Surgical management of the bleeding aortopulmonary fistula. A technique utilizing endobronchial intubation with a Carlens tube and a TDMAC-heparinless shunt is described for management of the actively bleeding aortopulmonary fistula. An illustrative case report is presented.


A method of preventing air embolus in open-heart surgery. Intraoperative air embolus following cardiac surgery poses a serious problem. Many maneuvers have been suggested in an attempt to minimize its occurrence. Partial aortic clamping, creating a cupola which collects this air, is combined with aortic venting. The use of this simple technique is described as an alternative and easily applicable trouble-free method.


The significance of electrode surface area and stimulating thresholds in permanent cardiac pacing. This paper reports a long-term clinical study of evolving chronic thresholds of cardiac stimulation in patients with implanted pacemakers and two types of permanent prevenous unipolar pacing leads. A comprehensive collection of threshold measurements is presented and analyzed. These data were accumulated over a period of more than 4 years by measuring stimulation thresholds at each of five stimulus pulse durations ranging from 0.5 to 2.5 msec. Measurements were made at initial implantation and at first (21 month) and second (42 month) reimplantations.


Abnormalities of regional lung function associated with ventricular septal defect and pulmonary artery band. Xenon-133 ventilation-perfusion scans and technetium-99m angiocardiograms were performed 47 times in 34 patients. All patients had ventricular septal defect (VSD), 17 with pulmonary artery band (PAB), 6 with isolated VSD, 4 with pulmonary valvar stenosis (PS), and 7 with transposition of the great arteries (d-TGA), VSD, and PAB. Patients with VSD had slightly depressed ventilation fraction of the left lung and slightly elevated perfusion fraction of the left lung, both before and after closure of the VSD. Patients with VSD and PAB had slightly depressed ventilation fraction of the left lung but perfusion fraction of the left lung that was either markedly elevated or markedly depressed. After closure of VSD and removal of PAB the perfusion abnormality returned toward normal in some patients but remained abnormal in most. The findings were similar in most patients with d-TGA. Ventilation-perfusion ratio was nearly normal in patients with VSD alone, both before and after closure of VSD. In patients with VSD with PAB the severe abnormality of ventilation-perfusion ratio returned toward normal after corrective operation but did not reach normal. There was no abnormality of distribution of perfusion along the cephalocaudal axis of the lung with the patient supine.


Surgical therapy of lung cancer.

Surgical therapy of lung cancer. A total of 1,615 patients with a confirmed diagnosis of lung cancer were treated at Roswell Park Memorial Institute between 1963 and 1974. Particular emphasis was given in this review to the 295 patients that underwent surgical resection of their primary lung lesion. Factors such as histology, type of resection, sex, age, staging, and degree of dissemination were considered possible influences on survival. The risks and benefits of intentional reductive or palliative surgery are considered along with the risk related to thoracotomies performed for diagnostic purposes.


Carcinoma of the gastric cardia and hiatal hernia. Carcinoma of the cardia of the stomach in patients with sliding hiatal hernia is a disease of poor prognosis, since symptoms nearly always occur late in its course at an already incurable stage. Eleven cases are reviewed from the records of The New York Hospital-Cornell Medical Center from 1932 to 1975. Resectability of tumor appeared related to shorter interval between onset of symptoms and diagnosis. Barium studies combined with esophagoscopy led to correct preoperative diagnosis of malignancy in all cases.


Familial myxomas in four siblings.

Familial myxomas in four siblings. Familial myxomas of the heart are very rare, with only two previous reports noted in the literature. This report documents four siblings with myxomas, and three of these patients had two or more myxomas. One sibling had four myxomas excised. The clinical findings, history, examination, and surgical treatment are described.


Plasma ionic calcium levels following injection of chloride, gluconate, and gluceptate salts of calcium. The ionic equivalency of three calcium salts was tested in 15 patients undergoing cardiac surgery with extracorporeal circulation. Of the three salts tested (chloride, gluconate, gluceptate), only calcium chloride showed a reproducible and highly significant relationship between the increase in total calcium and the increase in ionic calcium. It is suggested that extracorporeal circulation may be one clinical situation in which use of a calcium electrode may be of major value. The marked distortion of plasma proteins and pH, the addition of large amounts of citrate, and the differences between various calcium salts indicate that it is probably not possible to predict ionic calcium with assurance and that direct measurement may be necessary for optimal therapy.


Blunt traumatic rupture of the atria.

Blunt traumatic rupture of the atria. The case histories of 2 patients with atrial rupture from blunt chest trauma are presented, one of whom is the tenth survivor. Based on a review of these cases and the literature, important factors in the diagnosis and treatment of this easily repairable anatomic lesion are discussed. The importance of rapid recognition and early operation are emphasized.


Malignant pleural mesothelioma. Report of 19 cases. Malignant pleural mesothelioma may be composed of sarcomatous, epitheliomatous or mixed cell types. They can be differentiated from localized, benign mesothelioma. Malignant pleural mesothelioma is a rapidly fatal tumor that poses serious diagnostic and therapeutic problems. A series of 19 cases was compiled at the North Carolina Baptist Hospital, and data from these cases were compared to those of other series. The average survival time was 10 months. The most common symptoms were dyspnea, chest pain, pleural effusion, and weight loss. Three patients had a definite history of exposure to asbestos; in 6 more there was a questionable exposure. The most helpful investigative screening tool was the chest roentgenogram, in that it demonstrated an intrathoracic abnormality; however, mesothelioma could not be differentiated from inflammatory reaction or bronchogenic carcinoma with pleural effusion. Sputum cytology as well as pleural effusion cytology was only suggestive of malignancy. Bronchoscopy was not helpful. Needle biopsy yielded malignant cells in 3 of 8 patients. Exploratory thoracotomy was the most accurate means of diagnosis but was frequently followed by seeding into the incision and severe, intractable incisional pain. Therapy proved to be palliative at best. Thoracotomy did not alter the course of the disease; in fact, the production of severe incisional pain was deleterious to the patient's well-being. Cordotomy done in 3 patients brought no relief. Neither radiation therapy nor chemotherapy had a significant effect on survival time or palliation.


Prevention of air embolism with intravascular carbon dioxide washout. Air embolism remains a constant hazard from all operative procedures which involve opening the central cardiovascular system. Standard surgical maneuvers have been developed to prevent embolization by evacuating the air before restoring the circulation. Under certain circumstances these maneuvers may not be effective in removing air from the aortic arch. Introduction of carbon dioxide directly into the aorta to displace blood for adequate visualization has proved to be a simple, safe adjunct to the prevention of air embolization in operations involving the aortic arch.


Multiple pulmonary leiomyomatous hamartomas in women. A rare case of multiple pulmonary leiomyomatous hamartomas is described and seven previously reported cases are reviewed. The pathological and clinical features of this lesion, which is benign and occurs in middle-aged women, are unique; a conservative approach following the establishment of diagnosis is recommended.


Successful prolonged heparinless venoarterial bypass in sheep. In order to investigate the safety of prolonged heparinless venoarterial bypass (HL-VAB), we subjected 18 sheep to prolonged HL-VAB for up to 6 days. Three animals died of granulomatous lung abscess and one died from intra-abdominal abscess. One animal died of generalized thromboembolism secondary to  mechanical damage of the nonthrombogenic coating occurring at the time of cannulation. HL-VAB was successfully carried out in 13 sheep. Although clots were found at all tubing connections where blood turbulence occurred, only the previously mentioned animal showed evidence of thromboembolism. Damage to the nonthrombogenic tubing exposed to the roller pump head was seen in all animals, and its severity appeared to be related to the duration of bypass. Scanning electron microscopic examination revealed scattered platelet aggregates on the nonthrombogenic coated surfaces without clinical evidence of embolization. Hematocrit values, leukocyte counts, platelet counts, prothrombin time (PT), activated partial thromboplastin time (PTT), thrombin time (TT), plasma fibrinogen levels, and factor V and VIII levels remained unchanged, whereas free plasma hemoglobin levels rose slightly during 6 days of HL-VAB. HL-VAB for up to 6 days appears to have little adverse effect on blood cells and blood coagulation factors. For current clinical use, the nonthrombogenic coated tubing circuit should be changed every 48 hours because of time-related trauma to the coated tubing from the roller pump.


Extracorporeal oxygenation with various experimental venoarterial bypasses during prolonged apnea. This work compares various conventional venoarterial closed-chest circuits where satisfactory oxygenation of myocardium and brain in total apnea with extracorporeal circulation is concerned. Eleven dogs were studied during 3 hours of curare-induced apnea. We used single and double vena caval drainages connected to an oxygenator. A single-vein drainage yielded approximately 50 per cent and a double-vein drainage 75 per cent bypass. Two separate roller pumps fed arterialized blood variously into  carotid and femoral arteries. In single-vein drainage, the oxygen partial pressure in the coronary artery was consistently poor and carotid oxygen partial pressure was poor for 100 per cent femoral infusion while more and more arterialized blood reached the carotid arteries in the other single-vein drainage circuits. In double-vein drainage, the coronary oxygen partial pressure for 100 per cent femoral infusion remained poor while, for the other circuit types, the coronary arteries received arterialized blood except where 100 per cent carotid infusion was concerned. The carotid oxygen partial pressure was sound for all groups in the double-vein drainage except for some obtained in 100 per cent femoral infusion. Consequently, where the bypass was large and the carotid and femoral arteries received a share of arterialized blood, both heart and brain received sound oxygenation.


Thrombotic phenomena with nonanticoagulated, composite-strut aortic prostheses. Twenty-nine patients received no anticoagulant therapy after aortic valve replacement with a Starr-Edwards Model 2400 prosthesis. Hemodynamic studies were performed at 3 to 26 months (average 12 months) in 18 of 29 patients. Mean aortic valve gradients ranged from 14 to 62 mm. Hg and averaged 34 mm. Hg. Calculated aortic valve area varied from 0.20 to 1.75 sq. cm. and averaged 0.98 sq. cm. Thirteen of 18 patients had critically stenotic valve orifices. At reoperation or autopsy, examination of the prostheses consistently revealed pannus and thrombus which narrowed the inflow orifice and usually extended to the struts. Of the remaining 11 patients, 3 have died (2 suddenly and one after a cerebrovascular accident), 2 have had embolic episodes, and 6 have refused a repeat study but are being given anticoagulant therapy. Clinical examination, serum lactic dehydrogenase (LDH) levels, phonocardiography, echocardiography, and fluoroscopy of the prosthesis were often unrevealing. Cardiac catheterization was the only reliable method for critically evaluating prosthetic function. In conclusion, close follow-up, preferably with cardiac catheterization, is recommended in any patient who received a Starr-Edwards Model 2400 aortic valve prosthesis without anticoagulation. Long-term anticoagulation with sodium warfarin is indicated in all patients with a Model 2400 aortic valve prosthesis unless there is a contraindication to such therapy.


