[Accident in treatment of porphyria cutanea tarda by chloroquine (Resochin) (author's transl)]. About a 65-year old patient with the typical clinical and biochemical characteristics of porphyria cutanea tarda (Pct) is reported. After treatment with Resochin in an erroneously high dosage (1.250 mg instead of 125 mg) an acute crisis set in with a triple increase of porphyrin excretion, fever, tachycardia, hypertension and joint-discomfort. Despite the rise in excretion of total porphyrines in urine to approximately 18.00 mcg/l there was no change in the amount of the porphyrin precursors (ALA, PBG). The pattern of the porphyrin-metabolites (URO-, HEPTA,- HEXA-, PENTA-, COPRO-porphyrin)-expressed in rel.%-does not change during the excessive rise of porphyrin excretion. The duration Resochin-therapy could obviously not be shortened by an initial too high dosage of chloroquine. The mechanism of action of chloroquine in Pct is not clear. It is discussed that a change in the permeability of the liver mitochondria leads to a continuously increased excretion of porphyrin and to an exhaustion of the hepatic porphyrin pool.


Investigative studies of the dermatitis caused by the larva of the brown-tail moth (Euproctis chrysorrhoea Linn.) II. Histopathology of skin lesions and scanning electron microscopy of their causative setae. Two different  aspects related to the dermatitis caused by the so-called nettling hairs of the larva of the brown-tail moth, Euproctis chrysorrhoea L., are documented. The first part describes the sequence of histopathologic changes associated with the inflammatory process in the human skin induced by epicutaneous application untreated (UT-N) and heat treated (HT-N) nettling hairs. The penetration of untreated and heat treated nettling hairs into the epidermis is evident from their presence in 12 out of 29 UT-N lesions and 5 out of 10 HT-N lesions respectively. The introduction of nettling hairs into the skin leads to damage and bulla formation of the surface epithelium and early inflammatory signs consisting of edematous changes of the dermis and pervascular infiltration of neutrophils, eosinophils and mononuclear leucocytes. After few hours the intensity of the dermal infiltrate has increased and spongiotic changes appear. After 48--72 h the perivascular infiltrate is mainly composed of mononuclear cells, while along with increased spongiosis the damaged surface epithelium may show repair. The traumatic changes of the surface epithelium in HT-N lesions appear less prominent in comparison with the UT-N lesions. The second part describes the findings obtained by scanning electron microscopy of the nettling hairs. Evidence is brought forward to support the view that the offending setae may be looked upon as tapering, hollow microcapillaries which are open at both ends. The present findings are consistent with the idea that the nettling hairs may serve as microneedles from which irritant substances may be liberated when penetrating into the skin, and that the resulting inflammatory reactions are attributable to combined mechanical and toxic effects.


[Structural changes of the basement tubule membrane in the so-called Sertoli cell syndrome (author's transl)]. In the so-called Sertoli cell syndrome nearly always club shaped invaginations of the basement tubule membrane with intact cellule membrane can be seen. These protuberatons ultrastructurally prove to be multiplicated piles of the lamina densa of the basement membrane. The cells in the Sertoli cell syndrome show a quantitatively and qualitatively reduced pattern of enzymes in contrast with the active Sertoli cells.


[Cellular immunity in melanomalignome (author's transl)]. Cellular immunological reactivity was examined in 20 patients having melanomalignoma at different clinical stages, using Leukocyte-Migration-Inhibition-Test. As antigens three homologous melanoma-extracts were used, produced by our own method. Independent from the clinical stages cell-migration inhibition could be established in 15 out of the 20 patients. In this way, these tumor extracts have been shown to contain melanoma-associated antigens. Regardless of the clinical stage of the disease, the melanomalignomas patient produces cellular immunity against those tumor-antigens. It is note-worthy that the actual course of the disease seems not to be influenced by immun-mechanisms.


Lung cancer following exposure to chloromethyl methyl ether. An epidemiological study. A historical prospective epidemiological study was conducted on workers exposed to chloromethyl methyl ether (CMME) containing 0.5% to 4% bis(chloromethyl) ether (BCME) as an impurity. The study period was 1948 to 1972. Follow-up procedures located 98.9% of the cohort, including those separated from the plant. The cause of death was established for 95.3% of the 278 known deceased men. A CMME exposure rating system was established from employees' work histories and recollections of supervisors. This system approximated relative exposure concentrations and duration times. Analysis on an age-specific basis revealed a relative risk of lung cancer 3.8 times higher in 669 exposed vs 1,616 unexposed workers, a significant increase. Although limited by lack of quantitative environmental sampling data, dose-response relationships were established between lung cancer an intensity and/or duration of exposure.


Respiratory tract deposition of smoke particles using a nasal bypass device. In order to avoid nasal absorption, an intralaryngeal cannula was tested as a device for bypassing the nose in delivering smoke into the lungs of hamsters. The intralaryngeal cannula increased lung deposition of radiolabeled smoke particles twofold to threefold over that in nose-breathing controls. Stabilization of respiration (absence of avoidance reaction), rather than prevention of nasal absorption of smoke, was demonstrated to be the cannula's major mechanism of action. Although suitable for acute exposures, the device is of limited use for chronic exposures that require daily insertion of the cannula during an extended period of time.


Studies of respiratory morbidity in rubber workers. Part III. Respiratory morbidity in processing workers. Respiratory questionnaires and pulmonary function tests were administered to sixty-five men exposed to dust in the processing are from three rubber tire manufacturing plants. Similar tests were done on 189 "control" workers. Compared with the controls, the processing workers had a higher prevalence of chronic productive cough. Overall, the processing group showed a decrease in the ratio of FEV to FVC. The processing workers with more than ten years of exposure showed a significant decrease in the ratio of FEV1.0/FVC, the FEV1.0, the residual FEV1.0, and the flow rates at 50% and 25% of the forced vital capacity. None of the pulmonary function effects could be solely explained on the basis of smoking, age, ethnic, or socioeconomic factors: all were related to the length of exposure. Based on these results we conclude that exposure in the processing area produces pulmonary disease.


Increased life span and decreased weight in hamsters exposed to cigarette smoke. Five groups of fifty-one 2-month-old male Syrian golden hamsters received three 10-minute exposures to cigarette smoke per day, 5 days per week, for the duration of their lives. Three of the groups were also chronically exposed to aerosols of chrysotile asbestos, cobalt oxide, and nickel oxides, respectively. The fourth group received twelve weekly injections of 0.25 mg of diethylnitrosamine. The smoke-exposed groups lived significantly (P less than .01) longer than their sham-exposed cohorts and untreated controls. Their mean body weights were significantly (P less than .01) lower than in the sham-exposed groups. The hypothesis is proposed that delayed onset of amyloidosis and lower body weight in the smoke-exposed hamsters may have been responsible for their increased life spans. It is hypothesized that cigarette smoke affected the immune system of the animals, resulting in retardation of amyloidosis, a frequent cause of death in hamsters.


Morbidity studies of workers exposed to whole body vibration. Insurance claims for medical services submitted on behalf of a group of workers in the construction industry were collected over a 20-month period. The morbidity experience of those workers exposed to whole body vibration was contrasted with that of an unexposed control group eligible for benefits under the same plan. Using Mantel-Haenszel adjustment for age and experience, a significantly elevated relative risk was found among the exposed group in three of the thirty disease categories studied. In no disease category did the control group possess a significantly higher risk of requiring medical services. A striking proportion of the disease categories showed an initial increase in risk for exposed workers followed by a decrease with experience. This pattern suggests a selection process in which workers leave exposed-group jobs as they become afflicted with certain disease conditions.


Mercury and selenium distribution in a defined area and in its population. In the Amiata Mountain area of Tuscany, Italy, a survey has examined the concentrations of mercury and selenium in the environment, in the food chain, and in human biological samples of blood, urine, and hair. This area was selected for study because of its large mineral deposits and concentration of elements, e.g., iron, copper, silver, antimony, and particularly mercury. Subjects consisted of a group with high occupational exposure to mercury vapor, a group randomly exposed to mercury dust, and a group nonoccupationally exposed to mercury. The selenium and mercury contents in all samples were determined by nondestructive neutron activation analysis, and results showed that the human metabolism of mercury is different from that of selenium and that the selenium retention in man could be influenced by the mercury intake. Furthermore, a great part of selenium introduced through the diet passes into the blood, where it is mainly associated with blood cells.


Hypoxia and induced mutations in Syrian (golden) hamsters. The origin and perpetuation of a species. We were able to identify anomalous chromosome patterns-monosomy, trisomy, and polyploidy-in metaphase plates prepared from embryos of Syrian hamsters (Mesocricetus auratus) whose mothers had been exposed to low-pressure hypoxia during the hours after copulation. These females were exposed in a low-pressure chamber for 4 hours at pressures equivalent to 30,000 feet of altitude before (estimated) ovulation to create acid shifts of pH equilibrium in the milieu of newly released eggs during passage of sperm upward, during fertilization itself, and during early cleavage stages. The D group chromosomes were most frequently involved in both monosomy and hyperdiploidy. The easily identifiable X chromosome also appeared to be susceptible to aneuploid formation. Chromosomally abnormal patterns most frequently among sibling embryos conceived by aging mothers exposed to low-pressure hypoxia. The significance of induced mutations is discussed.


Reducing sample sizes when comparing experimental and control groups. In comparing rates for two groups (one control and the other experimental), one may use an historical control to reduce the sample size needed for a test of significance to one-fourth that required if the control is not historical. If there is some doubt as to whether one's control is comparable to the historical control, a test showing the equality of the historical and experimental controls can lead to a halving of the sample required for significance testing. This same argument also applies to the comparison of two means.


Management of acute sulfide poisoning. Effects of oxygen, thiosulfate, and nitrite. Oxygen (100% at 1 atmosphere) did not protect mice against death from acute sulfide poisoning as compared with animals maintained under air at 1 atmosphere. Sodium thiosulfate had a small, but statistically significant (P less than .05) protective effect against death due to sodium sulfide, whether the mice were maintained under air or oxygen. Pretreatment with sodium nitrite, however, increased the acute intraperitoneal lethal dose for 50% survival of the group (LD50) of sodium sulfide 2.5 times. Neither oxygen, thiosulfate, nor the combination potentiated the protective effects of nitrite against sulfide poisoning. Antidotal effects of nitrite in acute sulfide poisoning were demonstrated in rats. The therapeutic efficacy of nitrite in acute poisoning is clearly superior to that of oxygen, which is the more widely recommended antidote.


