Localized ureteral fibrosis: an unrecognized complication of radiation therapy for prostatic carcinoma. Complications of radiation therapy for prostatic carcinoma are frequent but usually minor. A patient is described in whom localized ureteral fibrosis developed following curative radiation therapy, which subsequently required a reconstructive operation. An analogous situation regarding patients with carcinoma of the cervix is examined and possible etiologies are discussed. This complication should be recognized so that proper management can be instituted.


Vesicoureteral reflux complicating sterile hemorrhagic cystitis: a case report. An unusual case of sterile hemorrhagic cystitis with bilateral vesicoureteral reflux is reported. Such a case has not been described previously.


Priapism: an unusual complication of parotitis without orchitis. A 10-year-old white boy is described in whom priapism developed as a complication of parotitis without orchitis. Medical study failed to reveal any other etiology. The syndrome was assumed to be related to a mumps virus. Treatment by corpora cavernosa-spongiosum shunt relieved the acute symptoms as well as preserved the patient's ability to have an erection.


Melanosis of the prostate gland: report of a case with neoplastic epithelium involvement. Prostate gland melanosis is an uncommon lesion and the precise histogenesis is unclear. Melanin may be found within melanocytes in the prostatic stroma, within prostatic epithelium and, rarely, in both locations. The stromal dendritic cell has been shown to contain premelanosomes and melanosomes suggesting primary melanin production by this cell. The melanogenic potential of prostatic epithelial cells has not yet been conclusively established. An example of prostatic melanosis is presented in which stromal and epithelial components were found. This dual distribution of melanin has been regarded as an indication that melanin in the epithelial cells results from phagocytosis of melanin from stromal melanocytes as a secondary phenomenon. Melanin pigment was identified not only within hyperplastic prostatic epithelium but also was found in the epithelial component of a well differentiated prostatic adenocarcinoma.


3-dimensional graphic display of electrocardiograms. We developed a new method to display a potential distribution of the heart activity on the body surface. Electrocardiograms were recorded from many points distributed regularly on the precordial region. From these electrocardiograms three-dimensional graph of potential distribution was produced by a small digital computer and displayed on the CRT. This graph continuously changes with time according to change of potential distribution like an animation. An interpolation method that we had derived took a short execution time and give a smooth approximated curve. Three-dimentional graphs of electrocardiograms were produced for healthy male subjects. From these graphs a transmission of a wave front of the ventricular activation can be seen as if the wave moves over the picture.


Alterations of the internal elastic membrane in the coeliac trunk and its branches. Changes in the internal elastic membrane of the coeliac trunk and its branches begin in the foetus. Usually these changes increase with advancing age. The intensity of involvement varies in different arteries, localized swelling is of particular importance as a measure of atherosclerotic involvement. There is a close relationship between morphology and chemical structure.


Electrophysiological consideration on sick sinus syndrome. 1) Factors influencing abnormally prolonged Sinus Recovery Time in Sick Sinus Syndrome were investigated with a microelectrode technique. 2) Although the action of released acetyl choline was confirmed by the effect of atropine and neostigmine on the SRT, an abnormally long SRT like that in SSS was not produced by vagal stimulation in the in situ heart. 3) When the drive rate exceeded a certain value (e.g. two times the spontaneous rate in normal preparations), SA entrance block resulted in less overdrive suppression. When the SA junction is easily blocked with relatively low drive rates, the maximum SRT must be determined within a wide range of drive rates. 1) Verapamil in a concentration of 10(-7) g/ml produced an abnormal SRT suggesting that ionic derangement is one of the factors influencing SRT. 5) A preparation from an aged rabbit with an abnormal SRT revealed fibrosis and reduction in the number of SA nodal cells. The latter seems to be one of the main factors causing a reduction in the potency of the pacemaker and a prolonged SRT in SSS.


Clinical studies on the sick sinus syndrome. 1) Overdrive suppression is clinically useful to evaluate depressed cardiac automaticity in the sick sinus syndrome. 2) His bundle electrograms revealed frequent association of atrioventricular conduction defects with the depressed automaticity in this syndrome. 3) Especially in BTS, marked intra-atrial conduction defect was observed, and this conduction defect may play a role for development of re-entrant tachycardia. 4) Pathologic changes in the sick sinus syndrome are supposed to involve the whole atrial tissues including not only the S-A nodal region but the A-V node and its approaches.


A-V block.

A-V block. In this report, 61 A-V block patients were analysed using HBE. According to the site of the block, these cases were classified into P(A)-H block, BH block H V block and mixed block. In P(A) H block group (23 cases), the permanent pacemaker implantation was not needed except for one patient with persistent heart failure due to marked bradycardia. Postmortem histology of this patient was well coincident to the results of HBE. In BH block group (18 cases), moderate number of patients were needed to have permanent pacemakers implanted (33%). RA pacing induced split H block with H-V prolongation and varied H and QRS configuration in two cases of this group. These phenomena may be well explained by the longitudinal dissociation theory. In H-V block patients, permanent pacemakers were implanted in all patients (12 cases). In this group, it is difficult to decide the exact location of block, either distal His, bifurcation or bundles, because of the difficulty to record the left or right bundle potentials in clinical practise. Finally, it is important to record the HBE in order to decide the exact site of block, and to choose the suitable therapy for A-V block patients.


[A case reported of double parasystole-combined atrial and ventricular parasystole- (author's transl)]. Parasystole is an arrhythmia resulting from simultaneous activity of two independent impulse-forming foci, one of which is protected by the other. Ventricular parasystole which arises from an ectopic focus situated in ventricule is relatively common. On the contrary, supraventricular parasystole which is centered in the atria or atrioventricular junction, is extremely rare. Kaufmann and Rothberger studied first parasystole as an entity, and they reported the first case of atrial parasystole. However, the first correctly mentioned example of atrial parasystole was described by Jervell. In the previous paper, we described one observation on atrial parasystole and discussed on its consisting-mechanism. The occurrence of ventricular parasystole is not a rarity, since it has been estimated to be present once in every 1,200 electrocardiograms taken in a general hospital. In contrast, well-documented cases of atrial parasystole are exceedingly rare, and since the first case of it was reported by Kaufmann and Rothberger, only 25 cases have hitherto been reported. In the present paper is described and discussed a case of the extremely rare combination of atrial and  ventricular parasystole with exit block and fusion phenomenon...


[Experimental study on the changes of blood pressure induced by afferent stimulation on the somatic nerves (author's transl)]. It has been shown by many authors that afferent stimulation of various somatic nerves results in the different types of responses with regard to blood pressure and heart rate. It was revealed by Hunt that afferent "weak" stimulation of the somatic nerves caused depressor responses, and "strong" stimulation, pressor responses. Ranson and Gordon thought that the depressor response to the afferent stimulation of the somatic nerves would involve the thick myelinated nerve fibers, and the pressor response, the fine non-myelinated nerve fibers. On the other hand, it has been postulated that the socalled chest pain and/or nonspecific complaints observed in patients with myocardial infarction, angina pectoris and neurocirculatory asthenia (NCA) are related to some alterations at the cervical and thoracic vertebral levels of the spinal cord or nerve roots. Maekawa, Hayase and Konishi attached importance to the presence of subclinical arachnoiditis adhesiva cerebrospinalis at the cervical and thoracic vertebral levels in patients of NCA. These facts suggests that the contribution of the spinal cord and the nerve roots to the circularoty system is different between the cervico-thoracic levels and the lumbar levels. Based on these facts, the author stimulated the somatic nerves of both the forelimbs and the hindlimbs afferently in alpha-chloralose anesthetized dogs, with a train of square electric pulses for 20 seconds, and studied the response of the circulatory system to such stimuli.


[Gentamicin therapy of infectious diseases by pathogens (author's transl)]. Gentamicin (GM) was intramuscularly injected to 29 patients with various infections in the doses of 40-60 mg twice a day. The maximum dose was 1,800 mg. Satisfactory clinical results were obtained in the treatment of not only urinary tract infections but also respiratory tract infections, bile duct infections and others. This clinical results would coincide with the fact that almost all organisms isolated had a high sensitivity to GM. No significant abnormal findings was observed in this clinical study. This clinical result indicates that GM is a useful drug in the treatment of various infections.


[A clinical study on gentamicin in the field of surgery]. Gentamicin (GM), one of the amino-glucosides, was administered intramuscularly to 27 patients with Pseudomonas and/or other antibiotics resistant infections. The clinical evaluation of the results obtained was classified excellent in 1 case good 6, fair 8, none 11 and indeterminate 1, the effectiveness accounting for 57.7 percent. Satisfactory results were noted in wound infections, peritonitis and urinary tract infections. Among untoward side effects, an elevation in GOT and GPT values was observed in 6 cases, an elevation of BUN value in 1, proteinuria in 1 and hematuria in 1. However, it is difficult to conclude that those side effects were attributable to GM itself because blood transfusion or combined therapy with anti-cancer agents was conducted in these cases during the GM therapy.


[Clinical use of gentamicin in the field of surgery (author's transl)]. Gentamicin (GM) was intramuscularly administered to 24 patients with various infections (including 1 for prophylaxis of a postoperative infection) in the dose of 40 mg X 2/day for 4-26 days. In children, the maximum daily dose was 3.4 mg/kg and the minimum was 1.2 mg/kg (mean: 2-3 mg/kg). The results obtained are as follows: 1) Clinical efficacy of GM was excellent in 2, good in 9, fair in 4, null in 4 and indeterminate in 5, out of 24 cases. The effective rate was 57.9% (11/19). 2) In 21 strains isolated in 13 cases out of 24, efficacy of GM was good in 10, fair in 5, null in 3 and indeterminate in 3. The effective rate was 55.6% (10/18). 3) No significant side effect was observed in this clinical study.


[Clinical experience with gentamicin in complicated urinary tract infections (author's transl)]. Gentamicin (GM) was intramuscularly administrated to 25 patients with complicated urinary tract infections in doses of 20-120 mg a day for 4-16 days. The results obtained are as follows: 1. The clinical results of GM were excellent in 4, good in 3, fair in 1, poor in 3 and indeterminate in 14 patients out of 25 patients. The effective percentage was 63.6% (7/11). 2. The clinical results of GM against 20 isolates were excellent in 4, good in 3, fair in 1, poor in 3 and indeterminate in 9 isolates. The effective percentage was 63.6% (7/11). 3. In laboratory examinations, BUN elevation was noted in 1 patient, GOT elevation in 2 patients and GPT elevation in 1 patient during GM therapy. No other abnormal findings were observed in this clinical study.


