Carbohydrate metabolism in fetal and neonatal rat brain during anoxia and recovery. Systemic and cerebral metabolic responses to acute anoxia were studied in term-fetal and neonatal rats in order to account for the greater anoxic tolerance of fetuses. Measurements of blood acid-base balance were correlated with changes in the concentrations of adenine nucleotides, creatine, phosphocreatine, and glycogen in brain, and of glucose, pyruvate, and lactate in brain, blood, and cerebrospinal fluid during 1) exposure (20-40 min) to 100% nitrogen at 37 degrees C, and 2) subsequent recovery in air. Blood PCO2 was higher initially in fetuses and increased more rapidly during anoxia in fetuses than in neonates, exceeding 150 mmHg after 20 min. Brain glycogen, phosphocreatine, and total adenine nucleotides declined more slowly in fetuses than in neonates during anoxia, whereas brain glucose levels declined at similar rates in the two groups. From the changes in these preformed and potential energy stores, it was estimated that total cerebral energy consumption during anoxia was significantly lower in fetuses. The data suggest that the more severe hypercapnia superimposed on anoxia in fetuses decreased cerebral metabolic demands, and thus prolonged survival. An incidental finding was that L-lactate readily enters the immature brain from the blood during anoxia, and in the early recovery phase may constitute the preferred substrate for cerebral oxidative metabolism, sparing glucose.


Use of pyrazinamide to assess renal uric acid transport in the rat: a micropuncture study. Free-flow micropuncture studies were performed to evaluate renal uric acid transport in control and pyrazinamide-treated rats. In all studies [2-14C]uric acid and [methoxy-3H]inulin were administered. [2-14C]uric acid was determined after column chromatographic separation from its labeled oxidation product in tubular fluid, plasma, and urine. Tubular fluid collections were obtained from the early and late proximal tubule under hydropenic conditions and from the early proximal tubule during volume expansion induced with 0.9% sodium chloride. These studies indicate that pyrazinamide, in the dose employed, provokes a uniform reduction in fractional uric acid excretion but simultaneously inhibits both net uric acid reabsorption and secretion in the early and late proximal tubule, respectively. In addition, these experiments unmasked uric acid reabsorption within the late proximal tubule and bidirectional transport beyond this nephron site. These studies also suggest at least two mechanisms for uric acid reabsorption; one sodium dependent, the other independent of sodium and water transport.


Changes in body temperature produced by prostaglandins and pyrogens in the chicken. Bacterial pyrogen from S. abortus equi (SAE) was injected into the wing veins of chickens. Following injection of 0.05-0.5 mug SAE, body temperatures did not change significantly, whereas 2.0 or 10 mug of pyrogen caused falls in body temperature of 0.56 +/- 0.10degrees C and 1.1 +/- 0.21degrees C (mean +/- SE, n=5). The temperature falls were accompanied by a flushing of the comb and an increase in respiratory rate and were not antagonized by 1.0 g of acetylsalicylic acid (ASA) given orally. The injection of SAE (0.1 mug in 1 mul) into the anterior hypothalamus produced fevers averaging 1.24 +/- 0.07 degrees C (n=9) which were antagonized by oral ASA. Injections of SAE at other brainstem loci produced no temperatur changes. Seven chickens were also injected with 0.1 mug PGE in 1.0 mul into the anterior hypothalamus, and they developed fevers averaging 0.90 +/- 0.16 degrees C. The results support the concept that prostaglandins may be involved in fever in chickens but suggest that the action of pyrogen injected intravenously may be different from that following its injection directly into the hypothalamus.


Neurophysiological studies on central chemosensor in medullary ventrolateral areas. Nonphasic unit potentials were recorded with glass microelectrodes from the ventrolateral medullary areas in spontaneously breathing cats. The firing rate changes were studied during metabolic acidosis and alkalosis induced by intravenous injections of 4 ml 0.1 N HCl and molar NaHCO3, respectively, and during CO2 rebreathing. Three groups of units were distinguished among 44 neurons: 1) 9 U were markedly sensitive to variations in acid-base parameters; each reacted in the opposite manner upon acidosis and alkalosis, and these reactions were reproducible. 2) Twelve units were responsive to touch of a contralateral limb with a prompt and massive rise in firing rate. 3) The remaining 23 U were classified as nonsensitive to any of the stimuli applied. All these 44 U were found to be intermingled. It is possible that the chemosensitive cells found may be part of the central chemosensor.


Michaelis-Menten kinetics of galactose elimination by the isolated perfused pig liver. The relation between galactose elimination rates and blood concentrations in the isolated perfused pig liver was analyzed by a mathematical kinetic model. It assumes that the substrate, under steady-state conditions, is removed from the blood that flows through the sinusoids by an irreversible process which follows Michaelis-Menten (i.e., saturation) kinetics. The experiments consisted of successive periods with constant infusions of galactose. The model fitted the data to within the experimental uncertainty. The estimated maximal rate (Vmax) ranged from 0.34 to 0.57 mmol-min(-1)-kg(-1) liver, and the Michaelis constant, Km, ranged from 0.12 to 0.30 mmol-liter(-1) plasma water in nine experiments. The ratio between the galactose concentration in hepatocyte water and plasma water was not significantly different from 1.0, indicating that membrane transport is not rate limiting for the elimination of galactose. In experiments with increasing concentrations of galactose in hepatocyte water and approximately saturated elimination rates, the concentrations of galactose 1-phosphate, UDPgalactose, and UDPglucose remained essentially constant. This indicates that the phosphorylation of galactose to galactose 1-phosphate is the rate-determining process.


Lateralized phrenic nerve responses to stimulating respiratory afferents in the cat. We stimulated electrically pharyngeal branch of both glossopharyngeal nerves (PGLN), internal branch of superior laryngeal nerves (ISLN), and carotid sinus nerves (CSN) in anesthetized cats. We recorded simultaneously, averaged, and compared bilaterally evoked phrenic nerve (PHR) activity. Our objective was to demonstrate a short-latency evoked response in the PHR contralateral to the stimulus. Low-intensity stimulation of PGLN and ISLN during inspiration evoked a short-latency contralateral excitation with a latency of 5.2 ms +/- 0.2 SE (16 cats) for PGLN, and 3.8 ms +/- 0.1 SE (13 cats) for ISLN. This excitation could follow stimuli delivered at 100 Hz. Stimulation during expiration did not result in a lateralized excitation. The excitation is followed by bilateral inhibition. Neither strychnine nor picrotoxin prevented either the lateralized response or the inhibition, though strychnine diminished a delayed bilateral excitation following PGLN stimulation. This dalayed (latency 18.7 ms +/- 0.7 SE) bilateral excitation corresponds to the sniff reflex. CSN stimulation did not result in lateralized excitation. We suggest that the lateralized evoked response results from a gated paucisynaptic reflex pathway involving the PGLN and ISLN, ipsilateral inspiratory neurons, and contralateral PHR motoneurons.


Equilibration of 15N-labeled amino compounds in man. Following an overnight fast, either 15N-labeled glycine, or ammonium chloride, or L-aspartate was orally administered to human volunteers in equal hourly aliquots for 8-12 h. In a parallel series of experiments, [15N]glycine and [15N]ammonium chloride were given intravenously at a constant rate for 10-12 h. The amount of 15N given ranged between 2.7 and 27.3 mg/h. Five hundred milligrams of sodium benzoate were given hourly. Venous blood and urine samples were collected serially. The 15N enrichment of the plasma amino nitrogen, urinary ammonia, hippuric acid, and urea were determined. Irrespective of the 15N carrier used or the route of administration, the plasma amino nitrogen, urinary ammonia, and hippuric acid 15N enrichments approached a plateau within 6-10 h. We concluded that human [15N]glycine metabolism was not atypical of amino acids and that mixing, rather than nitrogen interchange reactions, determines the rate in attaining an approximate plateau.


Circadian distribution of bile acids in the enterohepatic circulatory system in rats. The bile acid pool was first determined in six adult male rats to be 12.8 +/- 0.7 mg/100 g by comparing the total radioactivity of tritiated bile acid drained through the bile fistula and the initial bile acid specific activity. The distribution of bile acids in the enterohepatic circulatory system at various times of the day was then studied in 24 additional rats, each received a single dose of tritiated taurocholate intraperitoneally and was sacrificed 24 h later. The nearly complete recovery of the administered radioactivity from the serum, liver intestinal wall and content, and 24-h feces indicated the confinement of bile acids to the enterohepatic circulation. A remarkable circadian fluctuation of the bile acid content was observed in serum, liver, and intestinal contents. The patterns of such rhythmic change varied from each other in various segments of the intestinal tract but seemed to correlate with the time sequence of movement of bowel content and absorption of bile acids. The circadian rhythm of hepatic synthesis of bile acids but not cholesterol observed by others might be, in part, directly related to the circadian fluctuation of the amount of bile acids in the liver.


Endogenous glucagon regulation in genetically hyperlipemic obese rats. Glucagon concentration and regulation were examined in the Zucker rat, in which obesity and hyperlipemia are phenotypic expressions of an autosomal recessive gene. Using littermate animals which are phenotypically thin and normolipemic as controls, we observed reduced basal plasma glucagon levels in the obese lipemic rats. In response to fasting, obese lipemic animals inappropriately demonstrated a further reduction in plasma glucagon concentration. In response to pharmacologic glucagon stimulation (arginine), a subnormal rise in plasma glucagon concentration was observed in the obese, lipemic animals. Glucagon suppressibility with exogenous glucose remained intact. The reduced secretion of glucagon may be a consequence of the abnormal elevation in concentration of plasma insulin, free fatty acids, and glucose, which are characteristic of the obese, lipemic animal. A possible role of glucagon deficiency in the evolution or maintenance of the lipemic state is suggested.


Genetic predisposition to stroke in spontaneously hypertensive rats. Hypertension and stroke in spontaneously hypertensive rats (SHR) were investigated genetically using stroke-prone SHR (A3), stroke-resistant SHR (C) and their hybrids, hybrid of A3 and C (F1), offspring of F1 X F1 (F2), and those of backcrossing of F1 to the respective parental strains, BC(F1 X A3) and BC(F1 X C). The average blood pressure measured without anesthesia increased in the following order during the experimental period: C less than BC (F1 X C) less than F1 approximately F2 less than BC(F1 X A3) less than A3. The F2 represented a wider spread of variation than the F1, with some of the pressure extending into the range of both parental strains. When the drinking water was replaced with a 1% salt solution, the blood pressure increased and the onset of stroke markedly accelerated in all groups of SHR. Under the hypertensive conditions, the incidence of stroke was associated with A3-gene concentration rather than with the level of blood pressure. Similar but less dramatic effects of salt were observed in another series of hybrid groups derived from A3 and normal Wistar-Kyoto rats. These findings suggest that the genetic factors are of great importance in the development of stroke as well as hypertension in the SHR.


