[Inflammatory chronic processes of the central nervous system. Neurosurgical aspects]. A study into the neurosurgical approach to thirty-five patients with increased intracranial pressure due to inflamatory diseases affecting the central nervous system and meninges is reported. The entitites under consideration were found to have similar surgical aspects despite the heterogeneity of etiologic agents. As regards the surgical treatment, two groups of cases were recognized. Group 1 comprises 7 patientes with symptoms of a space-occupying lesion; in these patients craniotomies were performed with good results. Group 2 included the remainder 28 cases with acquired hydrocephalus. In this group differents methods for ventricular drainage were used, but ventriculo-auriculostomy and specially ventriculo-peritoneal shunts proved to give more gratifying results. Chemotherapy was administred when the etiologic agent was disclosed. Corticosteroids were institued to reduce inflammatory reations and cerebral edema. A review of the literature supported the practical classification and surgical techniques employed.


[Ferruginated neurons in cerebral infarcts]. The study of the ferruginated neurons in the analysis of 87 cases of cerebral infarcts is reported. The lesion found in 40,3% of the cases was demonstrared to contain iron and calcium. It was found to be more frequent in older patients and predominantly in the cortical necrotic areas. The minerals were also detected in basophilic granules found outside the cells in the necrotic tissue. There was no correlation with the basic disease, although in 17% of the cases there was an association with sickling of the red blood cells. The role of the mineral content of the nervous tissue in the pathogenesis of the incrustation is discussed. The demonstration of other minerals besides the iron in the cells makes the term "mineralization of neurons" more acceptable.


[Hereditary proximal neurogenic muscular atrophy (Wohlfart-Kugelberg-Welander disease). Electromyographic, anatomo-pathologic and clinical study in 3 brothers]. The cases of three brothers with proximal weakness and muscles atrophies beginning in childhood are reported. Muscles biopsies and electromyographic studies have shown neurogenic pattern of atrophy and a dystrophy-like picture. It is concluded that this histological and eletromyographic picture can occur in pure partial denervation of long standing. The histopathologic study of the spinal cord of one patient revealed degenerative changes and loss of anterior horn ganglion cells. This is the fourth case of Wohlfar-Kugelberg-Welander disease with postmortem examination.


A model for familial trends in oligophrenia. Theories and evidences on etiology of mental retardation are presented. Five cases of mental retardation from a Clinical Genetics Service are reported, as basis for an etiological model on mental retardation, quite operational in genetic counseling and familial orientation.


[Bilateral facial paralysis].

[Bilateral facial paralysis]. A case of bilateral facial paralysis following meningococcal meningitis and herpes simplex infection is reported. The author discusses the differential diagnosis of bilateral facial nerve paralysis which included several diseases and syndromes and concludes by herpetic aetiology.


Cerebral embolism, marantic endocarditis, and cancer. Two subjects with cerebral embolism were found at autopsy to have marantic (nonbacterial thrombotic) endocarditis (NBTE) and an unsuspected carcinoma. A additional 16 subjects with marantic endocarditis and cancer were found on reviewing the autopsy records of 22 subjects with NBTE. Of these 18 subjects with NBTE and cancer, eight developed a stroke during their illness, in five as the initial manifestation of cancer. Although the association of cancer and marantic endocarditis is generally well recognized, cerebral embolism from this source should be more seriously considered as one of the "remote effects" of cancer on the nervous system.


Reduced plasma norepinephrine response to standing in autonomic dysfunction. In five patients having primary autonomic dysfunction with clinical manifestations including postural hypotension, the mean plasma norepinephrine concentrations were significantly lower than those of normal subjects after two and five minutes in the standing position. The mean (+/-SE) increment in the plasma norepinephrine concentration after two minutes standing were 123 +/- 19 pg/ml in the normal subjects and 13 +/- 4 pg/ml (P less than .001) in the patients with primary autonomic dysfunction. After five minutes standing, the mean increment in plasma norepinephrine concentration was 244 +/- 36 pg/ml in the normal subjects and 99 +/- 51 pg/ml (P less than .05) in the patients. There were no statistically significant differences in plasma epinephrine between the two groups.


Symptoms of pheochromocytoma, with particular reference to headache, correlated with catecholamine production. In a series of 27 patients with proved pheochromocytoma, differential analysis of catecholamines in blood, urine, and tumor specimens of 19 patients enabled grouping of subjects into those whose tumors produced predominantly norepinephrine (NE) (11 patients), predominantly epinephrine (E [Two patients]) and approximately equal amounts of both (six patients). Sustained hypertension was more common in the first group and pallor and tremor in the latter two groups, but no distinctive syndrome could be recognized as signifying the secretion of NE or E. Headache was a symptom in 20 of 27 patients and was related to sudden, transient elevation of the blood pressure, rather than sustained hypertension. The variable duration and intensity of the headache in different patients can be explained by the pressor and cranial vasoconstrictor effects of the secreted amines, which respectively enhance and diminish vascular headache.


Shy-Drager syndrome with abnormal respirations and antidiuretic hormone release. A patient with Shy-Drager syndrome exhibited a partial defect in antidiuretic hormone (ADH) release, and cluster breathing, an indication of pontomedullary respiratory center damage, with a normal CO2 response curve. This extends the spectrum of abnormalities associated with the degenerative disease of the central nervous system. The presence of a pontomedullary respiratory pattern without an impaired CO2 response curve suggests that neurons that determine respiratory rhythm function independently from those that function as chemoreceptors.


Drug-induced IgA deficiency in epileptic patients. Serum concentrations of IgA, IgG, and IgM were determined by immunodiffusion technique in 184 epileptic patients and 95 healthy individuals. Twenty-one percent of adult and 42% of children patients receiving anticonvulsants had serum IgA levels below 0.6 mg/ml (the lowest value detected in normal sera). Serum concentrations in non-drug-taking epileptic patients were normal. Deviations in IgG/IgM concentrations were smaller and less consistent. Serum IgA level was determined at intervals before and during phenytoin treatments. A fall in the IgA level occurred in several patients. In two patients, IgA deficiency developed within two to three months of treatment. Low IgA-responders were more frequent among men and children. The IgA anomaly was not specific for any type of epilepsy.


Brain specialization for language does not depend on literacy. Aphasia in focal brain-damaged illiterates is analogous to aphasia in patients who have learned how to read and write, regarding (1) expectancy rate, (2) distribution of clinical types, (3) semiological structure, and (4) score of relevant laboratory variables. The organization of neurological structures whose lesions produce language disturbances seems to be independent from the acquisition of reading and writing skills.


Infantile hemifacial spasm.

Infantile hemifacial spasm. A 6-week-old infant had recurrent contractions of the facial musculature on the left side, which continued throughout early childhood. Surgical exploration at 5 1/2 years of age revealed a ganglioneuroma of the fourth ventricle. Hemifacial spasm (HFS) in infancy and childhood suggests the possibility of serious intracranial pathologic findings.


Properties of non-neurovirulent plaque-forming mutants of Newcaslte disease virus. The mesogenic Hertfordshire (H) strain, a vaccine strain of Newcastle disease virus, represents a heterogeneous virus population differing in physical, chemical, and biological properties. Small (S) and large (L) plaque-forming mutants were isolted from strain H in chick embryo fibroblast cell cultures. Part of the S mutants lacked neurovirulence, with an intracerebral pathogenicity index  for day-old chicks of 0 to 0.46 vs 1.0 to 1.4 for L mutants. S mutants grew only to a very low titer in the brain of day-old chicks and cleared from the brain by the sixth day, whereas L mutants killed the chicks after a 1000-fold titer rise. The S mutants caused a complete cell destruction in fibroblast culture by 12 hours, but they had 10--20 times lower virus yields than the L mutants. The infective titers of S and L mutants grown in allantoic cells were identical, but the infectivity to hemagglutinin ratio was 10 to 50 times lower for S than for L. The thermostability of infectivity and hemagglutinin varied with the different mutants. As for the immunogenicity of the  mutants, the minimum dose of S mutants inducing full protection by subcutaneous inoculation was 10(6) plaque-forming units per chicken, thus being about 100 times less immunogenic than either the L mutants or the parent strain H.


The presence of avian adenoviruses and adeno-associated viruses in healthy chickens. Avian adenoviruses were isolated from 56 of 106 fecal and rectal tissue samples taken from apparently healthy young chickens on 4 farms. Only one isolation was made from the 37 samples from 3- and 4-week-old chicks, while the isolation frequency was 64-100% in groups 5 weeks old and older. The 56 adenovirus isolates were classified into 6 serotypes. Vurses of 3 or 4 types were found on each farm. Avian adeno-associated virus CF antigens were found, using chicken embryos coinfected with an adenovirus helper, in 2 of the 38 adenovirus isolated studied.


Aerosol vaccination against Newcastle disease. I. Studies on particle size. Studies revealed that the majority of particles emitted by three different aerosol generators were in the size ranges of 0.5-1 and 1-3 mum. In general, the smaller the aperture setting, the larger the total number of particles. The difference between the generators in number of particles emitted were not significant enough to produce appreciable difference in antibody titers obtained from vaccinated chickens. Antibody titers were higher in birds vaccinated with the LaSota strain of Newcastle disease virus than in birds vaccinated with the B-1 strain, although protection against challenge was approximately similar. Aerosol challenge was found as effective as intramuscular challenge.


In vitro DNA synthesis in lymphocytes from turkeys vaccinated with LaSota, TC, and inactivated Newcastle disease vaccines. In vitro cultures of peripheral blood lymphocytes from turkeys vaccinated and revaccinated with Newcastle disease (ND) vaccines were stimulated to transformation when exposed to the homologous and heterologous strains of ND virus. The mitogenesis was measured by the uptake of 3H-thymidine into newly synthesized DNA. There was considerable difference in DNA synthesis by lymphocytes drawn 0, 2, 5, and 10 days after vaccination and revaccination with the three vaccines. Stimulation of DNA synthesis, evident as early as the 2nd day, was highest in lymphocytes from turkeys vaccinated or revaccinated with TCND intramuscularly. Stimulation was least in lymphocytes from turkeys vaccinated and revaccinated with LaSota vaccine by aersol. Stimulation was intermediate from an inactivated vaccine given subcutaneously. DNA synthesis was greater with the homologous than with the heterologous strains of NDV. Synthesis was even greater when the same strain was used as a viral suspension in allantoic or cell-culture fluid than the commercial vaccine. The bovine paramyxovirus (PI3) resulted in a minimum DNA synthesis or completely inhibited it. A many-fold (order of magnitude) stimulatory effect was observed when PHA was used as an antigen. The stimulation of DNA synthesis did not parallel the HI antibody response.