[Clinical experiment of gentamicin in patients with urological diseases (author's transl)]. 1. Gentamicin was effective in 20 patients out of 25 with urological diseases. 2. Gentamicin was more effective on acute symptoms than on chronicones. 3. No marked side effects were noted. 4. No conclusion was drawn on difference in efficacy of gentamicin by dosage, duration of administration and kinds of organisms in this clinical trial.


[Clinical studies on gentamicin in complicated urinary tract infections (author's transl)]. Twenty cases with complicated urinary tract infections were treated with gentamicin. Good results were obtained in 7 of 14 cases with chronic pyelonephritis and 2 of 4 cases with chronic cystitis and in 1 of 2 cases with acute prostatitis. No side effect was observed throughout this treatment. But in laboratory examination, slight elevation of S-GOT and S-GPT was observed in 3 of 20 cases after gentamicin treatment.


[Antibacterial and bactericidal activity of tinidazole against anaerobic bacteria comparing with metronidazole (author's transl)]. Antibacterial activity of tinidazole (1-2-(ethylsulfonyl)-2-methyl-5-nitroimidazole) against anaerobic bacteria including Peptococcus, Peptostreptococcus, Eubacterium, Propionibacterium, Bacteroides and Fusobacterium was studied by agar dilution method comparing with metronidazole. In addition to this work, bactericidal effect of tinidazole and metronidazole against P. prevotii, B. fragilis ss. fragilis and F. varium was examined by quantitative culture method after incubation in GAM broth containing of 4 MIC, 2 MIC, 1 MIC and 1/2 MIC of both drugs against each of three strains for 1, 3, 6, 12 and 24 hours. All the strains of Peptococcus and Peptostreptococcus including P. anaerobius, P. saccharolyticus, P. prevotii and Ps. anaerobius and others were susceptible to a concentration of 6.25 mcg/ml of this drug. A concentration of 3.13 mcg/ml inhibited all strains of Bacteroides including B. fragilis ss. fragilis (12 strains), ss. vulgatus (5 strains), ss. thetaiotaomicron (4 strains) and ss. distasonis (2 strains). To this concentration all strains of Fusobacterium including F. varium (20 strains), F. mortiferum (2 strains) and other Fusobacterium sp. (5 strains) were susceptible. On the contrary, Propionibacterium acnes (6 strains) was resistant to 100 mcg/ml or more of tinidazole and metronidazole. The antibacterial activity of tinidazole was stronger against Bacteroides than that of metronidazole, while almost equal against Peptococcus, Peptostreptococcus, Eubacterium and Fusobacterium. Tinidazole was bactericidal against F. varium in a concentration of 2 MIC till 24 hours of incubation but did not show such an activity on B. fragilis ss. fragilis in same concentration even after 12 hours of incubation. On the other hand, metronidazole was bactericidal against B. fragilis ss. fragilis while was not against F. varium. Against P. prevotii bactericidal activity of both drugs was similar. Tinidazole as well as metronidazole is an excellent chemotherapeutic agent against anaerobic bacteria excluding Propionibacterium acnes and Bifidobacterium adolescentis.


[Clinical trials with amoxicillin (Pasetocin 'Kyowa') on infections of respiratory apparatus (author's transl)]. Amoxicillin at a daily dose of 1-1.5 g was orally administered to total 30 cases comprising 6 of acute tonsillitis, 6 of chronic tonsillitis, 8 of acute bronchitis, 4 of chronic bronchitis, 4 of bronchiectasis, 1 of suppurative diseases of the lung and 1 of exudative pleurisy. The clinical results and side effects are reported. 1. The effect of amoxicillin was remarkably good in 15 of 30 cases with infections of respiratory apparatus (50%), good in 7(23%), poor in 5(17%) and unknown in 3(10%); the effectiveness was 73%. 2. In terms of diseases, amoxicillin was effective in 33% of acute tonsillitis, in 50% of chronic tonsillitis and in all of acute bronchitis, chronic bronchitis, bronchiectasia and suppurative disease of the lung. No effect was observed in exudative pleurisy. 3. In terms of strains detected, amoxicillin was effective in 67% of Staphylococcus aureus, in 89% of Haemophilus and in 50% of Klebsiella. This drug was effective in all cases caused by Escherichia coli, Acinetobacter calcoacetines, beta-Streptococcus, Flavobacterium, Streptococcus pneumonia, though these strains were not frequently detected. Pseudomonas aeruginosa had no response to this drug. 4. Two cases of transient hepatic dysfunction, 6 of eruption, 5 of gastro-intestinal disorders, 1 of arthralgia and 1 of pyrexia were observed as side effects (some cases had side effects in overlap).


Anaerobic coryneforms isolated from human bone marrow and skin. Chemical, biochemical and serological studies and some of their biological activities. Eighteen isolates if anaerobic coryneforms from human bone marrow and skin and four type strains of Propionibacterium were studied chemically, biochemically and antigenically. All of the isolates were identified as Propionibacterium acnes; of the 18 isolates,16 belonged to sterotype I and two to serotype II. By means of gas liquid chromatography and mass spectral analysis, a large amount of iso-type fatty acids, such as iso-pentadecanoic and iso-heptadecanoic acids were detected in whole cells of isolates and type strains. Antitumor and adjuvant effects of the isolates and type strains were found to differ considerably among the strains. One of the isolates, P. acnes C-7, which showed potent biological activities was fractionated by hot phenol-water extraction. The resulting insoluble middle layer was found the most effective in tumor protection, adjuvant action in immune response and phagocytic activity in mice.


Electrocardiographic changes in traumatized patients. Traumatized patients who sustain a severe physical or psychological insult may develop myocardial ischemic changes, espicially those patients over the age of 40 years. The electrocardiogram (EKG) findings in 34 chest injury patients out of 200 multiple injury cases over a period of two years were studied. Two types of myocardial changes were found: injury pattern (of a permanent character) and ischemic pattern (of a transient nature). The first type was more frequent in the penetrating noncardiac chest injury cases, and the second more common in the blunt chest injury cases. It is necessary to make early and serial EKG tracings on traumatized patients in order to detect myocardial changes.


Fluid and electrolyte problems in the emergency department. In management of fluid and electrolyte problems in the emergency department several important principles are: (1) never completely trust the laboratory, (2) abnormalities should be treated at approximately the rate at which they developed, (3) correct only half the calculated deficit at a time and reevaluate the patient, (4) the highest priority in treatment is maintenance of intravascular volume and tissue perfusion. The osmolarity of fluid compartments as related to the fluid and electrolyte responses to stress and resultant fluid requirements for basic needs, current losses and deficits of fluid and electrolytes are discussed in depth. The characteristics of volume, sodium, potassium, chloride, bicarbonate, calcium and magnesium deficits and how to correct them are outlined.


Simple febrile convulsions.

Simple febrile convulsions. Simple febrile convulsions occur in otherwise normal children, aged six months to five years, with extracranial infection. Cerebrospinal fluid examination should be done on all children with their first febrile convulsion to rule out an underlying organic disease, especially purulent meningitis. Initial treatment includes antipyretics, tepid sponging and intramuscular phenobarbital. If a seizure recurs, the usual anticonvulsant measures should be carried out and, if prolonged, the patient should receive appropriated doses of diazepam or phenobarbital, intravenously. Patients with suspected epileptic convulsive disorders precipitated by fever, or those with seizures thought to be associated with underlying organic disease, should be hospitalized for further evaluation or treatment or both. Patients with simple febrile convulsions have a benign disorder and can be safely treated as outpatients.


Life-support system: emergency medical care for conventions. The life-support system described provides on-site emergency medical care for a designated group of people. It consists of a fixed subunit, a back-up emergency department; a temporary subunit, a life support station, and a mobile subunit, an ambulance and mobile medical personnel. A proposal for a life-support system for indoor conventions is presented with specifications of personnel, communications, supplies, registrant education and life-support team function. Results, critique, and discussion of a life-support station at the 1974 Annual ACEP/EDNA Scientific Assembly are presented.


Air embolism and decompression sickness in scuba divers. The recognition and prompt treatment of air embolism and decompression sickness by the emergency physician can do much to reverse the unfavorable outcome of these two medical emergencies. Recognition depends on the physician maintaining a high index of suspicion. While the primary treatment for these disorders is recompression, other forms of therapy are outlined which must be instituted promptly.


The embedded broken-off needle.

The embedded broken-off needle. A technique for removal of broken-off needles embedded in the sole of the foot is described. Posteroanterior and lateral x-ray films with a radiopaque marker at the needle entry point make it possible to calculate the position of the needle. Using the marker as a third point of reference, solid geometry is used to identify the position and angle of the needle in the space of the foot. A stab wound using a No. 11 blade is aimed on a 90 degree angle at the middle of the needle, permitting its easy removal.


Progressive quadriparesis, mental retardation, retinitis pigmentosa, and hearing loss: report of two sibs. Three- and four-year-old brothers, ostensibly with a nonprogressive spastic quadriparesis, had retinitis pigmentosa and mental retardation. One had clinical deafness. The brothers showed little developmental progress in infancy and exhibited deterioration in childhood. Known metabolic and acquired causes were excluded. Although they have some features of several other syndromes,the condition reported here is unique.


