece surface; this material is similar in appearance to dense material seen in restricted areas of the epididymal lumen. At the proximal and distal ends of the midpiece the plasma membrane comes into intimate contact with underlying structural specializations and it is suggested that these zones of fusion may serve to preserve regional differences in membrane composition.


Logarithmic growth of the hominoid mandible. The growth of the basal unit of the mandible was studied by plotting the position, relative to the median plane, of the oval, mandibular and mental foramina in immature and adult skulls of Man, chimpanzee and gorilla. In Man, the basal unit was found to grow out along a constant logarithmic spiral. In the apes, the basal unit grew along a constant logarithmic spiral, the amount of unfolding being greater  in the gorilla than in the chimpanzee. It is argued that the mode of growth seen in the apes evolved, as these forms became more prognathous, because it requires less compensatory rotation of the mandible, while the mode seen in Man is probably closer to that which occurred in common ancestral form.


Ultrastructural studies of the female breast: I. 9 + 0 cilia in myoepithelial cells. 9 + 0 cilia associated with diplosomes were observed in myoepithelial cells of the ductal system in the undiseased, resting, adult female breast. Ciliary diameter was 250 nm, and the longest found was 830 nm. The centrioles comprising the diplosome were 500 nm in length and 160 to 200 nm in diameter. Satellite bodies were associated with the diplosome but there was no rootlet system. Evidence suggested that all myoepithelial cells bear a cilium. The possible functions of the cilia in a sensory role as chemo- or mechanoreceptors related to myoepithelial and epithelial activities are discussed.


The ligaments of the human wrist and their functional significance. The ligamentous anatomy of the wrist was analyzed by studying (1) 28 dissected human wrists, (2) and by examination of 19 wrist injuries created mechanically. Six volar intracapsular ligaments are described, two stabilizing the distal carpal row, three stabilizing the proximal carpal row and one stabilizing the proximal scaphoid pole. More specific terminology for these ligaments is proposed. An explanation of how these ligaments participate in the mechanical functioning of the carpus is advanced. Mechanically created wrist injuries had ruptures of specific ligaments as described augmenting a need for a more specific terminology. Suspected mechanisms of injury in perilunate and lunate dislocations are mentioned based upon the functional understanding of the intracapsular ligaments.


The subdural neurothelium of the cranial meninges in man. The neurothelium obtained from human biopsy specimens is a very thin cellular layer located between the dura mater and the arachnoidea. It is a pluri-stratified squamous layer which has some epithelial features (desmosomes and tonofilaments), and lacks connective tissue fibers in the extracellular spaces. Usually there is increased nuclear and cytoplasmic density and enlarged extracellular spaces from the deepest to the most superficial layer. Since neurothelium is fragile and easily torn apart, it probably occupies the position considered to be the subdural space.


A correlative histofluorescence and light microscopic study of the formation of the sympathetic trunks in chick embryos. The appearance and development of the primary and secondary sympathetic trunks in staged chick embryos was studied using the Falck-Owman histochemical method for the demonstration of primary monoamines. The earliest appearance of catecholamine (stage 20) was in individual fluorescent cells located in the region of the dorsal root ganglia about two stages prior to the formation of primary trunk aggregates. These cells are believed to be sympathetic precursor cells and correspond to formaldehyde-induced fluorescent cells observed in recent explantation experiments. Aggregates of fluorescent cells had formed bilaterally dorsolateral to the aorta at stage 22. These aggregates became continuous to form primary trunks by stage 24. The secondary sympathetic trunks were first seen in stage 25 and appeared to form at least partially by dorsal migration of cells from the primary trunks. Fluorescent cell processes were first observed at this stage. Secondary trunk formation was essentially complete by stage 28, and the primary trunks had become small and discontinuous. Definite rami communicantes could be observed by the early part of stage 28 in silver preparations. The significance of the development of two successive trunks in avians is discussed.


The accessory optic fiber system of the golden hamster with special reference to retinohypothalamic projection. The hamster accessory optic fiber system has been investigated with the use of de Olmos-Ingram and Fink-Heimer silver methods following the production of unilateral ocular enucleation. It was found that this fiber system consists of both crossed and uncrossed inferior and superior fasciculi. The fibers of the inferior fasciculus (anterior accessory optic tract) run along the medial edge of the cerebral peduncle and terminate within the medial terminal nucleus of the accessory optic system. The fibers of the superior fasciculus (posterior accessory optic tract) leave the main optic tract, pass superficially over the medial geniculate nucleus and the cerebral peduncle; they synapse within the dorsal, the lateral and the medial terminal accessory optic nuclei. The presence of a retinohypothalamic tract could not be confirmed.