Progressive changes in serum proteins and the rheumatoid factor of chickens infected with Mycoplasma synoviae. Sera from controls and chickens infected with Mycoplasma synoviae were examined for serum protein content by cellulose-acetate electrophoresis, and for rheumatoid factor (RF) by a latex-agglutination test at 8, 18, 28, 38, and 48 days postinoculation (DPI). Mean total serum protein concentration was significantly elevated by 8 DPI and rose to much higher concentrations on each subsequent  day of examination. The mean albumin concentration was significantly decreased by 8 DPI, and continued to decline to very low levels at 18 and 28 DPI, after which it began to rise and by 48 DPI did not significantly differ from the controls. The mean alpha-globulin concentrations were significantly elevated on all days of examination. The mean beta- and gamma-globulin concentrations were significantly elevated by 8 DPI and reached maximum levels at 18 DPI but remained elevated throughout the test. The percentage of chickens having RF titers increased on each successive examination day, but only 56% of the chickens had titers at 48 DPI.


Antibody response and resistance of turkeys to Newcastle disease vaccine strain LaSota. Studies were undertaken to determine the influence of repeated revaccination on the immune response in immuno-competent turkeys as measured by humoral antibody and resistance to challenge. Protection was better in turkeys given the LaSota spray vaccine at 4 weeks and 30 days later than in turkeys given one vaccination by spray or intramuscular route or exposed 4 times at 10-day intervals by the aerosol route. The anamnestic response, as measured by the HI tests to revaccination with the same immunogen, was not evident by the 3rd day postrevaccination but was observed on the 7th day. The interval between primary and secondary vaccination was found to be important to a true and optimal anamnestic response. Response was greater, however, in vaccinated turkeys exposed to VVND, a more virulent virus antigenically different from the vaccine strain. Exposure to LaSota vaccine by the intramuscular route gave a poorer HI response than LaSota given by aerosol.


Determination of regional pulmonary mechanics using a scintillation camera. Electrical circuit R-C analogue models that reflect the difference in disease state between normal and diseased subjects, and normal and diseased regions of a diseased lung, were used to evaluate distal and proximal resistances and compliances for lung regions. Experimental values of regional flows and volumes for normal and diseased human lungs were obtained from a noninvasic scintillation camera technique in which the subject breathed Xe133-seeded air. Values of resistance and compliance were obtained with the additional use of an esophageal balloon. Total volumes and flows were measured through spirometry. Regional volumes were determined and regional flows were found through numerical differentiation. In analytical modeling, values of resistances and compliances were chosen so that the computed flow and volume curves corresponded to the actual flow and volume curves. Differences in resistance were an order of magnitude higher for the diseased subjects while compliances were generally several times lower than those for the normal subjects. However, the absolute values do not correlate well with those values generally found in the literature because compliance is usually measured statically and resistance measured during tidal breathing or panting. Since the forced vital capacity maneuver used here is extremely dynamic, there is significant airway collapse which results in functionally higher resistances and lower compliances. This maneuver tends to accentuate the differences between normal and diseased subjects and a subject's normal and diseased lung regions.


Recovery of 61 Salmonella serotypes from artificially contaminated turkey skin. Selenite brilliant-green sulfa enrichment broth containing Tween 80 was streaked to brilliant-green sulfa plates for use in comparing recoverability of 61 different salmonella serotypes from turkey tails artifically contaminated with very low levels of each serotype. Recoverability was 100% with 43 of the serotypes, 80% with eight, 60% with four, and 40% or less with six.


Ethnic variations in psychological performance under altitude stress. Sea-level performance of 120 subjects equally drawn from Gorkha, Madrasi, and Rajput groups was compared with that at an altitude of 4,000 m after 10 months' stay. Alterations in concentration, eye-hand coordination, anxiety, depression, and social interaction were recorded to ascertain ethnic differences in withstanding the altitude stress. Results showed a uniform fall in the scores for eye-hand coordination and social interaction at altitude for the three ethnic groups. However, the effects on concentration, anxiety, and depression were differential for these groups indicating a better toleration of altitude stress by Gorkhas. Climatic similarity between the region of natural habitat of Gorkhas and altitude environment has been suggested to be responsible for their better performance over the other two groups.


Focal hepatic necrosis in turkeys with hemorrhagic enteritis. Disseminated acute focal hepatic coagulation necrosis was present in 9 turkeys submitted from 5 outbreaks of hemorrhagic enteritis. The lesion was unaccompanied by inflammatory cell infiltrate, biliary hyperplasia, or pancreatic necrosis, all of which tentatively distinguish this lesion from that of turkey viral hepatitis. No inclusion bodies were found.


Trying to explain an effect of "per se" hydrostatic pressure on heart rate in fish. Specific effects of "per se" hydrostatic pressure on mean heart rate have been studied on eels (Anguilla anguilla L.), both untreated and treated with atropine and propranolol, and on isolated eel's heart. Because temperature brings, by itself, heart rate modifications in fish, a quantitative study was performed in order to take away the increment of heart rate due to the water warming, which cannot entirely be suppressed during compression. The specific effects of "per se" pressure have been identified as a bradycardia above 24.5 degrees C and as a tachycardia below this temperature. The use of atropine and propranol, which abolish extrinsic heart control, shows that pressure acts both through extrinsic mechanisms of heart control and through a direct action on autonomic cardiac cells. This effect of "per se" pressure on cardiac cells is interpreted according to chemical kinetics laws. The hypothesis that pressure acts at the molecular level, possibly by the means of reversible structure modifications of some molecules, is suggested.


Effects of increased pressures of oxygen and air on short-term memory in mice. The purpose of this study was to determine the effects of increased oxygen tensions on short-term memory in mice following one-trial, passive-avoidance learning. Neither increased oxygen tensions per se nor 6 ATA air had any measurable deleterious effects on retention of the learned task. Interference with memory of the learned task occurred only when the animals were subjected to oxygen-induced convulsions. Oxygen-induced convulsions did not result in permanent brain damage such that the animals were incapable of learning. Oxygen-induced convulsions following a 2-h interval after learning did not result in a retrograde amnesia. It appears that oxygen-induced convulsions interferes with the consolidation process of memory.


Changes in pulmonary volumes with relocation to 1,600 m following acute translocation to 4,300 m. In studies of 12 volunteer subjects, VC and ERV significantly decreased during a 3-d sojourn at 4,300 m while VE, VT, TLC, FRC and RV were elevated. Acid-base parameters showed typical changes associated with translocation to high altitude. Thus, PaO2, PaCO2 and SaO2 were immediately reduced upon translocation to 4,300 m, while the compensatory reduction in arterial HCO3- concentration was delayed temporarily by 24 h; pH, however, remained essentially unchanged throughout the sojourn. Upon relocation to 1,600 m, there was a gradual return to VC, ERV, TLC and RV to prealtitude values. FRC, on the other hand, remained elevated as did VE and VT through the third day of relocation to 1,600 m. PaCO2 and arterial HCO3- concentration showed a slight delay in returning to prealtitude values upon relocation, while the remainder of the acid-base measurements returned to prealtitude values within 24 h. The conclusion drawn from these results indicates a physiological adjustment period as long as 3 d may be required for individuals returning from a 72-h sojourn to high altitude (4,300 m).


Brain lesions in mallard ducklings from parents fed methylmercury. Methylmercury dicyandiamide was fed to mallard ducks at 3 ppm mercury. Mercury accumulated in the eggs to an average of 7.18 and 5.46 ppm on a wet-weight basis in 2 successive years. Mercury in the eggs is believed to have caused brain lesions in the hatched ducklings. Lesions included demyelination, neuron shrink-age, necrosis, and hemorrhage in the meninges overlying the cerebellum. Brains of dead ducklings contained an average of 6.17 and 5.19 ppm mercury on a wet-weight basis in 2 successive years.


Effects of IgY antibody on the development of Marek's disease. The effects of passive immunization with immunoglobulin Y (IgY) on the pathogenesis of Marek's disease (MD) were examined in an experimental line of White Leghorn chickens highly susceptible to MD. Purified IgY with anti-MDV antibody activity, when injected into chicks, delayed the development of MDV viremia and lesions until 9 days postinoculation (PI) with Marek's disease virus (MDV). The blastogenic response of spleen cells to concanavallin-A was depressed at 6 days PI in the birds without passive immunization, whereas it was not totally depressed until 17 days in birds passively immunized with IgY anti-MDV antibody.


Head and neck cooling by air, water, or air plus water in hyperthermia. The effects of air, water, and air plus water head cooling on thermoregulatory responses and human operator performance were studied in nonacclimatized, heat-exposed men. Forty chamber exposures (46 degrees C, 30 mm Hg water vapor pressure) were conducted under noncooled and the aforementioned subconditions of head cooling. Five subjects, exposed for 80 min, were monitored for mean skin and rectal temperatures, heart rate, sweat loss, and compensatory tracking performance. A modified Air Force helmet shell provided facial air ventilation (24 degrees C) at 8 cfm. Eight interconnected neoprene modules fastened beneath a helmet linear provided water cooling (20 degrees C at 0.9 l/min). Tracking performances was unchanged across conditions. Elevation of rectal temperature and heart rate, sweat loss, and Physiological Index of Strain were significantly reduced by each condition of head cooling. Air is as effective as water as a cooling agent. Air ventilation acts synergistically with water cooling in reducing physiological strain. Relative merits of each approach to head cooling, in an operational context, are discussed.


Clinical, cultural, and serologic observations of avian mycoplasmosis in two chicken breeder flocks. Two chicken breeding flocks from different breeding lines were studied serologically and culturally for Mycoplasma gallisepticum (MG) throughout their growing and laying period. Infection was proven by successful isolation of MG from both breeders and progeny originating from these two flocks. Observations of these flocks which were serologically and culturally negative for Mycoplasma synoviae (MS) further disclosed that: 1) negative plate tests of large numbers of day-old progeny may sometimes be found in flocks known to be infected with MG; 2) it may be very difficult to isolate MG consistently from some infected flocks; 3) overgrowth of M. gallinarum may interfere with successful cultivation of MG; 4) a persistent breeder flock reactor rate of greater than 10-20% but less than 80-100% for a 4-to-12-week period is a strong indication of MG infection despite weak or negative MG hemagglutination-inhibition (HI) test results; and 5) antibodies for all strains of MG may not react equally to the standard USDA MG-HI antigen.