Double-outlet right ventricle with tunnel from left ventricle to aorta. The successful surgical correction of an unusual form of double-outlet right ventricle (DORV) in a 4-year-old boy is described. A long tunnel-like structure was present between the left ventricle and the aorta and also communicated with the right ventricle. hemodynamic and angiographic evaluation demonstrated restrictive communications between the tunnel, the aorta, and each of the ventricles. A pathological concept explaining the anatomic abnormality seen in this patient is discussed.


Use of balloon-tipped vena caval cannulas during open cardiac surgery. Experience over the past twelve months with the use of balloon-tipped vena caval cannulas for central cannulation during cardiopulmonary bypass is reported. Based on this experience, we fell that such cannulas should become useful to the cardiac surgeon, particularly for complex reoperation.


Long-term follow-up of cloth-covered Starr-Edwards prostheses. One hundred patients in whom cloth-covered Starr-Edwards prostheses were implanted have now been followed for 3 to 7 years. The hospital mortality rate was 5 per cent, and survival at five years was 70 per cent. Complications related to valve design occurred in 8 per cent (4 per cent fatal). The majority of late deaths and poor results were related to progressive cardiac disease rather than valve-related complications. The results indicate that cloth-covered prostheses have significantly lowered the incidence of thromboembolism and eliminated poppet dysfunction. The problem of strut cloth wear was clinically observed only twice in 500 patient-years of follow-up.


Interference with function of unipolar pacemaker due to muscle potentials. One hundred and seventy-three unipolar pulse generator systems were tested in 169 patients to determine the incidence of sensing of muscle potentials. One hundred and twenty-two implants in the pectoral region were suitable for assessment and 60 (49 per cent) demonstrated sensing. Ventricular-inhibited units sensed muscle potentials in 69 per cent (47 of 78), with 9 patients complaining of related symptoms. Ventricular-synchronous units sensed in 30 per cent (13 of 34) with no patient manifesting symptoms.


Blood and urine catecholamine concentrations after implantation of artificial heart. Plasma and urine epinephrine and norepinephrine concentrations were measured before and after implantation of an artificial heart in 20 calves and before and after thoracotomy in 3 control calves. All animals had similar preoperative plasma and urine catecholamine concentrations. During the first 4 postoperative days, plasma and urine epinephrine and norepinephrine concentrations were markedly elevated in all animals. However, calves with an artificial heart had significantly higher concentrations than control calves. Thereafter, catecholamine levels in control animals returned to preoperative levels, whereas epinephrine concentrations in artificial heart recipients remained elevated for 2 weeks and norepinephrine concentrations remained elevated for over a month. Two artifical heart recipeints survived longer than 2 months and had normal plasma and urine catecholamine concentrations from day 32 until a few days before being put to death. Although the mechanism in unclear, these findings suggest that early artificial heart function is associated with a significant metabolic stress which slowly disappears or becomes tolerable after one month.


Pulmonary valve replacement. Report of an operation performed for calcific pulmonic stenosis associated with total anomalous pulmonary venous drainage and atrial septal defect. Calcification of the pulmonic valve is an uncommon lesion that is usually associated with other congenital cardiac defects. Prior attempts at valvotomy or partial excision of the puolmonic valve have carried a high mortality rate. Pulmonary valve replacement itself is an equally uncommon surgical procedure and, in the past, has been performed only during reconstruction of the right ventricular outflow tract, when the pulmonic valve itself had to be utilized as an aortic prosthesis, and in one patient in whom pulmonary regurgitation following valvotomy was not well tolerated. A case of calcific pulmonic stenosis in association with an atrial septal defect and total anomalous pulmonary venous drainage is reported. The patient was treated successfully by pulmonary valve replacement with a Hancock stented porcine xenograft aortic prosthesis in association with correction of the other congenital cardiac lesions.


Effects of coronary perfusion during myocardial hypoxia. Comparison of metabolic and hemodynamic events with global ischemia and hypoxemia. The effects of metabolic accumulation on myocardial metabolism during global heart oxygen deprivation were evaluated in a working in situ swine heart preparation with controlled total coronary blood flow. Myocardial oxygen consumption was depressed to a similar extent by either reducing total coronary flow 60 per cent (ischemia, low coronary perfusion) in 10 swine or by decreasing coronary perfusate PO2 to 30 mm. Hg at normal flows (hypoxemia, high coronary perfusion) in 13 swine. Compared with findings in 13 control hearts, ischemia significantly (p less than 0.05) decreased myocardial oxygen consumption (640 to 390 mumole per hour per gram), glucose uptake (185 to 16 mumole per hour per gram), and free fatty acid consumption (32 to 17 mumole per hour per gram). ttissue levels of glycogen, creatine phosphate, and adenosine triphosphate (tatp) were significantly reduced (p less than 0.005), and tissue lactate, adenosine diphosphate (ADP), and adenosine monophosphate (AMP) were increased (p less than 0.001). During hypoxemia, glucose uptake was increased (240 mumole per hour per gram) and free fatty acid consumption was somewhat less depressed (19 mumole per hour per gram). Creatine phosphate and ATP were higher than with ischemia (p less than 0.01), and lactate, ADP, and AMP accumulations were less (p less than 0.01). Thus, in the period immediately following myocardial oxygen deprivation, inadequate coronary perfusion caused greater metabolic buildup which inhibited myocardial substrate utilization and energy production. High coronary perfusion, even though the perfusate was unoxygenated, was associated with greater preservation of substrate utilization, higher levels of high-energy phosphates, less accumulation of metabolic products, and a longer survival. These data suggest a critical role of coronary perfusion in protecting myocardial metabolism in the immediate period following global heart hypoxia.


Fatal cerebral atheromatous embolization after cardiopulmonary bypass. Cholesterol embolization to the abdominal viscera is common. Fatal cholesterol embolization to the central nervous system is rare. This report describes a 55-year-old woman with severe atherosclerotic disease who underwent cardiac surgery during which she suffered a fatal cerebrovascular accident. Postmortem examination revealed multiple infarcts in the brain, eye, and spleen due to emboli of cholesterol crystals and other atheromatous debris from a ruptured atherosclerotic plaque in the ascending aorta at the site of an aortotomy for cardiopulmonary bypass. In patients known to have severe atherosclerotic disease, atheromatous embolization to the central nervous system should be regarded as a potential complication of surgical manipulation and incision of the aorta for cardiopulmonary bypass. Ophthalmoscopic examination may be of diagnostic value in such cases.


Operative indication for corrective surgery in cases of complete transposition of the great arteries associated with large ventricular septal defect. Among 23 patients with complete transposition of the great arteries (TGA) and large ventricular septal defect (VSD) who underwent corrective surgery, there were nine deaths (39 per cent). Since 1972, improvement in operative techniques, linked with increasing experience in postoperative care, has reduced the hospital mortality rate to 29 per cent (five deaths in 17 patients). Only one of these 23 patients had pulmonary artery banding prior to definitive repair. Analysis of the preoperative hemodynamic data suggests that complete surgical repair is not indicated for patients who have TGA and large VSD, without significant pulmonary stensosis, when the pulmonary arteriolar resistance is greater than 2,500 dynes-sec.-cm.-5 or the effective pulmonary flow index is less than 1.2 L. per minute per square meter of body surface area.


Improved technique of double valve replacement. Double valve replacement in the aortic and mitral positions continues to present significant morbidity and  mortality rates. At present, the replacement operation is performed with the use of either ischemic arrest or coronary perfusion. In this report, we describe a new method whereby the anterior portion of the mitral valve and the aortic valve are replaced with the aid of ischemic arrest, and then the posterior portion  of the mitral valve and left atrium are repaired while the myocardium is being perfused through the native ostium. This technique has been used in 33 patients with one operative death in the last 4 years and has significantly reduced our mortality rate in this time.


The selection of patients with bronchogenic carcinoma for mediastinoscopy. The records of 112 patients treated at the Ochsner Foundation Hospital with the diagnosis of bronchogenic carcinoma were reviewed. A new concept for defining the location of central versus peripheral tumors is presented. Criteria important in selection of patients for whom mediastinoscopy is likely to be helpful are cell type, location (peripheral versus central), and radiographic evidence of  mediastinal metastasis. The size of the tumor is not a useful criterion except possibly for squamous cell lesions. A high incidence of mediastinal metasis was found associated with central tumors (63 to 100 per cent) of all cell types and with peripheral lesions (63 per cent) of undifferentiated cell types. A relatively low incidence of mediastinal metasis was associated with peripheral asenocarcinomas or squamous cell tumors. We would, therefore, recommend mediastinoscopy for all patients with central lesions and those patients with peripheral lesions of an undifferentiated cell type. When correlated with radiographic findings, only 4.6 per cent of peripheral carcinomas of a differentiated cell type with a radiographically normal mediastinum were found to produce mediastinal metastases, and mediastinoscopy is not recommended. In patients with peripheral tumors of indeterminate cell type, a decision for mediastinoscopy may be influenced by other factors such as the operative risk of a thoracotomy and location of the primary tumor within the lung.


Left aortic arch with right descending aorta and right ligamentum arteriosum. A rare form of vascular ring. The combination of left aortic arch, right descending aorta, and right patent ductus arteriosus is a rare form of aortic arch anomaly. Only 11 such cases have been previously reported. A 6-month-old infant with this anomaly manifested severe respiratory difficulty and feeding problems in the early newborn period. The aortic arch abnormalities were confirmed by angiocardiography, and operative correction was successful. This is the first case reported in which the patient developed severe respiratory and feeding difficulties due to this type of a vascular ring.