Urogenital anomalies in fetal rats produced by the anticancer agent 4(5)-(3,3-dimethyl-1-triazeno) imidazole-4-carboxamide. Pregnant Wistar rats injected intraperitoneally on gestational day 12 with single doses (100-1,000 mg/kg) or 600 mg/kg of 4(5)-(3,3-dimethyl-1-triazeno) imidazole-4-carboxamide (dic) were autopsied on day 21 (100-1,000 mg/kg) or at 24-hour intervals on days 13-20 (600 mg/kg). Controls received CMC on the same schedule. All fetuses were weighed and examined for urogenital system (UGS) malformations. Those given 600 mg/kg were also studied histologically. DIC produced significant growth retardation at all doses on day 21 (18-72%). UGS malformations occurred in 27-67% of the fetuses at 200-400 mg/kg and in 100% of those given 600 mg/kg or more of DIC. Abnormalities included renal growth inhibition, fusion, ectopia, and ureteropelvic dilatation. At 600 mg/kg renal and body weights were reduced 40 and 55%, respectively. Ureteropelvic dilation was common, and cortical glomeruli, nephric collecting tubules, and papillae were retarded in development. The juxtamedullary glomeruli were well developed. Proximal nephric tubular mitotic activity was 85% greater than in control animals (day 17). On the basis of pertinent morphological and physiological data, it is postulated that the dilated upper urinary tracts represent functional hydronephrosis incident to severe renal retardation and its resultant compensatory response.


Hormonal regulation of male reproduction (with reference to infertility in man). In mammals, pituitary control of spermatogenesis varies with age. In the rat, before puberty FSH is highly active whereas LH is not; after puberty it seems that LH alone is able to support spermatogenesis. The mode of action of hormones is discussed. In the human, in case of infertility due to hypogonadotrophic hypogonadism, spermatogenesis can be restored by HCG or HMG. The best results are obtained after simultaneous treatment with both hormones, LH activity being predominant.


Immunologic and testicular response in guinea pigs after unilateral traumatic orchitis. An acute and intense trauma was inflicted in one of the testes of adult guinea pigs. The immunological response and histological changes developed both in the injured and contralateral glands were studied at different intervals of time. It was observed: 1) Necrotic seminiferous tubules and a granulomatous cell reaction were seen in the injured gonad at 15 days. This was followed by a reduction of the mononuclear cell infiltration at 48 days. Finally a fibrotic tissue replaced the damaged areas at around 100 days. 2) Foci showing the classical picture of immunologic orchitis appeared in the contralateral gland at 15 and 48 days. Less frequent lesions were detected in the final period of the experiment. 3) These lesions were accompanied by cellular immunity detectable by the macrophage migration inhibition test at 15 and 48 days. With the exception of cytophilic activity also detected in same periods, no antibodies of hemagglutinating and sperm-agglutinating types could be found.


[Studies of acrosin and human sperm trypsin inhibitor activity in human semen. I. Relations to sperm density]. Report concerning the sperm examination of 825 patients of the Dept. for Andrology. The acrosin as well as the human sperma trypsin inhibitor activity were investigated. The results were related to sperm density. It was found that acrosin activity was significantly dependent on sperm density. For the human sperma trypsin inhibitor activity this relationship could not be established, although lower values were found by sperm deficiency and higher values by high sperm density.


Plasma testosterone values in hypopspadiacs. The plasma testosterone values were determined by radioimmunoassay in a group of 42 patients with a severe form of hypospaida, in one case of epispadia, in a control group of 69 boys with an adequate development of sex organs, and in 48 well fertile men. It was found that the beginning of pubescence started in both groups at the same age but that already from 13 years onwards the level of male sex hormone in the blood was lower in hypospadiacs than in the individuals of the control group. The difference is statistically significant in the subgroups from 19 years of age onwards. It is assumed that the function of gonads was insufficient in these patients not only in the period of intrauterine life, but that it often remains reduced even in puberty and adulthood.