Preliminary observations on an isolate from synvoial fluid of patients with rheumatoid arthritis. A very slow-growing micro-organism has been isolated from the synovial fluid of patients suffering from rheumatoid arthritis. This organism exhibits some of the properties of a mycoplasma such as growth in the presence of penicillin, and the requirement of serum and yeast, but generally does not behave like any known species of this group. Colonies resemble some types of T-mycoplasma in morphology and size. Scanning electron microscopy showed that the size of the components of these colonies was exceedingly small.


Arthritis of mice induced by Mycoplasma arthritidis. Humoral antibody and lymphocyte responses of CBA mice. Peak arthritis occurred 7 days after intravenous injection of CBA mice with Mycoplasma arthritidis and persisted in some animals for 84 days. A marked leucocytosis was apparent for the first 21 days. Complement-fixing antibodies reached a peak 14 days after injection of the organisms and persisted at high levels for 84 days. Metabolic-inhibiting and mycoplasmacidal antibodies were present but at much lower titres.


Thermoanalytical and histological study of intra-articular papain-induced degradation and repair of rabbit cartilage. II. Mature animals. The effect of papain treatment on the cartilage tissue of the knee joint of mature rabbits was studied by histological and thermoanalytical methods. Changes taking place in the composition of cartilage in the course of ageing were shown. As a result of papain treatment a significant irreversible destruction of the ground substance took place. Papain-induced loss of proteoglycans and the intensity of repair reactions and age-related differences are discussed.


Antibody-mediated leucocyte cytotoxicity to Chang human liver cells in rheumatoid arthritis and other diseases. The incidence of an IgG-antibody which induces lymphocyte cytotoxicity to Chang human liver cells in culture was estimated in the sera of patients with rheumatoid arthritis, systemic lupus erythematosus, ankylosing spondylitis, psoriatic arthritis, Crohn's disease, ulcerative colitis, and in healthy controls. It was found in 4.1% of control subjects and in 31% of patients with rheumatoid arthritis. None of the other patient groups differed from the control group. This may be the first demonstration of an antibody response to an antigen or antigens which is almost entirely confined to patients with rheumatoid arthritis. The possibility that an antigenic similarity exists between the rheumatoid synovial membrane and Chang cells is currently under investigation.


Serum immunoreactive gastrin: specificity for rheumatoid arthritis, bimodality of distribution, and failure of effect of anti-inflammatory drugs. A significant rise in immunoreactive gastrin in a proportion of patients with rheumatoid arthritis is confirmed. Such a rise does not seem to occur in other inflammatory or tissue destructive diseases. The patients with raised immunoreactive gastrin appear to form a separate population but the factors determining this separation remain obscure. Anti-inflammatory drugs, at least during short-term administration have no influence on immunoreactive gastrin concentrations.


Early abnormalities of pisiform and triquetrum in rheumatoid arthritis. Erosions on the triquetrum and pisiform are frequent in early rheumatoid arthritis and occur characteristically at 3 sites. (a) A shallow erosion on the proximal medial triquetral "bare" area is related to synovial proliferation at the margin of the radiocarpal cavity, although compressive forces from an adjacent long ulnar styloid may be contributory; (b) an erosive abnormality on the distal medial triquetrum is related to synovial proliferation along the margin of the midcarpal joint; and (c) ring-like erosions on apposing surfaces of the triquetrum and pisiform are produced by pannus within the pisiform-triquetral compartment.


Surface strain distribution in isolated single lumbar vertebrae. The surface strains of isolated single lumbar vertebrae under compressive load were examined by the techniques of brittlecoat and photoelastic analysis. Directions of principal strain components have been determined. Areas of stress concentration were found around the vertebral rims, near the pedicles, and around the foramina of the basivertebral veins.


Lubrication of synovial membrane.

Lubrication of synovial membrane. (1) An apparatus has been constructed to measure the coefficient of friction of synovial membrane against a glass slider. (2) Provision was made to vary the load on the specimens. (3) The coefficient of friction varied from 0-006 to 0-07. (4) A presentation similar to that used in the Sommerfeld analysis of journal bearings indicated that in these experiments synovial membrane was lubricated in the hydrodynamic regimen.


Effect of yttrium 90 on experimental allergic arthritis in rabbits. Seventeen rabbits were immunized with complete Freund's adjuvant and bovine serum albumin by the method of Dumonde and Glynn (1962), as modified by Cooke and Jasin (1972). Fifteen weeks after allergic arthritis developed in the knee joint, 8 animals were given an injection of 20 muCi yttrium 90 (90Y) into the left joint cavity; 7 were injected with 400 muCi. The animals were sacrificed at 2, 4, 8, 12, and 16 weeks and at 6 and 12 months after the injection. The right knee joint served as control for assessment of untreated allergic arthritis. Morphological control of the severity of the arthritis was provided by sacrificing 2 uninjected animals 13 weeks after immunization.


Single daily dose corticosteroid treatment. Thirteen patients with rheumatoid or psoriatic arthritis who had not previously received corticosteroids were treated with prednisolone in a single-dose each morning. Insulin-hypoglycaemia tests were performed before starting steroids in each patient, and again at the conclusion of the study in twelve of the thirteen (duration of steroid treatment 8-40 m). There was no difference in the mean basal or peak levels of corticosteroids, or the mean peak of growth hormone (GH) in the tests done before or during treatment, although one patient lost GH responsiveness. There was thus no evidence of hypothalamo-pituitary-adrenal (HPA) suppression in any of the twelve patients, and there was a good therapeutic response in twelve out of thirteen. One patient was dropped from the trial because treatment failed. In contrast, of seven patients who had received a similar total dose of prednisolone twice daily, three showed HPA suppression and two had lost GH responsiveness.


Serum uric acid concentrations in a Xhosa community in the Transkei of Southern Africa. Serum uric acid (SUA) concentrations were measured in specimens obtained from 479 respondents aged 15 and over during an epidemiological survey of bone and joint conditions in a tribal Xhosa community living in the Transkei, Southern Africa. Population SUA levels in the Xhosa were significantly lower than those previously observed in South Africa Negro groups in rural and urban environments. This finding agrees with the observations that population SUA concentrations tend to rise with increasing complexity of life style.


Objective measurement of rheumatoid arthritis using technetium index. The technetium index was measured in 22 patients with rheumatoid arthritis, before and after 6 months' treatment either with penicillamine or with anti-inflammatory drugs. The index was calculated by dividing the sum of the count rates over both knees and both wrists by the dose of technetium given. In the penicillamine group there was a significant reduction in the technetium index and the changes correlated well with some clinical measurements of improvement. It is suggested that the technetium index is a useful objective measure of the effects of drugs with a specific activity in rheumatoid arthritis.


Evaluation of dominant thyroid masses.

Evaluation of dominant thyroid masses. Controversy exists concerning the management of solitary thryoid nodules because of conflicting information converning the high clinical incidence of thyroid nodules, the varying incidence of cancer reported in those surgically excised and the infrequency of death from thyroid cancer. During the past several years, a plan for evaluating patients with dominant thyroid masses has evolved. The objective is to avoid unnecessary operations by identifying patients with a high risk of cancer. The criteria which are used are the age and sex of the patient, the duration of the mass, 125I or 99mTc scans, 75Selenomethionine scans, B-mode ultrasonography and the response of the mass to suppressive therapy. This is a report of the findings in 222 patients who have been studied employing this approach. Thirty per cent of the patients were operated upon. Forty per cent had neoplasms (well differentiated cancer--28.8%, adenoma--12.1%), 47.0%--nodular goiter, 6.1% cysts, and 6.1% chronic thyroiditis. The incidence of cancer in the 222 patients was 8.6% and adenoma 3.6%. Patients at greatest risk of having cancer are those with solid nonfunctioning nodules which fail to regress with suppressive therapy. This study indicates that the approach described above is effective in selecting for surgical excision those individuals at greatest risk of having thyroid cancer.


Myxoma of the heart: clinical and experimental observations. During the past 12 years, 13 patients with atrial (10 left and 3 right) myxoma have been treated. The tumors of the left atrium produced signs and symptoms of mitral valve obstruction and/or subacute bacterial endocarditis and those of the right atrium manifestations of tricuspid valve disease or of pulmonary embolus or hypertension. The diagnosis was established by angiocardiography in 8 patients, at surgery performed for suspected mitral stenosis in 3 patients, and at autopsy in 2 patients. Resection of the atrial myxoma alone in 5 patients or with atrial septum where the atrial myxoma was attached in 4 or with the whole right atrial wall where the atrial myxoma was attached in one patient was performed and all are doing well without evidence of recurrence. Studies of experimentally produced 1.5-3 cm in diameter left atrial thrombus in 30 dogs divided into 5 groups and followed cineangiocardiographically and sacrificed from 14 days to 6 months indicated that the implanted thrombus is absorbed over a 3 to 6 month period. These experimental and human left atrial thrombi were found to be histologically and histochemically different from human atrial myxomas. The electron microscopic studies performed on some of the resected atrial myxomas suggested that the atrial myxoma cells are active cells of endotheilial origin. These observations suggest that atrial myxoma is a primary tumor of the heart which can mimic other clinical entities, and the results of its surgical treatment are gratifying and long lasting.


Sphincteroplasty and choledochoduodenostomy for benign biliary obstructions. Both sphincteroplasty and choledochoduodenostomy are valuable for choledocholithiasis, stenosis of the terminal bile duct, and occasional cases of pancreatitis. Selection of patients, technical details, and advantages and limitations of both operative procedures are presented. In a personal series of 600 benign biliary operations 73 patients had a sphincteroplasty or choledochoduodenostomy. Sixty of these had a sphincteroplasty without operative mortality, serious complication, or recurrence of biliary problems although 5 still have pain. A positive morphine-prostigmine test was a prime indication for surgery in these 5 patients. The evocative tests are now negative. Thirteen patients had a choledochonduodenostomy without mortality or significant complication. Twelve are symptom free but one has a "sump syndrome." Sphincteroplasty has been preferred because it gives dependent drainage, direct inspection of the ampullary area, and facilitates removal of impacted stones and debris. It is not always applicable and choledochoduodenostomy has been chosen in elderly poor risk patients or in those with pancreatic inflammation or periampullary duodenal diverticula. Both operations have specific advantages and limitations such that the surgeon should not use one to the exclusion of the other.


