Observations in vitro regarding the mechanism of the cell destruction by stimulated lymphocytes. In contrast to other cells stimulated lymphocytes release substances probably cytotoxic which are incorporated by the target cells. The cellular material is released by tearing off parts of fine processes which the lymphocytes extend on to the surface of the target cells. This explains the before mentioned observations that the cell destruction mediated by lymphocytes depends absolutely on a close contact between the lymphocytes and the target cells.


Immunomorphological lymph node processes in some cirrhogenic liver diseases. Dynamics of the lymph node modifications as well as hepatic and immunoserological in various cirrhogenic hepatopathies have been studied on human and experimental material. Lymph nodes showed early and progressively immunomorphological reactions with maximum intensity in evolutive stages of certain cirrhoses. Such reactions as well as in other areas of reticulo-endothelial system are decreasing during the immunosuppressive treatment and in advanced stages of cirrhosis. The lymph nodes participation in the pathogenic mechanism of some cirrhogenic hepatopathies has been very little studied, whereas that of the liver and of the spleen has been more approached. Our previous investigations (1) have disclosed the existence of some chronic lymphadenites as well as reactional reticuloses on necroptic material from young cirrhotics. Equally, during some preliminary experimental studies (7) We remarked intense lymph node reactions even in incipient phases of cirrhoses, which fact stirred us up to examine them thoroughly.


Research on a new type of antiinsulin antibody in a diabetic female patient: the cytotoxic antibody. antiinsulin cytotoxic antibody. A study was carried out on a diabetic patient showing allergy to insulin, with urticaria and Quincke's edema, apparently owing to sensitization with IgE antibodies. By means of a hyposensitizing treatment her allergy improved due to the building up of IgG protecting antibodies, but at the same time she showed resistance to insulin, probably owing to IgG antibodies as well. This suggest that caution should be exerted before applying hyposensitization with insulin on diabetic patients allergic to the hormone. We were able to describe on the same patient a type II sensitization caused by a cytotoxic antibody against insulin. It was shown that this antibody agglutinates leukocytes which had been previously incubated with insulin and damage occurred when complement was present. Those effects could be especifically inhibited when the antigen (insulin) was added to the medium. The antibody belongs to the IgG group and it acts both in vivo and in vitro. In the case under study, the cytotoxic antibody disappeared as soon as treatment with insulin was discontinued for a year, and reappeared when renewed. It does not seem to occur very frequently, for it was not found in 20 consecutive diabetic patients under insulin treatment.


[House-dust allergens. II. Correlations of intradermal reactions of house-dust extract and extract of "D. pteronyssinus"]. In a previous study we had found a high correlation between the positive reaction to standard house dust and to a mites pool extract of 0.86. The study had indicated that the dominant mite found in standard house dust in Barcelona seemed to be D. pteronyssinus. We wished to further confirm this finding by comparing skin reactions to an extract of this mite with skin reactions to the city's dust. A dust extract (HDS-B) was prepared according to the Spieksma technique in a proportion of W/V 1/10 and diluted to 1/1,000 with the liquid of the extract. Extracts of D. pteronyssinus were prepared with a culture medium (HDM), diluted to 1/1,000,000 and a control of thc culture medium at 1/100. A study was made of 56 children suffering from asthma due to house dust, their ages ranging from 4-14 years. 19 were eliminated due to positive reactions to the control. Among the remaining 37 a skin-reaction to histamine ratio was established. The correlation coefficient found was 0.91, which is significant at a level of P less than 0.001. It is also noteworthy that of the nineteen children (33.9%) who reacted to the control, 10 (17.85%) of them reacted positively with at least 2-3 crosses, which leads us to think that human dander may act as a lesser allergen. We therefore conclude that: 1. D. pteronyssinus is the principal source of allergen in domestic dust. 2. The precise role of human skin dander needs to be clarified.


Kveim-test in patients suspected of sarcoidosis and in leprosy patients in a geographical area not yea investigated. The Kveim-test was studied in a geographical area (São Paulo, Brazil) not yet investigated, and leprosy patients were also tested. One hundred and forty seven patients from a general hospital who had had the possibility of sarcoidosis, as a differential diagnosis, were tested with Kveim suspension. Another group of 13 patients with clinical and histological diagnosis of leprosy (10 with tuberculoid leprosy lepromin-positive and 3 with indetermined leprosy) was also tested with Kveim suspension. Sixteen Kveim-tests (10 per cent) with sarcoid granulomatous reaction revealed histologically were considered positive. Three patients with sarcoidosis for more than 3 years gave negative Kveim-test. Four patients with positive Kveim-test had respectively lymphosarcoma, Crohn's disease, lung fibrosis and concurrent tuberculosis infection. Nine positive Kveim-tests (5.6 per cent) were coincident with sarcoidosis. Thirteen leprosy patients (ten tuberculoid) gave negative Kveim-test.


Community screening for Tay-Sachs disease. Tay-Sachs disease is a fatal genetic disease affecting Jewish infants of eastern European ancestry. While the disease may go unrecognized until nearly one year of age, death occurs by age three or four. Community screening programs have been organized to detect carriers of this autosomal recessive trait. Prenatal diagnosis now allows carrier couples to have normal children without the risk of having an affected child. These programs hopefully will serve as models for the future prevention of other genetic diseases.


Anorexia nervosa.

Anorexia nervosa. Anorexia nervosa occurs predominantly in white, middle-class, adolescent females with perfectionistic tendencies. Their solution to the intense guilt induced by any sensory pleasure is to deny themselves the pleasure of eating. Amenorrhea is universal. Diagnostic criteria include a 25 percent weight loss. Therapies are long and involved different approaches. All recognize that food is the medicine for the body and that some form of supportive psychotherapy is the medicine for the mind.


Compliance: a problem in medical management. The prevalence of noncompliance is underestimated and the role of the physician in promoting and inhibiting complicance is not often recognized. Physicians accept the need for patient education but do not accept responsibility for the patient's compliance. The disease denial/rationalization syndrome is a useful label for emotional resistance to the treatment program. An important factor is the extent to which the physician seeks to ascertain compliance. Compliance-gaining strategies must be applied with tact and flexibility.


Brain imaging.

Brain imaging. Imaging with radionuclides should be used in a complementary fashion with other neuroradiologic techniques. It is useful in the early detection and evaluation of intracranial neoplasm, cerebrovascular accident and abscess, and in postsurgical follow-up. Cisternography yields useful information about the functional status of cerebrospinal fluid pathways. Computerized axial tomography is a new technique of great promise that produces a cross-sectional image of the brain.


Editorial: Observations on the diagnosis of isolated rheumatic carditis. There are many similarities between the clinical features of viral heart disease and of rheumatic carditis, as defined in the revised Jones criteria for the diagnosis of rheumatic fever. Because of this, it is likely that viral heart disease has been, and still is, diagnosed as rheumatic. This situation can be avoided if isolated rheumatic carditis is diagnosed only when a viral etiology has been definitely excluded, and when there is unequivocal evidence of recent infection with an appropriate strain of streptococcus.


Clinical correlates of coronary cineangiography in young males with myocardial infarction. Thirty-eight men who suffered acute transmural myocardial infarction before age 40, and after recovery were New York Heart Association functional Class I or II, were studied by noninvasive means and by coronary angiography in order to determine whether these nonivasive studies could predict the presence of significant coronary artery disease remote from that felt to be responsible for the previous myocardial infarction. Patients were divided into two groups on the basis of the absence (Group I) or presence (Group II) of obstructive disease in a major coronary artery supplying myocardium remote from the prior myocardial infarction. There were 21 patients in Group I and 17 patients in Group II. They did not differ with respect to age, abnormalities of lipid or glucose metabolism, family history, history of hypertension or cigarette use, presence of obesity, or infarct localization. Ten of 17 patients in Group II had angina pectoris; only 3/21 patients in Group I had angina pectoris (p less than 0.01). All 12 patients tested in Group II had a positive maximal exercise tolerance test; only 1/17 patients tested in Group I was similarly positive (p less than 0.001). The absence of angina pectoris and the presence of a negative maximal exercise tolerance test is strong evidence against the pressure of significant CAD remote from that responsible for the prior myocardial infarction.


A combined electrophysiological and anatomical study of the human fetal heart. Five human fetal hearts of gestational ages ranging from 12 to 16 weeks were studied with both electrophysiological and anatomical techniques. The electrophysiological behavior of these hearts was comparable with results obtained with other animal species and adult human hearts. This indicates that the fetal heart is functionally mature from an early stage of development; however the tissues are not fully differentiated from an anatomical standpoint. Results of mapping experiments indicated that atrial activation occurred through broad wave fronts, and no electrophysiological evidence was found to support the concept of "specialized internodal conduction." In two hearts, the node and bundle were found to be anatomical contiguity with ventricular myocardium throughout their length, but the conducting tissues were already functionally insulated from the ventricles. The results have significance with regard to concepts of the "sudden death in infancy syndrome" and ventricular pre-excitation.


Single right-sided precordial lead in the diagnosis of right ventricular involvement in inferior myocardial infarction. The ST segment in a single right-sided chest lead, CR4R, has been studied in 92 consecutive patients with acute inferior transmural left ventricular myocardial infarction. A transient ST- segment rise of more than 1 mm. was recorded in 35 patients, and strongly indicated a significant extension of the infarction to the posterior free right ventricular wall according to autopsy findings. This ECG pattern was furthermore associated with right-sided heart failure, hypotension and oliguria. Left heart failure was also common. The short-term prognosis of patients with ST-segment elevation in CR4R was poor.


Relative insesitivity of isovolumic phase indices in the assessment of left ventricular function. 1. The authors compared the sensitivity of the isovolumic phase indices (contractility indices) against LV function curves ("pump-function" indices) in assessing ventricular performance. 2. Certain modifications of the usual isovolumic phase indices, especially those introducing the concept of comparison of exercise with rest, seemed to us to be slightly more helpful in separating normal subjects from the patient with coronary artery disease or cardiomyopathies, but these differences were not striking when statistically evaluated, and could not be utilized in assessment of left ventricular function in individual patients. 3. The construction of left ventricular function curves, in our hands, yielded equally as satisfactory information and, in addition, was much simpler to perform. 4. It is concluded that contractility indices are relatively insensitive in the assessment of left ventricular function, and that they offer little advantage over "pump-function" indices for this purpose.