Effect of administration of a single dose of testosterone oenanthate on constituents of human seminal plasma and serum gonadotropins. Testosterone oenanthate was administered intramuscularly in six infertile men with oligozoospermia and its effects on serum gonadotropins and some constituents in the seminal plasma were studied. One week after injection the mean serum FSH level was decreased to about 50%. Serum LH levels did not change. The mean ornithine decarboxylase activity in human semen was increased by 100% after the testosterone administration. The androgen dependent nature of ODC, fructose and sialic acid have been demonstrated.


A note on serological interpretations.

A note on serological interpretations. This paper deals with the interpretation of binary serological data. It attempts to render exact and answer two questions: 1) What are all the serological interpretations of a given set of data? 2) How can different interpretations be distinguished serologically? It is hoped that the formal analysis of serology presented herein will prove to be helpful to those working with complex immunological systems.


Genetic variation of pancreatic esterase isozyme in Japanese quail. A genetic variation was found in pancreatic esterases of Japanese quail which appeared to be arylesterase. It was found on the cathode side in the agar gel electrophoresis. Three phenotypes, A,B and AB, were observed. These phenotypes were shown to be controlled by one autosomal locus, designated as Es-4, with co-dominant alleles Es-4A and Es-4B. Es-4 esterase isozymes were detected in all the individuals from about 4 days of age, but the activity was very weak. However, it gradually increased to reach a level almost the same as that of a mature quail from about 15 days of age.


Pulmonary function tests and the diagnosis of bronchial asthma. The uncertainties which combine to make the physiological profile of bronchial asthma difficult to define are discussed in this article. Although the clinician may take comfort when the physiologist has substantiated his diagnosis, he should not defer to the physiologist when pulmonary function testing fails to support his assessment of the patient.


Ibuprofen (motrin) hypersensitivity in intrinsic and extrinsic allergic patients. The introduction of new anti-inflammatory chemicals derived from propionic acid raised the possibility that they would not cross-react with the aspirin-salicylate type of anti-inflammatory drugs (and this group's cross-reactant chemicals). Thic allergic patients who have low tolerance for aspirin or BHA-BHT if concomitant low tolerance for iodides is also present. Likewise, ibuprofen is poorly tolerated by iodide intolerant patients. However, ASA or BHA-BHT intolerant patients who are tolerant of iodides tolerate a single 400 mgm motrin challenge; chronic motrin usage awaits further study. This study indicates that motrin is tolerated in patients tolerant of iodides but who suffer with extrinsic, atopic, allergic diseases and also in normals.


Immunotherapy: its evaluation by RAST.

Immunotherapy: its evaluation by RAST. A recommended procedure carried out effectively on 132 patients and based on three essential criteria that may help the allergist in his decision to terminate immunotherapy in a patient is reviewed and discussed. These criteria, embodying clinical reappraisal of the patient, skin retesting and definitive RAST profile results, are offered as a new approach for consideration by the clinical allergist in the care of his patients.


Hyposensitization in ragweed pollinosis. The efficacy of hyposensitization in the control of ragweed hay fever has been demonstrated in both the clinic and the laboratory. In this paper evidence is presented that it also is important in preventing ragweed asthma. This is based on an experience with seven untreated patients who developed severe asthma in the 1975 season. The results of a 15-year study of constitutional reactions resulting from hyposensitization is summarized and means of their prevention is discussed.


A multifactorial study of patients with asthma. Part 2: air pollution, animal dander and asthma symptoms. As part of a multifactorial computer-assisted study of patients with asthma, the relationship between air pollution, animal dander and asthma symptoms was evaluated. No association was found between four major air pollutants (carbon monoxide, ozone, nitrogen oxides and sulfur dioxide) and asthma symptoms. Patients who owned cats and dogs reported more severe asthma symptoms (p less than .01) than patients who did not own cats and dogs. The evaluations completed to date indicate that daily exposure to cats and dogs accounts for more of the asthma symptoms differences between patients than daily exposure to air pollutants.


