Resumption of work after acute myocardial infarction. A total of 644 patients, admitted to the Coronary Care Unit of a district hospital on account of acute myocardial infarction, have been discharged during a 3-year period. Of these patients, 71% had been employed at the time of the infarction and more than 80% of this group returned to work. Among the long-term survivors (LTS) aged less than 65 years who had been employed at the time of infarction, 87% of the male and 74% of the female patients had resumed work some time afterwards. Among 347 LTS age was found to be the main factor to determine whether or not patients would be able to resume work, whereas the number of experienced infarctions as well as signs and/or symptoms of heart failure during the acute phase were of no consequence. The occurrence of additional symptoms of ischaemic heart diseases (recurrences of infarction, presence of angina pectoris, demand for drugs) was of prognostic importance for whether or not patients would have to abandon work. The ability of patients to resume their previous work. The ability of patients to resume their previous work depended on the character of the latter, i.e. its type and the physical strain involved. About 80% of the LTS resumed work within three months. Patients in whom heart failure had occurred during the acute phase tended to return to work later than those without this complication. No more than half of the LTS who had abandoned work declared that cardiac symptoms had been the reason.


Characteristics of representative male survivors of myocardial infarction compared with representative population samples. A series of 299 men, aged 27-67, who had survived their first myocardial infarction (MI), have been compared with representative population samples with respect to tobacco consumption, alcoholic intemperance, physical activity during work and leisure time, occurrence of hypertension, and cholesterol and triglyceride levels in serum. The infarction patients comprised 90% of all surviving, diagnosed cases of primary MI in men aged 67 years or below during 1968-70 in Göteborg, Sweden. The comparison between infarction patients and general population samples revealed that the patients smoked more, and were less physically active during leisure time but not during work. They had more often a positive history of hypertension and treatment for high BP and their serum cholesterol and serum triglyceride values were higher. For all these variables the difference decreased with increasing age and was generally not statistically significant above the age of 60 years. Alcoholic intemperance was more common among infarction patients who died outside hospital, but there was no difference in this respect between surviving patients and the general population.


Systemic lupus erythematosus in twin sisters following ten years of hyperglobulinemic purpura (Waldenström). Uniovular twin sisters have been diagnosed 10 years ago as having hyperglobulinemic purpura (Waldenström) at age 12. The diagnosis was documented by purpura of the lower extremities, increased gamma-globulin after serum electrophoresis, and increased 7S component upon ultracentrifugation. In addition, there was an elevated ESR, a positive rheumatoid arthritis latex test, and their LE prep. was negative at that time. At a later date, however, both of them developed polyarthritis. After 9 years for the one and 10 years for the other, their LE prep. became strongly and constantly positive, while their gamma-globulin remained within abnormal limits.


Morphological aspects and biomechanical properties of the vertebroaxial joint (C2-C3). The C2-C3 intervertebral joint must be regarded as a transitional area situated between the upper cervical spine where most rotation of the neck and little flexion and extension occur and the lower cervical spaces where chiefly motion in the sagittal plane and also somewhat rotation take place. Under normal circumstances the range of flexion-extension reaches 11 degrees, slighter than below (19.5 degrees at C5-C6); on the opposite, the range of rotation attains 7 degrees; less than above but much more than below (0 degrees at C5-C6). The motion in the sagittal and coronal planes is relatively poor because of the location of Penning's motor-axis of C2 which runs far from the vertebral body and the lowness of the intervertebral disc. However, the rotation of C2 with respect to C3 is fair by the peculiar inclination of the articular facets which slope sagittally but also coronally and trace a sphere whereupon C2 may move around its motor-centre in any plane. When C2-C3 is surgically fixed by bone graft, the lack of motion is completed by a "compensatory movement" in the upper cervical spaces and especially at the atlantooccipital joint for flexion-extension. In the same way, C2-C3 may improve its mobility especially in the sagittal plane when the inferior partner is blocked by surgical or arthritic fusion.


On the acetylcholinesterase activity in the vestibular ganglion of the rat. Acetylcholinesterase was demonstrated in the ganglion cells of the vestibular ganglion of the rat with Karnovsky's method. The acetylcholinesterase content was evaluated after a 24 hours incubation time by means of a three-grade scale. The cell size was determined by a particle size analyser. No correlation between the two values could be established. A comparison with the spiral ganglion showed a slightly lower acetylcholinesterase content in the vestibular ganglion. The content of acetylcholinesterase in the vestibular ganglion cells seems to be lower than in the spinal ganglion cells.


Biology of the rice rat (Oryzomys palustris natator) in a laboratory environment. IX. Preweaning growth of the skull. The pattern of skull growth of the rice rat (Oryzomys palustris natator) over the pre-weaning period of development reveals a characteristic triphasic outline which stems, in part, from the interplay of the external environment and the genetic endowment. Within the triphasic spectrum the neural skull growth exhibits an accelerated rate of growth during the early phases which eventually reverses to a rapid deceleration in the final phase. In contrast, the facial skull growth shows increased growth rate following the decline of the neural group, eventually reaching a slow linear deceleration. Thus the neural components appear to be synchronised to the brain growth while the facial elements gain a new and greater impetus following the neural decline. The general growth of the skull throughout these changes, i.e. triphasic and neural/facial, continues to show a basic slow linear increase.


The effects of experimental unilateral anotia on skull development in the chick embryo. III. Chondrocranial development in anotic embryos of 7-20 days of incubation. The study of the development of of the chondrocranium in chick embryos with unilateral (right-sided) anotia revealed the following main characteristics. 1. The median axes of the chordal and the prechordal part of the cranial base are not in a straight line but show a deviation toward the right side. The angle between the two axes has its vertex in the region of the foramen hypophyseos. 2. The metotic cartilage and the foramina of the IXth and Xth cranial nerves are normal in position. 3. The tectum synoticum develops later and to a lesser extent than normal. 4. Between the basal plate, the metotic cartilage, the occipital arch and the supracapsular cartilage a foramen is formed which, later in development, is closed by outgrowths of the metotic cartilage and the basal plate. 5. The "optic area" shows a practically normal appearance which indicates that the cartilaginous ventral wall of the lagenal capsule is of basal plate origin. 6. The pro-otic process develops practically normal and, hence, is independent of the ear capsule. 7. The quadrate cartilage and the right lower jaw are displaced ventro-posteriorward. The earliest development of the perichondral bones shows some particularities which are closely correlated with the development of the various cartilaginous structures.


Surgical indications in normotensive hydrocephalus. A retrospective analysis of the relations of some diagnostic findings to the results of surgical treatment. Twenty two of fifty five patients initially suspected of suffering from normotensive hydrocephalus were surgically treated (CSF ventriculoatrial shunt). The results of surgery were related to the findings of the different diagnostic examinations (pneumoencephalography, isotope cisternography, transfer fron CSF to blood of isotope labelled serum albumin, constant infusion manometric test, long lasting intraventricular pressure recording). 1.Pneumoencephalography, intraventricular pressure recording, and, above all, isotope cisternography provided the most reliable data for diagnosis and surgical prognosis. 2. The combined use of pneumoencephalography and isotope cisternography was sufficient for a correct diagnosis and surgical prognosis in about 50% of the patients examined. 3. When the diagnostic information given by the combined results of the two above examinations was not sufficient, intraventricular pressure recording proved to be the most useful examination to supplement it. 4. The relation of the results of the study of transfer of istope labelled serum albumin from CSF to blood and of the constant infusion manometric test to the surgical outcome was uncertain.


Tabetic lumbar osteoarthropathy with cauda equina syndrome. Case report. The case is described of a 52 year old patient admitted for acauda equina compression syndrome (flaccid paraplegia of the lower limbs, bilateral lumbar and sciatic pains, urinary incontinence) of rapid onset and due to narrowing of the lumbar canal from tabetic arthropathy. These vertebral manifestations occur in a low percentage of tabetic arthropathies, which are relatively rare, and are not often accompanied by severe neurological disturbances. Decompressive laminectomy afforded rapid and lasting relief.


[Epidural hemangiopericytoma. A casuistic contribution to the differential diagnosis of angiomatous meningiomas]. The clinical presentation together with macroscopic and microscopic findings in a case of epidural fronto-parasagittal hemangiopericytoma occurring in a 59 years old female are reported. Pathogenesis, clinical and macroscopic findings, and microscopicaspects of this tumor aspected with the angioblastic (angiomatous) meningioma are discussed. The relevant literature is reviewed.


[False aneurysm of the artery of the angular gyrus caused by vascular injury during ventricular puncture]. This description of a false aneurysm of the artery of the angular gyrus resulting from damage by a Cushing needle demonstrates the origin and the development of the lesion, and also its healing following thrombosis. The pathogenesis of the aneurysm is shown by illustrations of the angiographic findings and the histology.


The EEG in normal pressure hydrocephalus. Fourteen patients with NPH were studied with special reference to associated EEG changes, one case being reported in detail. In 13 cases the EEG was abnormal, the abnormality most frequently observed being a of the rhythmic slow wave type, consisting of bursts of monorhythmic theta or delta waves seen in both hemispheres. This type of abnormality was present in 7 cases. In 4 of the 5 cases with serial EEG's the abnormality became more accentuated with the advance of the illness. In 4 of 5 cases in whom postoperative EEGs were obtained there was significant improvement of the EEG after the shunting procedure. There were stron correlations between the EEG abnormality described, demonstrable ventricular reflux on cisternography, and the effectiveness of the shunt operation. It was considered that serial EEGs are a useful diagnostic procedure in following up patients at risk of developing NPH.


Telemetry of intracranial pressure.

Telemetry of intracranial pressure. A new technique is described for telemetric measurement of intracranial pressure in man using an external energy source and a small pressure transducer, called a TELECEPTOR, implanted in the skull. The method presents advantages, especially for long term recordings.