Vestibular habituation in flightcrew.

Vestibular habituation in flightcrew. Vestibular habituation is a general reaction to any repetitive sensory stimulation. It can be characterized by four main features: acquisition, retention, loss or dishabituation, and transfer. This study concerns three groups of subjects: The first group consists of a) 27 pilots at present serving in the French Air Force, b) 12 pilots at present serving in the major civil airlines, c) 8 navigators, radio-navigators, and crew mechanics, some of whom are flying club pilots, and d) 3 professional pilots trained in flying clubs. All of these subjects had more than 2000 h flying time. They were from 27 to 50 years old. The second group consists of airline stewards. The third group consists of trainee pilots still in flying school. All of these subjects were examined for their suitability, in particular undergoing a damped swing test. The first oscillation was in an anticlockwise direction and the damping extended over 20 periods. The following parametre was measured: the ratio of total left nystagmus frequency to total right nystagmus frequency. In "normal" control subjects the ratio is greater than 1. The results were: The first group: In 41 out of 50 subjects, the ratio of left tremors frequency to right tremors frequency was less than or approximately equal to 1. In the second group: The results showed no significant differences in comparison with a control group of subjects. In the third group: Zero flying time--the results were identical with those of control subjects; 40 h flying time--the ratio approached 1; 100 h flying time--the ratio was less than 1. Vestibular habituation, that is inversion of the preponderance of the total number of left tremors over the total number of right tremors, was observed in the technical flightcrew. The appearance of this inversion during the pilots' training was studied and its retention tested. This test for showing vestibular habituation may be of use for monitoring the function of equilibrium and the development of habituation during flight training. In this report, we shall first review the definition and characteristics of vestibular habituation, and the main body of recent work on this phenomenon in flightcrew. Our own findings will be then presented.


Prolonged visual loss and bradycardia following deceleration from +6 gz acceleration: a case report. Visual blackout during high GZ acceleration is not an unusual phenomenon. Bradycardia is often seen following similar acceleration exposure. An instance of prolonged visual loss associated with bradycardia following a +6 GZ acceleration is described. Possible mechanisms are proposed, and significance in the study of high acceleration is discussed.


Cell-mediated and humoral immune response of chickens to Mycoplasma synoviae. The leukocyte migration-inhibition test was employed to demonstrate the presence of cell-mediated immunity and to ascertain its relation to immunoglobulin production in Mycoplasma synoviae infection in chickens. With peripheral leukocytes and a preparation of M. synoviae used as antigen, good discrimination was obtained between naturally or experimentally infected birds and uninfected control birds. Only the infected groups showed significant inhibition. Positive migration inhibition values developed in the second week of infection, often before the appearance of hemagglutination-inhibition titers, and continued to accompany the production of immunoglobulins with some degree of correlation for at least 6 or 12 months.


[Injection methods for the demonstration of the coronary arterial vasculature (author's transl)]. Four different methods for the demonstration of the coronary arterial vasculature are examined. Among the techniques studied corrosion casts (epoxid- and acrylic resin) permit the best qualitative and quantitative evaluation of superficial and deep arteries and arterioles. Down to the smallest infusible vessels of 15-25 mum there is practically no shrinkage. X-ray arteriography with an aqueous solution of barium sulphate is less suitable because X-rays allow no satisfactory stereoscopic view. The demonstration of arterioles and collaterals is limited to vessels larger than 50 mum because of the low resolution of the X-ray tube. Silicone rubber does not only fill the arteries, but also the capillary bed and the venous system. Therefore deeper parts of the vasculature can only be studied after slicing the heart. The substantial shrinkage of the material makes quantitative measurements difficult.


The effect of isolation on myocardial properties. Denervation deprives the heart of its normal adrenergic and cholinergic control via the sympathetic and parasympathetic pathways. In a heart which is blood supplied by a donor animal of the same species, normal contractility is maintained, probably by blood borne catecholamines or possibly by unknown inotropic agents of the donor. A heart receiving blood oxygenated by isolated lungs is in a state of failure. Substitution of blood by a cell and protein free solution diminishes oxygen availability in cardiac muscle, both in the perfused and bathed preparation. In the unphysiological environment, myocardial cells lose K+ and gain Na+. Under best possible conditions of oxygen supply but in a later stage of perfusion, contractility during rhythmical stimulation is depressed more at lower than at higher rates. Frequency potentiation and the inotropic effectiveness of noradrenaline is more pronounced in vitro than in situ. In excised papillary muscles and ventricular and atrial strips, the disarrangement and a more or less severe lesion of individual fibres accelerates the decay in mechanical performance. The role of endogenous catecholamines for the maintenance of normal contractility in situ and in vitro is still a matter of discussion.


The slow membrane channel as the predominant mediator of the excitation process of the sinoatrial pacemaker cell. The slow upstroke velocity of the action potential of primary pacemaker cells of the sinoatrial node suggests the slow membrane channel to be involved in the excitation process of these cells. In order to prove this the effect of promotors and inhibitors of the slow membrane channel upon the excitation process of the isolated sinoatrial node of rabbits was studied. 1. The action potentials of primary pacemaker cells had an upstroke velocity of 1.7 +/- 1.1 V/sec and an overshoot of 8.1 +/- 4.6 mV with a threshold potential of -40.1 +/- 4.5 mV. A decrease of the extracellular Ca concentration from 2 mM to 0.2 mM led to reduction of upstroke velocity and overshoot whereas an increase from 2 mM to 4 mM augmented both parameters. But the inward current is not only carried by Ca ions but by Na ions as well, since Na withdrawal diminished upstroke velocity and overshoot. 2. The promotors of the slow inward current, isoproterenol and caffeine, produced a significant increase of upstroke velocity and overshoot. On the other hand, verapamil (1 mg/1) and D 600 (0.4 MG/1) completely blocked the excitation process within 20-25 min. The same effect could be produced by the bivalent cations Ni (1 mM), Co (1 mM), and Mn (1 mM). These organic and inorganic inhibitors exerted their blocking effect without significant changes of the maximal diastolic potential and the threshold potential. 3. In the continued presence of Ni, Co and Mn ions their inhibitory effect could be neutralized nearly completely by isoproterenol (2.5 mg/1). But excess Ca (6 mM) increased the upstroke velocity only to a small degree. In contrast to the findings in the ventricular myocardium the blocking effect of verapamil and D 600 could be overcome neither by isoproterenol nor by excess Ca. The excitation process in the sinotrial node is mediated solely by the slow membrane channel. It allows the influx of both Ca and Na ions which act as charge carrier of the slow inward current. The fact, that the inhibitory effect of verapamil and D 600 cannot be neutralized by catecholamines or excess Ca seems to indicate that some properties of the slow membrane channel are not exactly identical in sinotrial pacemaker cells and in the ventricular myocardium.


Acetylation of nuclear proteins in the isolated perfused rat heart. Female rat hearts were maintained by retrograde perfusion under a hydrostatic pressure of 75 cm H2O. The perfused heart had a coronary flow of 8-9 ml/min and a heart rate of 220-240 beats/min. Recirculation of [3H]acetate (2 muCi/ml perfusate) for 20 min was sufficient to label nuclear proteins. Total nuclear proteins were separated into three major classes: (1) 0.14 M NaCl soluble nucleoplasmic proteins, (2) nucleohistones and (3) nonhistone residual proteins. Approximately 88-90% of the (3H)acetate incorporated was found in the nucleohistone fraction. Polyacrylamide-urea gel electrophoresis of the histones indicated that fraction f1 was not acetylated while f3 and f2al were highly acetylated, containing 75% of the total histone radioactivity. Fraction f2b + f2a2 was moderately acetylated contributing 20-25% of the radioactivity. Nucleohistones isolated from myocardial cells showed the same percentage distribution of (3H)acetate in the histone fractions as the whole heart. Acid hydrolysis followed by steam distillation released more than 95% of the acetyl groups from the two major nucleoproteins. These data suggest that the isolated perfused heart may provide a model system to study covalent modification of nucleoproteins under controlled physiological and biochemical conditions.


Transmural differences in myocardial blood flow and in coronary dilatory capacity in hemodiluted conscious dogs. In 16 conscious resting dogs regional myocardial blood flow and the local coronary dilatory capacity were studied with the particle distribution technique during isovolemic hemodilution (hct = 13%). Postischemic peak coronary hyperemia following release of temporary circumflex coronary artery occlusion was used for quantification of regional coronary dilatory capacity. In hemodilution (arterial blood oxygen content less than one third of normal) left ventricular blood flow (LVBF) was 460 +/- 36 ml/100 g - min, subendocardial/subepicardial flow amounted to 1.3 +/- 0.1. During postischemic peak hyperemia LVBF increased by 33% up to 606 +/- 63 ml/100 g - min. This 33% increase in LVBF was distributed mainly to the subepicardial layer, while in the subendocardial layer there was no significant flow increase. It is concluded that the increase in heart rate and systolic coronary vascular compression in addition to the lowered arterial oxygen content lead to exhaustion of the dilatory reserve in the subendocardium during hemodilution. Therefore the remaining overall dilatory capacity is without functional significance.


Hemorrhagic shock with fixed hypotension and with spontaneous recovery of blood pressure. A comparison of two shock models. In 26 dogs anesthetized with a barbiturate peripheral blood flow, O2 consumption and acid-base balance have been studied in two kinds of hemorrhagic shock: 1. Hemorrhagic shock with fixed hypotension (hypotensive shock, n = 12) 2. Hemorrhagic shock with spontaneously recovering arterial blood pressure (normotensive shock, n = 14). In both groups the same amount of blood is withdrawn and stored in a reservoir (31-32 ml/kg) to reduce arterial pressure to 40 mm Hg. In hypotensive shock there is a continuous outflow of blood into the reservoir in order to maintain an arterial pressure of 40 mm Hg. After 1 1/2 hours this shift of blood reverses itself spontaneously. In normotensive shock the arterial pressure is allowed to increase after the initial withdrawal of blood. 1 1/2 hours later it reaches a peak of 93 mm Hg after which it starts declining again. The duration of oligemia which the animals control themselves is nearly identical in both groups (4 hours). Both kinds of hemorrhagic shock have a mortality rate of 80%. The survival time is shorter (p less than 0.01) in hypotensive (3 hours) than in normotensive shock (7 1/2 hours). In both kinds of shock heart rate increases to more than 200 beats/min. However, in hypotensive shock it decreases in the late stage of hypovolemia, whereas the increase is continuous in normotensive shock. Cardiac output is significantly higher in the normotensive animals nearly throughout the entire hypovolemic phase although the initial decrease is the same in both groups (71%). Also a greater increase in total peripheral resistance occurs in these animals. The increased cardiac output and total peripheral resistance. A "centralization" of the circulation is also observed in this kind of shock as is made evident by the changes in the relationship between cardiac output and carotid blood flow. Hyperventilation occurs in both kinds of shock. In hypotensive shock respiratory rate decreases at the end of the oligemic phase possibly due to a smaller cerebral blood flow.