The development of allergy in infants of allergic parents: a prospective study concerning the role of heredity. Ninety-four infants of allergic mothers were studied from birth to age 24 months. If the father was also allergic, the family history was termed bilateral (36 infants); if the father was not allergic, the family history was termed unilateral (58 infants). Data concerning family history, methods of feeding (bottle versus breast) and allergic skin reactivity were obtained. Significantly, more infants developed allergy if they were from a bilateral allergic parentage (P = less than 0.044). When skin test negative, bottle-fed infants with a bilateral family history were compared to breast-fed infants with a unilateral family history, there was significantly less asthma in the latter group (P = less than 0.047). During the first three months of life there was significantly less atopic dermatitis in the breast-fed infants with an unilateral family history than in the breast-fed infants with a bilateral family history (P = less than 0.027). In this study it remained unclear why infants with positive allergy skin tests demonstrated a different incidence of allergic disease from those who were skin-test negative when the variables of family history were the same.


IgE levels in Hodgkin's disease.

IgE levels in Hodgkin's disease. Serum IgE levels were determined in a retrospectively selected group of 37 patients with Hodgkin's disease. IgE was determined by a double-antibody radioimmunoassay and expressed as International Units/ml. Patients were analyzed by stage and histologic classification of disease and compared to a group of 102 normal controls. IgE levels for the total group with Hodgkin's disease were significantly higher (p = .02) than controls but there was considerable overlap in ranges. Significant elevation of IgE was found in nodular sclerosing (p = .005) and Stage II Hodgkin's disease p = .0025). IgE elevations seen in other stages and histologic classes were not significant. While not conclusive, the IgE elevations that were found would be consistent with a suppressor T cell dysfunction in Hodgkin's disease.


Acquired coagulation factor X activity deficiency connected with Hymenoxys odorata DC (Compositae), bitterweed poisoning in sheep. An acquired coagulation factor X activity deficiency was demonstrated in sheep fed Hymenoxys odorata, bitterweed plant. All coagulation tests were normal before the sheep were given the plant material. All tests involving the function of factor X, including a specific factor assay, became abnormal after the sheep were given bitterweed. Other specific factors remained within normal limits. The presence of an inhibitory activity could not be shown.


Normal abomasal electromyography and emptying in sheep and the effects of intraabomasal volatile fatty acid infusion. Electromyographic activity and emptying of the abomasum were studied in 3 sheep. Pacesetter potentials (PP), with a frequency of 6.06 +/- 0.05 (X +/- SEM) cycles/minute and propagated distally with an increased conduction velocity approaching the pylorus, were recorded from the distal 11 cm of the antrum. Spike burst and fused action potentials (AP) were superimposed on a variable percentage of PP. The aborad propagation of both types of AP was associated with abomasal emptying at the net rate of 12.61 +/- 1.38 (X +/- SEM) ml/minute. Intraabomasal infusion of 50 ml of a 300 mM solution of either acetic, propionic, or butyric acid was associated with a marked decrease in abomasal AP activity and in the emptying rate. Butyric acid was most effective, followed by propionic and acetic acids. The importance of the results in relation to the pathogenesis of left displaced abomasum (LDA) in dairy cows was noted.


Reproductive disease experimentally induced by exposing pregnant gilts to porcine parvovirus. Porcine parvovirus (PPV) was administered intravenously or intranasally and orally between the 22nd and the 81st days of gestation to 20 pregnant gilts that were free of hemagglutination-inhibiting (HI) antibody for PPV. Gilts were exposed to 1 or both of 2 strains (NADL-7, NADL-2) of PPV and were killed 21 or more days later. Fetal and maternal fluids and tissues collected at necropsy were tested for PPV, viral antigen, and HI antibody. Transplacental infection occurred with 11 of 12 gilts given the mixture of strains NADL-7 and NADL-2 and with the 1 gilt given strain NADL-7 alone, but not with any of the 7 gilts given strain NADL-2 alone. The 8 noninfected litters were comprised of 74 fetuses of which 73 were alive and 1 was dead. The 12 infected litters were comprised of 91 fetuses of which 62 were alive (31 infected) and 29 were dead (26 infected). Virus was isolated from all of the 57 infected fetuses. Viral antigen was detected in tissues of 50 fetuses, including 5 live fetuses and 24 dead fetuses that were laden with antigen. All dead fetuses with a high concentration of viral antigen in their tissues were members of litters of gilts that were exposed to PPV no later than the 42nd day of gestation. Antibody was detected in serums (HI titers 10 through 1,280) of 27 of the 31 live infected fetuses and in serum (HI titer 10) of 1 fetus for which infection was not demonstrated. All serums collected from gilts at necropsy contained antibody (HI titers 320 through 2560) for PPV, but with the exception of isolating virus from 1 uterine lymph node, neither virus nor antigen was detected in maternal tissues.