Methodology for intraventricular and subarachnoid continuous recording of intracranial pressure in clinical practice. The methodology for continuous monitoring intracranial pressure (ICP) being presently employed in the Neurosurgery Service of the University of Pennsylvania is presented. The methods are intraventricular recording of ICP (IVP) and subarachnoid recording of ICP (SaP). The indications for employing either method are briefly presented. IVP is favored in those situations in which the lateral ventricles are enlarged and SaP is preferred in the cases of brain swelling or other situations in which there is a small ventricular system.


Surgical treatment of subdural effusions in infants. We puropose a simplified method for external drainage of subdural effusions in infants, not calling for a second operation to remove the catheters. This method allows the daily control of evacuated fluid, guarantees smooth and uninterrupted drainage, and permits analysis of the subdural collection. This operation which we would like to call external controlled drainage, does not call for parenteral feeding, but demands paediatric and neurosurgical collaboration. The method has no pretensions other than being simple, easy, and safe.


Clinical study of chronic arachnoiditis in the posterior fossa. A series of 12 cases of chronic arachnoiditis in the posterior fossa is reported. The diagnosis in six patients was established at suboccipital craniectomy whch brought about marked improvement in symptoms. The other six were diagnosed as having arachnoiditis in the posterior fossa from the facts that improvement in clinical symptoms was achieved by lumbar air insufflation, which has often been said to be effective in arachnoiditis, and no abnormal findings were revealed by pneumoencephalo-roulette tomography. By investigating the clinical features of these cases, we came to the following conclusions: many cases of this disease have had head trauma or chronic inflammatory disease in the past; the symptoms are apt to occur abruptly, and display repeated remission and aggravation; symptoms originating in the cranial nerves are diversified, and are often bilaterial; peripheral vestibular disturbances and retrocochlear hearing losses are observed on neuro-otological examination. In the caloric test especially the patients show canal paresis (CP) on the more impaired side, but none of them appeared to be nonresponsive to the test; lumbar air insufflation is often an effective treatment for this disease; pneumoencephalo-roulette tomography is very useful for diagnosing pathological changes in the posterior fossa.


[Topgraphical classification of craniopharyngioma]. Squamous cell nests of Erdheim have been observed along the lateral blood vessels to the adenohypophysis in 4 cases. Their developmental origin and topographical distribution correlate with the sites in which craniopharyngiomas are found. The theory of dysontogenic origin of cranopharyngiomas is supported by these findings. Metaplasia of cells of the adenohypophysis is not considered to be a likely cause of craniopharyngioma formation.


[Pulmonary changes in cranio-cerebral injuries and respiration with high oxygen concentrations]. In 131 cases of craniocerebral trauma it was shown in what respect definite changes in the lungs, demonstrated by clinical course, radiographs and blood gas analyses, occurred in proportion to the severity of the trauma. The causes of these changes were considered and the possibility of complicating the course of the illness by administering oxygen in high concentrations was investigated. In 98 patients was an indication for treatment with a respirator. 41 patients were so treated for longer than 5 days (mean 17.7 days). The need for respirator treatment rose with the increasing severity of the trauma. Frequency and severity of tracheobronchial aspiration increased in proportion to the depth of unconsciousness. It occurred in 50-60% of cases with severe trauma. Minor pulmonary lesions developed in 13% of those patients who only had minor disturbances of consciousness. Patients who had aspirated had lower arterial oxygen tensions than those who had not aspirated. In a high percentage of cases considerable improvement could be achieved, despite lung changes. In patients treated with the respirator mean inspiratory oxygen concentrations of 75% were necessary to achieve arterial oxygen tensions of 150-200 mm Hg. No evidence of oxygen toxicity was found, despite long periods of treatment with high oxygen concentrations. Very often cases of craniocerebral injury are followed both by tracheobronchial aspiration, causing lung damage, hypoxia and acidosis, and by disturbances of coagulation. These disorders are to be considered as most important, each needing specific therapy.


Effects outflow tract obstruction on total and regional coronary blood flow, and its influence on ventricular function. Animal experiments suggest a model of coronary blood flow in which left ventricular subendocardial muscle is perfused only in diastole, while more superficial muscle is perfused throughout the cardiac cycle. Once maximal coronary vasodilatation has occured, subendocardial flow per minute depends on the area between aortic and left ventricular diastolic pressure time heart rate [DPTI per minute]. Since left ventricular oxygen needs are related to the area under the left ventricular pressure curve in systole [SPTI], the ratio DPTI/SPTI reflects balance between myocardial oxygen supply and demand. Marked reduction in the ratio causes relative subendocardial ischemia which can be predicted from teh ratio. There is evidence that outflow tract obstructions in man also cause subendocardial ischemia by similar mechanisms, and that this ischemia occurs despite normal coronary arteries.


Indications for and resluts of tricuspid valve replacement. A review of our experience with tricuspid valve replacement over a 7.5-year period is presented. Isolated disease of the tricuspid valve was encountered infrequently [8 of 87 patients] and was due to a variety of causes. In the remaining cases, the tricuspid disease was associated with rheumatic valvular disease of the mitral and/or aortic valves. The hospital mortality for the entire group of patients was 22%, and the late mortality during a mean follow-up of 32 months was 16%. Operative and late mortality were clearly affected by the severity of myocardial dysfunction present preoperativley. Problems related to the prosthetic valves and to anticoagulant therapy were relatively few. Our present indications for replacement of the tricuspid valve and presented. Earlier operative intervention in patients with tricuspid valvular disease should improve the early and long-term results.


Indications for and results of surgery in congenital aortic stenosis. All of the follow-up data indicate that aortic valvotomy is a safe and effective means of treatment. No instances of sudden death have been observed during the postoperative follow-up period. Of course, additional long-term studies of the results of surgery are indicated and it is certainly possible that the current criteria relating to indications for hemodynamic study and operation may well require modification in the future.


Debate on valvular heart disease. Con: early surgical intervention in valvular heart disease. Patients with valvular heart disease, particularly aortic and mitral incompetence, may have significant derangement of myocardial function, often in the absence of significant symptoms, which directly affects early and late survival and functional status following valve replacement. With declining hospital mortiality rates and improved valvular prostheses, consideration must be given to valve replacement in patients of this type in order to preserve myocardial function. This should improve long-term survival and the functional results following valve replacement. Attention should be directed to identifying and closely observing patients of this type, perhaps with noninvasive techniques, and proceeding with valve replacement before irreversible myocardial damage has occured.


Indications for and results of surgery in ventricular septal defects. Surgical closure of VSDs is indicated mainly for those that are larger and causing either servere congestive heart failure or else pulmonary vascular disease. The latter, producing an increased pulmonary vascular resistance, is usually reversible if the VSD is closed under 2 years of age, but may become irreversible if left for longer times. Primary closure of the VSD, even in infants is in many centers done with a lower mortality than banding of the pulmonary artery and late VSD repair. Selection of patients needs great care because VSDs frequently get smaller or close spontaneously, even if initially large.


Interpretation and limitations in stress testing. In summary, although exercise is, as is every other procedure, imperfect with regard to sensitivity and specificity, it provides an invalualbe adjunct in the evaluation of patients with coronary disease. The test is simple, inexpensive, safe and rapidly performed and is an invaluable aid in screening patients with possible coronary disease. It is used in an asymptomatic population for industrial purposes, is useful in assessing the etiology of otherwise undiagnosed chest pain, helpful in evaluating the overall severity of ischemia [and therefore in culling-out those patients that might benefit from coronary angiography], is useful in following the course of patients with proven coronary disease [including those with acute myocardial infarction], and has found a place in the follow-up evaluation of individuals having aortocoronary bypass surgery. As a screening procedure, the treadmill test aids in seeking out that group of patients with coronary disease with potentially malignant lesions, i.e. main left coronary lesions, triple-vessel disease and [to a lesser extent] severe proximal left anterior descending coronary disease. Hence, the finding of marked depth of ST depression, prolonged duration of ischemia associated with deep ST segments, serious exercise-induced ventricular arrhythmias and hypotension produced during mild-to-moderate exercise might each be an indication of extensive coronary angiography. In many cases exercise testing is superior to coronary angiography, being a simpler, safer screening procedure, and a more functional test in documenting the presence or absence of coronary insufficiency.


Study of drugs affecting cholesterol-induced atherosclerosis in rabbits. 1. Effects of various drugs on cholesterol-induced atherosclerosis in rabbits during the progression phase have been studied. The drugs tested are antimetabolites (mercaptopurine, hydroxyurea), surface active agents (sodiumdodecyl sulfate), inhibitor of adrenocoritcal steroid synthesis (o, p'-DDD), lysosome stablizers (chloroquine, acetylsalicylic acid) with antihistaminic (chlorpheniramine) and cholesterol binder (nystatin). 2. Mercaptopurine treatment showed marekd reduction in both atherosclerotic lesions and cholesterol concentrations of the serum and aorta. 3. Hydroxyurea reduced both the aortic cholesterol concentration and the lesions, but the serum cholesterol concentration remained high. 4. Sodiumdodecyl sulfate and o, o'-DDD showed slight inhibition of the development of atherosclerosis. 5. Pyridinocarbamate showed a slight beneficial effect on the prevention of atherosclerosis only when it was administered prior to the meal. 6. Nystatin, chloroquine and acetylsalicylic acid + chlorpheniramine showed little effect.