Effects of insulin on cardiac muscle contraction and responsiveness to norepinephrine. The effects of insulin (In) on contractile activity of isolated cardiac muscle were studied in right ventricular moderator band (MB) of piglets and papillary muscle (PM) of cats and kittens. The muscles were bathed in modified Krebs solution containing 5.6 mM glucose at 30 degrees C and gassed with 95% O2 and 5% CO2. They were paced at 24 contractions per minute isometrically at Lmax. Addition of In (1 U/ml) to the bath induced a biphasic inotropic response to piglet MB. The initial negative effect was due to the preservative (0.2% phenol) in the regular commercial In solution. Following the transitory depression, both active isometric tension (AT) and maximal rate of tension development increased to a maximum (about 120% of control) within 15 min and then declined slightly toward control. Similar positive responses were observed in both cat and kitten PM, but without the initial negative effect. Maximal responses were not diminished by the absence of glucose in the bath. Increases in AT and dT/dt of both MB and PM in response to NE were significantly attenuated in the presence of In compared with untreated muscle. These findings demonstrate that In elicits a positive inotropic effect on mammalian cardiac muscle and that it impairs the inotropic action of NE.


Eelctrophysiologic and ultrastructural characteristics of the canine tricuspid valve. Collagen extending from chordae tendineae sweeps into each tricuspid leaflet in a loose fanlike arrangement merging with the annulus. Each leaflet contains variable amounts of cardiac muscle in continuity with right atrial muscle; valve fibers are sparse, and scattered myofibers and/or bundles of myofibers usually extend only 2-3 mm into the leaflet body. Valve myofibers are structurally identical to working right atrial muscle but are 2-3 mum in diameter compared to 5-7 mum in working muscle. Electrical stimulation of the low right atrial wall often induces propagated activity in the leaflet. Transmembrane recordings obtained from isolated Tyrode superfused leaflets showed low maximum diastolic potential, action potential amplitude, and rate of depolarization; action potentials usually had prominent plateaus. Excitation of discrete regions in tricuspid leaflets did not excite atrial wall, but valve muscle fibers often developed spontaneous diastolic depolarization and automaticity after stretch or exposure to catecholamines Automaticity was suppressed by acetylcholine. Physiological and pathophysiological significance of tricuspid muscle may reside in its participation in valve closure during ventricular contraction and the fact that it is a site of abnormal impulse formation.


Cardiovascular responses to electrocardiogram-coupled stimulation of rabbit aortic nerve. Electrical stimulation of the rabbit's aortic nerve during one or more cardiac cycles resulted in a reflex fall in heart rate and mean arterial blood pressure (MAP). The onset of bradycardia and of fall in MAP were independent of the number of beats stimulated. The initial slope of the heart rate and MAP responses increased as the number of beats stimulated increased, reaching a maximum at five beats of stimulation. Bradycardia peaked 8 and 10 beats after the end of one and two cycles of stimulation, respectively, while the peak response occurred at, or prior to, the end of stimulation when 12 or more beats were involved. Onset and recovery of both responses were consistent, and seldom did MAP indicate a return toward control during stimulation. Thus, central nervous system modulation of sympathetic activity to the peripheral vasculature was sustained as long as the aortic nerve input was maintained. However, reflex control of heart rate was more complex, involving simultaneous alteration in both vagal and sympathetic efferent activity.


De novo synthesis of alanine by the perfused rat hindlimb. Due to the disproportionately large production of alanine by muscle, it has been suggested that part of the alanine released by muscle is synthesized de novo by the transamination of glucose-derived pyruvate. This glucose-alanine conversion was quantitated in the isolated rat hindlimb perfused with a solution of bicarbonate buffer containing 2% albumin, 2.4% dextran, 2.5-15.9 mM glucose, 32-34% dog erythrocytes, and 0.05 muCi/ml [14C]glucose. Measurement of labeled alanine production allowed quantitation of de novo alanine synthesis. De novo derived alanine accounted for an average of 33% of the total alanine released by the perfused tissue (perfusate glucose concentration 8.3 mM), concurrently 2.7% of the glucose taken up by the limb was converted to alanine. By increasing the glucose concentration perfusing the muscle, both the rate of glucose uptake and de novo alanine release were increased. Addition of insulin to the perfusate (700 muU/ml) resulted in a significant increase in the rate of glucose uptake and de novo alanine production, but the rate of total alanine release was significantly decreased by the hormone. It was concluded that de novo alanine production accounts for a sizeable portion of the total alanine released by muscle, nevertheless a comparatively small fraction of the glucose carbons are actually transformed to alanine.


Ability of exogenous alanine to lower blood beta-hydroxybutyrate during development in rats. The intraperitoneal injection of L-alanine into 10- and 21-day-old fed Wistar rats resulted in blood alanine levels of 3-5 mM and in a rapid, significant decrease in the concentration of beta-hydroxybutyrate (betaOHB) in blood. The drop in betaOHB was unrelated to changes in the concentrations of pyruvate, lactate, or glucose. The intraperitoneal injection of glutamate at the same age had no effect on betaOHB values. In 2-day-old pups and in older weaned animals, the injection of alanine had either no effect or increased the levels of betaOHB in blood. The most rapid disappearance of exogenous alanine occurred in 35-day-old and not in 10- and 21-day-old rats. These data suggest that alanine has a depressant effect on the level of circulating betaOHB at a specific stage in the animal's maturation.


Sympathetic innervation of guinea pig uterus and ovary. The relative contribution of the ovarian nerves and hypogastric plexus in the innervation of the guinea pig uterus and ovary was assessed. Chronic section of the hypogastric nerve did not reduce norepinephrine (NE) concentration in either organ. Localization of the hypogastric plexus in female guinea pigs was unsuccessful. Crushing the ovarian nerves 1) lowered the NE concentration in the ovary (70%) and in all portions of the uterus (86%), 2) decreased by 80-90% the uterine retention of [3H]NE, and 3) decreased the intensity of fluorescent adrenergic fibers in the uterus. However, the denervated uterus failed to exhibit supersensitivity to NE. In conclusion, sympathetic innervation of the guinea pig uterus and ovary is predominantly via the ovarian nerves, and a minor pathway of innervation may come from hypogastric plexus.


Influence of the oral cavity on insulin release in the rat. Blood glucose and insulin levels were measured in undisturbed and free-moving rats. The insulin level rose in the 1st min after the start of food intake; the glucose level began to increase only in the 3rd min if a fluid carbohydrate-rich food was eaten. The insulin release followed a biphasic pattern. If the same quantity of food ingested orally was injected into the stomach in the same time as the animals needed to complete oral ingestion, delayed insulin release could be seen and the second phase of insulin release was exaggerated. The glucose level, which started to rise in the 3rd min, increased much more than during oral ingestion. With respect to insulin release the same phenomena could be observed if carbohydrate-free fluid food was used instead of carbohydrate-rich fluid food. It is argued that the oral cavity plays a major role in the first phase of insulin release, which in its turn seems to be important in the homeostasis of the blood glucose and insulin levels.


Cerebrospinal fluid [Ca2+] and rectal temperature response during exercise in dogs. Rectal temperature (Tre) was measured in five dogs during 1 h of rest and 1 h of moderate treadmill exercise (1.2 m/s up a 12 degree slope), with no infusion and with continuous infusion (40 mul/min) of normocalcic (1.3 mM Ca2+, 151.5 mM Na+) and hypercalcic (2.6 mM Ca2+, 149.6 mM Na+) concentrations of artificial cerebrospinal fluids into the left lateral cerebral ventricle. There was no effect of the normo- or hypercalcic infusions on resting Tre. In comparison with the postexercise Tre level of 39.9 degrees C (deltaTre= +1.4 degrees C) with no infusion, Tre rose to 40.0 degrees C (delta Tre = +1.4 degrees C) with normocalcic infusion (NS); there was a significantly smaller (P less than 0.01) rise in Tre to 39.2 degrees C (delta Tre = +0.8 degrees C) with hypercalcic infusion. The smaller rise in Tre in response to excess Ca2+ in cerebrospinal fluid was not due to plasma fluid or electrolyte shifts. During exercise the mean body weight loss was greater with hypercalcic infusion (-2.7%) compared with normocalcic (-1.0%) and no infusion (-1.4%) values. The results suggest that Ca2+ ions affect the sensitivity of the central thermoreceptor to thermal stimuli and cause an increased heat loss during physical exercise in dogs.


Micropuncture evidence of rapid hydrolysis of bradykinin by rat proximal tubule. 3H-labeled bradykinin ([3H]BKN) and 14C-labeled inulin ([14C]In) were simultaneously microinfused into proximal or distal tubules in Inactin-anesthetized rats, and urinary excretion and tubular transit times were measured. In other experiments higher doses of [3H]BKN were microinfused and intact peptide and its metabolites identified and quantified by two-dimensional peptide mapping. The site of infusion was identified by neoprene injection and microdissection. Urinary recovery of 3H label was 24.1% when proximal tubules were infused and 98.0% when distal tubules were infused. For proximal tubules, 85% of 3H activity recovered from urine consisted of metabolites (81%[3H]Pro and 4% [3H]Arg1-Phe5) and 15% was intact BKN. Urinary recoveries of [3H]BKN and metabolites were unrelated to tubular length. With distal tubules all 3H activity appeared as intact BKN. Excretion curves of simultaneously infused [3H]BKN and [14C]In showed no marked differences in configuration for either proximal or distal or distal tubules. We suggested that removal of [3H]BKN by proximal tubular cells occurs by rapid enzymatic cleavage at the luminal surface with reabsorption of most of the products and excretion of the remainder.