Korotkoff sound filtering for automated three-phase measurement of blood pressure. Under rest conditions, changes in the Korotkoff sounds at phases I, IV, and V can be correlated with specific frequencies within the bandpass of the stethoscope. A filter capable of detecting the changes in Korotkoff sounds at phases I, IV, and V is described together with the frequency changes that characterize these phases. The importance of frequency components outside the bandpass of the stethoscope is stressed, especially in terms of the possibility of yielding more clinical information and, perhaps, additional clues above the origin of the Korotkoff sounds themselves.


Formation of coronary arterial thrombi in relation to onset of necrosis in acute myocardial infarction in man. A clinical and autoradiographic study. The presence of radioactivity in coronary arterial thrombi was studied at necropsy by autoradiography in 12 patients with acute myocardial infarction. Seven patients had been given 125I-and five patients 131I-labeled fibrinogen. With a short interval (less than 10 hours) between onset of symptoms and injection of fibrinogen the entire thrombus was radioactive in four of five patients, whereas with longer time intervals only parts or none of the thrombus contained detectable radioactivity. The findings give further evidence that thrombus formation in acute myocardial infarction probably is a slow process and that the major part of the thrombus may form after the onset of necrosis.


Ventricular performance measured during ejection: Studies in patients of the rate of change of ventricular power. An expression indicative of the rate of change of ventricular power was derived and applied to the evaluation of left ventricular performance of patients with angina. Patients were categorized as having normal or abnormal ventricular performance on the basis of the ejection fraction, mean velocity of circumferential fiber shortening, and left ventricular end-diastolic volume index. In those with normal performance, the ejection rate of change of power was (25 +/- 2) times 108 dyne cm. sec. (-2); in patients with abnormal performance it was (11 +/- 1) times 10(8) dyne cm. sec. (-2) (P less than 0.001). There was no overlap of values between categories of patients. Such a clear distinction between categories was not seen with any of the commonly utilized isovolumic indices of performance. The rate of change of ventricular power measured during ejection is free of assumptions, yet has a fluid dynamic as well as a physiological meaning. It serves in an intergrative fashion by incorporating terms previously shown to be of functional significance. Previous studies in dogs showed that it reflected alterations of the inotropic state, yet it was relatively independent of alterations of preload or afterload. It appears, therefore, that it is an indicator of ventricular performance that has desirable characteristics.


Atrial T (Ta) loop in dogs with or without atrial injury. In 46 dogs with experimentally produced complete A-V block, the P and the Ta waves before and after the atrial injury were recorded in scalar orthogonal ECG leads at high speed and high amplification. The P and the Ta loops were drawn by hand from the scalar ECG'S. In the dogs without atrial injury, the maximum Ta vector was oriented to the right, superiorly and anteriorly. The P-T angle was close to 180 degrees in each of the three planes. The magnitude of the maximum Ta vector was nearly proportionate to that of the maximum P vector in each plane. The Ta loop was a smooth, elongated ellipse in configuration and showed clockwise rotation in all planes, as did the P loop. The spatial atrial gradient obtained from the scalar ECG was small. In the dogs with atrial injury, the Ta loop changed in direction, configuration, and inscription direction. The P-Ta angle and the relative magnitude of the maximum Ta vector to that of the maximum P vector changed markedly. The change of the P loop remained minimum. The maximum Ta vector and spatial atrial gradient were oriented toward the atrial injury site. The magnitude of the spatial atrial gradient was extremely large after injury. These findings were thought to be important in suggesting the presence of atrial injury and its localization.


Percutaneous balloon atrial septostomy in infants with transposition of the great arteries. Initial experience with PBAS in early management of neonate with TGA is described. Standard percutaneous techniques were used and modified by a series of dilations designed to introduce a septostomy catheter into the femoral vein. Thirty infants with TGA were catheterized, and PBAS was accomplished in 25. The mean aortic oxygen saturation rose from 55 to 72 per cent. Twenty-four infants were clinically palliated for at least 3 months; however, five required pre-elective surgery thought due to inadequate atrial mixing. No severe complications followed PBAS. Twenty-three patients underwent follow-up catheterization, in 17 through the vein used for PBAS. When compared to patients with TGA who had cutdown insertion of balloon septostomy catheters, the group treated by PBAS was similar in patient material, and successful septostomy. Those ballooned percutaneously had fewer complications and required slightly less time for the procedure. We feel that PBAS is a relatively easy and safe palliative procedure when performed in an infant with TGA. It should be considered by all those performing percutaneous diagnostic catheterization in infants and children.


Cannon waves with A-V association.

Cannon waves with A-V association. Under appropriate circumstances, cannon waves can occur in the presence of A-V associated rhythms. Presented here is a case of first degree A-V block with cannon waves. Recognition of these waves and their behavior aided in diagnosing the patient's rhythm. The cannon waves were documented by jugular venous pulse recordings.


Remission and recovery from chronic, established, complete heart block. The return of A-V conduction is described in a patient after two decades of high-grade or complete congenital heart block. Similar cases have been reported by others, with remission or even recovery commencing up to the fourth decade or later. A similar phenomenon is also described in four patients with acquired heart block of four to ten years' duration; in them, remission was usuallly brief but persisted for seven years in one patient. No full report of this seems to have been published previously. Possible explanations are discussed, but no conclusion is reached. Apart from its interest, the phenomenon is of importance with respect to the selection of demand-type electronic pacemakers in the management of patients with heart block.


Arterial thromboembolic complications in patients with Starr-Edwards aortic ball valve prostheses. Aterial thromboembolic complications were studied in 253 patients who had a single aortic Starr-Edwards ball valve implanted. During the first postoperative month, six patients died from myocardial infarction, one was reoperated because of leakage caused by thrombus on the valve, and five others suffered six thromboembolic episodes. Forty-six late thromboembolic complications occurred in 40 of the 216 patients who survived the postoperative period. Seven died, four from cerebral emboli and three from myocardial infarction. The late incidence was 7 episodes per 100 patients per year. Valves of series 1200 carried a significantly higher risk of arterial thromboembolism than did those of series 2300, and most episodes occurred in patients with cell controlled anticoagulant treatment. The incidence was not influenced by time since operation, continuous arrhythmia, concomitant mitral valve disease, heart size, or the degree of intravascular hemolysis. It is concluded that arterial thromboembolic complications represent a major threat to patients with aortic ball valves even several years after operation and in spite of intense anticoagulant therapy.


Effect of altitude on personal respirable dust sampler calibration. Air sampling instruments often are used at altitudes other than the altitude at which they were calibrated. This investigation quantitates the effect of personal samplers and provides empirical relationships for adjusting the calibration mark for use at any altitude.


User tests of ear defenders.

User tests of ear defenders. Ten different common muff-type ear defenders were tested by 50 potential users for comfort and ease of use. Results showed short-term (3 min) impressions to be a good predictor of long-term comfort; defenders were ranked for comfort and pointers are given for important design features. Only comfortable ear defenders will be worn properly.


Experimental human exposures to tetrachloroethylene vapor and elimination in breath after inhalation. Volunteers were exposed in a controlled environment chamber and concentrations of tetrachloroethylene in alveolar air were determined. Results show a proportional relationship between the level of exposure and the alveolar concentration curve. Accordingly, tetrachloroethylene breath decay curves can be used as a method to monitor time-weighted average exposures.


An improved method for monitoring heat stress levels in the workplace. Studies in 15 industries revealed characteristic empirical relationships between workplace environmental conditions and outside weather conditions. These relationships, expressed in the form of predictive models for Wet Bulb Globe Temperature, can be used to estimate WBGT from weather forecasts, weather reports, or current meterorological measurements.


A simple gas chromatographic method for the analysis of trace organics in ambient air. A simple method using adsorption, heat desorption, and F.I.D. gas chromatography to determine ppb quantities of various organic vapors in air is described. Laboratory results with chemicals such as bischloromethyl ether, vinyl chloride monomer and volatile ketones are discussed.


Work scheduling under normal and prolonged-vibration environments. This paper summarizes the research conducted to study human performance and recovery under prolonged, whole-body, vertical vibration. The results showed that performance under vibratory environment is inferior to that under normal environment. Interaction between work-rest schedules and the vibratory environment was detected. Parameters affecting selection of optimum work-rest schedules are discussed.


Elevated urinary phenol levels in beagle dogs treated with salol. Dogs administered 500 or 250 mg of salol/kg/day showed transient toxicity of a reversible nature. Doses of 125 mg salol/kg/day caused no discernible ill effects in spite of urinary phenol levels elevated as high as 6144 ppm. It appears as if exposure to a compound other than benzene can cause an elevation of urinary phenol.


Tris (2,3-dibromopropyl) phosphate: human contact sensitization. Liquid TBP caused delayed hypersensitivity in human subject maximization tests. It showed a dose/response relationship and is judged a weak to mild sensitizer. Patch testing a pre-sensitized subjects using fabrics containing TBP produced responses varying with the availability of the agent at the fiber surface. It appears improbable that treated textiles affording low TBP availability will cause sensitization.


Correlation of echocardiographic and clinical findings in patients with pericardial effusion. Clinical data and echocardiographic findings were correlated in 20 patients with pericardial effusion. Moderate to large effusions were associated with increased motion of the entire heart within the pericardial sac. A correlation was found between the estimated volume of fluid and the diastolic excursion and velocity of the right ventricular and left ventricular walls (P less than 0.01). For any given volume of fluid as estimated from the echocardiogram neoplastic effusions resulted in greater increments in wall motion (P less than 0.02). Patterns of "pseudo" mitral valve prolapse occurred and were correlated with the extent and timing of cardiac swinging and heart rate. A diminished E-F slope of the mitral valve echo and notch on the right ventricular epicardial echo during early systole were found in all four patients with pericardial tamponade. These preliminary observations suggest that echocardiographic examination of patients with pericardial effusion may provide clues to the presence or absence of tamponade in addition to providing an estimate of the quantity of fluid in the pericardial sac.


