Blood flow and relative tissue PO2 of brain and muscle: effect of various gas mixtures. The effects of inspiring low O2 or high CO2, or low-O2-high-CO2 gas mixtures on tissue perfusion and tissue Po2 of brain and muscle were studied in 76 anesthetized rats. Under control conditions, relative tissue Po2 of cerebral white matter measured polarographically averaged 16.4 mmHg and 18.7 mmHg in the biceps brachii. With low-O2 gas mixtures, tissue Po2 declined in both brain and muscle, but more in muscle. Tissue Po2 increased under high-CO2 conditions, with the brain increasing to a greater extent. Control cerebral cortex tissue perfusion averaged 23.5 ml/min per 100 g and muscle was 18.3 ml/min per 100 g measured by H2 clearance. Brain perfusion increased under all experimental conditions. Muscle perfusion did not change with low O2 alone, but increased with low-O2-high-CO2 or high-CO2 gas mixtures. Brain perfusion increased under all conditions significantly more than muscle. The brain appeared better protected compared to skeletal muscle in terms of tissue Po2 and perfusion under the stress of hypoxia and hypoxic-hypercapnia. The effects of hypercapnia are also greater on the brain.


Effects of saline drinking on malignant course of renal hypertension in rats. In rats with unilateral renal artery stenosis and an intact contralateral kidney, a malignant course of hypertension (MH) may develop, which is characterized by 1) high BP levels, 2) sodium and water loss and a polyuric-polydipsic syndrome, 3) marked activation of the renin-angiotensin system, 4) malignant nephrosclerosis in the contralateral kidney and high plasma urea concentrations, and 5) deterioration of the animals' general condition. (Some rats exhibit signs of a cerebral vascular crisis; some rats die). When such rats are offered in addition to water 0.9% NaCl, they compulsively drink the saline, BP falls for some days to levels found in the other hypertensive animals, and signs of MH nearly or completely disappear. It is concluded that high saline intake has, for a limited period, a beneficial effect on the malignant course of renal hypertension in rats. The observations made are consistent with the hypothesis that salt and water loss, which ensue subsequent to an increase of BP into a critical high range might trigger the onset of malignant hypertension.


Tachypnea after stimulation of afferent cardiac sympathetic nerve fibers. The role of afferent cardiac sympathetic nerve fibers in the regulation of respiration has been examined. Application of potassium chloride or lactic acid solutions to the left ventricular surface of anesthetized vagotomized dogs resulted in a decrease in the manimum firing rate and shortening in period duration of firing of phrenic nerves. Also, application of the agents caused a decrease in amplitude and an increase in rate of respiratory thoracic movements. The same changes in phrenic nerve activity and respiratory movements were produced by coronary artery occlusion and centrifugal electrical stimulation of the left inferior cardiac nerves. The results indicate tachypnea that can be produced by excitation of afferent cardiac sympathetic nerve fibers.


Effect of initial length on relations between oxygen uptake and load in dog muscle. Oxygen uptake for brief tetanic contractions was calculated from measurements of blood flow and blood arteriovenous oxygen content differences. Each muscle preparation was pretested under isometric conditions to establish optimal length, Lo. After this one group of preparations performed afterload isotonic contractions at several loads with initial length, Li, less than Lo. The other groups of preparations performed similar contractions with Li greater than Lo. When Li was less than Lo, oxygen uptake for the highest load was always greater than oxygen uptake at the lowest load whereas intermediate loads were usually higher than both extremes. However, when Li was greater than Lo, oxygen uptake at the highest load was always less than oxygen uptake at the lowest load; again the intermediate loads were usually higher than both extremes. The data confirm and extend similar effects of initial length on heat production for contractions by amphibian muscles (7). It seems likely that the differences in initial lengths may account for the fact that the Fenn effect has not previously been observed in studies of mammalian skeletal muscle energetics.


Oxygen uptake for negative work, stretching contractions by in situ dog skeletal muscle. Oxygen uptake for negative work, stretching twitch contractions by in situ gastrocnemius-plantaris muscle was calculated from measurements of venous outflow and arterial and venous blood oxygen contents. Contractions were produced by valving air at high pressure into the pneumatic lever 10-50 ms before stimulation of the muscle. The loads produced were up to about 2.5 times isometric. Muscle length was always below optimal isometric length. Oxygen uptake for shortening contractions increased with increasing load up to isometric load. Oxygen uptake for stretching contractions decreased with increasing loads above isometric load. Velocity of shortening decreased with increasing loads up to isometric load whereas velocity of stretching increased with increasing loads above isometric. In shortening contractions external work done by the muscle was greatest at intermediate loads, but in stretching contractions the work done on the muscle increased with increasing loads. In stretching contractions the ratio of the energy equivalent of the work absorbed by the muscle reached 8.0 times the energy equivalent of the oxygen uptake. Since this ratio cannot exceed 1.0 for an engine, muscles must act as brakes during stretching contractions.


Inhibition of the CNA trigger process for arousal from hibernation. Ground squirrels (Citellus lateralis) produced three distinct types of thermogenic response during hibernation. These responses were evoked spontaneously as well as after stimulation produced by brief handling, or after microinjection of acetylcholine into the midbrain reticular formation. Type I responses were characterized by small magnitude and a slow (mean rate, 0.03 degrees C/min), variable rising phase. Type II responses were characterized by a smooth, rapid rising phase with a mean rate of increase of 0.11 degrees C/min and by an abrupt reversal of the rising phase within a restricted ceiling temperature band with a mean value of 9.4 degrees C. The third type of response, full arousal, was characterized by a return of body temperature to euthermic (nonhibernating) levels and by an early rising phase that was indistinguishable from the rising phase of type II responses. This indicates that the rising phase of type II responses and the duplicate portion of full arousals are produced by a common neuronal mechanism that functions as the trigger for arousal from hibernation, and that this mechanism can be spontaneously inhibited when increasing internal temperature reaches a hibernation ceiling level.


Effect of cervical sympathetic nerve stimulation on canine carotid sinus reflex. In the chloralose-anesthetized dog the carotid sinus on one side of the neck was isolated vascularly. Pressure in the isolated sinus [carotid sinus pressure (CSP)], electrocardiogram, and systemic arterial pressure were recorded. Both vagosympathetic trunks were cut and the contralateral common carotid artery was occluded or the contralateral sinus nerve was cut to reduce reflex buffering of arterial pressure changes. By varying CSP from 50 to 250 mmHg the full range of the reflex response was examined. Electrical stimulation of the peripheral end of the cut ipsilateral cervical sympathetic nerve brought about a rapid decrease in mean arterial pressure (MAP) and heart rate (HR) at lower CSPs, no change in these variables at midrange CSPs, and a gradual increase at higher CSPs, such that the gain of the reflex was reduced (1.89 +/- 0.19 to 1.33 +/- 0.15 mmHg/mmHg). The decrease in MAP and HR at lower CSPs implies an increase in baroreceptor activity whereas the converse would appear to occur at higher CSPs. These responses attained a maximum value at low stimulus frequencies (less than 10 Hz).


Ba2+ and K+ alteration of K+ conductance in spontaneously active vascular muscle. The spontaneous spiking of vascular muscle in hepatic portal vein was converted from a burst pattern to single spiking by K+ concentrations greater than 20 mM. A pronounced decrease in contraction amplitude was always associated with the conversion of bursts of spikes to single spikes. The single spikes were accompanied by contractions that were only 1-5% of the magnitude of the contractions associated with spike bursts. Ba2+ (1 mM) increased the number of spikes per burst in myovascular cells at low(less than 10 mM) K+ concentrations. Even though Ba2+ caused depolarization, which itself tended to cause conversion to single spiking, the number of spikes per burst and contraction amplitude were greater in Ba2+ solutions. The slope of the Em-log [K+]o relationship depended on the time allowed for changes in [K+], and a maximum slope of 36 mV/decade and an extrapolated [K+]i of 160 mM were the highest slope and lowest [K+]i values recorded. Ba2+ slightly decreased (to 28 mV/decade) the slope of the curve but did not alter the intercept at [K+] = 160 mM. Ba2+ caused an increase in input resistance (rin) and depolarization independent of CL- concentration, and thus appeared to decrease K+ conductance. K+ concentration increases tended to increase K+ conductance (decrease rin) with depolarization. Spontaneously active vascular muscle thus appears to have a K+ conductance that can be altered and to show different spike patterns and altered conduction, resulting in a marked change in contractions. The spike pattern appears to depend at least partially on the combination of K+ conductance and Em.


Hemodynamic mechanisms influencing sodium excretion during angiotensin infusion. To examine mechanisms of transition between antinatriuresis and natriuresis, angiotensin II was first infused intrarenally (0.001-0.07 mug/kg-min) in anesthetized dogs; glomerular filtration rate (GFR), sodium excretion, and intrarenal pressure (IRP), indicating tubular pressure, fell as during mechanical aortic constriction. During supplementary intravenous infusion (0.10-0.30 mug/kg-min), renal blood flow (RBF) rose toward control (tachyphylaxis). Tubular reabsorption increased but was still 17.1% below control. Filtration fraction averaging 0.31 remained constant. Sodium excretion and IRP exceeded control but were normalized by restoring renal arterial pressure mechanically. During intrarenal angiotensin infusion, carotid constriction increased blood pressure more, but RBF, IRP, and sodium excretion less than intravenous angiotensin. Intrarenal infusion of angiotensin at 0.10-0.20 mug/kg-min increased RBF and sodium excretion more in infused than in contralateral kidneys. Thus, angiotensin natriuresis depends on increased perfusion pressure and is augmented as tachyphylaxis develops. High correlation between sodium excretion and IRP at unchanged filtration fraction suggests a regulation of sodium excretion by hydrostatic rather than oncotic pressures in glomerular and peritubular capillaries.


Regulatory and secondary water intake in rats with lesions of the zona incerta. Bilateral electrolytic lesions of the zona incerta (ZI) permanently reduced daily water intake of rats by 20-30%. Lesioned rats did not differ from controls in daily food intake, body weight, hematocrit, or serum osmolality, Na+ or K+ levels. The hypodipsia was not caused by changes in water requirements or excretory function or by a nonspecific depression of behavior. Compensatory reductions in water losses maintained fluid balance. Lesioned rats drank as much water as controls in response to intracellular and extracellular dehydration, but unlike controls, appeared to restrict their daily water intake to these regulatory responses. Lesions of the ZI attenuated the ingestion of extra water observed when rats were maintained on a liquid diet adequate to meet fluid requirements, and daily water intake of lesioned but not control rats closely followed changes in water needs. It was concluded that lesions of the ZI reduce daily water intake towards minimal requirements for fluid balance by attenuating secondary drinking (drinking independent of water needs for fluid homeostasis.