Oxygen toxicity: augmentation of antioxidant defense mechanisms in rat lung. In studies directed at determining the activities of selected enzymes in lung tissue after in vivo exposure to hyperoxia, 70-day-old rats were exposed to 85% or 90% O2 for 1-14 days. After 7 days of exposure to 90% O2 (1atm), superoxide dismutase activities in mitochondrial and cytosolic fractions increased, respectively, to 245 and 145% of control; glutathione peroxidase, glutathione reductase, and glucose-6-phosphate dehydrogenase activities increased, respectively, to 317, 175, and 413% of control. The levels of reduced glutathione and total nonprotein sulfhydryl compounds were elevated to 195% and 365% of control. Similar changes were observed in rats exposed to 85% O2 for up to 14 days, but to a lesser degree. The changes are interpreted as a reflection of the overall magnitude of oxidant-induced lung injury-reparative processes. The results suggest that hyperoxia induces an increase in lung "antioxidant" defense capabilities. This apparent adaptive response may be important in decreasing the susceptibility of lung tissue to continued O2 toxicity.


Participation of beta receptors in reflex vasodilatation in the dog. The effects of propranolol, given by direct intraarterial injection, on the reflex vasodilatation induced in the atropinized isolated gracilis muscle by rapid intravenous administration of norepinephrine, were studied in dogs. In these studies, both atropine and atropine plus propranolol did not significantly alter the maximum fall in vascular resistance in the perfused gracilis muscle following intravenous norepinephrine; however, if the reflex responses were evaluated as integrated areas of vasodilatation, atropine attenuated the vasodilatation and the administration of propranolol further attenuated the reflex. In fact, the value of the integrated areas of vasodilatation was 52.8 +/- 9 mmHg/min in the basal state, 39 +/- 6 mmHg/min after administration of atropine, and 24 +/- 7 mmHg/min after propranolol, whereas the integrated areas of the systemic hypertension did not show any modification. These results prompt us to conclude that the adrenergic beta receptors participate in the reflex vasodilatation, although the mechanism of their action needs further elucidation.


Influence of blood rheology on intrarenal blood flow distribution. This study examined the effects of hematocrit and colloid-induced changes in blood rheology on renal blood flow (RBF) distribution. Blood viscosity, measured by coneplate viscometry, was raised 65% in anesthetized dogs either by increasing hematocrit or giving isoncotic dextran 500. Blood volume was kept constant and arterial pressure was unchanged. An increase in hematocrit caused either no change in RBF or a slight increase at each cortical level (zones 1-4). However, dextran hyperviscosity caused decreases in all four zones, the most pronounced in zone 1 (8.03-5.19 ml min(-1) g(-1)) and the least in zone 4 (1.63-1.46 ml min(-1) g(-1)). These data suggest either that increased hematocrit has less effect on "apparent viscosity" of blood within the kidney than does plasma colloid or that increased hematocrit causes renal vasodilatation while colloid hyperviscosity does not cause it. Since GFR remained constant in both types of hyperviscosity, it is possible that GFR is the autoregulated variable and the observed changes in RBF distribution and vascular resistance resulted from the changes in afferent and efferent arteriolar resistance required to preserve GFR.


Effect of protein intake on weight gain and plasma amino acid levels in uremic rats. Chronically uremic rats weighing approximately 180-200 g and sham-operated controls of similar weight were pair fed diets containing 5, 15 or 23% protein for 10-12 wk. At each level of protein intake, uremic animals gained less weight and had lower protein efficiency ratios than controls. In addition, certain plasma amino acid levels were altered in the uremic animals. These included tyrosine and the tyrosine/phenylalanine ratio, which were decreased, and citrulline, glycine, and the methylhistidines, which were increased. In both uremic and control rats, plasma concentrations of certain amino acids, primarily nonessential ones, varied inversely with protein intake; with the 5% protein diet, the ratio of essential to nonessential amino acids was significantly reduced. These observations indicate that both uremia and reduced protein intake may affect growth and amino acid metabolism in rats with chronic renal failure. The finding that uremic rats utilize protein less efficiently may indicate that marked reductions in protein intake may be particularly hazardous to the nutritional status of the uremic patient.


The "intoxication state of consciousness": a model for alcohol and drug abuse. The author describes a model of intoxicant use based on altered states of consciousness and reviews his own and others' research on marijuana to illustrate the utility of this model, which is derived from both introspective reports and observed data. The relationship of social behavior and cognitive functioning to the "intoxication state of consciousness" is discussed. This state of consciousness may have an adaptive value in engendering and stabilizing social cohesion. Possible treatment implications include cognitive labeling of cues that precipitate episodes of abuse, training for moderated drug use while patients are intoxicated, and providing abusers with altered consciousness through other means, such as meditation.


The future of alcohology: craft or science? The authors discuss the problems that have resulted from the influx of professionals into the field of alcoholism, which has historically been dominated by paraprofessional workers. The interaction of the professional alcohologist, who operates from a scientific model, with the paraprofessional worker, whose model of treatment has followed craft lines, has created unique problems and tensions. A synergism has been created which has been detrimental rather than complementary. The authors suggest that the future of the alcoholism field will have to be established along craft (paraprofessional) or scientific (professional) lines because the two models cannot profitably co-exist.


Can psychiatry police itself effectively? The experience of one district branch. The growing demand by consumers and government for greater accountability from psychiatry is challenging the traditional system of self-policing by which the profession's standards of ethical conduct are established and maintained. The authors describe the operations of a district branch ethics committee, including types of complaints recieved, investigatory procedures, disposition of cases, and factors limiting the committee's effectiveness. They conclude that in some cases lack of funds, lack of time, and the use of peers to judge alleged misconduct make unbiased and thorough evaluation of complaints difficult. They suggest that psychiatry must take steps to improve public confidence in its ability to police itself so that the power to regulate professional conduct will remain within the profession.


Cultural perspectives on the impact of women's changing roles on psychiatry. The author examines sex role stereotypes in the United States and their impact on the self-concept of women. She suggests that the fact that women's roles are changing may have a positive impact on general mental health because both men and women will profit from increased flexibility ingender role specifications. She emphasizes the fact that therapists as well as their patients have been socialized into accepting the values and assumptions of our society; there is thus a high probability that not only the presenting complaints but also the treatment goals for women in therapy are culturally determined.


A general systems approach to severe family pathology. The author proposes a general systems approach to the examination and understanding of family functioning. Scrutinizing the family as an open system with 1) evolutionary goals and tangible tasks, 2) a need for "semipermeable" boundaries, 3) cultural and subcultural communication modes, 4) leadership effectiveness, and 5) the nature and age-appropriateness of the affective bonds will enable clinical judgements about family functioning that indicate general system competencies and defects. Such a framework may also lead to a typology of family process because the major functions of the family as a system (creation, nurturance, enculturation, and guidance of the young into adulthood) can be evaluated regardless of symptoms or diagnoses.


The fatal myth of death in the family.

The fatal myth of death in the family. The author hypothesizes that the observed pathogenic effects on a child of the death of a parent are the result of the family's culture-bound inability to integrate death as a natural part of the process of living. The family tries to deal with death by the avoidance mechanisms of myth and family mystification; it is this process which is pathogenic rather than the experience with death itself. To illustrate his thesis he presents the case history of a man who was fatally affected by the family myth and mystification process.


A new concept and finding in morbid jealousy. The authors describe an unexpected coincidental finding in three couples who sought therapy because the husband was pathologically jealous. In the course of treatment they found that during early adolescence each of these men had witnessed his mother engaged in extramarital sexual activity. The authors discuss the implications of this finding for further understanding of the etiology of the syndrome of pathological jealousy, its transactional dimensions, and possible psychotherapeutic approaches. They also present a typology of morbid jealousy that consists of excessive obsessional-delusional, and ego dysfunctional forms.


Treatment for the parents of feminine boys. Because extreme boyhood femininity is often a precursor of adult transsexualism, transvestism, and homosexuality, the author recommends early intervention for boys who meet specific behavioral criteria of gender disturbance. It is necessary to involve the parents in such treatment and to deal with the resistances they may have to recognizing and working on the problem as well as problems within the marital relationship that may affect the child's behavior. These boys are remarkably responsive to treatment given between the ages of 5 and 12, becoming more masculine in behavior and more comfortable with their identity as males.


ECT in the treatment of mania: a controlled study. In a chart review study of manic patients, the author found that ECT remarkably improved outcome variables of condition at discharge, duration of hospitalization, and social recovery in comparison with an untreated matched control group. More conclusive evidence would depend on a prospective trial with random assignment of manic patients to ECT, lithium carbonate, and major tranquilizers and blind evaluation of outcome.


Psychiatric illness in homicide victims. The authors studied the demographic characteristics and history of psychiatric treatment of 214 homicide victims and 67 suicide victims. Thirty-two (15%) of the homicide victims and 12 (18%) of the suicide victims had a record of psychiatric care; these rates were higher than the treatment rate of the general population. The authors suggest that there may be a connection between the occurrence of homicide and the increased frequency of psychiatric disorders among victims of this crime.


Forensic psychiatry: profiles of two types of sex offenders. The authors examined records of 239 individuals charged with sexual offenses and referred by the courts to a forensic service. Defendants charged with rape were typically under 30 with histories of antisocial behavior that included other types of violence. Major mental illness was rare in this group. Child molesters in the sample were of no particular age, usually had no history of violent behavior, and had a low incidence of psychosis. The most common secondary diagnosis in both groups was alcohol or drug abuse.


Peer review of prescribing patterns in a CMHC. Monitoring the prescribing patterns of psychiatrists is a challenging and now necessary professional responsibility. The authors describe a peer review and feedback system in a decentralized CMHC, linked to continuing education in psychopharmacology, that made staff psychiatrists familiar with the state of the art and accountable for practice within its guidelines. Data are presented that confirm shifts from polypharmacy toward more appropriate use of psychotropic medications.


Low urinary dopamine and prediction of phenothiazine-induced Parkinsonism: a preliminary report. Psychiatric patients who excreted larger amounts of urinary free dopamine before treatment were significantly more likely than patients excreting smaller amounts to develop parkinsonian side effects during moderate-dose trifluoperazine therapy. If this finding is replicated, urinary free dopamine determinations could prove valuable in indicating which patients should receive those antipsychotic drugs least likely to produce extrapyramidal side effects.