Long term transhepatic intubation for hilar hepatic duct strictures. A technique for repairing benign hilar hepatic duct strictures using transhepatic intubation with a large bore silastic stent is described. This procedure has been used in 10 patients. In 9 instances the stricture involved the common hepatic duct, and in one patient the right and left hepatic ducts. Nine of the strictures followed cholecystectomy; one followed the primary repair of a gun shot wound to the hepatic duct. Hepaticojejunostomies were created and the transhepatic silastic stent was left in place for 6 months in one patient, and for 12 months in 8 patients. In one patient the silastic stents are still in place. There have been no treatment failures. All patients are healthy and at full activity from one year, 3 months to 6 years, 6 months from the time of repair (average 3 years, 5 months). In the 9 patients whose stents have been removed, the serum bilirubin levels are normal There have been no episodes of cholangitis following repair. This method of repair using long term transhepatic silastic stents is recommended for all high hilar hepatic duct strictures.


The fate of esophageal varices following selective distal splenorenal shunt. Esophagographic evaluation of the fate of esophageal varices after distal splenorenal shunt was obtained. The radiologist-observer was blinded as to the surgical status of the films under study. The results indicate that varices are likely to persist after surgery. However, the sizes of the varices are clearly diminished following selective distal splenorenal shunt. The incidence of postoperative bleeding has been low, 3.7% (2/54) or one episode for each 441 months of postoperative survival.


Unified approach to carcinoma of the esophagus. The reversed gastric tube is advocated as a technique to be used in all patients who have carcinomas of the esophagus, whether the lesion is located in the upper, middle or lower esophagus. The tube, constructed out of the greater curvature of the stomach and supplied by the gastroepiploic vessels, invariably has adequate length and sufficient blood supply to heal per primum or to close anastomotic leaks spontaneously when they occur. Since the procedure requires a celiotomy and an incision in the neck, the presence and extent of metastatic disease below the diaphragm and above the clavicle can be evaluated. With prompt resumption of eating, the patients' nutritional status rapidly improves so that they can maintain weight during postoperative irradiation or further surgical procedures, e.g. esophagectomy. It is also effective as a palliative procedure since the patients handle their saliva and other secretions adequately after the procedure.


Malignant melanoma in the American Black. Malignant melanoma in the American Black is an uncommon disease. Scattered reports have appeared in the literature indicating a somewhat different behavior and distribution from melanoma in the White patient. The last published report prior to the organization of the Tumor Registry at Charity Hospital of Louisiana on melanoma in the Black was in 1948 by Muelling when 28 cases were reported. From 1948 through 1974, 96 additional patients have been recorded in the Charity Hospital Registry which represents the largest reported experience in the American Literature. The average age at diagnosis is 57.8 years as opposed to 53 years for White patients observed over the same time period. The ratio by sex is essentially equal in Blacks. The disease usually presents on the palmar or plantar surfaces of the hands or feet in the Black. In the registry data 51% occurred on the lower limb, 11% on the upper limb, 6% on the trunk, 6% on the genitalia, 1% on the head or neck, 13% were of extradermal origin, and 10% had unknown primary sites. The 5-year cumulative survival for all Black patients in this series is 27%. In contrast to the poor overall survival, a 78% 5-year survival has been achieved in Stage I patients treated with perfusion, wide excision, and regional lymph node dissection.


The surgical treatment of carcinoma of the colon and rectum: an index of quality care and sociologic and geographic distribution. A comparative experience of 474 patients with primary carcinoma of the colon and rectum has been evaluated in several hospital settings, with particular respect to patient populations, geographic distribution, and surgical characteristics. The differences and similarities are interpreted with caution but may provide a format by which significant objective determinants become the basis for subsequent assessment of quality care in an illness which is prevalent and amenable to relatively standardized operative management. No difference in quality of medical care provided was detectable across the sociologic and geographic boundaries studied. Notable increases in extent of neoplasm and severity of co-existent illness in the urban, "indigent" population adversely influenced both short and long-term mortality rates.


The curative treatment of carcinoma of the sigmoid, rectosigmoid, and rectum. This retrospective series comprises 902 patients who underwent curative resection of the sigmoid colon, rectosigmoid, and upper rectum at the Mayo Clinic during the years 1959 to 1969. Lesions were divided according to the location from the dentate line, with 346 patients having had a lesion located more than 20 cm from the dentate line; in the remaining 556 patients, the lesion was between 6 and 20 cm distant. A thorough analysis was undertaken comparing these two groups of patients on the basis of operative mortality and morbidity, including anastomotic complications, 5- and 10-year survival, and incidence of local recurrence. Overall operative mortality was 1.9%, with an 8.1% incidence of anastomotic complications. The overall 5-year survival rate was 72% and the 10-year survival rate was 55%. The incidence of anastomotic recurrence for anastomosis performed with the use of extraperitoneal rectum was 5.8%; recurrence at the suture line developed in 2.9% of patients who underwent anastomosis to serosa-covered bowel. In addition to the above data, information will be presented which demonstrates the effect of the patient's height and weight on the surgeon's ability to perform a low-anterior anastomosis. Finally, the incidence of anastomotic complications and of local recurrence were analyzed according to the intestinal preparation employed, the use of parenteral antibiotics , and the method of drainage used near the anastomosis.


Long-term ventilatory support by diaphragm pacing in quadriplegia. Thirty-seven quadriplegic patients with respiratory paralysis were treated by electrical stimulation of the phrenic nerves to pace the diaphragm. Full-time ventilatory support by diaphragm pacing was accomplished in 13 patients. At least half-time support was achieved in 10 others. There were two deaths unrelated to pacing in these two groups. Fourteen patients could not be paced satisfactorily, and 8 of these patients died, most of them from respiratory infections. The average time the 13 patients on total ventilatory support have had bilateral diaphragm pacemakers is 26 months. The longest is 60 months. Many of these patients are out of the hospital and several are in school or working. Injury to the phrenic nerves either by the initial trauma to the cervical cord or during operation for implantation of the nerve cuff was the most significant complication. Nerve damage from prolonged electrical stimulation has not been a problem thus far. A description of the pacemaker, the technique of its implantation, and the pacing schedule are reported.


Pheochromocytoma: present diagnosis and management. In the 25-year period 1950-1975 forty-four patients with pheochromocytoma were observed at Vanderbilt University Affiliated Hospitals. Bilateral adrenal tumors occurred in 3 patients (6.8%) and extra-adrenal tumors occurred in 7 others (16%), 33 patients (75%) had single tumors arising in one of the adrenal glands; in one of these 5 years after operation, a malignant tumor developed in the same renal fossa. Five of the 44 patients (11.3%) proved to have malignant tumors and died with metastases. In 11 patients in the earlier years of this study the clinical diagnosis was not made and the tumor was identified by the pathologist at autopsy. There was a single postoperative fatality among the 33 patients in whom the clinical diagnosis was made. Seventy per cent of all survivors with benign tumors have remained normotensive during followup periods of one to 20 years.


Predicted survival in peptic ulcer patients based on computer analysis of preoperative variables. A prospective study designed to emphasize and quantitate the operative risk of patients preparing to undergo surgery for the treatment of complicated peptic ulcer disease is presented. Data were gathered from 347 consecutive patients operated on with benign gastric and/or duodenal ulcers in a Veterans Hospital over an 8-year period. Resident surgeons performed all operations and for the most part decided on the operative procedure used, with advice from attending faculty. Preoperative factors influencing the operative mortality in 34 patients were compared with those in surviving patients and subjected to a multivariant discriminant function analysis by computer. Ten variables were identified as being significantly different (P less than 0.05-P less than 0.01) between the survivor and non-survivor groups. Using the discriminant weights of these variables, a computer program was written to calculate the 30-day operative mortality of any preoperative patient based on this past experience. The accuracy of the program is excellent in good risk patients; i.e., a predicted greater than 90% chance of survival was correct 98.9% of the time with 3 deaths in 279 patients. Patients at the low end of the scale (less than 10%) were predicted with 85% accuracy. In the last 8 months, 29 patients have undergone surgery after prospective computer assessment of their operativ risk. All have survived with a predicted chance of greater than 50%. Four patients died with survival chances predicted at 4, 2, 1, and 1%. The computer may be used as an educational vehicle for sharpening our preoperative assessment of a patient with ulcer disease, particularly regarding operative risk.


The effects on gastrin and gastric secretion of five current operations for duodenal ulcer. We have measured serum gastrin and gastric acid secretion in 66 duodenal ulcer patients before and after vagotomy and pyloroplasty (V + P--15 patients), selective proximal vagotomy without drainage (SPV - D--11 patients), and with drainage (SPV + D--19 patients), and vagotomy, antrectomy, and either gastroduodenostomy (V + BI--15 patients) or gastrojejunostomy (V + BII--6 patients). Basal and peak postprandial gastrin levels were increased in postoperative V + P, SPV - D, and SPV + D patients. Basal and peak postprandial levels of gastrin were unchanged after V + BII, indicative of duodenal release of gastrin. Gastrin response to food was abolished in V + BII patients. Acid output was reliably reduced after all five operations; reduction was greatest in patients after antrectomy and least in patients after SPV. No beneficial results were found with drainage in SPV patients. Acid secretion increased with time in SPV patients, especially those with drainage.


Late clinical problems with Beall model 103 and 104 mitral valve prostheses: hemolysis and valve wear. The purpose of this study was to determine the influence on hemolysis of the spatial orientation of the struts in the Beall mitral valve prosthesis, Models 103 and 104. Thirteen pairs of patients were selected to match struts oriented parallel and perpendicular to the left ventricular outflow tract axis. The average time after operation was 3.73 years. Complete blood counts and relative serum chemistry values were determined.


Successful closure of ventricular septal defect through a left-sided ventriculotomy in corrected transposition of the great vessels. Corrected transposition of the great vessels is often associated with other cardiac anomalies. Ventricular septal defect (VSD) is the most common among them. Closure of a VSD is usually performed through a right-sided ventriculotomy. We had previously closed the VSD through the right-sided ventricle in 2 patients with corrected transposition of the great vessels and in 2 others with double-outlet right ventricle with ventricular inversion, which resulted in complete heart block. Recently we have closed the VSD through the left-sided ventricle in 3 patients with corrected transposition, and no block resulted.


Operative repair for tricuspid atresia.