Nonsurgical removal of foreign body from right heart. A new percutaneous approach. A new method is described for the nonsurgical removal of foreign bodies from the right heart. By means of the percutaneous Seldinger Technique, endoscopic forceps were passed throught the internal jugular vein to remove a fragment of polyvinyl catheter from the right atrium of a patient who had had heart surgery. The procedure is atraumatic and can be performed on patients who are critically ill and those who recently have had surgery.


Anomalous origin of the left coronary artery from the right pulmonary artery. A previously unknown coronary artery anomaly is reported: origin of the left coronary artery from the right pulmonary artery. This unusual anomaly can probably be explained by the theory of dual embryonic development of the coronary arteries from angioblastic buds in the truncus arteriosus. It is thought that these buds anastomose with a capillary network that is developing on the surface of the ventricles. Complete repair of this lesion with restoration of a two-coronary artery system was accomplished in a 10-month-old baby. The coronary artery was detached from the pulmonary artery, with a button of pulmonary artery being retained around the coronary artery ostium. Direct systemic arterial flow to the left coronary artery was established by anastomosis of the left coronary to the right subclavian artery.


Heparinless, oxygenatorless perfusion rewarming following surface-induced deep hypothermia for open-heart surgery. To facilitate perfusion rewarming without the use of total body heparinization or an oxygenator following open-heart correction with surface hypothermia, we divised a pump circuit. The circuit, totally primed with 100 c.c. of saline, consists of polyurethane-polyvinyl-graphite (PPG) coated Tygon tubes (with one end tapered by heat treatment) and a copper-coil heat exchanger. A roller pump was used to achieve partial bypass from the left atrium to the ascending aorta with flow rates up to 70 c.c. per  kilogram per minute. Experiments in dogs resulted in rapid rewarming, immediate return of cardiac function, and hematologic alterations similar to those noted during surface rewarming. The safety of the method was also demonstrated. Prothrombin time, partial thromboplastin time, and platelet values returned to control levels upon rewarming, and no thromboemboli or bleeding problems were noted. Six clinical experiences were accumulated. Details of the method, hematologic and blood chemical analyses in dogs, and the first clinical trial in a 3-month-old infant with transposition of the great vessels are reported.


Methylprednisolone. Pharmacologic doses in shock lung syndrome. Patients with shock lung syndrome were identified as those who developed acute respiratory failure after a profound episode of hypotension secondary to hemorrhagic, gram-negative, or endotoxic shock. In this study, each of the 10 patients with shock lung syndrome received methylprednisolone sodium succinate, 30 mg. per kilogram, intravenously every 6 hours for 48 hours. In addition, all patients were supported with mechanical ventilation, with or without positive end-expiratory pressure (PEEP). Arterial oxygenation improved markedly, and pulmonary edema resolved in all patients. Nine were discharged from the hospital and one died subsequently of disseminated intravascular coagulation. This study demonstrated a significant improvement in mortality rate with repeated pharmacologic doses of methylprednisolone compared to previously reported mortality rates of 60 to 90 per cent in patients with shock lung syndrome treated without repeated pharmacologic doses of steroid therapy.


A new instrument for the evaluation fo tissue tonicity in lymphoedema. An instrument which measures the resistance of the tissues to compression has been used to assess the effectiveness of a therapy for long term lymphoedema. In this preliminary study, all cases of long standing lymphodema showed an increased resistance of the affected tissue to compression. Following an average of 30 months' Venalot treatment the resistance of the fibrotic tissues was restored to normal levels. It is believed that this way of assessing the state of the tissues and the value of therapy is a more accurate representation of the actual situation and should be used in preference to measurement of the circumference or plethysmography.


Role of lymphography in management of filarial chyluria. 1. One hundred patients with chyluria were studied with lymphography and 80 cases were followed up for a period varying between six months to two and one half years. 2. There was preponderance of left sided lesions. The site of fistulations were mostly in the region of pelvis and calyces of the kidney. 3. It was observed that lymphography was very useful in treatment of chyluria. Thirty-eight patients (48%) with chyluria were completely free from symptoms and after lymphography, 23 (28%) of them had relief and 19 (24%) of the patients did not have any beneficial effect after lymphography. This procedure was of great help in demonstrating the site of fistulations which could be surgically corrected, in certain situations. 4. Lymphographic appearances of thoracic duct was helpful in deciding the operation of thoracic duct jugular vein anastomosis in some cases. 5. Lymphatico venous anastomosis was done in 3 patients at the root of the scrotum in whom retrograde flow of contrast material occurred into the testicular lymphatics on lymphography.


Lymphographic changes caused by lymph node metastases in carcinoma of the suprarenal glands. In the literature reviewed, only two articles were found describing lymphographical changes caused by metastases of malignant adrenal tumours. A patient with anaplastic carcinoma of the suprarenal gland is presented here. In this patient, postoperative retroperitoneal lymphography with control films was of vital importance for the planning of post-operative treatment and follow-up.


Diffuse lymphangiomyomatosis.

Diffuse lymphangiomyomatosis. A case of diffuse lymphangiomyomatosis with involvement of the large veins of the body is reported. The clinical, pathologoanatomic and especially the roentgenologic findings are described. Interstitial lung thickening, pleural effusions and spontaneous pneumothorax are findings which together with a stasis in the lymphatic system strongly suggest the diagnosis. The extensive involvement of the venous system supports the theory of a hamartomatous nature of the disease.


The lymph node in experimental xanthomatosis. There is significant, progressive replacement of the lymphoid elements of the lymph node by foam cells in experimental xanthomatosis. These cells first form islands in the subcortical area. Subsequently they involve the medullary cords and finally, they replace the cortex. The xanthomata are higly vascular, consisting of a dense capillary network of samall and short capillaries. These newly visualized capillaries are fully integrated and incorporated in the normal blood supply of the lymph node. No significant distortion of the larger venules and arterioles were observed. It is noteworthy to observe the great capacity of the vascular supply of the lymph node in reacting to situations of significant enlargment and replacement of the lymphoid elements.


Lymphocyte function in Hodgkin's Disease. The immunologic deficiency of Hodgkin's disease includes skin anergy, delay in homograft rejection, negative transformation response of blood lymphocytes, and susceptibility to infections, particularly those of fungal or viral etiology (1, 3, 5). Since thymus-derived lymphocytes normally mediate these functions, a disturbance of this cell system would account for the observed immunological deficiencies in Hodgkin's disease. The majority, if not all of thymus-derived lymphocytes belong to the pool of recirculating, long-lived, small lymphocytes and an unimpeded circulation of these cells between lymph and blood is considered essential for a complete expression of their immunocompetence. Blockage and alteration of this circulation at the level of the lymph node is likely to occur in patients with Hodgkin's disease because of the characteristic infiltration of the lymph nodes by neoplastic cells. The question arises, therefore, whether the immunological deficiencies of Hodgkin's disease are due to intrinsically incompetent lymphocytes or the result of a faulty circulation of intrinsically competent lymphocytes. To answer this question the thoracic duct lymphocytes as well as blood lymphocytes of a patient with Hodgkin's disease have been studied with regard to re-circulation and immunocompetence.


On radioactive labelling of the lymph drainage regions of the pelvis. The introduction of radioisotopes in the surgical management of cervical carcinoma at our clinic in 1970 constituted a major advance in this respect. Prior to surgery the lymphatic tissue of the pelvic region is labelled by subcutaneous applications of radioisotopes. Our experience shows that the body's kinetics encourage the deposition of the radionucleide and thus visualization even of the groups of lymph nodes located in the deeper layers of the pelvic region. This method allows virtually complete lymphonodectomy with resultant improvement of cure rates.


A new derivation of average molecular weights of nonlinear polymers. A new method for calculating average molecular weights is presented for nonlinear polymers. In contrast to the previous methods of Flory and Stockmayer which first calculate the distribution of all species and then use the distributions to calculate average properties, the new method calculates these properties directly. In contrast to the method of Gordon, probability generating functions are not required. Starting with elementary probability and utilizing the recursive nature of network polymers property relations can be developed more simply. We illustrate the method for calculations of Mw Mz, and the gel point for a wide variety of polyfunctional polymerizations.


Intrachain reaction of a pair of reactive groups attached to polymer ends. II. Monte carlo study on the intrachain reaction proceeding on trans/cis-polysarcosine chain. Monte Carlo calculation was performed to evaluate the ring-closure probability of short polysarcosine chains. Calculations were made for unperturbed trans- non-self-intersecting trans-, and non-self-intersecting trans- and non-self-intersecting trans/cis-polysarcosine chains. In the latter case, the main chain amide bond was allowed to take cis as well as trans conformations. The ring-closure probability for unperturbed trans-polysarcosine chains was found to be substantially greater than for non-self-intersecting trans chains. Virtually no difference was observed between the ring-closure probability was used to estimate the cyclization constant, i.e., the ratio of rate constant for the intramolecular reaction of the two groups attached to the polymer ends to that of the intermolecular one. The results were compared with the experimental data for the intrachain reaction proceeding on polysarcosine chain reported in the first paper of this series. The Monte Carlo results roughly reproduced the experimental data and the calculated chain length dependence was consistent with the observed one for longer chains.


Determination of the structure of cellulose II. The structure of regenerated cellulose is shown by x-ray diffraction to be comprised of an array of antiparallel chain molecules. The determination was based on the intensity data from rayon fibers and utilized rigid-body least-squares refinement techniques. The unit cell is monoclinic with space group P2(1) and dimensions a = 8.01 A, b = 9.04 A, c = 10.36 A (fiber axis), and gamma = 117.1 degrees. Models containing chains with the same sense (parallel) or alternating sense (antiparallel) were refined against the intensity data. The only acceptable model contains antiparallel chains. The -CH2OH groups of the corner chain are oriented near to the gt position while those of the center chain are near to the tg position. Both chains possess an O3-H-O5' intramolecular hydrogen bond, and the center chain also has an O2'-H-O6 intramolecular bond. Intermolecular hydrogen bonding occurs along the 020 planes (o6-h-o2 bonds for the corner chains and O6-H-O3 bonds for the center chains) and also along the 110 planes with a hydrogen bond between the O2-H of the corner chain and the O2' of the center chain. This center-corner chain hydrogen bonding is a major difference between the native and regenerated structures and may account for the stability of the latter form.