Elastic behavior of brain tissue in vivo. A measurement system and a test sequence have been developed to determine the in vivo elastic response of brain tissue in terms of a pressure-depth ratio. This parameter appears sensitive to changes in the tissue environment that may occur due to the influence of, e.g., anesthetic agents, hyperventilation, etc., and thus may be useful in evaluating such influences. The measurements are made with the dura-arachnoid membranes intact, thus maintaining the influence of the cerebrospinal fluid compartment on the response behavior of the brain tissue that comprises the subpial region. As an integral part of the test, the procedure also serves to determine the depth or position of the subpial region and thus assures that the subsequent pressure-depth measurements invole brain tissue response. Finally, some discussion is given to relating the measured pressure-depth ratio to the classical elastic modulus. Values of the pressure-depth ratio and the corresponding elastic modulus for seven dogs are given.


Effect of prolonged angiotensin II infusion on thirst. To determine the effect of prolonged angiotensin II (A-II) infusion on thirst, daily water intake by drinking was measured in dogs during a 4-day control period, a 4-day period of vehicle infusion without A-II, a 10-day period of A-II infusion, and a 4-day recovery period of vehicle infusion without A-II. During the control period and the periods of vehicle infusion in the absence of A-II, daily water intake by drinking in four dogs averaged 118 +/- 20 ml/day (mean +/- SE). During the 10-day period of A-II infusion at the rate of 13.0 ng/kg per min drinking increased to 269 +/- 49 ml/day (paired t; P less than 0.05). Angiotensin II infusion at the rate of 26.0 ng/kg per min produced a sustained increase in water intake in two dogs during an 8-day period of infusion. These results demonstrate that in dogs, prolonged infusion of angiotensin II stimulates the thirst mechanism and that the effect lasts for more than a few days.


Independence of onset of compensatory kidney growth from changes in renal function. Renal function was measure before and shortly after uninephrectomy in mice to evaluate if work expended in the reabsorption of glomerular filtrate plays a role in the initiation of compensatory growth. To exclude the possibility of small but undetectable increments in glomerular filtration rate and absolute sodium reabsorption these functions were experimentally reduced immediately after uninephrectomy and sham nephrectomy. The onset of growth was indicated by an increased rate of [14C]choline incorporation into phospholipid in renal cortical slices. [14C]choline incorporation increased significantly only after uninephrectomy and remained unchanged after sham operation regardless of the magnitude or direction of the concurrent change in sodium reabsorption. The rate of incorporation increased by 40 +/- 8% (P less than 0.005) in uninephrectomized animals whose sodium reabsorption was reduced by 34 +/- 6% (P less than 0.001) and rose 45 +/- 11% (P less than 0.005) when sodium reabsorption remained unchanged. These results indicate that compensatory kidney growth is not triggered by an increase in renal work expended in the reabsorption of glomerular filtrate; in fact, it can occur when reabsorptive work is substantially decreased.


Effect of tachycardia on left ventricular blood flow distribution during coronary occlusion. The effect of heart rate on the amount and distribution of collateral blood flow was determine in open-chested dogs 1 h after coronary artery ligation. Flows to ischemic and nonischemic regions of left ventricle were measured with 7- to 10- mum diam radioactive microspheres during base-line conditions (118 +/- 6 beats/min) and again during atrial pacing at rates 20 and 40% above control (141 +/- 7 and 165 +/- 9 beats/min). During pacing aortic and left atrial pressures and cardiac output did not change significantly, whereas ST segment elevation in epicardial electrograms increased markedly. In nonischemic myocardium, mean flow increased approximately in proportion to the increase in rate, but subepicardial (EPI) flow increased somewhat more than subendocardial (ENDO) flow. In ischemic myocardium, overall flow did not change significantly, but a redistribution from ENDO to EPO was seen. At the faster rate ENDO flow fell 25% (P less than 0.02), EPI flow increased slightly, and ENDO/EPI fell in 8/9 animals (mean 0.54-0.43, P less than 0.01). The ENDO/EPI maldistribution present in ischemic muscle is thus accentuated by tachycardia; this may account for part of the harmful effect of tachycardia in acute myocardial infarction and may help explain the disproportionate ENDO ischemia seen in angina pectoris.


Effect of an angiotensin II antagonist on autoregulation in the isolated dog kidney. The effect of the specific angiotensin II antagonist (AIIA), [1-sarcosine-8-alanine]angiotensin II, on autoregulation of glomerular filtration rate (GFR) and renal blood flow (RBF) in an isolated dog kidney was examined. Infusing the AIIA into the renal artery at 1.9 mug/min inhibited the renal vasoconstrictor action of angiotension II infused simultaneously at 1.15 mug/min. Under conditions of constant renal arterial pressure the AIIA had no significant effect on sodium excretion, GFR, RBF, cortical blood flow distribution (microsphere method), or renin secretion in non-renin-depleted kidneys. Similarly, no agonist properties were observed when the AIIA was infused into renin-depleted kidneys. This dose of the AIIA did not impair the capacity of the isolated kidney to regulate GFR or RBF when renal arterial pressure was increased from 100 to 150 mmHg. Efficiency of autoregulation of GFR and RBF was 77 and 82% of that predicted for perfect autoregulation. These values are not significantly different from those of the isolated kidney not infused with the antagonist. It is concluded that the angiotensin II antagonist, [1-sarcosine-8-alanine]angiotensin II, has no significant agonist properties, that it antagonizes the renal vascular effects of exogenously administered angiotensin II, but does not impair renal autoregulation. These data provide no support for the hypothesis that the renin-angiotensin system mediates the autoregulation of GFR and RBF.


Direct neural inhibition of insulin secretion in response to systemic hypoglycemia. The innervated pancreas of an anesthetized small "pancreas" dog was cross-perfused with blood from a large "support" dog in order to separate neural from blood-borne influences on the immunoreactive insulin secretion rate (ISR). The arterial plasma reducing sugar (sugar) concentration could be varied independently in the pancreas dog systemic circulation and in its pancreas. After tying of the hepatic arteries and portal vein in the pancreas dog, its systemic arterial plasma sugar concentration was allowed to fall in 10 experiments. This was prevented in five control experiments by intravenous glucose infusion (7 mg/kg-min). In all experiments, pancreatic arterial plasma sugar concentration was sustained, and at 40 min it was elevated 50 mg/100 ml by glucose infusion into the pancreatic blood supply. Bilateral splanchnic nerve section at 120 min caused an increase of the ISR in all experiments, but a greater rise occurred from the pancreases of the 10 dogs allowed to become hypoglycemic (P less than .02). In two further experiments, the splanchnic nerves were not cut, and no rise in ISR occurred. In conclusion, systemic hypoglycemia can inhibit insulin secretion by means of the splanchnic nerves.


Cardiovascular and electrophysiological responses to sympathetic pathway stimulation. Anesthetized, vagotomized, and paralyzed cats were used to study the relationship between changes in blood pressure and T2 preganglionic nerve activity elicited by stimulation of descending spinal sympathoexcitatory pathways. While low-frequency stimulation (1-10 Hz) resulted in a depressor response, an attenuation of sympathetic nerve evoked discharges was noted after the second pulse of twin-pulse stimulations with 1,000- to 100-ms intervals between stimuli (corresponding to 1-10 Hz). High-frequency stimulation (greater than 10 Hz) resulted in a pressor response, while preganglionic nerve-evoked discharges were enhanced during twin-pulse stimulations with intervals between stimuli less than 50 ms (corresponding to greater than 20 Hz). These data suggest that the depressor response during low-frequency stimulation may be explained by impulses occurring during the silent period of the previous response. During this time the preganglionic neuron is inexcitable and spontaneous activity is abolished; therefore, the blood pressure falls. High-frequency stimulation may result in a pressor response by increasing the number of preganglionic neurons that are activated. This may be due to a process of temporal summation, with initial stimuli bringing cells closer to their threshold for firing and additional stimuli close in time causing these neurons to discharge.


Thiamine transport in the central nervous system. Total thiamine (free thiamine and thiamine phosphates) transport into the cerebrospinal fluid (CSF), brain, and choroid plexus and out of the CSF was measured in rabbits. In vivo, total thiamine transport into CSF, choroid plexus, and brain was saturable. At the normal plasma total thiamine concentration, less than 5% of total thiamine entry into CSF, choroid plexus, and brain was by simple diffusion. The relative turnovers of total thiamine in choroid plexus, whole brain, and CSF were 5, 2, and 14% per h, respectively, when measured by the penetration of 35S-labeled thiamine injected into blood. From the CSF, clearance of [35S]thiamine relative to mannitol was not saturable after the intraventricular injection of various concentrations of thiamine. However, a portion of the [35S]thiamine cleared from the CSF entered brain by a saturable mechanism. In vitro, choroid plexuses, isolated from rabbits and incubated in artificial CSF, accumulated [35S]thiamine against a concentration gradient by an active saturable process that did not depend on pyrophosphorylation of the [35S]thiamine. The [35S]thiamine accumulated within the choroid plexus in vitro was readily released. These results were interpreted as showing that the entry of total thiamine into the brain and CSF from blood is regulated by a saturable transport system, and that the locus of this system may be, in part, in the choroid plexus.


Protein synthesis and RNA in tissues of the pig. The rate of protein synthesis in 75-kg pigs was measured by continuous intravenous infusion of [14C]tyrosine. In the whole body, over 600 g of protein were synthesized each day. In pigs, rats, and man the rate of protein synthesis in the whole body was related to metabolic rate. The fractional rate of synthesis of protein in the tissues was also measured. The proteins of visceral organs (liver kidney, lung, and spleen) were renewed at rates close to 20% per day, those of brain at 8% per day, heart 7% per day, and skeletal muscle 4% per day. A significant correlation was observed between the fractional rate of protein synthesis in the tissue and RNA concentration. Calculation of the total amount of protein synthesized in skeletal muscle of the pig (fractional rate of synthesis X protein content) shows that muscle contributes 42% of whole-body synthesis. By contrast, in the rat only 19% of whole-body synthesis occurs in muscle.