Cholestero metabolism in rats sensitive to high cholesterol diet. There was great individual variation in the elevations of serum cholesterol concentrations in a Wistar strain of rats by the ingestion of a large amount of cholesterol, although their cholesterol concentrations were almost identical while under the feeding of a regular stock diet. Their serum total phospholipid and dextran precipitable beta-lipoproteins showed the same tendencies, but serum triglycerids concentration was not affected by the dietary supplement in both groups. So, the rats with the different elevation rates of serum cholesterol concentrations were divided into good, normo and poor responding groups to cholesterol ingestion by the degrees of the elvations and bred for several generations. Serum lipid levels in the descendants from hyperresponding rats were not different from those from hyporesponding rats during the observed period, when they were given a stock diet. However, the response of serum cholesterol level to oral cholesterol ingestion in the former was larger than that in the latter. Therefore, it is suggested that the susceptibility of serum cholesterol to cholesterol ingestion may be heritable from parents to their offsprings. By the results of the tracer experiments, it was demonstrated that neither hepatic cholesterol synthesis nor absorption was affected in hyperresponding rats. On the other hand, a half life of labeled cholesterol was prolonged in this selected group. The relative fractional turnover rate was 17.8 per cent in hyporesponding rats and 15.8 per cent in hyperresponding rats. Excretion of the radioactivity from labeled cholesterol into the bile in good responding rats with bile fistula was slower than that in poor responding rats. When 1 g per 100 g body weight of glucose was given to the rats after 40 hours fasting, hepatic cholesterol synthesis increased at the same rate in both groups of rats, but the induction of hepatic cholesterol 7alpha-hydroxylation in hyperresponding groups was slower than that in hyporesponding groups. The distribution rates of the radioactivities into livers seemed to be delayed in good responders after the labeled cholesterol was ingested orally.It means that some disturbances in cholesterol transport may exist which induce the metabolic abnormality in such animals. It was shown that cholesterol metabolism was impaired in aged animals as compared with young ones. Serum cholesterol concentrations were elevated in good responders more than in poor responders by aging. The inborn errors of cholesterol metabolism in such animals might be emphasized from the fact of the impairment of cholesterol metabolism by the aging process.


Produced by selective breeding of Japanese quail animal model for experimental atherosclerosis. The Japanese quail (Coturnix coturnix japonica) was bred selectively to produce a strain highly susceptible to experimental atherosclerosis. A population was produced where aortic atherosclerosis is contracted by 99% of the fourth generation males and 83% of the femlaes. Forty-three percent of the males exhibited severe atherosclerosis making this line of Japanese quail a suitable model for discovering and testing anti-atherosclerosis compounds. This feature is augmented by other features such as size, disposition, and abundance which qualify them as suitable experimental subjects. A second line of Japanese quail was bred to be resistant to dietary-induced atherosclerosis. This strain may be a useful research tool for characterizing the etiology of atherosclerosis.


A mechanism for lipid accumulation and central necrosis in fibrous plaques. This is a step section study of 3 fibrous plaques from the abdominal aorta of an ostrich. The distribution of gelatinous like lesions in these plaques suggested that the gelatinous lesions were formed by the influx of plasma at the plaque shoulders. Two gelatinous lesions extended like tunnels into the center of one of the plaques. The presence of focal necrosis and large cholesterol crystals in one of these gelatinous tunnels deep within the plaque suggested that gelatinous lesions might represent one mechanism by which fibrous plaques are converted to atheromatous plaques.


The baboon in atherosclerosis research: comparison with other species and use in testing drugs affecting lipid metabolism. Despite the deomnstration of spontaneous atherosclerosis in the wild state, the baboon is not the best species for the production of atherosclerosis experimentally since it develops only a mild hypercholesterolaemia when fed cholesterol. Nevertheless, it is useful for the study of mild lipid deposition in the aorta and the effect of drugs thereon, particularly if protein antigens are also employed in addition. For studies of the hypocholesterolaemic effect of potential therapeutic compounds in man, the baboon fed a high protein commercial diet, with and without cholesterol, is a useful second species to smaller laboratory animals.


Factors predicting mortality in the elderly in the community. Factors which best predict mortality within five years have been examined in a random community sample of 852 people over 65. Apart from sex, multiple-regression analysis shows the best predictive factors to be higher age and the occurrence of proteinuria in both sexes. In men, low vitamin c intake and an unfavourable clinician's assessment of the subject's health were also significant predictors. In women, whether the subject was housebound, the diagnoses of stroke and of diabetes and a low serum pyridoxine were additional adverse factors. The findings regarding low vitamin C intake in men and low serum pyridoxine levels in women should be regarded with caution. The former appears unlikely to represent a true vitamin deficiency effect and whilst the latter might, the evidence is no more than suggestive and further confirmatory studies are required.


Red-blood-cell potassium and hand-grip strength in healthy elderly people. Red-blood-cell potassium (RBCK) as an indicator of body potassium status was measured in 103 healthy elderly subjects over the age of 65 years. There was no correlation between RBCK and grip strength. The only significant predictors of grip strength were age and sex. The RBCK values formed a single normal distribution. There was no hypokalaemic subpopulation such as would be expected if potassium deficiency were common in these old people.


The causes of osteomalacia in the elderly. Investigations into the causes of osteomalacia in 12 geriatric patients with a histologically proven diagnosis, revealed no predominant aetiology. The metabolic bone disease in these patients appeared to have multifactorial causes in at least half the cases.


Myocardial contractility in aged rats.

Myocardial contractility in aged rats. The elastic and mechanical behaviour of isolated papillar muscle was studied in aged and in young rats. The spontaneous fall in tension (stress relaxation phenomenon) and the duration of the active state of the contractile element during the isometric and isotonic contraction were greater in aged than in young rats. The elastic properties of the elements in parallel and in series and the intensity of the active state in the contractile elements, on the contrary, did not exhibit any significant difference between aged and young rats.


Caring for relatives of stroke patients. The methods used by the Rehabilitation Unit of the Repatriation General Hospital, Daw Park, to involve relatives of stroke patients in the rehabilitation process are outlined. The use of group therapy techniques for relatives is described and the issues commonly encountered are discussed. The value of the group meetings for relatives and staff is emphasized.


Sweat responses in the aged.

Sweat responses in the aged. The sweating responses to thermal stimulation and to the intradermal injection of acetyl choline or methacholine were measured in 28 men and 18 women aged 70 and over and were compared with the responses in young control subjects of both sexes. There was found to be a marked reduction in the sweating activity of the majority of aged men in comparison with the younger age groups and the body temperature threshold for the onset of sweating was increased. The reduced response and elevated threshold were even more pronounced in aged females. There is considerable variability in response in different subjects and at different bodily sites. Impairment of thermoregulatory function due to diminished or absent sweating is thought to be one of the factors responsible for increased mortality in the elderly population during heat-waves.


Recognizing oral lesions.

Recognizing oral lesions. Common benign lesions include hemagniomas and congenital cysts, pyogenic granuloma, aphthous ulcer, fibromas and changes produced by drugs. Many of these are self-limited and of little consequence. The point of the careful examination is the early detection of oral cancer. Only one patient in three with oral cavity cancer is cured. Premalignant and early asymptomatic lesions must be detected. Recognize the high-risk patient and examine the oral cavity meticulously.


Psychiatric aspects of intestinal bypass surgery for obesity. Intestinal bypass patients were studied six and 30 months postoperatively with regard to medical morbidity, weight loss and psychologic and behavioral adjustments. In general, at 30 months they were more stable and productive. Their expectations in terms of weight loss and psychologic changes may not have been met; yet, a majority of them have recommended the operation to others. Preoperative selection criteria will help physicians choose good candidates and discourage the others. Long-term follow-up is essential.


Injuries from rotary power lawnmowers.

Injuries from rotary power lawnmowers. Injuries from power lawnmowers most frequently involve the toes or the foot. The most common injury is caused by an extremity being caught in the moving parts of the machine. The greatest injury is to the skin and soft tissue by degloving or avulsion. Most of these injuries, especially those which occur to children who are passengers on self-propelled mowers, are preventable by observance of simple precautions.


Medical management of urolithiasis.

Medical management of urolithiasis. Knowledge of the crystalline structure of the calculus provides the basis of the therapeutic plan. Laboratory evaluation depends heavily upon routine urinalysis. Assessment of renal function, serum calcium, phosphorus, uric acid and, in some cases electrolytes is usually indicated, as is urography. General principles of management include maintenance of an ample urine volume, eradication of infection and correction of any obstructing lesions or metabolic abnormalities. Specific antistone regimens are indicated for patients with recurrent urolithiasis.


Physostigmine treatment of delirium induced by anticholinergics. Medication with anticholinergic properties are used commonly in family practice. Toxic delirium, which may resemble an acute psychosis, can occur as an adverse drug reaction to properly prescribed anticholingeric medication and to recommended doses of many patent medicines. More frequently it is due to overdosage. The key to diagnosis is the presence of peripheral signs of parasympathetic blockade. Delirium induced by anticholinergic drugs can be treated rapidly and effectively with physostigmine salicylate.


Stress fractures.

Stress fractures. Stress fractures, well-known occurrences in military recruits, also occur in civilians. There is a gradual alteration of the bone resulting from repeated unaccustomed stresses. Pain usually precedes positive x-rays by one to two weeks. Serial films are therefore required. Differential diagnosis can be a problem but treatment is simple. Femoral neck stress fractures can become complicated.


Group care for psychiatric patients.

Group care for psychiatric patients. The family physician and one or two office staff members or associates can conveniently and effectively provide ongoing care for a large group of reasonably stable, yet severely disturbed, psychiatric patients. The main goal is to promote successful integration into meaningful family and community relationships. In many cases, the family physician is the most appropriate health professional to provide this care, due to his knowledge of the patient's family, community situation and physical health.


Psychologic factors associated with obesity. Obesity, particularly of the juvenile-onset type, is often associated with anger and anxiety underlying a facade of joviality. There may be marked disturbances of body image. Regardless of whether psychologic factors are the cause or result of obesity, they must be considered if efforts at weight reduction are to be successful. Substitutes for the gratification of food must be provided.


Evaluation of the infertile couple.

Evaluation of the infertile couple. Infertility may be caused by gross pelvic pathology, difficulties with insemination of the cervix and uterine cavity, partial or complete occlusion of the fallopian tubes, female endocrine abnormalities or male factors. Some forms of pelvic pathology as well as some tubal occlusions are amenable to surgical correction. Clomiphene citrate has given good results in some patients with endocrine abnormalities.


