Weight gain in infancy and physical development between 7 and 10 1/2 years of age. Heights and weights were measured in 963 10-year-old children, whose weight data from the first year of life were available. Rapid weight gain in infancy was arbitrarily defined on the basis of sex-specific percentiles of weight gain at four-month intervals and from birth to 12 months. In girls, no significant association between rapid weight gain in infancy and overweight at 10 1/2 years was found. In boys, the association was significant for severe overweight (greater than 120% of standard weight for height). An estimation of the possible benefit of an intervention programme (food restriction in all male infants with rapid weight gain) showed, however, that at the very best 12% of the boys treated in this way could be expected to gain some benefit. The result of a correlation analysis between weight gain in infancy and change in height and relative weight between 7 and 10 1/2 years suggested that the factors which determined weight gain in infancy were no longer operative at ages between 7 and 10 1/2 years.


Relationship of weight gain in infancy to subcutaneous fat and relative weight at 10 1/2 years of age. In a representative sample of 895 schoolchildren, aged between 9 years 10 months and 11 years 2 months, the risk of being overweight or obese was compared between those who had gained weight rapidly during infancy and those whose weight gain had been normal. A substantially increased risk ratio was found only in boys for whom a correlation analysis showed that the total weight gain during the first year of life was associated with the total body mass in relation to height, more or less independently of the degree of fatness at 10 1/2 years of age. In girls, a direct but very weak association was found between weight gain in infancy and the degree of fatness at 10 1/2 years. The implications of these findings with respect to aetiology and the possibilities of prevention are briefly discussed.


Drug problems dealt with by 62 London casualty departments. A preliminary report. A study of the whole spectrum of drug incidents dealt with in one month by 62 casualty departments in the Greater London area was carried out in the summer of 1975. Apart from demonstrating the large number of such incidents, this preliminary report presents an analysis of the drugs responsible for these episodes, basic demographic characteristics of the drug users, and an estimate of the contribution of drug dependence.


Adrenosympathetic overactivity under conditions of work stress. Serial measurements of urinary adrenaline, noradrenaline, and 11-hydroxycorticosteroid excretion were performed on 32 healthy men under two conditions of work stress; piecework and work on assembly line. A statistically significant increase in adrenaline, noradrenaline, and 11-hydroxycorticosteroids was observed for piecework and assembly line workers compared with salaried and 'ordinary' workers. The results support the assumption that psychosocial factors of an everyday type have significant effects on the sympathoadrenomedullary and adrenocortical function.


Incomplete right bundle branch block and vital capacity. Right bundle branch block (RBBB) is occasionally encountered in young persons who lack any other evidence of overt cardiac disease (Hiss and Lamb, 1962; Lancaster, Schechter, and Massing, 1972). The block may be complete or incomplete, the latter being more common. Right bundle branch block has been studied in relation to body weight, obesity, serum cholesterol and glucose levels, and blood pressure, but the results have been negative (Ostrander, 1964; Kannel et al., 1962). Data presented here suggest that incomplete RBBB is related to vital capacity.


Detection and treatment of hypertension in an inner London community. A postal survey of a random sample of the population living near St Mary's Hospital, Paddington was taken to determine earlier experience in these people of blood pressure measurement and treatment. Eighty-five per cent of those who could return their questionnaires did so; eighty per cent of the respondents said they had had their blood pressure measured in the past, and 60% reported such a measurement during the previous three years. The respondents aged between 40 and 59 years were invited for a blood pressure screening measurement and 52% responded. Seventy-seven per cent of those found to be hypertensive on screening (systolic greater than or equal to 160 mmHg and/or diastolic greater than or equal to 100 mmHg) said they had had their blood pressure measured during the preceding three years. The reason for the poor control of hypertension in a community, therefore, is more likely to be a failure of doctors to take action on hypertension than a failure to detect it in the first place.


A relationship between Eysenck's P scale and change in muscle action potentials with attention to perceptual tasks. An experiment is described in which an index of change in muscle tension produced by perceptual discrimination tasks, and scores on Eysenck's PEN scales, were measured on 39 university students. It was hypothesized that if P is an index of psychoticism, as has been claimed (Eysenck & Eysenck, 1968) then an index of one central feature of so called 'psychotics', namely attention difficulty while decision making, should correlate positively with P. P was found to correlate significantly with a measure of increase of EMG on the perceptual discrimination tasks (r = 0-54, P less than 0-001). Correlations of this index with N and E were zero. The results are considered to be particularly significant, since scores on P, E and N gave almost zero intercorrelations in the sample tested, and L scores were exceedingly low. Further evidence is provided which suggests that both P and muscle tension increase are directly related to the degree of endorsement of paranoid ideas.


Extraversion, neuroticism and strength of the nervous system. The hypothesized identity of the dimensions of extraversion-introversion and strength of the nervous system was tested on four groups of nine subjects (neurotic extraverts, stable extraverts, neurotic introverts, stable introverts). Strength of the subjects' nervous system was estimated using the electroencephalographic (EEG) variant of extinction with reinforcement. Introverted subjects were found to have weak nervous systems, according to the EEG index, while extraverted subjects had strong nervous systems, thus confirming the hypothesis. It was also found that the dimension of strength of the nervous system was unrelated to differences in neuroticism. The results are interpreted as adding support to Eysenck's theory relating differences in extraversion-introversion to differences in cortical arousal.


Oculomotor adaptation to prisms: complete transfer between eyes. It is argued that previous experiments investigating interocular transfer of adaptation have been concerned with an adaptation of the registered position of the limb used to indicate direction. Thus the question of interocular transfer of adaptation sited at the eye remains open. Two experiments are reported. The first showed that there was complete transfer between exposed and unexposed eyes. The conditions were such that the adaptation could be explained only as a change in the registered position of the eye in the head, or of the head on the shoulders. The second experiment showed that changes of this latter kind did not occur.


Visual behaviour in social interaction: the validity of eye contact assessments under different conditions of observation. On each session of the experiment, each of five subjects was assigned to act as either gaze-sender (GS), gaze-receiver (GR), direct-sight observer (DSO) TV observer (TVO) or one-way mirror observer (OWO). The GS had to look into the GR's eyes each time he received prerecorded signal through earphones. The GR and the three observers recorded GS's eye-gaze behaviour. Two conditions of distance between GR and GS were included. Results showed that (1) the GR, DSO and TVO presented an equivalent accuracy in their EC recordings as compared with the programmed signals, while the OWO's accuracy appeared significantly lesser; (2) as a concealed observer, OWO was also less efficient than TVO since the agreement of the former with GR's records was significantly lower than that of the DSO, which was not the case for the latter; (3) with increment of distance, OWOs recorded longer EC periods, a tendency which was not found significant among the other observers.


The effect of embedded words in a brief visual display. In a replication and extension of an experiment by Eagle, Wolitzky & Klein (1966), subjects wrote brief stories describing an Object Relations Test card following exposure to a 7 x 7 letter matrix in which were embedded either neutral words or emotive words. Of six groups of subjects who participated, two groups were exposed to the matrices for 10 sec ('supraliminal control condition'), and the remaining four groups for 1 sec ('subliminal condition'). Independent judges were able to distinguish, to a significant degree, between the stories of subjects who were exposed to emotive words and those exposed to neutral words under the 'subliminal condition'; they could not distinguish, however, between the stories of subjects exposed for the longer duration ('supraliminal condition') to emotive and neutral words respectively. A crude content analysis yielded significantly more unpleasant words in stories from the subgroups exposed to emotive rather than neutral words, but again only under the very brief exposure condition, the difference being absent in supraliminal control groups. The relevance of these findings to previous experiments is discussed.


The components of the Poggendorff illusion. An explanation of the Poggendorff misalignment illusion in terms of three basic components, the horizontal-vertical, longitudinal-transverse and obtuse angle effects, is proposed. It is argued that these effects amy either singly or jointly give rise to an apparent elongation- contraction of the space between the aligned elements with consequent change in apparent oblique direction. Experimental evidence for the involvement of the three components in various combinations and for modification of perceived direction between the transversals is presented. It is shown that the illusion in various forms of the Poggendorff figure can be accounted for by the involvement of one or more of the three components, each of which can be demonstrated independently of the illusion. It is suggested that other classical illusions, including the Müller-Lyer, might also be analysed in terms of basic components.


A coordination of hand preference and skill replicated. Annett (1970a) described 283 subjects classified for hand preference and measured for the movement time of each hand on a peg moving task. A new sample of 804 subjects has been examined and classified as before. The mean differences between hands for each preference group are very similar in both samples. Hand preference can be regarded as anchored to an objective measure of manual skill. Both preference and skill are continuously distributed variables, not discrete ones. The quest for the 'essence' of left handedness should be replaced by studies of the characteristics of the distributions involved and of the criteria used to identify segments of the distributions.


Test anxiety, observation, and range of cue utilization. Sixty females scoring high on the Sarason Test Anxiety Scale and 60 scoring low on the same scale served as subjects in an experiment on cue utilization. One-third of all subjects were given a simple learning task with relevant cues added, and one-third were given the task with irrelevant cues added. Half of all subjects in each cue condition were observed by the experimenter as they performed and half were not observed. Relative to subjects in the other conditions combining observation and anxiety, those subjects who were high in test anxiety and also were observed showed a narrower range of cue utilization. The results are discussed in terms of current research on social facilitation.


Drivers use of seat belts as a function of attitude and anxiety. It is shown that drivers' reported and actual use of seat belts are predictable from their opinions about the comfort and effectiveness of belts. These relationships are, however, moderated by anxiety about possible accidents, in that low-anxiety drivers exhibit a stronger association between attitude and behaviour than do high-anxiety drivers.