Sex bias in psychotherapy: a failure to confirm. The authors examined the questions of sex-related countertransference and bias in psychotherapy by asking 65 male and 57 female experienced group therapists for clinical reactions to case materials of a bogus outpatient who was designated either male or female. They found that varying the patient's gender produced only small differences in the therapists' responses, and conclude that sex-related countertransference problems may not be as prevalent as had been previously thought.


Anticipating the impact of Public Law 93-641 on mental health services. Implementation of the new federal law setting up Health Systems Agencies (HSAs) on a regional basis offers many opportunities for participation by psychiatry. On the basis of interviews with mental health service providers, planners, and citizen representatives, the author formulated an inventory of the law's potential impacts, grouped around six general themes. He discusses the positive aspects of each, along with possible problems and hazards.


A framework for prevention: changing health-damaging to health-generating life patterns. A set of propositions is offered to provide a frame of reference for proposed strategies to improve healthful behavior by placing personal choice-making in the context of societal option-setting. The health status of populations at a given point in time is seen as a result of customary personal choice-making. These choices in turn are limited by both the perceived and actual options available to individuals, depending on their personal and their community's resources, from which to make choices. Most people, most of the time will make the easiest choices, i.e., will do the things, develop the patterns or life-styles, which seem to cost them less and/or from which they will gain more of what they value in tangible and/or intangible terms.


Application of social science theories to family planning health education in the People's Republic of China. The transformation of the Chinese society was political and economic by revolution; it was also social and cultural through mass education. Group decisions have been used to induce social change in the Chinese society and applied extensively to the family planning program. The methods which Kurt Lewin developed to change food habits, have been perfected on a grand scale of myriad ways by the Chinese.


Restraint systems for the prevention of injury to children in automobile accidents. Highway accidents are the leading cause of child deaths in the United States from the ages of 1-14 years-6,122 such deaths occurred in 1973. In most instances deaths and permanent injuries occurred with the child as a passenger in an automobile. One approach toward alleviating this problem is the restraint of children in automobiles to reduce the likelihood of injury in a crash.


An evaluation of three techniques improving immunization levels in elementary schools. Three techniques for improving immunization levels among school-age children were tested and then compared for most effective use of school nurses' time. Method A involved reviewing school immunization records, specifically inviting immunization-deficient children to a school-based clinic, with some follow-up to achieve good response. Method B involved sending out permission slips for a school-based clinic to all students without additional investment of nursing time. Method C involved a health education program encouraging parents to have their children immunized on their own. Using an average of 38 hours of school nurse time, Method A succeeded significantly better then Method B in immunizing more immunization-deficient children and raising immunization levels , while giving fewer unnecessary immunizations. Method C did not produce significant improvement of immunization levels.


Skin cancer, melanoma, and sunlight.

Skin cancer, melanoma, and sunlight. Recent theoretical studies suggest that the earth's ozone layer which filters ultraviolet radiation may be depleted by a fleet of supersonic transports or by continued use of chlorofluoromethanes. It is now generally accepted that short wavelength ultraviolet radiation leads to the development of skin cancer. In this report we demonstrate an approach to estimating the increase in skin cancer incidence associated with increases in skin cancer incidence associated with increases in ultraviolet radiation. The purpose is to demonstrate the logic used and the assumptions that must be made when such estiamtes are made or cited. We emphasize that such estimates should be considered crude until the many assumptions can be investigated.


The community hospital as a focus for health planning. A community hospital focus for health planning has been developed by a Department of Community Medicine in a "non-teaching" voluntary hospital. Results of three years of planning experience have included: descriptions of service area populations and utilizer populations; implementation of neighborhood based health centers with transportation and outreach programs; integration of emergency services with other ambulatory care resources; and proposals for geriatric day-care, ambulatory surgery, and patient education. Working relationships have been developed between the hospital Department and local planning bodies, among them the Comprehensive Health Planning agency, the County Health Services Department, consumer groups, voluntary agencies and a University Health Services Center.


Education for adolescent mothers in a hospital setting. This paper describes an innovative service program designed to help adolescent mothers become more effective parents. Mother-infant pairs are recruited in the postpartum unit of Cincinnati (Ohio) General Hospital, and weekly classes are held in a pediatric clinic waiting room until infants are approximately six months of age. Medical consultation and/or treatment and education for parenthood in the areas of health, nutrition, and infant stimulation are the foci of the program. The interest and participation of the mothers, the opinion of professionals, tests of maternal knowledge, and measurements of maternal-infant interaction attest to the value and success of this program.


Association between juvenile onset obesity and severe adult obesity in 73, 532 women. The association between juvenile obesity and severe adult obesity was examined using a questionnaire completed by 73,532 weight conscious women. Relative obesity as an adult was determined by the ratio Weight/Height. The question, "Were you considered a fat child?" determined childhood weight status. Analysis of the data revealed that severely obese women (regardless of age) were 2.4 times more likely than normal weight women to have been fat children. This association was noted for all parity groups. The data also suggests that the risk of a fat child developing severe obesity is substantially greater than that for a non-fat child. Since adult obesity is associated with a number of adult diseases, this study emphasizes the importance of weight control in childhood.


Development of a minor illness inventory for children in day care centers. A Minor Illness Inventory has been developed for use in systematic investigations of the nature and incidence of minor illness of pre-kindergarten aged children in day care centers. Other researchers are invited to use the authors' Inventory to conduct investigations of some of the important problems associated with health and day care of young children.


Vagotomy of the fundic gland area of the stomach without drainage. A definitive treatment for perforated duodenal ulcer. Twelve patients in Sweden and thirteen patients in Houston underwent selective proximal vagotomy or parietal cell vagotomy, respectively, for the treatment of perforated duodenal ulcer. A drainage procedure was performed in four of the former and in none of the latter group of patients. There were no operative complications and no operative deaths. Twenty-two of the patients were followed from six months to four years. No patient has recurrent ulcer, dumping, diarrhea, or other significant gastric symptoms during the follow-up period. At the time of their last follow-up, the results were considered excellent or good in all twenty-two patients. The results of this study suggest that SPV or PCV without drainage may be the method of choice for the definitive treatment of all patients with perforated duodenal ulcer who have no obstruction and no contraindications to an operative procedure of greater magnitude than simple closure.


The urgency of diagnosis and surgical treatment of acute suppurative cholangitis. Twenty patients with suppurative cholangitis were seen at the Massachusetts General Hospital over a nine year period. Fifteen patients had acute obstructive suppurative cholangitis due to complete obstruction of the common duct, many with coma, hypotension, and positive blood cultures. Sixty per cent of patients were older than seventy years, and most had a history of biliary tract disease. Although most had jaundice, abdominal pain, and fever, clinical symptoms were variable. The diagnosis of cholangitis was made in only 30 per cent of patients before autopsy or surgery. Eighteen patients had calculi in the common duct, and two had primary fibrosis of the ampulla. Patients explored less than 24 hours after admission or deterioration died less often than those operated on after some delay. Most patients underwent common duct exploration and four had a concomitant sphincterotomy. In one instance, cholecystostomy only was performed and this patient died because of ongoing sepsis. The overall mortality was 40 per cent; of those subjected to operation, 25 per cent died in the hospital. Recovery was dramatic among most survivors, and calculous disease did not recur, except for two patients with retained stones. Prophylactic cholecystectomy is recommended to prevent the occurrence of this subtle and highly dangerous syndrome.


The continuing challenge of acute and perforated appendicitis. A two year review of 216 patients with a preoperative diagnosis of appendicitis is used to help clarify the continuing points of controversy concerning appendicitis. Morbidity of perforated appendicitis by far exceeds that of nonperforated cases. Twenty-nine per cent of patients had perforation with a postoperative complication rate of 33 per cent. Rate of wound infection after perforation was 15 per cent despite antibiotics and delayed wound closure. Pediatric patients in this study did not experience a higher incidence of perforation or complication. A decision tree for management of acute appendicitis is presented.


Surgical management of pancreatic trauma. Ninety-one patients treated for pancreatic injuries are reviewed. Difficulty of diagnosis, including the surgical management of these injuries and their complications, are discussed in detail. The presence of associated multiple injuries, delay in diagnosis, and lack of sound surgical principles of treatment are directly proportional to the rate of complication and mortality.


Spontaneous pneumomediastinum.

Spontaneous pneumomediastinum. Five cases of spontaneous pneumomediastinum are presented. This is a benign condition that requires no specific therapy.


Carcinoma of the breast in young women.

Carcinoma of the breast in young women. The clinical records of 111 young women with breast carcinoma aged thirty years and  younger have been analyzed with respect to the clinical stage of disease when first seen, the histologic status of the regional lymph nodes, and ten year survival. Survival in these young women with mammary carcinoma is equivalent to that of older women when the cancer is in its earliest stage, Stage A, but only if the regional lymph nodes are free from metastatic disease. Once the regional lymph nodes are involved by cancer, the prognosis for these young women is indeed dismal, with less than 20 per cent ten year survival regardless of clinical stage.


Breast biopsy: a trial of wound drainage. A prospective randomized trial of wound drainage has been performed in a series of ninety-two patients undergoing one hundred breast biopsies. The overall incidence of wound hematoma was 14 per cent but the insertion of a wound drain did not protect against the development of wound hematoma. The wound infection rate was 1 per cent.


The open jejunum: a patch for large duodenal defects. A practical solution is presented for the difficult problem posed by a large duodenal defect in a very sick patient. A segment of jejunum opened along its antimesenteric border was applied as a mucosally lined patch, with a favorable result.


Lymphangioma of the stomach in a child.

Lymphangioma of the stomach in a child. A case of cystic lymphangioma arising from the stomach wall in a child is reported. This is a rare site of origin for the tumor and its manner of presentation, traumatic rupture, is also unusual. These tumors have not been associated with malignant degeneration. Treatment for these lesions is surgical.


Serosal patch repair for benign duodenocolic fistula secondary to duodenal diverticulum. A case of duodenocolic fistula secondary to a perforating diverticulum of the third portion of the duodenum was successfully managed by primary repair with use of a serosal patch over a difficult duodenal closure. The advantages of the serosal patch technic are discussed in light of other technics used for dealing with duodenal defects and fistulas.


Papilloma of the gallbladder.

Papilloma of the gallbladder. A case of papilloma of the gallbladder is reported. The gallbladder was associated with cholesterosis but not with stones. The causes of colicky pain in this case are discussed. Papillomas of the gallbladder exhibit no characteristic clinical picture; the symptoms are similar to those of any type of gallbladder disease. Papillomas of the gallbladder may be associated with malignant degeneration. Cholecystectomy is the treatment of choice.