An operated case of Holt-Oram syndrome with autosomal dominant inheritance. This report is concerned with a patient successfully operated for Holt-Oram syndrome. The disorder is inherited dominantly with complete penetrance and variable expressivity. It is pointed out that in cases of congenital heart disease familial cumulation must be borne in mind which can easily be verified by pedigree investigation. After demonstrating autosomal dominant inheritance, suitable inferences must be drawn for genetic counseling. Attention is drawn to the heart-surgical significance of the rhythm disorders so often associated with the syndrome.


Effect of high doses of nicotine in pigs. I. Changes of the electrocardiogram. Pigs in which venous catheters were positioned for long-term use were injected i.v. with high doses of nicotine in physiol. saline. The LD50 was 2.656 mg/kg body weight. Clinical symptoms were mainly: forced respiration, muscular tremor to tetanoid spasms, cyanosis of the skin, salivation and sometimes vomiting. The degree and duration of symptoms were dose-dependent. Ecg changes in anaesthesized pigs following intravenous nicotine injections of 0.126 mg/kg and 0.378 mg/kg at 15 minutes' interval were immediately commencing disturbances of the heart rate in form of bradycardia and asystolia. After 5 sec we observed extrasystoles, tachycardia, sino-auricular block and AV-block of first and second degree as well as a number of T- and P-changes. Changes of the ecg were observed generally for 10 to 15 min, however, the T-wave remained sometimes negative or biphasic-preterminal negative for some hours.


[Potassium-dependent modification of the lidocaine effect: an experimental investigation (author's transl)]. Lidocaine was supplied to 10 cats by 2 comparative infusions of 7.5 mg/kg respectively. Once the drug was dissolved in a physiological and the other time in a K-Mg-concentrated electrolyte solution. The sequence of both infusions alternated. Serum potassium remained constant during infusion of the physiological electrolyte solution, but increased by about 1 mEqu/1 under K-concentrated solution. Lidocaine caused an enhancement of ventricular fibrillation threshold to an absolutely identical degree in both groups. Increase in cardiac output and stroke volume and decrease of sinus rate was significant in both groups, but more pronounced under K-Mg concentrated solution. Mean arterial pressure, peripheral vascular resistance, PQ, QRS, and QT interval remained constant on the whole. We deduce from these results for antiarrhythmic therapy on normokalemic patients, that the addition of potassium and magnesium to lidocaine solution does not enhance its antifibrillatory effect. This statement is valid for doses up to 20 mEqu/h of magnesium and 40 mEqu/h of potassium.


[The calcium metabolism of myocardial mitochondria and sarcoplasmic reticulum in experimental potassium deficiency (author's transl)]. Mechanical Parameters of the whole, Langendorff-perfused cat heart and of isolated right ventricular papillary muscles are depressed in chronic potassium deficiency. 45Ca binding of sarcoplasmic reticulum (SR) was found to be diminished and correlated with a reduced contractility of the perfused hearts. 45Ca uptake of sarcoplasmic reticulum isolated from potassium deficient hearts was also reduced. The mitrochondrial 45Ca binding and endogenous Ca concentration were increased and there was a positive correlation between these two parameters. The data suggest that a reduced SR Ca binding plays a role in the depression of myocardial contractility in chronic potassium deficiency. Increased mitochondrial 45Ca binding in the presence of reduced 45Ca binding and uptake of sarcoplasmic reticulum suggests the possibility that mitochondria are an additional myocardial calcium pool in chronic potassium deficiency.


[The significance of the half axial projection in coronary angiography (author's transl)]. The proximal segments of the left coronary artery are foreshortended in the usual projections. By additional cranio-caudal (half axial) projections the X-ray beam can be directed perpendicular to these segments. In some patients lesions especially of the left main coronary artery or the proximal LAD can be seen or accurately evaluated only in the half axial projection, as demonstrated by examples. The clinical implications are discussed.


Polymorphism of esterase-10 in Mus musculus. An esterase, esterase-10, in the house mouse, Mus musculus, is specific for esters of 4-methylumbelliferone and exhibits a polymorphism detectable by electrophoresis. Fifteen inbred strains and two outbred strains have been examined for this polymorphism, and two phenotypes, ES-10A and ES-10B, have been observed. Each phenotype manifests itself as a single band of enzyme activity, but under the electrophoretic conditions used the ES-10A phenotype has less anodal electrophoretic mobility than the ES-10B phenotype. In F1 hybrids (C3H/He/LacxC57BL/Gr) a third phenotype was observed, ES-10AB, consisting of three bands of enzyme activity, two of which correspond to the parental forms and the third with intermediate mobility. The triple-band pattern in the F1 hybrids indicates that esterase-10 is a dimeric enzyme protein.


Hemoglobin polymorphism in the encinal mouse, Peromyscus pectoralis. Horizontal starch gel electrophoresis revealed five hemoglobin phenotypes in natural populations of the encinal mouse, Peromyscus pectoralis, from northeastern Mexico. Populations of the encinal mouse from Texas, Oklahoma, and northwestern and north central Mexico were monomorphic for multiple-band phenotypes. Analysis of the hemoglobin polymorphism indicates that two loci control this variation.


Genetics of lucilin, a storage protein from the sheep blowfly, Lucilia cuprina (Calliphoridae). Lucilin, the main storage protein of larval fat body and hemolymph in the sheep blowfly, Lucilia cuprina, has been isolated as a series of trimers composed of subunits of 83,000 +/- 5%, daltons. Extensive electrophoretically detectable polymorphism of lucilin subunit patterns occurs in wild and laboratory populations of Lucilia; from four to nine bands are seen in any one individual. Evidence from genetic, electrophoretic, immunological, and structural studies suggests the existence of a series of 12 or more closely related structural loci (designated Luc-1 to Luc-12) which may have arisen through gene duplication. Codominant allelic variation has been found at several of these loci. Luc-1 and Luc-3, and probably the other structural loci of the series, are located on chromosome 2.


Gene action in fish of tetraploid origin. III. Ribosomal DNA amount in cyprinid fish. Phylogenetically diploid and tetraploid cyprinid fish species have cells of very similar volumes and protein contents. This finding has prompted us to postulate a regulatory system established during the evolution of the tetraploids leading to a diploid state of genic expression. It was proposed that this might be accounted for by a selective loss of ribosomal genes. RNA-DNA hybridization experiments, however, reveal a clear-cut 1:2 relationship of ribosomal DNA amounts between the diploid and the tetraploid species.


Polymorphism of transferrin in carp (Cyprinus carpio L.): genetic determination, isolation, and partial characterization. Seven transferrin variants (A,B,C,D,E,F, and G) have been found in carp sera (Cyprinus carpio L.). Genetic analysis involves five variants and agrees with the hypothesis of simple codominant autosomal inheritance at one transferrin (Tf) locus in spite of the fact that the carp is a tetraploid in relation to other species of the same family. Carp populations from three regions were studied which differed in gene frequencies. Individual populations were in Hardy-Weinberg equilibrium. The polymorphism of carp transferrins can be used for the identification of offspring of single parent pairs, stocked in one pond. Transferrins have been isolated and characterized. Homozygous phenotypes comprised four iron-binding components differing in electrophoretic mobility. This heterogeneity is not caused by sialic acid, which is absent. Amino acid composition, content of hexoses (1 mole/mole of protein) and hexosamines (1 mole/mole of protein), molecualr weight (70,000), and the isoelectric point (5.0) have been determined. No N-terminal amino acid could be detected.


Genetic studies of murine catalase: regulation of multiple molecular forms of kidney catalase. Starch gel electrophoresis of kidney catalase in inbred strains C3H and C57BL/6, their F1 hybrid, and first and second backcross generations demonstrated that single-component (type A) v. multiple-component (type B) electrophoretic patterns are controlled by a single locus. The type A electrophoretic pattern is dominant. Twenty-five inbred strains of mice were classified according to their kidney catalase electrophoretic pattern. The data indicate that the segregating genetic factor determines a specific substance in the type A kidney which affects the electrophoretic mobility of catalase. A comparison of the F1 hybrid enzyme with a 1:1 mixture of C3H and C57BL/6 enzyme showed that the alteration of electrophoretic mobility is the result of posttranslational modification of the catalase molecule. An association of kidney catalase electrophoretic pattern and the H-2kappa haplotype indicates that the locus controlling the electrophoretic pattern is most likely located on chromosome 17 in close proximity to the H-2 complex.


Structural differences between albumin A and albumin C of the house mouse, Mus musculus. Two albumins, albumin A from C3H mice and albumin C isolated from descendents of the wild mice in which the variant was first uncovered, were found to differ in their electrophoretic properties. Albumin C was shown to bind two more H+ ions than albumin A at pH 5.4. Peptide mapping after trypsin digestion revealed that albumin C had three peptides (TP-C1, TP-C2, and TP-C3) which were missing in albumin A. The latter likewise had a peptide (TP-A1) which was not found in albumin C. An amino acid analysis of the variant peptides suggests that TP-A1 had been split into TP-C1 and TP-C2 on digestion with trypsin, because a glutamic acid in TP-A1 was replaced by a lysine. This change would also appropriately alter the electrophoretic properties of albumin C. No obvious counterpart was discovered for TP-C3 of albumin C in albumin A.


Alcohol dehydrogenase of Biomphalaria glabrata (Molusca: Pulmonata): polymorphism, genetic analysis, and interspecific variations. Alcohol dehydrogenase of Biomphalaria glabrata has been characterized by electrophoresis, substrate specificities, and other physiochemical means. It exists as a multiple molecular form possessing a minimum number of three bands in ovotestis, five in digestive gland, and six in albumen gland. Each organ shows characteristic electrophoretic forms which differ in substrate specificities and the response to the organomercurial inhibitor p-hydroxymercuribenzoate. Mercaptoethanol treatment has no effect on any electrophoretic form. Genetic analyses of the electrophoretic variants show that three different loci are responsible for the synthesis of the various electrophoretic forms observed in this species. Different species vary in their electrophoretic patterns. A possible role of alcohol dehydrogenase isozymes in the phylogenetic relationship among three species, B. glabrata, B. tenagophila, and B. straminea, has been discussed.