Subdivided left atrium: an expanded concept of cor triatriatum sinistrum. Twenty-four hearts with cor triatriatum were studied. On the basis of this material and a review of the literature a new classification of "subdivided left atrium" is proposed. Tye A, the most common form of subdivided left atrium, is the classic cor triatriatum with its multiple variations of partial anomalous pulmonary venous drainage; the fossa ovalis can be related to the proximal left atrial chamber (type A, a) or the distal left atrial chamber (type A, b). Type B hearts are related to (but not identical with) total anomalous pulmonary venous drainage into the coronary sinus; the coronary sinus opening is atretic in these hearts; abnormal defects connect the proximal left atrial chamber usually with the right atrium only, rarely also with the distal left atrial chamber. The Type C heart, first reported in this paper, has a superiorly and medially situated proximal chamber, located between the right and distal left atrium; it does not receive any pulmonary veins; the coronary sinus is normally formed. Current morphogenetic hypotheses that satisfactorily explain the Type A b and B heart fail to account for the Type A a and C heart.


Aortic valve atresia: a new classification based on necropsy study of 73 cases. Certain clinical and morphologic observations are described in 73 necropsy patients with aortic valve atresia. The mean age at death was 5 days; 80 percent died during the first week of life, and 70 percent were boys. Of the 73 patients, 69 (95 percent) had a hypoplastic left ventricle with intact ventricular septum and either an atretic (25 patients) or hypoplastic (44 patients) mitral valve. The other four patients had a well developed left ventricle with one or more defects in the ventricular septum and either an atretic (one patient) or well developed (three patients) mitral valve. Review of previous reports on aortic valve atresia disclosed that a well developed left ventricle or ventricular septal defect in association with absence of the aortic valve was extremely rare. A new classification for aortic valve atresia is presented based on the status of the ventricular septum, which in turn appears to determine the size of the left ventricular cavity. The predilection for male subjects for all types of aortic valve disease, including atresia, is emphasized.


Congenital valvular aortic stenosis: clinical detection of small pressure gradient. Prepared for the joint study on the joint study on the natural history of congenital heart defects. Clinical variables (from the history, physical examination, electrocardiogram and chest radiograph) were related to the pressure gradient measured between the left ventricle and the aorta in 434 young patients with congenital valvular aortic stenosis admitted to a national collaborative study. The aim was to devise a composite clinical criterion for the recognition of patients with a small pressure gradient, so as to expand the opportunity for avoiding cardiac catheterization in such patients. Flattened or inverted T waves in lead V6 were found to be inconsistent with mild disease. Therefore, a composite criterion, providing an estimate of pressure gradient, was developed for patients without T wave changes. The final criterion, based on multivariate analysis, involved only the intensity of the systolic murmor, the presence or absence of an early diastolic murmur, and voltages of the Q and R waves in lead V6. Patients with a low estimate by this procedure rarely had a large measured gradient. Only 3.7 percent (6 of 161) with an estimated gradient of less than 45 mm Hg had a gradient at cardiac catheterization of 80 or more mm Hg; none (0 of 32) with an estimated gradient of less than 30 mm Hg had a gradient of 50 or more mm Hg. This criterion should be helpful in avoiding unnecessary catheterization by identifying some patients with valvular aortic stenosis who have a small pressure gradient.


The palliative Mustard operation: rationale and results. The tendency toward development of severe pulmonary vascular obstructive disease in patients with complete transposition of the great arteries and associated large ventricular septal defect has been well documented. The physiologic consequence of this process is a significant reduction in intercirculatory mixing, resulting in increasingly severe levels of systemic arterial hypoxemia, compensatory polycythemia and an associated significant increase in symptoms. Data indicate that definitive surgical correction in patients with pulmonary arteriolar resistance of more than 10.0 units m2 is associated with a prohibitive operative mortality. However, the "palliative" Mustard operation (that is, intraatrial baffle repair, leaving the ventricular septal defect open) can be accomplished with relatively low risk and substantial hemodynamic benefits to the patient. It is erroneous to assume that the result of the operation will be a mere "reversal" of the preoperative systemic arterial and pulmonary arterial saturations, as shown by a review of the hemodynamic changes attributable to the operation. After the operation, systemic arterial saturations of 80 to 93 percent have been achieved, with a concomitant significant reduction in hemoglobin concentration, to a near normal level in some. Although the long-term prognosis in such patients is unknown, the reduction in symptoms and increase in exercise tolerance soon after operation are most gratifying.


Residual hypertension after coarctectomy in children. Coarctectomy in 190 children aged over 1 year to 15 years at operation produced a significant reduction in blood pressure for the group as a whole. Forty-nine patients (24 percent) remained hypertensive. Postoperative hypertension was unexplained in 29 (15 percent) of the 190 patients, and coarctation persisted or recurred in 20 (11 percent). For patients operated on between the ages of 4 and 15 years the earlier the age of operation, the greater the reduction in the blood pressure index: (measured blood pressure/normal mean systolic [or diastolic] blood pressure for age) X 100.


Role of echocardiography in patients with coronary artery disease. Impaired left ventricular performance, one of the hallmarks of coronary artery disease, can be detected by echocardiography in various ways. One of these approaches is the recording of abnormal wall motion. Because of the way in which the left ventricle can be examined echocardiographically, this technique has the capability of detecting regional wall abnormalities. In fact echocardiography is probably the most sensitive technique available, including even contrast ventriculography, for the detection of akinetic, hypokinetic or dyskinetic wall segments. With increasing experience it is apparent that more areas of the left ventricle can be examined echocardiographically than had previously been thought possible. Newer techniques include directing the ultrasonic beam not only through the body of the left ventricle but also toward the apical portion of the ventricle near the vicinity of the papillary muscles. In addition the true anterior left ventricular wall can be examined by moving the transducer laterally away from the left sternal border. Yet another approach utilizes a subxiphoid position for the transducer while the ultrasonic beam is directed through the medial portion of the septum and posterolateral wall of the left ventricle. M-mode scanning techniques together with recently developed cross-sectional echocardiographic instruments give great promise of improved detection of abnormalities of ventricular shape, especially the presence of aneurysms. The cross-sectional approach makes it possible to examine the left ventricular apex, an area virtually impossible to record with M-mode echocardiography. Recording of left ventricular dimensions and abnormal mitral valve motion may help in assessing overall left ventricular performance. A dilated left ventricular dimension in the vicinity of the mitral valve seems to be an ominous finding both in patients with acute myocardial infarction and in patients with chronic coronary disease being considered for possible surgery. Another echocardiographic sign of abnormal ventricular performance is altered closure of the mitral valve, which reflects a significantly elevated left ventricular diastolic pressure. These echocardiographic techniques are still in the investigational stages and are more technically difficult than the usual echocardiographic applications. However, the preliminary data are encouraging and make us hopeful that echocardiography will prove to be an important tool in the overall evaluation of the left ventricle in patients with coronary artery disease.


Auscultatory perception of the fourth heart sound: effects of interval form fourth to first sound (S4-S1) and aging. A clinically heterogeneous group of 48 subjects (aged 19 to 76 years) were searched for a fourth heart sound (S4) by three independent "blind" auscultators. Phonocardiograms recorded immediately after auscultation were measured by another "blind" observer. An S4 was identified in 32 subjects (67 per cent) in phonocardiograms with nominal filter peaks of both 70 and 35 hertz. Results in these subjects revealed two groups by auscultatory performance: those with an "easily heard" and those with an "easily missed" S4. Subjects with an "easily missed" S4 were significantly younger than those with an "easily heard" S4 (31.2 +/- 2.8 years versus 50.0 +/- 4.0 years, P less than 0.001). P-R and P-S4 intervals and relative amplitude of S4 (ratio of fourth to first heart sound [S1] amplitude) were not significantly different in the two groups. Splitting of the first heart sound (S1) was observed more frequently in the phonocardiogram of patients with an "easily missed" S4, but this trend did not reach statistical significance. The interval between S4 and the low frequency component of S1 was significantly short in those with an "easily heard" S4 (49.4 +/- 4.1 msec versus 70.0 +/- 5.0 msec, P less than 0.005). The mean S4-S1 (low frequency component) interval for the group with an "easily heard" S4 approximated 1 cycle length for S4 vibrations, a finding consistent with temporal acoustic summation. An alternate hypothesis is modification of S1.


Clinical and arteriographic features of Prinzmetal's variant angina: documentation of etiologic factors. Coronary arteriography performed in 17 patients with Prinzmetal's variant angina demonstrated high grade fixed obstructions in 9 patients (Group I) and insignificant or no fixed lesions in 8 patients (Group II). Group I consisted mostly of middle-aged or elderly men with S-T segment elevations in various sites; Group II included five younger women with S-T segment elevations in inferior electrocardiographic leads. In Group I patients, arteriography revealed a discrete high grade lesion located proximally in a major coronary artery in four patients and multivessel involvement in five patients. In Group II patients, spontaneous spasm was documented in three patients and spasm was pharmacologically provoked in two others during arteriography. The current study indicates that spasm is the responsible pathogenetic mechanism of myocardial ischemia in some patients with Prinzmetal angina and that this mechanism may be suspected from the clinical characteristics of these patients.


Interventricular septal motion during preexcitation and normal conduction in Wolff-Parkinson-White syndrome: echocardiographic and electrophysiologic correlation. Interventricular septal motion was studied by echocardiogram in 20 consecutive patients with documented Wolff-Parkinson-White (WPW) syndrome before and during electrophysiologic evaluation using His bundle recordings and pacing techniques. Characteristic abnormal interventricular septal motion was seen in 8 of 11 patients with type B WPW syndrome (groups I and II). All eight patients had electrocardiographic patterns consistent with an anomalous pathway located in the anterior right ventricular wall (group I). In five of these eight patients normalization of the QRS complex for one or more beats was accomplished and produced normalization of the septal motion in four; whereas in the fifth patient, who had an underlying atrial septal defect, the abnormal septal motion remained abnormal. All nine patients with type A WPW syndrome (groups III to V) had normal septal motion both during total preexcitation and during normalization of the QRS complex. The normalization of the abnormal interventricular septal motion with normalization of the QRS complex in type B WPW syndrome strongly suggests that the abnormal motion is related to an abnormal sequence of ventricular depolarization during preexcitation. Furthermore, persistent abnormal septal motion after normalization of the QRS complex suggests that other factors such as right ventricular volume overload may be responsible. Likewise, when abnormal septal motion occurs in the presence of type A WPW syndrome, an explanation other than preexcitation must be sought.