Ligandin and Z protein in binding of thyroid hormones by the liver. Sephadex G-100 chromatography of rat liver supernatant after addition of [125I]T3 revealed four peaks of protein-bound radioactivity in the void volume, albumin, ligandin, and Z-containing regions, respectively. The peaks were identified by cochromatography of BSP and [125I]T3 and immonodiffusion with antiratligandin IgG and antirat Z IgG. Binding of [125I]T4 to rat liver supernatant occurred in void volume, albumin, and Z regions only. Studies in vivo reveal a pattern of [125I]T3 binding to rat liver supernatant fractions quantitatively different from that observed in vitro. [125I]T4 binding to liver supernatant fractions in vivo occurred in all four peaks. BSP or bilirubin added to liver supernatant decreased T3 and T4 binding by each fraction. Flavaspidic acid inhibited binding of T3 and T4 to albumin, ligandin, and Z protein. Phenobarbital pretreatment of rats increased binding of T3 by ligandin and of T4 by albumin-containing fractions. Circular dichroism studies with purified rat liver ligandin suggest that T3 and T4 bind competitively to the same site as does bilirubin; the association constants of T3 and T4 for ligandin are 10(6) and 10(5) M-1, respectively. T4 was bound only by purified ligandin and not by ligandin in liver supernatant. To determine whether unconjugated bilirubin interferes with hepatic uptake of T3, [125I]T3 was administered to icteric homozygous and phenotypically normal heterozygous Gunn rats. Hepatic uptake and supernatant binding [125I]T3 were significantly reduced in homozygous Gunn rats. Hepatic uptake of [125I]T3 was also reduced in vivo by infusion of BSP with or without flavaspidic acid. BSP infusion abolished [125I]T3 binding to ligandin; BSP and flavaspidic acid abolished binding to ligandin and Z. These observations suggest that ligandin and Z protein are thyroid hormone binding proteins in rat liver cytosol and may influence the net flux of iodothyronies from plasma into the liver.


Dopamine-induced dissociation between renal metabolic rate and sodium reabsorption. The stimulatory effect of dopamine on renal energy metabolism and its relationship to changes in tubular sodium reabsorption and plasma concentration of free fatty acids (FFA) were examined in anesthetized dogs. Dopamine infused intravenously at 25 mug/kg body wt-min for 30-60 min increased renal oxygen consumption (Rvo2) by 28 +/- 3%; glomerular filtration rate rose from 37 +/- 3 to 40 +/- 2 ml/min without significant changes in sodium excretion. Plasma FFA increased about 6 times. Total-body metabolic rate increased to 152 +/- 7% and fell to 119 +/- 5% of control after normalizing plasma FFA by beta-pyridylcarbinol; Rvo2 remained unchanged. Cortical and outer medullary heat accumulation rated increased to 137 +/- 6 and 133 +/- 10% after 1 h and to 163 +/- 18 and 179 +/- 26% of control after 2 h of dopamine infusion without further changes in sodium reabsorption. Furosemide reduced cortical and outer medullary metabolic rates as much as in control experiments (14 +/- 8 and 69 +/- 7%, respectively). Hence, dopamine exerts a renal calorigenic effect which cannot be accounted for by increased sodium reabsorption or attributed to increased supply of FFA.


Effect of lithium of responsiveness of rat uterine smooth muscle to angiotensin. Studies were carried out to investigate the effect of Na+ deprivation on the response of rat uterine smooth muscle to angiotensin II (AII). Replacement of Na+ with Li+ in a low-Ca2+-, Mg2+-free solution resulted in a concentration-dependent inhibition of both AII and acetylcholine (ACh)-induced contractions. Inhibition was noted at 10% Li+ substitution and was usually complete when 50% of the Na+ was replaced by Li+. The inhibition was not observed when an equivalent amount of tris(hyroxymethyl)aminomethand (Tris+) or sucrose was used to replace Na+. However, elevation of Ca2+ concentration from 0.2 to 0.5 mM did prevent full expression of the Li+ inhibition of AII. The Li+ effect was rapid in onset (60% inhibition after 5 min preincubation) and readily reversible following removal of the Li+. If, however, the tissue was placed in a depolarizing solution (151 mM KCL), Li+ inhibition of AII WAS NO LONGER OBSERVED. These results are interpreted to mean that Li+ interferes with an essential Ca2+-dependent step involved in membrane excitation following agonist-receptor interaction. The results are discussed in relation to a previously suggested model for AII-induced contractions in this tissue.


Active state of normal and dystrophic mouse muscle. Computer-controlled quick releases were used to determine the kinetics of active state tension decay in normal and dystrophic EDL muscles of the mouse (129/Re-J). Also included are measurements of the duration of the active state plateau, isometric twitch and tetanus parameters, and the stress-strain properties of the elastic elements. Alterations in the isometric tension characteristics of dystrophic muscles confirm previous investigations and indicate that dystrophic sarcomeres have a diminished ability to shorten and produce tension. The compliance of the series-elastic elements is not changed, whereas a 50% reduction in the interanl extension of the series elements is noted for dystrophic muscle. The rate of decay and maximum intensity (Po) of active state decay is reduced 60-70% in dystrophic muscles. The first-order rate constant and the total duration of the active state are not altered. These results are discussed in terms of the possible involvement of the contractile proteins and the sarcoplasmic reticulum in determining active state deficits.


Effects of some vasodilator drugs on transcapillary fluid exchange in renal cortex. In 23 Munich-Wistar rats with surface glomeruli, the determinants of glomerular ultrafiltration and peritubular capillary uptake of proximal reabsorbate were studied before and during intra-arterial infusions of mildly vasodepressor doses of prostaglandin E1,acetylcholine, and bradykinin. For each drug single-nephron glomerular filtration rate remained unchanged from normal hydropenic values while glomerular plasma flow rate increased, resulting in declines in single-nephron filtration fraction (SNFF). Mean glomerular transcapillary hydraulic pressure difference (delta P) increased or remained unchanged on average. Declines in SNFF were accompanied by reductions in efferent arteriolar oncotic pressure (piE). Filtration pressure equilibrium, equality between pi E and delta P, obtained before but not during drug infusions. In the latter situation values for the glomerular capillary ultrafiltration coefficient were calculated and found to be significantly reduced from published control values. Despite marked falls in pi E during drug infusion, absolute proximal reabsorption was not reduced significantly, due, it is suggested, to the opposing effects of increases in efferent arteriolar plasma flow and interstitial hydraulic pressure.


Estimation of glucose turnover and recycling in rabbits using various [3H, 14C]glucose labels. The glucose replacement rate, percent carbon recycling, mean glucose transit time, and the glucose mass were determined in fasted unanesthetized rabbits after administration of [2-3H,U-14C]-, [3-3H,U-14C]-, [5-3H,U-14C]- or [6-3H,U-14C]glucose using the procedures of Katz et al. (10). The glucose replacement rates and carbon recycling determined with [2-3H,U-14C] and [5-3H,U-14C]glucose are equivalent and greater than those obtained with [3-3H,U-14C]- and [6-3H,U-14C]glucose. Although the means of the glucose replacement rates and percent carbon recycling obtained using [3-3H,U-14C]- and [6-3H,U-14C]glucose are similar, greater variation resulted using the former tracer. Comparisons of detritiation rates and percent carbon recycling using [2-3H,U-14C]- and [6-3H,U-14C]glucose suggest that about 10% of tritium is lost from carbon 2 via futile cycling at the glucose 6-phosphate level. Similarly, comparisons of [5-3H,U-14C]- and [6-3H,U-14C]glucose metabolism suggest that about 10% of tritium lost from carbon 5 occurs via futile cycling at the fructose diphosphate level and/or via the transaldolase reaction. Our results indicate that [6-3H,U-14C]glucose is the more suitable tracer for determining the glucose replacement rate and carbon recycling in vivo.


Effects of maleate on carbohydrate metabolism in rats. Intraperitoneal administration of maleate produced an increase in blood alpha-ketoacid, acetoacetate, and free fatty acids. The effect of this treatment on blood glucose levels depended on whether the rats were fed or fasted. In fed rats it was accompanied by slight, transient hyperglycemia connected with depletion of liver glycogen stores. In fasted animals moderate hypoglycemia was observed. The in vivo conversion of various precursors into blood glucose was not inhibited, suggesting that maleate does not affect hepatic gluconeogenesis. Neither was a direct effect on liver glycogenolysis observed. On the other hand, maleate inhibited renal gluconeogenesis from various substrates and stimulated anerobic glycolysis in kidney cortical alices. The data are interpreted in terms of increased utilization and decreased production of glucose by the kidney followed by secondary changes in liver carbohydrate metabolism.


Kidney pressures after temporary renal artery occlusion in the rat. Acute kidney failure was produced in the anesthetized rat by 1 h of complete renal artery occlusion. Kidney function was studied either immediately after release of the occlusion or 1 day later using clearance, micropuncture, histological, and nephron dissection techniques. Polyfructosan clearance was decreased to 5% of normal after temporary occlusion. Proximal tubular pressure (PTP) averaged 13-14 mmHg in normal kidneys, 39 mmHg immediately after release of unilateral occlusion, 19 mmHg 1 day after unilateral occlusion, and 25 mmHg 1 day after bilateral occlusion. The increased PTP reduces the glomerular filtration rate (GFR). Glomerular capillary pressure, estimated from the sum of the stop-flow and arterial plasma colloid osmotic pressures, was not decreased after temporary ischemia. Single-nephron GFR, measured without intratubular pressure control, was only slightly below normal 1 day after bilateral occlusion. Most distal tubules from ischemia-damaged kidneys contained hyaline casts. Tubular obstruction is a major factor in this model of acute kidney failure.