Dissociation-recombination of intergenic sunflower alcohol dehydrogenase isozymes and relative isozyme activities. Two unlinked genes, Adh1 and Adh2, control of the production of alcohol dehydrogenase (ADH) in seeds of the animal sunflower (Helianthus annuus). Each gene is polymorphic, having F and S alleles. Starch gel electrophoretic zymograms of the four possible double homozygotes have three bands, representing two homodimers and an intermediately migrating intergenic isozyme. Zymograms of double heterozygotes consist of nine bands produced by ten isozymes: six intragenics and four intergenics, two of which are coincident. Results of dissociation-recombination (D-R) experiments are reported which demonstrate the subunit composition of the intergenic isozymes, thus supporting the relationships suggested by genetic studies. Densitometric tracings of the zymogram of a cleared gel and measurements of activities of homodimer isozymes eluted from gels follwoing D-R of an intergenic isozyme showed that the Adh2 isozymes were more that twice as active as those of Adh1. Measurements of activities of crude extracts from the four possible double homozygous genotypes indicated that the seeds of the genotype Adh1F/Adh2F, Adh2S/Adh2S produced more activity than the other three. This genotype is the most common one found in wild and cultivated stocks. Isozymes eluted following electrophoresis of the same extracts had averages of 19%, 70%, and 11% of total activity contributed by the Adh1, Adh2, and intergeneic isozymes, respectively. A simple but efficient method of isozyme elution from starch gels is described which resulted in nearly full expected recovery (approximately 46%) of the ADH activity in the applied sample.


The quantitative analysis of ligand binding and initial-rate data for allosteric and other complex enzyme mechanisms. 1. The eight methods for plotting enzyme kinetic data are classified and analysed, and it is shown how, in each case, it is only possible to obtain quantitative data on the coefficients of the lowest- and highest-degree terms in the rate equation. 2. The combinations of coefficients that are accessible experimentally from limiting slopes and intercepts at both low and high substrate concentration are stated for all the graphical methods and the precise effects of these on curve shape in different spaces is discussed. 3. Ambiguities arising in the analysis of complex curves and certain special features are also investigated. 4. Four special ordering functions are defined and investigated and it is shown how knowledge of these allows a complete description of all possible complex curve shapes.


Purification and properties of pyruvate kinase from the hepatopancreas of Carcinus maenas. Pyruvatekinase from the hepatopancreas of the common shore crab, Carcinus maenas, was purified to a specific activity of 240 units/mg of protein in the assay conditions described. 2. In one method of purification the enzymic activity could be resolved into two fractions after chromatography on DEAE-cellulose. Fructose 1, 6-diphosphate was able to effect the conversion of one form (peak 1) into the second (peak 2). 3. In the presence of a saturating concentration of fructose 1, 6-diphosphate both forms of the enzyme were kinetically similar. 4. Polyacrylamide-gel electrophoresis of the enzyme 1 day after preparation showed a single protein band. On storage at least three protein bands became visible, all of which were associated with pyruvate kinase activity. 5. Chromatography of the enzyme on Sephadex G-200 indicated a mol.wt. of 247000, but in the presence of fructose 1, 6-diphosphate the elution volume of the enzyme increased corresponding to a mol.wt. of 193000. 6 Dissociation of the enzyme in sodium dodecyl sulphate and 2-mercaptoethanol followed by polyacrylamide-gel electrophoresis produced one major protein band with a mol.wt. of 55000.


Quantitative determination of N-terminal amino acids of peptides and proteins with cobalt(III) chelates. Quantitative N-terminal peptide-bond hydrolysis with the cis-beta-hydroxyaquo(triethylenetetramine) cobal (III) ion, i.e. beta-[Co(trien)(OH)(OH2)]2+, is reported. The method has been demonstrated with 20 small peptides, a hexapeptide, bradykinin, insulin A chain (oxidized), glucagon and insulin. The procedure involves no acidic hydrolysis step and thus no destruction of labile amino acids.


High-angle electron diffraction of frozen hydrated collagen. By using the techniques developed by Taylor et al. [(1975) J. Mol. Biol. 92, 165-167] (freezing of the hydrated specimen before its insertion into the electron microscope and keeping it frozen throughout the diffraction experiment), it was possible to obtain a high-angle electron-diffraction pattern from collagen fibrils. This pattern is in good agreement with that obtained by high-angle X-ray diffraction. Electron diffraction will be very useful to study collagen, because the diffraction pattern from a carefully selected area of one fibril is now feasible.


The N-terminal amino acid sequence of plastocyanin from Stellaria media L. An exercise to establish criteria for the identification of residues from a sequenator. The N-terminal amino acid sequence of plastocyanin from Stellaria media L. (chickweed) has been determined by means of an automatic sequencer. Amino acid derivatives obtained during the degradation were identified by a combination of t.l.c., g.l.c. and regeneration of the parent amino acid. The analytical results are presented for each sample, and the criteria used to establish the amino acid sequence are discussed.


A phospholipid-deacylating system of bacteria active in a frozen medium. A phosphatidylcholine-deacylating system present in a Butyrivibrio species (probably fibrisolvens) shows appreciable activity at low temperatures with a maximum hydrolysis rate at--10 degrees C. 2. The rate at--10 degrees C is higher than at 39 degrees C unless the system at the latter temperature is stimulated by adding oleic acid or sodium dodecyl sulphate. 3. The low-temperature phospholipase activity has an absolute requirement for thiol reagents, e.g. cysteine, dithiothreitol or mercaptoethanol. 4. Ca2+, Mg2+ and Mn2+ stimulate the activity up to 10 mM, but EDTA inhibits; higher concentrations of Ca2+ also inhibit. 5. The enhancement of activity at low temperatures appears not to be associated with a crystalline change in the hydrated phospholipid substrate, but depends on the formation of a solid phase in the incubation medium which brings the substrate and bacterial cells into juxtaposition or causes fusion.


Isolation, composition and reactivity of the neutral glycoproteins from human meconiums with specificities of the ABO and Lewis systems. Blood-group-specific A1, B, AB, H and Lea neutral glycoproteins were isolated from suitable pools of human normal meconiums by a preliminary fractionation with a cationic detergent at pH5 and 9 (borate), followed by ion-exchange and gel chromatography. The ABH materials have sedimentation coefficients of about 10S-11S, whereas the Lea preparation, not strictly homogeneous, shows a coefficient of 7S. From the detailed analytical data collected, the following relations are deduced between these various substances; they all possess a common peptide core; there are stable ratios of N-acetylglucosamine/N-acetylgalactosamine in the B, H and Lea materials and of N-acetylglucosamine/galactose in A, H and Lea materials, from which the numbers of A and B determinants are estimated. In the ABH substances, the ratio of glucosamine to the sum of threonine and serine is stable. Presumably because of genetic factors, the amount of fucose varies among the different glycoproteins, but it is always definitely lower than in the average cyst substances. Various serological tests and precipitin methods were used to measure the potency, purity and integrity of the preparations, including comparisons between A1 and A2 substances from this source. The Leb activity did not appear as high as it is in glycoproteins from adults and a possible interpretation would be the immature Lewis system as observed on erythrocytes; this could explain their very strong inhibiting power towards iso-agglutinins. This family of substances with various specificities has common features with that prepared from ovarian cysts, but differs clearly on some points.


Carbohydrate composition of lymphocyte plasma membrane from pig mesenteric lymph node. Pig lymphocyte plasma membrane isolated from mesenteric lymph node contained 69 mug of carbohydrate/mg dry wt., which was made up of neutral sugar, amino sugar and sialic acid in the molar proportions 5:1.7:1. The neutral sugar comprised fucose, ribose, mannose, glucose, galactose and inositol (molar proportions 2:9:11:15:26:1), and the amino sugar glucosamine and galactosamine (molar ratio 2:1). The ribose was most probably derived from RNA. All of the fucose and mannose and almost all of the glucosamine were associated with the membrane protein whereas the membrane lipid contained all of the inositol. The remaining sugars were distributed in various ratios between the protein and lipid fractions.


Isolation, properties and amino acid sequences of three neurotoxins from the venom of a sea snake, Aipysurus laevis. Aipysurus laevis venom was chromatographed on CM-cellulose and Bio-Rex 70 columns. Three neurotoxic components, toxins Aipysurus laevis a, b and c, were isolated. The toxins a, b and c corresponded to 22, 33 and 21% respectively of the proteins in the original venom, and accounted for almost all the lethal activity of the venom. The three toxins a, b and c were monodisperse on disc electrophoresis at pH4; toxins a and b moved at the same velocity and c a little faster. They were monodisperse also on sodium dodecyl sulphate-polyacrylamide-disc-gel electrophoresis, giving a molecular weight of 7600. The molecular weight of toxin b estimated by gel filtration was 7000. The amino acid sequence analyses of these toxins revealed that they consisted of 60 amino acid residues and that Aipysurus laevis b was [25-methionine, 28-arginine] Aipysurus laevis a. Aipysurus laevis c was [28-lysine] Aipysurus laevis a, the tryptic peptide sequence relying on homology. The LD50 values of these toxins for 20g mice were 0.076 mug/g body wt. They inhibited the acetylcholine-induced contracture but did not affect the CKl-induced contracture of the isolated muscle.


Investigation of ribonuclease-catalysed kinetics by a micro-calorimetric method. A rapid micro-calorimetric method for the simultaneous determination of the Michaelis-Menten parameters and the enthalpy of enzymic reactions is developed. The hydrolysis of 2': 3'-cyclic CMP by ribonuclease A is studied to test the proposed method; values obtained are in good agreement with already published data. Enzymic hydrolysis of yeast RNA, unlike that of cyclic phosphates, is shown to be endothermic. This result is explained by the two-step mechanism of this reaction.


Intraarticular activation of the complement system in patients with juvenile rheumatoid arthritis. Analyses of CH50, complement components, properdin factors, and kininogen in synovial fluid of patients with juvenile rheumatoid arthritis revealed evidence of activation of the classic complement pathway in all clinical subgroups. Juveniles with the adult pattern of disease had the greatest incidence of complement abnormalities. Evaluation of individual components by both activity determination and protein measurement showed decreased synovial fluid specific functional activity (activity per microgram protein) to the more marked in synovial fluids with profound depressions of complement activity. These findings provide further evidence that nonfunctional, antigenically intact component protein may remain after complement activation. Radial immunodiffusion measurements of properdin factors and kininogen failed to support their involvement in joint inflammation. Serum complement component measurements by activity but not protein concentration correlated with other parameters or inflammation. Four patients had isolated depressions of serum C2 activity. Immunoglobulin levels, particularly IgA, correlated with some complement measurements and with the sedimentation rate.