[Valvulo-muscular kinetics of the heart in some rhythm and conductivity disorders]. To study the valvulo-muscular kinetics of the heart in the presence of various rhythm and conductivity disorders 20 patients were examined by means of ultrasonic valvulocardiography, electrokimography, oesophagoatriography and rheography. It was found that in cases of left venous ostium stenosis complicated by atrial fibrillation the opening of the mitral valve during the diastole occurs in 0.03--0.04 sec following the beginning of the II sound, and in cases of cardiosclerosis complicated by atrial fibrillation -- in 0.08 sec following the beginning of the II sound of the phonocardiogram. In cases of atrioventricular block, stage I and II, a lagging of the perisystolic signal was noted on the ultrasonic cardiogram after the termination of the P--wave of ECG by 0.02--0.08 sec, with the period of the perisystolic signal growing up to 0.01 sec. In cases of an incomplete atrioventicular block, stage III, the perisystolic signal during the blocked perisystole was found to last as long as 0.18 sec. In cases of complete atrioventricular block the perisystolic signal was found to lagg behind after the termination of the P--wave on ECG by 0.06--0.08 sec. In cases of ventricular extrasystole early movements of the mitral valve were noted, preceeding the extrasystolic complex on ECG by 0.08 sec.


[Morphology of the lungs during various periods of artificial ventilation after surgical correction of heart disease]. The lungs of 84 patients dying following radical corrections of their congenital or acquired heart diseases were examined. The dynamics of the morphological changes developing in the pulmonary tissue depending on the duration of artificial pulmonary ventilation in the postoperative period is described. The pathogenesis of pulmonary complications of long-term artificial ventilation of the lungs is suggested.


[Rheopulmonographic and pathomorphological parallels in congenital heart defects with increased blood circulation in the lungs]. A comparison of clinico-pulmonographic and morphological changes in the lesser circulation of 12 persons who died due to congenital heart failures involving an increased blood flow in the lungs revealed the presence of a correlation between these changes in the phases of compensation and decompensation.


[Heart preservation by means of hypothermia and hyperbaric oxygenation]. The efficiency of the methods of hypothermia and hyperbaric oxygenation for the preservation of canine hearts was studied. The cardiac function was found to reestablish itself nearly completely after 3 hours of preservation, despite some significant metabolic shifts -- disintegration of oxidation and phosphorylation, activation of lysosomal enzymes, reduction of the store of adenyl macroergs and biogenic amines. Five hours of preservation result in irreversible changes in the heart.


[Registration of cases of non-hospitalized patients sudden death due to acute myocardial infarct and acute coronary insufficiency and its importance for further improvement in the control of ischemic heart disease]. An analysis is presented on the recording, in accordance with the WHO programme, of extramural deaths in the city of Kaunas attributable to acute myocardial infarction and acute coronary insufficiency. In 89 patients who died outside of hospital walls the morphological studies revealed only a scar (not exceeding 0.5 cm in size) of a sustained acute myocardial infarction. In 64% of them the diagnosis of acute myocardial infarction was not made intravitally. The recording of cases of extrahospital mortality is of great practical importance. It indicates that the medical aid to patients with ischaemic heart disease remains insufficient.


[Sudden death due to acute coronary insufficiency]. The study was conducted in the course of 2 years in accordance with the programme of myocardial infarction register of all mortality cases among the inhabitants of one of the Moscow districts. In conformity with the criteria recommended by the WHO Expert Committee, general figures of sudden death incidence at the age of 20 to 64 years comprised 80.3--76.2 and 32.7--34.5 per 100,000 males and females, respectively, during the 1st and 2nd year of observation. Autopsies performed in 89.5% of the mortality cases established that only in 39.8% of the cases death ensued in the presence of fresh foci of necrosis in the myocardium, while in the rest no myocardial infarction was found. In an overwhelming majority of the dying patients severe stenoses or occlusions of the coronary arteries were seen, and only 13% had no stenoses. However, the latter group showed fresh necroses or postinfarction cicatrices in the myocardium. The obtained data indicate that sudden death occupies an important place in the structure of mortality in ischaemic heart disease. It has been demonstrated that no reduction of general mortality due to myocardial infarction is possible without effective measures against this kind of death.


[Catecholamines and other vasoactive substances in blood in cardiogenic shock]. The blood levels of catecholamines, serotonin, histamine and acetylcholine were studied in 17 patients with severe and moderate coronary shock. The blood level of the above vasoactive substances varied widely, and no clear regularity was noted in the changes of the content of the catecholamines, histamine, serotonin and acetylcholine. A relatively higher (on the average) level of noradrenaline was noted in severe shock, in contrast to the moderate cases, as well as a relatively low level of noradrenaline and acetylcholine in the blood of patients with a full atrioventricular block and bradycardia. In studying the vasoactive substances dynamically similar, phase-like fluctuations of the blood level of histamine and serotonin were noted in some patients. In a few cases similar, often phase-like, changes were also noted in the blood content of noradrenaline and acetylcholine


[Prevention of ventricular fibrillation during the acute phase of experimentally induced myocardial infarction by affecting the ion and acid-base balance of the heart]. For the purpose of prevention of ventricular fibrillation in acute coronary insufficiency a multi-component solution was developed that produces a normalizing effect on the acid-base and ion balance disorders in the heart under ischaemia. The injection of this solution into the left atrium sharply elevated the ventricular fibrillation threshold in cats with an occluded coronary artery. The administration of the solution into the left atrium of dogs following an occlusion of the descending left coronary artery prevented the development of fibrillation in all the experiments, while in the control series of experiments it developed in 62% of cases (p less than 0.001). The solution was decided to posses a high antifibrillation activity that manifests itself when the solution is introduced into the left atrium, and the mechanisms of the beneficial effects of the solution are discussed


[Drug prevention of cardiac rhythm disorders during the acute period of myocardial infarct]. Among 152 patients with myocardial infarction admitted to a specialized department within a few hours (1st day) of the onset of the disease without cardiac rhythm disorders, or with "minor" arrhythmias, 31 patients were receiving Panangine intravenously, 10--20 ml daily, for 7 days since the moment of admission. Another group of patients was comprised of 75 persons who, in addition to the above regimen of Panangine therapy, received at the moment of their admission a single intramuscular injection of Retabolil (50 mg). The control group was formed by 46 patients receiving no antiarrhythmic drugs. Monitoring of the cardiac rhythm during the acute period of myocardial infarction demonstrated that with preventive employment of Panangine prognostically dangerous rhythm disorders (especially paroxysmal tachycardia) developed less often than in the controls. A combined employment of Panangine and Retabolil resulted in a still better preventive effect, largely preventing, among other developments, the appearance of multiple polytopic extrasystoles. No ventricular fibrillation was observed in the examined patients.


[Influence of anti-arrhythmia agents on electrolyte metabolism]. In 73 patients with hypertensive and ischemic heart diseases the total body potassium content was studied by measuring natural radioactivity with reference to K40 before and after administration of quinidine, isoptin and inderal. Furthermore, in 74 patients subject to determination was the blood plasma and erythrocytes potassium and sodium levels on application of the said agents. Following administration of quinidine and isoptin the level of total potassium in the organism was rising substantially, while taking inderal lead to a drop of the potassium concentration in the body. No clear cut parallels between the blood plasma and erythrocytes ontent and the level of total potassium in the organism could be uncovered. Mechanisms underlying the antiarrhythmic action of quinidine, isoptin and inderal are discussed.


[Changes in cerebral circulation during various types of cardiac arrhythmias]. The cerebral volume blood flow was measured in acute canine experiments in three major arteries of the brain using an electromagnetic flowmeter. Paroxysms of ventricular tachycardia caused by electric stimulation of the heart resulted in varying degrees of reduction of the cerebral blood flow and arterial pressure that was most significant with cardiac contractions rate exceeding 240/min. Bradycardia with the contractions rate below 60/min also caused a reduction of the cerebral blood flow and arterial pressure. A parabolic correlation was revealed between the changes in the heart contractions rate and the amount of decrease of the cerebral blood flow and arterial pressure. Grouped ventricular extrasystoles resulted in a brief sharp fall of the cerebral blood flow...


[Electocardiographic changes in cerebral stroke patients with atherosclerosis and hypertension]. A dynamic electrocardiographic observation was conducted in 200 patients with cerebral stroke (57 patients had intracerebral haemorrhages, 143--ischaemic strokes). ECG changes  as a sequele of cerebral stroke were found to manifest themselves in various cardiac rhythm disorders, disturbances in the conductivity and repolarization phase. "Cerebrogenic" ECG changes were found in 76.5% of the patients. ECG changes were noted to occur in different combinations which permits to distinguish three main variants.


[Atrial dissociation].

[Atrial dissociation]. A case of atrial dissociation with left-side atrial flutter is described in a patient with a transmural anterior myocardial infarction. A favourable outcome of this arrhythmia was achieved. Inviting the literature data the paper discusses the problems of impulse transmission from the right atrium to the left, the mechanism and causes of atrial dissociation, the electrocardiographic and differential diagnosis of this arrythmia, the prognosis in atrial dissociation.


[Micro-focal myocardial infarct with a relapsing course]. The observation was conducted in 96 patients with micro-focal myocardial infarction who developed recurrences within the acute or subacute period (up to 2 months). In 47 patients the secondary infarction was of a micro-focal nature, in 49 -- macro-focal. Recurrence of micro-focal infarctions was observed predominantly in aged patients with a long history of angina pectoris who have had repeated myocardial infarctions earlier. Recurrent macro-focal myocardial infarctions were more often noted in younger patients with a brief coronary history, their primary infarction having been of a micro-focal nature. In both groups of patients congestive cardiac insufficiency and pulmonary oedema were often noted. Cardiogenic shock was mainly seen in those with relapses of macro-focal myocardial infarction. Recurrent microfocal myocardial infarction was often characterized by the development of rhythm and conductivity disorders and high mortality rate, especially when the recurrence was of a macro-focal type.


[Fast diagnosis of hemodynamic disorders in patients with heart disease]. The informativeness of arterial pressure, central venous pressure, cardiac contractions rate in the diagnosis of blood volume disorders combined with cardiac failure was studied in cardiac patients. The examination was carried out in 150 patients 80 of whom had been operated on the heart, mainly under extracorporeal circulation. The most informative parameter appeared to be the central venous pressure. An express-index is introduced that permits to differentiate between the following states: "isolated" hypovolemia, hypovolemia combined with cardiac failure combined with normovolemia, cardiac failure combined with hypervolemia.