Atrial T(Ta) wave and atrial gradient in patients with A-V block. The P and the Ta waves of two patient groups with A-V block were magnified with a direct-current amplifier and recorded at a high paper speed. In Group A patients (those without serious cardiovascular complications except A-V block) the P and the Ta waves were recorded in the opposite direction in every lead and there was a linear relationship between the amplitude of the P and the Ta waves. The atrial gradient was nearly zero. There existed a positive correlation between the P + Ta time and the P-P interval. In Group B patients (those with serious cardiovascular complications besides A-V block) there were significant differences in the Ta wave from Group A with respect to form, polarity, amplitude, duration, and the relationship between the Ta and the P waves. The atrial gradient was markedly large. Careful attention should be paid to the deviation of the PQ segment caused by the Ta wave in daily ECG's to detect atrial abnormalities. The Ta wave extends into the ST segment and, while describing the deviation of the ST segment, the influence of the Ta wave should be kept in mind.


The effects of smoking on myocardial conduction in the human heart. Inhalation of a few puffs on a cigarette increases the velocity of conduction and shortens the effective refractory period of the A-V node. These effects are attributed to adrenergic stimulation produced by minute amounts of nicotine absorbed. Wenckebach block is abolished whether induced by atrial pacing or occurring spontaneously. Conduction velocity in the His-Purkinje system and in the anomalous pathways in the WPW syndrome were not affected. Smoking increases the ventricular rate in atrial fibrillation, and antagonizes the cholinergic effects of digitalis.


Comparison of selective left ventriculograms with levophase ("forward") ventriculograms in patients with  coronary artery disease. In order to compare levophase ("forward") ventriculograms to standard (selective) LV cineangiography, 10 patients with coronary artery disease were studied by (1) selective injection of contrast medium into the LV cavity followed by (2) injection into the right ventricle and filming the levophase. Biplane cineangiograms were used to calculate the end-diastolic volume index (EDVI), end-systolic volume index (ESVI), stroke volume index (SVI), and ejection fraction (EF). Values for the two respective techniques were then compared. Not only were correlation coefficients for the two methods low, but there was also a statistically significant difference between the two SVI (66 +/- 26 ml. for selective and 53 +/- 25 ml. for levophase injection; p less than 0.02) and the two EF (67 +/- 7 per cent for selective and 52 +/- 12 per cent for levophase injection; p less than 0.01). Levophase cineangiograms therefore significantly underestimate the LV ejection fraction when compared to standard (selective) LV cineangiography. These differences must be considered when evaluating greatly divergent interinstitutional survival rates for patients with low EF who undergo coronary artery bypass surgery, and when selecting candidates for bypass surgery on the basis of the angiographic data.


Relationship between duration of systolic upstroke of apexcardiogram and internal indexes of myocardial function in man. In 11 patients with nonobstructive cardiomyopathy and coronary heart disease and decreased myocardial function of the left ventricle, as well as in nine patients without left heart valvular or myocardial disease, left apexcardiograms were recorded during diagnostic heart catheterization, wherein micromanometers were used; ACG's were registered additionally in 54 healthy volunteers in order to establish the normal range of apexcardiographic parameters. In all cases the apex tracings were recorded by means of a pulse transducer with infinite time constant. The most important finding of this study was the close correlation between the duration of the systolic upstroke (SUT) of the apex tracing and some accepted isovolumic indexes of  left heart function (isovolumic contraction time, time interval from the onset to peak of the first derivative of left ventricular pressure, maximal value of the first derivative of left ventricular pressure, and the peak measured velocity of shortening of the contractile elements). Further, the mean value of SUT in patients with impaired left myocardial function was significantly prolonged, compared to the control subjects; an overlap was apparent due to the fact that some of these patients showed a normal left myocardial performance at rest, having an abnormal response only to exercise tests. The apexcardiographic SUT can practically always be measured when the first derivative of apex tracing is simultaneously recorded. It showed itself to be only slightly influenced by the resting heart rate. The mentioned relationship of the systolic upstroke time of the ACG to internal isovolumic indexes of myocardial function makes this noninvasive measurable parameter an additional excellent tool for the evaluation of the left myocardial state, thus supporting a new aspect of the value of quantitative apexcardiography.


"New" treatment for chronic intractable congestive heart failure. The use of hexamethonium injected intravenously in successive 2.5 mg. doses resulted  in alpha-adrenergic sympathetic nerve blocking and associated peripheral vasodilation with dramatic improvement of the symptoms and signs in patients with marked chronic intractable CHF. The vasodilatating effect of the drug is simple to  monitor at the bedside and serves as an effective, simple means to "bleed" the patient intravenously by decreasing systemic venous tone and reducing the wall stress in the vessels. This intravenous "bleeding" results in a shifting of excessive blood from the lungs and central systemic venous areas to the larger volume of the more peripheral systemic venous reservoirs. Rheoplethysmorgraphic recordings of digital blood flow in the fingertips of the patients revealed marked constriction of all vessels of the fingers during CHF. Hexamethonium dilated all these vessels and increased digital blood flow even though arterial blood pressure was reduced by the drug. Theoretic discussions of aspects of the mechanism of congestive heart failure of the two-pump system of the heart of man and the mechanical or hemodynamic advantages of the small veins over the larger centrally located veins tend to explain why the use of hexamethonium benefits the circulation by producing vendoilatation. These studies indicate the therapeutic usefulness of hexamethonium in the management of acute and chronic intractable CHF and provides physiologic and theoretic data to explain why the drug is effective.


Therapeutic implications of diazepam in patients with elevated left ventricular filling pressure. Diazepam (0.1 mg. per kilogram) was given intravenously to 12 patients with hemodynamic left ventricular failure at the time of cardiac catheterization. Anxiety was effectively relieved in 10 patients. Systemic and coronary hemodynamic parameters were assessed before and 5 and 15 minutes after diazepam. Heart rate, cardiac index, and left ventricular stroke-work index did not change significantly. Mean aortic pressure decreased in all patients (average of 10 mm. Hg) and left ventricular end-diastolic pressure (LVEDP) decreased from a mean +/- S.E.M. of 24.3 +/- 3 mm. Hg at rest to 16 +/- 2.1 at 5 minutes (p less than 0.001)  and 15.8 +/- 2.1 at 5 minutes (p less than 0.002). Left ventricular angiography performed 30 minutes after diazepam did not increase LVEDP above the pre-diazepam control value. Systolic ejection period and tension-time index also decreased significantly after diazepam. Coronary hemodynamics and myocardial metabolism were unaltered by diazepam. The fall in LVEDP induced by diazepam is probably secondary to a decrease in arterial pressure (afterload) possibly associated with a decrease in venous return (preload). Our data therefore suggest that diazepam exerts a beneficial action on depressed left ventricular function and, thus, may be a sedative agent of choice in patients with myocardial infarction and heart failure.


Improved sinus node sensing after atropine. Although atropine is known to increase sinus rate through its vagolytic effect, the effects of atropine on sinus node sensing are unknown. The purpose of this study was to investigate alterations in sinus node sensing produced by atropine. Measurement of the zone of sinus node reset and sinoatrial conduction time was performed in 10 patients by programmed premature atrial stimulation. The zone of sinus node reset was determined as the transition point where premature atrial stimuli were followed by a less than compensatory pause. Sinoatrial conduction time was calculated from sinus node return cycles in the area where sinus node reset occurred. Atropine administration produced a significant increase in the percentage of the sinus cycle length at which premature atrial contractions penetrated and reset the sinus node. Sinus node reset occurred at a mean percentage of the sinus cycle of 71 +/- 8 per cent before atropine and 83 +/- 5 per cent after atropine (P less 0.01). The sinoatrial conduction time was significantly reduced from 109 +/- 29 to 62 +/- 23 msec. (P less than 0.01) from atropine as sinus cycle length was reduced from 909 +/- 118 to 642 +/- 75 msec. after atropine. Sinus node echoes were observed in two patients. In one patient atropine abolished the appearance of sinus node echoes. In the second patient atropine reduced the coupling interval necessary to produce sinus node echoes but appeared to facilitate sinus node re-entry by the appearance of an additional sinus node echo and a reduction in the echo cycle length. This study demonstrates that atropine produces significant improvement of sinus node sensing in man.


Residual effects when chronic propranolol therapy is discontinued within 48 hours of cardiopulmonary bypass. Recommendations regarding the safe waiting period between discontinuing chronic oral propranolol therapy and beginning cardiopulmonary bypass have varied from a few hours to 2 weeks. In the present study, utilizing adult dogs, propranolol was discontinued 8 or 48 hours prior to surgery. A reduction in cardiac output and elevations of left ventricular end-diastolic pressure, peak systolic pressure, and systemic resistance were noted when cardiac function was evaluated following the induction of anesthesia and prior to undertaking cardiopulmonary bypass. The magnitude of these differences was directly related to the degree of volume loading and inversely related to the interval between the last dose of propranol and the determination of cardiac function. Reduction of heart rate was the most evanescent of propranolol's hemodynamic effects as the marked bradycardia which persisted throughout the course of propranolol therapy was no longer evident 8 hours after the last oral dose of the drug. Following total cardiopulmonary bypass of 1 hour's duration, undertaken 8 hours after the last oral dose of propranolol, cardiac output and left ventricular end-diastolic pressure had returned to normal but peak systolic pressure and systemic resistance remained significantly elevated, When 48 hours had elapsed between discontinuing propranolol and beginning cardiopulmonary bypass, postbypass cardiac function was essentially normal with only slight persistent elevations of peak systolic pressure and systemic resistance detected. When the combined effects of ischemic heart disease and propranolol therapy, the altered metabolic and hemodynamic effects of different routes of drug administration, and the varying durations of cardiopulmonary bypass are taken into consideration, some of the discrepancies between previously reported clinical and experimental findings regarding the duration of persistent propranolol effects can be understood. The clinical course is usually benign in patients who have received propranolol to within a few hours of surgery without specific indication. However, it is often complicated when the drug is continued until just prior to surgery in patients dependant on propranolol for pain or arrhythmia control. In patients demonstrating propranolol dependence, control of symptoms with intra-aortic balloon counterpulsation is recommended followed by the gradual withdrawal of propranolol and elective aortocoronary bypass surgery.