Vigilance and arousal in depressive states. An experiment was performed to investigate predictions of vigilance performance among depressive patients, based on the assumptions that vigilance would vary in a predictable manner with level of arousal, and that levels of arousal among diagnostic categories of depressive patients are well known. It was found that psychotic depressives, presumed to be hypo-aroused relative to normals, exhibited poor signal detection performances and committed few false positive errors relative to normals. This was consistent with predictions. Neurotic depressives, presumed to be hyper-aroused relative to normals, detected fewer signals than did normals, but also made more false positive errors than normals. Again this was consistent with predictions. A measure of arousal in experimental subjects, namely barbiturate tolerance, was found to directly relate to the false positive error rate in all subjects. The relationship between arousal and total signal detection rate was significantly curvilinear, and an 'inverted U' (quadratic) function provided the best fit. This justified the conclusion that vigilance performance is a function of at least that component of arousal measured by barbiturate tolerance.


Associative and conceptual organization in thought disorder. Thought disorder has frequently been described either as a disturbance of associative response hierarchies or as an inability to deal with objects or events as representative of classes. The tendency of normal subjects to organize free recall by clustering associatively or conceptually related words suggested the recall task as a means to investigate these views of thought disorder. Two groups of psychiatric patients, one with high scores on Lovibond's version of the OST, one with low (thought-disordered and non-thought-disordered, respectively), were presented with randomly ordered word lists containing pairs related associatively and pairs related taxonomically. Thought-disordered and non-thought-disordered groups were not differentiated by any tendency to cluster more of one kind of pair than another. Rather, the thought-disordered showed a general lack of organization in recall, and significantly less improvement over trials in amount recalled. The results do not support the view that thought disorder is specifically a disorder of concept use or conceptual mediation. Research needs to be addressed to variables which affect the activation or inhibition of mediational links in thinking.


Goal-setting behaviour and coronary heart disease. In order to test Dunbar's (1943) theory about goal-setting behaviour in cardiovascular subjects, measures of performance and goal levels were taken on 25 coronary subjects, 25 hypertensive subjects and a control group of 25 fracture subjects. Ths hypertensive pattern of goal-setting behaviour appeared not significantly discriminated from that of control subjects, although the data were in the direction predicted by Dunbar, hypertensive subjects being higher for success and for low goals. For coronary subjects, the results were in complete agreement with the tested theory, these subjects showing a significantly higher rate of high goals than control subjects, and recording a higher rate of failure.


Styles of decision-making and probability appraisal in selected obsessional and phobic patients. A questionnaire was administered to obsessional and phobic patients and normal subjects. The results of this survey confirmed the prediction that a sizeable proportion of phobic patients report irrational expectations associated with their most feared situations. A group of phobics who reported irrational expectations, a group of obsessionals who reported an abnormal degree of checking behaviour and a group of normal subjects, took part in a probabilistic inference task. Several predictions about the differential performance of these groups were fulfilled. (i) Deviations from the optimal model for individual responses were greatest in the obsessional group. (ii) When Neuroticism was partialled out, the three groups differed with respect to amount of evidence required prior to a decision, the obsessional group having the highest score on this variable. (iii) The phobic group were more likely than the other two groups to make irrational event predictions.


A physiological evaluation of professional soccer players. The purpose of this study was to evaluate the physiological functions of a professional soccer team in the North American Soccer League (NASL). Eighteen players were evaluated on cardiorespiratory function, endurance performance, body composition, blood chemistry, and motor fitness measures near the end of their competitive season. The following means were observed: age, 26 yrs; height, 176 cm; weight 75.5 kg; resting heart rate, 50 beats/min; maximum heart rate (MHR), 188 beats/min; maximum oxygen intake (VO2 max), 58.4 ml/kg-min-1; maximum ventilation (VEmax BTPS), 154 L/min; body fat, 9.59%; 12-min run, 1.86 miles; and Illinois agility run, 15.6 secs. Results on resting blood pressure, serum lipids, vital capacity, flexibility, upper body strength, and vertical jump tests were comparable to values found for the sedentary population. Comparing the results with previously collected data on professional American Football backs indicated that the soccer players were shorter; lighter in body weight; higher in VO2 max (4 ml/kg-min-1) and body fat (1.8%); and similar in MHR, VE max, and VC. The 12-min run scores were similar to the initial values observed for the 1970 Brazilian World Cup Team. The agility run results were superior to data collected from other groups. Their endurance capabilities, agility, and low percent of body fat clearly differentiate them from the sedentary population and show them to be similar to that of professional American football backs.


Sub maximal oxygen uptake related to fat free mass and lean leg volume in trained runners. The sub maximal oxygen uptake (VO2) of 32 trained male middle and long distance runners aged 19.5-36.0 years was determined at five treadmill speeds. There was a significant linear relationship (p less than 0.01) between VO2 at each of the treadmill speeds and Fat-Free Mass (FFM) and Lean Leg Volume (LLV). To explain the relationship other factors are considered, the most important of which may be the mechanical configuration of muscle and mitochondrial function.


Effect of prolonged exercise of serum testosterone levels in adult men. The purpose of the study was to: 1) identify the differences in serum testosterone levels among four groups of adult men differentiated on the basis of physical fitness and age, and 2) determine the effect of a four-month physical fitness programme consisting of running, calisthenics and recreational activities on the serum testosterone levels of the four groups. The groups were designated: high-fit, young aged about 32 (n = 7); high-fit, old aged about 52 (n = 7); low-fit, young (n = 7), and low-fit, old (n = 7). The subjects were selected and grouped according to physical fitness scores obtained using the regression equation of Ismail et al. Serum testosterone was determined by a radioimmunoassay method. The pre-test ANOVA revealed that the high-fit groups had a significantly (p less than .01) higher testosterone level (754.29 ng/100 ml) than the low-fit groups (548.07 ng/100 ml) and the high-fit, young group (925.01 ng/100 ml) was significantly (p less than .01) higher than the other three groups. Post-test values were adjusted using pre-test testosterone values as covariates. No significant differences among the groups were found indicating that the serum testosterone levels were the same regardless of different ages and fitness levels. The findings were discussed in light of physiological, biochemical and psychological factors.


The clinical significance of pneumographic cerebellar atrophy. The clinical significance of apparent pneumographic cerebellar atrophy has been studied in a group of 44 otherwise unselected patients found to have cerebellar atrophy, according to previously suggested criteria, at pneumoencephalography. Lateral and postero-anterior tomography of the posterior fossa was performed in all these cases. In each case the width of two or more sulci in the cerebellar vermis exceeded 2 mm. We have concluded that: (1) There is a relationship between the severity of pneumographic cerebellar atrophy and the severity of clinical signs of cerebellar disease (p = 0.03). (2) Severe or moderate atrophy of the vermis, whether generalized or focal, is usually associated with clinical signs of cerebellar disease, but mild atrophy of the vermis, equivalent to the "moderate" atrophy of previous studies, has no apparent diagnostic significance. (3) Atrophy of the cerebellar hemispheres, in the absence of atrophy of the vermis, is very unusual and it cannot, by itself, be correlated with clinical signs of cerebellar disease. (4) In individual cases, assessment of the significance of pneumographic cerebellar atrophy cannot be made without adequate clinical information.


Quantitative radiology: radiogrammetry of cortical bone. Based on personal experience and data in the literature, an overview is given of radiogrammetry of cortical bone of the second metacarpal. There is a within- and between-observer error which amounts respectively to 1.2 and 1.5% for the outer diameter and 4.8 and 6.4% for the inner diameter. The systematic + or-- trend between observers indicates that one observer working according to certain defined rules obtains the most reliable results. There is a large variability in amount of bone within one age and sex group which is partly due to skeletal size differences, are insufficient since skeletal size differences still exist. The variability is reduced when the data are divided into strata of skeletal size. Since cortical area shows the best correlation with outer diameter within each age group and since cortical area represents best the ash content of the bones the values of this index are most suited to be grouped according to outer diameter. In differentiating pathological from physiological bone loss this procedure is an improvement on the previously published indices of amount of bone. When comparing different populations this method has advantages since skeletal size differences are eliminated. Comparing seven populations it was found that populations living in the United States of America have more bone for a given skeletal size than populations in Europe or Nigeria. Bone loss with age is a general phenomenon but differences in rate of loss are observed between the sexes and between ethnic different populations. The decrease of bone mass is faster after the age of 50 years in woman than in men. Blacks living in the United States loose less bone with age than whites. Radiogrammetry of cortical bone in groups gives useful information on bond remodelling during ageing and in pathological conditions. At an individual level, however, it is difficult to evaluate changes on a short term basis with radiogrammetry. Radiogrammetry of cortical bone is a simple and reproducible method which measures bone mass indirectly. Changes in cortical width show a high degree of correlation with the changes in mass of cortical bones but trabecular bone is not measured. This is a serious handicap, since most of the metabolic diseases of the skeleton affect trabecular bone to a greater extent than cortical. Nevertheless the measurement of cortical thickness certainly has added to the knowledge of changes in bone mass in ageing and in disease.


Bone demineralization in renal failure: a longitudinal study of the distal femur using photon absorptiometry. The bone mineral content (BMC) of the lower end of the femur was measured by photon absorptiometry in 87 patients with chronic renal failure. The gamma-ray photon source was Am241. Serial measurements were obtained for up to two years. The mean BMC of the adult patients, comprising: 18 pre-dialysis (CRF), 41 chronic haemodialysis (CHD) and 19 renal transplant (RT) patients were all significantly lower than controls with the exception of the male CRF group. Two adults and one child on chronic haemodialysis showed a significant rate of bone loss (less than 2% per year). In one of these adults the addition of daily oral 1 alpha hydroxycholecalciferol was associated with no further reduction in BMC. Two children and one adult on chronic haemodialysis showed a significant rate of increase in BMC (less than 2% per year). This adult had had a tendency to loss of BMC on standard CHD treatment but after receiving parenteral 1,25 dihydroxycholecalciferol three times weekly showed a significant rate of loss of BMC on serial measurement. Two adults and one child with CRF had a significant rate of increase in BMC on standard treatment.


Effect of Crohn's disease on colonic diverticula. Fifteen cases in which the same part of the colon has been affected by both diverticular disease and Crohn's disease have been studied. When Crohn's disease affects an area of colon where diverticula are present, radiological examination may show a diminution in number or disappearance of the diverticula with progress of the Crohn's disease. With improvement in the Crohn's disease diverticula may appear.