Intramural gastric abscess.

Intramural gastric abscess. Two patients who underwent surgical resection of intramural gastric abscesses are described. Intramural gastric abscesses is a rare problem that simulates more common surgical conditions. The salient features of the symptoms, signs, and findings are reviewed.


Triage for the breast biopsy.

Triage for the breast biopsy. A plan is advocated for the management of the dominant breast mass with use of local anesthesia in the outpatient setting as the primary diagnostic tool, but with selection of certain patients for immediate general anesthesia biopsy in the "conventional" manner. Experience with this plan in 2,492 patients during a period of 114 months shows local anesthesia biopsy to be efficient and accurate. Five year survival for all mastectomy-treated patients whose cancers were diagnosed under local anesthesia is 72 per cent. Use of a triage method for selecting biopsy procedures has resulted in a thirteen-fold decrease in the number of patients subjected to general anesthesia.


A stomal appliance for provisional ileostomy in neonates of low weight at birth who require temporary ileostomy. In the surgical treatment of infants of low weight at birth for various congenital or acquired intestinal defects, it occasionally becomes necessary to divert intestinal contents by temporary ileostomy. There are no commercially available stomal appliances that are suitable for patients of this size. A rapid and easy method of constructing such an appliance is presented. The appliance protects peristomal skin, reduces nursing skin care time, and provides an easy and efficient method of collecting and measuring stomal affluent.


An investigative duodenal tube.

An investigative duodenal tube. A triple lumen balloon tube has been designed to study the neutralization and dilutional factors in the pathogenesis of acid-peptic ulceration. This tube is designed to create an in situ duodenal pouch from which duodenal contents may be retrieved before and after stimulation with 0.1 N hydrochloric acid.


Facial signs of respiratory distress after cardiac surgery. A plea for the clinical approach to mechanical ventilation. The face is a rich source of information about the respiratory, cardiovascular and neurological state of the patient. These systems are particularly affected in the adult respiratory distress syndrome (ARDS) after cardiac surgery. It is possible to make firm decisions about mechanical ventilation by scrupulously careful clinical examination, without blood-gas analysis or measurement of respiratory dynamics. The method is also applicable to many other conditions.


Neonatal flaccidity. Survival after neonatal respiratory failure with extreme flaccidity. The birth of a flaccid neonate is described. Oxytocin, diazepam and extradural bupivacaine were used during labour. The baby survived 1 1/2 hours of artificial ventilation and was subsequently healthy. An account is given of the assessment of foetal maturity and the diagnosis of neonatal flaccidity is discussed.


Neonatal pneumothorax. A Simple drainage device. A simple method of providing under-water-seal drainage using readily available equipment is described. It enables adequate treatment of pneumothorax to be instituted with the minimum delay.


A case of industrial carbon dioxide poisoning. A case of poisoning by carbon dioxide from an overhead fire-extinguishing apparatus is reported, and the subsequent rapid reversal of blood-gas and acid-base changes during the recovery phase described. A possible explanation of these changes is discussed.


Centralised system of humidification for respiratory treatment. A centralised system of hot water humidifiers for an intensive therapy unit has been described and its performance examined.


A cuffed nasotracheal tube for microlaryngeal surgery. A technique of general anaesthetia for microlaryngeal surgery which entails the use of a specially designed long 5 mm cuffed nasotracheal tube is described.


The immediate care of eye injuries.

The immediate care of eye injuries. The various types of injury which may occur to the eye are described. These may be easily missed altogether, or their extent not realised, unless great care and vigilance is exercised by those who first see the patient. Emphasis has been placed on the immediate care required and the urgency with which the different categories of injury must be referred to a specialist.


A clinical scoring system for adult respiratory distress. Preliminary report of its use in heart disease. A clinical scoring method for assessing adult respiratory distress and the need for mechanical ventilation was matched against simultaneous blood-gas analysis in 27 patients with grave heart disease. The results showed little correlation between the two. Possible reasons for this are discussed.


[Preoperative haemodilution: basis adaption mechanism and limitation of clinical application (author's transl)]. Basically the adaptational mechanism in acute, normovolaemic dilutional anaemia with dextran-60 is an increased flow rate to organs and tissues due to decreased viscous flow resistance. There is no decrease in systemic oxygen transport and no increase in oxygen extraction ratio unless the hematocrit drops well below 20%. Thus adequate tissue oxygen supply is guaranteed in limited dilution as shown by direct measurements of tissue PO2. The feasibility of a new concept of acute preoperative haemodilution with subsequent autotransfusion of the shed blood is demonstrated in 34 patients. Within the safe limits of clinical dilution in the haematocrit range of 25-20% adequate tissue oxygenation is provided by a rise in cardiac output, whereas heart rate, blood gases and acid base status are essentially unchanged. Autotransfusion during surgery and postoperatively helps to save donor blood, is easy to perform, gives better tissue perfusion at the microcirculatory level and prevents postoperative thromboembolic complications.


[Haemodynamics, oxygen demand and oxygen uptake of the heart during isovolaemic haemodilution (author's transl)]. 1. In experiments on 5 closed chest dogs an isovolaemic haemodilution with 6% dextran resulted in a drop of haemoglobin content to 6,4g%. Except for a small decrease of arterial pO2 and O2-saturation the body oxygen supply remained undisturbed. -- 2. According to only very small haemodynamic alterations (except compensatory cardiac output increase) myocardial O2-demand increased very little and mainly is caused by moderate augmentation of ventricular wall tension. The decrease of arterial O2 content was fully compensated by an increase of myocardial blood flow. O2 supply to the myocardium was not critically changed. -- 3. In accordance with other investigators it is concluded that in case of coronary insufficiency or increased myocardial O2 demand intentional hemodilution should be avoided. Patients with myocardial insufficiency considered for therapeutic hemodilution should be digitalized preoperatively.


[Haemodynamics and tolerance to hypoxia of the myocardium under 6%-oxygen ventilation following acute isovolaemic haemodilution in experimental animals (author's transl)]. 1. In experiments on closed chest dogs in a control group and a group of previous isovolaemic haemodiluted dogs a cardiovascular stress was produced by means of reduction of inspiratory O2 content to 6% O2--2. Under haemodilution only small changes of the heart rate, aortic pressure and dp/dtmax occurred, pointing to a decreased sympathoadrenergic response. Augmentation of LVEDP and pulmonary artery pressure is considered to be related to left ventricular insufficiency.--3. According to haemodynamic changes myocardial O2 demand in the control group during hypoxia is increasedby 120% and in contrast remains unchanged after previous haemodilution.--4. Despite the reduced oxygen content under haemodilution severe arterial hypoxemia affects mean survival time of the animals (18.5 min and 21.5 min respectively) only little. However, there is a greater variation from 11 to 26 min in the haemodiluted animals.


[Myocardial contractility during limited haemodilution (author's transl)]. The direct cardiac effects of limited isovolaemic haemodilution by low molecular dextran was investigated in the cat heart-lung preparation. This type of preparation does not allow evaluation of the significance of nervous or humoral influences. All haemodynamic and contractile parameters remain unchanged as does myocardial adaptability to acute changes in pressure or volume load. However, cardiac function curves and the estimation of contractility by means of force-velocity-relations reveal a slight increase of the inotropic state.


[Hypertonic circulatory response to clinical haemodilution (author's transl)]. Preoperative haemodilution was performed in 46 patients. By exchange of 1785 ml of patient's blood with plasma substitutes, haematocrit was lowered to 24.8% mean. Cardiac output rose, the other circulatry parameters remained constant on average. 8 patients experienced, however, a circulatory reaction with acute systemic and pulmonary hypertension, peripheral vasoconstriction, and ST-depression in ECG. These cases showed a decrease in oxygen uptake. In further 42 patients haemodilution was limited to haematocrit 27%, and only three weak hypertonic reactions were observed. Therefore we recommend haemodilution to be limited to this hematocrit. Saving homologous blood transfusions is the major goal of haemodilution. In comparable surgical procedures 60-70% of patients without haemodilution are given homologous blood. In our two patient groups with haemodilution blood transfusions were necessary in 15 and 21%, respectively. Thus, haemodilution is a valuable mean of hepatitis prophylaxis by saving homologous blood transfusions. This advantage outweighs the possible risks of circulatory reactions.


[Special problems in anaesthesia of haemodiluted patients (author's transl)]. In a series of 46 patients acute haemodilution was deliberately performed to test the validity of experimental data in clinical practice. Several metabolic and haemodynamic parameters as well as continuous registration of ECG were followed. The withdrawn blood has been exchanged by Dextran 60/PPL in equal quantities resp. by 5% human albumin. Using Dextran 60/PPL a light degree of hypervolemia (700 ml) was applied. Results confirmed that haemodilution is practicable in patients in principe. Exchange of blood by human albumin was followed by less severe side effect of haemodilution than was exchange by Dextran 60/PPL. in mild hypervolaemia. The course of haemodiluted and non haemodiluted patients during comparable surgical procedures (gastrointestinal operations) has been analysed: although measured parameters did not differ significantly between both series--except of Hb and Hk--side effects of the cardiovascular type were more frequently observed in the hemodilutiongroup. Provided there is knowledge of the dangers and side effects and special care (control monitoring) of the patients by the anesthesiologist, acute hemodilution is further recommended.


[Clinical experiences with induced preoperative haemodilution in vascular surgery (author's transl)]. A procedure of haemodilution modified for the particular requirements of vascular surgery has been used on 90 hospital patients. 61% of the operations have been performed without using homologous blood. The method applied being clinically well tolerable, it the object of this study to find to what extent a measurable reduction of the loss of blood during the operation with consequently a reduction of the amount of homologous blood administered can be attained. If the tolerable loss of blood is estimated to be 600 ml, in 22% of the cases operated on the administration of homologous blood has been avoided. The improvement in rheology by the infusion of low molecular weight dextran is considered an additional advantage in the special field of vascular surgery.