[Utilization of the thermodilution method for study and assessment of rapid changes in central hemodynamics under clinical conditions]. The authors report of the employment of the thermodilution method for repeated serial measurements of the cardiac output in 60 patients during Fentanyl -- Epontol induction anaesthesia conducted in accordance with Darbinyan's technique. The concept is illustrated by the data obtained during heart catheterization in 38 cases of congenital and acquired heart diseases, various myocardiopathies. The authors describe the technical aspects of the method. With proper technical facilities available, the method of thermodilution proves accessible, simple, precise and safe for the examination of cardiac output.


[Comparative assessment of data of echocardiography and phonocardiography in the diagnosis of heart diseases]. A comparison was made between the echo- and phonocardiographic examinations and the final clinical diagnosis of 85 patients with various cardiac pathology. Echo- and phonocardiography were found to be not alternative, and the less -- contradictory, but mutually supplementing methods. Echocardiography has certain advantages over phonocardiography in the diagnosis of mitral valve defects -- in evaluating the degree of its stenosis and in characterizing the morphological changes of the valve, but it is somewhat inferior in diagnosing mitral insufficiency. In the diagnosis of aortic valve defects phonocardiography appears to be more informative since echocardiography does not always permit to record the state of the aortic valve. Indisputable advantages of echocardiography in the diagnosis of the tricuspid valve defects were revealed. The comparison of the data of echocardiography and phonocardiography permitted to decypher the syndrome of "a late systolic click with a late systolic murmur" that was previously interpreted as a pericardium sound. Besides, the echocardiographic data on the changes in the left ventricular outflow tract help to explain the origin of the spindle-form systolic murmur. So far their interpretation was rather complicated, although they are often seen on phonocardiograms of normal individuals and patients with heart diseases.


[Resistance testing of cytostatic agents on human tumors (author's transl)]. An in vitro short term incubation of human tumors with different cytostatic agents and their corresponding radioactive precursors of cell metabolism allows detection of those drugs which are inefficacious on the examined tumor. The pretherapeutical knowledge of those substances keeps the patient from unnecessary and damaging cytotoxic treatment. The in vitro and in vivo correlation of this technique was tested on 3 different groups of tumor patients: 1. Chemotherapeutically treated tumor patients with primary or secondary induced resistance against the applied cytostatic agents: all substances which clinically did not influence the tumor growth at the moment of the test also were inefficient in the in vitro test system. 2. Tumor patients who were treated according to a clinical therapy regimen contrary to the results of the in vitro testing: corresponding to the test, no influence on tumor growth was seen. 3. Tumor patients who were treated according to the results of the resistance test: after 8 weeks observation none of these patients had any signs of tumor progression.


[Determination of creatine kinase-MB in serum using inhibiting antibodies (author's transl)]. A new method for the determination of creatine kinase-MB activity in the serum is presented. The principle of this method is the direct measurement of the activity of creatine kinase M subunits by inhibiting antibodies. The total test procedure takes 15 min. In the sera of all the 83 patients tested, who have clinically proven myocard infarction, creatine kinase-MB activity can be measured between the 6th and 28th hour after infarction. At the time of maximum total creatine kinase activity the percentage of creatine kinase-MB activity is between 6 and 17%, the mean value being 8%. In cases of emergency this method can be used for the differential diagnosis of elevated total creatine kinase activities of unknown origin.


Increased consumption of refined carbohydrates in patients with Crohn's disease. The nutritional habits of 63 patients with Crohn's disease (C.d.) were explored by means of questionnaires and compared with a control group of 63 persons matched as to age, sex and social status. Before the disease was recognized patients with C.d. consumed 742 grams/week (g/w) sweets and 1380 g/w pastries, during the disease 482 g/w sweets and 905 g/w pastries. The controls only consumed 285 g/w sweets and 563 g/w pastries. The differences between both groups are highly significant. There existed no significant difference in the intake of other foodstuffs such as proteins, fats, vegetables or alcohol. The high intake of refined carbohydrates in patients with C.d. may be partly responsible for its increasing incidence in the developed countries. This might be due to the sugar content as such and/or the food additives.


[Effect of hyperventilation on cerebral blood flow and metabolism in man; continuous monitoring of arterio-cerebral venous glucose differences (author's transl)]. CBF decreases when arterial PCO2 is lowered by physiological, pathological or therapeutically induced hyperventilation. This is accompanied by an undelayed compensatory increase of oxygen-av-differences. Continuous monitoring of enzymatically determined glucose-av-differences of the brain during hyperventilation has for the first time shown that there is an undelayed fall of the cerebral venous glucose content, too. This indicates that the brain cells extract an augmented amount of glucose per ml blood during decreased CBF. Therefore glucose metabolism of the brain is not impaired during non-critical CBF reduction. However, when arterial PCO2 falls below 25 mmHg a detrimental effect on CBF and cerebral metabolism has to be expected. CBF will then decrease below the critical threshold for an undisturbed oxygen supply, and the respiratory alcalosis will lead to a disturbed oxygen delivery due to the Bohr-effect. As a consequence both of these factors will reduce the energy-yielding oxydative glycolysis and augment the little energy producing anaerobic glycolysis with a concomitant increase of lactate formation, resulting in a tissue and spinal fluid lactate acidosis. From our results it is therefore concluded that induced hyperventilation should be avoided, and that central hyperventilation in diseased states has to be considered as an additional threat to the brain.


[The effect of potassium on ouabain-binding to human cardiac cell membranes (author's transl)]. The concentration of cardiac glycosides in the serum of an individual patient does not necessarily correlate strictly with the known effects or side effects of these drugs. It is good clinical experience for instance that an acutely decreased serum potassium concentration due to diuretic therapy or dialysis may cause severe digitalis-induced arrhythmias in spite of an unchanged serum glycoside level. On the other hand digitalis intoxication often is treated successfully by the application of potassium. These observations prompted us to investigate the specific binding of tritiated g-strophanthin to isolated human cardiac cell membranes in the presence of different potassium concentrations. Potassium in a concentration-dependent manner displaces ouabain from its binding sites by decreasing the affinity of the receptor for the drug. However, the number of receptor sites remains constant. When analysing the association and dissociation rates of the ouabain-receptor complex it was found that potassium inhibits the binding process only, without affecting the dissociation. At least up to a concentration of 5 mM the potassium induced displacement of ouabain from its binding sites seems to be competitive. These in vitro measurements of the strophanthin--receptor interactions agree with clinical observations and are helpful in their explanation.


Serum digoxin concentration and half-life in newborn. Serum digoxin concentration and half-life were radioimmunologically determined in 9 mature newborns after 7 days medication with digoxin. The newborns were in respiratory distress treated with continuous positive airway pressure or were suspected to have serious congenital heart disease. Loading dose was 26 mug/kg body weight intravenously and 35 mug/kg body weight orally, respectively. Maintenance dose corresponded to 1/8th of the digitalization dose twice daily. The serum digoxin level 12 h after the last dose varied between 1.4 and 2.5 ng/ml (mean 2.0 ng/ml, Sx=0.4). The serum half-life of digoxin varied between 21.7 and 42.4 h (mean 30.0 h, Sx=7.7). The mean serum half-life of digoxin of 30 h attained values found in adults without renal disease. This suggests that the serum digoxin levels of newborns which are usually higher if compared with those of adults result from higher digoxin doses per unit body weight and not from diminished digoxin elimination.


[On thyroid phosphatase in human serum (author's transl)]. Patients with hyperthyreoidism often present an increased activity of alkaline phosphatase in serum. Determination of isoenzymes may help to assign to different organs an elevated enzyme-activity in serum. This report deals with a patient suffering from hyperthyreoidism. In his serum alkaline phosphatase of the thyroid gland could be identified by comparison with organ-extracts. Raised activity of this isoenzyme can contribute besides bone, liver and small bowel to the increased serum-activity of total alkaline phosphatase in patients with hyperthyreoidism.


[Dietary problems in the management of type I hyperlipoproteinemia (author's transl)]. The therapeutic effect of different diets varying in long chain and medium chain triglycerides, carbohydrate, and protein was tested in two siblings with type I hyperlipoproteinemia. Despite administration of an extremely fat reduced diet ( less than 5 g daily), a normalization of plasma TG could not be obtained because-as a consequence of its high carbohydrate and/or its MCT content-it resulted in a considerable increase in pre-beta-lipoproteins. As life long dietary therapy has to be maintained, the risks of a normal therapy has to be maintained, the risks of a normal fat containing diet (mainly bouts of pancreatitis) and those of a carbohydrate and MCT rich diet (premature atherosclerosis) are to be carefully considered. On the basis of our data we therefore suggest the following dietary regimen: 1. Reduced intake of long chain triglycerides (less than 30 gms per day), but with sufficient amounts of essential fatty acids (4-6 gms linoleate daily). 2. The carbohydrates should not exceed 50% of total calories and ought to consist mainly of starch. 3. The caloric deficit thus generated should be balanced by a high protein intake. This is faciliated by applying a specially protein-enriched food. 4. Medium chanin triglycerides may be necessary when adherence to the protein-rich diet turns out to be bad.


[Blood coagulation and fibrinolysis in women receiving estrogen, gestagen and estrogen-gestagen-contraceptives (author's transl)]. Eight femal subjects received a contraceptive with a low estrogen content (Neogynon), the estrogen component (50 mug ethinylestradiol) and consecutively the gestagen component (250 mug D-Norgestrel) of the contraceptive. Each treatment cycle was followed by a control cycle. At various times of the control and therapy cycles several coagulation and fibrinolytic parameters were investigated. Statistical analyses were performed by multivariate two-factorial analysis of variance. Plasminogen exhibities a statistically significant increase during the treatment with ethinylestradiol and the combination of this steroid with D-norgestrel. No significant changes were found for all other parameters, including partial thromboplastin time, fibriogen, factors X, IX, VIII, factor VIII-related antigen, antithrombin III and fibrin(ogen)degradation products.


[Electronmicroscopic visualization of virusparticles in cases of gastroenteritis of infants and children (author's transl)]. In 72 faecal extracts examined from babies and infants with an acute gastroenteritis, virus particles were found in 29 cases. These particles could be classified as reovirus-like in 16 cases, coronaviruses in 11 cases and adenoviruses in 2 cases. The electron microscopic investigation of 11 faecal extracts from healthy babies did not show any of these particles. Comparative studies on the concentration methods were performed.