Giant gas filled cysts of the sigmoid colon: a report of two cases. Two case reports of giant gas filled cysts of the sigmoid colon are presented. It is considered that radiology provides the only useful and conclusive diagnostic investigation. In one of the cases, operative confirmation was obtained. In the other, the radiological appearances are considered to be diagnostic.


Stenosis of the deep femoral artery: an evaluation of the accuracy of single-plane, anteroposterior arteriograms. Pre-operative evaluation of the deep femoral artery is important in determining surgical treatment of aortofemoral disease. We reviewed 16 years' experience in bilateral aorto-femoral by-pass grafting and found that 63.2% of stenoses of the deep femoral arteries seen at surgery had been missed on conventional antero-posterior arteriograms. These findings demonstrate the inadequacy of a single, antero-posterior projection and the need for supplementary views in assessing lesions of the deep femoral artery.


Treatment of locally advanced prostatic carcinoma. An analysis of 66 patients with prostatic carcinoma treated by telecobalt therapy more than two years ago shows that this can be curative in a high percentage of cases. Local failure occurred in 20.5%. Well-differentiated tumours are more radiosensitive. Clinical regression can take a long time and histology can remain positive for even longer in an inactive prostate gland. A high dose is however required. The use of oestrogens should be delayed until further treatment is needed, as oestrogen seems to increase the radioresistance of the tumour. Radiotherapy seems to be the treatment of choice in inoperable (and even operable) patients with carcinoma of the prostate limited to the pelvis.


The spectrum and intensity of extra-focal (off-focus) radiation. Conflicting results have been obtained by other workers for the quality of radiation originating outside the area of the focal spot on X-ray tubes. This extra-focal radiation results in poorer picture quality, especially in cases where grids are not being used. As part of an investigation to assess the importance in diagnostic radiology of the various factors affecting the output from X-ray tubes, the photon spectrum has been examined using a Ge(Li) detector. The measured spectra have been adjusted for the effect of the detector characteristics. Results show that the extra-focal radiation is softer than that from the focal spot and, for the X-ray generator measured, constitutes approximately 8% of the exposure at 100 kV with a total filtration equivalent to 2 mm of aluminium. The possibility of further collimation to reduce this component, thus improving picture quality, is considered.


An assessment of lithium borate thermoluminescent dosimeters for the measurement of doses to patients in diagnostic radiology. A pilot survey of doses to patients undergoing four types of radiological procedure--barium enemas, intravenous pyelography, cardiac catheterization and mammography--has been made using lithium borate TL dosimeters. The survey was designed to test the operational suitability of the dosimetry system and to gain experience and gather data for the planning of further larger surveys. The TL dosimeters were calibrated against conventional ionization chambers, and then used on patients for determining gonad doses and maximum doses to the skin. Few difficulties were encountered in using the system. The measured doses to patients have been compared with previous determinations by other authors and reasonable agreement demonstrated.


The Ask-Upmark kidney: a form of ascending pyelonephritis? The case is presented of a young girl with recurrent urinary tract infection and vesico-ureteric reflux who developed a small scarred kidney and subsequently, hypertension. Pathologically, the renal changes were compatible with those of an Ask-Upmark kidney. The pathogenesis of the Ask-Upmark kidney is discussed. It is postulated that the lesion is not necessarily of congenital origin but may well be related to infection and intrarenal reflux, it is concluded that long-term follow-up of a young patient with a scarred kidney is indicated.


The surgical significance of the proteus stone. 62 patients with staghorn calculi who underwent conservative surgery at the Liverpool Regional Urological Centre since 1962 have been reviewed. The evidence shows that stone disease due to proteus is more rapidly progressive than that due to other organisms. Recurrences of proteus stones continue to behave in the same manner. Complete kidney clearance at operation is an essential part of the management of these stones, if renal substance is to be preserved.


The thermogravimetric analysis of renal stones (in clinical practice). Thermogravimetric (TG) analysis has been used as a routine technique for renal tract stone analysis. The results obtained in a consecutive series of 502 renal stones are described and evaluated. The technique is easy, rapid and gives quantitative information about stone composition. Results were compared with quantitative data obtained by standard chemical methods. Correlation coefficients for oxalate and urate were o-947 and 0-97 respectively. The comparison also showed that 63% of the stones could have been correctly analysed by TG analysis alone; in an additional 31%, TG analysis provided helpful information. TG analysis permits the identification of the proportions of mono- and dihydrate of oxalate present in calcium oxalate. It is confirmed that the centres of calcium oxalate calculi are richer in dihydrate than the exterior surfaces.


Embolism in a single functioning kidney: report of two cases. 2 cases of embolism in single functioning kidneys are reported. In the first case there was an occlusion of the main trunk of the renal artery; the patient was treated by embolectomy. In the second case the occlusion of a major arterial branch was demonstrated; because of the bad general conditions the patient was treated with medical therapy. The authors review the literature and the indications for embolectomy in embolism in a solitary kidney.


Upper urinary tract obstruction: pressure/flow studies in children. 34 upper urinary tract pressure/flow studies were carried out in 24 children. Obstruction was reliably diagnosed in 8 studies, and excluded in 21. This technique may provide information of clinical value in the patient with upper urinary tract dilatation.


Diagnosis of gross vesico-ureteric reflux using ultrasonography. A simple non-invasive ultrasonic technique which identifies gross vesico-ureteric  reflux (VUR) in adults is described. It is based on the time position (TP)-mode (or M-mode) of ultrasound imaging. This method warrants assessment as a possible screening procedure for gross VUR in newborn children.


Urinary Symptoms and total hysterectomy. A prospective study of urinary symptoms before and after total hysterectomy for a variety of gynaecological disorders has been made in 104 women. 62% were symptomatic preoperatively. Of this group 11% of the preoperatively symptomatic and 25% of the preoperatively asymptomatic either had their symptoms worsened or had symptoms appear 6 months after the operation. However, the total number of symptomatic women was reduced to 50% 6 months postoperatively. The case against total hysterectomy in the production of urinary symptoms remains to be proven.


Nephrogenic adenoma: a form of adenomatous metaplasia of the bladder. A clinical and electron microscopical study. 3 additional cases of "nephrogenic adenoma" of the bladder are added to the 20 previously reported cases. Light and electron microscopic studies of the first 2 cases support the hypothesis of urothelial metaplasia. The name "adenomatous metaplasia" should replace "nephrogenic adenoma". Malignant change occurred in the third case, suggesting that this ought to be regarded as a potentially dangerous from of metaplasia. In the absence of malignant change, ileocaecocystoplasty with subtotal cystectomy afforded symptomatic cure in 2 cases: radical cystectomy was performed in the third because of malignant adenocarcinoma.


Further studies on effects of irrigation solutions on rat bladders. Further studies on the effects of certain irrigating fluids on the rat bladder for 18 hours are reported. The results have shown that the degradation product p-choloroaniline is not a significant factor in chlorhexidine-digluconate associated erosive cystitis. A high percentage of kanamycin-colistin and povidone-iodine irrigations were associated with erosive cystitis and suggested a possible complication with human usage. Picloxydine irrigations appeared to have a lower incidence of erosive cystitis but further studies would have to be performed before it could be recommended for use in urological procedures.


Artificial insemination (A.I.H.) for sperm antibodies and oligozoospermia. Artificial insemination using husband's semen (A.I.H.) was carried out in 74 couples in most of whom the men had low sperm densities and/or a reduced sperm motility. There were 19 pregnancies (24%). The problems encountered and the reasons for failure are discussed.


Pulsatile changes of electrical impedance in the lower limb. The ratio of the pulsatile and the mean value of the volume of blood flowing through the calves of normal subjects with each heart beat was calculated from electrical impedance changes during venous occlusion plethysmography. Measurements made concurrently by proven Doppler ultrasound techniques did not correlate with ratios derived from the impedance measurements. The pulsatile change in electrical impedance in the limbs appears to be due more to changes of resistance in the blood than to pulsatile changes in the volume of the limb.


Successful repair of an idiopathic spontaneous aortoduodenal fistula. A case of idiopathic spontaneous aortoduodenal fistula treated surgically is reported. This case is probably the first successful repair of an idiopathic fistula to be recorded in the literature. The difficulty in diagnosis and possible aetiology are discussed.


Special problems associated with abdominal aneurysmectomy in spinal cord injury patients. There were 8 patients with spinal cord injury in the last 100 consecutive patients with abdominal aortic aneurysm resected at the Long Beach Veterans Administration Hospital. Emphasis is placed upon the problems in management not found in individuals without spinal cord injury. A successful outcome is dependent upon: (a) aggressive control of foci of infection, (b) early diagnosis and planned surgical intervention, (c) continuous intraoperative arterial and central venous pressure monitoring and (d) alertness to the prevention of postoperative complications, with emphasis upon careful tracheal toilet and anticipation of delayed wound healing.


Lingual ectopia of the thyroid gland and autotransplantation. A case of lingual ectopia of the thyroid gland in an adult patient is presented. The management by total excision and autotransplantation of the thyroid is described with a brief review of literature.


Hyperparathyroidism associated with a parathyroid cyst: an unusual presentation. In a case of hyperparathyroidism associated with a large parathyroid cyst a causal association was demonstrated by the presence of enormous quantities of parathormone in the cyst fluid. Assay of hormone levels in the cyst fluid in future cases may be helpful in elucidating the aetiology of this rare condition.


Riedel's thyroiditis.

Riedel's thyroiditis. Riedel's thyroiditis is a rare chronic inflammatory disease of unknown aetiology and may be one manifestation of multifocal fibrosis. Four patients were seen over a period of 12 years and unusual presentations in 3 of them caused difficulty in diagnosis. The aetiology and methods of treatment are discussed.


Obstructive uropathy due to primary retroperitoneal tumour (leiomyosarcoma): report of 2 cases and review of the literature. Two cases of primary retroperitoneal leiomyosarcoma presenting with obstructive uropathy which were successfully treated by surgical excision are reported. The classification of primary retroperitoneal tumours and their symptomatology, treatment and prognosis are discussed in detail based on a review of the literature and the current experience of treating these tumours by combination therapy. It is felt that with advances in the diagnosis and therapy the prognosis is likely to improve.


