Pressure and flow changes during Valsalva-like maneuvers in dogs following volume infusion. In eight dogs anesthetized with chloralose and urethan, Valsalva-like maneuvers (VLMs) were performed and central blood volume (CBV) measured following incremental volume loading with blood-dextran. Changes in blood pressure during VLM were characterized by 1) maximum change in systolic pressure (deltaPmax) during VLM; 2) change in systolic pressure during the first five beats of VLM (deltaP1-5); and 3) the change in pulse pressure during the first 10 beats of VLM. In three dogs, we also measured changes in right and left atrial pressure (PRA, PLA), esophageal pressure (PE), and pulmonary and aortic blood flow. We found that volume loading produced a continuous spectrum of hemodynamic changes culminating in the "square-wave" response. deltaPmax and deltaP1-5 correlated with changes in CBV. Changes in hemodynamic responses were produced by increases in CBV, and by incomplete prevention of systemic venous return during VLM. The mechanism of the square-wave response may be a combination of both these effects, with the latter the more significant of the two.


A numerical method for fitting compartmental models directly to tracer data. A numerical method is presented for obtaining the exchange rates of a metabolic compartmental system, working directly from the time course of tracer activity and excretion after bolus injection. The conventional mathematical formulation of this problem, in terms of sums of exponential functions, is bypassed, enabling implementation of the method in a short computer program. An important by-product of the method is a set of variance-covariance estimates for the fitted parameters. The method is tested on "classic" data, both simulated and real. Its capabilities and limitations are demonstrated, and the strategy of its effective application is discussed.


Dynamic responses of CO2-sensitive avian intrapulmonary chemoreceptors. Single-unit extracellular potentials from CO2-sensitive intrapulmonary chemoreceptors (IPC) were recorded with tungsten microelectrodes from the nodose ganglia of unidirectionally, artificially ventilated White Leghorn cockerels. The responses of IPC to step and sinusoidal forcing functions of fractional concentration of carbon dioxide (FCo2) indicate that 1) about two-thirds of IPC are bidirectionally rate sensitive, 2) delay to forcing varies from essentially zero to several times larger than the time of nitrogen gas passage through the lung and, on the average, is significantly shorter to step decrease than step increase in fco2, and 3) IPC with irregular discharge intervals are more rate sensitive and respond to higher frequencies than IPC with regular interspike intervals. The physical and chemical properties of the "receptor-lung" complex are probably important in determining the dynamic responses of IPC by partitioning of CO2 from other gases within the lumen of the parabronchus. IPC are located along the length of the bronchial gas exchange areas of the avian lung and transmit information to the CNS concerning the mean level, rate, and direction of change in the partial pressure of carbon dioxide (PCo2).


Sympathetic inhibition of thermogenesis in the infant rat: possible glucostatic control. Nonshivering thermogenesis (NST) was examined during cold exposure (30 degrees C) in 5-day-old rats, during food deprivation. NST in the fed state doubled the O2 consumption observed at neutral temperatures. With fasting, the additional O2 consumption stimulated by cold dropped to that observed at thermoneutrality within 6 h, and colonic temperature (Tco) dropped concomitantly. Blood glucose (BG) concentration was halved. Oxygen consumption and Tco in the cold varied linearly with BG changes during food deprivation. 6-Hydroxydopamine transiently stimulated norepinephrine release and elevated metabolism nonadditively with cold stimulation in fed animals, and also stimulated O2 consumption. The drug also partially restored BG concentration, after it had declined during fasting. NST and BG were also restored by gastric infusion of glucose. These data suggest that the decline of NST, and the subsequent hypothermia during food deprivation, is in large part a sympathetically mediated reflex response to low cerebral BG concentration. However, glucose injection in doses sufficient to restore BG after fasting did not restore NST, nor was NST abolished by intracellular glucoprivation with 2-deoxy-D-glucose in fed rats. Thus, it is not argued that BG concentration is in itself an adequate signal for controlling NST.