[Haemodilution in neurosurgical operations (author's transl)]. The subject of this paper is an investigation of the usefulness of haemodilution in neurosurgical operations. The studies were carried out on 30 patients undergoing operations for intracranial aneurysms (17 patients) or intracranial tumours (13 patients). The control group consisted of 50 patients undergoing operations for intracranial tumours (25 patients) or cerebral aneurysms (25 patients). It was found that during haemodilution cerebral oedema did not occur during the operation, while in the control group cerebral oedema was observed in 28% operations of the cerebral aneurysms and in 56%-- of the cerebral tumors. The amount of transfused blood in the group with intracranial tumors was diminished by ca 150 ml and in the group with cerebral aneurysms blood transfusion was not necessary at all (in the control group the average transfusion was 310 ml). Described method in correlation with the controlled hypotension should be more widely used in the neurosurgical operations.


[Experiences in performing preoperative isovolaemic haemodilution in a medium-sized hospital (author's transl)]. The paper discusses the question whether preoperative isovolaemic haemodilution is indicated in relation to operations in a medium-sized hospital. Haemodilution with Dextran 40 and Dextran 60 is performed the day before operation and both methods are compared. It seems, that preoperative haemodilution with Dextran 60 may be recommended in certain circumstances.


[Possibilities and limit of preoperative isovolaemic haemodilution in a district hospital (author's transl)]. Methods and techniques of preoperative isovolaemic haemodilution in a district hospital are described. In 15 of 19 patients the retransfusion of autologous blood was adequate to compensate the intraoperative loss of blood after isovolaemic haemodilution. Fatalities of serious incidents were not observed. The performance of isovolaemic haemodilution presupposes the necessity of sufficient staff and technical equipment.


[Early influence of acute preoperative haemodilution with human albumin and ringer's lactate on coagulation (author's transl)]. Acute haemodilution was performed in 10 patients scheduled mainly for vascular surgery. Before induction to anaesthesia 910 +/- 29.1 ml whole blood was taken and simultaneously replaced as follows: 50% of that amount with 3,6% albumin solution, another 50% X 3 with lactated Ringer solution. The haematocrit was thus lowered from 39.8 +/- 1.71 to 28.4 +/- 1.7 vol%. Extensive clotting studies were performed to investigate the early influence of haemodilution on the clotting mechanisms in the time span between the end of blood collection and the point of surgical anaesthesia. The group of patients with normal clotting studies prior to haemodilution has shown a slight and short-lasting hypercoagulability. This has been proven by a shortening of r and k in TEG, by a shortening of non-activated Partial Thromboplastin Time (means activation of the XII and XI factor) and also, by the presence of an activated factor Xa and by an increase of maximum platelet aggregation and of platelet factor 3 availability. This mechanism of clotting activation is similar to the one observed after marked blood loss. It was assumed that this minor, early and short-lasting hypercoagulability has no further influence on the well known usual intra- and post-operative changes in clotting mechanisms (intra-op lowered, post-op enhanced coagulability). In contrast to the patients with normal clotting, a clotting defect due to preexisting liver-cell damage becomes worse during the haemodilution, which method in the presence of hepatic insufficiency therefore is contraindicted. A few additional data on input-output, serum and urine electrolytes and on 2,3 DPG have been gathered during our study. They indicate a positive fluid balance and the necessity for a close watch of electrolytes. The possible trend of 2.3 DPG elevation which has also been found might reflect a compensatory mechanism increasing oxygen transport capacity of haemoglobin if the above described method of haemodilution is used.


[What gains are actually attained through acute preoperative haemodilution? (author's transl)]. The effect of haemodilution defined as a gain in volume of bodyowned erythrocytes amounts only 116 ml. This calculation assumes an acute haemodilution with four banket-blood and a blood-loss of 2,000 ml during the operation. In addition to this method--if considered useful at all--a conserve of bodyowned blood, to be taken ca. one week before the operation, is recommended.


[Why are calculated "in-vitro" effects of preoperative haemodilution in variance with respective clinical findings? (author's transl)]. Whereas theoretical calculations on the effect of hemodilution show a low gain of erythrocytes, the blood saving effect under clinical conditions is considerably higher. Withdrawal of 1,975 ml blood for haemodilution and an intraoperative blood loss of 2,480 ml resulted in saving of 298 ml of red cells or 850 ml of whole blood (haematocrit 35%). This amount of blood saved seems not very much, but it made the transfusion of donor blood unnecessary in cases when otherwise 1--2 units of homologous blood would have been given. Withdrawal of autologous blood 8--10 days prior to an operation planned to be performed under haemodilution is possible, in our experience however, not practical in clinical routine, because of the considerable logistical problems involved.


Ultrastructural changes in satellite cells after denervation and reinnervation of skeletal muscles. Changes taking place in the satellite cells after denervation and reinnervation of skeletal muscles are studied. A certain degree of similarity and synchrony of the changes occurring in these cells and in the muscle fibers is established during the degenerative and regenerative processes. Formation of new satellite cells and fusion of the same with muscle cells is not observed. These findings are explained by the fact that postdenervation changes in the skeletal muscles are not so heavy as in their direct lesion when, according to literature data, the satellite cells participate directly in the reparative process.


[The influence of the N-mustard derivative "cytostasan" on pregnancy and fetal development in the rat]. This presentation describes the action of Cytostasan, a nitrogen mustard compound of benzimidazole, on reproduction and embryonic development of Wistar rats. Single doses from 20 through 100 mg/kg body weight were given intraperitoneally on the 4th, 7th, 9th, 11th or 13th day post coitum. All test animals were sacrificed on the 20th day of pregnancy. The following parameters served as a base for evaluation: the means of implantation rates, resorption rates, fetal body weights and the number of dead and living fetuses. Malformations were detected by outer inspection for gross anomalies, by means of the razor blade technique for malformations of organs and by alizarin preparations for detecting anomalies of the osseuos skeleton. All results were compared with those of an untreated control group and evaluated by statistical means. Cytostasan exerts embryotoxic and teratogenic effects in appropriate dosage. Notwithstanding the fact of giving high doses (1/2 LD 50) there is no loss of blastocysts before implantation: the number of implantation sites equals that of the control group. The resorption rate increases at all examined days of development after application of 40 mg/kg, but 20 mg/kg exert effects only on days 4, 7, and 11 p. c. There is no action on the number of living fetuses after injection of 20 mg Cytostasan/kg body weight. After application of 40 mg/kg the number of living fetuses decreases especially on the 7th, 9th, and 13th day p. c. There is a dose-dependent stunting: the fetal body weight is not reduced after a dosage of 20 mg/kg, but 40 mg/kg cause a considerable loss of weight during embryogenesis (days 9, 11, 13). It is impossible to induce stunting during blastogenesis (days 4 and 7). The observed patterns of malformation are relatively uniform: kinked tails, omphaloceles, hydronephroses, hydrocephali. Skeletal defects are absent. The results received are compared with other findings on aklylating antitumour drugs.


[The influencing of blastogenesis and embryogenesis in rats through aminoacetonitrile]. The study was designed to determine the influence of the lathyrogenic substance aminoacetonitrile on blastogenesis and embryogenesis of the Wistar rat. 91 female Wistar rats, weighing from 190 through 380 g, received a single injection of 300 mg aminoacetonitrile (AAN)/kg body weight. Substance was given intraperitoneally on days 5, 7, 9, 11 or 13 of pregnancy. The detection of sperms in the vaginal smears was counted as day 1 post coitum. Animals were sacrificed on day 21 of pregnancy. The following parameters served as a base of interpretation: fetal body weight, numbers of implantations, resorptions, dead and living fetuses. Malformations were detected by outer inspection for gross anomalies, by the razor blade technique for internal malformations, and by skeletal preparations. All results were evaluated by statistical means. AAN influences pregnancy and fetal development. The rates of fetal resorptions are enhanced after application of AAN beyond the 7th day p. c. The maximum of fetal death is reached on day 11 p. c. There is no influence on the mean implantation number. With the exception of the 5th day of development AAN reduces the number of living fetuses. After application of AAN on day 13 p.c. the mean body weight decreases significantly. All over the investigated range malformations can be observed. Abnormalities of internal organs are frequent: Hydrocephalus, hydronephrosis, situs inversus. Malformations of the skeletal system are only observable on days 5, 7 and 9: sternal fissure, supernumerary ribs, destruction of the lumbar spine. AAN does not induce gross anomalies of the fetus.


Further observations on the epicardial lymph circulation. In the lymphatic vessels in the heart of the pig are structures that influence and determine the direction of the flow of the lymph. These flow-directing structures include simple invaginations of the vessel walls, single-valvulate valves, and double-valvulate valves. The anatomy, frequency, and placement of these structures vary according to differences in the forces maintaining lymph flow. The histology and fine structure of these valves is similar to those of the mesenterium.


Gross, histomorphological and histochemical changes in the thyroid gland of goat with age. III. Occurrence of thymic tissue. The observations on the thyroid glands from 26 goats aged between 20 days and about 5 years revealed the presence of thymic tissue embedded within or in close vicinity of thyroid in 26.9% of the animals, generally occurring in association with parathyroid tissue (23.08%) and only occasionaly (3.84%) alone. Different forms of the thymic tissue associated to thyroid and variations in their histomorphology and PAS reaction in relation to age has been observed and discussed.


[Ultrastructural changes in cells of the inner enamel epithelium, stratum intermedium and reticulum stellatum in the enamel organ of the upper incisor of the Wistar rat at different phases of amelogenesis]. An electronmicroscopical study of the enamel organ of the upper incisors germs of Wistar rats was performed to analyse the ultrastructural features of the cells of the inner epithelium, the intermediate layer and the stellate reticulum, during preimary, young, transitional and mineralized enamel phases of amelogenesis. So, it was observed that the mitochondria in the ameloblasts are ovoid before the beginning of the enamel matrix formation and in the primary and young enamel phases. However, in the transitional and mineralized phases, these organelles are long and tortuous and some are characterized by a compact structure. In the cells of intermediate layer and stellate reticulum, the mitochondria are ovoid until the beginning of the mineralized phase. At the ending of this phase, these organelles are very long and present irregular form; many of them show also a compact structure. The "zonula adhaerens" could be observed only in the ameloblasts of the primary and young enamel phase. The cytoplasm of ameloblasts, during primary and young enamel phases is characterized by an abundance of free ribosomes and a branular endoplasmic reticulum; but during transitional and mineralized enamel phases, the cytoplasm of these cells shows little granular endoplasmic reticulum and free ribosomes, but ehe agranular endoplasmic reticulum is present. The granular endoplasmic reticulum and free ribosomes are abundant in the cells of the intermediate layer and stellate reticulum at the ending of the young enamel phase, in the transitional enamel phase and in the beginning of the minieralized phase. During different phases of amelogenesis, in the three above referred layers of the enamel organ, were also studied the features of the Golgi apparatus the presence and topographic distribution of the pigment granules, as well as the lysosomes, desmosomes and the tonophibriles.