Clinical diagnosis of abdominal tuberculosis. One hundred and eighty-two cases of abdominal tuberculosis admitted to Swaroop Rani Nehri (SRN) Hospital, Allahabad, in the past 7 years have been reviewed. The clinical diagnosis of abdominal tuberculosis was made correctly only in 50 per cent of cases. About half the cases presented with chronic or acute on chronic intestinal obstruction. The remaining patients had vague pains, tender abdomen, constitutional symptoms or a mass in the abdomen. Diarrhoea was not frequent and fistula formation was rare. A chronic obstructive type of lesion was found not only in cases with a bowel lesion but also in patients with chronic miliary peritonitis and tuberculous mesenteric adenitis. Similarly, a lump was present not only in hypertrophic bowel tuberculosis but also in chronic miliary peritonitis and tuberculous mesenteric adenitis. On radiological examination false positive features such as fluid levels, bowel dilatation or even the 'string' sign were encountered. Liver and endometrial biopsies were positive in only a very few cases. Peritoneal biopsy was of considerable help, being positive in 88 per cent of ascitic cases and in 42-1 per cent of non-ascitic cases. Open peritoneal biopsy obtained after making a small incision in the right iliac fossa was found to be the most useful investigation in the diagnosis of abdominal tuberculosis. An ascitic fluid protein content of 2-5 g or more and a predominantly lymphocytic count of over 100/mm3 are diagnostic, but a cell count of 10/mm3 was recorded in one tuberculous case.


Results of Heller's operation for achalasia of the oesophagus. The importance of hiatal repair. A survey of 108 patients with achalasia treated by cardiomyotomy is reported. All the operations were done by the abdominal approach and all the patients were followed up for a minimum of 4 years. Fifty-five patients had some form of hiatal reconstruction, 11 of these having a formal plastic repair as practised for oesophageal reflux problems. At 4 years after operation 71 patients (65-5 per cent) had entirely satisfactory results. Twenty-seven patients had recurrent dysphagia and 20 patients had symptoms of reflux oesophagitis. The group who had had a formal repair of the hiatus had no reflux symptoms after operation and also had better swallowing than the other groups. These results suggest that much of the dysphagia following Heller's operation is due to occult gastro-oesophageal reflux and can be avoided by a reflux-preventing procedure. Adequate hiatal repair after myotomy is strongly recommended.


Mesocoloplasty for sigmoid volvulus: a preliminary report. A technique of mesocoloplasty for the prevention of recurrence of sigmoid volvulus is described. The manoeuvre is simple, and does not open the gut. It can be performed confidently by junior doctors undergoing surgical training and appears to be an eminently safe technique as a routine procedure in any emergency service.


The pattern of intestinal obstruction in Malaysia. This is a review of 261 patients operated for 271 instances of mechanical intestinal obstruction over a 5-year period in a developing country in the tropics. The pattern of intestinal obstruction in Chinese is similar to that in Caucasians, where adhesions account for the largest number of cases. The occurrence in Malays, Indians, Pakistanis and Ceylonese is similar to that in other developing communities where external hernia is commonest while adhesive or tumour obstruction is rare; however, these racial groups do not exhibit the high incidence of intussusception and volvulus found in Africa and India. The operative mortality was 13-9 per cent, which is comparable to that in Western series. The major adverse factors in intestinal obstruction, i.e. extremes of age, associated disease, gangrenous bowel, large bowel obstruction and malignancy, were confirmed. Fluid and electrolyte imbalance was frequent, as in other tropical series, but with intensive preoperative correction it was not an important adverse factor.


An elemental diet as preoperative preparation of the colon. In a study comparing patients prepared for colonic surgery with an elemental diet (Vivonex) with a control group there was no significant difference in incidence of wound infection or other complications between groups. Furthermore, there was no change in the population levels of the colonic microflora nor were the numbers of species decreased after 2-4 days on the diet. Although in most cases aiding in the mechanical preparation of the colon, the elemental diet has not been shown to confer any other advantage.


Inflammable antiseptics and theatre fires. This paper describes an investigation designed to find out if theatre fires could be started by the antiseptic painted on the patient's skin being ignited by cautery or diathermy. It was found that hot wire cautery or diathermy generated enough heat to ignite all alcohol-based antiseptics even if these contained as little as 20 per cent alcohol. They could also cause iodine to explode in the presence of nitrous oxide, and nobecutane to explode in the presence of nitrous oxide or increased oxygen. The likelihood of these combinations causing fires is discussed, and it is recommended that when diathermy or cautery is to be used near the surface of the body, either an aqueous-based antiseptic is used or if spirit solutions are required they are carefully dried off before proceeding.


The effect of surgical biopsy on the cell production rate of a murine tumour. The rate of cell production of a mammary adenocarcinoma following surgical biopsy has been investigated using vincristine sulphate as a metaphase arrest agent. Small implants of the tumour were implanted into the inguinal region of young mice of both sexes and were seen to have a constant rate of cell production both between different tumour generations and during tumour growth. Such a constant rate of tumour cell production provides an extremely useful model for exploring the effects of surgical biopsy. Measurement of the cell production rate showed a 60 per cent decrease for the first 48 hours following biopsy after which recovery ensued to reach control levels again. Sham-anaesthetized controls and sham-resected controls demonstrated none of these changes. Similar depression in the rate of cell production was seen following biopsy of one tumour in mice bearing bilateral tumours. The 48-hour depression was observed both in the ipsilateral remnant tumour and in the contralateral implant which has not been biopsied.


Renal stones and urinary infection: a study of antibiotic treatment. Twenty-two patients in whom renal calculi and urinary infection were closely associated were studied over two to five years. Four patients had previously had stones surgically removed, and five underwent pyelolithotomy during the course of the study. Urinary infection was treated with an appropriate antibacterial agent, and treatment was followed by long-term prophylaxis, usually with cotrimoxazole. A sterile urine was maintained for long periods in all these patients. In four patients, however, apparent stone growth occurred while the urine was sterile. On entering the study 21 of the 22 patients complained of symptoms. After treatment 19 of the 20 patients who were still attending were symptom-free. Six of the 22 patients entered the study with raised levels of serum creatinine; levels fell in four and remained raised in two. This antibacterial regimen, either alone or after surgery, will usually relieve symptoms and may prevent deterioration of renal function.


Sudden deaths among Finnish conscripts.

Sudden deaths among Finnish conscripts. The epidemiology of sudden deaths was studied among conscripts in Finland in 1948-72 (660 000 man-years) and among Finnish men aged 15-24 years in 1969-70 (900 000 man-years). The incidence of sudden deaths among the conscripts was 6-8/100 000 man-years. The onset of acute symptoms occurred during strenuous exercise in a third of the conscripts but in only a few of the other young men. Cardiovascular diseases caused two-thirds of the deaths in both groups. Sudden death tended to be more common among conscripts than among other young men during the corresponding period, but overall non-violent deaths were less common among conscripts than among other young men. On the basis of health records an attempt was made to separate the sudden deaths among conscripts from those among the controls by multiple discriminant analysis. For all practical purposes, however, the separation power proved poor.


Metronidazole and anaerobic sepsis.

Metronidazole and anaerobic sepsis. Fifty patients with anaerobic sepsis were treated with intravenous and oral metronidazole. In 26 cases this was combined with other antimicrobial agents. Highly satisfactory clinical results were obtained in most patients, though in many surgical drainage was also essential. No side effects or thrombophlebitis were seen. Mixed growths of anaerobic and aerobic bacteria were isolated from all except five patients, who produced only anaerobes. Metronidazole is the only available antimicrobial agent providing selective activity against anaerobic organisms. It is effective and safe and is usually the drug of choice for treating severe anaerobic sepsis.


Use of long-acting depot progestogen in domililiary family planning. Medroxyprogesterone acetate injections have been used as a long-term contraceptive by the domiciliary family planning service in Glasgow. The injections were particularly useful in women with a high risk of becoming pregnant and in whom oral or intrauterine contraception had failed or was unacceptable. The optimum dose was 200 mg every 15-16 weeks. It was accepted by an increasing proportion of women, only 12 out of 162 discontinuing because of side effects. Continuation rates compared favourably with those for the pill, but less well than those for intrauterine contraceptive devices. The theoretical hazards should be weighed against the positive good resulting from controlled fertility in domiciliary patients.


Mortality in relation to smoking: 20 years' observations on male British doctors. In 1951 the British Medical Association forwarded to all British doctors a questionnaire about their smoking habits, and 34440 men replied. With few exceptions, all men who replied in 1951 have been followed for 20 years. The certified causes of all 10 072 deaths and subsequent changes in smoking habits were recorded. The ratio of the death rate among cigarette smokers to that among lifelong non-smokers of comparable age was, for men under 70 years, about 2:1, while for men over 70 years it was about 1-5:1. These ratios suggest that between a half and a third of all cigarette smokers will die because of their smoking, if the excess death rates are actually caused by smoking. To investigate whether this is the case, the relation of many different causes of death to age and tobacco consumption were examined, as were the effects of giving up smoking. Smoking caused death chiefly by heart disease among middle-aged men (and, with a less extreme relative risk, among old men,) lung cancer, chronic obstructive lung disease, and various vascular diseases. The distinctive features of this study were the completeness of follow-up, the accuracy of death certification, and the fact that the study population as a whole reduced its cigarette consumption substantially during the period of observation. As a result lung cancer grew relatively less common as the study progressed, but other cancers did not, thus illustrating in an unusual way the causal nature of the association between smoking and lung cancer.


Characteristics and prognosis of alcoholic doctors. Five medically qualified women and 36 men who were being treated for alcoholism at a London postgraduate hospital were studied. Most were middle-aged and at an advanced stage of alcoholism. They had usually started drinking heavily in the wake of well-established drug dependence or other psychiatric disorder; as students or housemen; and in the armed forces. Thirty-six doctors were followed up for a mean of 63 months. Five doctors either killed themselves or died of cirrhosis, and nine persisted in almost continuous dependent drinking, while seven completely overcame their alcohol problem and 10 had only occasional relapses. Their prealcoholic careers had ranged from repeated failure to spectacular success, but of 29 doctors alive at follow-up only eight were practising satisfactorily.