Attacks of ventricular fibrillation and unconsciousness in a patient with prolonged QT interval. A family study. A syndrome previously recognized by Romano and Ward is characterized by prolonged QT interval on the ECG, and spells of unconsciousness. The case of a patient is reported with successive ECG recordings during the attacks; ventricular flutter and multifocal ventricular tachycardia were noted, with rapid spontaneous recovery and relapse. Cases of stillbirth and sudden death in infancy among the siblings, together with QT interval tachycardia were noted, with rapid spontaneous recovery and relapse. Cases of stillbirth and sudden death ininfancy among the siblings, together with QT interval prolongation in the relatives point to an autosomal dominant transmission, with the propositus being apparently homozygous. The chromosomes of the patient are normal. The attacks were controlled by the association of propranolol and digitalis which seems to be the optimal long-term therapy in such cases. In view of the poor prognosis in untreated cases, and the good results of a correct therapy, an ECG should be recorded at rest and after exercise in all children suffering from spells of unconsciousness.


Particle size distribution and chemical composition of coal-tar fumes. The study was intended to characterize the chemical and physical nature of coal-tar fumes emitted from spreading applications of coal tar. Two separate experiments were performed. The first resulted in the determination of a coal-tar fume particle size distribution. The second experiment resulted in the identification of the primary compounds found in collected tar fumes and a determination of their relative concentration.


Respirator cartridge efficiency studies: VI. Effect of concentration. The service life of organic vapor cartridges was determined for ten vapors at concentrations between 50 and 3000 ppm. The breakthrough time (tb) conformed to the empirical expression tb = aCf, where C is the concentration in ppm and a and be are constants. The average value for b at 10% breakthrough was -0.67 +/- 0.17. The service life is inversely proportional to flow rate for acetone and benzene.


Health hazards from oil, soot and metals at a hot forging operation. An extensive study of a hot forging operation was performed to characterize and quantitate worker exposures to the aerosol formed by an oil-based die lubricant and it's decomposition products. Total particulate breathing zone levels up to 65 mg/m3 and benzo (a) pyrene levels up to 2.9 mug/m3 were measured.


Investigation of sound level conversion as a means of rating ear protector performance. Sound level conversion, a single-number measure describing the noise reduction afforded by ear protectors, was calculated for 30 ear protectors in 615 industrial noise spectra. The results vindicate the utility of this measure for situations in which the noise hazard is characterised only by C- and A-weighted sound levels. A simple procedure for calculating SLC, accurate within +/- 1dB, is proposed. Minor adjustments of the calculation procedure enable wearer protection rates in the range 50% to 97% to be achieved.


Occupational aspects of passive smoking. Peak carbon monoxide levels of 30 ppm were found during a work shift in a poorly ventilated tavern. A time-weighted average concentration of 17 ppm CO was found as well as elevated particulate levels. The occupational exposure to cigarette effluents is discussed in light of OSHA regulations.


Gas chromatographic determination of acetic acid in industrial atmosphere and waste water. A gas chromatographic (GC) method is presented for the specific determination of acetic acid in air and total ionic acetate (as acetic acid) in industrial waste water. Atmospheric air samples are collected in fritted midget bubblers containing aqueous sodium carbonate solution; wastewater samples are treated directly with sodium carbonate. Both air and water samples are concentrated by evaporation of water, and the acetic acid is regenerated by the addition of hydrochloric acid. The amount of acetic acid is determined quantitatively on a porous polymer packed column by internal standardization with propionic acid. GC conditions are described for the suppression of "ghosting" and "tailing" caused by adsorption phenomena associated with the GC behavior of organic acids.


The effect of general fatigue on isometric strength-endurance measurements and the electromyogram of the biceps brachii. Contraction strength, endurance and the electromyogram of the biceps brachii were examined following treadmill exercise at 50 and 60% of maximum aerobic capacity. Exercise did not exert a significant influence on any of these parameters indicating they are relatively insensitive indicators of general fatigue.


Respirator cartridge efficiency studies: VII. Effect of relative humidity and temperature. Cartridge service life is not appreciably affected at relative humidities below 50%. However, performance is severely compromised when the humidity exceeds 65%. Experimental values are compared from those calculated from the adsorption isotherm, Mecklenburg and modified Wheeler equations. Calculations indicate that temperature does not play a significant role in service life predictions.


A summary of the NIOSH evaluation program of portable direct-reading meters. The National Institute for Occupation Safety and Health (NIOSH) has developed a program to evaluate portable, direct-reading instruments. The results of these evaluations for CO, SO2, combustible gas, and NO2 instruments are reported. Realistic performance specifications have been developed for each of these types of instruments.


Characterization of talc and associated minerals. The unequivocal identification of mineral impurities in talc requires definitive analytical techniques due to the very similar structure of many naturally occurring silicates and the small quantities of associated minerals frequently found. The instrumental methods and techniques extant for this purpose are reviewed. Light microscopy, x-ray diffractometry, and differential thermal analysis have been found to be particularly useful, complementary, and practical for both exploratory and routine determinations of mineral impurities in the talc matrix. When necessary, transmission electron microscopy is recommended for the analysis of mineral components present at sub-trace levels.


In-home measurement of background particles and particulates and propellents produced by an air freshener. When an aerosol product is dispensed into the atmosphere a mixture of particles and propellent gases is released. The potential exposures resulting from normal use were measured and compared to the background and the exposure of the healthy industrial worker. This model can serve as a guide for assessing use exposures of aerosol products.


Improved hopcalite procedure for the determination of mercury vapor in air by flameless atomic absorption. Mercury vapor is efficiently trapped from air by passage through a small glass tube filled with hopcalite. The hopcalite and adsorbed mercury are dissolved in a mixture of nitric and hydrochloric acids. Solution is rapid and complete, with no loss of mercury. Analysis is completed by flameless atomic absorption.


Vacu-Samplers, a simple method for taking accurate quantitative gas and vapor samples using partially evacuated steel containers. The Vacu-Sampler, a partially evacuated steel cylinder, has been widely used as a diagnostic industrial hygiene sampling system. This study examines the rational behind the Vacu-Sampler and two simple, quantitative procedures that can be used to obtain accurate sample results in ppm with gas chromatographic analysis.


Impaired parasympathetic responses in patients after myocardial infarction. To assess whether vagal and sympathetic responses are impaired 3 months after myocardial infarction, 27 patients, 15 age-matched control subjects and 13 young normal subjects underwent physiologic stress tests. In patients, facial immersion in water at 25 degrees and 0 degrees C provoked less slowing of heart rate than in age-matched control subjects. Young normal persons responded with the greatest reduction in heart rate. Response to facial immersion decreased linearly with age in normal subjects (Y = -0.97X+86). Isometric handgrip or cold pressor test elicited brisk increases in blood pressure in almost all patients, but the vagal response to facial immersion correlated poorly with such pressor responses. Thus, in the patients studied 3 months after myocardial infarction, the parasympathetic response to facial immersion was significantly impaired whereas sympathetic pressor responses remained intact.


Pacemaker failures characterized by continuous direct current leakage. Pulse generator failure caused by continuous leakage of direct current through an output capacitor has not previously been appreciated. Routine post-explant electronic evaluation has identified the defect in six implanted and one external pulse generator. The constant direct current in the implantable units, 0.14 to 0.26 milliamperes, is in the range that produces ventricular arrhythmias in dogs although this did not occur in our patients. Evidence of local myocardial damage existed in four cases and of electrode deterioration in three. The implant failures occurred without warning and in four cases within 2 weeks of demonstrated normal function, blunting the predictive benefits of pacemaker monitoring programs. Capacitor discharge circuits used in many pacers are inherently capable of developing direct current leakage in the event of output capacitor short circuit. In one model of pacemakers such continuous direct current leakage caused 8.3 percent (3 of 36) of pulse generator failures, widely scattered in time at 23, 27 and 46 months after implant. Capacitor short circuit causing constant direct current leakage can masquerade as primary battery failure and should be suspected when cessation of pacer function is associated with increased threshold or poor myocardial electrogram without evidence of wire break or displacement.


Effects of unilateral cardiac sympathetic denervation on the ventricular fibrillation threshold. A train of gated stimuli scanning the entire vulnerable period was delivered to the right anterior or left posterior ventricular surface to study the ventricular fibrillation threshold in anesthetized and vagotomized dogs. Heart rate was held constant by atrial pacing. Measurements were obtained in control conditions and after surgical removal of one stellate ganglion. To avoid the shortcomings associated with an irreversible procedure like stellectomy, control fibrillation threshold measurements were also alternated with determinations during reversible blockade by cooling of one stellate ganglion. The results were similar with both techniques. In nine animals, ablation or cooling of the left stellate ganglion increased ventricular fibrillation threshold by 72 +/- 35 (mean +/- standard deviation) percent compared with control values (P less than 0.001). By contrast, in 11 animals, ablation or cooling of the right stellate ganglion lowered the threshold by 48 +/- 14 percent compared with control values (P less than 0.001). Electrode location did not influence the results. The observed changes depended solely upon unilateral removal of cardiac sympathetic activity and were not demonstrable if such activity was low. These results suggest that right and left cardiac sympathetic nerves may have different and specific effects on cardiac excitability. They also contribute to the understanding of the pathogenesis of the long Q-T syndrome (characterized by episodes of ventricular fibrillation associated with increased sympathetic activity) and increase the rationale for left stellectomy as the specific treatment for this illness. Left stellectomy, by raising the ventricular fibrillation threshold, may also represent an alternative measure in patients at high risk of sudden death from ventricular arrhythmias resistant to medical therapy.