Induction of lesions of selenium-vitamin E deficiency in pigs fed silver. Four weanling swine fed for 4 weeks a commercial ration adequate in selenium and vitamin E, but supplemented with 0.5% silver acetate, developed lesions typical of selenium-vitamin E deficiency. Clinically, the pigs fed this high level of silver had anorexia, diarrhea, and growth depression; 3 of 4 pigs died. At necropsy, hepatic lesions of hepatosis dietetica were present in 4 of 4 silver-fed pigs, and 1 of 4 pigs had cardiac and skeletal muscle lesions characteristic of selenium-vitamin E deficiency. Development of lesions and mortality was prevented in 2 pigs fed the silver diet supplemented with alpha-tocopherol (100 IU/kg of diet), but not in 2 pigs fed the ration supplemented with selenium as selenite (1 ppm). Four pigs fed a lower dose level of silver (0.2% silver acetate) for 6 weeks failed to develop clinical or pathologic features of selenium-vitamin E deficiency. However, hepatic selenium content was significantly increased in pigs fed the silver-supplemented ration.


Fine structural changes of the porcine uterine tube epithelium during early and late pregnancy. Ultrastructural changes in the uterine tube (oviduct) of pregnant gilts have been investigated with special reference to the ciliated, secretory, and stromal cells. Tissue from the uterine tube ampulla and infundibulum was taken from 18 gilts at different stages of gestation (days 31, 36, 101, 102, 107, 110, and 112). Cilia were present throughout pregnancy, and deciliation was not apparent at any stage of gestation. The low epithelium of the uterine tube appeared similar to that of the luteal phase of the estrous cycle when corpora lutea were full grown. Prominent features at end of the gestation were numerous fibrous granules and basal bodies, indicating active formation of ciliary precursor organelles. Fibrogranular aggregates were also present in association with the basal bodies. In addition, numerous polyribosomes, mitochondria, and microtubules were encountered in the cytoplasm of ciliated cells at end of the gestation. The appearance of electron-opaque, fibrous granules during late pregnancy probably could be correlated with increasing endogenous levels of plasma estrogen. Intimate morphologic association between fibrous granules and basal bodies indicate that fibrous granules might provide precursor material for the development of cilia or rootlets.  Characteristics ultrastructural changes observed in secretory cells during the estrous cycle were not discernible in secretory cells during pregnancy. The secretory cells appeared similar to those of the luteal phase of the estrous cycle. The apocrine secretory cells contained prominent, apical, cytoplasmic projections; pinching-off process of these protrusions was frequently observed during early and term gestation. Extruded nuclei along with other cytoplasmic organelles were also present, lying free in the tubal lumen. The endoplasmic reticulum was predominantly tubular in form. Synthesis, storage, and release of secretory granules were not apparent at early or late pregnancy. It is suggested that progesterone might have an inhibitory effect on the synthesis, storage, and release of secretory granules. Ultrastructural changes in stromal cells were not apparent at any stage of gestation. The stromal cells appeared similar to that of the luteal phase of the estrous cycle.


Cardiopulmonary effects of rebreathing and nonrebreathing systems during halothane anesthesia in the cat. Cardiopulmonary variables were measured in 3 groups of halothane-oxygen anesthetized cats. The groups, each containing 6 animals, were treated similarly except for maintenance anesthetic systems, and system variation was the basis for comparison. Groups were maintained, using a pediatric circle CO2 absorption system with an O2 flow of 0.5 L/minute, an Ayre's T-piece system with an O2 flow of 3 L/minute, and an adult circle CO2 absorption system with an O2 flow of 0.5 L/minute. Anesthesia was induced by mask, endotracheal intubation was done, and end-expired halothane was maintained at 1.4%. Measurements of cardiopulmonary variables were reported at 30-minute intervals for 135 minutes, the first measurements being made 15 minutes after induction. Control data were similar for all groups. Measured variables were not statistically or clinically different among groups, and change from control within groups was related to halothane anesthesia. The 3 systems produced similar cardiovascular and respiratory effects. Consequently, none of the systems proved superior to the other 2 on the basis of measured variables. Halothane anesthesia produced cardiopulmonary changes comparable to changes reported in other species anesthetized and maintained by similar techniques.