Syphilitic aortic regurgitation. An appraisal of surgical treatment. During the 10 years from 1964 to 1973, fifteen patients with severe syphilitic aortic regurgitation were treated surgically at the National Heart Hospital. In thirteen the valve was replaced and in two it was repaired. In addition four had replacement of an aneurysmal ascending aorta with a Dacron graft and seven some form of plastic repair to the coronary ostia. Three patients died within 1 month of surgery and a further six during the follow-up period which varied from 1 to 55 months (mean 25-5). The six survivors have been followed-up for an average of 33 months. Factors contributing to this high mortality were analysed and it was found that the mean duration of effort dyspnoea was 22 months in the survivors compared with 48 months in those who had died. Similarly the average duration of nocturnal dyspnoea was 4 months in the survivors compared with a mean of 8 months in those who had died. Only six out of the fifteen patients had angina; this was present in two of the survivors and in four of the fatalities. The pulse pressure, heart size, and haemodynamic findings were similar in the two groups. The prognostic value of an elevated erythocyte sedimentation rate was also examined. It was concluded that preoperative investigations should include aortography, coronary arteriography, an assessment of left ventricular function, and whenever possible myocardial biopsy. These data were interpreted as suggesting that patients should be referred for surgery at an earlier stage in the disease--certainly before the onset of cardiac failure and--and that if this more aggresive attitude was adopted, as it has been in non-syphilitic cases of aortic valve disease, the present high mortality in this group would be reduced.


Gonococcal urethral stricture and watering-can perineum. A total of sixteen patients with urethral stricture and/or perineal urinary fistulae (water-can perineum) complicating gonorrhoea were seen at the Special Treatment Clinic, University College Hospital, Ibadan, Nigeria. The patients were aged between 25 and 80 years, and the latent period between the time of original attack of gonococcal infection and the development of complications varied from 4 to 50 years. The rate of divorce or marital separation is high among these patients with late sequelae of gonorrhoea. The factors responsible for the present higher incidence of early and late complications of gonorrhoea among patients in Nigeria and other tropical countries compared with their counterparts in Europe and North American include: (a) Lack of medical facilities in most rural areas; (b) Inadequate treatment of veneral diseases, including the urban areas where self-medication is practised on a large scale by the general population; (c) Illiteracy and ignorance of venereal diseases. The cases of watering-can perineum reported here, and the subsequent chronic pyelonephritis and hypertension, reinforce the plea for early and energetic treatment of acute gonorrhoea in Africa as well as large-scale control measures by the health authorities.


Gonorrhoea in patients with scabies.

Gonorrhoea in patients with scabies. 242 patients with scabies were examined for gonorrhoea at the Municipal Hospital of Copenhagen over a one-year period. We found asymptomatic gonorrhoea in 2% of the male patients and 12%. of the female patients. The incidence of gonorrhoea in female patients with scabies is thus higher than in other routinely examined groups of patients (Andersen and Nielsen, 1974; Gregersen, 1972; Hansen and Lange, 1973; Nielsen, 1974; Starck, Bygdeman, Eriksson, Heinerz, and Moberg, )971). Our suggestion is that all patients with scabies, male as well as female, should be examined routinely for gonorrhoea.


Isolation of Chlamydia trachomatis from women attending a clinic for sexually transmitted diseases. Attempts were made to isolate Chlamydia trachomatis from the cervix of 300 women attending a clinic for sexually transmitted diseases in Leeds. The women were divided into four groups; (1) 130 were consorts of men suffering from non-specific urethritis; (2) 66 were suffering from gonorrhoea, or were consorts of men suffering from this disease; (3) 56 were suffering from other sexually transmitted diseases; (4) 48 had no evidence of STD. The overall isolation rate of Chlamydia trachomatis was 20%. Positive results were obtained in 30%. of Group 1, in 27-3%. of Group 2, in 3-6%. of Group 3, and in 2-1%. of Group 4. No pathogenic sign or symptom of Chlamydia trachomatis infection of the cervix was detected.


Lymphographic studies in acute lymphogranuloma venereum infection. Lymphography, a radiological method of demonstrating lymphatic channels and nodes, has been used to investigate three cases of acute bubonic lymphogranuloma venereum (LGV). There is general agreement that LGV has a predilection for lymphatic channels and lymph nodes. However, very little is known of the extent of lymph node involvement in the early bubonic stage and whether there is merely a lymphangitis or complete lymphatic obstruction. The present study was undertaken to determine the lymphographic appearance in acute bubonic LGV, the extent of lymphatic node involvement in early LGV, and the usefulness of the procedure in the management of LGV patients. The buboes were not outlined by this procedure. The vessel phase of the lymphogram appeared normal, while the nodal phase showed a gradient of pathological involvement from the inguinal region lessening towards the lumbar nodes. The main drawbacks of lymphography in LGV are the difficulty of visualizing the lymphatics in the negroid skin and the lack of diagnostic criteria for inflammatory diseases of the lymphatic system. The lymphographic findings in LGV as described here may be regarded as typical of LGV but cannot be accepted as specific for LGV with a high degree of confidence. It is suggested that the procedure could be used for monitoring patients with the severe and late sequelae of LGV infection.


Lymphocoele and localized lymphoedema of the penis. Six patients with lymphocoele or sclerosing lymphangitis of the penis attended the Department of Venereology, Royal Infirmary, Edinburgh, during a 9-month period. Clinical details of these patients are given and the aetiology of the condition is discussed.


Polymyositis with biological false-positive serological test for syphilis. A case report. A young female came to the clinic with polymyositis and a biological false-positive serological test for syphilis (BFP reaction). Polymyositis, like other connective-tissue diseases, should be considered in the study of BFP reactors.


Differential effects of unilateral and bilateral caudate lesions on side preference and passive avoidance behavior in rats. The effects of unilateral and bilateral caudate lesions on side preferences, passive avoidance learning and locomotor activity were determined in rats. Unilateral lesions ipsilateral to preoperative side preferences increased side preference and facilitated passive avoidance learning. Contralateral lesions reversed side preferences and impaired passive avoidance learning. Bilateral lesions increased side preference in some rats and decreased or reversed side preference in other rats; the increase or decrease in side preference was related to a lesser or greater impairment in learning, respectively. All caudate lesions increased locomotor activity. It is suggested that an intrinsic nigro-striatal asymmetry has a modulatory role in learning and that the effects of bilateral caudate lesions are, in part, attributable to very slight asymmetries in lesion locations. The effect of a unilateral caudate lesion will depend upon whether the lesion is placed in the more or less active striatum.


Effects of nerve activity on the postsynaptic membrane of skeletal muscle. The effect of nerve activity on the sensitivity of the neuromuscular junction to acetylcholine was studied. After 1 h of nerve stimulation the flexor hallucis longus muscles of cats become more sensitive to the blocking effect of suxamethonium than before stimulation. Similar results were found using rat soleus muscles. The increased sensitivity to suxamethonium was still observed in muscles from rats which had been curarized during the period of stimulation. Intracellular recordings from end plates of rat soleus muscles revealed an initial transient increase in miniature end-plate potential (MEPP) frequency after stimulation and an increase in the amplitude of MEPPs which persisted for as long as 4 h. Moreover the depolarising responses to acetylcholine and suxamethonium added to the bath were always greater in stimulated muscles. It was therefore concluded that activity of the motor nerve increases the sensitivity of the end plates to transmitter.


On GABA function and physiology in the pineal gland. Pineal gamma-aminobutyric acid (GABA) content and glutamic acid decarboxylase (GAD) activity were found not to be influenced by environmental light, catecholamines, sympathetic innervation, or input via the pineal stalk. The observation that GAD activity did not disappear after pineal stalk section, ganglionectomy, or 48 h of organ culture leads us to suggest that GAD activity is not located in nerve processes entering the pineal gland. Treatment in organ culture with an inhibitor of protein synthesis did not greatly influence the slow rate of decrease of GAD activity. This finding is consistent with the conclusion that GAD turnover is slow. Treatment of denervated glands or glands containing functional sympathetic nerve structures with GABA, amino-oxyacetic acid (AOAA) or bicuculline in organ culture did not alter unstimulated levels, or significantly block the adrenergic stimulation of the activity of pineal serotonin N-acetyl transferase (NAT). It is clear from our studies that GABA does not influence or modulate the adrenergic regulation of.pineal NAT activity, and that GABA content and synthesis are not regulated by an adrenergic mechanism. The role of GABA in the pineal gland remains to be discovered.


Neurochemical aspects of the ontogenesis of cholinergic neurons in the rat brain. Ontogenic development of central cholinergic neurons in rat brain was examined by measuring the activity of choline acetyltransferase (CAT), concentration of acetylcholine (ACh) after focused microwave irradiation, the activity of the high affinity uptake process for choline and the apparent muscarinic receptor as quantified by specific binding of [3H]3-quinuclidinyl benzilate (QNB). For whole brain, the specific activity of CAT increases from 1 to 8% of adult between 15 days gestation and 7 days postpartum and then increases linearly to 83% by 4 weeks postpartum. The concentration of ACh is 22% of adult at 15 days gestation, rises to 29% by birth and attains adult levels by 4 weeks postpartum. The developmental rise in specific binding of [3H]QNB is intermediate between CAT and ACh with 10% of adult concentration of receptor at birth and a linear increase to 90% by 4 weeks postpartum. The development of the uptake of [3H]choline parallels that of CAT. In all regions of the neonatal rat brain, the relative level (% adult) of ACh is higher than [3H]QNB binding, which is higher than CAT. The neonatal medulla-pons has higher levels of [3H]QNB binding and activity of CAT (% adult) and develops more rapidly than the parietal cortex and corpus striatum; the hypothalamus and midbrain-thalamus exhibit intermediate rates of development.