Experimental myocardial infarction: XII. Dynamic changes in segmental mechanical behavior of infarcted and non-infarcted myocardium. The mechanical behavior of ischemic myocardium was studied in anesthetized open chest dogs. In each animal, a small well localized myocardial infarction was produced by ligation of a single ventricular branch of the left circumflex coronary artery. Serial in situ measurements of segment length were made by mercury-in-Silastic gauges sutured directly to the left ventricular surface. After coronary ligation, systolic aneurysmal bulging of the ischemic segment was uniformly noted. This was quantified as follows: normalized segment length change in this region, expressed in muscle lengths (where muscle lengths = phasic segment length amplitude/end-diastolic segment length), immediately increased from 0.06 +/- 0.01 (standard error of the mean) to 0.10 +/- 0.02 muscle lengths (+67 percent, P less than 0.02). Over a 6 hour period, muscle lengths progressively declined to near control values, but retained an aneurysmal contour. End-diastolic segment length increased 5 percent above control values after coronary occlusion and remained fixed at this level for 6 hours. In contrast, noninfarcted myocardium exhibited no significant changes in muscle length or end-diastolic segment length. These studies demonstrate that the degree of systolic aneurysmal bulging in infarcted myocardium, although initially great, resolves within 6 hours but retains an aneurysmal contour. These findings are consistent with either partial return of contractility or diminished local compliance, but persistence of an aneurysmal shape favors the latter mechanism. The fixed increase in end-diastolic segment length suggests that "stress-relaxation" takes place in the infarcted region. It is possible that diminished compliance in zones of infarction, previously noted after several days, begins within a few hours after the onset of ischemia.


Beneficial effect of lidocaine on ventricular electrical stability and spontaneous ventricular fibrillation during experimental myocardial infarction. Several studies have questioned the efficacy of lidocaine in reducing the incidence of ventricular fibrillation shortly after acute myocardial infarction when arrhythmogenic mechanisms may be different from those operative several hours later. To determine whether lidocaine inhibits the occurrence of early ventricular fibrillation, the left anterior descending and septal coronary arteries were occluded at their origins in open chest anesthetized dogs. Fourteen of 16 control dogs died with ventricular fibrillation. Fifteen dogs received two different dose regimens of lidocaine before coronary occlusion. Of the 11 treated dogs maintaining lidocaine bl), 6 survived (P less than 0.05). Five dogs received the larger dose; all died, four having blood levels of 6.3 mug/ml or greater at the time of death. Ventricular fibrillation threshold also increased in six of eight dogs when lidocaine was administered after coronary occlusion. It is concluded that lidocaine at blood levels of 1.2 to 5.5 mug/ml significantly reduces the incidence of ventricular fibrillation early after coronary occlusion. Administration of this agent therefore may be of particular value in the early phase of acute myocardial infarction.


Combined hemodynamic-ultrasonic method for studying left ventricular wall stress: comparison with angiography. Calculation of left ventricular wall stress in man has traditionally required angiographic and left ventricular pressure measurement, making study of interventions difficult. We have developed a combined hemodynamic-ultrasonic technique for measuring left ventricular meridional wass stress (sigma m) throughout the cardiac cycle. Simultaneous measurements of left ventricular pressure, ultrasonically determined wall thickness (h[echo]), and minor axis (D[echol]) were made during cardiac catheterization in nine subjects, three with chronic left ventricular pressure overload, four with left ventricular volume overload and two with normal left ventricular function. Within 30 minutes, left ventricular cineangiography was performed in each subject and angiographic wall thickness (h[angio]) and minor axis (D[angio]) were measured. Comparison of values for each subject throughout the cardiac cycle (average 18 data points/cycle) yielded close correlation: For D(echo) versus D(angio), r values ranged from 0.82 to 0.98 whereas for h(echo) versus h(angio), r values ranged from 0.56 to 0.98 for the nine subjects. Meridional wall stress was calculated after the method of Sandler and Dodge as PRi2/h(2Ri + h), where Ri equals the inner wall radius, calculated as D/2 for both ultrasonic and angiographic methods. Agreement between ultrasonic and angiographic methods was excellent in each subject, with close superimposition of the stress-time plots constructed by the different techniques. In summary, a new method for measurement of left ventricular wall stress has been developed and validated by comparison with an angiographic reference standard. This method has potential advantages, including the ability to study meridional wall stress continuously and to assess its response to serial interventions.


Force-velocity-length relations in man expressed by a single hemodynamic expression: the ejection rate of change of power at peak tension. An attempt was made to develop a hemodynamic indicator of pump function that relates to the contractile characteristics of cardiac muscle. The ejection rate of change of power has ideal characteristics for this purpose. It is firmly based upon theories of fluid dynamics and its derivation is free of assumptions related to heart structure and function. It is measured as p dQ/dt + Q dp/dt, where p = pressure and Q = flow. When measured at peak tension, the ejection rate of change of power was (12.3 +/- 0.8) X 10(8) dynes cm sec-2 in 11 patients with abnormal ventricular performance (P less than 0.001). Studies in dogs showed no effect of preload or afterload. This suggests a relation to characteristics of muscle fibers, which was shown. If one assumes a thin wall sphere, the ejection rate of change of power at peak tension reduces to the following function of tension (T), fiber length (2 pi r), and rate of shortening (2 pi dr/dt): d(power)/dt = 8 pi T](dr/dt)2 + r d2r/dt2[. Thus, the contractile characteristics of muscle fibers (force, velocity and tension) are related in an uncomplicated fashion by a single and highly discriminating hemodynamic indicator of ventricular performance, the ejection rate of change of ventricular power measured at peak tension.


Definition of myocardial perfusion by continuous infusion of krypton-81m. Krypton-81m, a radionuclide emitting a 190 kev gamma ray, has a half-life of 13 seconds. It is a radioisotope of an inert water-soluble noble gas and is produced at a constant rate by spontaneous decay of rubidium-81 in an 81Rb-81mKr generator-delivery system. Delivery is through a minibore Teflon catheter that can be threaded through a standard no. 7 or 8F angiographic catheter. The generator is eluted by 5 percent dextrose-in-water, delivered by infusion pump at 1.5 ml/min, and the eluate is infused intraarterially directly into any organ. Delivery and decay reach equilibrium within 2 minutes, producing a heterogeneous distribution that is proportional to the perfusibility of the tissue concerned and the time required to reach it. The ultrashort halflife of the radionuclide rapidly eliminates activity when delivery ceases; thus, experiments can be sequentially repeated at brief intervals. The radiation hazard for easily imaged doses is negligible. Preliminary studies in open chest dogs were visualized by scintillation camera, stored on digital data disk, processed, and displayed in dual channel, dual color mode on a video system. Images of myocardial perfusion defined relative levels of perfusion, collateral circulation between coronary arterial branches, equilibrium time of diffusible perfusion of the myocardium, focal defects in induced occlusion, collateral circulation to occlusion, and reactive hyperemia after release of induced coronary occlusion. The system and technique appear applicable to human subjects.


Unstable angina pectoris: national cooperative study group to compare medical and surgical therapy. I. Report of protocol and patient population. A preliminary report is presented of a prospective randomized trial conducted by eight cooperative institutions under the auspices of the National Heart and Lung Institute to compare the effectiveness of medical and surgical therapy in the management of the acute stages of unstable angina pectoris. To date 150 patients have been included in the randomized trial, 80 assigned to medical and 70 to surgical therapy; the clinical presentation, coronary arterial anatomy and left ventricular function in the two groups are similar. Some physicians have been reluctant to prescribe medical or surgical therapy by a random process, and the eithical basis of the trial has been questioned. Since there are no hard data regarding the natural history and outcome of therapy for unstable angina pectoris, randomization appears to provide a rational way of selecting therapy. Furthermore, subsets of patients at high risk may emerge during the process of randomization. The design of this randomized trial is compared with that of another reported trial. Thus far, the study has shown that it is possible to conduct a randomized trial in patients with unstable angina pectoris, and that the medical and surgical groups have been similar in relation to the variables examined. The group as a whole presented with severe angina pectoris, either as a crescendo pattern or as new onset of angina at rest, and 84 percent had recurrence of pain while in the coronary care unit and receiving vigorous medical therapy. It is anticipated that sufficient patients will have been entered into the trial within the next 12 months to determine whether medical or surgical therapy is superior in the acute stages of unstable angina pectoris.


Multivariate prediction of coronary heart disease during 8.5 year follow-up in the Western Collaborative Group Study. The Western Collaborative Group Study is a prospective study of 3,154 employed men aged 39 to 59 years. Ischemic heart disease occurred in 257 subjects during 8.5 years of follow-up. Risk of coronary heart disease was studied with use of the multiple logistic risk model. The incidence of coronary heart disease had a highly significant association with serum cholesterol level, behavior pattern, cigarette smoking and systolic blood pressure in younger (39 to 49 years) and older (50 to 59 years) men and also with age and corneal arcus in the younger group. Type A behavior pattern was strongly related to the incidence of coronary disease in both age groups, independent of interrelations of behavior patterns with any other risk factor.


Acute coronary embolism complicating bacterial endocarditis: operative treatment. A patient with bacterial endocarditis and no previous history of angina substained an acute anterolateral myocardial infarction while awaiting surgery. Selective coronary arteriography revealed a filling defect in the left anterior descending coronary artery with limited flow beyond the area of occlusion. A calcific embolus from the infected aortic valve was removed at the time of valve replacement, and the patient had an uneventful immediate postoperative course. Late postoperatively paravalvular aortic regurgitation recurred before and after a second repair.