Gamma camera imaging of bilateral adrenocortical hyperplasia and adrenal tumors in the dog. Gamma camera imaging of the adrenal glands was done in 8 dogs with hyperadrenocorticism and 4 normal dogs given intravenous injections of 131I-19-iodocholesterol. In normal dogs, both adrenal glands could be visualized separately, and there was no difficulty in distinguishing among the images of normal glands, hyperplastic glands, and functional adrenal tumors. In addition, gamma camera imaging enabled the correct surgical site to be selected for removal of adrenal tumors. Hyperadrenocorticism was diagnosed in 8 dogs by evaluation of urinary 17-hydroxycorticosteroid (OHCS) excretion rates, urinary 17-OHCS and plasma 11beta-OHCS  RESPONSES TO DEXAMETHASONE SUPPRESSION OF ENDOGENOUS ADRENOCORTICOTROPIN (ACTH) secretion, and plasma 11beta-OHCS response to intravenous administration of ACTH. Base line 17-OHCS excretion increased in 5 of the 8 dogs. Plasma 11beta-OHCS concentrations were not decreased by dexamethasone administration in the 4 dogs subsequently found to have adrenal tumors; however, there was an exaggerated increase in plasma 11beta-OHCS concentration after administration of ACTH in 3 of the 4 dogs which had bilateral adrenocortical hyperplasia.


Determination of the facility of aqueous humor outflow in the dog, comparing in vivo and in vitro tonographic and constant pressure perfusion techniques. The gross facility of aqueous humor outflow (C) was estimated in the normal in vivo and in vitro dog eye, using tonography and constant pressure perfusion. Tonographic C value for 36 normal eyes, with the dog anesthetized with ketamine hydrochloride and acetylpromazine maleate, was 0.21 (+/- 0.14, SD); the mean tonographic value in 35 eyes with the patient anesthetized with sodium pentobarbital was 0.15 (+/- 0.09). Constant pressure perfusion of the in vivo normal dog eyes at 20 mm of Hg intraocular pressure yielded a mean C value of 0.13 (+/- 0.07) and at 30 mm of Hg 0.18 (+/- 0.13). As intraocular pressure increased from 10 to 50 mm of Hg, the rate of outflow, as determined by constant pressure perfusion, increased. The C values from in vitro constant pressure perfusion were greater than those in the in vivo eyes and deceased in most eyes as intraocular pressure was increased as compared with the in vivo preparation.


Effects of training on resting and postexercise ECG in standardbred horses, using a standardized exercise test. Five healthy, mature, previously trained Standardbred horses were given no exercise (left in a stall) for 4 months, then jogged (slow exercise) for 3 weeks, and placed in a 6-week training period. Cardiac variables were measured at the beginning of training and after 14, 20, 35, and 42 days of training before and at 10, 15, 20, 25, and 30 minutes after a 1.8-km (in 3:12 +/- 2 seconds) standard, submaximal exercise test on a deep 0.53-km track. There was no significant change during the 6-week conditioning period in the following variables at rest or at any of the times observed during recovery from test exercise: heart rate, PQ-interval, QRS-duration, QT-interval, and ratio of electrical systole to diastole. It appeared  that measuring heart rate by electrocardiogram at rest and during recovery from execise is not of significance in evaluating the fitness in the previously trained adult horse.


Detection of Moraxella bovis antibodies in infectious bovine keratoconjunctivitis by a passive hemagglutination test. A passive hemagglutination test was developed to detect antibody response to Moraxella bovis in tears. Tannic acid-treated sheep erythrocytes were sensitized with sonicated antigen prepared from M bovis cultures. The test was found to be a relatively simple, specific, and reliable procedure for titrating antibodies in lacrimal secretions. The hemagglutination test could be a valuable method for seroepizootiologic investigation of infectious bovine keratoconjunctivitis.