Open-loop respiratory chemosensitivity in chickens and ducks. In order to study the behavior of the avian respiratory center under open-loop conditions, recordings of respiratory motor discharges were made from an intercostal nerve in a unidirectionally ventilated paralyzed preparation during normoxic hypercapnia, hypoxic normocapnia and asphyxia, and under control conditions. Respiratory motor burst rate (RMBR) in ducks showed a maximum at 40 mmHg Paco2 with depression at higher and lower values, both in the steady state and during rapid transients. RMBR was apparently independent of Paco2 in chickens, and of Pao2 in both species. During asphyxia, RMBR in ducks fell steadily while the number of spikes in each burst did not change. RMBR during asphyxia bore the same relationship to Paco2 as during unidirectional ventilation. Chickens did not respond consistently to asphyxia, but RMBR tended to increase and, in some cases, the number of spikes per burst also increased. Possible mechanisms and functions of the asphyxic respiratory depression observed in ducks are discussed.


A comparative study of pulsatile arterial hemodynamics in rabbits and guinea pigs. Pulsatile pressure and flow were measured in the ascending aorta and other arteries of 22 anesthetized rabbits and 16 anesthetized guinea pigs. Pressure/flow relationships were expressed as vascular impedance. Aortic flow waves were almost identical in the two species, but pressure waves were quite different. Reflected pressure waves returned earlier from the periphery in guinea pigs, augmenting pressure during late systole and resulting in relatively high external left ventricular work, an inappropriately larger difference between mean systolic and mean diastolic pressure and absence of any aortic diastolic pressure wave. Values of impedance modulus and phase were similar but differed in the frequency at which maxima and minima occurred. In both species, impedance curves were interpreted to indicate a functionally discrete reflecting site in the lower body whose position corresponded to the region of the aortic bifurcation. In addition, rabbits showed evidence of an upper body reflecting site approximately one-third as far distant from the heart. As in dogs, the arterial system in both species can be represented by an asymmetrical T-shaped model of realistic dimensions.


Ouabain-mediated sodium uptake and bile formation by isolated perfused rat liver. Ouabain exhibits a dose-dependent choleretic effect in the isolated perfused rat liver. Its uptake from the perfusate into the liver is maintained against a concentration gradient and becomes clearly saturated at higher perfusate concentrations. A low extracellular sodium concentration inhibits the rate of ouabain transfer into liver cells, resulting in a marked decrease of the maximal transport rate. Dibucaine completely abolishes the uptake of the glycoside by the isolated liver. Determination of Na-22 tracer fluxes suggests that ouabain uptake is accompanied by a net flux of sodium into the cell, which seems to be due to a cotransport of sodium with ouabain rather than to the inhibition of the sinusoidal Na+ -K+ -ATPase. Sodium introduced into the cell in this way apparently is extruded into the bile canaliculi. The increase of isotonic bile flow, which is simultaneously observed, points to a dilution of the canalicular sodium gradient by water and electrolytes through an intercellular pathway. Our results present further evidence that bile secretion is controlled by transcellular sodium movements.


Absence of fetal placental waterfall phenomenon in chronically prepared fetal lambs. An electromagnetic flow sensor was placed on the distal fetal aorta (umbilical flow fraction 78.1 +/- 1.6 SEM, %), an inflatable occluder was tied around the umbilical cord, and catheters were placed in distal branches of an umbilical artery and vein, a uterine vein, and in the amniotic cavity. An inflatalbe occluder was tied around the vagina of some of the ewes. Control values 3 days after surgery were (mean +/- SE): fetal femoral artery pH, 7.37 +/- 0.01; umbilical blood flow, 186 +/- 14 ml-min-1 .kg fetus-1; fetal arterial blood pressure, 39 +/- 3 mmHg; and umbilical venous pressure, 7.4 +/- 1.0 mmHg (above intrauterine pressure). Fetal weight at autopsy was 3.1 +/- 0.3 kg, n = 11. Small increases in umbilical vein pressure caused immediate decreases in placental blood flow without decreases in fetal arterial blood pressure. The relation between venous pressure and umbilical blood flow at constant arterial pressure was that of an inert system, i.e., no evidence of a surrounding pressure (Starling resistor effect or waterfall phenomenon) could be found with increases in venous pressures of 2-40 mmHg. The results were not affected by increases in uterine vein pressure between 2 and 30 mmHg, nor by anesthesia and supine position of the ewe, nor by ganglionic blockade of the fetal ANS. It was concluded that surrounding pressures in the fetal placental circulation could not be demonstrated.


Interaction of interval-force relationship with aortic pressure and stroke volume. The modification by aortic pressure and stroke volume of the response in cardiac performance to increases in heart rate (interval-force relationship) has not been previously studied. To investigate this interaction, 30 adrenergically blocked anesthetized dogs on right heart bypass were studied. At constant low aortic pressure and stroke volume, increasing heart rate (over the entire range 60-180) is associated with a continuously increasing stroke power, decreasing systolic ejection period, and an unchanging left ventricular end-diastolic pressure and circumference. At increased aortic pressure or stroke volume at low rates (60-120), increases in heart rate were associated with an increased performance. However, at increased aortic pressure or stroke volume at high rates (120-180), increases in heart rate were associated with a leveling or decrease in performance. Thus, an increase in aortic pressure or stroke volume results in an accentuation of the improvement in cardiac performance observed with increases in heart rate, but this response is limited to a low heart rate range. Therefore, the hemodynamic response to given increases in heart rate is critically dependent on aortic pressure and stroke volume.


Effects of azotemia on renal extraction and clearance of PAH and TEA. Dogs were made azotemic by bilateral ureteral-venous anastomosis. Subsequently, the left ureter, a systemic artery, and the left renal vein were cannulated. Left renal blood flow (RBF) was measured by an electromagnetic flowmeter. Left renal clearances and extractions of [14C]tetraethylammonium ([14C]TEA) and p-aminohippuric acid (PAH) were determined at five 40-min intervals after administraiton of loading doses and institution of a maintenance infusion containing PAH and [14C]TEA. The renal extraction of TEA was independent of blood urea nitrogen (BUN), whereas the extraction of PAH correlated inversely with BUN. Renal plasma flows calculated from urinary clearances and renal extractions agreed with renal plasma flows calculated from flowmeter data. The extraction of TEA remained constant over the 200-min experimental period, whereas the extraction of PAH increases progressively as a function of time. It is probable that those organic acids which accumulate in azotemia, and interfered with renal tubular secretion of PAH, were themselves eliminated after opening the ureteral-venous anastomosis. Thus, TEA is superior to PAH for evaluation of the renal circulation in azotemia.


Short-loop feedback control of luteinizing hormone in the rabbit. A radioimmunoassay for rabbit luteinizing hormone (rLH) in which rLH shows no significant cross-reaction with human LH (hLH) or human chorionic gonadotropin (HCG) was employed to test for the existence of a short-loop feedback for LH in the rabbit. Two weeks after castration, hCG and hLH were administered intravenously to rabbits, and the effects on circulating rLH were measured. Purified hLH (10 ng or 100 IU) produced significant depression of blood rLH within 30-60 min of intravenous injection. Saline administered to the same animals produced no changes in rLH. Injection of hCG (2,000 IU) under the same conditions also produced a significant fall in rLH. However, hCG administered to rabbits castrated 6 wk prior to study failed to suppress endogenous rLH. These data demonstrate, by direct radioimmunoassay quantification of blood hormones, the existence of a short-loop negative feedback for LH in the rabbit. They also suggest that the sensitivity of the short-loop changes with time after castration.


Neurally mediated increase in mitosis and DNA of rat parotid with increase in bulk of diet. A transient burst of mitosis was induced in rat parotid gland 2 days after change from a diet of solid chow only to one consisting of 50% inert cellulose and 50% solid chow (bulk diet). Mitosis was thus induced when glandular activity was changed from normal levels (solid chow) to levels greater than normal (bulk diet). Elimination of either autonomic pathway inhibited the mitotic response, but elimination of the parasympathetic had the greater inhibitory influence. The burst of mitosis induced by bulk diet was followed by increases in total DNA (16%), RNA (24%) and weight (27%) of the gland 2 wk after the dietary change. These changes did not occur when both autonomic pathways were, or only the parasympathetic was, removed immediately prior to the dietary change. Effects of sympathectomy were less pronounced. The parasympathetic innervation has the principal role in regulation of mitosis, cell number and size, and nucleic acid content when glandular activity is increased above normal by physiological means.


Intestinal villus blood flow measured with carbon monoxide and microspheres. The purpose of the present study was to compare the small intestinal blood flow that equilibrates with luminal CO (FLco) with simultaneous determinations of villus blood flow measured by a recent modification of the microsphere technique. These studies, carried out in rabbits, showed that FLco closely correlated (r = 0.83) with villus flow measured with microspheres over a three-fold range of flows, and the mean rate of flow to the villi by both techniques was about 0.08 ml/min X g of intestine. Thus, FLco appears to be a measure of villus blood flow. Based on previous studies of inert gas uptake from the rabbit small intestine, it appears that absorption of readily diffusible substances in the rabbit can be represented by a simple two-component model: a flow-limited component in which substances equilibrate with villus blood flow and are carried away without subsequent countercurrent exchange, and a diffusion-limited component which presumably represents uptake by the blood flow of the crypt region or submucosa.


Heat loss from feet of herring gulls at rest and during flight. The role of the feet of herring gulls (Larus argentatus) in heat dissipation was estimated during rest and wind-tunnel flight. We determined the blood flow to the feet and the arteriovenous temperature difference and thus estimated heat loss from the feet. Determinations of oxygen consumption and respiratory water loss at rest gave a heat production of about 8 W; 37-56% of this heat was lost from the feet (air temp = 10-35 degrees C). During flight heat production was estimated to be about 57 W and heat loss from the feet was 46 W, about 80% of the heat production in flight. Thus the webbed feet are an important avenue of heat loss in the herring gull.


Intracellular osmoregulatory role of amino acids and urea in marine elasmobranchs. Little skates, Raja erinacea, and stingrays, Dasyatis americana, were gradually transferred over a period of 4-5 days from full strength to approximatley 50% seawater. Plasma and muscle osmolarity fell. Hematocrits were essentially unchanged. Extracellular fluid volume (ECF) of muscle, estimated as the chloride space, increased 70% during this period. Regulation of muscle cell volume was associated with sharp declines in cellular concentrations of total amino acids (ninhydrin-positive materials) and urea. The osmoregulatory importance of the free amino acid pool in erythrocytes and muscle was a particularly prominent feature in both species. Intracellular amino acid concentration in R. erinacea muscle fell from 214 to 144 mmol/liter during transfer to 50% seawater, urea from 398 to 264, and trimethylamine oxide (TMAO) dropped from 63.9 to 35.8 mmol/liter. TMAO plasma levels were similar in stingray and skate, but muscle TMAO concentrations were much higher in the former. Urea content in stingray plasma greatly exceeded that in R. erinacea-630 and 574 mmol/liter in two specimens-perhaps the highest recorded.