Repetitive myocardial ischemia of Prinzmetal type without angina pectoris. In a patient with a normal electrocardiogram, normal treadmill exercise test, normal coronary arteriogram and no symptoms to suggest angina pectoris, continuous monitoring during several days exhibited repetitive (one to two per hour) S-T segment elevations in the precordial electrocardiographic leads and hemodynamic changes typical of Prinzmetal's angina (reduction in arterial pressure and cardiac index and increase in systemic peripheral resistance and pulmonary wedge pressure). This case demonstrates that electrical and dynamic cardiac alterations of Prinzmetal's angina can occur even in the absence of angina pectoris.


Pulmonary varix regression after mitral valve replacement. Pulmonary varix is a rare finding; only 35 documented cases have been reported. The first case was described in 1843 as an icidental postmortem finding. The first clinical diagnosis was not made until 1951. In more than half of the 35 cases, the varix was present in the absence of congenital and acquired heart disease. Six patients have had concomitant mitral rheumatic heart disease. This communication describes the second patient with rheumatic mitral regurgitation in whom the pulmonary varix became radiographically invisible after prosthetic mitral valve replacement.


Myotonia dystrophica: ventricular arrhythmias, intraventricular conduction abnormalities, atrioventricular block and Stokes-Adams attacks successfully treated with permanent transvenous pacemaker. In a patient with myotonia dystrophica multiple ventricular arrhythmias and high degree atrioventricular block requiring a permanent pacemaker developed. Patients with skeletal muscle disease may present with disproportionately advanced manifestations of associated cardiac disease. Early recognition of potential serious underlying cardiac disease is important in patients with this condition.


Fine structure of differentiating ameloblasts in the kitten. The fine structure of differentiating ameloblasts was studied in the lower second molar of 1-week-old kittens after perfusion fixation with and without subsequent decalcification. The differentiation zone was divided into three phases. In Differentiation 1, ameloblasts are about 27 mum long and face an uninterrupted basal lamina. The predentin adjacent to the basal lamina contains a few collagen fibrils oriented mainly at right angles to the ameloblast surface. The specialized predentin forms a well-defined layer, up to 1.5 mum thick, referred to as the junctional layer. In Differentiation 2, ameloblast processes extend through the basal lamina and the thickness of the junctional layer. The processes consist of cytoplasmic sheets forming a honeycomb-like network. Dentin starts to calcify after process-formation is underway. Two distinct types of odontoblast processes, having different shapes and contents, come in contact with the ameloblasts and push into the ameloblastic layer. In Differentiation 3, stippled material appears in the extracellular spaces between ameloblasts. Later, stippled material-like substances appear in the predentin close to the ameloblast apex and close to odontoblast processes within the dentin. Ameloblasts now are up to 40 mum high. Enamel secretion starts in small circumscribed areas which gradually enlarge, leading to the disappearance of the ameloblast processes. These findings are compared with results obtained in other species, including man, and their possible functional significance is discussed.


An angiographic study of the carotid arterial and jugular venous systems in the cat. Standard techniques for performing carotid angiography in dogs and in man were adapted to the cat in order to study the vascularization of both intracranial and extracranial structures. Venous drainage was examined by venography of selected vessels. The carotid-cerebral and the vertebral-basilar arterial systems of the cat were studied, although no attempt was made to define the territory supplied by each system. In serial angiograms, vascularization of the rete mirabile conjugatum was visualized and distinct arterial and venous retia were delineated. Large facial veins were seen approximately one second after the intra-arterial injection of radio-contrast material. The early filling of the large facial veins appeared to be the result of an artery-to-venous shunt. Contrast material flowed posteriorly in these veins and drained into the venous rete. When contrast material was injected either into the sagittal sinus or retrograde in the external jugular vein, the internal jugular vein was visible in four of ten cats. This vessel drained blood directly from intracranial contents before anastomosis with the vertebral and external jugular veins.


Immunological competence in Snell-Bagg pituitary dwarf mice: response to the contact-sensitizing agent oxazolone. Snell-Bagg pituitary dwarf mice are an autosomal recessive mutant, their dwarfism being the result of an anterior pituitary defect. A number of investigators have reported that these mice, in addition to having hormonal deficiencies, have immunological defects. Dwarf mice reject allogenic skin grafts slowly, show a reduced response to contact agents and decreased graft-vs-host reactivity. Other investigators have suggested that these results indicate a thymus-cell-deficiency. Contrary to this conclusion, we have found that the thymuses in our dwarf mice have a normal cellular composition and the T-cell-dependent zones in the peripheral lymphoid tissues are not deficient in the lymphocytes. Therefore, this investigation was undertaken to study the response of dwarf mice to the hapten, oxazolone, which produces one type of T-cell-dependent response, delayed hypersensitivity, and to compare this response to that of normal littermates in animals 15 to 90 days of age.


Proliferative kinetics of large and small intraepithelial lymphocytes in the small intestine of the mouse. The proliferative kinetics of the intraepithelial lymphocytes (IL) of the mouse intestine have been evaluated. By inducing mitotic arrest it was found that large IL - constituting about 50% of the IL - showed a mitotic rate of 2.3. Autoradiographic results obtained after two different schedules of 3H-thymidine injections showed that 30% of the large IL were in DNA synthesis, and that the large IL were renewed at a rate comparable to that of blast cells from Peyer's patches, mesenteric lymph nodes and thoracic duct lymph. The small IL were renewed very rapidly compared to small lymphocytes of peripheral lymphoid tissues, although small lymphocytes with lifespans of several weeks were also present in the epithelial sheet. By the use of intestinal perfusion, in vivo, it was estimated that the loss of lymphocytes from intestinal villi into the lumen of the gut was negligible, and it is concluded that the most probable kinetic model for the majority of IL is: B and T lymphoblasts invade the epithelium and undergo mitosis. B lymphoblasts give rise predominantly to plasma cells, and T lymphoblasts give rise to small lymphocytes - probably long-lived - which reenter the circulation.


An electron microscopic study of the closure of the optic fissure in the golden hamster. During early development of the mammalian eye, invagination and differential growth result in the formation of a cleft, the optic fissure, through which the hyaloid artery reaches the interior of the optic cup. Closure of this fissure was studied by electron microscopy in hamster embryos from days 10 through 12 of gestation. Closure occurred only when and where the basal lamina, which invests the entire wall of the optic cup, had disappeared. No morphological evidence was found that indicated a mechanism for the breakdown of the basal lamina lining the fissure, the fusion of surface cells of opposing sides and restoration of the basal lamina along inner and outer margins of the wall after closure. While in previous light microscopic investigations of the developing human eye eversion of the inner layer into the fissure has been reported, an inversion of the outer layer was found in this study. During inversion cells of the outer layer temporarily changed their orientation. While most of these cells remained within the layer when it returned to its normal position, some cells became separated and degenerated. Inversion of the outer layer, breakdown of the basal lamina and degeneration of superfluous cells appear to be necessary events for a normal closure to occur.


The effect of frozen ovarian autografts on compensatory ovulation and steroid production in unilaterally ovariectomized rats. In the present study rats were unilaterally ovariectomized (ULO) and the surgically removed ovary was frozen for 13 days. After allowing the remaining ovary to compensate with respect to number of ova shed, the frozen graft was thawed and transplanted subcutaneously to determine the effect on ovulation number, cycle length, uterine weight, ovarian weight and plasma levels of estradiol-17beta (E2) and progesterone. Rats ULO at 45 days of age, which received an autograft 13 days later, had a decrease in the number of eggs shed as compared to control ULO rats (6.4 +/- 0.8 vs. 11.1 +/- 0.9 eggs, respectively) and a decrease in plasma E2 (14.5 +/- 1.7 VS. 21.0 +/- 1.5 PG/ML, respectively). No differences were observed in progesterone concentration, uterine weight, ovarian weight or cycle length. In contrast, rats ULO at 31 days of age, which received an autograft 13 days later, showed no  differences in comparison to control ULO rats. Castrates which received ovarian autografts developed cycling vaginal smears and had increased E2 (31.9 +/- 4.3 pg/ml) and decreased progesterone (18.3 +/- 1.9 ng/ml) levels. Since ULO animals with autografts shed fewer ova, the present study demonstrates that the amount of ovarian tissue influences ovulation number either by utilization of gonadotropins or by an, as yet, undefined mechanism.


Renal vasculature of the trout demonstrated by scanning electron microscopy, compared with canine glomerular vessels. In order to gain additional information regarding renal circulatory patterns, we have used both ink and resin injections to study the arterial supply to the mesonephric kidney of trout. Arterial injections through the dorsal aorta with ink were made for histological preparations in which the length, termination and relationship of glomerular vessels were examined. Similar injections with methyl methacrylate were made in preparation of corrosion casts to provide us with gross replicas of the aortic branches to the kidney as well as casts of glomerular structure for scanning electron microscopy. The sequence of vessels through which arterial blood passed to the renal corpuscle and ultimately to the uriniferous tubules was traced. Each afferent arteriole was found to terminate in three to six branches which formed anastomosing circuits of capillaries; these vessels reunited at the hilum to form a single efferent arteriole. The efferent arterioles in trun traveled a short distance to peritubular capillary beds and sinusoids. Morphological evidence was found for preglomerular sphincter-like action only. The glomerular vessels were found to be similar to, although less complex than, those of the outer and mid-cortical regions of the dog kidney.


Quantitative analysis of muscle cell changes in compensatory hypertrophy and work-induced hypertrophy. The cytological characteristics of two modes of muscle hypertrophy were studied in the extensor digitorum longus muscle of the rat. Comprensatory hypertrophy (CH) was produced by tenotomy of the tibialis anterior muscle and work-induced hypertrophy (WIH) was produced by forced swimming of the animal. While both methods produced an increase in muscle weight and cell size, these two parameters did not correlate. Morphometric analyses of the hypertrophied muscle cells demonstrated that in CH-muscle there was an increase in mitochondrial volume density, a decrease in myofibrillar volume density and no change in sarcotubular or nuclear volume density. WIH-muscle demonstrated an increase in sarcotubular volume density but no change in mitochondrial, myofibrillar or nuclear volume density. It is concluded that in CH-muscle, the cell volume increase is attributable to mitochondrial volume increase and that there is no increase in the contratile myofibrillar component of the cell. WIH-muscle, on the other hand, has a cell volume increase which is attributable to a proportional increase in these organelles.