The role of the deep femoral artery in revascularization of the lower extremity. The deep femoral artery is often peculiarly resistant to atherosclerosis when the common and superficial femoral arteries are severly affected. At the Mayo Clinic between 1964 and 1972, 43 patients had aorta-deep femoral artery bypass as the definitive revascularization procedure for arteriel insufficiency of the lower extremities. Of the patients with grade 1 ischemia, 82% became asymptomatic as did 44% of those with grade 2 ischemia and 43% of those with ulceration and incipient gangrene. After 2 years, 25 of 40 (62%) previously symptomatic lower extremities had remained asymptomatic (in 31 patients available for follow-up evaluation). The rates were 68% and 55% after 3 and 4 years, respectively.


Skin fibrinolytic activity in cutaneous and systemic vasculitis. Study of involved and uninvolved skin from patients with necrotizing vasculitis revealed diminished tissue fibrinolytic activity deposition of immunoreactants in involved skin. In these patients, the depletion of tissue fibrinolytic activity is probably the result of vessel injury secondary to the local deposit of immunoreactants. In addition, there was diminished tissue fibrinolytic activity in uninvolved skin from patients with and without clinical skin involvement, unassociated with the deposition of immunoreactants. The precise mechanism for diminished tissue lytic activity in these latter patients is not known, but it may be associated with generalized activation of the coagulation and fibrinolytic mechanisms that result in local depletion of tissue fibrinolytic activity. These local changes may aggravate the clinical course of the disease as well as inhibit the healing of the lesions.


Gastrocolic fistula complicating benign unoperated gastric ulcer. Report of four cases and review of the literature. Of 957 patients undergoing operation for benign gastric ulcer and its complications from 1965 through June 1975, 90 had perforated ulcers. Among these were four patients in whom a gastrocolic fistula had formed. Although two of the four patients had symptoms due to peptic ulcer dating back 12 and 68 months, symptoms of a gastrocolic fistula were the initial presentation of ulcer disease in the other two. All four patients had watery diarrhea and weight loss, and barium enema examination was diagnostic in each case. The perforating ulcers were located in the distal stomach on the greater curvature in all four patients. Although enterostasis was not present in these cases, regurgitation of colonic contents probably results in bacterial overgrowth in the small intestine, causing structural and functional damage to the mucosal cells by bacterial products, manifested clinically by diarrhea in 75% of the patients. Surgery should be advised in all cases after adequate preparation of the patient; bowel preparation with cathartics, enemas, and oral antibiotics is mandatory. The preferred operation is one-stage enbloc hemigastrectomy and resection of the involved segment of colon along with the fistulous tract. The present series brings to 43 the total number of cases of gastrocolic fistulas complicating benign, previously unoperated gastric or duodenal ulcers. There is an appreciable mortality associated with this condition - 7 of these 43 patients (16%) died as a direct consequence of their fistula.


One-year graduated exercise program for men with angina pectoris. Evaluation by physiologic studies and coronary arteriography. Eight men, 45 to 50 years of age, with mild stable angina pectoris, participated in a graduated exercise program. Coronary arteriography, left ventriculography, left ventricular hemodynamics at rest and during supine leg exercise, treadmill testing with electrocardiographic monitoring, and measurement of oxygen uptake were obtained before and 1 year after the exercise training program. No change was noted in the arteriographic appearance of coronary artery lesions or of collateral circulation. Left ventricular performance, assessed by qualitative left ventriculography and the hemodynamic response of the left ventricle to supine leg exercise, was unchanged after the training program. Oxygen consumption for a given repetitive work load during treadmill exercise decreased. Two patients with a pretraining exercise ECG positive for ischemia reverted to a normal response after the exercise program. All had a decrease in angina, an increase in self-esteem, and a more positive attitude toward their work and their disability.


The in vitro spectrum of the cephalosporins. The cephalosporins may currently be classified according to their relative susceptibility to beta-lactamases. Cefoxitin, cefamandole, cefatrizine, and cephanone are relatively resistant to the gram-negative beta-lactamases, whereas cephalothin, cefamandole, and cefoxitin are resistant to staphylococcal beta-lactamase. Although the inhibitory activity of cephalothin is representative of that of cephaloridine, cephalexin, cefazolin, cephapirin, cephacetrile, and cephradine, there are significant differences between its activity and that of cefoxitin, cefamandole, and cefatrizine, especially against Enterobacter, Serratia, indole-positive Proteeae, Bacteroides fragilis, and ampicillin-resistant Haemophilus influenzae.


Persistent Nausea without organic cause. The onset of functional nausea among 77 patients was frequently related to an organic disease or to a psychophysiologic response to stress. Later, the nausea had obvious features of conversion, hypochondriasis, or an hallucination. The patients had significant psychiatric disorders as assessed by the Minnesota Multiphasic Personality Inventory (MMPI) and by clinical examination. While in the hospital most patients experienced symptomatic improvement but they did not accept a psychologic explanation for their nausea.


The electroencephalogram in pernicious anemia. EEGs were recorded in 54 patients with pernicious anemia. Six patients without nervous system involvement had normal EEGs, 10 patients with spinal cord or peripheral nervous system involvement had normal or minimally abnormal EEGs, 17 of 19 patients with evidence of mental dysfunction had abnormal EEGs with the most consistent finding being an excess of theta slowing, and 19 patients with pernicious anemia and other neurologic diseases showed EEG findings reflecting the complicating disease process. In general, the EEG abnormalities in patients with pernicious anemia correlated well with the presence of cerebral dysfunction but not with the degree of anemia. The EEG was also a good indicator for detecting and confirming other intracranial disease processes unrelated to pernicious anemia.


Normal renal function: CIN and CPAH in healthy donors before and after nephrectomy. To establish normal values for glomerular filtration rate and effective renal plasma flow for age and sex, the records of 141 healthy renal transplant donors were reviewed. These patients had no history of renal or systemic disease, had normal physical examinations, and had normal laboratory studies in addition to having studies of the clearances of insulin (Cin) and para-amino hippurate (Cpah) preoperatively. Regression analysis of the clearance data revealed no significant sex differences in renal function. A linear age-related decline in renal function begins in the 20's and decreases by 4 ml/min per decade for Cin and by 35 ml/min per decade for Cpah through the 60's, our oldest patients studied; therefore, the absolute lower limits of normal (lower fifth percentile) for Cin and Cpah were calculated as a function of age. Residual function was constant with average postoperative clearances 70% of preoperative values regardless of age.


Neurovascular microsurgery: a model for laboratory investigation and the development of technical skills. An inexpensive and reproducible model to help in developing the technical skills for, and to investigate experimentally, a microvascular anastomosis resembling the superficial temporal-middle cerebral artery bypass is described. The model is used to illustrate the important principles of microvascular surgery. Using a standardized operative technique, we evaluated 50 successive preparations by perfusion; the patency rate was 100%.


Echocardiographic observations in a patient with acute myocardial infarction with a nondiagnostic electrocardiogram. Echocardiography revealed a persistent large segment of dyskinesis of the posterolateral wall in a patient with clinical an enzyme evidence of acute myocardial infarction but without diagnostic electrocardiographic changes. A left ventricular angiogram confirmed the echocardiographic findings.


Cytotoxic effects on the plasma membrane of human diploid fibroblasts--a comparative study of leakage tests. Confluent monolayers of human diploid lung fibroblasts were treated with cytolytic agents. The induced membrane damage was investigated by different test systems. Changes of membrane permeability were compared with morphological alterations. Four tests employed leakage of cytoplasmic markers of different sizes as criteria of membrane damage. Radioactive markers of the following decreasing size order were used: [3H]RNA (MW greater than 200,000) greater than 51Cr greater than [3H]nucleotides greater than [1-14C]alpha-amino-isobutyric acid (AIB, MW 103). Uptake of trypan blue was employed as a fifth criterior of changed membrane permeability. A comparison between the tests indicated the following order of sensitivity for detection of membrane damage: leakage of AIB-label greater than leakage of nucleotide label greater than leakage of 51Cr-label=uptake of trypan blue= morphological changes greater than leakage of RNA-label. Two distinct types of leakage patterns were evident: 1. Upon incubation with Triton X-100 all four release curves coincided. This was considered as representing large functional "holes". 2. With the polyene amphotericin B the smallest marker (AIB) was released to a strikingly greater extent than other markers. This was regarded as representing very small functional "holes". Melittin from bee venom and theta-toxin from Clostridium perfringens induced leakage patterns of two intermediate types. The results indicate that a combination of several different size markers may be useful for characterizing induced membrane lesions.


Changes in ribonuclease with age in the fungus Rhizoctonia solani. The enzyme ribonuclease (RNase) which was isolated from Rhizoctonia solani Kuehn degraded ribonucleic acid from both Torula yeast and from Rhizoctonia solani mycelia. As the Rhizoctonia mycelia aged, there was an increase in both the total and the specific activities of the RNase present in the mycelia. This change is discussed in relation to the age dependent decrease in protein synthesis in this fungus.


Relationship between cell replication and volume in senescent human diploid fibroblasts. Since alterations in cell replication rate and cell volume distribution are two of the earliest changes seen in the culture of human diploid cells, it was decided to examine the relationship between these parameters. After standardization of the conditions for cell volume measurements (enzyme treatment, temperature and stage of cell growth), a close correlation was observed between cell population doubling time and cell volume in WI-38 cells at various levels of in vitro passage. Cell populations which replicate more slowly (trisomic-21 fibroblasts, fetal skin fibroblasts) also demonstrated a shift to larger cell volumes when compared with control rapidly replicating cell populations at the same level of in vitro passage. Similar shifts to larger cell volumes were produced by reducing serum concentration, decreasing incubation temperature and inhibiting DNA synthesis. Separation of senescent WI-38 cells on the basis of cell volume revealed that the cell fractions with the largest modal cell volume contained the highest percentage of slow or nonreplicating cells. Therefore, an inverse relationship appears to exist between growth rate and cell volume in cultured human diploid fibroblasts.


DNA repair in late-passage human cells.