Thermal homeostasis in rats after intrahypothalamic injections of 6-hyroxydopamine. Specific destruction of at least 90% of the noradrenergic neurons in the preoptic/anterior hypothalamic region (PO/AH) by local injection of 9-hyroxydopamine (6-HDA) did not disrupt thermoregulation by rats either in the heat or the cold. Examination of the multiple effector mechanisms suggested that thermal balance was maintained in a normal fashion, and that compensatory adjustments did not conceal individual dysfunctions. In contrast with the ineffectual 6-HDA lesions of the PO/AH were the outstanding impairments seen in rats following electrolytic lesions of this area. All the latter animals became severely hyperthermic during the 1st h of exposure to an ambient temperature of 40 degrees C, and half of them were additionally unable to maintain body temperatures when exposed to an ambient temperature of 6 degrees C. The electrolytic lesions reduced norepinephrine levels in the PO/AH, but the 50-70% depletions were substantially smaller than those found in 6-HDA-treated rats. These results raise new doubts about whether central noradrenergic fibers have an important role in the regulation of body temperature by rats.


Effect of carotid sinus nerve stimulation pattern on cardiorespiratory responses. The reflex responses to steady and intermittent stimulation of the carotid sinus nerve (CSN) were compared in anesthetized dogs. Intermittent stimulation was less effective than steady stimulation in reducing the arterial blood pressure, and the disparity was exaggerated after acute sinoaortic denervation. With the sinoaortic nerves intact, at low mean stimulation frequencies the heart rate responses were greater during intermittent than during steady CSN stimulation. At higher mean stimulation frequencies, however, steady CSN stimuli were more effective than were the intermittent type. After sinoaortic denervation, steady stimuli evoked greater heart rate responses than did intermittent stimuli over the entire mean frequency range studied. Reflex changes in respiratory depth and frequency were also greater during steady than during intermittent CSN stimulation. The greater efficacy of steady than of intermittent stimulation in evoking.the observed reflex cardiovascular and respiratory changes is probably ascribable to the pronounced frequency limitation at the first synapse of the baroreceptor reflex in the brain.


Biliary secretion in elasmobranchs. II. Hepatic uptake and biliary excretion of organic anions. [35S]Bromosulfophthalein ([35C]BSP), [14C]sodium taurocholate ([14C]NaTC), AND 10 MG OF UNLABELED BSP.and of phenol-3,6-dibromophthalein disulfonate (DBSP) per kilogram body weight were injected in the caudal artery of free-swimming dogfish sharks (Squalus acanthias) and small skates (Raja erinacea). Twenty-four hours later, 85.8 +/- 15.7% of [35S]BSP was recovered in bile and liver in dogfish and 78.4 +/- 9.9% in skates. Similar results were obtained for [14C]NaTC. Unlabeled BSP or DBSP (10 mg/kg body wt) were also selectively excreted in bile over a 4-day period and at comparable rates in both species. More than 85% of [35S]BSP, BSP, and DBSP in bile was in unconjugated form. Selective hepatic clearance of BSP occurred despite nonselective binding to liver homogenates and very low concentrations of binding proteins in liver cytosol. Analysis of the organic anion plasma disappearance curves suggest that the clearance of anions into bile in elasmobranchs is delayed disproportionately relative to hepatic uptake. Albumin-BSP infusions did not prevent selective hepatic uptake of [35S]BSP, although biliary excretion was delayed further. These studies demonstrate that transport systems for biliary excretion of organic anions evolved prior to migration of marine life from the sea and relatively independently of intrahepatic conjugation and organic anion-binding proteins.


Hypophysectomy and regulation of body weight in the genetically obese Zucker rat. Genetically obese Zucker "fatty" rats (fa/fa) and nonobese siblings were weighed regularly from 7 to 150 days of age to determine the onset and time course of the excessive weight gain that characterized the fatty rat. At 150 days of age, male and female fatties and their lean littermates were sham operated or hypophysectomized to examine the role of the pituitary in the fatty obesity. The operated animals were then weighed until sacrifice at 220 days of age, when adrenal weights, gonadal weights, uterine weights, and the Lee Index were determined. Fatty rats were significantly heavier than their nonobese littermates even in the 2nd wk of life (day 7-13). Complete hypophysectomy blocked the continued development of the fatty obesity but did not eliminate the adiposity established prior to hypophysectomy. It is concluded that the pituitary and the major endocrine pathways it controls are not the locus of the primary genetic lesion responsible for maintaining the Zucker fatty rat obesity.


Free fatty acids and albumin as mediators of thrombin-stimulated fibrinogen synthesis. Mobilization of FFA in mice, triggered with an injection of thrombin, was followed within 24 h by a 2.5-fold increase in fibrinogen synthesis and a 30% increase in plasma fibrinogen concentration. In mouse liver slices, incubated in plasma, additions of palmitate or stearate in amounts similar to those expected in vivo in FFA mobilization stimulated fibrinogen synthesis 5.6- to 6.1-fold while unsaturated and short-chain FFA were less effective. Palmitate and linoleate also augmented albumin synthesis although not as stongly as fibrinogen synthesis. These observations raised the possibility that the greater effectiveness of saturated FFA in stimulating fibrinogen synthesis may reflect higher FFA/albumin ratios within hepatocytes in the presence of saturated FFA. Injection of exogenous defatted albumin into mice before thrombin injection prevented the FFA-associated rise in fibrinogen synthesis and plasma concentration. In incubated liver slices, defatted albumin abolished the FFA stimulation of fibrinogen synthesis when FFA/albumin ratios were maintained to the physiological range. These studies indicate that the FFA/ALBUMIN RATIO MAY PLAY A MAJOR ROLE IN THE REPLENISHMENT OF FIBRINOGEN AFTER PERIODS OF RAPID DEFIBRINOGENATION.


Women in psychiatry: a review.

Women in psychiatry: a review. Throughout the world, psychiatry is in a period of accelerated transition. In each nation the role of women in psychiatry, and the role of psychiatry in the lives of women, reflect one aspect of the development of egalitarianism. Women psychiatrists have perennially been confronted with conflicts between their professional and private life responsibilities. Internationally, the external and internal factors that prohibit or limit women's personal development and vocational participation are being scrutinized. American psychiatry is proving to be a pioneer among medical specialities in this area.


Lithium in the treatment of depression.

Lithium in the treatment of depression. The author reviews the studies of lithium as an antidepressant, evaluates the evidence that there might be specific subgroup of patients for whom it is effective, and reports a study he and his associates conducted that found lithium to be effective for 13 of 21 depressed patients. He concludes that there is convincing, although not conclusive, evidence for an antidepressant effect of lithium and that only by identifying the subgroup of patients for whom it is effective can the continuing uncertainty surrounding lithium's role in affective disorder be resolved. He also calls for a reevaluation of the relationship between mania and depression.


A review of major implications of the O'Connor v. Donaldson decision. Although the Supreme Court's decision in O'Connor v. Donaldson is narrow from the legal perspective, it will have wide clinical applications for psychiatry if it reflects a trend in future court decisions. The author assesses the impact of this decision on the mental health profession in terms of the issue of dangerousness as grounds for involuntary commitment for psychiatric treatment, the principle of least restrictive alternative to hospitalization, the question of adequacy of treatment in light of the absence of nationally defined standards, and the personal liability of physicians for their professional actions.


Marijuana effects on simulated flying ability. The authors studied the effects of marijuana intoxication on the ability of 10 certified airplane pilots to operate a flight simulator. They used a randomized double-blind crossover design to compare the effect of active versus placebo marijuana. They found that all 10 pilots showed a significant decrease in measurements of flying performance 30 minutes after smoking active marijuana. For a group of 6 pilots tested sequentially for 6 hours, a nonsignificant decrease in flying performance continued for 2 hours after smoking the active drug. The authors conclude that the effects of marijuana on flying performance may represent a sensitive indicator of the drug's psychomotor effects.


The family in exile: Cuban expatriates in the United States. For the nearly one million Cuban exiles in this country, the ordeal of expatriation has meant anguish and uprootedness, challenge and accomplishment. Several factors account for the comparatively successful aspects of their struggle: relatively high occupational and educational levels, formation of vigorous communities that permit the maintenance of a positive ethnic consciousness and the creation of strong social ties, and effectively organized reception by the United States. Expatriation is always traumatic and produces "casualties," but mastery of the struggles it involves can lead to personal growth and expanded horizons. The Cuban expatriate experience shows that the influx of large numbers of refugees can be a creative and enriching process for both the host country and the individual refugee.


Pseudohomosexuality in feminist students. The author describes the influence of the feminist movement on the intellectual, social, and sexual behavior of feminist college students. The complex interrelationship between sexual political ideology and actual sexual behavior creates confusion and anxiety for some vulnerable students in their attempts to evolve a satisfactory sexual identity. A series of vignettes illustrates the struggle of such students, who initially expressed concern over actual or potential lesbianism and its connection to the movement, to resolve their conflicts concerning feminism and sexual preference.


It is always the woman who is raped.

It is always the woman who is raped. Rape is described as an act of power that is sanctioned by literature, myth, and culture. Rape is a dire experience for women because it implies total loss of self--the woman is a function, not a person. The victim experiences total emptiness and isolation from self and society. The author believes that an effective "treatment" for the rape victim is community. Women asserting themselves by speaking out about their experience validate themselves as persons.


The rape victim: psychodynamic considerations. Rape challenges a woman's ability to maintain her defenses and thus arouses feelings of guilt, anxiety, and inadequacy. Women's individual responses are determined by life stage considerations as well as their defensive structures: concerns about separation-individuation may be aroused in the young woman; a divorced or separated woman may find her credibility questioned; older women's fears of sexual inadequacy may be compounded. In counseling, the victim's previous adjustment should be assessed, she should be given support and reassurance, and specific considerations related to her life circumstances should be acknowledged and dealt with.


Coping behavior of the rape victim.