The hypothalamic magnocellular neurosecretory system of the guinea pig. III. Ultrastructure of the fetal neural lobe. The ultrastructure of the fetal guinea pig neural lobe was studied from day 40 to day 60 of gestation. Pituitaries were taken every five days and at least four glands from each gestational period were examined. Bundles of nerve fibers had invaded the periphery of the gland on day 40. By day 50 axon profiles were distributed throughout the entire posterior pituitary though pituicyte processes continued to act as a barrier between axons and the perivascular space of capillaries. Neural processes established contact with the capillaries between days 55 and 60. Neurosecretory granules (NSG) were present within a few axons on day 40. The number of axons with NSG and the total quantity of granules increased gradually throughout fetal development. Electron-lucent granules (microvesicles) were observed infrequently until the day of birth. A population of dense-cored vesicles, 70-80 mmu in diameter, was present from day 50 onward; a second population with larger diameters was also present throughout the developmental sequence and these increased from 90-130 mmu in diameter to 170-220 mmu in diameter between days 40 to 60. The presence of neurosecretory granules is discussed in relation to the onset of synthesis and storage of neurohypophysial hormones.


Amino acid levels across normal forearm muscle and splanchnic bed after a protein meal. To characterize further the role of blood cells in amino acid transport, four normal volunteers were asked to ingest 200 g of broiled ground sirloin within a 10-min period. Blood samples from a radial artery, a deep vein draining forearm muscle bed, and a tributary of the hepatic vein were obtained prior to and for 4 hr after the meal and analyzed for various hormones and substrates. At rest, analysis of arterio-deep venous differences across the forearm revealed the blood cell and plasma amino acid compartmentmental contents to be relatively constant except for alanine and glutamine. Whole blood arterio-hepatic venous (A-HV) amino acid differences were not significantly different from zero; however, blood cell A-HV difference analysis revealed a significant release of threonine from the splanchnic bed while plasma A-HV difference analysis revealed modest but significant releases of glutamate and ornithine and uptakes of phenylalanine and histidine. After the ingestion of the meat meal, plasma and blood cell levels of almost all of the measured amino acids increased significantly. Notable exceptions included glycine and alanine, levels of which did not change significantly and glutamine. The arterial blood cell content of the latter amino acid paradoxically decreased while arterial plasma levels increased significantly. Most importantly, large quantities of branched chain amino acids were released from the splanchnic bed and removed by forearm muscle. These data suggest that the blood cells of normal man do actively participate in amino acid transport, and that the magnitude and direction of change induced by the ingestion of a proteins meal varies with the individual amino acid.


Treatment of children with phenylketonuria using a phenylalanine-free protein hydrolysate (Albumaid XP). Albumaid XP, a phenylalanine-free protein hydrolysate, was used for treatment of five phenylketonuric infants born between January, 1970, and September, 1972. The results were compared with those obtained from the five infants most recently treated with Lofenalac in our clinic prior to 1970. Treatment was begun by 2 months of age in all instances. Satisfactory physical growth and mental development were achieved using either Albumaid XP or Lofenalac, and there were no major differences in the outcomes with either treatment. The two protein sources may be used interchangeably for treatment of phenylketonuria.


Neocortex development during severe malnutrition in the rat. Histological methods (Golgi-Cox and Nissl) were used to study the maturation of the large pyramidal cells of layer V of the occipital cortex in malnourished rats (according to the method of Araya et al.). The main alterations were observed in pyramidal cells of cortical alyer V; These showed a decrease of the number and span of dendritic basilar processes. An increase in cell density was also observed in this layer. We assume that malnutrition during this period of development provokes a derangement which disturbs the process of neuron differentiation, with effects that probably are permanent.


Certain metabolic consequences of jejunoileal bypass. Jejunoileal bypass for obesity has been shown to be associated with increased hepatic triglycerides during the period of brisk weight loss. The current report describes certain metabolic changes observed in 29 patients 21 months after bypass. Significant decreases in serum cholesterol, serum triglycerides, blood sugar after a glucose load, and fasting plasma insulin levels were noted. Increased oxalate excretion and occasional episodes of hypomagnesemia occurred. Repeated clinical and laboratory observations by a medical-surgical team offer the best opportunity to evaluate this procedure.


Zinc nutrition in celiac sprue.

Zinc nutrition in celiac sprue. Zinc nutritional status was examined in 10 adult patients with biopsy-proven celiac disease; five of these patients were clinically well on gluten-free diets at the time of study. Plasma zinc and taste acuity were used as indices of zinc nutrition. Depression of plasma zinc and lowered taste discrimination were observed among the untreated patients, and some patients who were otherwise in clinical remission also had impaired zinc nutrition. With confirmation of plasma copper depression in patients with celiac sprue, these observations indicate that trace metal deficiency is another common nutritional complication of adult celiac disease.


Reversal of experimental essential fatty acid deficiency by cutaneous administration of safflower oil. The intriguing observation that cutaneous application of essential fatty acid (EFA)-rich oil corrects the biochemical abnormalities of EFA deficiency was evaluated in EFA-deficient rats. Approximately 185 mg of safflower oil (140 mg of linoleic acid) were applied daily for 15 days to the kin of EFA-deficient rats. Before and after treatment with the safflower oil, the fatty acid patterns of plasma and erythrocyte phospholipid as well as of plasma triglyceride and cholesterol ester fractions were determined. The linoleic and arachidonic acid content of both plasma and erythrocyte phospholipid increased, while the eicosatrienoic acid content of both fractions decreased. The linoleic acid content of plasma triglyceride increased with safflower oil treatment, but little change occurred in the almost undetectable pretreatment levels of arachidonic  and eicosatrienoic acid. In the plasma cholesterol ester fraction, arachidonic acid increased with treatment and eicosatrienoic acid decreased, but the small increase in the linoleic acid content was not statistically significant. Thus, the study confirms the observation that cutaneous application of EFA-rich oils reverses the plasma biochemical manifestation of EFA deficiency. In addition cutaneously applied EFA-rich oils reversed the biochemical  manifestations of EFA deficiency in erythrocytes. Whether or not cutaneous application of such oils will prevent EFA deficiency, however, remains to be proven.


A method for qualitative identification of sugars and semiquantitative determination of lactose content suitable for a variety of foods. A semiquantitative chromatographic technique was developed and standardized using water/chloroform extracts of foods which are spotted onto heat-activated silica gel thin layer chromatographic (TLC) plates, run in butanol/acetic acid/ether/water, developed in acids anisaldehyde, and quantitated planimetrically using Purdy and Truter's formula. Clinically significant amounts of lactose were found in low-calorie sweeteners, breads, yogurt, margarine, penicillin, Gantrisin, and other commonly ingested nondairy substances.


Efficacy of diet and exercise in the reduction of serum cholesterol and triglyceride in free-living adult males. Young males with levels of serum cholesterol or triglyceride in the upper quartile of the distribution for volunteers tested, participated in a program designed to determine the effect of diet and exercise on serum lipids. Dietary modifications involved caloric restriction superimposed on either the National Institutes of Health (NIH) recommendations for type II or IV hyperlipoproteinemia, as appropriate, or superimposed on a fat-controlled regimen in which fat of an unspecified nature was restricted to 30% of total calories. Participants with elevated levels of cholesterol responded significantly better when instructed in the diet meeting NIH criteria, 21% change in cholesterol, than when instructed in a diet controlled in fat, 11% change in cholesterol. For those with elevated levels of triglyceride, the NIH type IV diet was no more effective at the end of 6 months than the diet controlled in fat where caloric restriction was a part of both dietary regimens. The mean change in triglyceride for this group was 32%. Those with elevated levels of both cholesterol and triglyceride were less amenable to change than those with a single hyperlipidemia. For some diagnostic types, the results were suggestive of a beneficial effect of exercise in addition to diet in accelerating or maintaining reductions in serum lipids.


Protein status of the elderly as measured by dietary intake, hair tissue, and serum albumin. The nutritional status of 95 Medicare-age individuals was evaluated by dietary intake, physical condition, and components of urine, blood, and hair roots. Correlations between protein intake and five variables (serum albumin, red blood cell count, percentage of anagen hairs, protein content per anagen hair root, and anagen bulb diameter) selected as indicators of protein nutriture were studied. Deficient protein intake correlated positively with the protein content of anagenic hair roots. The protein content of anagenic hair roots correlated positively with the serum albumin levels. Protein intake did not correlate with serum albumin level. It is likely that with the relative depletion of protein stores there is impaired synthesis of hair root protein before a decrease in the synthesis of serum albumin which serves a more vital function.


Growth, hemoglobin, cholesterol, and blood pressure observed in rats fed common breakfast cereals. Most of the common breakfast cereals tested were unable to support growth or promote health in young rats that consumed these products as their only food. An anemia, accompanied by fatty liver and large concentrations of iron stored in the liver, was observed with cereals having the lowest protein content. Some cereals produced a marked elevation of systolic blood pressure at certain times. Low cholesterol levels were invariably associated with fatty livers, whereas high cholesterol levels seemed to be associated with hypertension at the 45-day period. When only the ready-to-eat cereals were considered, there was a positive correlation between the dietary zinc/copper ratio and the plasma cholesterol concentration.


The carbon pathway for lipogenesis in isolated adipocytes from rat, guinea pig, and human adipose tissue. The synthesis of fatty acids from a variety of labeled substrates by isolated adipocytes of the rat, guinea pig, and human was investigated. The incorporation of radioactive glucose and pyruvate into triglyceride fatty acids was considerably lower in human than either rat or guinea pig adipose tissue. By contrast, the incorporation of palmitate into adipose tissue triglycerides was approximately the same in all three species. End carbon analysis of fatty acids isolated from adipocytes incubated with pyruvate-U-14C indicated that although the synthesis of fatty acids in human adipose tissue was extremely low compared to that of the rat and guinea pig, it represented de novo biosynthesis rather than chain elongation of existing fatty acids. It is suggested that in the human, fatty acids are synthetised de novo primarily in the liver. In adipose tissue, lipogenesis consists essentially of the esterification of fatty acids, obtained from plasma, into triglycerides.