[Kinetics of sulfobromophtalein using albumin-bound BSP (author's transl)]. BSP-kinetics are examined after adding different quantities of albumine to the solution to be injected. At a dosis of 5 mg BSP per kg body weight no changes are observed in the elimination half-life up to a BSP-albumine ratio of 1:10, at larger albumine dosis the value is prolonged.


Hemoglobins of the opossum (Didelphis virginiana Kerr). I. Developmental changes from yolk sac to definitive erythropoiesis. In 5- to 7-da old opossum pouch young, hemoglobins were observed. The "primitive" species I, II, and IV were shown to be electrophoretically distinct from the adult hemoglobin III. Hemoglobin I was detectable until the 7th postnatal da. Hemoglobins I, II, and IV were detected only during the period when yolk sac-derived primitive erythroblasts were seen in circulation, ei, until the 13th postnatal da, but in decreased amounts from the 6th to 13th da. The electrophoretic pattern of hemoglobin of pouch young after the 13th postnatal da was indistinguishable from that of the adult opossum.


An evaluation of sedatives and anesthetics in the agouti (Dasyprocta sp). Seven drugs administered im were evaluated to determine their efficacy in immobilizing captive agoutis. Ketamine HCl (63-83 mg/kg) and phencyclidine HCl (16.5-22.0 mg/kg) produced immobilization and analgesia. Phencyclidine administration was accompanied by numerous side effects and prolonged recovery. Xylazine HCl (3-70 mg/kg) and fentanyl-droperidol (0.28-1.11 ml/kg( produced varying degrees of ataxia and intermittent recumbency. Acetylpromazine, chlorpromazine, and promazine HCl were ineffective. Surgical anesthesia was successfully induced and maintained with halothane.


Birth sequence in mice.

Birth sequence in mice. Succession of deliveries at parturition was determined in mice following a marker injection in utero. The data failed to refute the hypothesis of a random birth order, as delivery from either uterine horn was found to be unpredictable. In addition, significantly more females delivered the first pup from the right uterine horn, supporting the concept of a "physiological dominance" for the right side of the mouse reproductive tract.


Thiamin status of laboratory rabbits.

Thiamin status of laboratory rabbits. Measurements of blood thiamin concentration, erythrocyte transketolase (TK) activity, and stomach and cecal thiamin concentration were made in 10 normal New Zealand white rabbits consuming a commercial pelleted rabbit diet. The concentration of the vitamin was somewhat higher in stomach content (57.2 +/- 11.8 m mug/g) than in cecal content (38.5 +/- 14.9 mmug/g). Erythrocyte TK activity was well within the range reported as normal in other mammalian species (TPP effect=2.6% for hexose and 0.5% for pentose).


A new castration technic in the guinea pig. A castration technic was perfected for removing seminiferous tubules and Leydig cells from the tunica albuginea, leaving the epididymis and its nerve and vascular supplies intact. There was a significant decrease in seminal vesicle weight in 15 guinea pigs castrated by this new procedure, indicating that the testicular androgen source was removed during castration. Spermatozoa remained motile in the ductus deferens of 18 animals that had been castrated for periods ranging from 7-70 da. The longevity of spermatozoa in the excurrent ducts was attributed to minimal trauma and damage to the ducts and their vascular and nvere supplies using this new technic.


Development of an animal model for Mycoplasma-related reproductive failure. Pregnant hamsters and mice were injected ip with various doses of Mycoplasma hominis, M fermentans, and M arthritidis, all of which may have a potential role in human or animal reproductive failure. Inoculations were made near the completion of each trimester, and the products of conception were removed by hysterectomy 24 hr before anticipated delivery. Resorptions and birth defects were tabulated. Preliminary data on 1869 fetuses indicate that BALB mice merit further evaluation as a possible model for mycoplasma-related reproductive failure.


A new technic for obtaining blood from mice. A practical technic was described for collecting serial blood samples from mice. Blood was obtained from a tail incision made immediately after the mice had been exposed to an ambient temperature of 45 degrees C. Individual samples sufficient for most tests were readily obtained without significant hemolysis. The technic was rapid, reliable, humane, and required no special skill.


Histopathologic changes in laboratory animals resulting from various methods of euthanasia. The histopathologic changes caused by various methods of euthanosia were studied in rats, mice, guinea pigs, and rabbits. Lesions resulting from a particular methods of euthanasia were consistent from species to species. Each method studied affected the lungs to some degree, ranging from mild congestion of alveolar capillaries to marked intramural edema of pulmonary arteries and alteration of vascular permeability. Euthanasia of experimental animals by overexposure to CO2, or ip injection of concentrated sodium pentobarbital seemed most suitable for pulmonary studies. Decapitation (mice, rats, guinea pigs), cervical dislocation (mice), CO2, and intracardial injection of sodium pentobarbital were more suitable for examination of abdominal viscera.


Improved caging for nine-banded armadillos. Impact resistant polyethylene cages were evaluated in  these laboratories as replacements for plywood boxes for housing nine-banded armadillos. They were found to be less expensive, easier to sanitize, and to require less than one-third as much floor space per animal as the boxes. This innovation has made it practical to house large numbers of armadillos economically and conveniently in almost any animal facility.


Levels of spontaneous malformations in the CD rat and the CD-1 mouse. Extensive information was supplied about the frequencies and types of spontaneous skeletal and visceral malformations in control and test fetuses which may be encountered during teratological assays. Data were also provided on fertility, agerage body weights, water consumption as a function of diet, and food consumption. The two strains used, Crl:COBS CD (SD) BR (France) rats and Crl:CD-1 (ICR) BR (France) mice, are valuable research tools since they are prolific, have a low rate of spontaneous malformations, and are responsive to teratogenic agents. The difficulties of determining the significance of infrequent anomalies were discussed.


Current experience using the laboratory rat in aging studies. The breeding and maintenance conditions for 2 strains of inbred rats, the WAG/Rij and BN/Bi rats, were described. The survival characteristics of these 2 strains were compared with those of 2 other experiments in which rats were kept for longevity studies under different environmental conditions of microbiologic status and diet. Data were provided on the rate and types of spontaneous tumors found in these 2 rat strains. It can be concluded that in order to obtain rats of good quality and in sufficient numbers for aging studies, breeding and raising the animals under strict SPF conditions is warranted. It is also necessary to maintain them under "clean conventional" conditions for long-term studies.


Histological and histochemical studies of myocardial lesions in BALBc/Cr mice. Myocardial lesions were noticed in BALBc/Cr mice during experiments with Moloney sarcoma virus (MSV). A study was initiated using unifected BALBc/Cr mice to determine whether these lesions were the result of a viral infection. Sixty percent of the females and 30% of the males used were found to have macroscopic lesions (mainly white spots on the right ventricle). The reported lesions were studied both histologically and histochemically. The animals were also examined for parasites such as Toxoplasma and tapeworm larvae, and were found negative. The investigation, which is still in progress, demonstrates the spontaneity of myocardial lesions in BALBc/Cr mice.


Advances in animal care technology at the National Center for Toxicological Research. The research purpose of the NCTR as it relates to animal care emphasizes the improvement of protocols for safety assessments, the study of irreversible lesions, and the use of valid animal models. The development, building, and operation of the "A" Barrier were described. The "A" Barrier is a complex of equipment, instrumentation, and rooms with controlled entry designed to prevent introduction of microoranisms or environmental factors into the SPF animal colonies. Support facilities such as computer controls and pathology were also described. The first experimental compound being tested is 2-acetylaminofluorene (2-AAF) which will be administered to a total of 25,000 mice in some 72 different treatment groups at 7 dose levels. The desired end-product of the center is to produce a series of tests which can be done quickly, efficiently, and economically and allow for a realistic estimate of risk to man of suspected toxic chemicals.


Progress report on the Charles River Breeding Laboratories' free-ranging rhesus monkey breeding colony on Key Lois, Florida. The nucleus of a breeding colony of free-ranging rhesus monkeys (Macaca mulatta) free from tuberculosis, herpes-B virus, shigellosis, and salmonellosis has been established on Key Lois, Florida, USA. Standardized procedures for trapping, quarantine, and shipping from the wild in India to the island have been established. The monkeys seem to have adapted well to the Florida Keys' climate. Reproduction has proceeded according to expectations, and social groups have been formed with continual restructuring as each new group is placed on the island. The isolation of Key Lois from other inhabited keys by the open sea affords good isolation and has discouraged intrusion by unwanted visitors. The operational costs of this island breeding program are encouraging. It is projected that by 1976 or 1977, monkeys should be available from this colony at a lower price than for animals bred in indoor facilities; and their availability will be in excess of animals trapped in the forest and subjected to a conventional conditioning and quarantine period.


Surface characteristics of normal and atherosclerotic human arteries including observations suggesting interaction between flow and intimal morphology. High resolution casts of the femoral and coronary arteries were made at physiologic pressure in 44 cadavers. A magnifying surface and profile analyzer were used for examination of the small surface characteristics of the casts. Corresponding portions of the arterial wall were compared by gross and microscopic examination. In sections without pathologic evidence of atherosclerosis, the cast surface characteristically demonstrated small longitudinal plicae, similar in size to those previously reported in studies with the scanning electron microscope. With increasing degrees of intimal thickening and atherosclerosis, longitudinal ridges were seen. In complete involvement of the intima, the ridge pattern was replaced by a locally smooth, grossly irregular surface. The orientation of ridges at curves and near branches and discrete plaques suggested the direction of secondary surface flow streamlines expected of these areas on the basis of hydrodynamic theory. Therefore, there may be formative interactions between blood flow and wall structure on a more local basis than previously surmised.


Permeability alteration of sarcolemmal membrane in catecholamine-induced cardiac muscle cell injury. In vivo studies with fine structural diffusion tracer horse radish peroxidase. Cardiac muscle cell injury was produced in male Sprague-Dawley rats weighing 300 to 450 gm. with catecholamines, norepinephrine, and isoproterenol; sarcolemmal membrane alteration was tested in vivo using the extracellular macromolecular tracer, horseradish peroxidase. Norepinephrine was administered in continuous intravenous infusion in a dose of 4 to 6 mug. per 100 gm. of body weight per minute, whereas isoproterenol was given as a single subcutaneous injection in a dose of 8.5 mg. per 100 gm. of body weight. Horseradish peroxidase was injected intravenously and localized in the right ventricular myocardium following 6 and 30 minutes of circulation time by light and electron microscopy. As early as 10 minutes after norepinephrine infusion, horseradish peroxidase appeared within cardiac muscle cells possessing normal fine structure. Selective deposition of the tracer on normal and altered myofilaments was noted. Similar observations were made in the isoproterenol model at 60 to 90 minutes. The results indicate that sarcolemmal membrane permeability alteration is an early event in catecholamine-induced cardiac muscle injury. The possible functional significance of the findings is discussed.