Metabolic changes in rabbit articular cartilage due to inflammation. The effect of inflammation on the articular cartilage of rabbit knee joints were studied. The inflammation was induced by intraarticular injections of corton oil or rabbit peritoneal leukocyte lysates. An increase in the activities of various lysosomal enzymes was observed in the synovial fluid as well as in the cartilage of the inflamed joints. Loss of proteoglycans, increased rate of degradation of collagen and proteoglycans, and increased rate of their synthesis were evident in the treated cartilage. The rate of uptake of 3H-thymidine was also increased. A significant change was observed in the type of collagen synthesized by these explants in vitro. In addition to synthesizing their characteristics Type II collagen, the cartilage explants from the treated joints synthesized Type I collagen.


The arthropathy of relapsing polychrondritis. Twenty-three adults (11 males and 12 females) with well-defined relapsing polychondritis (RP) are studied in order to characterize the arthropathy of RP. Arthritis was found in 19 patients-as the presenting feature in 8 and as a significant symptom in 11 others. The usual pattern of involvement was migratory, asymmetric, non-nodular, nonerosive, and seronegative, and affected large and small joints as well as parasternal articulations. In addition RP was seen in 3 patients with preexisting chronic polyarthritis or associated rheuamtic disease.


Deforming arthritis of the hands in polymyositis. Arthritis of the hands with erosions, periosteal calcification, and interphalangeal thumb joint instability was seen in 6 patients with polymyositis. "Overlap" features such as Raynaud's phenomenon, positive LE clot test, and positive antinuclear antibody test were present, but clinically the primary disease was clearly polymyositis. This rather unusual constellation of roentgenographic findings strongly suggests the possibility of polymyositis.


Differentiation and characterization of autoantibodies and their antigens in Sjögren's syndrome. Autoantibodies in Sjögren's syndrome (SS) were identified by their precipitin reactions with tissue antigens in immunodiffusion. The source of antigens was a sonicated extract of human lymphoid cells (WiI2) grown in tissue culture. Three distinct precipitin systems were identified and referred to as precipitins SS-A and SS-B, and rheumatoid arthritis precipitin. These studies show that precipitins SS-A and SS-B are present in high frequency in sera of patients with SS without associated rheuamtoid arthritis (RA) and are absent or present in low frequency in many other connective tissue diseases. On the other hand patients with SS who also had clinical features compatible with RA (SS-RA) did not have precipitins SS-A and SS-B but had rheumatoid arthritis precipitin (RAP). The latter precipitin was also present in RA patients in a similar order of frequency as in SS-RA. All three precipitin systems were shown to be reactions betweeen immunoglobulins and cellular antigens. The origin of SS-A and SS-B antigens was demonstrated by immunofluorescence to be primarily from the nucleus but the origin of RAP in the cell has not been established.


Histocompatibility antigens in systemic lupus erythematosus. Histocompatibility (HL-A) antigens were determined in 120 patients with systemic lupus erythematosus (SLE) and 120 matched controls. Increased frequencies of HL-A1 and HL-A8 were found. HL-A1 was more strongly associated with SLE in black patients (71 patients), whereas HL-A8 was more impressively associated with SLE in white patients (49 patients). In addition HL-A1 appeared more frequently in those with early onset of disease in both races; and HL-A1, HL-A8, and the HL-A1,8 phenotype seemed to be associated with severe SLE (renal and central nervous system involvement) in white patients. These data support the proposal that there are genetic influences in the pathogenesis and expression of SLE.


Effect of aspirin on liver tests in patients with RA or SLE and in normal volunteers. Aspirin was given to 20 patients with RA, 16 patients with SLE, and 3 normal volunteers. Four of the RA patients, 7 of the SLE patients, and 1 normal volunteer developed abnormal liver tests, during the study. The abnormalities (elevated transaminases) were most frequent and of rapid onset in patients with cliniclaly active SLE. Increases in BUN and creatinine related to aspirin were observed in several subjects. In a retrospective survey of 80 patients with SLE, aspirin appeared responsible for two-thirds of episodes of liver test abnormalities in 19 patients.


Clinical evaluation of benzbromarone: a new uricosuric drug. The long-term efficacy and safety of benzbromarone were studied in 21 nontophaceous hyperuricemic men. Daily doses of 40 or 80 mg of micronized benzbromarone caused a rapid fall in plasma urate which was maintained throughout a study period that lasted up to 1 year. A concomitant marked increase in the clearance of urate indicated that benzbromarone is a potent uricosuric drug. Initial treatment was accompanied by transient hyperuricosuria, following which urinary uric acid reverted toward, but failed to reach completely, pretreatment values. Benzbromarone did not inhibit xanthine oxidase nor did it influence the activity of purine phosphoribosyl transferases. These observations suggest that benzbromarone has no direct effect upon purine metabolic pathways, but exerts its hypouricemic action solely by blocking tubular reabsorption of uric acid. Concomitant administration of aspirin interfered only slightly with the uricosuric properties of benzbromarone. No side effects directly attributable to the drug were observed.


Fibrinogen catabolism in systemic lupus erythematosus. Because there is mounting evidence that localized intravascular coagulation may contribute to tissue injury following a variety of immunologic events, including immune complex diseases, fibrinogen catabolism was studied in patients with systemic lupus erythematosus to determine factors correlating with accelerated coagulation. 125I-fibrinogen half-life in controls was 90.1+/- 11 hours and the mean SLE half-life was 60.5 +/- 12. SLE patients in complete clinical remission had normal half-lives, but patients with symptomatic clinical disease, including renal disease, had significantly reduced fibrinogen survival. Accelerated fibrinogen consumption also correlated with positive tests for anti-DNA antibodies, but not with hypocomplementemia. These observations support the hypothesis that the coagulation system is activated in patients with immune complex diseases. Further studies are required to define the role, if any, that coagulation may play in causing tissue injury.


Antigenic profile of the rat chondrocyte. Hetero- and alloantisera were obtained following hyperimmunization of nonsensitized New Zealand rabbits and dark agouti (DA) rats with washed chondrocytes which had been enzymatically isolated from the long bone cartilage of 17-19-day-old rat fetuses of the Fischer strain. Analyses of these antisera by PVP hemagglutination, dye-exclusion cytotoxicity, and indirect immunofluorescence indicated the presence of major histocompatibility antigens, as well as tissue-specific antigens on chronrocytes. Serologic specificity of reactions was demonstrated by serum absorptions and appropriate controls. These findings supprot previous work suggesting that chrondrocytes are endowed with major histocompatibility antigens. The significance of these findings in relation to rheumatoid arthritis is discussed.


Carpal arthritis with ankylosis in late onset Still's disease. Thirteen patients are described in whom Still's disease began after age 15. All had objective evidence of arthritis, and 10 developed chronic synovitis of larger joints, especially the wrists. A characteristic evolution of roentgenographic changes was observed in 7 patients. Carpometacarpal and intercarpal joint spaces became selectively narrowed without erosions, and bony ankylosis eventually occurred. These roentgenographic changes may be a valuable clue to the diagnosis of Still's disease, regardless of the age at onset.


[Metabolism and effects of phosphorus in eutrophic infants dehydrated from diarrhea]. To verify whether there is a state of phosphate depletion in dehydrated infants with diarrhea and whether phosphate administration affects recovery from metabolic acidosis, two groups of infants were studied. All were males, from 1 to 7 months old, and in good nutritional state. The control group was treated with a standard regimen of I.V. fluids initially, followed by feedings of a diluted milk formula starting on the 2nd day of treatment. The study group, in addition to this standard regimen, received sodium phosphate (Na2HPO4/Na2HPO4, 4:1, pH 7.4), initially by the I.V. route and thereafter orally with the feedings, at the dose of 2mM/kg/day. During the first 6 days of treatment, daily electrolyte (Na, K, Ca, Mg. Cl and P) and nitrogen balances were recorded. Hydrogen ion excretion (NH4 + TA--HCO3) was determined daily. Clinical findings and course were similar in the two groups. No untoward effects were observed with phosphate administration. In the control group, P balance was negative during all the periods and losses were in excess of those expected from nitrogen losses, thus suggesting a state of depletion. In the P-treated group however, P retention was not demonstrated in the first 2 days, finding a not suggestive of a P depleted state. Linear regressions between both daily and cumulative balances of P-nitrogen-free and Ca indicated a close correlation, thus suggesting that these two ions are mobilized concommitantly.


[Height of children with G. lamblia and there capacity to absorb d-xylose]. The investigation was carried out with the purpose of studying the capacity to absorb d-xylose in children with G. lamblia establishing also, whether or not their height was reduced. The study is included 25 school age children with giardiasis, pairing them according to sex and age with another 25 without intestinal parasitosis.


[Electroencephalogram in children during wakefulness and during induced sleep]. With the purpose of determining the advantages obtained in the electroencephalographic diagnoses of different clinical conditions, 567 electroencephalograms were practiced to 276 patients from the outpatient service of the Hospital Infantil de México of different ages and clinical diagnoses during various stages of wakefulness, spontaneous or sleeping induced with chlorous hydrate and nembutal. In comparative studies carried out under induced sleeping, it was found that bioelectrical abnormalities showed up in a high percentage of the recording obtained during wakefulness, independently of age; thus, it is considered the ideal state. And in cases suggestive of hypsarrhythmia, or where asymmetries are investigated it is convenient to practice recordings under both conditions: wakefulness and sleep.


[Disseminated intravascular coagulation, 113 cases, including 17 children with fulminant purpura]. Between 1964 and 1971, 113 children with the syndrome of disseminated intravascular coagulation were studied at the Hospital Infantil de México, including 17 cases with the diagnosis of fulminant purpura. Comparison was established with reports from foreign institutions. The following conclusions are offered: Fulminant purpura appears after a period of latency following the causal disease. It is not caused by septicemia; shows a clear picture in infants, preschool and school children, with letality index of 17.7%. In Mexico, DIC was caused by infection in 88% of the cases and in 68% of them, the infection started in the digestive tract. The diagnosis of fulminant purpura is based on the clinical picture, while in DIC, the diagnosis must also be based on laboratory tests unless one half of the diagnoses be missed.