Computer simulation of the effects of errors in birth registration on age-dependent anthropometric methods. In developing countries birth registration is likely to be delayed, leading to official ages which systematically underestimate the true ages. A computer simulation showed that such official ages underestimate the incidence of malnutrition in a community and lead to misclassification of the nutritional status of many subjects. These errors are more marked below than above 2 years of age. Estimation of the mean delay and its addition to the official ages led to improvement of the results. Above 2 years such estimated ages gave acceptable results; below that age the results were still not acceptable. It is suggested that one method of improving age estimates in large scale anthropometric studies in areas where birth records exist might be to carry out a preliminary survey to estimate the"mean delay in registration. This mean dealy would be added to all official ages and results above 2 years would be accepted. Below 2 years the estimated birth date would be used as a starting point from which the true birth date can be obtained by careful questioning of the parents. Anthropometric results referred to the ages so obtained would give better results than those of uncorrected ages or age-independent anthropometric methods.


Family planning in a Chinese-American population. Among 26 American-born women of Chinese ancestry, 43 Chinese immigrant women who had lived in San Francisco longer than 5 years, and 199 who had immigrated within the last 5 years, fewer than 39% practiced contraception. Oral contraception was used by significantly more of the American-born than of the other two categories of women. Condom or foam was relied upon by sizeable percentages of each immigrant group. Eleven percent of each immigrant group, and 13.3% of the American-born women were sterilized. The only users of an intrauterine device were 3.7% of the immunigrants who had lived in the United States longer than 5 years.


The role of Chinese medicine in New York City's Chinatown. 1. This study reports on use patterns of traditional Chinese and Western medical resources in New York City's Chinese community. Extensive data from field-work and interview are presented which provide significant new information concerning the health-care attitudes and problems of this unique community.


Cardiovascular effects of Gardenia florida L. (Gardeniae Fructus) extract. Intravenous injection of Gardeniae Fructus extract in rats significantly lowered the systemic arterial pressure which was related to a decreased cardiac output with decreased stroke volume. Gareniae Fructus extract decreased the myocardial contractility of perfused isolated rat heart. Electrocardiogram revealed evidence of myocardial damage and atrioventricular block after a large dose of the extract.


The effects of acupuncture needling on the evoked responses of brain, spinal cord and muscle in man. The effects of acupuncture (needling at the Stomach Meridian-36) on the somatosensory evoked responses from the brain (SER), from the spinalcord (EESG) and on the evoked electromy o-gram (EEMG) were studied in normal healthy man. Although amplitude of the early component of the SER was variable during the course of acupuncture and among the subjects, the inhibition of amplitude was seen during and after acupuncture needling. Late components of SER and the negative and positive waves of the EESG showed a high variability during the course of needling and among the subjects. The H-wave amplitude and H/M ratio were also variable, but decreased during and after the needling. The M-wave showed no significant changes. These results suggest that acupuncture reduced the excitability of the specific sensory pathway.


Temperature measurements and photoelectric plethysmography in the evaulation of acute and long-term effects of acupuncture upon vasomotor activity of hand skin: a methodological study. Skin temperature measurements and photoelectric plethysomgraphy were used evaluating the changes in vasomotor activity of hand skin induced by acupuncture in 8 normal subjects, 10 patients with a chronic pain syndrome and 3 patients with an acute pain syndrome of one upper extremity. In normal persons acupuncture induced short-term fall in the skin temperature and the amplitude of photoelectric plethysmogram. This was undoubtedly a normal physiological reaction to pain. In cold sick hands with a chronic pain syndrome acupuncture induced warming of the hand skin and prolongation of the propagation time in the photoelectric plethysmogram. In warm sick hands with an acute pain syndrome acupuncture induced equalization of the temperature difference and shortening of the propagation time. It seems possible to evaluate the effects of acupuncture upon vasomotor activity of hand skin with these methods.


D.C. skin conductance variation at acupuncture loci. Skin conductance was measured in 10 subjects with a DC Wheatstone bridge in 10 areas purportedly containing acupuncture loci on the Triple Burner (TB) and Lung (Lu) meridians. When the results were compared to those from anatomically similar locations devoid of acupuncture loci, local conductance variation was found to be significantly different (p less than 0.05) in most acupuncture locus locations.


Acupuncture tonification: adjunct in psychiatric rehabilitation. Our aim was to "tonify" chronic psychiatric patients, i.e., restore their physiological homeostasis and sense of well-being by using standardized acupuncture. In eighteen subjects, eleven diagnosed as schizophrenic, feelings of well-being lasting no longer than three days were obtained in over 60% of the treatments. In more than two-thirds of the cases normalization of blood pressure values tending to 120/80 was evident. Degree of physiological change did not appear to be associated with overall psychological improvement; neither was the number of treatments associated with long-term improvement. For future studies, increased treatment frequency and less rigidly controlled procedures are suggested.


Three essential factors in effective acupunture therapy. Three essential factors for achieving effective therapeutic results utilizing acupuncture are described: (1) Immune/inflammatory reactions are mobilized when any area of the skin is sufficiently stimulated. (2) Peripheral neural stimulation occurs when specific acupuncture loci are mechanically, electrically, chemically, or thermally activated. Precise stimulation of specific loci (i.e. peripheral neural receptors) may modulate central nervous system regulation of specific physiological functions in the body. (3) Psychological support is well known to be an important factor in all healing experiences, and that includes acupuncture therapy. The authors suggest that the most effective application of acupuncture involves sufficient stimulation of properly selected and precisely localized acupuncture loci combined with a dedicated concern for health that is clearly communicated to patients.


Pathologic findings from the national surgical adjuvant breast project. (Protocol no. 4). III. The significance of extranodal extension of axillary metastases. One hundred fifty-eight patients with axillary nodal metastases recovered from radical mastectomy specimens for operable, invasive breast cancer were divided into those in whom such metastases were confined within the node and those in whom one or more nodes manifested extranodal extension. The relationships of these patterns to 33 pathologic and seven clinical features of these cases were investigated by contingency table analysis. Statistically significant associations (p less than .05) between extranodal extension of such metastases and short-term treatment failure, as well as the presence of four or more involved nodes, infiltrating ductal NOS histologic tumor type, stellate tumor border, and nipple involvement, were found. When the metastases were confined to the node there was a significantly greater likelihood that the cancers were either medullary or tubular histologic types. Associations with severe cell reaction and a nuclear grade of 1 were also found, but appeared to reflect the high frequency of medullary carcinomas in this group. The results suggest that evaluation of extranodal extension of axillary nodal metastases in patients with breast cancer may represent an important prognostic discriminant.


Clindamycin-induced pseudomembranous colitis. Report of three cases. Three cases of Clindamycin-induced pseudomembranous colitis are reported. Special attention is focused on histology in the description of the lesions and their recovery in reference with radiologic findings.


Chediak-Higashi syndrome in a black infant. A light and electron microscopic study with special emphasis on erythrophagocytosis. Clinicopathologic observations in the case of a black infant with Chediak-Higashi syndrome are reported. Light and electron microscopic examination of spleen, liver and lymph nodes revealed abnormal large lysosomes as well as marked erythrophagocytosis without hemosiderosis in infiltrating histiocytes and Kupffer cells. In addition, there were abnormal ocular findings. It is suggested that the erythrophagocytosis without hemosiderosis might also be a specific anatomic expression of this disease due to defective lysosomal digestion of phagocytosed erythrocytes.


Congenital hemophagocytic reticulosis.

Congenital hemophagocytic reticulosis. A fatal case of an apparently congenital form of hemophagocytic reticulosis is reported. The onset was manifested by hyperbilirubinemia and hepatosplenomegaly which were present at birth and persisted throughout life. Fever, anemia and pancytopenia developed at 1 month of age and became progressively worse. A splenectomy was performed at the age of 3 months, but the child died one day later with disseminated intravascular coagulation and pulmonary hemorrhage. The literature is reviewed with regard to the relationship of this case to (familial) hemophagocytic reticulosis and malignant histiocytosis (histiocytic medullary reticulosis). It is suggested that congenital hemophagocytic reticulosis, as described here, (familial) hemophagocytic reticulosis in infants, and malignant histiocytosis in adults all represent the same basic disorder with different ages of onset and clinicopathologic manifestations.


Unusual intravascular material in the brain. Autopsy findings in a patient treated with antihemophilic factor concentrates. Widespread vascular occlusion caused by unusual particulate material in the brain of a patient who was intensively treated with antihemophilic factor (AHF) concentrates prior to death is described. The intravascular particles were seen partially or completely occluding both veins and arteries of small caliber in the brain and also to a much lesser extent in other organs. The resultant small focal infarcts were predominantly distributed in the cerebral white matter. The pathogenesis of this apparently unique vascular occlusive phenomenon and its relationship, if any, to the massive AHF concentrate infusion in this patient remain unknown.


Experimental induction of caprylate-dependent albumin antibodies. A normal donor with the caprylate-dependent albumin agglutinins volunteered to receive 50 ml. of 25% caprylate-stabilized human albumin to determine the clinical significance of the antibodies. The donor manifested no clinical sign of a reaction. Samples of blood and urine collected before, during and after administration of albumin were subjected to extensive laboratory investigation. Biochemical, immunologic, hematologic, hemostatic and immunohematologic variables investigated showed only insignificant variations in all blood and urine samples. Results indicated that the infusion of albumin was safe, for the donor showed no sign of a hemolytic, febrile, allergic or anaphylactic transfusion reaction. However, since this is the first and only reported experiment of its kind, it is deemed advisable to exercise caution when administering albumin to patients who have caprylate-dependent albumin agglutinins until sufficient supportive data attesting to the complete safety of this procedure have accumulated.