Operative repair for tricuspid atresia. Twelve patients with tricuspid atresia underwent physiological operative repair. The criteria for their selection for operation included normal pulmonary vascular resistance and normal left atrial and left ventricular end-diastolic pressures. Four patients died (30% mortality). The 8 surviving patients developed pleural effusion, ascites, and hepatomegaly, which markedly improved in the subsequent weeks. Five of the 8 survivors underwent cardiac catheterization. The arterial oxygen saturation in these patients averaged 82% preoperatively, 89% immediately postoperatively, and 94% or better six months later. All had improved subjectively and developed increased exercise tolerance.


Atherosclerosis of the internal mammary artery. To better evaluate the incidence of atherosclerosis in the internal mammary artery (IMA), 215 IMA segments from routine postmortem examinations were evaluated microscopically. Significant atherosclerotic narrowing was seen in 9 patients (4.2%). No patient had more than a 50% reduction in lumen diameter. The degree of incipient atherosclerosis correlated well with age, hypertension, diabetes, and peripheral vascular disease.


Direct diagnostic thoracoscopy.

Direct diagnostic thoracoscopy. Direct diagnostic thoracoscopy under general anesthesia using the mediastinoscope or bronchoscope has been done in 40 patients. No deaths or serious morbidity occurred. We recommend the use of this technique when other efforts fail to establish a diagnosis in patients with pleural disease.


Pulmonary giant cell carcinoma.

Pulmonary giant cell carcinoma. Pulmonary giant cell carcinoma is one of the most highly malignant neoplasms of the lung. Eighteen patients with this tumor are presented. Histologically the neoplasm is composed of a preponderance of multinucleated giant cells, round cells, and spindle cells. Some of the most differentiated tumors show adenocarcinomatous foci and ultrastructural features of secretory epithelium favoring its classification as a variant of pulmonary adenocarcinoma. The giant cells of this neoplasm can be differentiated from those encountered in undifferentiated large cell carcinoma and epidermoid carcinoma by the abundant cytoplasm, the presence of more nuclei and nucleoli, and the significant degree of phagocytosis. The clinical picture and roentgenographic findings present no pathognomonic features.


Direct monitoring of arterial pressure in the newborn and infant: a difficult procedure made easy. Accurate continuous measurement of arterial blood pressure, especially during and following operation, is indispensable for optimal management of the seriously ill newborn or infant. Conventional indirect techniques (flush technique, auscultation, Doppler monitoring device) for assessing the circulatory status in this age group are not reliable, and a direct method would be preferable. Arterial cannulation in such patients has been discouraged by the technical problems related to former techniques.


Removal of intraaortic balloon without vascular complications. A technique for inserting and removing the intraaortic balloon pump without vascular complications is descirbed. Prevention of clot formation at the graft-arterial junction, preservation of collateral circulation by insertion in the common femoral artery, removal of potentially infected graft material, and enlargement of the common femoral artery by patch angioplasty are important factors.


Transaortic cannulation for balloon pumping: report of a patient undergoing closed chest decannulation. A technique is described for introduction of an intraaortic balloon (for circulatory augmentation) through the transverse aorta using a crimped Dacron arterial graft brought out through a lateral skin incision. When balloon pumping is discontinued, the balloon catheter is withdrawn through the percutaneous graft without reopening the chest. The graft is amputated and buried without ill effect.


Effects of diphenylhydantoin on cardiac arrhythmias induced by carotid occlusion in the cat. The effects of diphenylhydantoin (DPH) on cardiac arrhythmias induced by occlusion of the common carotid arteries were studied in vagotomized cats under light chloralose anesthesia. It was found that the mean effective dose of DPH via the i.v. route was 11.0 mg/kg. When DPH was injected into the vertebral artery, the carotid artery or the 4th cerebral ventricle, the mean effective dose was 0.8, 1.2 and 0.32 mg/kg, respectively, When DPH was injected directly into the posterior hypothalamic regions, the mean effective dose was even smaller, i.e., 0.14 mg/kg. On the other hand, when DPH was injected into the left ventricle of the heart, the mean effective dose was 1.7 mg/kg and the dose was significantly increased to 4.4 mg/kg when cerebral circulation was temporarily occluded. The data suggest that DPH exerts a potent antiarrhythmic effect through its action on the central nervous system. For the cardiac arrhythmias induced by occlusion of the common carotid arteries, it appears likely that DPH acts on the posterior hypothalamus.


Effects of some dopamine analogs and haloperidol on response to stimulation of adrenergic nerves using cat atria in vitro. Dopamine analogs, N, N-dimethyldopamine, apomorphine and 5,6-dihydroxy-2-dimethylaminotetralin (M-7) produced inhibition of positive chronotropic and inotropic responses to transmural stimulation of isolated right atria of cats. Haloperidol antagonized inhibitory effects of dopamine analogs. Also haloperidol increased atrial responses during transmural stimulation. N,N-dimethyldopamine, M-7 and apomorphine did not alter responses to exogenous norepinephrine. Haloperidol did not antagonize the inhibitory effect of clonidine.


Direct renal effects of sodium acetate in the dog. Sodium acetate (AC) is used in clinical medicine as it provides a ready source of fixed base. The direct renal dynamics of this buffer salt are not well known. In anesthetized dogs the left renal artery was infused with solutions of AC. In concentrations of 0.1 to 0.5 muEq/min, the acetate ion was always immediately detected in the urine. There were no demonstrable renal changes in volume, PAH clearance, creatinine clearance or electrolytes during the perfusion periods. Direct infusion of AC into the renal artery did not cause any change in blood pressure. We conclude that AC in the conditions of our experiments did not cause renal vasodilation or changes in renal excretions patterns and appears to have a zero renal threshold.


Hyperaemic responses in two vascular beds of the anaesthetised cat. In the chloralosed cat reactive hyperaemia to vessel occlusion, and vascular escape associated with vasoconstriction produced by drugs, have been examined in the hindquarters and splanchnic region, and following periaterial mesenteric nerve stimulation in the splanchnic region. The hyperaemic responses were not of a purinergic nature or mediated by an acetylcholine, histamine, dopamine or beta-adrenoceptor stimulant-like substance, and were independent of adrenergic innervation. These responses may respresent a local mechanism by which the vasculature produces vasodilation in response to reduced blood flow.


Drugs and PGO waves in the lateral geniculate body of the curarized cat. II. PGO wave activity and brain 5-hydroxytryptamine. Ponto-geniculo-occipital (PCO) waves induced either by the benzoquinolizine derivative, Ro 4-1284 (=PGO(CPA), were  continuously recorded and counted in the lateral geniculate bodies of unanaesthetized immobilized cats as described in the preceding communication. The effect of various drugs interacting with central 5-hydroxytryptaminergic mechanisms on the density (number hr(-1) or number 0.5 hr(-1) of PGO waves was investigated. The density of PGO waves was dose-dependently decreased and the waves were eventually abolished by the precursors of 5-hydroxytryptamine (5-HT), L-tryptophan and 5-hydroxytryptophan. 5-HT itself, injected intracerebroventricularly, tended to diminish the density. Lysergic acid diethylamide (LSD) was an extremely potent depressor of PGO(1284) and PGO(PCPA); psilocybine was almost as potent as LSD, whereas higher doses of N,N-dimethyltryptamine, bufotenine and yohimbine were required for the reduction of PGO waves. A number of tricyclic antidepressants reduced the density of PGO waves, their order of potency corresponding to that reported for their inhibitory effect on the uptake of 5-HT; tertiary amines were more potent than secondary amines. Desipramine was more potent on PGO(PCPA) THAN ON PGO(1284). Two dibenzothiepine antipsychotics, methiothepin and octoclothepin, increased the density of PGO(1284) and PGO(PCPA) and also induced PGO waves in untreated cats; the evidence suggests that these two compounds antagonize the effect of endogenous 5-HT in the brain. These results confirm some earlier findings and augment the pharmacological pieces of evidence for the stron inhibitory influence of 5-HT neurones on the generation ofPGO waves.


Drugs and PGO waves in the lateral geniculate body of the curarized cat. III. PGO wave activity and brain catecholamines. The possible implication of central catecholamines in the phasic phenomenon of ponto-geniculo-occipital (PGO) waves was investigated using PGO waves induced by the benzoquinolizine derivative, Ro 4-1284 (=PGO(1284), and the inhibitor of tryptophan hydroxylase, p-chlorophenylalanine (=PGO(PCPA); they were continuously recorded and counted in the lateral geniculate bodies of unanaesthetized immobilized cats as described in a previous report. The effect on PGO(1284) and PGO(PCPA) of various drugs interacting with the different steps of catecholaminergic transmission was studie. Injections of noradrenaline (NA) and of dopamine (DA) into the lateral brain ventricle tended to decrease the density of PGO(1284). The stimulant of central alpha-adrenoceptors, clonidine, suppressed PGO(1284) and PGO(PCPA) in very small doses. Apomorphine in high doses had inconsistent depressant effects which were probably not related to its stimulant action on DA receptors. Release of brain NA by dexamphetamine and beta-tetrahydronaphthylamine decreased the density of PGO waves, alpha-Methyldopa diminished PGO(PCPA) but not PGO(1284. The MAO-inhibitor, nialamide, depressed PGO(PCPA) more than PCO(1284), whereas pheniprazine was inactive. The inhibitor of catechol-O-methyltransferase, tropolone, reduced the density of bially blocks the uptake of NA, was more potent on PGO(PCPA) than on PGO(1284). The alpha-adrenoceptor blocking agent, phenosybenzamine, markedly increased the density of PGO(PCPA). Similar effects were obtained with thioridazine and clozapine, which aare also known to be blockers of central alpha-adrenoceptors. Inhibition of tyrosine hydroxylase (by alpha-methyltyrosine) and of DA-beta-hydroxylase (by disulfiram or Ro 8-1981), in addition to the inhibition of tryptophan hydroxylase by PCPA, induced PGO waves comparable in density and temporal distribution to those occurring following the application of Ro 4-1284. The acute bilateral lesion of the dorsal and caudal parts of thel ocus coeruleus increased the density of PGO(PCPA). The results strongly suggest that, in addition to the 5-hydroxytryptaminergic system, noradrenergic neurones, probably originating in the locus coeruleus, depress the neurones in the pontine reticular formation involved in the generation of PGO waves.