DNA repair in late-passage human cells. Monolayer cultures of WI-38 cells from passages 18 to 60 were exposed to ultraviolet radiation, or to N-acetoxy-AAF, or to gamma-rays. The cultures were incubated in 3H-dThd, and unscheduled DNA synthesis--a measure of DNA repair--was measured radioautographically. Late passage cultures showed less repair, and many cells showed none. Double-label radioautographs indicated that there is an excellent correlation between cells that do scheduled synthesis and cells that do unscheduled synthesis. We interpret our results as indicating that failure of repair is not a causal event in the failure of late passage cells to divide, but that as cells age the ability to do the many coordinated steps in repair declines.


Decrease in the number of synapses in the senescent brain: a quantitative electron microscopic analysis of the dentate gyrus molecular layer in the rat. Axo-dendritic synapses were counted in electron micrographs taken from the middle third of the dentate gyrus molecular layer of young adult and senescent Fischer 344 rats. A significant decrease in the number of synapses was found in senescent animals relative to young ones. This loss of synapses, which involved all the morphological varieties of axo-dendritic synaptic contacts in the dentate gyrus molecular layer, appeared to be unrelated to changes in dimensions of synapses, tissue volume or number of postsynaptic granule cells. It is proposed that the age-related loss of synaptic contacts might be attributed to a reduced capacity of senescent brains for synaptic regeneration and remodelling.


Ovarian development in athymic nude mice. III. The effect of PMSG and oestradiol upon the size and composition of the ovarian follicle population. The response of 1 month old congenitally athymic nude mice and their phenotypically normal littermates to exogenous pregnant mare serum gonadotrophin (PMSG) and oestradiol-17beta has been tested. An equal increase in the number of growing follicles was detected in both nudes and controls in response to PMSG. A specific increase occurred in the number of unilaminar follicles in the initial growth stages in addition to the increase in the number of multilaminar and vesicular follicles. Oestradiol depressed follicular growth equally in both nudes and controls. The contracted appearance of growing follicles in nudes disappeared under the influence of PMSG and was induced in ovaries of control mice treated with oestradiol. We conclude that the ability of the mouse ovary to respond to exogenous PMSG and the oestradiol is not impaired by congenital athymia as expressed in the nude genotype. The data suggest that the retardation of follicular growth already reported in 1 month old nudes arises from a deficiency of gonadotrophin.


The performance of merging hospitals.

The performance of merging hospitals. The primary aim of this paper is to examine the impact of mergers on the performance of hospitals. The study tests the null hypothesis that no significant differences exist in efficiency and effectiveness between hospitals that merge and those which remain independent entities. The performance evaluation model follows closely similar models used to study the performance of merging banks. The findings of the study suggest that 1) large urban hospitals contemplating merger should view carefully the trade-offs involved between efficiency and effectiveness as indicated by the measures employed in this study, since the evidence indicates that the increased service capability achieved in merging hospitals is accompanied by a significant increase in costs; and 2) the concept appears very promising for small rural hospitals, especially in veiw of evidence that various benefits extend over the short-, intermediate-, and long-range time frames employed in the study.


Health information system installation: principles and problems. Many studies have been done to identify health problems and practices and to obtain knowledge of the characteristics of the population. Often specific data desired by the investigators are not available at the time of final analysis. This paper emphasizes the importance of planning and designing the system for recording and processing information together with the planning and development of the program or project. Principles that were applied and problems that occurred in demonstration projects in developed and less developed countries are described. Some examples of applications to improve the health services for the rural dewellers in a less developed country are illustrated. The methodology evolved has broad application and may be useful to others who have needs for data on an ambulatory population.


Modeling health services systems.

Modeling health services systems. A conceptual model for the analysis of personal and collective health services systems is proposed. By placing existing formal models in the framework of this conceptual model, we emphasized their qualities and shortcomings. We discussed the normative and descriptive approach of formal modeling. Finally we emphasized the close conceptual parallel that exists between personal and collective health services systems.


The recipients and results of acupuncture. A private clinic was established in Los Angeles in late 1972 to perform acupuncture. Most individuals seeking treatment were middle-aged and well educated. All had considerable experience with traditional medical care for their problem. The principal reason for seeking care was relief from chronic pain. Thirteen per cent had received other nontraditional forms of therapy; over one-third indicated that they sought acupuncture as a "last resort." The results of certain psychological tests taken by these patients were within the range of normal. On completion of six or more treatments, 74 per cent said they had been helped; 54 per cent of those followed for three months and 24 per cent contacted one year later were improved. A subgroup of patients who received only temporary improvement had significantly different scores on psychological scales suggesting the results noted in this group may have been due to a "placebo" effect. A significant proportion of those who dropped out of treatment did so because they had achieved the desired benefits.


Mailed versus telephoned appointment reminders to reduce broken appointments in a hospital outpatient department. This study compared mail, telephone, and control strategies to reduce the rate of broken appointments in a pediatric outpatient department. Based on 1,039 randomly assigned appointments, the mail strategy had a broken appointment rate of 29.1 per cent, the telephone strategy of 25.3 per cent, and the control of 44.2 per cent. Both strategies were significantly effective, but the difference between them was not significant. Patients without telephones had a higher rate of broken appointments than patients with telephones. Mailed reminders are the more cost-effective intervention.


Consumer participation and social accountability. Consumer participation in the planning and management of health care programs is prescribed as a method for increasing provider responsiveness to the goals and needs of users of services. However, issues related to the nature of mandates to implement consumer participation has not had the impact on policy development proposed for it. While structural changes can be identified which might enhance the consumer role in decision making, it will also be necessary for the consumer sector to develop a strategy which will prompt major rather than incremental movement.


Office records in the evaluation of quality of care. Trained reviewers audited 10,500 charts in the offices of 166 pediatricians and family physicians. Criteria for child health supervision and three diseases had been previously validated for relevance to health outcome and suitability for peer review. Overall documentation of criteria was approximately 50 per cent. Measurements and laboratory data were recorded frequently; counseling items infrequently. Pediatricians documented health supervision items more often than family physicians. Members of large groups recorded more than those in solo practice or small groups. The presence of equipment considered important for health care did not correlate with percentage of recording. The method of review was judged accurate and acceptable by physicians, but only 50 per cent said the results accurately portrayed their performance. Lack of accurate recording may make it impossible to achieve valid peer review of ambulatory child care.


Obstetric care in a family health-oriented university associated neighborhood health center. The structure, staffing, and planning methods of the obstetric component of a family-oriented University Hospital associated family health care facility are briefly described. The interviews and screening procedures are outlined necessary to develop a broad data base for total health care planning. The roles of the members of the multiprofessional team employed are described with particular emphasis on the use of a nurse midwife as the primary obstetric care professional. Management procedures are referred to as well as the educational component present within such a program. The program is evaluated in terms of clinical outcome, patient and professional acceptance, and cost.


Patient acceptance of the family nurse practitioner. Because of the limitations of published studies concerning patient acceptance of new health professionals and in the absence of published studies of patient acceptance of the family nurse practitioner, the present study compared levels of satisfaction among patients seeing a family nurse practitioner (Primex) with satisfaction levels among patients seeing traditional providers (doctors, nurses) withing the same setting. Based upon 1,912 patient-provider encounters using multiple evaluation criteria in ten ambulatory care settings, it was found that patient satisfaction with the Primex was equal to or more favorable than levels of satisfaction with traditional providers on four out of five measures.


Who is a nurse practitioner? Processes of care and patients' and physicians' perceptions. During a repeat of a previous study of nurse practitioners conducted at the University of Kansas, an opportunity occurred to examine the impact of two different styles of care provided by nurse practitioners on patients and physicians with whom they worked. The two nurse practitioners involved had similar backgrounds in terms of work experience. The participated in the same training program for nurse practitioners, practice in the same environment, and cared for patients randomly allocated to one or the other practitioner. One practitioner saw her patients more often and for longer periods of time, ordered more medications, and less often sought physician consultation. She also was most optimistic regarding the impact of her services on patients' conditions. The other was more dependent upon physicians for validation of her actions. Physicians did not distinguish between the two practitioners in terms of their performance. However, patients cared for by the practitioner whose behavior suggested an integration of medical and nursing care processes saw nurses as a more common source of information about illness and demonstrated more significant shifts in preferences for services provided by nurses rather than physicians. No significant changes were noted from pretest values among patients cared for by the other nurse practitioner.


Pre and post-glycerol special audiometric tests battery results in endolymphatic hydrops. The glycerol test for endolymphatic hydrops was administered to 17 patients exhibiting classical symptoms of Meniere's disease. A complete battery of audiometric tests including the SISI, TTD (Rosenberg variation). ABLB, Sweep Frequency Bekesy, two tests of speech discrimination (Rush Hughes and Northwestern), and air and bone conduction thresholds were administered pre and post-glycerol ingestion in order to determine the effect of osmotic diuresis. Improvement in pure-tone sensitivity and speech discrimination scores were most often observed. Among the special audiometric tests only the SISI scores exhibited changes, however, these could be related to the threshold changes. There were no significant differences observed in the threshold tone decay tests nor in the ABLB. The sweep frequency Bekesy test revealed only the changes which were observed in pure-tone sensitivity.


Functional hearing loss.

Functional hearing loss. Functional hearing loss is a rather common entity, although it probably is overlooked more often than not. In most instances, the services of an experienced audiologist are necessary if one is to detect these cases. First, one must consider carefully the patient's behavior before and during the otologic and audiologic examination, and note the referral source, if any, since patients with certain backgrounds are more apt to exhibit functional hearing loss than others. Second, careful attention is given to certain aspects of the initial basic audiometric examination. Discrepancies here often stand out and point clearly toward functional loss. A so-called "modified approach" to conventional audiometry has enabled us to detect almost all cases of functional hearing loss without resort to the special audiometric tests designed for that purpose.


The management of sickle cell patients undergoing surgery. Between 10 and 15 percent of blacks have sickle cell disease or sickle cell trait. Either is capable of a sickle cell crisis which could occur during a surgical procedure. Because of this, we as otolaryngologists should be aware of how to diagnose sickle cell disease and what specific measures should be followed in order to avoid a sickle cell crisis. This paper deals with specific diagnostic tests available, their interpretation, and our protocol for managment of these patients when they are in the hospital for a surgical procedure.