Effect of HgCl2 on rat kidney cells in primary culture. Single cell suspensions, obtained from rat kidneys, were cultured with various concentrations of HgCl2 for different times to examine the effects on cellular synthetic activity. Unexpectedly, the RNA synthesis of kidney cells was stimulated with low doses of HgCl2, whereas it was inhibited with higher doses. Even at a higher dose, RNA synthesis was stimulated during early incubation but was inhibited during longer incubations. Thus, the effect of mercury showed a biphasic pattern both in dose-response and time-response relationships. Moreover, once the cells were exposed to HgCl2 for a certain period, RNA syntehsis was irreversibly inhibited. Since RNA synthesis was inhibited earlier than DNA or a protein synthesis, the RNA synthesizing system appeared most susceptible. Without HgCl2, by the time DNA synthesis reached its maximum, protein and RNA synthesis had already declined. In contrast, RNA synthesis of HgCl2-treated cells remained at its maximal level and showed no decline when DNA synthesis reached its peak.


Characteristics of epithelial cella cultured from feline lung. Cell cultures were initiated by trypsinization of lung tissues obtained from 55-day-old fetuses of Felis catus. After a period of cultivation, the cells were cloned and several clones with an epithelial morphology were established. On electron microscopy, at least four of the clones contained intracytoplasmic lamellar inclusion bodies typical in appearance to those observed in type II alveolar cell in situ. These clones should be invaluable for the study of the biosynthesis of long surfactant.


Disseminated intravascular coagulation induced by Liquoid in the rat. II. Effect of heparin on hematologic and complement abnormalities and renal lesions studied by light, fluorescence, and electron microscopy. A single intravenous injection (12.5 mg.) of Liquoid (polyanethol sulfonate) was given to anticoagulated (heparinized) rats. Fibrinogen concentrations, platelet counts, total serum complement (CH50),C3 protein, and terminal components (C3 to C9) were measured. Histopathology was assessed by light, fluorescence, and electron microscopy. Heparin given before Liquoid remarkably diminished the seferity of the histologic lesions, with good correlation among light, fluorescence, and electron microscopy. Levels of clotting factors, CH50, C3 and C3 to C9, however, were not statistically different in the heparinized rats injected with Liquoid from those of animals receiving Liquoid alone. Actually C3 protein concentration was lower in the anticoagulated (Liquoid-heparin) rats. It is postulated that under the present experimental conditions, heparin did not antagonize the procoagulant and precipitating or complement-activating Liquoid effects. The attenuated histopathology observed was perhaps the result of either local or systemic, as yet undefined, heparin effects other than anticoagulation.


Effects of indomethacin on renomedullary interstitial cells. The effects of indomethacin, an inhibitor of prostaglandin synthesis, on rat renomedullary interstitial cells were studied. Indomethacin, 5 mg. per kg. intravenously in divided doses over 48 hours, resulted in reduced granularity of interstitial cells (5.56+/-1.37 versus 9.85+/-1.07 granules per cell, (p is less than 0.001) and, at the same time, inhibited the incorporation of 14C-arachidonate into renomedullary phospholipids (715 + 11 versus 1299 + 42 c.pm.per mug. of lipid orthophosphate; p is less than 0.001) 14C-arachidonate incorporation into cortical phospholipids was not affected by indomethacin. There was a close correlation between individual granule counts and 14C-arachidonate incorporation into medullary phospholipids for both control (r=0.85) and indomethacin-treated animals (r=0.9). Radioactivity in the cytosol fraction was depressed by indomethacin reflecting inhibition of prostaglandin synthesis; cytosol radioactivity correlated closely with individual granule count (r=0.81) in the indomethacin-treated but not in the control rats. Indomethacin given as a single dose 4 hours prior to sacrifice resulted in a significant depression of 14C-arachidonate incorporation but did not affect granularity of interstitial cells. The results suggest that granularity of renomedullary interstitial cells reflects the activity of prostaglandin synthesis and the rate of prostaglandin precursor delivery from microsomal phospholipids.


Initiation of lung cell proliferation by trypsin. The ability of trypsin to initiate DNA synthesis in alveolar epithelial cells of mice was tested by introducing solutions containing trypsin into the lung. The concentrations tested ranged from 0.01 to 1.0 mg. per ml., the site of action was identified by adding colloidal carbon as a tracer, and chromosomal DNA synthesis was detected by autoradiography on the basis of strong nuclear incorporation of tritiated thymidine. In the above concentration range trypsin did not cause cell necrosis, general fragmentation of cell processes, or loss of mechanical contact at epithelial cell junctions. Edema and focal acute inflammation were apparent at concentrations of trypsin above 0.1 mg. per ml. In the alveolar epithelium maximal labeling was seen 2 days after treatment with 0.5 mg. per ml. of trypsin. At this time electron microscope autoradiography covering two "S" periods showed that one-third of the type II cells were labeled. No labeled type I cells were seen. Trypsin at levels less than 0.1 mg. per ml. did not increase the frequency of labeled type II cells above that of the saline-colloidal ink solution alone. Mesothelial cells lining the lung were stimulated by trypsin (0.5 mg.) given intrapleurally. The frequency of mesothelial cell labeling peaked at 2 days with a labeling index for a single tritiated thymidine pulse of 18 per cent. Neither alveolar type II cells nor mesothelial cells showed increased labeling when trypsin inactivated by diisopropyl fluorophosphate was used.


The use of auditory masking to estimate automatization of correct articulatory production. In order to estimate automatization of correct articulatory production in 71 elementary school children about to be dismissed from training, auditory masking was used during administration of the Deep Test of Articulation. White noise was presented binaurally at 86 dB SPL. The children's articulation was tested under three conditions: Condition I without masking, Condition II with masking, and Condition III without masking three to four months after Condition II testing. Children's performances on Conditions I and II were compared with their performances during Condition III. Results demonstrated that performance on the Deep Test during auditory masking as a criterion for dismissal would have resulted in children being correctly dismissed from therapy more of the time (94%) than the traditional (nonmasked) administration of the test (77%). In addition, use of experimental administration of the test would have resulted in 6% of the children being incorrectly dismissed from therapy while traditional administration would have resulted in 23% of the children being incorrectly dismissed. Clinical importance and implications for further investigation are discussed.


Developmental assessment of Spanish grammar. The Developmental Assessment of Spanish Grammar (DASG) provides a language analysis procedure for Spanish-speaking children similar to the Developmental Sentence Scoring (DSS) procedure in English. The DASG is not an attempted translation of the DSS but was developed independently, taking into consideration the present knowledge of Spanish language acquisition. The purpose of the DASG is to evaluate the language of children with deficient grammatical skills in Spanish and to serve as a model for structuring Spanish language therapy. Proposed syntactic hierarchies for the following six grammatical categories are presented: indefinite pronouns and noun modifiers, personal pronouns, primary verbs, secondary verbs, conjunctions, and interrogative words. Weighted scores are assigned to groups of structures within the hierarchies and are used to score Spanish sentences children use spontaneously in conversation with an adult. The DASG was standardized on 128 Spanish-speaking children between the ages of 3.0 and 6.11 years. Norms and reliability measures are presented.


Tongue thrust: a point of view.

Tongue thrust: a point of view. The purpose of the present paper is to present evidence to support the following hypotheses: (1) there is a relationship between tongue thrust and malocclusion, and it is probably a reciprocal one; (2) tongue thrust may yield spontaneously to non-thrusting patterns; (3) if tongue thrust does not yield spontaneously to nonthrusting patterns, some form of treatment should be considered; (4) if myofunctional therapy is the treatment of choice, its timing with respect to patient age, developmental factors, and orthodontic treatment should be an individual matter. The need for more definitive research is described. In order for such research to be meaningful, a standard definition of tongue thrust is required. Such a definition is proposed.


The phonological systems of deaf children. Samples of a group of deaf children's spontaneous speech were used to derive phonological rules. The predictive value of some of the rules was assessed by asking another group of deaf children to lip-read and read nonsense words. The results indicated that the phonological systems of profoundly deaf children are partially rule-governed. There was also some evidence which suggested that lipreading was a major input to the deaf children's phonological systems.


The modification of multiple articulation errors based on distinctive feature theory. The effectiveness of articulation remediation procedures based on distinctive feature theory was evaluated through the administration of an articulation program designed for this purpose. Two preschool children with multiple phoneme errors which could be described by a distinctive feature analysis were the subjects. Both children substituted stop phonemes for most continuant phonemes. Each child was individually administered the distinctive feature program which is described in full. Data are presented which indicate the adequacy of the treatment program, the acquisition of correct articulation of the two directly treated target phonemes, and the concurrent improvement of five other nontreated error phonemes. Such across-phoneme generalization was predicted by distinctive feature theory. Certain modifications in the treatment program are suggested and theoretical/empirical questions regarding articulation remediation from a distinctive features viewpoint are discussed.


Children's perception of time-compressed speech on two measures of speech discrimination. Time-compressed versions of the WIPI and PB-K 50 speech discrimination measures were presented at two sensation levels to 60 children divided into three age-groups of 20 each. Results showed that average intelligibility scores increased as a function of increasing age and sensation level and decreased with increasing amounts of time compression. The PB-K 50 measure was found to be more difficult than the WIPI for each age-group under each condition of time compression and sensation level. The several factors under study were found to interact. The results are discussed relative to open- versus closed-message set response tasks and the implications for audiological diagnoses of children with central auditory processing problems.