Coping behavior of the rape victim. The coping behavior of rape victims can be analyzed in three distinct phases--the threat of attack, the attack itself, and the period immediately thereafter. The authors analyzed the reported coping behavior of 92 women diagnosed as having rape trauma. Most of the women used verbal, physical, or cognitive strategies when threatened, although 34 were physically or psychologically paralyzed. The actual rape prompted coping behaviors in all but 1 victim. Escaping the situation or the assailant is the primary task immediately after the attack. In counseling the rape victim, it is important to understand her individual style of coping, to be supportive of it, and to suggest alternatives for future stressful situations.


Development of a medical center rape crisis intervention program. The Rape Crisis Intervention Program at Beth Israel Hospital utilizes volunteer multidisciplinary counseling teams drawn from psychiatry, social work, psychology, and nursing staffs. The premise of the program is that early crisis intervention can prevent later development of psychological disturbances in later development of psychological disturbances in victims. Counselors accompany victims throughout emergency room procedures: follow-up begins 48 hours after the initial contact and continues at regular intervals for at least a year. The authors discuss the problems of implementation, which include staff resistance, finding questions, and varying levels of counseling sophistication, and describe how these difficulties have been handled in their program. They note that this program is becoming a resource center for the community.


Assaults on psychiatrists by patients.

Assaults on psychiatrists by patients. The authors describe the results of a survey of 115 psychiatrists regarding assaults by patients. Forty-eight psychiatrists stated that they had been assaulted; a total of 68 assaults was reported. Psychiatrists were most often assaulted in the early stages of their career or while they were working in high-risk settings such as prisons or emergency rooms. Many reported retrospectively that they might have had a role in provoking the assault and that they could have anticipated it. The authors believe that psychiatrists avoid dealing with the issue of violence by patients for a variety of reasons, and they recommend that clinicians learn techniques for managing potentially assaultive patients.


Assault on the therapist.

Assault on the therapist. The authors conducted a questionnaire survey among psychotherapists in psychiatry, psychology and social work to determine how many patients posed a threat to others or to the therapist and how many actually assaulted the therapist. They found that 9.2% of all patients seen by 101 therapists in one year presented a threat to others, 1.9% posed a physical threat to the therapist, and .63% actually assaulted the therapist. The authors conclude that attacks on a therapist are infrequent but almost inevitable and suggest the development of techniques for coping with assaultive patients that therapists can use in crisis situations.


Nursing aides and patient violence.

Nursing aides and patient violence. The authors studied the incidence of violence in a psychiatric unit organized as a therapeutic community whose nursing staff was composed entirely of women in comparison with another unit staffed according to the traditional male and female nursing pattern. The unit staffed by women had no incidents of other-directed violence in the one-year period of the study, but the traditionally staffed unit had 13 violent incidents initiated by 5 patients. The authors state that the expectation of violence among psychiatric patients and the consequent use of male nursing aides to control violence may represent a self-fulfilling prophecy.


A violence clinic: three years' experience. The authors describe a clinical facility established for the neuropsychiatric treatment of individuals with a variety of psychopathological disorders where the common management problem is one of aggressive behavior. The authors present case vignettes to illustrate the clinic's consultation with mental health workers about the management of violent patients, countertransference problems, ward problems, the role of organic factors, medication, and prediction of violence. They urge that the subject of violence be included in the psychiatrist's training.


Reduced platelet monoamine oxidase activity in a subgroup of schizophrenic patients. Platelet monoamine oxidase (MAO) activity was significantly lower than control values in a subgroup of 16 schizophrenic patients (most of whom were paranoid) characterized by the presence of auditory hallucinations and delusions. Platelet MAO activity was not reduced in 16 other schizophrenic patients without auditory hallucinations. This finding suggests that reduced platelet MAO activity is not found in all schizophrenic patients but tends to occur in a clinically identifiable subgroup.


The 24-hour lithium level as a prognosticator of dosage requirements: a 2-year follow-up study. The authors have previously described a technique whereby individual lithium dosage requirements can be predicted from 24-hour blood samples. Further experience over a 2-year period has shown the predictions to be reproducible over time. A micromethod for lithium determination is described, as are several cases in which aberrant results were found to indicate inadequate laboratory techniques or patients' failure to take medication. Because the technique reveals immediately those patients at the extremes of dosage ranges, toxicity and the need for frequent sampling can be avoided.


Extrapyramidal side effects in lithium maintenance therapy. The authors neurologically examined 36 patients who had been maintained on lithium therapy for periods ranging from 6 months to 7 years to determine the presence of parkinson-like side effects. Only a few patients demonstrated rigidity, including cogweel rigidity, and this was at a low level of severity. These results do not support the previously reported frequent occurrence of cogwheel rigidity in patients on lithium maintenance.


Catatonia, gastric hyperacidity, and fatal aspiration: a preventable syndrome. Sudden death from aspiration pneumonitis during acute catatonia is a generally recognized but poorly understood occurrence. The author describes a case in which a schizophrenic patient died following aspiration of gastric contents. In view of findings that suggest that the acidity of gastric contents is related to morbidity following aspiration, he recommends that liquid antacid medication be given routinely to catatonic patients.


The life of psychiatry.

The life of psychiatry. Focusing on the definition, scope, and role of psychiatry today, the author discusses whether psychiatry is primarily medical, whether it is overstepping its boundaries in attempting to treat problems of living, and whether it is too involved with social questions. On the basis of an examination of the current scientific base of psychiatry, he predicts that psychiatry will continue to grow in size and diversity, that it will refocus substantially on biological issues, that it will become more humble about what it can do with regard to social problems, and that it will continue to yield new therapeutic measures and techniques.


The case for involuntary hospitalization of the mentally ill. The author examines three points of view on the question of society's right to involuntarily hospitalize a mentally ill individual. The "abolitionists" oppose involuntary hospitalization entirely; the medical model psychiatrists support the need for commitment under certain circumstances and so do the civil liberties lawyers, but by different standards. The author believes that with the current overreliance on the dangerousness standard, we are witnessing a pendular swing in which the rights of the mentally ill to be treated and protected are being set aside in the rush to give them their freedom. He favors a return to the use of medical criteria by psychiatrists, albeit with constructive legal safeguards.


Drug and psychotherapy interactions in depression. The authors conducted a series of multiple regression analyses of data from depressed patients. They found that 8 factors consistently predicted treatment response: a lower initial level of distress, imipramine treatment, a positive attitude toward group psychotherapy, and a good employment history predicted lower posttreatment distress levels; estrogen maintenance treatment was related to better response to diazepam, and a low level of intelligence predicted better response to both diazepam and imipramine; and a low initial level of interpersonal sensitivity and a significant other's having an unfavorable attitude toward psychiatric treatment were associated with better response to group psychotherapy.


Short versus long hospitalization:  a prospective controlled study. V. One-year follow-up results for nonschizophrenie patients. The authors studied the effect of long-term versus short-term hospitalization on a group of 74 patients with the diagnoses of affective disorder, neurosis and personality disorder, and hysterical personality one year after their admission to the hospital. Although they had found in an earlier study that short-term patients seemed to integrate more rapidly in the hospital, the results reported in this study showed no statistically reliable differences between the long-term and short-term groups. In contrast to the author's results for schizophrenic patients, their findings for nonschizophrenic patients do not support extended hospitalization.


Psychosis, thought disorder, and regression. Focusing on the definition, scope, and role of psychiatry today, the author discusses whether psychiatry is primarily medical, whether it is overstepping its boundaries in attempting to treat problems of living, and whether it is too involved with social questions. On the basis of an examination of the current scientific base of psychiatry, he predicts that psychiatry will continue to grow in size and diversity, that it will refocus substantially on biological issues, that it will become more humble about what it can do with regard to social problems, and that it will continue to yield new therapeutic measures and techniques.


Behavioral changes following surgery for obesity. The authors interviewed 69 subjects who had had jejuno-ileal bypass surgery for obesity to determine the relationship between weight loss and eating behavior after surgery. All patients had been extremely overweight; at an average of 37 months after surgery, their mean weight was reduced by 39%. There were four significant postoperative changes: voluntary restriction of food intake, "normalization" of eating patterns, resistance to eating during intense emotion, and far less dysphoria during postsurgical weight loss than during previous weight loss efforts. The authors therefore suggest that factors other than impaired intestinal absorption may account for some portion of postsurgical weight loss.


The significance of childhood neurosis for adult mental health: a follow-up study. The author compared the mental health of 42 young adults who had suffered from a neurosis in childhood with that of 20 control subjects. Various aspects of functioning were clinically assessed using the Current and Past Psychopathology Scales and the Health-Sickness Rating Scale. More than 75% of the former patients were at least mildly ill at follow-up, compared with only 15% of the control group. Intergroup differences in diagnoses and symptoms are described. The findings establish the fact that neurotic children require much more effective treatment than they have traditionally received in order to attain a good prognosis for adult mental health.


Evolution of behavior disorders into adolescence. The New York longitudinal study has followed the development of 136 subjects from infancy into adolescence. The authors report the distribution of diagnoses and outcome of 43 children who developed behavior problems before the adolescent period and the characteristics of 5 new cases diagnosed in adolescence and discuss issues of prediction. The analysis of the longitudinal data for subjects with and without behavior disorders permits discussion of two of the general issues in the literature: the significance of adolescent turmoil and the distinctness of adolescence as a developmental stage.


The role of neurosis in phylogenetic adaptation, with particular reference to early man. The author hypothesizes that neurosis results from maladaptation and leads to further maladaptation, thus creating a vicious cycle that can be viewed as having played a significant role in human evolution. Individuals who were less successful in the struggle for survival during prehistory would have been more likely to become neurotic, a maladaptation that would magnify existing genetically transmitted differences in their viability and affect both the choice of a mate and the viability of their offspring. This process would have accelerated human evolution by favoring the most viable. The author relates this theory to his concepts of assortative mating and to other theories of the role of neurosis.


Principles of the new sex therapy.

Principles of the new sex therapy. The authors review the development of their rapid treatment dual-sex therapy for sexual dysfunction. The basic tenets of the new sex therapy include 1) sound knowledge of physiology, endocrinology, and metabolic function, 2) institution of psychotherapy only when organic factors have been identified or ruled out, 3) treatment of the couple as a unit by dual-sex therapy teams, 4) a short-term intensive program, and 5) education in techniques of verbal and nonverbal communication. Since its inception in 1958, the new therapy has been adopted, modified, and examined by clinicians and researchers all over the world. The authors suggest that professionals interested in effective treatment for sexual dysfunction should improve techniques, train personnel, and encourage sound research.