Glutamate accumulation by human gliomas and meningiomas in tissue culture. The rapid accumulation of radioactive glutamate was studied in human brain tumor cells grown in tissue culture. The MGH-LM line of human astrocytoma demonstrated both a high (apparent Km = 20 muM) and a low (apparent Km = 0.2 mM) affinity component for the uptake of glutamate. The high affinity component was sodium-, temperature-, and energy-dependent and was present during the confluent (stationary) but not the log phase of cell growth. A study of confluent monolayer cultures of several other human brain tumors revealed that a similar high affinity uptake of glutamate occurred in 7 out of malignant astrocytomas and appeared to be independent of the grade of malignancy. In 3 optic gliomas and 5 meningiomas studied, low but not high affinity uptake of glutamate was found. These studies suggest that glial cells in the human brain may in some instances possess uptake characteristics for glutamate similar to those previously ascribed to nerve endings.


Prefrontal cortex and neostriatum self-stimulation in the rat: differential effects produced by apomorphine. In a dose-response experiment, the effects of intraperitoneal injections of the dopamine receptor agonist, apomorphine (0.075, 0.15, 0.3, 0.6 and 1.2 mg/kg) were studied on self-stimulation elicited from electrodes implanted in the medial and sulcal prefrontal cortex and caudate-putamen in the rat. From the medial and sulcal prefrontal cortex electrodes, apomorphine produced a dose-related decrease of self-stimulation rate which was consistent across animals. From the caudate-putamen electrodes, on the contrary, apomorphine produced a facilitatory effect in the majority of the animals at one or more doses, however, at other doses a decreased self-stimulation rate was observed. The clear and consistent effects of apomorphine on self-stimulation of the prefrontal cortex, together with other experimental evidence in the same line, suggest that dopamine is mediating self-stimulation of this cortical area.


Ontogeny of drinking behavior of preweanling rats with lateral preoptic damage. Male (N = 9) and female (N = 7) infant albino rats sustained bilateral lateral preoptic area (LPO) destruction on the tenth day of life. During development and as adults, these brain-damaged rats were subjected to repeated testing of drinking behaviors in response to cellular and extracellular dehydration. Immediately following LPO destruction the pups ceased suckling and most rats required tube-feeding to maintain life; however, all pups were maintaining body weight through voluntary suckling and/or feeding-drinking by 20-21 days of age. Daily water intakes were elevated from 30-42 days of age, following which intakes decreased to control vonse to water deprivation, polyethylene glycol injection and food deprivation treatments. These results are consistent with the suggestion that the LPO contains osmoreceptors for drinking behavior, and the present results suggest that such osmoreceptors, may be functional by the tenth day of life for rats.


Horseradish peroxidase tracing of the lateral habenular-midbrain raphe nuclei connections in the rat. Connections of the habenular complex to the nuclei of the midline in the midbrain (interpeduncularis, medianus raphe, and dorsalis raphe) have been studied classically by anterograde degeneration in the monkey, the cat, and marsupials. Passing fibers from the medial septal nucleus and lateral preoptic area, however, have also been demonstrated which can complicate interpretation of these results. In this paper the habenular projections were studied in the rat by the retrograde axonal transport of horseradish peroxidase (HRP). After HRP injections in the medianus raphe nucleus labelled neurons appeared in the lateral habenular nucleus and parafascicular nucleus. Labelled neurons were also found in the lateral habenular nucleus after injections in either the dorsalis raphe nucleus or the caudal central gray substance. The habenular projections were always bilateral. There were no labelled neurons in the medial habenular nucleus after HRP injections in the medianus raphe especially on the dorsalis raphe neurons which have usually been thought of as functionally related to other brainstem structures. The present results suggest also that in the rat the lateral habenular nucleus might be the link between basal forbrain inputs and the limbic midbrain area. Thus, the raphe nuclei of the midbrain appear to be crucial regions for integrating two descending circuits: first, a limbic (through septum) circuit, and, second, a basal forebrain (through lateral habenular-preoptic area) circuit.


Response-contingent stimuli and DRL performance after septal lesions in rats. An experiment was conducted to assess the effectiveness of providing response-contingent stimuli in improving the performance of rats with septal lesions on a DRL schedule of reinforcement. Groups of operated and control animals were given no stimulus, a light flash, or footshock in conjunction with all noncriterion lever presses. Footshock, but not light, was found to substantially ameliorate the lesion-induced DRL deficit. Improved schedule efficiency appeared to result from the punishing aspects of the shock and not to a response-feedback function.


Thalamic projections to visually responsive regions of parietal cortex. Thalamic efferents to visually responsive regions of parietal cortex of the cat were investigated by experimental retrograde tracing techniques. Two classes of photically evoked potentials recorded from the middle suprasylvian gyrus could be distinguished on the basis of waveform and latency. Type 1 responses were recorded from the Clare-Bishop area at the lateral border of the suprasylvian gyrus and Type 2 responses were recorded from association response areas on the crown of the suprasylvian gyrus. Studies  of retrograde degeneration in kittens and adult cats and retrograde transport of intracortically injected horseradish peroxidase indicate that afferents to the electrophysiologically identified Clare-Bishop area originate in the lateroposterior nucleus, the posterior nucleus, and the medial interlaminar nucleus of the lateral geniculate body. Afferents to electrophysiologically identified association response areas originate in the lateroposterior nucleus, ventroanterior nucleus, the pulvinar, the laterodorsal nucleus, and the central lateral nucleus. Studies of orthograde degeneration following placement of parietal lesions indicate a close reciprocity of corticothalamic and thalamocortical projections.


Principal cells in lateral geniculate: effects of metrazol on capacity to after-discharge. The effect of metrazol on the capacity of dorsal lateral geniculate nucleus (dLGN) principal (P) cells to repetitively burst (after-discharge) following visual system stimulation was examined in P cells which differed in terms of response patterns to visual stimulation (latency of initial spike, extent of repetitive bursting, and on- or off-type responding cells). Twenty-seven P cells were examined in as many subjects. Metrazol augmented repetitive bursting irrespective of the type of P cell as long as repetitive bursting was present in the pre-metrazol period. P cells that displayed only a single initial burst to photic stimulation did not exhibit after-discharge bursting during the metrazol challenge. In all but one cell metrazol enhanced baseline firing rate. These results are discussed in terms of the putative nature of inhibition in the rat dLGN.


Responses of neurons in rostral and caudal trigeminal nuclei to tooth pulp stimulation. Using immobilized, lightly anesthetized cats, the responses of neurons in the nucleus principalis-subnucleus oralis and subnucleus caudalis regions of the sensory trigeminal complex were studied following electrical stimulation of the canine tooth pulp. Recording loci were verified histologically. Pulpal stimulation activated 122 cells in the rostral nuclei and 44 in the caudal one. Neurons in the two, spatially segregated, regions exhibited different, though overlapping distributions of response and receptive field properties. More specifically, the rostral region cells tended to have lower thresholds and to reach peak firing rates at lower stimulus intensities. Their peripheral fields were generally more restricted and more frequently homolateral. Following supra-maximal stimulation, they ordinarily had briefer initial spike latencies and their response bursts typically contained a greater number of spikes. These findings are consistent with the view that each of the regions operates in a different manner in the mediation of oro-facial pain.


Role of retino-hypothalamic pathways in the entrainment of drinking rhythms. The role of retino-hypothalamic pathways in the re-entrainment of drinking rhythms after a 12 hr phase shift in the light-dark cycle was investigated by comparing the rate of re-entrainment of unilaterally blinded (UB) rats, with split optic chiasms (OCS) and controls. As reported previously, UB rats required more days to invert drinking rhythms than controls. The number of days required to re-entrain OCS rats fell between controls and UB rats but was not statistically significant from either group. Since OCS rats had the fewest retino-hypothalamic connections, the amount of retinal input to the surachiasmatic nuclei does not appear to play an important role in the rate of re-entrainment.  The results are consistent with the hypothesis that the unequal distribution of retiono-hypothalamic fibers in UB rats interferes with the entrainment process. Compared to controls, both UB and OCS rats showed a small but significant post-operative reduction in the nocturnality of drinking.


Open lung biopsy.

Open lung biopsy. During 16 years (1958-1974) 327 open lung biopsies were carried out in the Tuberculosis and Respiratory Diseases Research Institute, the 2md and 3rd Surgical Clinic of Charles University in Prague. A modification of the original Klassen's surgical technique with axillary or submammary approach was used. The patients (160 males, 167 women) were referred for biopsy because of various forms of diffuse pulmonary lesions without established diagnosis. The age of the patients varied from 6-72 years, 27 of them, aged over 60, were operated on nothwithstanding their compromised cardiopulmonary function. In 252 (79%) the definite diagnosis with characteristic histology was obtained, and in 70 (21%) only pulmonary fibrosis without exact specification was evaluated. The definite histologic findings were as follows: 102 (31%) diffuse interstitial pulmonary fibrosis (Hamman-Rich), 32 (10%) pulmonary lesions in systemic cardiopulmonary or bronchopulmonary diseases (collagenosis, eosinophilic and other granulomas, Wegener, hemosiderosis, etc.), 42 (13%) pulmonary sarcoidosis, 12 (4%) pulmonary tuberculosis, 45 (14%) pneumoconiosis, mostly silicosis, 24 (7%) neoplastic lesions. Post-operative morbidity of minor importance was 13,5%, mortality 0,3%: One 56 years old woman died 5 days following operation of cardiopulmonary insufficiency. This was an incorrect indication for biopsy based on inadequate evaluation of the patient's initial functional status. The open lung biopsy obtained by minimal thoracotomy is a valuable and well tolerated diagnostic method in cases where diagnosis cannot be obtained with certainty on the base of results of usual investigation procedures.


Heterotrophic activities of bacterioneuston and bacterioplankton. Numbers of viable bacteria as indicated by colony-forming units (CFU), microbial adenosine triphosphate levels, dissolved organic carbon (DOC), particulate organic carbon and nitrogen (POC and PON), glucose concentration, heterotrophic potential (Vmax), and in situ heterotrophic activity (Vn) of near-surface microlayer samples (70-80 mum depth), the neuston, and bulk column water samples (0.2-1.5 m depth), the plankton, of several natural waters were compared. DOC and glucose concentration values of near-surface and bulk water were similar, whereas POC and PON values of the near-surface were normally one order of magnitude greater than those of bulk water. Viable counts were generally greater in the neuston, but ATP levels were greater in the plankton. Comparative values of total heterotrophic potentials and heterotrophic activities fluctuated greatly. Heterotrophic potential per CFU of the neuston was 33% of that of the plankton; neuston heterotrophic activity per CFU was 10% of that of the plankton. These data suggest that neustonic heterotrophic bacteria are not as metabolically active as their planktonic counterparts and that they are under greater stress at the near-surface than in the column water.