Facial rehabilitation: surgical reconstruction following temporal bone resection. Facial reconstruction and cosmetic surgery following extensive bone and soft tissue resection for carcinoma of the ear has not been emphasized in the past. Poor long term survival and local recurrence rates previously recluded considering extensive rehabilitative effort. A patient is presented, illustrating the problems resulting from major ablative surgery of the temporal bone. The surgical concepts and techniques used in this patient's facial rehabilitation are enumerated and described from both the functional of the principles used to other aspects of facial reconstruction are mentioned.


Thin rubber sheeting in frontal sinus surgery: animal and clinical studies. Closure of the nasofrontal communication is the most common cause of failure of nonobliterative external of nonobliterative external frontal sinus operations for chronic sinus disease. To determine whether silicone rubber sheeting or tubing might prevent closure, we designed animal experiments and conducted a clinical study. We enlarged the nasofrontal duct in dogs, inserted silicone rubber tubing or sheeting and assessed ductal patency grossly and microscopically. The tubes prevented epithelization and failed to prevent local osteoblastic reaction, fibroplasia, and scar formation. In contrast, sheeting permitted rapid mucosal regeneration, less osteoblastic activity, and less fibrosis. Our 16 patients with chronic sinus disease underwent a modified Lynch operation, with enlargement of the nasofrontal duct and stenting with rubber tubes or sheeting. The sheeting provided the best long-term result. In our experience, it raised the success rate of the classic Lynch external operation.


The osteo-mucoperiosteal flap in repair of cerebrospinal fluid rhinorrhea. Repair of fistulas producing cerebrospinal fluid rhinorrhea, as with any reconstructive operations, should take into account the basic principles of reconstructive surgery for best results: 1. tissue needing replacement should be replaced by like tissue; and 2. a flap is always superior to a graft. In the case of this disease, the tissue sealing the fistula should be a flap containing not only mucosa or mucoperiosteum, but also pedicled bone. Two kinds of regional flaps are described which successfully closed the fistula in each of three patients. Follow-up is long term.


Nasal obstruction after rhinoplasty: etiology, and techniques for correction. Of 1,000 consecutive patients who underwent rhinoplasty, about 10 percent had some nasal obstruction postoperatively. The majority of patients in whom the author performed the primary rhinoplasty had an obstructive, vasomotor type of rhinitis that ensued, and which usually could be cured by the injection of corticosteroids into the turbinates. Fifty patients had undergone rhinoplasty by other surgeons, and most of those patients requested surgical correction to relieve the nasal appearance. In those patients the causes of nasal obstruction were; pre-existent, undetected, or diagnosed but uncorrected, septal deviation; or turbinate hypertrophy; intranasal adhesions; scar tissue web formation in the nasal vault; inadequate nasal tip support, and alar collapse. The author's technique of surgical repair for each of these conditions is outlined.


Tuberculosis of the larynx.

Tuberculosis of the larynx. Tuberculosis of the larynx, once a common disease, has become quite rare with the advent of anti-tuberculous chemotherapy. In the pre-antibiotic era two modes of laryngeal infection were recognized; bronchogenic and hematogenous. The literature is briefly reviewed. Thirteen patients in the past 15 years in whom tuberculous laryngitis was diagnosed upon indirect laryngoscopy by members of the University of Michigan Department of Otorhinolaryngology are presented. Bronchogenic infection was present in 11, and in two patients the disease was consistent with hematogenous spread. Tissue biopsy from a case of bronchogenic contamination demonstrated epithelioid tubercles, while numerous subepithelial acid-fast bacilli without typical tuberculous histological change were present in a case of hematogenous laryngeal infection. A case of cicatricial laryngeal stenosis was successfully treated surgically by laryngofissure, excision of fibrosis with arytenoidectomy, and free mucous membrane grafting. Finally, the initial subtle presentation of many of our patients emphasizes the importance of a consideration of tuberculosis in the differential diagnosis of chronic laryngitis.


Difficult direct laryngoscopy.

Difficult direct laryngoscopy. This article reviews some of the problems involved in direct laryngoscopy. It suggests adequate preparation and evaluation of the patient to avoid complications. An evaluation of laryngospasm is given. Solutions of the problems are suggested using gear power assistance and adequate drugs for relaxation. The importance of correct positioning of the patient is emphasized and illustrated. This summarizes clinical judgment and successful evaluation of the difficult mechanical problems in the exposure of the vocal cords.


Congenital subglottic fibroma in the newborn. Congenital subglottic fibroma is a rare clinical entity. A review of references did not disclose any previous report. A case of congenital subglottic fibroma is presented. Embryology, etiology, symptomatology and pathology of congenital anomalies of the larynx are reviewed and management discussed.


Glossopharyngeal neuralgia: surgical treatment and electron microscopic findings. Seven cases of idiopathic glossopharyngeal neuralgia were treated with surgical resection via pharyngeal approach. Two of these cases showed a recurrence of neuralgia and subsequently, one of the recurring cases underwent a IXth nerve section through a cervical approach. The resected nerves were examined with the light and electron microscope. In five of seven cases, degeneration of myelinated fibers was observed. Under electron microscope, disarrangement and disorganization of the myelin sheath were found, while axonal degeneration was relatively rare. The author recommends an initial resection by the pharyngeal approach. In cases of recurrence, a subsequent attempt to resect the nerve should be made by the cervical approach.


Schwannoma presenting as a nasal polyp.

Schwannoma presenting as a nasal polyp. An unusual presentation and treatment of an intranasal Schwannoma are discussed. The clinical and pathological features are also reviewed.


Sensori-neural hearing loss following radiotherapy to the nasopharynx. A retrospective study was done to ascertain the risks of cochlear damage from radiotherapy of the nasopharynx. Audiometric evaluation, pre and post-radiotherapy, revealed that 7 out 13 patients had sustained sensori-neural deafness. Contrary to what is generally believed of the resistance of the cochlea to radiotherapeutic damage, eventual loss of hearing can occasionally be expected in patients undergoing radiation therapy for head and neck tumors.


Inhibition of cholesterol absorption by (-)N-[alpha-phenyl-beta-(p-tolyl)ethyl] linoleamide in rats. The effect of (-)N-[alpha-phenyl-beta-(p-tolyl)ethyl] linoleamide (PTLA) on intestinal absorption of cholesterol was studied in rats. Oral administration of 15 mg PTLA to rats resulted in a significant (P less than 0.05) decrease in the radioactivity in serum and liver 4 hr after administration of labeled cholesterol. The effect of PTLA was greater on the absorption of cholesteryl oleate as compared with free cholesterol. The rate of hydrolysis of cholesteryl oleate in mucosal homogenates of rat intestine was decreased with PTLA, suggesting that the inhibition of cholesterol absorption by PTLA is related to its effect on cholesteryl ester hydrolysis in the intestine.


Effect of (-)N-[alpha-phenyl-beta-(p-tolyl)ethyl] linoleamide on lipid levels in serum and liver in cholesterol-fed rats. The effect of (-)N-[alpha-phenyl-beta-(p-tolyl)ethyl] linoleamide (PTLA) on lipid levels in serum and liver was compared with that of sitosterols in rats maintained on a diet supplemented with 1% of cholesterol, 0.5% of ox bile extracts, and 10% of hydrogenated coconut oil for 8 weeks. When PTLA was added to the diet at a level of 0.1%, the mean liver cholesterol level of male rats was reduced to 41% of the control and that of female rats was reduced to 19% of the control. In female rats, which showed higher cholesterol levels in serum and liver than male rats after cholesterol feeding, PTLA lowered the liver cholesterol level even at 0.0008% in the diet. Serum cholesterol was lowered by PTLA but not so markedly as liver cholesterol. The inhibition of cholesterol deposition in the liver suggests that the interference with cholesterol absorption is one of the main actions of PTLA. Sitosterols showed a similar pattern of lipid-lowering action, but the potency was far less than that of PTLA.


Effects of pentadecan-2-one on the growth of cells in culture. The effect of inclusion of trace amounts of pentadecan-2-one in the incubation medium on the growth of HeLa Cells was evaluated by measuring viable cell counts (cells excluding trypan blue) and incorporation of [14C] leucine into acid precipitable protein. Evidence is presented to show that exposure of the cells to trace amounts of the methyl ketone, 36mug/ml, effectively inhibits cell growth. This inhibition is relieved by simultaneously incubating the cells with a long chain primary alcohol, hexadecan-1- o1, but not with the secondary alcohol, pentadecan-2-o1. The observation that the ethyl ketone, hexadecan-3-one, also inhibits cell growth but at higher concentrations than that observed with pentadecan-2-one and that pentadecan-2-o1 at similar concentrations has no effect on cell growth indicates that, for optimal effect, the keto function must be at the 2-position. Inhibition of cell growth by pentadecan-2-one is not unique to HeLa cells, as suggested by the inhibitory effects of this lipid type on the growth of other malignant cell lines of human origin.


Rat testicular lipids and dietary isomeric fatty acids in essential fatty acid deficiency. Weanling rats were fed essential fatty acid-deficient diets, either completely fat-free, or with partially hydrogenated fish oil (PHFO, 28 wt %), or with fractions derived from PHFO containing primarily positional isomers of trans-eicosenoate (20:1, 3 wt %) or trans-docosenoate (22:1, 3 wt %). Control animals were fed a peanut oil-containing diet (28 wt %). After 5 or 15 weeks on the diet, the content of neutral and phosphorus-containing lipids in the testes was determined. The fatty acid distribution in major lipid classes was analyzed for animals fed the diets for 15 weeks. The testicular stage of maturation or degeneration was assessed by histology. The group fed PHFO exhibited signs of complete testicular degeneration, or lack of maturation, already after 5 weeks, whereas the animals on the diets with the very long chain monoenoic acids suffered severe degenerations only after 15 weeks. In the PHFO-fed rats, a sharp decline in the concentration of testicular triacylglycerols was observed. In all of the essential fatty acid-deficient groups, an increase in testicular sphingomyelin was observed. Cholesterol levels were fairly similar among all dietary groups. The total testicular fatty acids of the PHFO-fed animals contained somewhat more eicosadienoic acid than found in the other groups, and somewhat less (n-9)-acids. In all EFA-deficient groups, (n-6)-acids were lowered, in particular in triacylglycerols and phosphatidyl cholines. The PHFO group did not show a lower (n-6)-concentration than the other deficient groups, in spite of the more severe symptoms of deficiency. There was no evidence of a major accumulation of long chain isomeric fatty acids in the degenerated testes of the PHFO-, 20:1-, and 22:1-fed groups.