The role of sex therapy in marial therapy. Marital and sex therapy are clinically interrelated in most cases because they deal with different symptoms of overlapping aspects of the couple's total relationship. The connection between marital discord and sexual dysfunction determines the emphasis and course of treatment. For example, sex therapy is the immediate treatment of choice when sexual dysfunction produces secondary marital discord but not when severe discord precludes the possibility of good sexual functioning. The author presents case reports to illustrate the relationship of remote and immediate causes of marital and sexual problems and to emphasize the value of a multimodality approach to treatment.


Profiles of couples seeking sex therapy and marital therapy. Assessment of 29 couples seeking marital therapy and 25 seeking sexual therapy at the same institution permitted the delineation of two distinct profiles. Although the two groups were similar in the degree of their sexual and marital difficulties and in demographic characteristics, the relationships of the sex therapy couples were generally characterized by satisfaction and affection, whereas those of the marital therapy couples were often antagonistic. In addition, the sex therapy couples tended to be less conservative and more thoughtful in their approach to life and their problems.


Relationship between dosage and response to lithium prophylaxis in recurrent depression. The authors analyzed the results of a multihospital collaborative study on the effectiveness of lithium prophylaxis in recurrent depression in terms of dosage and found that serum lithium levels between 0.5 and 0.7 mEq/liter and doses below 1000 mg/day were relatively ineffective in preventing recurrences. Serum lithium levels between 0.8 and 1.0 mEq/liter and doses above 1000 mg/day were associated with a relatively low failure rate. The authors discuss the relevance of these findings to current prescription guidelines for lithium carbonate.


Pavor nocturnus: a complication of single daily tricyclic or neuroleptic dosage. The author tested the hypothesis that a single bedtime dosage schedule of tricyclic or neuroleptic medication produces increased frequency of night terrors by administering a questionnaire to 30 medical patients who were not receiving such medications and 100 psychiatric patients on either multiple- or single-dosage schedules. Psychiatric patients on multiple-dosage schedules reported no more frightening dreams than the medical patients, whereas almost three-fourths of those receiving single bedtime doses had frightening dreams, a significant difference from the medical sample. This preliminary report is presented to call attention to the possible undesirable effects of a single dose schedule.


Is dying being worked to death?

Is dying being worked to death? In recent years there has been a dramatic increase in the number of books and articles on death and dying. The ambivalence of some writers regarding the value of this proliferation of papers led the author to review and evaluate this literature; he found seven overlapping categories of death-related literature that were of both theoretical and practical value. He briefly explores possible reasons for the rise in this subject's popularity.


Computerized tomography in patients with tardive dyskinesia. The author reviews the results of computerized tomography performed on eight patients with tardive dyskinesia to determine whether there was permanent structural damage. No significant abnormalities were found. Although it may not be useful in routine workups, this new noninvasive technique might be helpful in differential diagnosis, and its increasing sophistication may suggest further research on tardive dyskinesia.


Hypothalamic tumor presenting as anorexia nervosa. The authors describe a patient with symptoms of anorexia nervosa who was initially treated on a psychiatric ward but was later found to have a hypothalamic tumor. They recommend repeated neurological and endocrine evaluations for patients with anorexia nervosa who are unresponsive or only partially responsive to psychiatric treatment. Initially negative medical evaluations, obvious psychopathology, and even some response to treatment may all prove insufficient to rule out organic disease.


Current regulatory status of foods for special dietary uses. The Food and Drug Administration has redefined foods for "special dietary use". Such foods must now: (1) Supply a special dietary need that exists by reason of a physical or physiological condition, such as convalescence, a pregnancy, lactation, or by reason of a specific disease or disorder; (2) Supply a vitamin, mineral, or other dietary property to supplement diet by increasing total dietary intake; (3) Meet a special nutritional need as the sole item of the diet. The stricter definition of this category of food means that the conventional foods with added nutrients or food for which nutritional claims are made or nutritional information provided will no longer be considered as foods for special dietary uses, although they must conform to standard nutritional labeling requirements. The new regulation establishes a clearly delineated position within which the consumer, industry, and FDA can deal with special dietary foods without the past confusion as to what belonged in this category.


Measuring response to a cancer information telephone facility: Can-Dial. In an attempt to meet the need for increasing public knowledge about cancer, a system providing free information by telephone has been developed. The system is comprised of 36 pre-recorded taped lectures containing information about various aspects of cancer. Interested individuals call a toll-free number, indicate a topic of interest, and listen to the pre-recorded lecture over the phone. An operator handles incoming calls and obtains information from callers used in evaluating the program. During the first year of operation, over 30,000 calls were processed. Topics most frequently requested included those concerning smoking, breast and cervical cancer, and general information. Female response exceeded male response in all age categories. Older people responded less frequently than younger. Urban utilization greatly exceeded suburban and rural utilization. Considerable fluctuation in response related to promotional activities was found. Printed advertisements elicited far greater response than radio and television. Promotional efforts in an experimental group of low-utilizing townships greatly increased utilization while no change was observed in a control group.


A facet of the biohazard control program: agent registration, risk assessment and computerization of data. An assessment of risk in handling microbial agents at a major biomedical research institute is given. Included also are the risks associated with handling tissue cultures and animals. Two computer programs are described for the storage and retrieval of data on agents, tissue cultures, and animals.


Sociocultural influences upon preventive health behavior and attitudes towards dentistry. One hundred eighty adults who presented for general dental care at an urban dental school clinic were interviewed and given epidemiological screening examinations. The findings presented include a profile of a clinic population with respect to ethnic identity, family income, education, nuclear family structure, and residence. The two major racial groups (black and white) are found to have highly significant differences in their perception of dental services and their experiences with dental disease and treatment. An assessment of dental health status indicates that whites were more likely to have filled teeth, and blacks, decayed or unfilled teeth. This relates to different patterns in seeking recent preventive dental services and a marked disparity in utilization early in life. Fear and anxiety about dental care, degree of orientation towards prevention and differences in exposure to preventive information varied with race. Consumerist orientation is examined in terms of willingness to criticize services, be cared for by auxiliary health workers and accept professional fees. The identification of diversity in perception and values with respect to dental health care is characterized as an element in developing understanding between providers and consumers.


Lead poisoning among migrant children in New York State. Potentially hazardous painted surfaces were found in 40% of 166 dwelling units surveyed in 97 upstate New York migrant labor camps, a figure substantially lower than comparable surveys in upstate New York high risk urban areas. Blood samples obtained from 79 migrant children in 1972 revealed only one child with blood lead level above 40 mug per 100 ml as compared to a 21.6% yield from 5,733 high risk urban area children. A second screening program in 1974 yielded only three children of 190 tested with proven blood lead levels above 40 mug per 100 ml, although seven additional children with possible elevations were lost to follow-up.


The effects of anticipated funding changes on maternal and child health projects: a case study of uncertainty. A questionnaire survey of Title V special projects--Maternal and Infant Care (M&I), Comprehensive Care for Children and Youth (C&Y), Neonatal Intensive Care and Children's Dental Care--indicated that the anticipated change from federal project grants to state formula grants caused anxiety among project directors, low morale and high turnover in project staff, difficulty in filling staff positions, and anticipation of service reductions. These effects were much more prevalent and severe in projects which could realistically be expected to suffer budget cuts as a result of the shift in funding method. Despite the widespread anxiety, low morale and adverse effects reported by program directors, there was no reduction in the number of patients served, the scope of services offered, or the number of staff employed.


The genetic associate: a new health professional. Sarah Lawrence College has pioneered a masters program to train Genetic Associates. The Genetic Associate is a new category of allied health professional in clinical genetics. Trained to offer coordinative and supportive care to the patient with potential or actual genetic disease, Genetic Associates are potential providers of unmet health needs in the developing field of human genetics. There are 56 graduates of this program employed in 12 states and one foreign country. This paper describes the curriculum, the students, and a preliminary evaluation of Genetic Associates' performance as members of the health care team.


Limited surgical excision as the basis of a comprehensive therapy for cancer of the breast. A comprehensive program of therapy has evolved with collaborating roles for surgery, pathology, radiotherapy, and chemotherapy. Our experience includes 131 patients with breast cancer treated at the Massachusetts General Hospital since 1956 by limited excision of the cancer. The tumors of 10 patients were noninvasive or sluggishly so; the patients received no further therapy. Because of the invasive character of their tumor, 121 patients received heavy postoperative irradiation. In 12 of these 121, the irradiation has been followed by immediate and prolonged chemotherapy. It is too soon to judge the effect of the chemotherapy, but survival rates of those treated by limited excision and primary irradiation compare favorably with those of patients treated by radical mastectomy.


Penetrating cardiac trauma. Experience with thirty-four patients in a hospital without cardiopulmonary bypass capability. A review of thirty-four consecutive penetrating wounds of the heart is presented. Thirty-one patients were in shock at the time of admission, and fourteen had no obtainable blood pressure and were comatose or moribund. The weapon used, clinical status of the patient on arrival, size of the cardiac wound, and presence of associated injuries affected the mortality rate. Seven of the eight deaths were considered unpreventable due to clinical deterioration by the time of arrival. Clinical recognition of cardiac tamponade is stressed. Early open thoracotomy and closure of the cardiac wound is advocated as the preferred method of treating this injury. No patient was lost due to lack of cardiopulmonary bypass capability.


Gastric bypass.

Gastric bypass. Gastric bypass in the very obese is a technically difficult and tedious procedure done in the attic of the peritoneal cavity. However, with careful attention to pre-, intra-, and postoperative detail, it is reasonably safe, effective, and relatively free from unmanageable complications.


Anterior resection for adenocarcinoma. Lahey Clinic experience from 1963 through 1969. The results of anterior resection for adenocarcinoma of the rectum and rectosigmoid are reported with respect to survival rates and complications. Anastomotic recurrence is related to low lying, ulcerated, and less well differentiated tumors that have penetrated the bowel wall. The incidence of recurrent disease at the anastomosis increases with decreases in the margin of resection. Distal margins of at least 6 cm offer significant protection from recurrence. This study shows that anastomotic septic and fistulous complications are related to advanced age, diabetes, anemia, atherosclerotic disease, construction of the anastomosis below the peritoneal reflection, perforated bowel, obstructed bowel, and the use of drains. The determination of those factors that correlate with the development of anastomotic complications can be accomplished with pre- and intraoperative examinations. The role of these factors in operative decision-making and patient management is emphasized.