Activation of left ventricular receptors with nonmedullated vagal afferent fibers during occlusion of a coronary artery in the cat. Studies were made of the effects of temporary occlusion of a coronary artery on the activity of nonmedullated afferent vagal fibers from the left ventricle of 15 cats. Recordings were made from 14 single fibers and 4 filaments with 2 to 3 fibers dissected from the right vagus. Their normal activity averaged 1.8 impulses/sec, and they were identified by an increase in activity to 4 to 17 impulses/sec during a brief occlusion of the aorta and by a conduction velocity of 0.6 to 1.3 m/sec (mean 0.9). The receptors studied were distributed throughout the ventricle, as determined by mechanical probing of the nonbeating heart at the end of the experiments. With a 1 to 1.5 minute occlusion of a coronary artery, the activity of receptors within the area supplied by that artery increased in concert with the systolic bulging of the ischemic area. The initial increase in activity occurred during systole, suggesting that the receptors were activated mechanically rather than by chemical changes in the ischemic zone. The activity soon became continuous, reaching a maximum of 15.4 impulses/sec (mean value). The maximal activity was not sustained; during occlusion of up to 40 minutes it decreased to 5 impulses/sec (mean value after 5 to 10 minutes. The decrease may result from anoxia since three of four tested receptors showed an increase in activity after release of occlusion.


Automated precordial mapping for S-T segment analysis: variability in serial mappings of normal subjects and patients with stable S-T elevation. An automated method of precordial mapping using a modified Caceres U.S. Public Health Service Electrocardiogram Diagnosing Program has been developed. The S-T segment elevation was measured in three successive complexes and averaged for each of the 35 precordial leads. The onset of the S-T segment (J point) was accurately located in over 99 percent of instances. The time required to sample the 35 leads averaged 8 1/2 minutes with subsequent data analysis requiring an additional 7 minutes. The S-T segment variability between serial mappings done over a 1 to 2 hour period was determined in normal subjects and patients with stable S-T elevation. The average S-T segment elevation/35 leads in normal subjects was 1.28 mv (range 0.41 to 2.14) and the between-mapping variability was +/- 0.25 mv at the 95 percent confidence level. The average S-T segment elevation/35 leads in the patients was 4.01 mv (range 1.35 to 7.28) mv. The between-mapping variability was +/- 0.29 mv (95 percent confidence level), and was not statistically different from the variability in normal subjects (P less than 0.05).


Normalized first derivative ofthe left apex cardiogram in assessment of left ventricular function. The relation between the left displacement apex cardiogram and the left ventricular pressure during isovolumic contraction was studied in 30 patients with cardiac disease. Using the instantaneous relation between the first time derivative and the magnitude of both the left apex cardiogram and the left ventricular pressure, normalized derivatives were obtained. These noramized velocities were correlated with each other and with several indexes of left ventricular function. The normalized derivatives of the left apex cardiogram (dD/dt/D) and the left ventricular pressure (dP/dt/P) were similar in magnitude, standard deviation and variation coefficient. No such similarity was present when the first time derivatives of each tracing (dD/dt and dP/dt) were compared. A highly significant relation was found between normalized displacement velocity and normalized pressure velocity using both total (r = 0.76, P less than 0.001) and developed (r = 0.75, P less than 0.001) displacement and pressure. Significant correlations with several other indexes of left ventricular function (end-diastolic pressure, peak dP/dt, maximal velocity of the contractile elements at zero load[Vmax]) were also observed. It is concluded that the index dD/dt/D of the left apex cardiogram is an important noninvasive tool for assessing left ventricular function in man.


Renal arterial stenosis and hypertension. II. Current criteria for surgery. Criteria developed from a previously reported study in 1969 concerning outcome of renal arterial surgery were applied over the next 5 years (1967 through 1971) to a group of 33 patients from a total of 121 with renal arterial stenosis. After demonstration of ischemia of the involved kidney, surgery was performed only when the degree of atherosclerotic disease and complications were minimal. With this selective process the incidence rate of significant postoperative improvement was raised from 26 to 75 percent and was maintained at 60 percent through the end of 1973, the mortality rate decreasing from 35 to less than 10 percent. The data indicate that medical therapy is the initial treatment of choice in patients over 50 to 55 years of age who have atherosclerotic disease but that the outcome of surgery can be satisfactory in properly selected younger patients.


Noninvasive diagnosis of a false left ventricular aneurysm with radioisotope gated cardiac blood pool imaging. Differentiation from true aneurysm. Unlike the true left ventricular aneurysm, false aneurysms have recently been shown to be subject to late rupture. Rarely diagnosed before surgery or autopsy, the false aneurysm has never been identified by noninvasive techniques. We report the first such noninvasive diagnosis employing radioisotope gated cardiac blood pool imaging. Due to the unique and possibly life-threatening clinical course and potential for surgical cure of false left ventricular aneurysm, early noninvasive diagnosis by imaging techniques may be critical. The methods shown here are generally applicable, becoming widely available and may help in evaluation of false left ventricular aneurysm as a cause of sudden death.


Wolff-Parkinson-White syndrome with 1:2 atrioventricular conduction. The QRS complex of the Wolff-Parkinson-White syndrome is thought to represent a fusion beat resulting from conduction over the normal pathway and an anomalous pathway. This report demonstrates utilization of both of these pathways resulting in two ventricular responses from a single supraventricular impulse. The presence of "1:2" atrioventricular conduction in this case firmly supports the fusion beat theory of the Wolff-Parkinson-White syndrome.


Multiple aortic aneurysms in relapsing polychondritis. A patient with relapsing polychondritis and thoracic and abdominal aortic aneurysms is described. The aortic changes were due to aortitis, which primarily involved the media, with increased vascularization, perviascular infiltration of mononuclear cells, increased amounts of collagen and decreased amounts of elastic tissue and sulfated acid mucopolysaccharides. Aortic aneurysms frequently occur in relapsing polychondritis; they are usually in the ascending aorta but may be multiple and involve the abdominal aorta; involvement of the ascending aorta results in aortic regurgitation and left ventricular failure, and involvement of the abdominal aorta may be clinically silent and result in fatal rupture.


The effects of sweat nitrogen losses in evaluating protein utilization by preadolescent children. A nitrogen balance study was conducted to determine the effects of three levels of nitrogen intake on the loss of nitrogen through sweat and to assess further the impact of sweat nitrogen on protein needs of preadolescent children. Values were determined through the collection of 24-hr, total body sweat samples from twelve healthy boys having a mean age of 8 years, 8 months. Mean height and weight of the subjects were 131.4 cm and 31.0 kg, respectively. Environmental conditions were relatively constant during the study. Mean sweat nitrogen losses were 208, 287, and 368 mg/day on daily protein intakes of 29, 54, and 84 g, respectively. Mean nitrogen balances per day were 0.39, 0.09, and 1.95 g when sweat nitrogen losses were included in the calculations. At the lower and moderate levels of protein intake, nine and six subjects were in negative nitrogen balance when sweat losses were considered. Sweat nitrogen losses in the boys were similar to a previous study with preadolescent girls. Based upon published basal metabolic rates and mean sweat nitrogen losses of 261 and 288 mg/day for girls and boys, the nitrogen lost through sweat was 0.25 mg/basal kcal for both sexes. An estimation of 0.5 mg/basal kcal for integumental nitrogen loss appears realistic for this age group.


Personality characteristics in obesity: relation of MMPI profile and age of onset of obesity to success in weight reduction. A group of 142 obese subjects was seen in an obesity clinic over a 2-year period. Of these, 116 had assessment of personality factors by the Minnesota Multiphasic Personality Inventory (MMPI), and 71 were followed for periods of 4 to 28 months in order to determine success at weight reduction by means of a conventional dietary regimen. The MMPI profiles of the obese subjects were compared to those of a general medical population of 50,000 patients seen in the Department of Internal Medicine at the Mayo Clinic. Obese male subjects had significantly higher scores on the F and MA scales. Obese female subjects had significantly higher scores on the F, PD, PA, SC, and MA scales, and a significantly lower score on the Q scale than the reference population. Even though these findings show that certain personality traits as measured by the MMPI may occur more frequently in obese persons, the individual MMPI profile codes point out the presence of diverse behavior patterns among obese persons rather than a single personality pattern characteristic of obesity. There were no apparent differences in the success in achieving a loss of 10% or more of initial weight among the male and female obese subjects having normal or abnormal MMPI profiles. Obese subjects having onset of obesity before age 12 years were slightly more successful in weight reduction than those whose obesity began later than this, but the differences were not statistically significant for either the male or female subjects.


Change of urinary nitrogen excretion in response to low-protein diets in adults. Data from nitrogen balance studies in young men and elderly women were analyzed for the pattern of urinary nitrogen excretion after the subjects had changed from an adequate to an essentially protein-free diet. The single exponential equation: y = P1e-p2t+P3, provided an adequate fit of the data, suggesting that a single-pool model describes the adaptive decline in urinary nitrogen excretion under these dietary conditions. Comparisons of the estimated parameters showed that the fractional rate constant, P2, was the same for both the young men and elderly women, but that the other coefficients differed between the two groups depending upon whether they were expressed per day, per kg of body weight, per unit creatinine excreted, or per kg of body cell mass. The length of time between the change in diet and the attainment of a new equilibrium in urinary nitrogen excretion (ts, or time to stability) is defined as ts = 1/p2 loge(p1/s) where s is the standard error of the fit. The average time to stability was the same in both groups (4.5 days), and 95% of the subjects reached the new equilibrium in nitrogen output within 8 days.


Stability of vitamin B12 in the presence of ascorbic acid. Experiments were performed in two independent laboratories, each using their own meal preparations which were exactly similar in composition to the meals described by Herbert and Jacob (J. Am. Med. Assoc. 230:241, 1974), in order to check their report that incubating meals (portions of daily food intake by man) of "modest" or "high" vitamin B12 content with increasing levels of added L-ascorbic acid (vitamin C) produced increasing destruction of vitamin B12. The present studies were performed with standardized and official methods. Vitamin B12 was determined microbiologically and by radioassay method. The results showed that 1) the vitamin B12 contents of these meals were in general agreement with values calculated from the literature for the foods involved, 2) the values obtained were manyfold higher than those reported by Herbert and Jacob, and 3) there was no deleterious effect of added ascorbic acid on the vitamin B12 content of meals, contrary to their published results.