Positional analysis of isovaleroyl triglycerides using proton magnetic resonance with Eu(fod)3 and Pr(fod)3 shift reagents: II. Cetacean triglycerides. The positional distribution of isovaleric acid in natural cetacean triglycerides has been studied using proton magnetic resonance with lanthanide shift reagents. Twenty-nine samples of melon, jaw, and blubber triglycerides from 13 genera in the Delphinidae, Phocoenidae, and Monodontidae families were examined. Isovaleric acid was found esterified only at the 1,3-positions in the monoisovaleroyl and diisovaleroyl triglycerides of these animals.


Influence of diet on conversion of 14C1-linolenic acid to docosahexaenoic acid in the rat. 14C1-Linolenic acid was incorporated into lipids of hearts, livers, and carcasses of male rats. We studied the influence of diet composition on extent and distribution of radioactivity. A CHOW diet, a purified, essential fatty acid (EFA)-deficient diet, a purified control diet, and EFA-deficient diets with four fatty acid supplements were used. Supplements of 18:2n-6, 20:4n-6, 15:3n-3, and 22:6n-3 were given as single doses. Radioactivities in liver phosphatidyl ethanolamines (PE), phosphatidyl cholines, and neutral lipids were measured. The distribution of radioactivity among the fatty acids in liver phospholipids was determined. Rats on CHOW diet incorporated far less radioactivity than any other group into lipids of hearts and livers. Most of the activity in livers was recovered as 20:5n-3 and 22:6n-3 in all rats. In EFA-deficient rats, the radioactivity in 22:6n-3 of liver PE was still increasing 36 hr after 14C1-linolenic acid had been administered. The n-6 supplements (18:2n-6 and 20:4n-6) seemed to reduce the coversion of 20:4n-3 to 20:5n-3 (desaturation), whereas the n-3 supplements (18:3n-3 and 22:6n-3) reduced the conversion of 20:5n-3 to 22:5n-3 (elongation). Formation of 22:6n-3 may be controlled by 22:6n-3 itself at the elongation of 20:5n-3 to 22:5n-3.


Physiological and analytical variation in cholesterol and triglycerides. Plasma cholesterol and triglyceride levels were determined, on each of two AutoAnalyzer systems in 11 healthy subjects, weekly over a 10-week and monthly over a 12-month period. Analytical variation was 1-2% for cholesterol and 2-5% for triglyceride. Cholesterol and triglyceride values on frozen quality control serum pools were not indicative of absolute values on fresh plasma. Even though the two AutoAnalyzer systems averaged within 1-2 mg/dl for triglyceride and cholesterol on the serum quality control pools during the 12-month period, the two systems differed by 7-8 mg/dl on fresh or frozen plasma samples. The coefficient of physiological variation on the 10 weekly samples averaged 5% (range 3-10%) for plasma cholesterol and 18% (range 9-27%) for plasma triglyceride. Analysis of the monthly samples suggested significant (P less than 0.05) seasonal trends: cholesterol was highest in the winter months and lowest in October, whereas triglyceride was highest in January and February and lowest in May and December. We conclude that intra-individual variation can be an important source of error in attempting to make a genetic diagnosis of hyperlipidemia and/or in evaluating hypolipidemic regimens in a given subject.


Mass spectrometric analysis of the fatty acids and nonsaponifiable lipids of Eimeria tenella oocysts. The fatty acids and nonsaponifiable lipids of Eimeria tenella oocysts were analyzed by gas liquid chromatography and combined gas liquid chromatography-mass spectrometry. The fatty acids detected were identified as C14:0, C16:0, C16:1, C18:0, C18:1, and C18:2. Though the wt of the fatty acid fraction decreased during sporulation from 91 mug per 10(6) oocysts to 47 mug per 10(6) oocysts, the relative amounts of these fatty acids did not change appreciably. The nonsaponifiable lipids of E. tenella consisted of cholesterol and unbranched primary alcohols of 22, 24, 26, 28, 30, and 32 carbons. Mass fragmentography demonstrated that each species of alcohol consisted of saturated and monounsaturated derivatives. Trimethylsilyl ethers of fatty alcohols were found to offer several important advantages over free alcohols for mass spectrometric characterization. Before sporulation, most fatty alcohols were in the oocyst wall. During sporulation, the wt of the nonsaponifiable lipids increased from 16 mug per 10(6) oocysts to 44 mug per 10(6) oocysts due largely to synthesis of C24 and C26 alcohols. The newly synthesized fatty alcohols were not deposited in the oocyst wall.


Effect of dietary di-2-ethylhexyl phthalate on lipid biosynthesis in selected tissues from the rat, in vitro. Di-2-ethylhexyl phthalate (DEHP), a plasticizer commonly used in the production of polyvinyl chloride plastics, has become an environmental pollutant. At the present time, the biological significance of phthalates in the environment is unknown. In the present studies, we observed that addition of DEHP to a stock diet of rats resulted in marked effects on incorporation of 14C-acetate into lipid by liver and kidney slices; other organs, such as heart, testes, and aorta, were unaffected. Incorporation of 14C-acetate into total lipid of liver (dpm/mg wet wt) from rats fed 0.5% or 1.0% DEHP for 10 or 18 days, respectively, was decreased to ca. 50% of control values. The decreased incorporation into liver lipid is not attributable to any one lipid fraction, inasmuch as incorporation into the phospholipid, sterol + diglyceride, free fatty acid, triglyceride, and sterol ester + hydrocarbon fractions was decreased 30-70% with respect to controls. In addition, the percent distribution of 14C-acetate among the individual phospholipids was ca. 25% lower in phosphatidyl choline of the DEHP-fed rats. In rats fed 0.5% DEHP, incorporation of 14C-acetate into total lipid of kidney was similar to control values, but incorporation into the triglyceride and sterol ester + hydrocarbon fraction was decreased 30-40%, whereas incorporation into the sterol + diglyceride fraction was increased 38%. Livers from DEHP-fed rats were ca. 20% larger than livers from control rats and, at the 0.5% level of DEHP feeding, testes wts were elevated; no significant changes were noted in wts of spleen, heart, aorta, kidney, or body wt gains in rats fed DEHP. These studies emphasize a subtle toxicity of phthalate esters not previously reported and emphasize the need for further biochemical studies to evaluate the effect of phthalates on biological systems.


beta-Oxidative cleavage of octanoyl- and dodecanoyl-CoA in rat liver cytoplasm. [12-14C] Dodecanoyl-CoA and [8-14C] octanoyl-CoA were tested as substrates for shortening the chain by two carbon atoms using both the 105,000 x g soluble fraction and the sonicated mitochondrial fraction of rat liver homogenate as the enzyme source. Both substrates were metabolized by the cytoplasmic enzymes giving rise to the accumulation of intermediates of the beta-oxidation process without formation of two carbon units from the methyl carbon of the acyl residue. A new method is described which allows quantitative estimation of volatile fatty acids formed by beta-oxidation of dodecanoyl- and octanoyl- Coenzyme A.


trans-6-Hexadecenoic acid in the spadefish Chaetodipterus faber. Fatty acid methyl esters were prepared from spadefish (Chaetodipterus faber) liver oil and were analyzed by open tublar gas chromatography. The unusual fatty acid trans-6-hexadecenoic acid was identified as a major monoenoic component by reductive ozonolysis and by mass spectrometry of the di-trimethylsilyl ether. Very minor amounts of 7-methyl-7-hexadecenoic acid were found.


Relationship between desaturation and chain elongation of palmityl-CoA in rat liver microsomes. The relationship between desaturation and chain elongation of palmityl-CoA was studied in rat liver microsomes. Enzyme activities for desaturation and chain elongation were stimulated by re-feeding starved rats. The activities of desaturation and chain elongation in re-fed rats were four- and twofold greater than those in normal rats, respectively. When a sonicated dispersion of lecithin was added to the incubation medium containing both reactions, chain elongation activity, especially formation of stearic acid, was stimulated and desaturation activity was apparently depressed.


Biosynthesis of molecular species of CDP-diglyceride from endogenously-labeled phosphatidate in rat liver microsomes. The biosynthesis of [14C] CDP-diglyceride was studied using rat liver microsomes which were endogenously labeled with [14C] phosphatidic acid by preincubation of unlabeled microsomes with sn-[14C] glycerol-3-phosphate and appropriate cofactors. The formation of CDP-diglyceride from radioactive phosphatidate showed an absolute requirement for CTP and MgCl2. The newly formed [14C] CDP-diglyceride was characterized by thin layer chromatography (TLC), isotopic labeling from radioactive CTP, and its ability to serve as substrate for the microsomal enzyme, CDP-diglyceride: inositol phosphatidyltransferase. The distributions of radioactive glycerol-3-phosphate among the various chemical classes of microsomal [14C] phosphatidate and [14C] CDP-diglyceride were determined following argentation TLC of their 1,2-diglyceride acetate derivatives. Most of the radioactivity among the phosphatidic acids was present in the monoenoic (36%) and dienoic (33%) molecular species, whereas 10, 8, 4, and 8% were associated with the saturates, trienes, tetraenes, and polyenes, respectively. Similar distributions of radioactivity were found among the corresponding classes of newly formed CDP-diglyceride. Only a slight enrichment of radioactivity in the tetraenoic CDP-diglyceride was found relative to the corresponding phosphatidates. Therefore, under the conditions of study, the microsomal CTP: phosphatidate cytidylyltransferase produces mainly monoenoic and dienoic species of CDP-diglyceride and shows little specificity towards different molecular species of phosphatidic acids. The present results suggest also that the arachidonoyl phosphatidate derived from the microsomal acylation of sn-glycerol-3-phosphate is not likely the major source of arachidonic acid in liver phosphatidylinositol.