Preoptic-hypothalamic periventricular lesions: thirst deficits and hypernatremia. To assess the significance of stimulation studies suggesting an anteroventral third ventricle (AV3V) dipsogenic site of action for hyperosmotic and angiotensin thirst stimuli, electrolytic lesions of periventricular tissue surrounding AV3V were produced under ether anesthesia in rats preselected for responsiveness to subcutaneous angiotensin and hypertonic NaCl thirst challenges. Lesions limited to preoptic-anterior hypothalamic periventricular substrates resulted in adipsia; those rats resuming ad lib. drinking after a period of adipsia exhibited persistent drinking deficits to angiotensin and hypertonic NaCl thirst challenges, reduced drinking after water deprivation, and increased plasma osmolality and sodium. Drinking to polyethylene glycol-induced hypovolemia and feeding after food deprivation did not differ between lesioned and sham-lesioned animals. The disturbances in behavioral control of fluid balance imply that AV3V periventricular tissue normally plays a key role in mediating regulatory drinking. It is proposed that these AV3V periventricular lesion-induced effects on drinking behavior are due to destruction of receptors and/or integrative systems monitoring fluid-borne angiotensin and hyperosmotic stimuli.


Impairment in fluid ingestion in rats with lesions of the zona incerta. Rats with lesions of the zona incerta (ZI) dorsal to the lateral hypothalamus drink as much water as controls following intracellular or extracellular dehydration but restrict their daily water intake to minimal requirements for fluid balance, suggesting a specific impairment in secondary drinking. Following water deprivation, however, rats with ZI lesions responded to changes in palatability of the water as if they were experiencing slightly greater difficulty or aversiveness in drinking than controls. The cause appears to be an impairment in the ability to lick fluids from a spout. When water was available ad libitum or when water or liquid diet were provided after water or food deprivation, rats with ZI damage were unable to obtain as much fluid per lick as controls. It is concluded that lesions in this region of the brain impair the motor act of drinking and that the subsequent reduction in the efficiency of drinking is the cause of the attenuation of excessive water intake.


Evaluation of the Grodins respiratory model via dynamic end-tidal forcing. The Grodins model for respiratory physiology is very descriptive in simulating the lung-blood-tissue gas transport and exchange system, including detail not found in previous or more recent models. Three alternative controllers have been proposed for control of this gas exchange system. This paper indicates how dynamic endtidal forcing enhances behavioral differences among these three controllers and therefore enhances discrimination when the behavior is compared with subject data. Previously published end-tidal forcing data are used in the comparison. Several deficiencies in the controllers for the Grodins model are indicated.


Involuntary ankle oscillations from normal subjects. Spectral analysis of ankle tremor records obtained from normal seated subjects during continuous elevation of the heel for 10-45 min revealed that the root-mean-square (rms) displacement amplitude of the tremor increased from minimum values of about 4 micronm to values as large as 4,000 micronm. Associated with this increase in the displacement amplitude was a systematic decrease in the tremor frequency from values of 7-8 Hz to values of 5-6 Hz. Spectral analysis of demodulated soleus EMG records indicated that the rms value of this EMG (calculated at the tremor frequency) and the rms displacement of the tremor are related by a power function, with the rms value of the EMG increasing over a range of about 4-40 micronV as the tremor displacement increased from about 4 to 4,000 micronm. The negative relation between frequency and rms displacement amplitude values for postural ankle tremor was similar to that found previously for postural hand tremor.


Psychotherapy of severe depression.

Psychotherapy of severe depression. The author discusses his clinical experiences in treating severly depressed patients with psychotherapy. The psychotically depressed person cannot use normal mechanisms to recuperate from sadness because he is prevented from doing so by a preexisting life ideology that may include living for a dominant other or a dominant goal and that restricts his vision of alternative approaches to living. The therapist treating the severely depressed must initially assume a strong role; later, he helps the patient recognize depressive cognitive patterns and guides and motivates him to try other ways of living.