Histomorphological and histochemical sutides on the female genitalia of ageing goat. II. Glands in cervix uteri. The cervical glands of cervix uteri of goat with particular relation to their histomorphology, histochemistry and changes with reference to age, estrus cycle, pregnancy and mode of secretion have been observed and discussed.


Goblet cell density in the eustachian tube in prematures and in newborn infants. In order to determine the goblet-cell pattern in a completely normal mucosa, the entire mucosa from the Esutachian tube of 14 prematures and newborns was dissected and stained in toto by the PAS-alcian blue whole-mount method. Goblet cells were counted in many localities and the results analysed statistically. The density proved very low, but uniform in the entire Eustachian tube, 10 cells per field, corresponding to 565 cells per mm2. These findings were compared with those from a normal adult autopsy material in which the density in the pharyngeal orifice was high, but gradually decreased towards the tympanic orifice where it was as low as in prematures. It is concluded that a marked postnatal increase in the density in the tubal orifice is abnormal, whereas a physiological increase in density may be expected in the pharyngeal part of the tube. One premature, intubated for three days, exhibited a very high density in the Eustachian tube, presumably as a consequence of sudden tubal occlusion.


[Comparative morphology of the trabecula septomarginalis in terrestrial mammals]. The authors studied macroscopic morphology and histologic structure of the moderator band - trabecula septomarginalis - in 100 earthly mammals. A real trabecula septomarginalis was never found in carnivora (dog and fox) because the "anterior" papillary muscle of the right ventricle is located on the lower part of the septum ventriculorum or at times bridge-shaped above the anteiror interventricular groove and attached on both septum and anterior wall of the right ventricle. On the opposite, in ungulates, a well-known band runs across the right ventricular chamber from the septum close to the musculus papillaris coni arteriosi up to the anterior wall close to the anterior papillary muscle. In fact the attachments lie more or less approximate to the pillars; in suidae, the trabecula usually ends on a vertical trabecula carnea just under Luschka's muscle. Three types of trabecula septomarginalis were encountered as previously described by Bortolami in ox: - Mostly (66%), the trabecula septomarginalis is a short and thick fleshy column. The ratio Length mm Thickness mm amounts to about 4 to 7 and can be regarded as reasonably constant within each variety. Moreover the quotients Length mm Height of septum MM. and Thickness of the trabecula mm Highest thickness of the anterior wall mm (measured just beneath the tricuspid attachment) keep constant in each group; thus it may be concluded that size and shape of the trabecula depend on the volume of the heart and the age of the animal. - Rarely, the trabecula looks like a tendinous cord. Such a fibrous string is nearly constant in suidae, especially in wild boar, but seldom in bovidae and cervidae. In all cases, the trabecula septomarginalis supports the right branch of the atrioventricular bundle and a thin artery which originates from the left coronary artery and branches into the right coronary vessels within the anterior papillary muscle. Some venous capillaries were also observed but only in the muscular trabeculae; they are not constant and mouth into the right ventricular chamber or run towards the septal veins around the atrioventricular node. Therefore whatever is the size, the trabecula septomarginalis must be regarded as the shortest pathway from the septum to the anteiror wall of the right ventricle and is a mere band bearing the "right nodal pedicle".


Comparative morphological remarks on the origin of the posterior femoral cutaneous nerve. The origin and course of the posterior femoral cutaneous nerve were observed macroscopically in 38 Japanese adult cadavers which were dissected in the University of  Hokkaido, Faculty of Medicine during the years 1971/72 and the results obtained were compared with those from some other mammals (rat, rabbit, dog and cat) and a number of bibliographical findings on the other animals. On the basis of the archetype of the pudendal plexus, the site of origin of the posterior femoral cutaneous nerve was divided into seven portions as follows: the sciatic nerve or inferior gluteal nerve (I) and its originating roots (RI), the bigeminal nerve (B) and its originating roots (RB), the part of junction of I and B (CIB), the pudendal nerve (P) and its originating roots (RP). According to the arising mode, the posterior femoral cutaneous nerve was calssified into seven types: Type A (the sciatic nerve type); the nerve arises from I and RI (horse, rat, bird, frog and salamander). Type B (the sciatic transitional type); the nerve arises from I, RI, CIB, RB and B (MAN AND MONKEY). Type C (the bigeminal nerve type); the nerve arises from CIB, RB and B (gorilla, chimpanzee, orangutan, cat and sphenodon). Type D (the pudendal transitional type); the nerve arises from CIB, RB, B, RP and P (dog). Type E (the pudendal nerve type); the nerve arises from RP and P (pig, cattle and rabbit). Type F (the mixed type); a mixture of A to E types. These various patterns in the posterior femoral cutaneous nerve may be explained by the comparative anatomical explanation on the limb medial rotation given in Braus' text-book of Anatomy (Bd. I, S. 273). From these descriptions it is reasonable to presume that the main trunk of the posterior femoral cutaneous nerve of the tetrapod below the Aves arises from the sciatic nerve and is analogous to the gluteal branches of mammals, with its main stem still retained in the pudendal nerve. If the cutaneous area supplied by the posterior femoral cutaneous nerve expands to the lateral border of the buttock in company with the lower limb medial rotation, the part between this area and that supplied by the pudendal nerve is enlarged. At first, these expanded areas are probably supplied by the branches of the pudendal nerve, which gradually become independent to become the main stem of the posterior femoral cutaneous nerve in mammals. This nerve seems, therefore, to be primarily a division of the pedendal nerve, and so in man has various types of arising patterns, A to E, in accordance with the scheme in the phylogeny. Those hypothetical changes are observed in the human sacral plexus, from which the cutaneous nerve arises with a fan-shaped overlapping.


Light microscopic and ultrastructural observations of the calcifying zone of the mandibular condyle in the rat. The hypertrophic stage of development of the rat mandibular condyle was investigated in 16 and 26-day-old rats by electron microscopy. Interest was focused on the zone of mineralization and erosion. It was observed that capillaries invaded the lower level of the hypertrophic zone, without any previous chondroclastic resorption of calcified partitions. The partitions surrounding the hypertrophic chondrocytes were not mineralized around their entire circumference at the level of capillary penetration. The capillaries were accompanied by perivascular cells but these showed no similarities to chondroclasts. Multinucleated chondro- or osteoclasts were however present at a lower level of the subchondral area. It is suggested that there are no inherent differences with respect to the pattern of mineralization and erosion between the epiphyseal growth plate and the developing mandibular condyle.


Numerical density of nuclei in the sheep placenta. A method is described for estimating the number of nuclei of different cell types in the sheep placenta. The method was applied to the study of six placentas of different ages and the results have been correlated with data on the chemical composition and the physiology of the ovine placenta. In agreement with studies of placental DNA content, there is no demonstrable increase in the total number of placental nuclei in the last two months of gestation. However, the number of fetal mesenchymal nuclei decreases and there is a concomitant increase of fetal endothelial nuclei from 80 days to term. These changes correlate with a decrease in volume of the core of the placental villi and increase in umbilical blood flow.


Surface morphology of human aorta as revealed by the scanning electron microscope. Human aorta was prepared for scanning electron microscopy using critical point drying. The aortic surface is lined by a continuous layer of squamous endothelial cells. The luminal surface of these cells contains many microvilli or microappendages and pinocytotic vesicles. In addition, at the periphery of each cell, larger marginal appendages or microfolds are present which allow the observer to see the cell boundaries clearly. The marginal folds are superficial to the cell junctions and could be observed without any staining procedures. These observations on human aorta are generally in agreement with our findings on the rabbit and guinea pig aorta and vena cava but in contrast to others who have reported the presence of ridges, intercellular bridges, and "hair-like" processes on the endothelial surfaces.


Cellular composition of the bone marrow in the chicken. I. Identification of cells. Incorporation of Fe55 in vivo was used for verifying on radioautographs the identity of chicken bone marrow cells that are in the process of hemesyntheses. Under the experimental conditions all labeled cells may be considered to be linked with erythroid differentiation. They were classified into five maturational stages according to their morphology and capacity for DNA synthesis. Granulocytes were identified by the presence of specific granules. All mononuclear cells were classified as lymphocytes which had a pachychromatic nucleus, a high nucleocytoplasmic ratio, lacked the capacity for DNA synthesis, and resembled small lymphocytes of the bursa, spleen and bone marrow that bound, in vitro, anti-chicken gamma globulins labeled with I125. Radioautography with H3TdR was used to identify proliferating and non-proliferating members of each cell population.


Astrocytic gap junctions in the rat lateral hypothalamic area. An extensive system of gap or nexus junctions has been found between astrocytic processes in the neuropil of the lateral hypothalamic area in the albino rat. These specialized interastrocytic junctions occur in regions of high synaptic density where neural processes are separated by the interconnected glial system. In this study, 90% of the gap junctions observed in the lateral hypothalamic neuropil are in the immediate proximity of synaptic terminals. The close morphological relationship of these glial gap junctions with synaptic contacts suggests that they may play a significant role in the process of synaptic transmission.


A proposed function for microridges on epithelial cells. Microridges (MR), also called microvillar ridges, microplicae and cytoplasmic folds, have been noted on many epithelial surfaces. Several functions have been proposed for these structures. In the present study we examine the mechanical role that microridges may play in holding mucus to the lumenal surface to the esophagus in the trout Salmo gairdneri. Our findings support the hypothesis that the microridges help hold a protective coat of mucus to the epithelium. In addition, the complex curved or whorled arrangement of microridges appears to facilitate the spread of mucus away from goblet cells.