Lipid metabolism in Achlya: studies of lipid turnover during development. The life cycle of Achlya involves germination of spores to form coenocytic somatic hyphae, followed by differentiation of hyphal tips into sporangia. From germination to release of new spores occupies 27-30 h. Total lipid made up 10% of dry weight in ungerminated spores. After germination, total lipid fell to 6% of dry weight in 15 h, then rose to 7.7% at the time of sporangium formation. Half of the initial loss of lipid took place within 2 h of germination. The ability of Achlya to incorporate [1-14C]acetate into lipid was maximal at the time of sporangium formation, and glycerides were the principal component of total lipid to become 14C-labelled at all stages of the life cycle. Fatty acid synthetase activity measured in cell-free extracts was low in spores and in actively elongating mycelium, but increased during idfferentiation to a level 15-fold greater than that in spores. Fatty acid oxidation, as estimated by the release of 14CO2 from 1-14C-labelled fatty acids, was also maximal at the time of sporangium formation.


Lipid metabolism in Achlya: changes in lipid composition during development. Fractionation of total lipid extracted from Achlya sp. at various stages of its developmental cycle revealed that in spores total lipid was composed of 62% neutral lipid, 13% phospholipid, and 25% glycolipid. After germination, the proportion of neutral lipid rose slightly after 2 h then fell sharply to 10% after 8 h, whereupon it rose to 55% of total lipid after 30 h of growth, when sporulation was completed. Conversely, phospholipid rose to 77% of total lipid after 8 h, then declined to 40% after 30 h. Glycolipid was maintained at 10-20% of total lipid throughout the life cycle after spore germination. Quantitative determination of neutral lipid components by photo-reflectometry showed that triglycerides accounted for 20% of neutral lipid in spores, and free fatty acids made up 50%. During growth, the absolute levels of both components fell precipitously on germination, remained at low levels throughout vegetative growth, and rose at the time of sporulation. The fatty acid composition of total lipid, phospholipid, neutral lipid, and free fatty acid fractions extracted from vegetative and sporulating Achlya cells was determined. The principal fatty acids present in all fractions of both stages of the life cycle were hexadecanoic and octadecanoic acids. Hydroxyhexadecanoic acid, eicosatetraenoic acid, and an unidentified long-chain acid were completely absent from the phospholipids of vegetative cells, although they were found in significant quantities in lipid fractions from other stages of growth.


Dehiscence and active spore release in pathogenic strains of the yeast Metschnikowia bicuspidata var. australis: possible predatory implication. Strains of Metschnikowia bicuspidata var. australis, pathogenic to brine shrimp (Artemia salina), were observed to form asci which, upon reaching maturity, forcibly expelled their needle-shaped spores. The mechanical force responsible apparently originates from the formation of an ectoplasmic mucilage capable of exerting pressure over all of the ascus contents; when the apex of the peduncle ruptures, the ascospores are violently released. Cytochemical analyses indicated that the gel is a substance highly resistant to chemical and enzymatic hydrolysis. Its chemical nature is not known as yet. The morphogenetic events of this process are described, and its ecological implication, the possibility of active mechanical predation in yeast, is discussed.


Morphological characteristics of a spirochete present in activated sludge. A free-living spirochete has been found in the activated sludge of purification plants in Amsterdam. A partial enrichment of the spirochete could be obtained with a passage through a thin layer of water agar. The morphology of this spirochetal strain does not fit into one of the described genera in Bergey's Manual. The cells have many regular primary coils on which broad secondary coils are superimposed and the protoplasmic cylinder is tightly wound around an axistyle,


Cellulase induction and the use of cellulose as a preferred growth substrate by Cellvibrio gilvus. Cellvibrio gilvus produced cellulase when grown in the presence of cellulose or carboxymethyl cellulose (CMC) but not when grown in the presence of glucose or cellobiose. This was so whether or not these compounds were the sole carbon sources present. Repeated addition of small amounts of glucose prevented cellulase formation in the presence of cellulose. It is concluded that cellulose and CMC induce cellulase formation and glucose and cellobiose repressit. Cellulose stimulated growth when added to organic media. Physical contact between cells and cellulose fibres was necessary for both cellulase induction and growth stimulation. If cellulase induction was prevented by glucose, cellulose did not stimulate growth.


Effects of Corynebacterium parvum alone and in combination with adriamycin in experimental tumor systems. Corynebacterium parvum (C. parvum) was used in antitumor tests against four murine tumor models in B6D2F1 mice. The C. parvum was effective at all doses and schedules tested against P388 leukemia, B16 melanoma, and Lewis lung carcinoma but was ineffective against L1210 leukemia. Combination immunochemotherapy of P388 leukemia and Lewis lung carcinoma with C. parvum and adriamycin was better than either regimen alone in increasing the lifespan of mice with tumors. The results show that the effects of C. parvum are due to nonspecific stimulation of the host rather than direct cytotoxic action on tumor cells. C. parvum protected the mice when given before as well as after tumor challenge. In vitro 51Cr-release assay showed that the peritoneal cells were cytotoxic to P388 tumor cells but spleen cells were not. While the C. parvum was effective against P388 in conventional mice, it was ineffective against P388 growing in athymic (nude) mice. Thus, the antitumor effect in this tumor system is T-cell dependent.


Synthesis and antitumor activity of 4-demethoxydaunorubicin, 4-demethoxy-7,9-diepidaunorubicin, and their beta anomers. Four new derivatives of daunorubicin, characterized by the absence of the methoxyl group at the C-4 position, have been obtained by chemical synthesis. 4-Demethoxydaunorubicin (NSC-256439) was effective against L1210 and Gross leukemias and ascites and solid Sarcoma 180 at doses four to eight times lower than those effective for daunorubicin. The beta anomer of 4-demethoxydaunorubicin was active at doses 13and eight times higher than those of its corresponding alpha anomer against L1210 and Gross leukemias respectively. 4-Demethoxy-7,9-diepidaunorubicin and its beta anomer were devoid of any biologic activity at the doses tested.


Adrenalectomy and oophorectomy plus limited-term chemotherapy in the treatment of breast cancer. A prospective study employing adrenalectomy and oophorectomy followed by limited-term combination chemotherapy was used in the treatment of 39 patients with advanced breast cancer. Chemotherapy was abruptly stopped at 8 weeks in order to take advantage of rebound immunocompetence. Delayed hypersensitivity was tested by dinitrochlorobenzene skin tests and responses to phytohemagglutinin. There were 22 CRs among 33 patients who entered remission. Eleven patients had a PR with greater than 50% reduction of tumor. Thirteen of 20 patients with visceral disease had a CR. There was a close association between response and competence of the cell-mediated immune system. The median duration of unmaintained remission in those patients with a CR was greater than 16 months. Four of the six failures had had recent radiation therapy to the chest wall which may have influenced immunocompetence. Responses to chemotherapy appear to be additive to endocrine ablation. Rebound of immunocompetence after chemotherapeutic immunosuppression may be related to remission induction and maintenance.


Device for constant Sc infusion of methotrexate: plasma results in mice. An infusion device is described which permits sc infusion of methotrexate into mice at a constant rate. Physical characteristics of devices ranging in size from 0.27-mm internal diameter X 15 mm long to 1.95-mm internal diameter X 2 mm long are described. Plateau plasma concentrations of methotrexate (1 X 10(-8) M to 1 X 10(-5) M) achieved from infusion rates varying over three orders of magnitude (less than 1- greater than 100 mug/hour) are presented. These data are evaluated in terms of the known toxic effects and pharmacokinetic behavior of this drug.


Inhibition of methotrexate transport from cerebrospinal fluid by probenecid. In rabbit, the efflux of intraventricularly injected methotrexate from the cerebrospinal fluid was retarded by pretreatment with 200 mg/kg of ip probenecid. In vitro, the ability of the isolated choroid plexus to concentrate methotrexate was depressed by the inclusion of probenecid in the incubation medium. These experimental results are consistent with the hypothesis that probenecid depresses the clearance of methotrexate from the cerebrospinal fluid by blocking the transport of methotrexate from cerebrospinal fluid to blood via the choroid plexus.


Cis-dichlorodiammineplatinum(II) in advanced bladder cancer. Cis-dichlorodiammineplatinum(II) (DDP) was given at a dose of 1.25 or 1.6 mg/kg to 24 patients with advanced measurable, urinary tract cancer. Eight patients (35%) achieved a partial remission and four additional patients had a minor response. There were 14 patients with epidermoid (transitional cell) bladder cancer who had had no prior chemotherapy and all eight partial responders were in this group. DDP appears to be one of the more active antineoplastic agents in bladder cancer.


Cyclophosphamide and CCNU in the treatment of inoperable small cell carcinoma and adenocarcinoma of the lung. Two hundred and fifty-eight patients with small cell carcinoma and 185 patients with adenocarcinoma were centrally randomized to receive either cyclophosphamide (1000 mg/m2 every 3 weeks) iv or cyclophosphamide (700 mg/m2 every 3 weeks) iv plus CCNU (70 mg/m2 every 6 weeks) orally. Those patients who were initially treated with the single agent were then treated with CCNU (130 mg/m2 every 6 weeks) at the time of cyclophosphamide failure. Objective tumor regression occurred more frequently with the combination regimen in patients with small cell carcinoma (43% vs 22%, P = 0.002), but no difference in response rates was apparent in patients with adenocarcinoma. In both cell types patients survived somewhat longer following treatment with the combination. The overall incidence of severe toxicity was equal for the two regimens in both cell types; however, the therapeutic index of the combination was superior to that of the single agent in small cell carcinoma. Severe drug toxicity was more frequent in small cell carcinoma patients with extensive disease, and survival was reduced in both cell types with extensive disease. Survival was better for ambulatory patients in both cell types and women survived longer than men. In women with small cell carcinoma, ambulatory status also was associated with a higher incidence of tumor regression. In patients with small cell carcinoma those who had prior lung surgery survived longer than those without prior surgery. Previous radiation therapy was associated with a reduced incidence of objective regression in men with small cell carcinoma. In both cell types patients with tumor regression lived longer than nonresponders; however, objective disease stability was associated with improved survival only in patients with adenocarcinoma. Stratification in future studies should consider extent of disease, performance status, sex, and prior therapy.