Continuing education, recertification, and examination anxiety. A substantial majority of the 645 psychiatrists responding to a questionnaire survey favored mandatory continuing education and evidence of continuing education as a requirement for relicensure. The respondents' overwhelming repudiation of recertification may be based on examination anxiety. The respondents recognized the value of continuing education, were even willing to document it in order to be relicensed, but did not wish to examined. Those respondents who were younger, Board-certified, and had an academic appointment were more likely to favor continuing education requirements in order to be relicensed. Private practitioners were underrespresented among the respondents, highlighting the important role that APA and its district branches must play in developing meaningful continuing education opportunities for psychiatrists.


Temporal disorganization and inner-outer confusion in acute mental illness. The authors found that changes in temporal disorganization covaried substantially and significantly with changes in Schneider's first-rank symptoms in 58 acutely ill psychiatric patients. Schneiderian symptoms reflect a confusion of inner and outer events; therefore, the findings suggest that difficulties in indexing events in time are closely related to problems in distinguishing experiences that arise within the self from outer experiences.


Evaluation of a psychiatric clerkship by videotape. The authors used a videotape-based objective examination ingeneral psychiatry to assess the clinical competence of medical students who had completed their third-year clerkship. The test has been shown to be a reliable, valid measure of clinical competence. Subjective faculty grading related positively to test scores. Students on one ward had significantly lower overall test scores, with particularly low scores on clinical judgement questions. However, faculty grades for these students were not significantly different. This suggests that the faculty was unable to assess the relative efficacy of its own teaching. The test can provide objective assessment of student clinical competence and is a means of program evaluation.


Freedon of inquiry and subjects' rights: an introduction. The author introduces the Special Section papers to follow, pointing out that two new issues have attached themselves to the issue of the physical safety and civil dignity of human subjects. One new issue is an emphatically legal defense of the concept of subjects' rights; the other is the evolution of political characterizations and caricatures of many forms of research.


Freedom of inquiry and subjects' rights: historical perspective. The author presents an historical overview of the various attitudes toward animal and human experimentation. He cites advocates (Bacon, Welch) and opponents (Johnson, Shaw) and traces the debate from the Graeco-Roman era, through the rise of the scientific establishment, to the present. Controversy over the fundamental rights of individual research subjects versus a future-oriented freedom of inquiry has been and continues to be a dilemma for clinicians and research scientists.


Research barriers in psychopharmacology. The author discusses barriers to psychopahrmacological research, including attacks by vocal human rights groups, regulation by local review boards, and Department of Health, Education, and Welfare restrictions. He suggests that those patients least able to give informed consent are most in need of the benefits of research on new drugs.


Problems in follow-up studies.

Problems in follow-up studies. Recent regulations concerning consent procedures and protection of privacy fall most severely on follow-up studies of childre. Indeed, rigorous sample selection, nearly complete follow-up, and objective assessment of outcome are virtually impossible now. Further, complicance with current "subjects' rights" regulations sometimes seems potentially more harmful to the subjects than is the research itself.


The functions of human subjects review committees. After summarizing the literature on the functioning of committees set up to review research involving human subjects, the author describes three latent or emerging functions of these committees. These include using the committees to protect institutions, to judge proposed research in terms of possible social policy impact, and to consider proposed research from the standpoint of "community acceptability". The author expresses concern about the possible politicization of review committee decisions.


Federal constraints: earned or unearned? The author discusses the evolution of federal constraints on medical, behavioral, and social science research. There has been only one court decision related to behavioral research and none in medical research. The burden of consent procedures can be lightened somewhat by careful consideration of the potential risks and nature of the research; questions are presented that can be used to determine whether constraints apply. The author notes that although there are good reasons for regulations in both behavioral and medical research, the appropriateness of current and proposed constraints is still a matter of debate.


Effect of diet on urinary MHPG excretion in depressed patients and normal control subjects. The authors studied the effect of a catecholamine-controlled diet on the urinary level of 3-methoxy-4-hydroxyphenylglycol (MHPG) of 6 depressed patients and 6 normal volunteers. The normal subjects showed no change in MHPG levels on or off the diet; the depressed patients showed a significant increase in MHPG while off the diet.