Effects of dietary saturated and trans fatty acids on tissue lipid composition and serum LCAT activity in the rat. Groups of rats were fed from weaning with diets containing 5% by wt of hydrogenated coconut oil (HCO), safflower oil, or a concentrate of ethyl elaidate and linolelaidate (TRANS) as the sole source of dietary fat. Fatty acid composition of the lipid classes from serum, liver, heart, and kidney was determined, and the serum lecithin: cholesterol acyl transferase (LCAT) activities were assayed for each animal. Serum LCAT activity was increased by both the HCO and TRANS diets in the early stages of the development of an essential fatty acid (EFA) deficiency but was suppressed in the animals of the TRANS group as they became older. The HCO and TRANS groups exhibited changes in tissue lipid fatty acid composition, as well as reduced growth, characteristic of an EFA deficiency. Coversion of oleic acid to eicosatrienoic acid was impaired in the animals fed the TRANS diet, greatly increasing the octadecenoic acid content of the tissue lipids at the expense of eicosatrienoic acid. The TRANS diet also suppressed incorporation of eicosatrienoic acid into cholesteryl esters of tissue and serum, indicating that, when fed as the sole source of unsaturated fat, trans fatty acids influenced the metabolism of unsaturated fatty acids and cholesterol.


Myocardial lipids and nucleotides of rats fed olive oil or rapeseed oil. After 1 week, the level of myocardial fatty acids was 4 times greater in young rats fed high erucic rapeseed oil than in those fed oliver oil. The proportion of erucic acid was 5.6% in the mitochondrial fraction, 15.1% in the microsomal fraction, and 34.8% in the floating fat fraction. This incorporation of erucic acid into triglycerides of the floating fat was evidence of esterification. The changes in the mitochondrial lipids did not alter the content of adenine nucleotides of the myocardium nor its apparent capacity to oxidize substrates.


Changes in muscle lipid composition and resistance adaptation to temperature in the freshwater crayfish, Austropotamobius pallipes. The phospholipid and fatty acid composition of muscle lipid extracts from crayfish acclimated to 4 C and 25 C (18 hr-light photoperiod) were analyzed. The phospholipid content and class distribution, and cholesterol content were unaffected by the acclimation treatment. Unsaturation of muscle phosphoglycerides was higher in cold acclimated crayfish. Serine/inositol phosphoglycerides from cold-acclimated animals showed somewhat higher proportions of mono- and polyunsaturated fatty acids, whereas choline and ethanolamine phosphoglycerides were less affected. This was correlated with a decreased resistance of cold-acclimated crayfish to lethal high temperature. Acclimation at 4 C under an 8 hr-light photoperiod caused an increased fatty acid unsaturation of the total phospholipid fraction compared to the 4 C, 18 hr-light photoperiod acclimated animals. The resistance of 4 C acclimated crayfish to lethal high temperature, however, was unaffected by daylength treatment. The resistance of freshwater crayfish to lethal high temperature is not simply related to the degree of saturation of the muscle phospholipids. It is suggested that a breakdown in the integrity of a bulk-lipid bilayer is not involved in the process of heat death; rather, that a membrane-bound protein factor, whose thermal sensitivity is modified by changes in its phospholipid environment during temperature adaptation but not during photoperiod adaptation, is the primary site of heat injury.


Effect of vitamin E deficiency on the lipid class and fatty acid composition of rat brain gray and white matter. Three-week old male Sprague-Dawley rats were placed on a control or vitamin E-deficient diet for 9 months. The total lipid and cholesterol contents of brain gray and white matter areas in the vitamin E-deficient group did not differ from controls. The concentration of cerebrosides was lower in white matter but higher in gray matter of deficient animals. However, sulfatide was significantly (P less than 0.001) higher in white and gray matter of deficient animals compared with controls. Lysolecithin was not found in vitamin E-deficient gray matter but was present in control gray matter lipids. No marked differences were found in the concentrations or relative amounts of sphingomyelin, phosphatidyl choline, phosphatidyl ethanolamine, phosphatidyl serine, or phosphatidyl inositol in the phospholipids of gray or white matter of vitamin E-deficient rats as compared to controls. In addition, no remarkable differences were found in the fatty acid composition of total lipid extracts of gray or white matter from vitamin E-deficient rats when compared with controls.


Changes in phospholipids and acyl group composition of rat mammary gland during pregnant, lactating, and post-weaning periods. The distribution of phospholipids as well as their fatty acid compositions of rat mammary tissues were examined during pregnant, lactating, and post-weaning periods. There was no apparent change in phospholipids and their acyl groups during the early and late pregnant periods. However, tissue phospholipid composition was different during pregnant, early, and late lactating periods. After parturition, there was a marked increase in the proportion of diacyl-glycerophosphorylcholine in the phospholipids of mammary tissue, but this proportion decreased gradually during lactation. The decrease in diacyl-glycerophosphorylcholine during lactation was marked by a corresponding increase in diacyl-glycerophosphorylethanolamie. Although the shorter chain fatty acids of triglycerides were increased during lactation, only a small proportion of these fatty acids was found in the phosphoglycerides. Marked changes in acyl group composition of individual phospholipids are found during these different physiological stages. In general, there was a rapid decrease in 20:4 and an increase in 18:2 in the major phosphoglycerides during parturition. The proportion of 20:4 in the phosphoglycerides remained low throughout the entire lactating period, while that of 18:2 continued to increase 2-3 fold. Most of the changes in acyl group of the phosphoglycerides during lactation returned to normal ca. 10 days after weaning. A possible relationship of the variation of phospholipid and acyl group compositions in mammary tissue to changes in hormonal pattern during different physiological stages is discussed.


Lipid metabolism of the yellow clam, Mesodesma mactroides: I. Composition of the lipids. The lipid composition of the yellow clam, Mesodesma mactroides, that lives in the northern beaches of the Buenos Aires province of Argentina was studied. The main nonpolar lipids are triglycerides and alkoxyglycerides. Phosphatidyl choline, phosphatidyl ethanolamine, and phosphatidyl serine are the main phospholipids. The predominant fatty acids are 16:0, 16:1omega7, 18:0, 18:1omega9, 20:5omega3, and 22:6omega3. They are mainly provided by the clam's food and stored in the hepatopancreas. The content of polyunsaturated acids increases in summer together with an increase in nonpolar lipids and is correlative with an increase in phytoplankton in the sea water. Sexual maturity modifies the lipid composition of gametes.


Nutritional effects of the cyclic monomers of methyl linolenate in the rat. Low levels (0.0075, 0.0225, and 0.15%) of cyclic fatty acid methyl esters (greater than 98% pure) were incorporated into diets of weanling rats fed different levels of protein. Animals on low protein diets (8-10% casein) exhibited decreased wt gains and feed consumption with increasing levels of cyclic esters in their diets after 6 weeks. Liver enlargements due to a significant (P less than 0.01) accumulation of liver lipid were noted in animals receiving 0.15% cyclic fatty acid esters in their diets.


Effects of oleic acid infusion on plasma free fatty acids and blood ketone bodies in the fasting rat. Oleic acid emulsions stabilized with albumin were infused into fasted rats. Blood samples taken before and during infusion were analyzed for free fatty acids (FFA), ketone bodies, glucose, and insulin. Turnover rates of FFA and ketone bodies were also determined using constant infusion of radioactive tracers. During oleic acid infusions at a rate of 2 mumoles/min/100 g body weight, FFA concentrations increased for a short time and then decreased to preinfusion levels. The decreases in concentrations were due to decreases in the endogenous rates of appearance of FFA into the blood. When oleic acid was infused at a rate of 3.5 mumoles/min/100 g body weight, FFA concentrations increased and remained elevated throughout the infusion. Ketone body concentrations more than doubled during infusions at 2 and 3.5 mumoles/min/100 g body weight and showed no signs of decreasing even when FFA concentrations decreased. Insulin concentrations doubled during infusion and glucose concentrations decreased. Insulin injected during infusion had little effect on concentrations of FFA or ketone bodies. It was concluded that infusions of oleic acid inhibit adipose tissue lipolysis and increase blood ketone concentrations in intact fasted rats. The injection of insulin does not inhibit ketogenesis when blood FFA levels are maintained by infusion.


Metabolism of amino- and carboxyl-sequence immunoreactive parathyroid hormone in the bovine: evidence for peripheral cleavage of hormone. Radioimmunoassays that detect specifically peptide sequences within either the biologically active amino region (N-assay) or inactive carboxyl region (C-assay) of parathyroid hormone (PTH) were used to evaluate the metabolism of PTH during and after infusion and injection of homogeneous (containing less than 0.1% hormonal fragments) intact bovine PTH (bPTH) into calves. During continuous infusions of hormone, when constant blood levels of immunoreactive PTH were reached, a dissociation between the concentrations of amino versus carboxyl immunoreactivity was observed; concentrations of hormone measured by the C-assay rose to a level of approximately three times higher than that measured by the N-assay. Analysis by gel filtration of immunoreactive PTH in plasma samples from calves after injection of hormone showed the rapid disappearance of intact hormone (N- and C-assays) and the appearance of a large fragment detected by the C-assay but not by the N-assay. The hormonal fragment lacked antigenic determinants within the amino peptide sequence required for biologic activity. No additional fragments of PTH were detected by gel filtration using the N- and C-assays. No detectable conversion of intact PTH to hormonal fragments occurred during incubation in vitro in bovine serum. The results are consistent with the concept that PTH is metabolized after entry into the circulation at peripheral sites located outside the vascular space, resulting in the rapid disappearance from blood of intact hormone and the appearance of a biologically inactive hormonal fragment(s). These studies done in calves agree with earlier studies done in dogs and man and point to the existence in mammals of common pathways for the peripheral metabolism of PTH.


Effect of alcohol administration on plasma growth hormone response to insulin-induced hypoglycemia. Plasma growth hormone (HGH) response to insulin-induced hypoglycemia was assessed in a group of normal adult volunteers, with and without prior consumption of ethanol. A significant difference was found in peak HGH concentrations on the two occasions, indicating that prior consumption of ethanol attenuates the normal HGH response to insulin-induced hypoglycemia. It is suggested that ethanol may deplete catecholamine stores in the neurons of the ventromedial nucleus of the hypothalamus and may thereby impair secretion of growth hormone releasing factor. Under certain circumstances this could be of importance in the pathogenesis of alcohol-induced hypoglycemia.