Triamterene-induced changes in aldosterone and renin values in essential hypertension. Evidence of a role for aldosterone in preventing blood pressure reduction. The effect of triamterene, a potassium-retaining natriuretic and diuretic agent, on arterial blood pressure was studied in 31 patients with essential hypertension; there were seven patients with low plasma renin activity and 24 patients with normal plasma renin activity. Triamterene exhibited mild antihypertensive action, somewhat more pronounced in the low-renin group. The patients were also analyzed by considering them in terms of their blood pressure response. Of the 21 patients in the nonresponder group, no blood pressure decrease occurred, despite induced volume depletion accompanied by an increased plasma renin activity and a concomitant rise in the aldosterone excretion. In contrast, the ten patients in the responder group exhibited a fall in blood pressure, but the aldosterone excretion rate did not change significantly, even though plasma renin activity increased significantly. Moreover, only in the nonresponder group did the stimulated aldosterone excretion rate correlate significantly with the stimulated plasma renin activity. Thus, the failure of triamterene to lower blood pressure in the nonresponder group can be closely related to a significant increase in aldosterone excretion rate. The data suggest the operation of a reactive pressor action mediated by aldosterone, independent of its sodium-retaining effect.


Delay in the prehospital phase of acute myocardial infarction. Lack of influence on incidence of sudden death. Prehospital delay is considered to be an important cause of out-of-hospital coronary mortality. Behavior of patients and physicians in response to the symptoms of myocardial infarction (MI) or impending out-of-hospital death (OHD) was studied for 107 consecutive acute coronary events in Framingham, Mass. Delay due to inappropriate patient behavior was the most important component of total delay. Delay related to patient-physician contact occurred in two thirds of MI cases and was more than 30 minutes in half of these. Office visits and inappropriate triage by nurses and receptionists were important factors in physician delay. However, 60% to 75% of OHDs occur so rapidly that their prevention by reduction of prehospital delay seems impossible. A strategy for reduction of delay that might be of benefit in preventing some of the remaining OHDs is described.


Endoscopy - related bacteremia. Incidence of positive blood cultures after endoscopy of upper gastrointestinal tract. A prospective study was undertaken to determine the frequency of bacteremia after endoscopy of the upper gastrointestinal tract. Three of 100 patients (3%) demonstrated positive blood cultures after the endoscopic procedure. Bacteriologic surveys disclosed that routine cleansing procedures of the endoscopy room and the endoscope itself frequently failed to achieve optimal sterile conditions. Particularly noteworthy was the growth of Enterobacter liquefaciens and Candida albicans on one occasion from the endoscope tip. We conclude that, although the incidence of postendoscopy positive blood cultures is low, a more vigorous approach to using clean equipment in clean surroundings is needed when dealing with a potentially susceptible host.


Aminocaproic acid in prolonged hematuria of patients with sicklemia. Forty-four episodes of sicklemic hematuria occurring in 40 patients during a 12-year period were reviewed. Seven of seven patients had evidence of a hyperactive fibrinolytic system. Fifteen of 38 pyelograms demonstrated obstruction of some portion of the collecting system by blood clots that cleared on follow-up studies (nine patients) in 2 to 37 days. Hematuria subsided spontaneously in 20 episodes. Aminocaproic acid was used in 22 patients whose hematuria prior to aminocaproic acid administration averaged twice as long as the total duration in patients undergoint spontaneous remission. Hematuria subsided in 2.2 +/- 0.3 days in the group treated with aminocaproic acid. Therapy with aminocaproic acid in this study was not associated with an increased incidence of thrombosis. Because of its potential untoward effects, however, EACA therapy in this disorder should be limited to patients with severe or prolonged hematuria.


Lymphocyte blastogenesis in patients receiving hemodialysis. Lymphocyte blastogenic transformation in response to plant lectins and allogenic cells was studied in patients with nonuremic, far-advanced, chronic renal failure and in healthy controls. Cell cultures were studied in the presence of normal sera, patient's sera, and with media of different buffering capacities. Minimal blastogenic depression was observed when patient's lymphocytes were cultured in indifferent plasma with effective bicarbonate buffering compared with the use of pooled patient's plasma or HEPES buffer. Fresh plasma in culture depressed concanavalin A (Con A) blastogenesis. The data suggest that, under optimal conditions, lymphocytes from patients with chronic severe renal insufficiency are more responsive to stimuli than previously reported and as a group are near normal control values. Further, the defect observed may be a result of intracellular acidosis.


Hypocalcemia after therapeutic use of magnesium sulfate. It is now recognized that magnesium plays an important role in calcium homeostasis. Although the effects of hypomagnesemia have been frequently reported, little has been written to suggest a clinically important role for hypermagnesemia. A case is reported in which severe hypocalcemia, with a low plasma parathyroid hormone (PTH) concentration, resulted from the therapeutic use of magnesium sulfate for toxemia of pregnancy. Following recovery, the parathyroid glands were shown to respond normally to a phosphate load. It is suggested that the hypermagnesemia directly suppressed PTH secretion, resulting in symptomatic hypocalcemia.


Incidence of acute exertional rhabdomyolysis. Serum myoglobin and enzyme levels as indicators of muscle injury. This study was conducted to determine, on a prospective basis, the incidence of acute exertional rhabdomyolysis (AER) among recruits at the Marine Corps Recruit Depot, San Diego, Calif. Blood samples were taken from each of 337 volunteer recruits on each of their first six days of regularly scheduled training. Serum myoglobin, serum creatine phosphokinase, lactic dehydrogenase, and serum glutamic oxaloacetic transaminase values were used as indicators of muscle injury. Substantial elevations of serum enzyme activity were observed throughout the study population. Of the study population, 39.2% had serum myoglobin levels that ranged from 0.37 mug/ml to 21.9 mug/ml during the study interval. Six subjects had serum myoglobin levels consistent with those reported in clinical cases of AER. It is concluded that, in a recruit population, large numbers of men may have myoglobinemia but not be seen initially as clinical cases.


Behçet syndrome with "aphthous colitis". A 46-year-old man with Behçet syndrome and a long history of recurrent bouts of colitis was studied by sigmoidoscopy, barium enema x-ray film, and colon biopsy. A nonspecific colitis characterized by shallow mucosal ulcerations and submucosal mononuclear infiltration in the absence of meaningful roentgenolographic changes was seen. A histopathological comparison was made between the oral and colonic lesions. The aphthous colitis appears, therefore, to be a colonic manifestation of Behçet syndrome, differing from typical chronic nonspecific ulcerative colitis in terms of clinical course, severity, and histologic appearance. The simultaneous occurrence of Behçet syndrome and inflammatory disease of the colon was discussed in terms of the differential diagnosis of colitis.


Derman necrosis due to thrombosis in severe secondary hyperparathyroidism. Two patients had gangrenous dermal necrosis associated with chronic renal disease and secondary hyperparathyroidism. Thromobosed and heavily calcified small arteries were underlying the infarcted areas. One patient had severe hypotension secondary to hemorrhage, which immediately preceded the appearance of dermal lesions. Both patients had notably elevated serum parathyroid hormone and serum alkaline phosphatase levels, as well as severe hyperphosphatemia. Therapy with phosphate binders and calcium and vitamin D supplementation corrected the hyperphosphatemia and reduced serum alkaline phosphatase levels. One patient died; the other patient's dermal lesions healed completely. Localized thrombosis, rather than obliterative intimal proliferation, represents a unique cause of dermal necrosis in this condition.


Cerebral embolization resulting from esophageal-atrial fistula. A rare but catastrophic complication of nontraumatic esophageal perforation is the formation of an esophageal-left atrial fistula. Although surgical correction of this condition should be possible, failure to recognize it antemortem has thus far prevented such intervention. A woman with long-standing severe esophagitis, was admitted with hematemesis and acute neurologic abnormalities that progressed to coma and death. A similar picture of chronic esophagitis terminating in uppergastrointestinal-tract bleeding accompanied by neurologic signs was seen in the three previously reported cases as well. Recognition of this symptom complex should permit future cases to be diagnosed clinically, and, it is hoped, corrected.


Editorial: The crisis in access.

Editorial: The crisis in access. During the last 50 years, great changes have occurred in the patterns of medical care in the United States. These changes have seriously affected physician geographic and specialty distribution and have escalated costs. New forces are developing that may have great effects on the actions of the health professions and the content of their educational programs. Orientation will change from cure to that of total health care and prevention. Today's emphasis seems directed toward comprehensive family health care, using the expertise of many new health professionals as members of a joint effort. The patient must become part of this health program by assuming an active role in the health maintenance of the individual and society. Such responsibility can be assumed by the patient only if health professionals provide access to information and knowledge.


[Determination of folates in food. Comparative and critical study]. A study on the microbiologic method for folate determination in natural products was carried out. The variables that must be considered were analyzed previous to the application of this technique, that is: nature of combinations of the compounds with vitamin activity, function and distribution of the conjugases, capacity of absorption of the polyglutamates present in foods, natural inhibitors of the conjugases and the importance of the selection of the microorganism used. Based on the preliminary investigations a modified microbiological microtechnique is proposed and its importance for some nutricional aspects is discussed.


[Coffee pulp and hulls. XI. Chemical characteristics of silaged coffee pulp with Napier grass (Pennisetum purpurem) and corn plant (Zea mays)]. Various physical and chemical changes that occur during the process of preparation of coffee pulp silage with the addition of molasses and forage, were identified and measured quantitatively. Three types of silage were prepared in duplicate in laboratory concrete silos, 45 cm wide and 50 cm high. The silages contained the following components: coffee pulp (EPC), pulp and Napier grass (EPCN), and pulp with corn fodder (EPCM). On a fresh basis, the last two contained equal proportions of coffee pulp and forage. Around 16% molasses were aded to all silages. Time of ensiling was 132 to 141 days. In order to determine the physical changes, the silage was weighed at the start and end of the ensiling period; the pH was determined at the end of same, and the drained liquids were measured during the experimental period. To determine the chemical changes, analyses were carried out on the various components used and on the mixtures ensiled at the start and at the end of the experimental period. The pH of the silage was 4.5, 4.3, and 3.8, and the losses of dry matter 10.6, 25.2, and 33.3% for the three types of silages, respectively. These percentages suggest that a better fermentation took place in those silages containing forages. The better fermentation of EPCN over EPC was due to the Napier grass which provided greater amounts of chemical components susceptible of fermentation than those found in coffee pulp. The quality of EPCM was superior due not only to the presence of corn fodder, which produced an effect similar to that of Napier grass, but also due to the fact that the coffee pulp used in this case contained the greater concentrations of soluble carbohydrates and lower levels of lignin than the coffee pulp used alone or with Napier grass. As a result of the fermentation process, in all three types of silage a decrease in dry matter content, of cellular contents and soluble carbohydrates was observed, as well as an increase in cellular walls and its components, and of protein. The magnitude of these changes was found to be directly related to the losses in dry matter. From the results of this research, it was concluded that the addition of forage improves the chemical characteristics of silage prepared from coffee pulp.