Community psychiatry in Tutuila, American Samoa. The author hypothesizes that the underreporting of mental illness in Tutuila, American Samoa, is a direct result of the social system, which provides a means of "curing" emotional disorder by family group process and shamanistic ritual, by making the disorder less disruptive, and by absolving the affected individual of personal guilt.


A comparison of outcome in adolescent- and later-onset bipolar manic-depressive illness. The authors hypothesized that childhood-and adolescent-onset bipolar manic-depressive patients might have a more severe or a different type of affective disorder; early-onset patients were therefore compared with patients whose illness onset was after the age of 45. The results indicate that early age of onset is not a factor in the variable course and prognosis of manic-depressive illness.


Psychotherapy in combination with antidepressant drugs in patients with severe masked depressions. Masked depressions rival overt depressions in frequency, but unfortunately an early correct diagnosis is rarely made. Psychotherapy in combination with antidepressant drugs is the treatment of choice in these patients, most of whom are severely ill by the time they are first seen by a psychiatrist. The nature of this syndrome and an overview of the treatment procedure is outlined in this paper.


Treatment of the abused child and the child abuser. Abusing parents are not always criminals. Deficient rearing during childhood deprived them of ego controls that could prevent them from injuring their children as projections of their own anger. Psychoanalytic therapy and ancillary measures can rehabilitate the crisis family. Methods are under study to identify and check potential abusing parents.


Psychotherapy of disadvantaged acting-out adolescents. Since the causes of acting out among delinquent adolescents are both psychologic and social, treatment requires both psychotherapy and social therapy. Acting out is manifested in many ways and although situations vary, a number of treatment methods are specified. Broadly, treatment consists of a tripod of vectors: support, control, and uncovering.


Treatment of crises in the lives of women: object loss and identity threat. A review of crises occurring in practice within a year's time suggested that these related essentially to object loss or threat to identity, at any age level, although certain phases find women inherently more vulnerable. Therapeutic efforts call for special sensitivity to the effects of rapid cultural change, and altered goals and expectations of women.


The survivor syndrome: a problem of nosology and treatment. Many features of the psychologic sequelae in survivors of Nazi persecution are consistent with "traumatic neurosis", but persistent guilt, which appears to be due to having identified with the aggressor, and self-loathing are not. Three cases of psychotherapy with survivors only peripherally affected by the persecution are discussed.


Effects of the therapist's philosophical premises on psychotherapeutic process. This article focuses on differences in assumptions forming the philosophical foundations of psychotherapy leading to profound differences in the interpretation of the clinical data of psychotherapy and corresponding variations of basic technique. These differences are not reconcilable because they are directly opposed; only the principle of complementarity, as described in the paper, permits a constructive approach to the antinomies.


Outpatient treatment of the aggressive offender. The treatment of aggression in an outpatient setting has not been tried often mainly because of the nature and intensity of the countertransference reactions. However, with some modification of traditional treatment practices plus a careful monitoring of the countertransference successful treatment is possible without great danger to the therapist.


Psychotherapy supervision: the problem of conflicting values. Psychotherapy supervision offers an opportunity for examination of value differences between therapist and patient and therapist and supervisor. Effects of availability of female supervisors are discussed in relation to these value differences affecting referrals, therapeutic goals, assessment of psychopathology, termination, and supervision of cojoint therapy. Advocacy and ombudsman function of the female supervisor in a training program are emphasized.


Psychotherapy with phobic patients: the marriage relationship as the source of symptoms and focus of treatment. Four patients demonstrating phobic symptoms occurring in the context of maladaptive marriages are presented. Thorough historical data collection is stressed. Similarities in family backgrounds and personality styles emerge in these cases and are discussed in relation to genesis of symptoms within the marital relationships. A psychotherapeutic approach is described and results of treatment examined.


Emotive-reconstruction psychotherapy: a short-term cognitive approach. Emotive-Reconstructive Therapy, a recently developed therapeutic modality deriving from cognitive theory, may be a promising short-term approach to psychopathology. Combining the use of imagery with selective hyperventilation, a therapist induces patients to reexperience past events, and subsequently to radically reconstrue themselves and significant others in a personally satisfying direction.