Acquisition of lipreading in a deaf multihandicapped child. Operant techniques were used to develop lipreading in a nine-year-old deaf boy who had failed to respond appropriately to previous speechreading training. Remediation was initiated with two experiments: the first entailed a reversal and the second a multiple baseline. A component analysis revealed that both tokens and social reinforcers presented simultaneously or separately were effective in shaping lipreading. In addition, the child learned to lip-read either voiced or nonvoiced names of objects.


Acquisition of esophageal speech subsequent to learning pharyngeal speech: an unusual case study. Laryngectomees who are delayed in obtaining alaryngeal voice therapy may develop pharyngeal voice, an undesirable type of alaryngeal voice. Pharyngeal voice is usually self-developed; however, it may also be acquired in the clinical setting when the patient is being taught to inject air for esophageal sound production. This report describes the principal findings involving a laryngectomee who had developed and used pharyngeal speech as his primary method of communication for two years prior to enrollment in alaryngeal voice therapy. A clinical technique that was found to be successful in altering the pharyngeal voice to esophageal voice is reported. Findings pertaining to the overall intelligibility as well as vocal fundamental frequency of the two different types of alaryngeal speech are included.


Spouses' understanding of the communication disabilities of aphasic patients. The language skills of 11 aphasic patients were assessed through the use of the PICA. Spuses's understanding of the aphasic partner's language deficits was measured by rating the aphasic spouse on the Functional Communication Profile. Results indicate that spouses of aphasic patients view the patient's communication to be less impaired than it actually is. Implications for the counseling role of the speech pathologist in language therapy are discussed.


Critical bandwidth and sensitivity prediction in the acoustic stapedial reflex. Critical bandwidth measurements and sensitivity prediction from the acoustic reflex (SPAR) test results were obtained on 20 normal-hearing and two groups of 10 hearing-impaired subjects each representing mild-to-moderate and severe hearing loss. Results of critical bandwidth measurements indicated that for center frequencies of 1000 and 2000 Hz the critical bandwidth was significantly greater for the hearing-impaired subjects. A statistical analysis of the differences in critical bandwidth between those predicted by the SPAR test to have a mild-to-moderate hearing loss and those subjects for whom the test predicted severe hearing loss indicated no differences in critical bandwidth at 2000 Hz. A significant difference was found at 1000 Hz but in the wrong direction. Analysis of the relationship between predicted slope of hearing loss and critical bandwidth also failed to show significance. Although the data for hearing-impaired subjects fail to support the rationale for the SPAR test, the results for the entire research sample offer substantial support. Further, the ability of the test to predict categorically degree of hearing loss was also strongly supported.


Therapeutic approaches to apraxia.

Therapeutic approaches to apraxia. Although identifying descriptions of apraxia are numerous in recent literature, few articles present guidelines for apraxia therapy. In this paper, several therapeutic techniques for apraxia are introduced and discussed. Sequencing of speech sounds is recognized as the apraxic patient's most characteristic problem. Rapid repetition of consonant plus /a/, build-up of speech sounds into syllables, and word attack by phone and syllable are all recommended for the purpose of improving sequencing. Facilitation techniques are discussed for the acquisition of articulatory postures. Case histories are presented to illustrate the therapy approach.


Effects of sentence context on recognition of words through lipreading by deaf children. Twenty monosyllabic nouns (10 animate, 10 inanimate) were presented in isolation and in three different positions in sentences to 15 profoundly deaf children to determine the effect of context on word intelligibility through lipreading. Isolated words were more intelligible (80%) than were words in sentences (46%). Animate nouns were more intelligible (70%) than inanimate nouns (33%) when used in initial position (as subjects) in sentences. Teacher ratings of children's "general lipreading ability" were correlated more highly with their recognition of words in the test sentences (r = 0.93) than with their recognition of words presented in isolation (r = 0.53). The results indicate that teachers of deaf children could enhance the intelligibility of important words by isolating them from sentences. The results also suggest that some speech-perception difficulties of deaf children could be diagnosed through lipreading tests which are scored on the basis of correctness of "key words" in sentences.


Pronominalization in the language of deaf students. Four hundred and eighty deaf students (age 10 to 18 years) and 60 hearing children (age eight to 10 years) were required to complete a stimulus sentence by selecting the appropriate pronoun from a list provided. The results indicated that subject and object case pronouns were easier than possessive adjectives, which were in turn easier than possessive pronouns and reflexives. Correct use of relative pronouns was the most difficult for both deaf and hearing subjects. Generalizations about the acquisition of the pronoun system must be limited, as it appeared that pronouns are mastered on a pronoun-by-pronoun basis rather than by categories (person, number, case) for both the deaf and hearing subjects.


The effects of word length and visual complexity on verbal reaction times. Thirty adult subjects learned to associate nonsense names varying in word length with nonsense visual stimuli varying in visual complexity. Simple reaction times (SRTs), visual duration thresholds (VDTs), matching response latencies (MRLs), and naming response latencies (NRLs) were then obtained from these subjects. The data indicate that SRTs, VDTs, and NRLs are significantly related to word length and that VDTs and NRLs are significantly related to visual complexity. There is also a tendency for MRLs to increase with increases in word length, particularly for "no" responses. However, the effects of word length on VDTs, MRLs, and NRLs may be confounded with the number of trials needed to learn the paired associates or with the number of overlearning trials. The data are consistent with an interpretation that motor planning or some form of implicit speech process may be a part of the total time required for the naming response.


Binaural masking effects in bone-conducted noise. When pure tones are masked by bone-conducted noise presented at the midline of the forehead, it is possible that binaural unmasking may occur due to the interaural phase relations of the noise. To study this possibility, the amount of masking produced in bone-conducted noise, in correlated air-conducted noise, and in monaural noise was determined using narrow bands of noise centered at 240, 500, 910, and 1900 Hz as markers and a block up-down two-interval forced choice procedure. The subjects were four women under 30 years of age with 10 dB HTL or better (ANSI, 1969) for the frequencies tested. The amount of unmasking (the masking-level difference) was determined by subtracting the masking levels obtained under each noise condition at each frequency from those obtained in the comparable monaural noise-monaural signal condition. Levels of binaural unmasking obtained in correlated air-conducted noise agreed with those in previously reported experiments. Comparable binaural unmasking effects were demonstrated for midline presentation of bone-conducted noise. Some clinical implications of the findings are discussed.


A comparison of the contributions of two voice quality characteristics to the perception of maleness and femaleness in the voice. Comparisons were made between the contributions of the fundamental frequency (F0) on one hand, and vocal tract resonances on the other, to a perception of maleness and femaleness in the adult voice. In the first of two experiments, the F0 of natural voice was found to be very highly correlated with the degree of maleness and femaleness in the voice. The vocal tract resonances were less highly correlated and it is apparent that in the presence of the natural laryngeal tone, these perceptions are based on the frequency of the F0. In the second experiment, a tone produced by a laryngeal vibrator was substituted for the normal glottal tone at simulated F0's representing both males (120 Hz) and females (240 Hz). When listeners were asked to identify the sex of the speakers some inconsistently with the findings of the first experiment was seen. The female F0 was a weak indicator of female voice quality when combined with male vocal tract resonance although the male F0 retained the perceptual prominence seen in the first experiment. This finding may be indicative of some basic difference in the normal glottal characteristics of males and females.


Bone conduction thresholds for normal listeners in force and acceleration units. In a previous article we reported on the standardization of normal hearing for bone conduction. All of our findings were reported in force units. Because many international users of this information express such findings in units of acceleration, we have, at the Editor's request, converted our force units into acceleration units to increase the scope of our results and to enhance their comparison with other investigations. This note presents data which may be useful to organization concerned with the development of standards for normal hearing by bone conduction.


Motor impairment following blockade of the infraorbital nerve: implications for the use of anesthetization techniques in speech research. Infraorbital nerve blocks were performed bilaterally in three subjects as a partial test of the hypothesis that some portion of the motor innervation to the facial muscles is provided in the trigeminal nerve. To ascertain the influence of this anesthetic procedure, the magnitude and rate of upper lip displacement (for speech and nonspeech tasks), the magnitude and rate of upper lip depression force, and diadochokinetic rate were transduced and recorded, both pre- and postanesthesia. All measures, along with bilateral muscle action potentials from orbicularis oris superior obtained for all force and displacement tasks, were reduced in magnitude as a function of the anesthetic condition. These findings, along with results from previous speech anesthetic studies, were interpreted to suggest that anesthesia of the infraorbital nerve produces measurable, if not substantial motor weakness in the supraoral musculature. The implications for previous studies, where anesthesia techniques have been employed, are discussed.


Instructed rehearsal strategies' influence on deaf memory processing. Congenitally deaf subjects were compared with normal-hearing subjects on short-term retention accuracy and correct response latency. The subjects paced themselves through serial lists of consonant letters six- or seven-items long. Presentation of each list was followed by a position-probe test requiring the subjects to specify where in the list a particular letter had appeared. The subjects were first observed while generating their own input strategies (free strategy). In subsequent sessions they adopted instructed rehearsal strategies involving primary and secondary memory components. Overall, the normal-hearing subjects were more accurate and responded faster than the deaf subjects. Instructing rehearsal strategies resulted in immediate gains on these measures for both groups. For both measures the deaf subjects became at least as proficient as the normal-hearing subjects had been under free strategy. The patterns of correct response latencies for the groups revealed strikingly different comparisons for primary and secondary memory. Following strategy instruction, latencies for the terminal list items never differed for the two groups, indicating that primary memory in the deaf is fully intact. However, the deaf responded slower on the first items of the list, indicating secondary memory deficiencies.


Use of low-pass noise in word-recognition testing. This study attempted to determine whether word-recognition scores obtained in noise were more sensitive to the presence of a hearing loss than recognition scores obtained in quiet. Subjects with normal hearing, high-frequency cochlear hearing loss, and flat cochlear hearing loss were tested in quiet and in the presence of a 500-Hz low-pass noise. Two signal-to-noise conditions were employed, -4 dB and -12 dB. Words were presented at 40dB SL in one experiment and at 96 dB SPL for normal-hearing subjects in a second experiment. The results indicated that, while the word-recognition scores of groups were similar in quiet, the more negative the signal-to-noise ratio, the greater the separation of group scores, with hearing-impaired subjects having poorer recognition scores than normal-hearing subjects. When the speech and noise were presented at high SPLs, however, the normal-hearing subjects had poorer word recognition than those with flat cochlear losses. The results are interpreted as indicating greater spread of masking in normal-hearing than hearing-impaired subjects at high sound pressure levels.