[Socioeconomic level of the family and nutrition in the rural area of Central America and Panama]. During the nutrition survey carried out in Central America and Panama in 1965-1967, information was obtained on the diets and nutrient intake of the rural populations, and on their anthropometric and nutritional-biochemical characteristics. Simultaneously, data were collected for each family studied, which permitted their categorization according to a scale of socioeconomic index. The findings of these studies demonstrate a direct relationship between the socioeconomic level of the families and their dietary and nutritional characteristics. The different types of data, that is, dietary, biochemical, anthropometric and socioeconomic, were all collected at the same time in order to avoid seasonal differences as a confounding factor. Restriction of the sample studied to the rural area of the six countries makes each population rather homogeneous with respect to environmental, genetic and cultural characteristics. Under these conditions, the direct association found between the socioeconomic index of the families and nutritional status acquires more meaning. The design of the study does not permit to determine the direction of a cause-effect relationship, that is, which is the cause of the other. Nevertheless, the findings lend themselves to interesting speculation in this regard.


Malnutrition, kidney size and composition. Kidneys from 42 infants were analysed for protein, fat, water, DNA and RNA. No significant differences in composition could be found between groups of children with different degrees of weight deficit. However, in a larger series of 200, it was shown that increasing degrees of weight deficit were associated with a reduction in kidney size. In the older children with the greatest degree of weight deficit, the kidney formed a significantly higher percentage of the body weight. The general conclusion is that in the most severely malnourished children kidneys are smaller than normal.


[Composition of bean broth].

[Composition of bean broth]. Bean broth is used as weaning food. Six samples were studied as well as the respective residues and the raw beans from which they were obtained. The proportion of components found in the broths expressed as percentage of that in the raw beans was 11.9% for proteins, 9.4% for triptophane, 4.7% for lysine, 5.6% for methionine, 3.2% for cystine, 13.1% for thiamin, 26.5% for riboflavin and 24.1% for niacin. Cooking losses were greatest in cystine, thiamin and niacin. According to these results, the broths proteins have a lower nutritive values than the cooked beans.


The end products of the metabolism of aromatic amino acids by Clostridia. The end products of the metabolism of phenylalanine, tyrosine and tryptophan by growing cultures of clostridia have been identified. The species used were Clostridium aminovalericum; C. bifermentans; C. botulinum proteolytic type A; C. botulinum proteolytic type B; C. cochlearium; C. difficile; C. ghoni; C. histolyticum; C. lentoputrescens; C. limosum; C. lituseburense; C. malenomenatum; C. mangenoti; C. propionicum; C. putrefaciens; C. sordellii; C. sporogenes; C. sporosphaeroides; C. sticklandii; C. subterminale; C. tetani; C. tetanomorphum. The mixture of aromatic compounds formed, which depended upon the species, included phenyl acetic acid, phenyl propionic acid, phenyl lactic acid, phenol, p-cresol, p-hydroxy phenyl acetic acid, p-hydroxy phenyl propionic acid, indole, indole acetic acid and indole propionic acid.


The cryopreservation of Chlorella. 2. Effect of growth temperature on freezing tolerance. The temperature at which Chlorella 211/8h was grown determined the response to a subsequent stress of freezing to and thawing from-196 degrees C. Cells cultured at 20 degrees C were the most sensitive to freezing injury; at both higher and lower growth temperatures resistance to damage induced by freezing developed. At all culture temperatures examined the freezing tolerance varied with the age of culture.


The fine structure of Micrococcus radiophilus and Micrococcus radioproteolyticus. The radiation resistant bacteria Micrococcus radiophilus and M. radioproteolyticus were studied by thin sectioning and freez-etching techniques and the two species were found to be similar in the fine structure. The only significant difference was in the appearance of the surfaces of the cell walls in freeze-etched preparations. Since the two species, together with M. radiodurans, possess a unique cell wall structure and a cell wall peptidoglycan, which is different from that of other micrococci and Gram-positive cocci, it is recommended that they be reclassified into a new genus.


Origin of sclerotia-like cells in submerged Claviceps purpurea producing clavine alkaloids. Ultrathin sectioning of submerged mycelium of Claviceps purpurea Tul. producing clavine alkaloids revealed yeast-like budding resulting in asexual spores-blastospores. These deciduous spores were born by extended hyphal cells and retained the same ultrastructure of cell organelles. Both the extended hyphae and the blastospores resembled the cells of ergot sclerotial tissue. A surface culture of C. purpurea Tul. producing no alkaloids was used as a reference.


[On the essential oil of green algae. I. The oils of the genus Chlorella (author's transl)]. Unicellular green algae of the genus Chlorella are able to synthesize essential oils. Some guajanolides (i.e., proazulenes) were shown to be its main components. Certain species produce as much oil as do higher plants. Formation of essential oils can serve as a taxonomic character in the genus Chlorella.


[The metabolic interactions between Paramecium bursaria Ehrbg. and Chlorella spec. in the Paramecium bursaria-symbiosis. I. The nitrogen and the carbon metabolism (author's transl)]. Symbiotic Chlorellae have been isolated from Paramecium bursaria Ehrbg. and cultivated under conditions of nitrogen deficiency. Reinfection of Chlorella-free Paramecium bursaria with these nitrogen-deficient algae resulted in a complete regeneration and multiplication of the algae within the host cells. The endosymbiotic algal cells of the Paramecium bursaria-symbiosis can be supplied by their host with nitrogen. The inhibition of photosynthesis by 3-(3,4-Dichlorophenyl)-1,1-dimethylurea (DCMU) leads in green Paramecium bursaria to a breakdown of the symbiotic steady state-system resulting in a loss of algal cells. Obviously the endosymbiotic algae cannot be fed heterotrophically by their host to such an extent that a stable symbiosis is maintained. The application of 3-(3,4-Dichlorophenyl)-1,1-dimethylurea (DCMU) can be used as a new method for culturing Chlorella-free Paramecium bursaria.


Effect of 5-fluorouracil and cycloheximide on the early development of Phycomyces blakesleeanus spores and the activity of N-acetylglucosamine synthesizing enzymes. The development of germinating Phycomyces spores was not inhibited by 5-fluorouracil (1mM) until the emergence of the germination tube. Fluorouracil was incorporated into RNA as efficiently as uracil; it did not inhibit the synthesis of proteins and the increase in respiratory activity during early development. Cycloheximide inhibited development as well as the increase in respiration and protein synthesis. This suggested that protein synthesis or some other cycloheximide dependent process, but no mRNA synthesis, was needed for the first developmental stages. The activity of two enzymes involved in the synthesis of N-acetylglucosamine increased markedly during germination. THis increase was inhibited by both 5-fluorouracil and cycloheximide; this suggested that those enzymes were synthesized on mRNA formed during germination.


Cytology of Thamnidium elegans Link. II. Distribution and behaviour of nuclei in hyphae, sporangiophores and sporangiospores. The resting nuclei in hyphae, sporangiophores and sporangiospores of sporangia and sporangiola of Thamnidium elegans consist of a large centrals nucleolus and a shell of chromatin surrounding the nucleolus. Division of the nucleus in hyphae and sporangiospores is achieved by elongation and constriction.


Identification and physiological characterization of the nitrogen fixing bacterium Corynebacterium autotrophicum GZ 29. The coryneform hydrogen bacterium strain GZ 29, assigned to Corynebacterium autotrophicum fixed molecular nitrogen under autotrophic (H2, CO2) as well as under heterotrophic (sucrose) conditions. Physiological parameters of nitrogen fixation were measured under heterotrophic conditions. The optimal dissolved oxygen concentration for cells grown in a fermenter with N2 was rather low (0.14 mg O2/l) compared with cells grown in the presence of NH+4 (4.45 mg O2/l). C. autotrophicum GZ 29 had a doubling time of 3.7 h at 30 degrees C with N2 as N-source and sucrose as carbon source and at optimal pO2. Acetylene reduction reached values of 12 nmoles of ethylene produced/min X mg protein. Although the oxygen concentration in the growing culture was kept constant, the optimal dissolved oxygen tension for the acetylene reduction assay shifted to higher pO2-values. The overall efficiency of nitrogen fixation amounted to 22 mg N fixed/g sucrose consumed; it reached a maximal value of 65 mg N fixed/g sucrose consumed at the beginning of the exponential growth phase. Intact cells reduced acetylene even under anaerobic test conditions; further anaerobic metabolic activity could not be ascertained so far.


Hyphal wall chemistry in Apodachlya.

Hyphal wall chemistry in Apodachlya. Hyphal walls were isolated from the Oomycete, Apodachlya sp. Microscope examination of wall preparations showed that they were clean and relatively free of cellulin granules. The principal wall constituents, accounting for more than half of wall weight, were beta-glucans with 1,3- and 1,6-glucosidic linkages. Apparently chitin was the second most abundant wall constituent (18%) and cellulose accounted for less than 10% of wall weight. Protein was a significant wall constituent (6.4%), and protein hydrolysis demonstrated nearly all common amino acids plus hydroxyproline; additionally, the unusual amino acid, hydroxylysine was tentatively identified. The lipid and ash constituents were small (1.7and 0.4%, respectively) and no particular significance was assigned to them. The possible occurrence of wall glycoproteins and the relationship between wall chemistry and systematics in Apodachlya and related genera were discussed.


Hyphal walls of isolated lichen fungi: autoradiographic localization of precursor incorporation and binding of fluorescein-conjugated lectins. The hyphal walls of three mycobionts, isolated from the lichens Xanthoria parietina, Tornabenia intricata and Sarcogyne sp. were investigated by two techniques: microautoradiography of fungal colonies exposed to radioactive carbohydrate precursors: and binding, in vivo, of fluorescein conjugated lectins to hyphal walls of such colonies. N-[3H] acetylglucosamine was readily incorporated into tips, young hyphal walls and septa of the three mycobionts and the free-living fungus Trichoderma viride, but not into Phytophthora citrophthora, indicating that chitin is a major component of the mycobionts' hyphal walls. All three mycobionts, but neither of the free-living fungi, incorporated [3H] mannose and [3H] mannitol into their hyphal walls. Fluorescein-conjugated wheat germ agglutinin was bound to the hyphal walls of the three mycobionts and T. viride, but not to the walls of P. citrophthora; the binding pattern was similar to the grain pattern obtained in autoradiographs after short N-[3H]acetylglucosamine labelling. As wheat germ agglutinin binds specifically to chitin oligomers, the lectin binding tests further confirmed that chitin is a mycobiont hyphal wall component. Binding characteristics of several fluorescein-conjugated lectins to the three mycobionts indicated that this technique can yield useful information concerning the chemical composition of hyphal wall surfaces.