Acute perforation of the colon associated with chronic corticosteroid therapy. Perforation of the colon occurred in thirteen patients receiving corticosteroids for diseases unrelated to the bowel. Treatment averaged 3.5 years. The paucity of symptoms, signs, and laboratory indexes of visceral perforation led to frequent delays in treatment and to incorrect preoperative diagnoses in all but three patients. The perforations were often unusual in location (cecum, hepatic flexure, and multiple points in the transverse and descending colon) and often resulted from single punched-out ulcers in otherwise normal bowel. In seven patients the lesion could not be distinguished from perforated sigmoid diverticulitis, but in two of these patients the ulcerations were found in adjacent diverticula. The evidence strongly suggests that corticosteroids can be responsible for ulceration and perforation of the colon either by direct injury or by interference with normal mechanisms of bowel repair.


The sequential femoropopliteal bypass graft. A five year experience. (1) A five year experience with sequential bypass grafts for femoropopliteal tibial reconstruction is presented. (2) Twenty-nine consecutive grafts were performed in twenty-eight patients in whom the saphenous vein was absent or inadequate for grafting purposes. (3) The series contains a high percentage of women (57 per cent), diabetics (39 per cent), and patients requiring surgery because of rest pain or tissue necrosis (83 per cent). (4) There was no operative mortality and no significant operative morbidity. (5) The overall graft patency rate is 71 per cent, which is comparable to that obtained with standard bypass technics. (6) There was no late failures in the ten grafts that survived one year or more. (7) This procedure appears to be a useful method for bypass grafting to the popliteal or tibial arteries below the knee when the saphenous vein is absent or inadequate.


Postgastrectomy syndromes.

Postgastrectomy syndromes. Postgastrectomy syndromes requiring further operation are fortunately uncommon, as the symptoms are disabling and the results of corrective surgery are, at times, disappointing. Our sixty-six patients underwent a total of seventy-six procedures with forty-one successful results and thirty-five failures. Among the secessful group, only fourteen results were graded as excellent. (Table V.) Our experience, like that of others, demonstrates the necessity of accurate evaluation of the patient and of accurate syndrome classification. This not only allows the appropriate operation to be chosen but also helps to indicate those in whom operation should be avoided. Where more than one surgically remediable syndrome exists, simultaneous correction should be undertaken. Treatment of the mechanical problems of obstructed afferent loop by jejunojejunostomy and of stomal obstruction by complete stomal reconstruction provides satisfactory results. Roux-en-Y anastomosis is effective in patients with alkaline gastritis, but we caution against the use of this procedure in patients with vague symptoms and minimal endoscopic changes. Antiperistaltic jejunal reversal is the procedure of choice in managing severe postvagotomy diarrhea. Although most patients with dumping can be managed conservatively, a small number with severe symptoms and nutritional problems cannot and require further operation. Our experience with conversion from Billroth II to Billroth I and with isoperistaltic interposition, although minimal, has been reasonably satisfactory. Four groups of patients remain with symptoms of chronic vomiting, late postvagotomy atonic stomach, dumping "plus," and miscellaneous symptoms. These patients have complaints that are difficult to define and usually have poor results with further operations. We believe that surgery should be avoided in these patients and that conservative measures be continued.


Colonic polypoid disease: need for total colonoscopy. Colonoscopic examination of the entire colon was performed on 146 patients for radiographically suspected benign polypoid disease. Of thirty-six patients who did not have a neoplastic lesion at the suspected site, seven (19 per cent) had unsuspected small benign polypoid adenomas elsewhere in the colon. Of the remaining 110 patients who had a neoplastic lesion at the radiographically suspected site, 17 lesions (15 per cent) were either adenocarcinomas or neoplastic polyps with invasive carcinoma. One hundred twenty-eight additional unsuspected neoplastic polyps were found in 62 of the 110 patients (56 per cent). Six of the additional neoplastic lesions were either adenocarcinomas or polyps with invasive carcinoma. Four of these malignant lesions were in patients who had a benign polyp at the radiographically suspected site. Suspected colonic polypoid disease should be evaluated colonoscopically despite radiographic evidence of benignity. Colonoscopic evaluation in colonic polypoid disease should include examination of the entire colon with pathologic documentation of all polypoid lesions encountered.


Emergency aortic valve replacement.

Emergency aortic valve replacement. The aortic valve was replaced as an emergency in twenty-seven patients between July 1970 and December 1974. Twenty-two patients had critical aortic stenosis and five had acute aortic insufficiency. The indications for emergency surgery were cardiac arrest in five patients, low cardiac output in four patients, and medically intractable pulmonary edema in eighteen patients. Cardiac catheterization was not undertaken in ten persons because of their critical condition. The clinical diagnosis in these patients was supported by noninvasive maneuvers. No surgical deaths occurred. Twenty-five patients are well, active and NYHA Class I at five to thirty-three months after surgery. There has been one late death and one patient has some residual exertional dyspnea. One patient required reoperation to relieve a clotted prosthetic valve. These results suggest that the patient with aortic valve disease may be offered a reasonable chance for survival, even when desperately ill.


Markedly improved pulmonary function after open heart surgery in infancy utilizing surface cooling, profound hypothermia, and circulatory arrest. The use of surface-induced profound hypothermia with limited cardiopulmonary bypass and circulatory arrest markedly diminished the need for mechanical ventilation for patients undergoing cardiac surgery. Eleven of twenty-two patients were extubated in the operating room and five more patients within 70 minutes postoperatively. Five patients required mechanical ventilation. Four of the five were extubated within 24 hours  (mean, 19.05 hours); only one patient required mechanical ventilation greater than 24 hours. This experience would indicate that as the age of surgery is decreased, in conjunction with improved technics of cardiac surgery and anesthesia, the need for mechanical ventilation should be diminished.


[Clinical study on the shock organs in relation to the duration of shock (author's transl)]. To elucidate the mechanism of development of renal, pulmonary and liver insufficiency after serious shock, retrospective analysis was performed in 85 patients with traumatic shock. Among them, 14 patients died of renal, pulmonary or liver insufficiency after the resuscitation of shock, where kidney and lung were damaged concomitantly in most patients. There was a close correlation between the death related to both insufficiency and the duration of the shockp when the shock was treated completely within 10 hours, there was almost no death related to shock organ, but when the shock persisted more than 10 hours, the death rate was increased as the shock persisted longer. On the contrary, no relation was revealed between death caused by liver insufficiency and the duration of the shock. Renal and pulmonary functions were also correlated with the duration of the shock. It was revealed that the lower PaO2/PAO2 ratio was, the higher urea-N was in these patients, when shock persisted more than 10 hours. On the other hand, no relation was found between the change in liver function and the duration of shock. It can be concluded that the kidney and lung have the same nature as a shock organ. In general both functions were impaired concomitantly, where 10 hours of persistence could be regarded as the critical border to develop the shock organ. The liver seemed to be independent of the others as the shock organ, so that it should be discussed separately.


[The concentrations of halothane in the operating theatre and its dependance on various methods of removal (author's transl)]. Measurement of halothane concentrations by means of gas chromatography was used to compare the efficiency of 1) a filtration system and 2) ducting of gases into the exhaust of the ventilation system of our operating threatre. The concentrations were found to be lower when the latter method was used. Measurements made subsequently provided data on halothane concentrations occurring during routine service when different methods of anaesthesia were used, with and without ducting of gases into the ventilation exhaust system.


Enflurane anaesthesia for removal of aldosterone producing adenoma. In a 31-year old woman with a six year history of headache and hypertension a diagnosis of primary aldosteronism was made on the basis of urine samples containing 45 mug/day of aldosterone. The preoperative systemic blood pressure was 240 mm Hg systolic and 120 mm Hg diastolic. The serum potassium level was 2.6 mEq/L and other laboratory findings were within normal limits. The patient was to undergo operation. Pre-medication consisted of oral pentobarbitone, intramuscular pethidine and atropine. For induction of anaesthesia, enflurane 2.0-2.5% maximum was given with O2 (21/min) and N2O (61/min); no intravenous agents were used. Suxamethonium chloride 40 mg was administered to facilitate endotracheal intubation. Anaesthesia was maintained with enflurane 1.5-2.0% with 50% N2O and O2. Tubocurarine 27 mg was given for muscle relaxation. When the tumour was manipulated, systemic arterial blood pressure was elevated again to 190 mm Hg systolic and 120 mm Hg diastolic. After removal of the tumour, the arterial pressure and heart rate were stable and recovery from anaesthesia was without circulatory or respiratory complications. Plasma aldosterone levels reached a maximum when the tumour was manipulated and fell to normal levels on the second post-operative day. Cortisol levels were not altered markedly even when the tumour was handled. These data imply that adrenocortical response to enflurane anaesthesia as jadged by plasma aldosterone levels would be different from that as estimated by plasma cortisol levels.


General anaesthesia for a patient with progressive muscular dystrophy. The case is reported of a four-year-old boy with progressive muscular dystrophy who underwent anal fistulectomy under neuroleptanaesthesia with Thalamonal. Recovery was uneventful. Anaesthetic problems associated with the disease include sudden death due to myocardial involvement and high postoperative mortality due to pulmonary infection. Mental retardation and ECG abnormalities may be present and acute postoperative gastric dilatation has been reported. Narcotics or minor tranquilizers and hyoscine are recommended for premedication. Light anaesthesia should be maintained throughout surgery and minimal doses of non-depolarizing muscle relaxants may be used if necessary. Suxamethonium chloride should be avoided because muscle damage and cardiac arrest might occur.


[A further case of malignant hyperpyrexia and its treatment with lidocaine, methylprednisolone and verapamil (iproveratril) (author's transl)]. A dramatic case of anaesthetic-induced malignant hyperpyrexia is described. The treatment (ice packs, treatment of acidosis, glucose-insulin, methylprednisolone, lidocaine, verapamil, muscular relaxation and oxygen breathing) was effective. In the discussion, the pharmacological effects on the cardiac muscle are considered predominantly.