[Basic diet in the treatment of infants with prolonged diarrhea]. Fourteen infants between 1 and 9 months of age received elemental diet by continuous nasogastric drip. All had diarrhea (average duration 32 days). All were malnourished. Eight had carbohydrate intolerance. Two had intestinal pneumatosis. Elemental diet was used at first in 12.5% concentration and increased progressively until it reached a 25% concentration. Clinical response was favorably in every case.


[Corticotherapy in hemangiomas].

[Corticotherapy in hemangiomas]. A group of 17 patients with different types of hemangiomas that were submitted to treatment with steroids (prednisone) is studied. The results obtained are analyzed, together with the indications for the drug, its mechanism of action and the advantages of the doses used. Although this is not a definitive solution in all cases, considering the short number of complications observed, it is believed to be a treatment that be taken into account before more aggresive measures are followed, but it should never be done routinely.


[Review of 70 cases of duodenal obstruction: diagnosis and treatment]. A review of 10 years (1964-1973) of patients admitted to the Hospital Infantil de Mexico with duodenal obstruction is made. There were 70 cases, 33 of which corresponded to intrinsic obstruction and 37 to the extrinsic type. The clinical picture, whether complete or incomplete obstruction is involved, is analysed and the importance of radiology is emphasized to reach an early diagnosis. The surgical management is described in accordance with the type of lesion found. Mortality in this type of pathology is still high in spite of the improvement in surgical techniques and intensive management of newborns, considering that these patients usually show low weight and a high frequency of associated malformations.


[Sinusitis in the child. Evaluation and indication for surgical treatment]. Sinusitis in children is a frequent problem in pediatric otorhinolaryngology. Medical treatment is often incomplete or inadequate, creating the need for proper surgical therapy. In a 3 year period (1972-1975), at the E.N.T. Dept. of the "Hospital Infantil de México", a total of 51 patients, from 2 to 16 years age, underwent sinus surgery. The clinical diagnosis was completed with radiological and bacteriological studies. Chronic ethmoidal-maxillary and maxillary sinusitis were the most frequent types seen. Besides, considering E.N.T. sphere, other problems were present, mostly: tonsilloadenoiditis, important rhinoseptal deformity, and chronic otitis media. Also, dental caries, anemia, secondary to malnutrition and intestinal parasitosis, were additional frequent medical problems, among others. Allergic rhinosinusitis was suspected in at least 50% of them and clinically diagnosed in 15%. Bilateral nasoantral windows (antrostomy), and unilateral Caldwell-Luc procedure, were the surgical procedures most frequently performed. Adenoamygdalectomy, septorhinoplasty and mastoidectomy, were other frequent E.N.T. procedures. A total of 57% of the patients showed positive surgical findings at the time of sinus surgery; this is coincident with the work of other authors. Results of surgical and complementary medical management showed 39% of recovery rate. A high percentage of patients (31%), were lost to follow-up after initial surgery. The point of necessary conservative sinus surgery in children, is stressed in this paper.


[Surgical management of presacral sacrococcygeal teratomas, or with intrapelvic extension]. Two cases of sacrococcygeal teratomas that were successfully treated surgically through the abdominosacral route are reported. Besides, a series of 36 children diagnosed through a period of 30 years is reviewed and considerations are made on the importance the classification of teratomas has, to choose the best route of approach for the surgical removal of these tumors. Mention is made of symptoms that allow the diagnosis of presacral teratomas and of those that show intrapelvic or abdominal extension.


[Pyelonephritis and bacterial tubulointerstitial nephritis]. With the purpose of establishing the clinicopathologic correlation in pyelonephritis and to discard other interstitial nephrites, with present day morphologic criteria we analysed 63 casos that had been diagnosed as pyelonephritis, following Weiss and Parker's histologic criterion. The clinicopathologic diagnosis of pyelonephritis was confirmed in 12 cases; all of them showed obstructive uropathy and in most of them, there was chronic renal failure. Interstitial nephritis was established in 27 cases, all of them showing septicemia and almost half of the cases showed acute renal failure. Other 20 cases showed tubulointerstitial nephritis secondary to different types of glomerulopathies, fetal glomerulosclerosis, dysplasias, nephrophthisis, radiation nephritis and renal infarct. In 4 cases, the study of sections finer than the original, showed absence of histopathologic lesions. The results of the present study point out the main causes of confusion with the pathological diagnosis of pyelonephritis, the necessity to investigate predisposing uropathy in patients with urinary infection and stresses the importance to establish correlation with clinical and laboratory findings in cases with tubulointerstitial lesions.


[Perinatal pathology].

[Perinatal pathology]. The study includes 965 cases of autopsies in premature and full term newborns comparing their pathology within the pre, intra and postnatal periods; the neonatal period was also divided into weeks. The results may be correlated from different parameters, pointing out susceptibility, risk, nature of the pathologic processes and their order of arrival within the stages mentioned. The suitable reason that may exist to explain the high index of anatomoclinical diagnoses, not correlated in this study, is analysed and it is believed that a knowledge of some of these problems may be useful to prevent and to manage them adequately within and outside our hospital units.


[Review of 1,172 clinical cases with human communication disorders]. The study comprised 1,172 clinical cases that were classified according to sex, age and speech disorders. A review is made on the most common alterations that they present, the selective treatment in each type and their rehabilitation.


[Krabbe's leukodystrophy. Report of a case]. A case of Krabbe's leukodystrophy is reported in a male child 18 months old, with evolution of 12 months. The clinical, radiological, pathological and genetic studies are described. Besides, this case was the basis to review the topic of leukodystrophy and the corresponding literature, considering that this is an uncommon disease in our milieu.


Change in symptoms of hypertensive patients after referral to hospital clinic. At their first visit to a hospital clinic 178 patients referred with a diagnosis of hypertension were given a self-administered questionnaire. They received a similar questionnaire 12 months later. Of the 178 patients 99 were not initially on treatment. Similarly 78 normotensive subjects were drawn randomly from the local population and sent a second questionnaire 10 months later. The symptoms at the first visit of the normotensive controls, the untreated hypertensive patients, and 477 patients on long-term treatment in the hypertension clinic were compared. Treated and untreated hypertensive patients complained more of nocturia and also of unsteadiness either on standing or in the morning. Treated hypertensives complained more of sleepiness, dry mouth, diarrhoea, and, in men, impotence and failure of ejaculation. Similarly, untreated hypertensives complained of excessive depression, blurred vision, and waking headache. Fifty-five of the normotensive subjects and 110 of the newly referred hypertensive patients responded to the second questionnaire. The proportions losing and gaining symptoms were calculated together with the proportions always complaining and never complaining of a symptom. Hypertensive patients tended to lose the complaints of unsteadiness and headache but to gain the symptoms of vivid dreams, a slow walking pace, and diarrhoea. The net improvement for a symptom was defined as the excess of patients who lost a symptom over those who gained the symptom, expressed as a percentage. Over the follow-up period the control subjects had a net improvement averaged over 14 symptoms of +2-4 per cent. A similar result was obtained for the hypertensive patients of +2-0 per cent, the symptoms lost being balanced by those gained. The changes in symptoms with time were related to the changes in blood pressure and it is suggested that only headache, 'unsteadiness, lightheadedness, or faintness' and nocturia can actually result from raised blood pressure and then only in a proportion of patients complaining of these symptoms.


[Morphological study of the myocardium in children and adults under normal conditions and in hypoxia]. At the light and electronic microscopes, 32 myocardial biopsies from 16 patients were studied. The study was carried out in 8 children under 5 years of age and in 8 adults over 20 years during open-sky surgery of the chest done to correct some congenital or acquired heart anomaly. Control biopsies were taken before the application of extracorporeal circulation and a second biopsy, after an average of 30 minutes of hypoxia, which was the time taken to perform the surgical correction of the anomaly. Following extracorporeal circulation, all cases showed mitochondrial mutuations, such as disorganization of their crests, marked distension, from edema to emptiness due to hypoxia. The lack of glycogen, the disorganization of the myofibrillae, decreased neatness of the sarcoplasm and nuclei with marginated chromation, were all preceded by mitochondrial mutations due to oxidative phosphorylation deficiency.


Echocardiographic evaluation of propranolol therapy for mitral valve prolapse. This study evaluates the effect of propranolol on the echocardiogram of 8 patients with late systolic mitral value prolapse. Echocardiograms were performed with the patients on no medication and again while on oral propranolol therapy. Propranolol caused a statistically significant increase in left ventricular volume; however, neither the echocardiographic pattern nor the timing of mitral valve prolapse was altered by propranolol. These findings suggest that factors in addition to left ventricular volume play a role in regulating valvular dysfunction in this condition.


[Acute leukemia with cardiac infiltration]. A nine years old female child with malnutrition who showed, six months before admission, a number of clinical manifestations consistent with leukemia. The outstanding clinical manifestation during her hospital stay was that of pericarditis with effusion, which was found associated with pericardial leukemic infiltration. The final picture was that of cardiorespiratory failure associated, both to leukemic infiltration of these organs, as to that of postoperative hemorrhage.


[Tetanus in the newborn. Epidemiologic, clinical and therapeutic aspects. Report of 34 cases]. This study is based on a review of the present situation of tetanus neonatorum. This study included 34 cases which were diagnosed as tetanus of the newborn. These 34 cases occurred in Dr A. Pumarejo hospital in the city of H. Matamoros, Tamaulipas (Mexico), during the period 1970-1974. It was found that during this pediatric age, in comparison with others, the incidence is high (61.8%) and shows a predominance of males over females of 4.62 to 1. The incidence of this pathology, as Cole & Youngman proposed, was as follows: grade I, 2.94% grade II, 11.76%; and 85.30% corresponding to grade III. The greater number of deaths were in those patients classified as grade III, which corresponded to 12 patients. The number of cases studied during spring and summer was much higher. The living conditions within our environment, our ecology and the unawareness of the basic means to prevent this pathology (correct management of the umbilical cord) were the main causes of this high incidence. Therefore, this case study leads to the conclusion that there is a great need to reorganize our programs of vaccination in order to protect this pediatric group, which is highly exposed.