Polyphosphate granules in encysted zoospores of Rozella allomycis. Methods of ultracytochemistry and of X-ray energy dispersive analysis have been used to demonstrate that the "gamma-like" granules in encysted zoospores of the chytrid Rozella allomycis contain polyphosphate. The possibility that cysts contain two classes of polyphosphate granules which differ in structure, in function, and in origin is discussed.


[Formation of bactericidal substances by Cosmarium impressulum (author's transl)]. 1. An already published test method for detecting bactericidal substances in paper chromatograms was further improved. 2. In cultures of Cosmarium impressulum free from bacteria, two bactericidal substances were found in the ether extracts from the algae and two others in the extracts of the culture medium. The are active against some or all bacteria testes (Serratia marcescens, Pseudomonas fluorescens; Aerobacter aerogenes or Bacillus pumilus). 3. If the culture medium of Cosmarium or another desmidiale was inoculated with the test bacteria, a clear bactericidal effect was never observed. 4. Because the activity of the bactericidal substances of Cosmarium is only small and the formation is not constant, it is concluded that the water-soluble bactericidal substances of the alga are not the cause that epiphytic bacteria do not grow normally on Cosmarium.


Unusual cell structures in tumor-like formations of Gracilaria (Rhodophyta). This paper deals with electron microscopic observations on cultivated plants of the marine red alga Gracilaria verrucosa which developed simple galla; also sea collected material, without galls, had been studied. The galls showed unusual but characteristic cell structured, caterpillar-like bodies, containing rows of fusiform bodies. These were found mostly in the cytoplasm near the plastids, in one case connected with the endoplasmic reticulum, occasionally even inside the nucleus, and are described here, as far as we know, for the first time. It does not seem probably that the caterpillar-like bodies represent mitochondria or bacteria, but the hypothesis that fusiform bodies are related to virus-like structures is discussed. The normal tissues as well as the gall tissue of the laboratory plants contained, besides plastids typical for the red algae, another type of plastids characterized by tubular thylakoids.


Synchronized cultures of a cell wall-less mutant of Chylamydomonas reinhardii. Synchronization and synchronous growth of a cell wall-less mutant of Chlamydomonas reinhardii have been described. The following growth conditions were used: A modified Sueokas' "high salt minimal medium", 14:10 h light-dark cycle, growth temperature 30 degrees C, light intensity 12-18 Klux and dilution of the culture at the end of the dark to a constant density of 1.0 . 10(6) cells/ml. The time course of increase and distribution of cell volume, cytopla-smic and nuclear division, release of motile cells after the division period and accumulation of DNA, RNA and protein are reported. These mutant cells did not make any sporangium in which the dividing cells were kept as a unit inside a mother cell wall. However, they usually adhered during the period of division, thus making clumps containing 2, 4 and 8 cells. Several of these cell clumps dissolved releasing either single or couples of 2 and 4 cells. After the end of division the cells became fl


Physical properties and metabolite regulation of ribulose bisphosphate carboxylase from Thiobacillus A2. Purified ribulose-bisphosphate carboxylase (EC 4.1.1.39) was strongly and equally inhibited either by ADP or GDP and to a lesser extent by IDP. AMP or ATP exerted little effect on activity. Inhibition by the nucleotide diphosphates was competitive with respect to RuBP and non-competitive with respect to "CO2" and Mg2+, respectively. Treatment of the enzyme with urea or guanidine-HCl resulted in rapid loss of activity that was not restored by dialysis even in the presence of Mg2+ and cysteine. Sodium dodecyl sulfate electrophoresis of 8.0 M urea treated enzyme revealed the presence of a fast-moving (small) sub-unit with molecular weight 14150 and a slower moving (large) sub-unit with molecular weight 68000. Examination of native enzyme by sodium dodecyl sulfate electrophoresis gave sub-units of 13700 and 55500 respectively. The amino acid content standardized to phenylalanine was essentially similar to that from other sources. Arrhenius plots showed a "break" at 29 degrees C with an Ea of 12.34 kcal per mole for the steeper part of the curve and a deltaH of 11.43 kcal per mole while for the less steep region, the Ea was 1.04 kcal per mole and the deltaH 1.92 kcal per mole.


Light and scanning electron microscopic studies on the esophageal spines in the Pacific ridley turtle, Lepidochelys olivacea. The peculairly specialized esophagus of the Pacific ridley turtle, Lepidochelys olivacea, was described by light and scanning electron microscopic studies. The esophagus is lined by a stratified squamous epithelium with remarkable keratinization, and its major part forms a number of large spines which have been called "pharyngeal teeth." The epithelium consists of three strate: stratum germinativum, stratum spinosum and stratum corneum. The surface of the spine is covered by a scaly keratin of possibly sloughing cells, and the cornified layer on the spine is very thick (more than 100 mu), reaching 3 to 7 times the depth of the corresponding layer in other parts. This peculiar structure in the marine turtle without toothed jaws prabably is used for breaking food into small pieces.


Kinetics of protein synthesis and release in the STH-cell of the mouse anterior pituitary as revealed by electron microscopic autoradiography of 3H-amino acids. In order to investigate the kinetics of the synthesis and release of the secretory protein in the STH-secreting cell of the pituitary anterior lobe, studies were made using the electron microscopic autoradiography of 3H-amino acids. Each mouse received an intravenous injection of 2.8 mCi of 3H-amino acids consisting of equal amounts of 3H-leucine, 3H-tyrosine, 3H-lysine, 3H-histidine and 3H-glycine. The animal was sacrificed at 3, 5, 15 and 30 min, 1, 2, 4, 8 and 24 hrs after the injection. Although the whole silver grains are very few 3 min after the injection, half of the grains are recognized over the r-ER (47.1%); the Golgi apparatus already shows a few grains (5.9%). Total silver grains over the STH-cell increase in number with the lapse of time; the ratio of the grain number over the r-ER to the total grains over the whole cell decreases gradually, while the ratio of the grain number over the Golgi apparatus increases to reach a peak about 30 min after the injection (40.1%) and then decreases gradually. The ratio of the number of labelled granules to that of total granules increases slowly until 24 hrs after the injection (3 min: 0%, 5 min: 0.8%, 30 min: 3.9%, 2 hrs: 5.0%, 8 hrs: 8.0%, 24 hrs: 12.3%). It is concluded that the turnover in synthesis and release of exportable protein in the mouse STH-cell is very slow as compared with that of the thyroid and parathyroid cell.


An electron microscopic study of the olfactory mucosa in the bat and rabbit. The olfactory epithelium and the olfactory gland were electron microscopically observed in the bat and rabbit. 1. In spite of abundant tubular components of sER, the supporting cells show no cytological signs of secretory activity. Numerous long irregular microvilli which are protruded from the supporting cells into the mucous film covering the olfactory epithelium contain no axial filaments. From the outer leaflet of the plasma membrane covering these cells and their microvilli, numerous polypoid processes are projected into the mucous film. These newly identified delicate processes with an apical vesicular swelling about 200 A in diameter may be involved in an extension of surface area or in a microapocrine release of unknown substance. 2. Olfactory cell perikaryon extends an apical dendrite forming an olfactory vesicle (better to be called "dendritic bulb") and a basal neurite or axon. Basal bodies of olfactory cilia are contained in the dendritic bulb and provided with 3 types of appendages: one or occasionally 2 striated conical basal feet directed toward the center of the dendritic bulb, an occasional 1.2 mu long striated rootlet and 9 spokes which extend between the distal end of each of 9 triplets of the basal body and the surface plasma membrane. 3. The present study has first disclosed the so-called "large dense-cored vesicles" about 750-1,000 A in diameter in the perikaryons and axons of olfactory cells. The dendrite and axon contain numerous neurotubules and mitochondria, but no neurofilaments. Cytological differences between dendrite and axon consist in that the former contains scattering free ribosomes but no large dense-cored vesicles, while the latter contains no free ribosomes but some large dense-cored vesicles. 4. Undifferentiated basal cells containing no tonofilaments, which are supposed to differentiate through mitosis into "intercalated cells," are proposed in this paper. Electron-lucent intercalated cells show cytological characteristics of undifferentiated cells, and may probably be precursors of both olfactory and supporting cells. 5. In the bat and rabbit olfactory gland, the presence of an intraepithelial excretory duct surrounded by proper epithelial cells lacking in secretory function seems doubtful. The olfactory gland seems to lack a basement membrane. Secretory cells are in various stages of the secretory cycle, but no distinct cell types have been distinguished. Secretory granules of low density with dense cores support, together with their histochemical properties, the mucous nature of the olfactory gland in both species, though the rich tubular elements of sER may suggest a possible peculiar nature of their secretions. Rabbit secretory cells contain "dense rodlets," which are probably derived from the tubular sER. They are discharged by apocrine process into the glandular lumen.


Histologic and histochemical changes in the aorta and myocardium of rats under the influence of atherogenic diet and phosphatidylcholine (EPL). The prophylactic and therapeutic action of EPL on arteriosclerotic changes induced with fat-rich diet in the aorta and myocardium of white rats was studied. Histologic and histochemical studies showed that EPL administered prophylactically in doses of 280 mg/kg and 900 mg/kg body weight does not significantly inhibit development of arteriosclerotic lesions if fat-rich diet is continued. A distinct prophylactic action of EPL was first seen at a dosage of 2800 mg/kg. The therapeutic action of EPL on pathologic changes in the blood vessels also depends on dosage. The higher the dosage of EPL, the less pronounced the changes. At a dosage level of 2800 mg/kg, changes are slight and sporadic.


A search for antitumor compounds. XI. Biologic studies. Antitumor properties of 19 new 9-aminoacridine and 1-or 3-nitro-9-aminoacridine derivatives. Results of studies on the antitumor activity of six 9-aminoacridine derivatives, four 3-nitro-9-aminoacridine derivatives, four 1-nitro-9-aminoacridine derivatives and five N-oxide of 1-nitro-9-aminoacridine derivatives in mice bearing Sa-180 of compound C-709 requires confirmation by further tests with Sa-180. The remaining 15 compounds were inactive. Some other general effects in the mice and some aspects of the structure-activity relationship are discussed.