Biochemical assessment of the nutritional status of low-income pregnant women of Mexican descent. Biochemical parameters of nutritional status were investigated in 300 women of Mexican descent during the first and second trimesters of pregnancy. Blood samples were obtained from the women during clinic visits, and measurements were made of serum iron, hemoglobin, hematocrit, serum protein, and transferrin saturation. Additionally, the nutritional status of seven vitamins was determined either by direct assay of the vitamin levels in blood or by measurement of erythrocyte enzyme stimulation. Thiamin and riboflavin were also determined in causal urine samples. Very few women, 8% or less, were classified as being low or deficient in hemoglobin, serum protein, iron, transferrin saturation, vitamin C, carotene, vitamin A, or vitamin B12. Thirty-one percent had low or deficient hematocrit values according to the guidelines used. Folic acid was the most prevalent vitamin deficiency, with 69% of the women having low or deficient serum levels. Based on the erythrocyte enzyme stimulation tests, 22% of the women were low or deficient in thiamin, 29% were low or deficient in riboflavin, and 9% were deficient in pyridoxine. None of the women had a low urinary excretion of thiamin, but 8% had excretion values of riboflavin below the acceptable level. Fewer deficiencies of thiamin and serum folic acid were observed in women taking vitamin and mineral supplements than in those who were not.


Effect of nutrition education on the nutritional status of low-income pregnant women of Mexican descent. Low-income pregnant women of Mexican descent were studied to determine whether their food habits could be improved by nutrition education. Biochemical indices of nutritional status were also investigated. Twenty-four-hour dietary recalls were obtained at an initial interview and again at a final interview after a nutrition education program, which was offered to a randomly selected treatment group. At the initial interview, the mean nutrient intakes that were most often below two-thirds of the Recommended Dietary Allowance (RDA) were iron, vitamin A, thiamin, and calcium. The mean energy value of the diets was also frequently below the RDA. At the final intakes, although the mean energy values and the calcium and carbohydrate of both the control and treatment groups increased significantly, the following improvements in dietary intakes were seen only within the treatment group: 1) there were significant increases in the mean intake of protein, ascorbic acid, niacin, riboflavin, and thiamin, 2) there were significant decreases in the percentage of intakes below two-thirds of the RDA for ascorbic acid and riboflavin, and 3) there was a significant decrease in the incidence of multiple low nutrient intakes. These dietary improvements, which occurred only in the treatment group, suggest the effectiveness of the nutrition education program. The most common biochemical deficiencies were of folic acid, thiamin, and riboflavin. Except for an improvement in mean serum folate levels, the biochemical indices for the treatment group did not appear to be influenced by the nutrition education. It is possible that the vitamin and mineral supplements which were taken by 80% of the women could have obscured improvements in biochemical indices which may have been due to the education program.


State planning of mental health services. Planning is the vital process that links needs to solutions. The interorganizational field of human services constitutes a "turbulent environment," a condition of rapid change, and there needs to be greater receptivity toward comprehensive planning on the part of state departments of mental health. Increased overlap with various welfare and educational service, advances in scientific knowledge, and shifts in general attitudes and social philosophy lead to demands for new and different types of service and require changes in approach and method. Generalized findings of a study of 14 state departments of mental health are presented.


Parents as therapeutic agents: the usefulness of filial therapy in a community mental health center. Filial Therapy, a program training parents as play therapists for their own children, has been found an effective part of the functioning of a child unit in a community mental health center. The basic philosophy and principles of Filial Therapy are identified. The use of parents as therapists is viewed as consistent with the growth of the community mental health movement and the concept of treating the context in which the child resides. The structure and flexibility of this model are delineated to provide the reader with a basis to introduce Filial Therapy in his/her own setting.


Comparison of two outcome groups in a school-based mental health project. Two samples of school-maladjusted children responding most and least favorably to a helping program with nonprofessional child-aides were compared on demographic, referral, and program experience variables. Outcome measures other than teacher ratings used to select the samples validated the inferred improvement differences. Subjects with poor outcomes were significantly more likely to reside in the city, older, from lower socioeconomic backgrounds, and initially more maladjusted than those with good outcomes, but there were no group differences in age, repeat in grade, or program experience variables. Implications of these data for future program directions and modifications of aide-training procedures are discussed.


Atrioventricular conduction in children with acute rheumatic fever. Atrioventricular conduction was quantitatively evaluated in 118 children with acute rheumatic fever. The mean PR index in children with acute rheumatic fever, 1.06 +/- 0.38, was significantly higher than normal children or children who had febrile illness of nonrheumatic or nonstreptococcal origin (P is less than .001). Among 35 children with rheumatic fever and an abnormal PR index, the disease presented as carditis in 21, arthritis in ten, and chorea in four. The mean PR index and the frequency distribution of abnormal PR indices were significantly higher in children with carditis (P is less than .001). Five children who initially had an abnormal PR index and arthritis or chorea subsequently developed carditis. These observations suggest that children with acute rheumatic fever and abnormal PR index warrant close observation for possible clinical evidence of myocardial involvement during subsequent course of the illness.


Estimation of gestational age in the neonate: a comparison of clinical methods. A combined evaluation of almost all the proposed morphologic and neurologic criteria for estimating gestational age in the neonate was performed on 710 newborns of 28 to 44 weeks' gestation. It is concluded that (1) the neurologic criteria used by Dubowitz et al in combination with the external (morphologic) criteria of Farr et al give very accurate results of estimation of the gestational age; (2) equally accurate results can be obtained if those criteria with the lowest correlation coefficients--namely, are and leg recoil, degree of edema, and appearance of the genitalia--are omitted; and (3) the use of only nine external criteria, the assessment of which is easier to perform on sick babies, gives an estimation of gestational age that is accurate for clinical purposes (r=0.878).


Children with superior intelligence at 7 years of age: a prospective study of the influence of perinatal, medical, and socioeconomic factors. Perinatal and medical information, growth, and the social background of 258 children who, in a prospective study, had superior intelligence at 7 years of age were reviewed. The subjects were divided into three categories on the basis of the results of psychological evaluation at age 7. Comparisons were made between those with superior (intelligence quotient greater than or equal to 120), average (IQ between 80 and 119), and low intelligence (IQ less than or equal to 79). A favorable parental social and educational background was the best correlate of superior intelligence in the children. Larger head size from 1 year of age was an early finding associated with superior intelligence. Greater height and weight, from 4 years of age were later findings. Correlations between psychological performance at ages 4 and 7 years were statistically significant. Perinatal factors and medical complications did not affect the intellectual status of children with superior intelligence.


Nonaccidental trauma and failure to thrive. Charts were reviewed of 140 children who were discharged from Denver General Hospital (DGH) with diagnoses of nonaccidental trauma or failure to thrive. These children were all enrolled in a neighborhood health program. It was found that boys and girls were affected equally and that most of these children were under 3 years of age. In relation to their representation in the Neighborhood Health Program, more white children were abused or failed to thrive than children from other racial groups. A disproportionate number of children had birth weights under 2,500 gm as compared to children born at DGH. Young parents who were raised in disrupted families were involved in child abuse more frequently than were individuals from more stable families. Bruising was the most frequent injury and was most prevalent among boys under 3 years of age. Fractures were the second most common injury and occurred equally among boys and girls. There appeared to be a seasonal variation in the incidence of abuse.


Blood pressure, salt preference, salt threshold, and relative weight. This study was performed to observe the relationships of salt preference, salt threshold, the relative weight to blood pressure. Three groups were selected from 4,800 school children on the basis of mean blood pressure: less than or equal to fifth percentile, in the area of the 50th percentile, and greater than or equal to 95th percentile. Salt threshold was determined by titrating, on each subject's tongue, solutions ranging from 1 to 60 millimols/liter of sodium chloride. Salt preference was tested by the addition of salt by each subject to unsalted tomato juice and beef broth according to individual taste. The samples were then analyzed for sodium concentration. The coefficient of correlation for the amount of salt added to juice and broth was significant (r=0.63). There was no relationship of salt threshold to preference, nor did threshold or preference relate to blood pressure. Relative weight was related to blood pressure range being the most obese.


Arteriovenous malformation of the vein of Galen: treatment in a neonate. Heart failure in a 2-day-old infant was not readily explained by clinical examination. Cardiac catheterization suggested an intracranial arteriovenous (AV) fistula, and cerebral arteriography showed a malformation of the vein of Galen. The major feeding arteries were surgically obliterated. At age 27 months, the boy has normal mentation but moderate left hemiparesis. Review of the literature disclosed 39 other infants with AV malformations of the vein of Galen producing heart failure before age 3 months. Most of them were boys, and had cyanosis, a systolic murmer, cranial bruit, cardiomegaly, and right bentricular hypertrophy. Only three of the 13 who had surgery for their malformation survived. Removal of the malformation is difficult; obliteration of the nutrient vessels, using the operating microscope, is the currently accepted treatment.


Appendicovesical fistula in childhood: a rare complication of ruptured appendix. The diagnosis of appendicovesical fistula is difficult and usually delayed. This is most unfortunate, since surgery is uniformly successful. The case we report reemphasizes the diagnostic value of the rectal examination, intravenous pyelogram, and foiding cystogram in a child with subacute or chronic abdominal pain. Only an awareness of this condition on the part of the attending physician will lead to prompt diagnosis and definitive therapy.


Wolman disease in a Pakistani infant.

Wolman disease in a Pakistani infant. In an infant with Wolman disease, confirmation of the diagnosis was made before death or radioological and enzymological criteria. It is the first case reported in a Pakistani infant.


Multidisciplinary Conferences in Gastroenterology. Cardiovascular effects of severe liver disease. This is the definitive review of the cardiovascular effects of liver disease. Physiologic and pathologic studies accomplished primarily in the 1950s and 1960s have been applied to a  case of a 16-year-old boy with cirrhosis of the liver who presented with weakness, dyspnea, cyanosis, and clubbing. The probable mechanisms for his signs and symptoms are discussed in detail. The cause for the hyperkinetic circulation is unknown. By exclusion, the cyanosis is attributed to intrapulmonary shunting. Portapulmonary shunts are not quantitatively important. The suitability of the terms micronodular and macronodular cirrhosis is highlighted. Indications for various types of surgical portal shunts are discussed. The value of preoperative hemodynamic measurements of the portal circulation to the individual patient is debated. A liver transplant is considered in this case with no promising medical therapy and a very poor prognosis. The renal disease manifested by red cell casts in the urine is thought to be caused by an immunologic reaction in the kidney somehow related to his liver disease. This discussion is led by Dr. Jack Myers, but his opinions are correlated with those of a pathologist, radiologist, surgeon, and gastroenterologist. It is a clinical tour de force, although not all the predictions are confirmed by laboratory studies such as this patient's hepatic wedge pressure, pulmonary artery pressure, and cardiac fluoroscopy.