The separation of methyl ethers of methyl 2-acetamido-2-deoxy-D-glucopyranosides on a strongly basic ion-exchange resin. The methyl ethers of methyl 2-acetamido-2-deoxy-alpha- and -beta-D-glucopyranoside can be isolated on a preparative scale by chromatography on Dowex-1(HO-) resin. This procedure greatly simplifies the purification of methyl ethers, and has been used to isolate the methyl ethers produced by partial methylation of methyl 2-acetamido-2-deoxy-beta-D-glucopyranoside. The separations are thought to depend on an ion-exchange process in which all the free hydroxyl groups are involved. It is concluded that the following acidity sequence holds: HO-4 greater than HO-3 greater than HO-6.


Determination of the structure of dextran by 13C-nuclear magnetic resonance spectroscopy. The 13C-n.m.r. spectra have been recorded for a series of dextrans whose structures, in terms of degree and type of branching, had previously been determined by methylation analysis. The spectra established that all observable linkages in these dextrans are alpha-linked. Correlation of the spectra with methylation data indicated that the 75-85-p.p.m. spectral region is diagnostic for establishing the presence of alpha-D-(1 leads to 2)-, alpha-D-(1 leads to 3)-, or alpha-D-(1 leads to 4)-linkages. Each chemical shift has been found to be temperature-dependent (deltadelta/deltaT) when referenced to either the deuterium lock or an external standard (tetramethylsilane). All carbohydrate deltadelta values are positive, and range from 0.01 to 0.03 p.p.m./degrees C. These values are considerably larger than analogous deltadelta/deltaT values previously observed for smaller molecules. Larger than average deltadelta/deltaT values are associated with the non-anomeric, sugar-linking carbon atoms.


A facile synthesis of 2-methyl-[3,4-di-O-acetyl-6-O-(chloroacetyl)-1,2-dideoxy-alpha-D-glucopyrano]-[2',1':4,5]-2-oxazoline. The use of the chloroacetyl group as a protecting group has been studied for a 2-methylglyco-[2',1':4,5]-2-oxazoline. The reaction of chloroacetyl chloride or chloroacetic anhydride with 2-acetamido-1,3,4-tri-O-acetyl-2-deoxy-beta-D-glucopyranose provided 2-acetamido-1,3,4-tri-O-acetyl-6-O-(chloroacetyl)-2-deoxy-beta-D-glucopyranose which, on treatment with anhydrous ferric chloride in dichloromethane, produced the desired oxazoline. The glycosylating capability of the oxazoline has been investigated with aglycon hydroxides, to give the corresponding 2-acetamido-2-deoxy-beta-D-glucopyranosides. The chloroacetyl group can be selectively removed by treatment with thiourea, and migration of O-acetyl groups was not observed under these conditions.


An improved method for the syntheses of p-aminophenyl 1-thio-beta-D-glycosides. The condensation of the appropriate acetylglycosyl bromides  with p-aminobenzenethiol in the presence of sodium methoxide afforded p-aminophenyl 1-thio-beta-D-glucopyranoside, 1-thio-beta-D-galactopyranoside, 1-thio-beta-D-xylopyranoside, and 2-acetamido-2-deoxy-1-thio-beta-D-glucopyranoside. p-Aminophenyl 1-thio-beta-D-glucopyranosiduronic acid was synthesized by condensation of methyl (2,3,4-tri-O-acetyl-alpha-D-glucopyranosyl bromide)uronate with p-aminobenzenethiol, followed by saponification with sodium hydroxide.


Effect of routine treadmill testing on the serum enzymes. A number of serum enzymes increase after strenuous exercise. However, there is no information concerning these enzymes after routine treadmill testing, SGOT, CPK and LDH were determined before, immediately after, at 4 and 24 h postexercise in 100 subjects undergoing this test. When the group was considered as a whole, only the SGOT showed a slight but statistically significant elevation immediately after exercise. The mean values of the SGOT at 4 and 24 h, as well as the mean values for the CPK and LDH at all times after exercise, were not significantly increased. SGOT increased more significantly immediately after exercise in those patients who exercised more than 6 min. This group of patients also showed modest but statistically significant elevations of their CPK immediately after completion of the exercise test. Analyses of the data in relation to the presence or absence of ischemic ST shifts and presence or absence of documented coronary obstruction, failed to show any significant correlation. The effect of conditioning on the serum enzyme changes postexercise was not demonstrable.


Evaluation of V max TP as an index of myocardial contractility during afterload and preload elevations. In order to test if the maximal velocity of shortening (V max TP) reflects the level of inotropism and is affected by preload and afterload, the behavior of this index was compared in two groups of anesthetized, atropinized dogs when preload and afterload were raised with an angiotensin II infusion. In seven dogs (group I), the arterial pressure elevation was allowed to inhibit reflectively the sympathetic tone and depress contractility. In eleven dogs (group II), the adrenergic activity was abolished by previous administration of reserpine. In group I, there was a significant decrease in V max TP during the angiotensin infusion. In group II, there was no significant change in the value of this index when the drug was infused. In six animals of this group, a further increase of arterial pressure was induced, but the values of V max TP remained similar to control. These results suggest that this index reflects the inotropic state of the myocardium and does not suffer significantly from the influence of preload and afterload elevations within our experimental limits.


Pacemaker Wenckebach phenomenon due to antiarrhythmic drug toxicity. Two patients with intractable ventricular arrhythmia were managed with ventricular pacing and antiarrhythmic drugs. Toxic levels of these drugs results in unusual conduction disturbances at the level of Purkinje ventricular junction which caused pacemaker Wenckebach phenomenon and marked QRS prolongation. Sodium bicarbonate and sodium lactate infusion improved the conduction velocity probably by hyperpolarizing the membrane and reversed the conduction disturbance.


Ventricular rhythms in acute myocardial infarction. Ectopic ventricular activity in acute myocardial infarction is considered to be benign if it is slow and regular (accelerated idioventricular rhythm), but ominous when rapid (ventricular tachycardia). However, it has been observed in an increasing number of reports that these two types may coexist in the same patient, altering thereby the clinical significance of both. In the present study electrocardiograms were analyzed of 55 patients hospitalized for acute myocardial infarction, in whom idioventricular rhythm occurred. It was found that three major types of ventricular rhythms could be identified: a regular-stable rhythm, an irregularunstable one, and a third variant which was a combination of these two types. The stable ventricular rhythm was self limited and harmless. The unstable and combined types which were characterized by random coupling times and varying interbeat intervals, were frequently associated with re-entrant beats and fast ventricular rates and therefore a potentially ominous prognosis. It is suggested that the Ca++ dependent slow diastolic depolarization may be the mechanism responsible for the unstable ventricular rhythm, and the reasons for this assumption are discussed. A therapeutic approach based on the above considerations is described.


Incidence and implications of abnormal intraventricular conduction in the coronary care unit. A transient, intermittent, or permanent disorder of intraventricular conduction was found in 35% of 404 patients with acute myocardial infarction. Patients with acute myocardial infarction and abnormal intraventricular conduction were older than patients with normal intraventricular conduction, but there was no significant age difference between patients with normal and abnormal intraventricular conduction who died. Mortality was only slightly higher in patients with preexisting intraventricular conduction disorder than in patients with normal intraventricular conduction. On the other hand, mortality was remarkably higher in patients in whom abnormal intraventricular conduction developed during the course of acute myocardial infarction than in patients with either normal intraventricular conduction or preexisting abnormal intraventricular conduction. Transvenous cardiac pacing had little impact on mortality, death being due to pump failure in the majority of the patients. This study identifies a group of high-risk patients in whom early aggressive management utilizing newer therapeutic modalities such as mechanical circulatory assistance, emergency aortocoronary bypass, or both, might be profitably applied.


Permeability of barnacle muscle fibers to water and nonelectrolytes. The permeability of isolated muscle fibers of the giant barnacle Megabalanus psittacus to water and nonelectrolytes was studied by determining their reflection and permeability coefficients. Reflection coefficients were obtained by comparing the osmotic fluxes produced by a test molecule to that produced by the impermeant sucrose molecule. Permeability coefficients were determined for measurements of tracer uptake. The results indicate that, in these fibers, nonelectrolyte permeability is closely related to lipid solubility and molecular size. A value of 2.16 X 10(-12) cm3/sec dyne for the hydraulic conductivity and a value of 10.45 X 10(-4) cm/sec for 3HHO permeability coefficient were obtained. The effect of membrane surface invaginations and clefts on the determination of permeability coefficients is discussed.


Chemical synthesis of dinitrodiphenysulfone derivatives of ethanolamine and serine and its application to the study of neighbor analysis of amino-phospholipids in the erythrocyte membrane. The dinitrodiphenysulfone derivatives of serine and ethanolamine have been prepared and their chromatographic and spectral properties are described. This cross-linking agent was used to determine the neighbor analysis of amino-phospholipids in the erythrocyte membrane. The results with erythrocyte ghosts show that at 50 muM probe 31-50% of the total phosphatidylethanolamine is cross-linked to itself and 10-12% of the phosphatidylethanolamine is cross-linked to phosphatidylserine. Approximately 10-12% of the phosphatidylserine is cross-linked to itself and 16-20% of phosphatidylserine is cross-linked to phosphatidylethanolamine. The cross-linking of amino-phospholipids of ghosts with difluorodinitrodiphenylsulfone (9 A span) is compared with cross-linking of these phospholipids by difluorodinitrobenzene (5 A span). It is important to use the same sample of ghosts for this type of study since biological variability was seen in ghosts prepared from different batches of stored blood.