Glycogenolysis in the heart and skeletal muscle during stimulation and blocking of cholinergic receptors. I. Action of parasympathicotonic compounds. In vitro changes in enzymatic activities during phosphorolytic and hydrolytic glycogenolysis in the working heart and resting skeletal muscle were studied after intravenous injection of parasympathicotonic compounds. Acetylcholine increased phosphorolytic activity in both muscles and at the same time decreased hydrolytic activity. Since administration of selectively parasympathicotonic compounds such as pilocarpine, furmethide and bethanechol did not produce similar effects, the observed action of acetylcholine does not seem to be connected with the muscarinic receptor. Experiments with isolated muscles (cardiac, skeletal) incubated with acetylcholine gave no results indicating a direct action of acetylcholine on the investigated enzymatic processes.


Glycogenolysis in the heart and skeletal muscle during stimulation and blocking of cholinergic receptors. II. Action of cholinolytic compounds. In Part I of this study it was found that slow injection of acetylcholine causes an increase in phosphorolytic activity in the working heart and resting skeletal muscle, and at the same time decreases hydrolytic activity. At present, it is shown that atropine and tubocurarine do not inhibit this activity of acetylcholine, but that it is inhibited by blocking the N1 receptor with hexamethonium. These findings indicate that neither the muscarinic receptor in the heart nor the nicotinic N2 receptor in skeletal muscle take part in regulation of glycogenolysis, which is connected with the action of acetylcholine on the cholinergic N1 receptor. Ganglioplegic compounds stimulate hydrolytic activity (hexamethonium, atropine in large doses).


Pharmacological analysis of regulation of phosphocreatine and ATP metabolism in resting skeletal muscle. Phosphocreatine and ATP metabolism in the gastrocnemius muscle of rats was studied using 32P. Infusion of acetylcholine decreased utilization of energy in the resting muscle, probably as a result of lowered tonus of the resting muscle in analogy to the changes following muscle relaxation with tubocurarine or denervation. Isoprenaline, adrenaline and noradrenaline accelerated incorporation of 32P in phosphocreatine and ATP and depleted their reserves, and phenylephrine had an opposite effect. Ligation of the adrenals slowed the rate of this metabolism. Presumably regulation of energetic metabolism and energy consumption in resting skeletal muscle is dependent on two mechanisms, one of which is connected witly with liberation of adrenaline and its access to the muscle.


Interaction of basic polyvalent trypsin inhibitor before and after acetylation with DNA and carboxymethylcellulose. 1. The interaction of soluble complexes of DNA with basic polyvalent trypsin inhibitor of Kunitz's type before and after acetylation was studied. The ORD and CD spectra indicate that the secondary structure of DNA in complexes with protein undergoes marked alteration. 2. The Raman, ORD, CD and IR spectra showed that secondary structure of unmodified and acetylated polyvalent inhibitor in complexes with polyanoin undergoes marked alteration. Its content of alpha-spirals decreases, and content of beta-structure increases.


The effect of carboxymethylcellulose on antiproteolytic activity of unmodified, guanidylated and acetylated BPTI. Acetylated BPTI loses its antitrypsin activity, but retains antichymotrypsin activity. Guanidylation diminishes the inhibitor's antitrypsin activity without affecting its antichymotrypsin activity. Acetylated inhibitor in complex with sodium salt of carboxymethylcellulose recovers antitrypsin activity which it did not have in the free state. Unmodified and guanidylated inhibitor in complex with CM-cellulose shows weaker antitrypsin as well as antichymotrypisn activity in comparison with free inhibitors.


Head injury in children and teenagers; functional recovery correlated with the duration of coma. Residual impairments and mortality were assessed in 48 patients under 20 years of age at least two years after a traumatic head injury had caused coma lasting more than seven days. In this study the duration of coma was defined as the period of time when it is impossible to establish intellectual contact with the patient. A classification of functional levels 1 to 8 was used to identify the residual impairment and relate this impairment to the duration of coma for each patient. Of 30 patients who remained in coma less than three month, only one did not have independent ambulation with or without equipment at the time of his last follow-up evaluation. This was one parameter among others to show that the prognosis for recovery in this age group is much better than expected following severe head injury. These follow-up data, correlated with the duration of coma, can assist rehabilitation personnel in the prognostic planning for younger people with severe head injuries. Rehabilitation medicine needs to be involved in patient care during the period of coma to prevent contractures and other complications which often interfere with and delay later rehabilitation programs, making them more costly and less successful.


Electrodiagnosis of ulnar nerve lesions at the elbow. To determine electrical criteria which might be helpful in the diagnosis of ulnar nerve entrapment at the elbow, clinical and electrodiagnostic features in 78 patients with suspected ulnar nerve entrapment at the elbow are described and compared to the results of sensory and motor conduction in the ulnar nerve in a control group of normal persons. These criteria include (1) absent or abnormal evoked sensory nerve action potential in the little finger, (2) motor conduction velocity of less than 45.0 meters/sec in across elbow segment of the ulnar nerve with elbow flexed at 35 degrees, and (3) abnormal electromyographic findings including the presence of increased insertional activity or signs of denervation in the first dorsal interosseous, abductor digiti minimi, and/or flexor carpi ulnaris muscles. Electromyographic abnormality was seen in 77.5% of patients with ulnar motor conduction velocity of less than 45.0 meters/sec across the elbow. The first dorsal interosseous was the most commonly affected muscle. A study of certain important anatomic and histologic factors, such as the arrangement and relative concentration of the motor and sensory fibers at certain key points inthe course of the ulnar nerve trunk, is necessary to understand the correlation between the clinicopathologic and electrodiagnostic features in patients with ulnar nerve entrapment at the elbow.


Ultrasound coupling media: their relative transmissivity. The relative transmissivities of several commonly used ultrasonic coupling agents were measured to determine if there were significant differences in their effectiveness. Coupling media were evaluated in thin films to simulate clinical use. In order to minimize experimental error in this determination, transmitted energy was measured in the far field of the sonating transducer; the receiving transducer was angled slightly to minimize standing waves; and the sonating chamber was made as anechoic as possible. It was found that there is no practical difference in the transmissivities of the common coupling agents, except that hydrocortisone ointments and creams had lower transmissivities, probably due to microscopically entrapped air. When used as a thin film, absorption of ultrasound in the media was insignificant, and variation in transducer pressure was found to cause differences in energy transmitted greater than those found between the common coupling media. Consequently, it was concluded that coupling media can be chosen primarily on the basis of cost and convenience.


Fast and slow skeletal muscles: simultaneous in vitro study. Simultaneous study of the function of fast and slow twitch skeletal muscles in the same in vitro preparation has obvious advantages. Equipment, method and technique are described for study of the soleus (slow) and extensor digitorum longus (fast) muscles from the mouse, and the problems involved in preparing and standardizing these studies are discussed. For nearly maximum function to be obtained from both muscles, careful attention must be given to the stimulus parameters used. Three separate studies were necessary to determine the appropriate stimulus duration, frequency and rest interval between the stimulus trains. The results indicate that for study of tetanic tension and rate of tension development of these muscles from the C57 NAB strain of mice at 20C the most satisfactory stimulus parameters are : duration 2 msec, frequency 100 pulses per second and duration of the stimulus train 700 msec. Rest interval between stimulus trains was two minutes as problems developed with rest intervals less than two minutes or greater than four minutes.


Electrical stimulation and feedback training: effects on the voluntary control of paretic muscles. The carry-over effect of gait-synchronized stimulation of the peroneal nerve on voluntary dorsiflexion of the paretic foot was evaluated in hemiplegic patients. The influence of providing audiovisual feedback of performance on voluntary control was also evaluated. Each patient received three test sessions separated at least one week apart. In each session, measurement of isometric torque from voluntary effort was repeated four times: before, and at 0, 30 and 60 minutes after a 20-minute walk period. Session 2 involved both peroneal stimulation during walking and performance feedback during voluntary efforts. Session 1 had stimulation only. Session 3 had feedback only. The results were inconsistent among the patients. Where increase of voluntary dorsiflexion was obtained, it was more a consequence of performance feedback than peroneal stimulation. General problems of using isometric torque produced by voluntary dorsiflexion as a measure of the carry-over effect are discussed.


Conditioning program for amputees with significant heart disease. A program has been developed for training amputees with significant heart disease. In seven patients, a stress test was performed to evaluate cardiac functional capacity and heart rate response, utilizing both invasive and noninvasive techniques. Following this test, a conditioning program was instituted to improve cardiovascular function. At discharge and six week follow-up, all patients were able to ambulate at least 90 feet (27.4 meters) without excessive pulse rise or cardiac symptoms. This study demonstrates that by proper application of the principles of exercise physiology and cardiac pathophysiology, one should not necessarily deny a disabled patient wiith significant heart disease the opportunity to participate in a rehabilitation program.


Medical recommendations--followed or ignored? Factors influencing compliance in arthritis. Physiatrists are frequently confronted by the failure of patients to follow medical advice, with resultant adverse effects on rehabilitation outcomes. This paper examines the compliance of arthritis patients with an exercise regimen. A number of factors are examined in this study in assessing elements related to patient compliance. Included are patient attributes and perceptions, professional home visits and form of instruction in the regimen and selected features of the patient's social environment. Age, activity status and marital status, use of medications, patient understanding of arthritis and professional home visits appear to have a bearing upon patient compliance. Careful attention to factors likely to influence patient compliance will prove helpful in efforts designed to enhance rehabilitative progress and, ultimately, improve the lives of patients.


Bio-behavioral monitoring: a method for remote health measurement. The treatment of chronic disease has been severely limited by the failure to develop a technology of self-measurement. To examine and validate remotely acquired data from ambulatory patients, 13 cirrhotic subjects were asked to make daily measurements of medically and behaviorally significant variables. Subjects transmitted data for six months on variables such as weight, alcohol consumption, medications, hours worked, liquid consumed and general activity, complying with 90.4% (10,078) of the requests for data. Highly significant relationships were found between patients' reports and criterion measures of weight data and alcohol consumption. Significant negative relationships between hours worked and alcohol consumption were found for several patients (P less than 0.001). The results suggest that ambulatory patients can systematically measure and communicate medically and behaviorally significant information.