Crohn's disease of the colon. Analysis of the diagnostic value of radiology, endoscopy, and histology. Radiologic, endoscopic, and histologic features were analyzed in 15 patients with Crohn's disease of the colon. Radiologic findings were considered of diagnostic value in only 6 (40%), characteristic endoscopic lesions were found in 13 (87%) and diagnostic histologic features in 11 (73%). Endoscopy combined with biopsy was diagnostic in all 15 cases. The extent of involvement of endoscopy frequently disagreed with the radiologic assessment, particularly in the rectosigmoid area. Studies in 8 patients indicate that sigmoidoscopy and coloscopy with multiple biopsies provide an accurate alternative to radiology to estimate the extent and severity of the lesions and their evolution during corticosteroid and/or azathioprine treatment.


Bile-induced acute erosive gastritis. Its prevention by antacid, cholestyramine, and prostaglandin E2. Intragastric administration of whole bile-produced acute erosive gastritis in rats. Concomitant intragastric administration of prostaglandin E2, Cholestyramine and an antacid (Maalox) was effective in preventing this type of acute erosive gastritis. The protective rffect of prostaglandin E - 2 in this regard was significantly more marked as compared to Cholestyramine and Maalox.


Pericarditis associated with ulcerative colitis and Crohn's disease. Extracolonic manifestations of inflammatory bowel disease are common and diverse. However, cardiac complications are unusual and we therefore wish to report two cases in which pericarditis occurred. The first was a patient with Crohn's disease of the colon, in whom the pericarditis developed postoperatively. In the second case an acute pericarditis came on simultaneously with the initial presentation of ulcerative colitis.


Serum bile acids in alcoholic liver disease. Comparison with histological features of the disease. Fasting serum bile acids were measured by gas-liquid chromatography in 64 patients with alcoholic liver disease and compared with histological features in their percutaneous liver biopsy specimens. Total bile acid concentrations were normal (less than 2 mug/ml) or minimally increased in 6 patients in whom fatty infiltration was the only hepatic lesion. In the remaining 58 patients with more severe histological lesions, levels were increased in 93%, whereas serum bilirubins were elevated in only 43%. Chenodeoxycholic acid was usually the predominant serum bile acid, regardless of the degree of necrosis or connective tissue change in the biopsy specimen. Only small amounts of the secondary bile acids, deoxycholic acid and lithocholic acid, were detected. Levels of these secondary bile acids did not correlate with histological features.


Acute hemorrhagic pancreatitis in the dog. IV. Treatment with vasopressin. Acute hemorrhagic pancreatitis was experimentally induced in the dog by the closed-duodenal-loop technique. The disease process was modified and partially reversed by intravenous infusions of vasopressin, as indicated by some of our tests for pancreatitis as well as histologic examination of the pancreas.


Effect of synthetic 15-methyl analog of PGE2 on gastric acid and serum gastrin response to peptone meal, pentagastrin, and histamine in duodenal ulcer patients. The effect of 15(S)-15-methyl PGE2, methyl ester (15-ME-PGE2), used intravenously in a standard dose of 0.5 mug/kg-hr on gastric secretion and serum gastrin level was studied in 6 duodenal ulcer patients. 15-Me-PGE2 caused an immediate and almost complete inhibition of basal gastric acid and pepsin secretion. Acid secretion induced by a peptone meal and determined by intragastric titration technique was almost as high as the maximal response to histamine and accompanied by a significant rise in serum concentration of immunoassayable gastrin. 15-Me-PGE2 caused a sudden and complete inhibition of gastric acid response to a peptone meal. 15-Me-PGE2 did not significantly affect serum gastrin levels both under basal conditions and in response to a peptone meal. Gastric acid and pepsin output induced by maximal stimulation with pentagastrin (4 mug/kg-hr) was inhibited by 15-Me-PGE2 by about 70% and that induced by histamine by about 45%. After the withdrawal of 15-Me-PGE2 infusion, gastric secretion remained reduced for the remainder of the test. We conclude that 15-Me-PGE2 is a very strong inhibitor of gastric acid and pepsin secretion induced by various secretory stimuli, particularly under basal conditions and in response to a meal. In view of prolonged inhibitory activity, 15-Me-PGE2 may have clinical potential in the treatment of peptic ulcer disease.


Kinetics of the subcellular distribution of iron and cobalt in the intestinal mucosa of the rat. A differential centrifugation technique was used to compare the subcellular distribution of labeled iron (Fe) and cobalt (Co) in iron-deficient animals (FeD), in which transport was active, with iron-loaded animals (FeL), in which transport was by diffusion. In FeL the amount of Fe and Co in each subcellular fraction was dependent upon dose; there was a linear relation between the amount of Fe or Co in each fraction and metal absorption. In FeD a curvilinear relation was noted between both Fe dose and absorption, and the amount of Fe in the particulate fractions I and II. In contrast, a linear relation was noted between both dose and absorption, and the smaller amounts of Fe in the other fractions. Most of the Co was in V ("soluble"), and the relation between Co in all the fractions and absorption was linear. The addition of Co to the Fe test dose was associated with a decrease in Fe in I and II. The results suggest that a constituent(s) in the particulate fractions I and II is involved in the enhanced absorption of Fe in FeD. The subcellular fraction responsible for the increased Co absorption in FeD was not identified.


Diagnosis of Barrett's esophagus by pertechnetate radionuclide. In Barrett's esophagus the normal stratified squamous epithelium of esophagus is replaced by columnar epithelium and other charcteristics of gastric mucosa. Barrett's esophagus has an increased tendency to bleed and is more prone to undergo malignant change. There are many procedures used to diagnose this entity, but only by serial and multiple esophageal mucosal biopsies can the diagnosis be confirmed. Harper et al (2) demonstrated an early and intense uptake of 99m Tc pertechnetate by the stomach in animals. Since the Barrett's esophagus is lined by gastric mucosa, pertechnetate scintigraphy was used as a screening procedure. The criteria for a postive scan was an area of increased uptake of technetium extending above the normal dense uptake of stomach configuration. Pertechnetate scintigraphy was performed in 4 patients with Barrett's esophagus and 6 controls with only one false negative result. Thus pertechnetate scintigraphy is a rapid, safe, and atraumatic screening procedure.


Pancreatic ascites: successful treatment with pancreatic radiation. A 51-year-old man with clinical and laboratory findings consistent with the diagnosis of pancreatic ascites is reported. Response to usual medical measures was inadequate. Single-dose irradiation to the pancreatic area (550 rads) resulted in marked improvement in his ascites. Operative pancreatogram months later revealed no evidence of ductal leakage. Low-dose pancreatic irradiation may be a unseful therapeutic adjunct in the older, high-risk patient with pancreatic ascites in whom surgery is not considered feasible.


Nonpancreatic-type hyperamylasemia associated with pancreatic cancer. Isoamylase analysis of the serum and urine of a patient with anaplastic spindel cell carcinoma of the pancreas revealed that virtually all of the serum amylase and almost all of the urine amylase behaved chromatographically as the salivary (S) type. Both the serum and urine amylases were bound by a substance derived from a macroamylase complex which had been shown to bind only salivary amylase and to lack any affinity for pancreatitis (P) type amylase. The ratio of amylase to creatinine clearance was markedly increased (12.5%) without evidence of acute pancreatitis at autopsy and despite the presence of only a minute amount of P-type isoamylase in the serum.


Parameters of liver spleen scans as an indication of portal hypertension. In 37 patients with suspected portal hypertension, the bone marrow and splenic uptake on 99mTc-sulfur colloid liver spleen scans correlated with increased portal pressures. The degree of increase was not possible to predict from the scans. In portacaval shunt patients, those with normal portal pressures could not be separated from those with elevated pressures on the basis of the scan alone.


Peroral staining method with toluidine blue as an aid in the diagnosis of malignant gastric lesions. Peroral, intragastric staining method with toluidine blue was performed in 42 patients with suspected neoplastic lesions of the stomach. Fifteen out of 18 malignant lesions and one out of 13 benign lesions were stained. Normal mucosa, areas of gastritis and most of the benign lesions appeared unchanged. According to our results, the use of toluidine blue staining method prior to endoscopy might be of help in demonstrating minute malignant lesions of gastric mucosa and in the differential diagnosis between benign and malignant ulcers of the stomach.


Emotion-related gastritis.

Emotion-related gastritis. The relationship of emotional stress to abnormalities of the gastric mucosa was considered in a review of 788 consecutive upper gastrointestinal endoscopies. Fifty-three precent of patients with gastritis not related to any generally accepted predisposing or precipitating cause had significant emotional problems documented on their clinical records, while only 10% of the comparable group of duodenal ulcer patients and 25% of a similar group of medical in-patients had significant emotional problems documented. Since this difference was statistically significant (P less than 0.01 and P less than 0.05, respectively), the data suggest that emotional stress may play a contributing role in the production of gastric mucosal abnormaltieis.


A new radioisotopic technic for the measurement of gastric emptying time of solid meal. The suitability of a radiopharmaceutical for measuring gastric emptying time of solid meal is described. The gastric emptying T1/2 value of solid meal in normal individuals has been established. Both animal and human experiments indicate 99mTc-DTPA to be an ideal nonabsorbable marker for determing gastric emptying rate and for other gastrointestinal studies as well. Studies are now underway to determine gastric emptying time in patients with gastrectomy and gastrojejunostomy, vagotomy, pyloroplasty, etc.