Opening snap and isovolumic relaxation period in relation to mitral valve flow in patients with mitral stenosis. Significance of A2--OS interval. In 15 patients with pure or predominant mitral stenosis and in a control group of 11 patients without mitral stenosis the blood flow velocity through the mitral valve orifice was recorded by means of a directional Doppler ultrasound velocity catheter introduced transeptally and positioned in the orifice of the mitral valve. A simultaneous surface phonocardiogram was obtained. The timing of the mitral opening snap in relation to the blood velocity record of the flow through the valve supported the hypothesis that the opening snap is due to a sudden tensing of the valve leaflets by the chordae tendineae. Determination of the exact time of mitral valve opening, made possible by the blood velocity record, led to the division of the classical A2-0S interval (aortic valve closure to opening snap) into two components representing respectively the diastolic isovolumic relaxation period and the time of excursion of the mitral valve cusps. The durations of the isovolumic relaxation period were compared with those in the control patients and were found to correlate with the severity of the mitral stenosis, whereas those of the excursion time of the mitral cusps were influenced by the presence or absence of mitral valve calcification.


[Susceptibility of 609 strains of Staphylococcus aureus, isolated during 1973-1974 from various infectious processes in children, to various antibiotics]. Staphylococcus aureus is a bacterium which has shown variations, as to susceptibility, to antimicrobial agents. By the plate dilution method, response to 12 different antibiotics is studied in 609 strains isolated from children admitted, or who attended the outpatient clinic of the Hospital Infantil de México, between 1973 and 1974. Ninety per cent or over, of all strains, were sensitive to eight of the antibiotics. The most effective were: gentamicin, (99.8%), cephalothin and cloxacillin (99%). Lesser sensitivity was found to penicillin (28.7%), ampicillin (33.5%) and tetracycline (49%). In general, resistance was greater in cases of surgical wounds and abscesses, and lesser in respiratory infections (pharyngeal exudates and bronchoaspirations). All strains isolated from purulent ophthalmias showed resistance to penicillin and 91%, to ampicillin.


Cardiac arrhythmias induced by hypokalaemia and potassium loss during maintenance digoxin therapy. Twelve patients with congestive heart failure receiving maintenance therapy with digoxin and potent diuretics were followed closely during development of hypokalemia and potassium loss. Cardiac arrhythmias compatible with digoxtin toxicity developed in 6 patients in the presence of stable, normal serum digoxin concentrations. The mechanisms involved in the development of the rhythm disturbances are discussed with regard to hypokalaemia, intracellular potassium loss, intra-/extracellular potassium gradients and digoxin, and the significance of maintaining a normal potassium balance in this setting is stressed.


Intermittent bundle-branch block in patients with accessory atrio-His or atrio-AV nodal pathways. Variants of the Lown-Ganong-Levine syndrome. Intracardiac electrophysiological studies were performed in two patients with a documented history of repetitive supraventricular tachyarrhythmias. Case 1, with short PR interval and narrow QRS complexes had a short AH interval and intermittent right bundle-branch block. Thus the short PR wide QRS syndrome is not always a result of the Wolff-Parkinson-White syndrome but can also be seen in the Lown-Ganong-Levine syndrome coexisting with bundle-branch block. Case 2, with normal PR and AH at the lower limits of normal, showed the dual pathway response to atrial pacing that can occur in patients with Lown-Ganong-Levine syndrome. He also had tachycardia-dependent right bundle-branch block and left posterior hemiblock. Therefore, neither the short PR interval nor the narrow QRS complexes characterized these forms of pre-excitation. The constant features were, from the clinical viewpoint, the occurrence of repetitive supraventricular tachyarrhythmias, and electrophysiologically the abnormal response to atrial stimulation.


Length of main left coronary artery in relation to atherosclerosis of its branches. A coronary arteriographic study. The relation between the length of the main left coronary artery and the presence of atherosclerosis in its branches or the presence of complete left bundle-branch block was studied by selective coronary arteriography in 43 persons. The length of the main left coronary artery was found to be significantly shorter in patients with coronary atherosclerosis than in subjects without angiographic evidence of coronary artery disease. In patients with electrocardiographic evidence of complete left bundle-branch block, the length of the left main coronary artery was significantly shorter than that in both previous groups. In view of these findings, it is suggested that a short main left coronary artery should be considered as a congenital factor predisposing to the development of coronary artery disease. The possible mechanisms leading to atherosclerosis of the left coronary arterial branches in the presence of a short main trunk are discussed.


Analysis of coronary collaterals in ischaemic heart disease by angiography during pacing induced ischaemia. Studies were made using ordinary selective coronary angiography and angiography during ischaemia produced by right atrial pacing, on a series of 41 patients with ischaemic heart disease, to examine the response of the collaterals to the ischaemia stimulus. Regional myocardial perfusion was determined under the same circumstances by measuring regional 133Xenon washout curves. No collaterals were found in 8 patients, none of whom demonstrated collaterals when angiography was repeated during ischaemia. Eleven of the 33 patients with prepacing collaterals (33%) responded to ischaemia with an increase in the collaterals, 16 patients (49%) showed no change, 5 patients (15%) showed a decrease in the collaterals, and one patient exhibited a bidirectional change. Regional myocardial perfusion responses closely paralleled the angiographic changes, yielding suggestive evidence that the collaterals were intimately involved in the enhancement of the flow. Despite different collateral and flow responses to ischaemia, the data on exercise tolerance, left ventricular end-diastolic pressure, ejection fraction, prevalence of left ventricular asynergy, and the topographic relation between synergy and collaterals, were largely similar. The data show that in some patients the collateral circulation reacts to ischaemia by enhancement, but the functional significance of this response is obscure.


Wenckebach phenomenon in the exit area from a transvenous pacing electrode. An unusual type of exist block from a transvenous pacing electrode was recorded in a 63-year-old man with an acute inferior infarct and cardiogenic shock. The pacemaker artefact to QRS interval increased gradually till there was loss of capture. A gradual change from I:I pacing rhythm to 4:3 and 3:2 Wenckebach cycles was recorded. This was followed by a fixed 2:I pacemaker artefact to QRS block.


Wenckebach phenomenon occurring in the distal conducting system in a young adult. This report describes the case of a young man who presented with right bundle-branch block and second degree atrioventricular block; intermittent episodes of Wenckebach periods were recorded. His bundle electrograms demonstrated progressive prolongation of the HV interval followed by block occurring distal to His. This report emphasizes the fact that the Wenckebach phenomenon as a manifestation of the distal conducting system disease can occur in young adults. The observations lend credence to the concept that Lenègre's disease can occur in young people.


Inhibition of demand pacemakers caused by potentials associated with inspiration. A 69-year-old man with a permanent demand pacemaker and a unipolar electrode system had intermittent failure of pacing during deep inspiration. Pacing was not interrupted when the unit was switched to fixed rate mode by an external magnet. Thus, the problem was not caused by a change in electrode position or to a loose connexion. The likely cause was inhibition by non-cardiac potentials, possibly myopotentials associated with respiration.


Creatine kinase MB isoenzyme studies in diagnosis  of myocardial infarction. Serial measurements of the MB isoenzyme of creatine kinase, total creatine kinase, aspartate mainotransferase, and urea stable lactate dehydrogenase have been made in the serum of a series of 139 patients admitted with a diagnosis of suspected myocardial infarction. Serum MB isoenzyme measurements have also been made on postoperative surgical patients and patients with medical disorders known to have caused raised serum total creatine kinase activity. All these enzymes were abnormal in at least one specimen from all patients with electrocardiographically proved acute myocardial infarction. The magnitude of the MB isoenzyme rise was 2 to 3 times greater than that of any of the other enzymes. The duration of its rise was relatively short. The MB isoenzyme was more specific for myocardial infarction than other enzymes and no increases were found in postoperative patients, except in those after cardiac bypass surgery. The MB isoenzyme seems the most sensitive and specific test for myocardial infarction available, though there are technical problems in its accurate measurement.


Correlation between praecordial accelerocardiogram and left ventricular pressure. The praecordial accelerocardiogram possesses important practical advantages over more familiar techniques of recording praecordial pulsations. We have compared the amplitude of the P wave of the praecordial accelerocardiogram in 6 normal subjects (group 1) and 21 patients with heart disease (group 2) at rest and after 3 minutes of isometric handgrip at 30 per cent maximum voluntary contraction. At rest in group 2 there was a significant linear correlation between the amplitude of the P wave of the accelerocardiogram, relative to the maximum systolic amplitude (P/DE), and the left ventricular end-diastolic pressure (P less than 0-01). However, comparison of the data for P/DE showed that the mean value (+/-SEM) of 29+/-5 per cent in group 1 was not significantly different from the mean value of 37+/-4 per cent in group 2 (P g .reater than 0-30). During handgrip the mean amplitude of the P wave did not increase significantly in group 1 (P greater than 0-20) but increased significantly in group 2 (P less than 0-02). In group 2 there was a significant linear correlation between the percentage increase in the amplitude of the P wave of the accelerocardiogram during handgrip and the percentage increase in the left ventricular end-diastolic pressure (P less than 0-01).


Clinical features and investigative findings in presence of mitral leaflet prolapse. Study of 85 consecutive patients. In a 14-month period mitral leaflet prolapse was diagnosed in 85 patients by echocardiography or cineangiography. Chest pain alone was the presenting complaint in 30 patients and linked with palpitation, dyspnoea, or syncope in 9. Eleven presented with major neurological disturbances (9 had transient ischaemic attacks), 10 with palpitation, 4 with undue and persistent fatigue, 2 with dyspnoea, and 2 with dizziness. Seventeen were referred not because of symptoms but because of clicks and murmurs. Overall, chest pain affected 61 patients and unless associated with coronary artery disease was not anginal. Palpitation was admitted by 42 patients; dizziness, lightheadedness, or paraesthesiae by 15, and syncope by 12. Systolic auscultatory abnormalities were noted in 69: 25 had single clicks, 3 had multiple clicks, 19 had both click(s) and murmur, and 22 had a murmur alone. Electrocardiography revealed ST segments flat for greater than 0-10 s in 21, prolonged QTc in 18, and T wave flattening or inversion in inferior limb and lateral chest leads in 14. The exercise stress test was abnormal in 13 of 27 patients. Mitral valve echograms showed definite mitral leaflet prolapse in 61, 'possible' prolapse in 14, and were normal in 8 patients with angiographic proof of mitral leaflet prolapse. Cardiac catheterization with left ventriculography showed prolapse of posterior mitral leaflet in 36, of both leaflets in 2, and left ventricular wall motion abnormalities in 16 cases. Selective coronary arteriography in 31 cases showed major vessel narrowing of larger than or equal to 80 per cent lumen diameter in 4, all with angina. This consecutive series indicates that the physical event of mitral leaflet prolapse is more common than hitherto appreciated, is priminently associated with non-anginal chest pain, palpitation, and neurological disturbances, and in 90 per cent of cases could be shown echocardiographically.