In vitro transformation of rodent cells by simian adenovirus 7 and bovine adenovirus type 3 (strain WBR-1). Hamster, rat, and mouse embryo cells were quantitatively transformed by simian adenovirus 7 with maximum efficiencies of 2.1 X 10(5), and 2.5 X 10(5) plaque-forming unit/focus-forming unit, respectively. Bovine adenovirus type 3 did not transform rat or mouse embryo cells, but transformed hamster embryo cells with a maximum efficiency of 3.4 X 10(4) plaque-forming unit/focus-forming unit. All of the transformed cells were tumorigenic in appropriate hosts and possessed viral-specific T-antigen.


Preliminary study of the in vivo motion in the canine shoulder. An instrumented spatial linkage was used to measure the total motion in a canine shoulder as the dog was engaged in a variety of activities, including walking on a level carousel track, as well as over a hurdle, up and down a step, and up and down a ramp placed on the same track. For each activity, the motion data were analyzed, using 2 procedures. First, the linkage data and the joint contour data were combined by computer, and the motion was represented by a series of sequential computer drawings showing the scapular and humeral articular surfaces in their proper relative positions for selected increments of time during the various activities described. As an alternate but approximate method for describing the relative humeral-scapular motion, rotations about 3 mutually perpendicular axes through the average center of the shoulder joint were determined.


Efficacy of albendazole against gastrointestinal nematodes of cattle. Forty-five calves with artificial and pasture-acquired nematode infections were medicated with albendazole at dose levels of 0, 2.5, 5.0, or 10 mg/kg of body weight. A dose level of 2.5 mg/kg removed at least 99% of adult Trichostrongylus axei, Trichostrongylus colubriformis, Cooperia oncophora, and Bunostomum phlebotomum. Burdens of Haemonchus contortus, Strongyloides papillosus, and Ostertagia ostertagi were reduced 79, 88, and 97%, respectively. At a dose level of 5.0 mg/kg, at least 95% of all adult nematodes were removed; at 10 mg/kg, at least 97% were removed. At least 99% of 4th-stage larvae of O ostertagi, T axei, C oncophora and T colubriformis and 96% of H contortus were expelled at a dose level of 2.5 mg/kg. At 5.0 and 10 mg/kg, 99 to 100% of all species of larvae were removed. Trichuris spp adults were slightly susceptible at all dose levels; larvae were susceptible (83%) only at 10 mg/kg.


Surgical preparation of miniature swine for atherosclerosis research. A 2-stage surgical procedure for chronic intestinal, vascular, and lymphatic sampling in miniature swine is described. Cannulas were placed in the jejunum and ileum, followed by a 2nd implantation of indwelling catheters in the portal and hepatic veins, caudal vena cava, abdominal aorta, and cisterna chyli. The techniques used proved that miniature swine can be surgically adapted to meet experimental requirements.


Use of duodenal drainage in the diagnosis of acalculous gallbladder disease. Because of overreliance on oral cholecystograms, we have re-evaluated a little used laboratory test, duodenal drainage. In a series of 56 patients with normal oral cholecystograms and upper GI series who underwent duodenal drainage and cholecystectomy, 53 (95%) were found to have positive microscopic examinations. We think duodenal drainage is a safe, simple test which should be used as an adjunct to history and physical examination and oral cholecystography. In regard to clinical follow-up, 96 per cent of patients followed were judged to have excellent-to-good results.


Clinical evalation of the the of local anesthesia for repair of inguinal hernia. Three hundred sixty-six patients undergoing elective inguinal hernioplasty were randomized to receive either local anesthesia or traditional spinal or general anesthesia. Overall operative complication rates were nearly the same, but wound complication predominated in the local anesthesia group while problems related to anesthesia were more common with spinal or general technique. Patients who had local anesthesia had significantly fewer postoperative symptoms than did the others.


Post-thyroidectomy hypoparathyroidism.

Post-thyroidectomy hypoparathyroidism. The incidence of hypoparathyroidism following thyroid surgery in the series reported was 7.8 per cent. Temporary hypoparathyroidism was present in 15 patients (4.6%) and permanent hypoparathyroidism in 10 (3.2%). Persistently low levels of serum calcium and high levels of serum phosphorus at six to 10 weeks after thyroid operation in patients with temporary hypoparathyroidism, with no tendency toward normalization, suggests permanent hypoparathyroidism. Serum calcium below 5 mg per cent suggests permanent hypoparathyroidism.