Critical importance of citrate--blood ratio in platelet aggregation studies. The effects of citrate concentration on adenosinediphosphate-, epinephrine-, collagen-, and ristocetin-induced human platelet aggregation were investigated. Relatively small increments in citrate concentration markedly inhibited platelet aggregation by all three physiologic agents. The inhibitory effect was greatest on epinephrine-induced aggregation, and least on collagen-induced aggregation. Ristocetin-induced aggregation was not affected by excess citrate anticoagulation. These findings indicate the importance of controlling the citrate:blood ratio in clinical platelet aggregation studies and in the assessment of antiplatelet drugs.


Comparison of a direct latex-agglutination technic with the tanned red cell hemagglutination inhibition immunoassay (TRCHII) for semiquantitation of fibrinogen/fibrin degradation products. A new latex-agglutination kit for rapid screening for fibrinogen/fibrin degradation products (FDP/fdp) has been compared with a standard tanned red cell hemagglutination inhibition immunoassay (TRCHII). The latex-agglutination test results agreed with the TRCHII results for 489 of 588 samples (83%). FDP/fdp values were elevated by the latex-agglutination kit when normal by the TRCHII for 79 (13%) samples, and the reverse was true for 20 (3%) samples. Serial dilution of serum sample allowed reliable semiquantitation of FDP/fdp levels compared with TRCHII results (r=less than .001). The latex-agglutination test gave FDP/fdp values of larger than or equal to 10 mug. per ml. for sera from 11 of 13 patients who had acute pulmonary embolism and for only one of 24 normal control samples. The direct latex-agglutination kit for FDP/fdp appears to have appropriate sensitivity to serve as a screening test for acute pulmonary embolism in patients not receiving heparin therapy.


Analysis and comparison of two methods to detect hepatitis B antigen. Counterelectrophoresis (CEP) and reversed passive latex-agglutination (RPLA) technic in relationship to radioimmunoassay. The authors evaluated two methods for detection of hepatitis B surface antigen, reversed passive latex agglutination and counterelectrophoresis, using radioimmunoassay as a control. The RPLA test (Antigen I, Pfizer Inc., Lot no. 403-94301-1) was compared with radioimmunoassay (RIA, Austria) and counterelectrophoresis (CEP) using serum specimens obtained at the Mount Sinai Medical Center, Miami Beach, Florida. Of the 100 selected sera tested as unknowns, 64 were positive by RIA and 36 were negative. The RPLA test yielded results comparable to those of the RIA technic in that the same 64 positives and 36 negatives identified by RIA were obtained with the RPLA test. Of the 64 positive samples obtained with the RIA technic, five yielded negative results with the CEP method. The RPLA test proved to be more sensitive than CEP in this survey.


A previously undescribed gram-negative bacillus causing septicemia and meningitis. This report describes a case of septicemia and meningitis secondary to dog bites by two different dogs on two consecutive days. The case is noteworthy because of the unusual characteristics of the etiologic agent and the inability to place the etiologic agent into any currently defined genus or to identify it by the existing systems of classification. The organism is a small, thin, Gram-negative bacillus after 24 hours of incubation on blood agar; after prolonged incubation, it becomes filamentous. The organism is catalase- and oxidase-positive, hydrolyzes esculin, and forms acid in glucose, xylose, and maltose after 21 days' incubation. The organism does not manifest lysis on sheep blood agar, and does not grow on MacConkey, Salmonella-Shigella, Centrimide, nutrient, or Kligler iron agars. The tests for urea, nitrate reduction, and indol are negative. The unidentified Gram-negative bacillus showed susceptibility to all antimicrobials tested except gentamicin.


Tuberculous meningitis in childhood. Forty-three cases. Forty-three patients in the pediatric age group had tuberculous meningitis. Therapy included the use of adrenocorticosteroids. All four patients who were in stage 1 on admission to the hospital, seven of the 33 in stage 2, and one of the six in stage 3 (coma) recovered without gross neurological sequelas. Eight patients died, and the remaining 23 recovered, with late neurological sequelas. Early diagnosis and appropriate treatment determine the prognosis of tuberculous meningitis.


Factors in the initiation of bicycle-motor vehicle collisions. In this study, 888 injury-producing bicycle-motor vehicle collisions were examined. On the basis of the movements of the vehicles involved, the bicyclist or the bicycle or both was probably responsible for the initiation of more than three fourths of the collisions. Bicyclist age was strongly related to probable responsibility for the collision. Through age 12, nine out of ten bicyclists were probably responsible for the collision; above age 12, probable responsibility decreased in proportion to age; and only 34% of the bicyclists aged 25 years or older were probably responsible. Collisions involving bicyclists in various age groups differed considerably in where, when, and how they occurred. The movements of the vehicles primarily involved in the initiation of the collisions were evaluated in terms of counter-measure planning.


Wide sutures and large fontanels in the newborn. Newborn infants with wide cranial sutures and large anterior fontanels, but having normal head circumferences, were prospectively studied and compared with a group of normal controls. The study group with wide sutures was composed of two different groups--one with good calcification of the calvaria, fairly large anterior fontanels, and no Wormian bones; and another with distinct parietal prominences, very large anterior and posterior fontanels with prolonged patency, poor initial calcification of the calvaria, and Wormian bones. Normal head growth and physical and mental development were observed in all the infants studied.


DDT levels in milk of rural indigent blacks. Human milk samples from low-income blacks residing in rural Mississippi and Arkansas and middle-class whites residing in metropolitan Nashville, Tenn, were analyzed for concentrations of DDT and its metabolites. The mean total DDT concentration (DDE [derivative of DDT]+DDT) of 38 samples from the blacks was 447 parts per billion (ppb); the range was 59 to 1,900 ppb. The mean of the 14 samples from Nashville residents was 75 ppb (range, 15 to 133 ppb). The difference in the DDT concentrations in the two populations indicates that rural low-income blacks are still highly contaminated with pesticides, even though the general use of DDT has been banned. Due to the limited amount of information from the donors, no correlation could be made between the DDT concentration and diet, age of child, home pesticide use, or distance of residence from farming fields.


Cognitive stimulation.

Cognitive stimulation. Cross-sectional studies suggest that the intellectual development of American children is affected by experiences in the first three years of life. Furthermore, Piaget and White have observed and documented direct effects of the environment on the development of infants during the first year of life. Principles derived from animal research and the disappointing results of preschool intervention programs highlight the irreversible nature of early infant-environment interaction. Future programs designed to prevent educational incapacitation among children must concentrate on optimizing the developmental milieu of the child before he is 4 years old. Accomplishing this task is the practical challenge in the field of child development today.


Accidental digitoxin poisoning.

Accidental digitoxin poisoning. A healthy 141/2-month-old child ingested 1.5 mg of digitoxin by accident. Digitoxin was wrongly identified as digoxin, the initial electrocardiogram was misinterpreted, and the vomiting was underestimated as an important symptom of toxicity. Symptoms persisted and the patient was hospitalized. Serial digitoxin levels were obtained and correlated with ECG and clinical course. It appears that serial digitoxin levels can be a useful adjunct in diagnosis, assessment of severity, and indication of recovery from digitoxin poisoning. In each patient, it is imperative that ECG, pharmacologic, and clinical indicators of digitalis toxicity be accurately identified for proper assessment of severity and appropriate management.


Recurrent arterial thrombosis in nephrosis. Recurrent arterial thrombosis without inciting trauma occurred in an 8-year-old boy with the nephrotic syndrome. Thrombosis of the left femoral artery was successfully managed by early thrombectomy and postoperative anticoagulation therapy, but the right leg finally had to be amputated. The development of hypovolemia in the nephrotic child receiving long-term steroid therapy apparently increases the tendency to a hypercoagulable state.


Epidermodysplasia verruciformis.

Epidermodysplasia verruciformis. Epidermodysplasia verruciformis (EV) is characterized by the early onset of extensive, persistent verruca plana that may undergo malignant transformation. Immunologic studies of a case of EV confirmed by electron microscopic identification of the virus disclosed no detectable abnormalities. The importance of this uncommon clinical syndrome lies in its demonstration that benign papovavirus, the etiologic agent of warts, can produce malignant neoplasms in genetically susceptible hosts.


Familial imperforate anus.

Familial imperforate anus. A boy, 2 years 5 months of age, was admitted for examination and was found to be mentally retarded. He had a history of low birth weight, covered anus, and perineal fistula. Investigation revealed ventricular septal defect and persistent left superior vena cava, left upper lobe atelectasis, hand and foot anomalies, agenesis or nonfunctioning right kidney and large left kidney with double pelves and double ureters, and large sigmoid colon. Family history revealed consanguineous parents and a mentally retarded elder sister who had anorectal atresia with introital fistula and perineal ectopic stenotic anus. This family demonstrates two extremes of the same syndrome, most probably inherited as an autosomal-recessive entity.


Bile salts and bioelectric properties of rat jejunum. Addition of conjugated bile salts increased transmural- and transserosal-potential differences of sheets of rat jejunum. Removal of Cl- from buffer solutions minimized the bile-sale induced bioelectric changes. Bile-salt induced doubling of tissue resistance was not explained by an observed increase in net Cl- serosa leads to mucosa flux. Electrical effects were unrelated to concentration and were observed only when bile-salt solutions perfused the jejunal mucosa. The molecular events associated with bile-salt interactions with the plasma membrane affecting ion fluxes may relate to their unique effects on sterol absorption.


Therapy with gastrin antibody in the Zollinger-Ellison syndrome. The therapeutic effectiveness of parenterally administered rabbit antigastrin antibody was evaluated in a patient with the Zollinger-Ellison syndrome who had a fasting serum gastrin level of 3020 pg/ml and a basal gastric acid secretion of 48.9 mEq/hr. Control globulin reduced gastric secretion to 32 mEq/hr. Gastrin antibody reduced it futher to 8.7 mEq/hr. Betazole hydrochloride which was given 75 min after administration of gastrin antibody stimulated acid secretion to 57.2 mEq/hr. One day later basal acid secretion was uninhibited although some antibody activity was present in the patient's serum. The results suggested that gastrin antibody acutely inhibited basal but not betazole-stimulated secretion.