Synergism between halothane and nitrous oxide in the production of nuclear abnormalities in the dividing fibroblast. When Chinese hamster fibroblasts divide in the presence of halothane there is an increased incidence of cells with abnormal nuclei, both in mitosis and in interphase. The authors compared the effects of halothane and nitrous oxide separately and in combination. Nitrous oxide, 75 percent, alone had no significant effect compared with controls, less than 1.4 per cent of cells showing abnormalities, while halothane alone had a dose-dependent effect on both phases of the cell cycle. Halothane, 1 per cent, caused abnormalities in 7 per cent (SEM +/- 0.32) of cells in interphase and in 12 per cent (SEM +/- 0.95) of cells in mitosis, but the combination of 0.75 per cent halothane with 75 percent nitrous oxide produced 15 per cent (SEM +/- 0.68) abnormal cells in interphase and 22 per cent (SEM +/- 0.51) abnormal mitoses. Similar highly significant differences were obtained throughout the dose-response curves to as much as 4 per cent halothane in air and 2.35 per cent halothane in 75 per cent nitrous oxide. This appears to demonstrate synergism between halothane and nitrous oxide in the production of this particular side effect. In contrast, the effects of halothane and nitrous oxide on growth rate were additive.


On-line systolic time intervals during anesthesia in patients with and without heart disease. Twenty-four patients with severe, 24 with moderate, and 24 without heart disease were selected for measurements of systolic time intervals (STI) and blood pressure before and during anesthesia. In all patients anesthesia was induced with thiopental, 4 mg/kg. After tracheal intubation, 12 patients from each heart-disease class received halothane-N2O-O2 (halothane) and 12 patients from each class morphine-d-tubocurarine-N2O-O2 (MS-dTc). Thiopental increased the pre-ejection period (PEP), decreased left ventricular ejection time (LVET), and accelerated heart rate (HR). These changes were similar in patients with and without heart disease. Halothane and and MS-dTc lowered systolic blood pressure and increased PEP/LVET. With halothane but not with MS-dTc these changes were more pronounced in patients who had heart disease. Changes of the PEP/LVET ratio during halothane anesthesia were a better discriminating variable among patients without, with moderate, and with severe heart disease than were changes in systolic blood pressure.


Epidural anesthesia in the normotensive pregnant ewe: Effects on uterine blood flow and fetal acid-base status. Lumbar epidural anesthesia was administered to 12 normotensive pregnant ewes. Blood pressure was maintained by intravenous fluid infusion. Six ewes received anesthesia with 1.5 per cent 2-chloroprocaine with 1:100,000 epinephrine and the remaining six received 1.5 per cent 2-chloroprocaine without epinephrine. The sensory level of anesthesia was between the umbilicus and xiphisternum. Except for a transient 14 per cent decrease in uterine blood flow in the ewes receiving 2-chloroprocaine with epinephrine, uterine blood flow remained near control values and was sufficient at all times to maintain stable fetal acid-base and blood gas values. Provided blood pressure and uterine blood flow were stable, the percentage of uterine blood flow distributed to the placenta in the absence of uterine contractions was not altered by epidural anesthesia or by addition of epinephrine to the anesthetic solution.


Dantrolene in porcine malignant hyperthermia. The effectiveness of intravenous administration of dantrolene in prevention and treatment of fulminant malignant hyperthermia (MH) initiated by halothene and succinylcholine (SCh) in genetically susceptible swine was assessed. In six animals, prior administration of dantrolene in doses of 5 mg/kg or more prevented MH, while 1 or 3 mg/kg attenuated MH, and 0.1 mg/kg had no effect. In ten additional swine, therapy was not started until MH was fulminant. Five of these were then given supportive therapy only (discontinuation of anesthesia, hyperventilation with oxygen, surface cooling, and NaHCO3). The remaining five received the same supportive therapy, plus dantrolene (7.5 mg/kg). With supportive therapy only, arterial blood pH, Po2 and Pco2 returned toward normal, but oxygen consumption (Vo2), blood lactate, potassium (K+), catecholamines, and temperature continued to increase and the course of MH was unaltered. When dantrolene was added to supportive therapy, Vo2, lactate, K+, catecholamines, and temperature decreased, and the course of MH was dramatically slowed and, apparently, reversed.


Enzyme induction by enflurane in man.

Enzyme induction by enflurane in man. Concentrations of 6-beta-hydroxycortisol (6-OHF), a polar metabolite of cortisol formed in the endoplasmic reticulum (microsomes) of the liver, and 17-hydroxycorticosteroids (17-OHCS) were measured in the urines of six healthy adult male volunteers exposed to a mean of 9.6 MAC-hours of enflurane anesthesia as an index of possible enzyme induction. The ratio of 6-OHF to 17-OHCS in 24-hour urine specimens collected five days before anesthesia was compared with the ratio of these metabolites in 24-hour urine specimens collected 16 to 18 hours after anesthesia. The ratio of 6-OHF to 17-OHCS increased markedly in five and decreased slightly in one volunteer following anesthesia. The results indicate that enflurane may cause induction of hepatic microsomal enzymes.


Effects of Intersept micropore filtration of blood on microaggregates and other constituents. Micropore filtration (Intersept) of whole, stored blood was examined in two studies. In Study A, 1 unit of 14-day-old blood flowed by gravity across the filter. In Study B, the filter was preloaded by passage of 2 units of blood, and the effects on a third, consisting of 21-day-old blood, flowing under 150 mm Hg pressure, were examined. Filtration did not significantly alter erythrocyte count, total hemoglobin, plasma hemoglobin, erythrocyte fragility, plasma sodium, potassium, albumin, or globulin in either study, although some platelets and leukocytes were removed. Microaggregates, assessed by Coulter counting, screen filtration pressure, total screen proteins, wet and dry weights of material retained, and scanning electron microscopy, were satisfactorily removed over the whole range of particle sizes. Comparison with the Bentley PFS-127, Fenwal 4C2417, Pall Ultipore, and Swank IL200 filters led to the conclusion that the Intersept is the most efficient filter available at the present time for removing microaggregates during massive blood transfusion.


Alteration of the response of guinea pigs to freund's complete adjuvant by ascaris extract: a preliminary histologic study. Freund's adjuvant has been asserted to cause systemic complications in man similar to those occurring with B.C.G. vaccine. In search of factors predisposing to such complications of this vaccine, the potential role of a coexisting parasitic infestation was considered. A potentiating effect of the ascaris antigen on the pathological changes produced in guinea pigs by intraperitoneally injected Freund's complete adjuvant was noted. The pertinency of this observation to immunotherapy of cancer with B.C.G. is purely speculative.


Temporal variability in airborne pollen concentrations. Tests were conducted to determine the relationship between concentrations of airborne pollens and sampling time, using sequential rotoslide samplers at urban and rural locations. Short-period data showed an increase in variability with time between samples. Two-hour data showed a stronger trend for the first 12 hours but better agreement as the time between samples approached one day.


Recurring and chronic urticaria: identification of etiologies. Most of the literature on chronic urticaria has emphasized the difficulties of identifying etiology. Employing the sequential vascular response test, the authors have had a 93% success rate in determining causative factors in 156 clinic patients and of identifying specific aggravants in 85% of 300 cases.


Characterization of some of the enzymes in ragweed pollen. Ragweed pollen contains 11 esterase, 5 acid phosphatase, 2 alkaline phosphatose, 2 hexokinase, 2 glucose-6-phosphate dehydrogenase isozymes and one leucine amino peptidase band which can be separated by starch gel electrophoresis. The isozymes were distinguished from one another by their electrophoretic mobility, heat inactivation temperatures and antigenic differences.


Infectious bovine keratoconjunctivitis: experimental induction of infection in calves with mycoplasmas and Moraxella bovis. Eyes of 14 calves were exposed by conjunctival instillation to cultures of either Mycoplasma conjunctivae (6 calves) or Acholeplasma laidlawii (8 calves). Calves were observed for clinical signs of infectious bovine keratoconjunctivitis (IBK), and eyes were examined for the test organisms by bacteriologic cultural technique for 60 days. Acholeplasma laidlawii became established in the eyes of 5 of 8 calves; M conjunctivae became established in the eyes of 4 of 6 calves. On day 28, eyes of 9 of the 14 calves were exposed by conjunctival instillation to Moraxella bovis, and all developed IBK. Five calves exposed to Moraxenjunctivae or A laidlawii, but not to Mor bovis, did not develop IBK. Four calves not exposed to M conjunctivae or A laidlawii, but exposed to Mor bovis, developed IBK. Mycoplasmas do not have a major role in IBK, but might produce ancillary effects similar to those of infectious bovine rhinotracheitis virus, wind, ultraviolet radiation, dust, and other irritants.


Scanning electron microscopy of ruminal papillae in calves fed various amounts and forms of roughage. Twenty neonatal calves were fed milk plus 1 of 4 rations ad libitum: pelleted concentrates plus alfalfa hay, pelleted concentrates plus ground alfalfa hay, pelleted concentrates alone, or pelleted concentrates containing whey. Eight calves were killed at 4 weeks of age, and 12 calves at 6 weeks. The ruminal mucosa was examined grossly, by light microscopy, and by scanning electron microscopy. Well-developed differences among groups were evident in calves at 6 weeks of age; changes at 4 weeks were similar, but less developed. In 6-week-old calves fed concentrates plus alfalfa hay ad libitum, papillae were flattened and tongue shaped on the ventral floor of the atrium ruminis (cranial sac). Calves fed concentrates plus ground alfalfa had tongue shaped, rounded, and finger-like papillae. Calves fed concentrates alone or concentrates plus whey developed small, nodular, branched papillae which were cauliflower shaped and severly parakeratotic and were arranged on transverse folds on the floor of the atrium ruminis and on zigzag folds elsewhere in the rumen, except on the dorsal wall in contact with the gas bubble. The transition from tongue-shaped to nodular-shaped papillae under the influence of ration occurred last on the floor of the atrium ruminis. At least in 6-week-old calves, that site generally is not typical of changes in most ruminal papillae.


Experimentally induced foot rot in feedlot cattle fed rations containing organic iodine (ethylenediamine dihydriodide) and urea. Foot rot was experimentally induced in feedlot cattle with a mixed inoculum of Fusobacterium necrophorum (Sphaerophorus necrophus) and Bacteroides melaninogenicus. Both bacteria were isolated from the lesions. Isolates of F necrophorum from 2 of the lesions were serologically compared, using a passive hemagglutination test with the strain used to induce the lesions. These isolates were serologically similar but not identical, indicating antigenic change had occurred during animal passage. The addition of ethylenediamine dihydriodide or urea to the rations did not affect the frequency of experimentally induced foot rot.