Tutorial: application of regression analysis concepts to retrospective research in speech pathology. The underlying logic of retrospective research in speech pathology is examined critically. This research model focuses on differences among discrete groups. Regression analysis concepts are suggested as a tool to evaluate the practical or theoretical importance of statistically significant differences obtained in retrospective research. This type of analysis focuses on the degree to which a criterion measure can be predicted from knowledge of group classification, rather than on differences among means.


Time-intensity trading functions for selected pure tones. A substantial number of investigations have examined the ability of the auditory system to trade time for intensity on a lateralization task. Most of these investigations, however, have employed clicks and noise bursts as stimuli with interaural disparities between onset times. Consequently, there is a lack of quantitative data for time-intensity trades where pure tones that had identical onset times but disparate phase were employed as signals. For this reason we employed sinusoids ranging from 200 to 2000 Hz and determined the extent to which the intensity of one signal must be decreased to achieve a midline image when interaural phase disparities of 0 degrees to 360 degrees were imposed between the binaural signals in 30 degree increments. The time-intensity trading functions yielded in this experiment demonstrate that (1) not unexpectedly, the largest time-intensity trades were accomplished for the lower frequencies; (2) the maximum time-intensity trade for each frequency occurred at interaural phase disparities of 90 degrees and 270 degrees; and (3) when the low-frequency tones were 180 degrees out of phase, essentially the same intraaural intensity relationship was required to achieve midline as was needed for the 0 degree interaural phase condition.


INDSCAL analysis of perceptual judgments for 24 consonants via visual, tactile, and visual-tactile inputs. Twenty-four normal-hearing subjects received CV stimuli of uni- and bisensory inputs through the visual (speechreading), tactile (touch), and visual-tactile (speechreading and touch) modalities. Stimuli were presented via either a videotape monitor or a tactile vibrator or both. The purposes were to investigate the contribution of the tactile modality in uni- and bisensory conditions, and to analyze consonantal substitution errors to find perceptual features utilized by the subjects in their decision-making processes. The subjects' consonantal perceptions were phonetically transcribed and submitted to INDSCAL analysis which yielded mainly a four-dimensional solution. The interpretations of these dimensions were primarily closed bilabial, easy to see/hard to see, voiced/voiceless, and front/back place. Additional features were retrieved, but occurred less consistently.


Influence of encoding and acoustic similarity on the ear advantage and lag effect in dichotic listening. Experiments with simultaneous and time lag dichotic listening conditions were used to test two hypotheses concerning the right ear advantage and lag effect in dichotic listening. One hypothesis is based on the similarity of acoustic spectra, and the other is based on a categorization of speech sounds as being either encoded or not encoded. Natural vowels and consonant-vowel syllables were used to obtain seven different types of speech stimuli: stop vowel syllables, fricative vowel syllables, stop burst noise, fricative noise, stop vowel transitions, fricative vowel transitions and steady state vowels. The presentation conditions were monaural, simultaneous dichotic, and dichotic with interaural time delays of 15, 30, 60, and 90 msec. With monaural presentations, all stimuli were identifiable above chance levels. For the simultaneous dichotic condition, significant right ear advantages occurred for stop vowel syllables, fricative vowel syllables, stop burst noise, and steady state vowels. For the time lag conditions, stop vowel syllables, stop bursts, and fricative noise produced consistent lag effects, but steady state vowels produced consistent lead effects. In general, the results gave stronger support to the hypothesis of acoustic similarity than to the encoding hypothesis in that stop burst noise produced both a right ear advantage and a lag effect whereas consonant-vowel transitions produced neither a right ear advantage nor a lag effect.


Development of the voicing contrast: a comparison of voice onset time in stop preception and production. The acoustic cue voice onset time (VOT) was used to study development of the voicing contrast in 10 two-year-old children, 10 six-year-old children, and 20 adults. Thirty utterances of the words bees, peas, bear, pear, dime, time, goat, and coat were elicited from each subject, VOT measured, and individual production distributions for labial, apical, and velar stops plotted. Significant age-related differences were shown for mean VOT, mean lead time for voiced stops, range of the same words that were examined in the production portion of the investigation were obtained for these subjects from their judgments of synthetic speech stimuli. The relationship between identification and production was examined by assessing the degree of correspondence between the perception and production VOT values. Results of this analysis showed a developmental pattern of change primarily for the voiceless stops in the form of increased correspondence between perceptual identification categories and production VOT values. Three stages for acquisition of the voicing contrast related to VOT are indicated.


Columnar cell-lined esophagus: assessment of etiology and treatment. A 22 year experience. Among 1,000 patients with hiatal hernias were 45 who had biopsy-proved columnar-lined esophagus (CLE). Twenty-one were male and 24 female, with bimodal age ranges peaking at zero to 10 and 48 to 80 years. Of the first decade patients, all boys, 2 were brothers. While 44 had dysphagia, one third also had iron-deficiency anemia. All had x-ray-proved sliding hiatal hernias, with esophageal stricturing at the squamous cell-columnar cell interface. In 43 cases this area was 35 cm. or less from the upper jaw. The epithelial histology showed simple, tubular, mucus-secreting glands (45 cases), goblet cells (7 cases), no goblet cells (38 cases), and gastric-type epithelium with parietal cells (19 cases). In 2 cases CLE was rising up the esophagus from 35 to 30 cm. in 3 years and from 40 to 23 cm. in 10 years. No stricture became neoplastic. Clinical evidence supports the view that CLE has a double etiology: It is congenital in children but acquired, akin to "intestinalization of the stomach," in adults with sliding hiatal hernias; in the latter instance, CLE occurs as an alternative end-point to reflux esophagitis. Treatments and long-term results are discussed. All patients had initial stricture dilatation with biopsy. In 17 this was the sole treatment. In 16 cases a later transthoracic herniorrhaphy was performed to reduce the hiatal hernia and prevent further stricturing. Fifteen patients had transmural strictures. For this group, our experience with Roux-Y esophagogastrostomy and esophagojejunogastrostomy, with stricture excision, and also with mere bypass of the stricture is stated. For the young, after stricture excision, eosophagojejunogastrostomy with pyloroplasty, performed in the second decade, is favored. In the elderly, especially after unsuccessful hiatal herniorrhaphy, eosophagojejunogastrostomy with stricture bypass proved satisfactory 3 years after the operation.


Congenital aneurysm of the sinus of Valsalva protruding into the left ventricle. Review of diagnosis and treatment of the unruptured aneurysm. During a routine physical examination, a 34-year-old man, in apparent good health, had an electrocardiogram which revealed left axis deviation. Cardiac evaluation disclosed mild aortic regurgitation and left anterior fascicular block. Nine months later, the patient was admitted to the critical care unit after he had experienced cardiac arrest while jogging. Angiograms demonstrated a large unruptured aneurysm in the right coronary sinus of Valsalva protuding into the left ventricle. Echocardiographic manifestations also suggested also suggested a sinus of Valsalva aneurysm. The defect was repaired through an aortic approach. The aneurysmal sac was emptied and the neck sutured securely. Twenty-two months postoperatively, the patient continues to be asymptomatic. We anticipate that this will decrease the threat of recurrent arrhythmias..


Systemic hypertension following myocardial revascularization. A method of treatment using epidural anesthesia. Seven of 12 patients (58%) undergoing myocardial revascularization surgery became hypertensive in the immediate postoperative period. The hypertensive patients had significant elevations in peripheral vascular resistance (22.0 +/- 2.0 S.E. resistance units) compared to measurements in normotensive patients (15.6 +/- 1.3 S.E. resistance units) (p less than 0.05), whereas the heart rates and cardiac indices were similar. Administration of thoracic epidural anesthesia to postoperatively hypertensive patients lowered systemic arterial pressure by decreasing peripheral vascular resistance (p less than 0.005) but not affecting the pulse rate and cardiac index. The ratio diastolic pressure-time index/systemic pressure-time index (DPTI/SPTI), an indirect measurement of subendocardial oxygenation, increased from preanesthetic values of 0.80 +/- 0.08 S.E. to 1.09 +/- 0.09 S.E. (p less than 0.025) after the systemic arterial pressure was lowered in postoperatively hypertensive patients. Hypertensive episodes following myocardial revascularization procedures appear related to increased alpha-adrenergic activity, which products elevation in peripheral vascular resistance. Decreasing peripheral vascular resistance by chemical sympathectomy with thoracic epidural anesthesia lowers the systemic arterial pressure and improves the DPTI/SPTI ratio.


Myocardial infarction complicating aortic valve replacement. One hundred consecutive aortic valve replacements were studied. Fifteen patients had a myocardial infarction as a result of the operation, and four of the five deaths in the series stemmed from this group. In the four deaths from infarction, autopsy revealed occlusion of a main coronary artery. This was attributable to coronary perfusion in three instances. All of the 11 survivors who sustained an infarct were free of angina and left ventricular failure 6 weeks after the operation. Patients with infarcts had longer bypass times and larger aortic systolic gradients than the patients who did not have an infarct. It is suggested that an infarct can occur as the result of occlusion of a main coronary artery; this is a fatal event commonly related to trauma from the coronary perfusion cannula. Alternatively, infarction may result from regional ischemia, perhaps without vessel occlusion, and is associated with long bypass times and with large aortic valve gradients. In such cases the prognosis is good. However, myocardial infarction was the major cause of death in this series.


Cardiorespiratory failure secondary to peripheral pulmonary emboli. Survival following a combination of prolonged extracorporeal membrane oxygenator support and pulmonary embolectomy. A 19-year-old woman developed cardiorespiratory failure from multiple, peripheral pulmonary emboli apparently developing over the preceding 3 weeks. She was not considered to be an operative candidate. However, when 3 days of intravenous heparin infusion and 30 hours of membrane oxygenator support failed to improve the pulmonary pathology, pulmonary embolectomy was performed. The membrane oxygenator support had to be continued for 34 hours following the operation before it was successfully discontinued. The patient made a complete recovery.