Evaluation of a screening program for heart disease. An evaluation of the effectiveness of a screening program using the Phono Cardio Scan to detect heart disease in 18,872 Baltimore (Meryland) elementary school children indicated that few cases were discovered and only one child medical treatment instituted as a result of the program. Most of the children referred to a cardiologist had known disease. There was considerable variability in performance both of the machine and of the three center which were involved in the program. The sensitivity of the machine may have been low as reported in some other studies.


Environmental correlates of pediatric social illness: preventive implications of an advocacy approach. A control prospective study of child abuse and neglect, failure to thrive, accidents and poisonings included 303 inpatients and 257 outpatients. Analysis of maternal interview clinical data demonstrated significant differences between cases and controls in summative indices of environmental stress, including housing, employment, and access to essential services. The associations with a postulated common causal underpinning of these illnesses argue for a broadened, ecologic conceptualization of etiology and a wider range of preventive approaches. A family advocacy program addressing the stress issues and utilizing community based individual was offered to families with pediatric social illness and to a comparison group. Indirect corroboration of the impact of environmental crisis is idicated by the prevalence of requests for this help in impatient cases of abuse (38 per cent) and ingestions (38 per cent) vs. controls (14 per cent). Discrimunant function regression analysis of data from the meternal interview demonstrates similarity between the attributes which most saliently describe the abuse group and those which decribe the users of advocacy.


Very young adolescent women in Georgia: has abortion or contraception lowered their fertility? Despite a state law enacted in 1972 which allowed minors to obtain contraceptive services without parental consent, births to very young women in Georgia (age 14 and less) have risen in recent years. Beginning in 1974, however, this trend has reversed. Increased access to induced abortion following the 1973 U.S. Supreme Court decision appears to have been responsible for the decline. Supporting this assertion are: 1) the temporal relationship between increased access to abortion and the decline in births, 2) the geographic evidence that the decline in births occurred first in Atlanta where abortion utilization is the highest and then followed in areas with somewhat more limited utilization, and 3) a similar observation that the decline occurred earlier and more markedly among young white teenagers whose abortion utilization is higher. Although abortion appears to have had the most visible impact on births, most people would probably agree that efforts toward providing contraception to these young women remain worth the challenge. The ratio of young teenegers accepting contraceptives to young teenegers getting pregnant is suggested as a useful intermediator of the success of family planning programs.


Lung function in fire fighters, I: a three year follow-up of active subjects. From a cohort of 1,768 Boston fire fighters studied initially in 1970, pulmonary function measurements were repeated on 1, 146 active subjects in 1974. The mean time between examinations was 3.4 years. The data on 1,430 subjects after one year of follow-up had indicated excessive decrements in levels of forced vital capacity and one-second forced expiratory bolume which were related to the frequency of fire exposure. The annual decline over three years was less than that observed over one year and could not be related to the number of fires fought or to other indices of acute fire exposure. Selection factors within the fire department appear to be important in protecting fire fighter from continued loss ventilatory capacity.


Induced abortion and sterilization among women who became mothers as adolescents. Four cohorts of urban women who delivered a child before reaching age 18 were followed for periods ranging from 6 to 12 years to determine use of abortion and sterilization. The two more recent cohorts had been served by comprehensive service programs. About 40 per cent of each of teh groups used abortion or sterilization to control fertility. Most of the women seeking abortion had no subsequent term or near term deliveries, suggesting that such a request may signal a desire to terminate childbearing, at least for a few years. A high proportion of the young mothers obtained abortions during the second trimister, even for repeat abortion.


Lung function in fire fighters, II: a five year follow-up fo retirees. In a study of the chronic effects of fire fighting on lung function, 1,768 employees from the Boston Fire Department were examined in 1970. From this cohort, 109 firefighters who retired in the period 1970 to 1975 have been restudied with questionnaire and ventilatory function tests. The observed vulues for pulmonary function when expressed as a per cent of predicted are consistently slightly below 100 per cent. The expected effect of cigarett smoking on lung function was demonstrated. The results suggest thetirement) are important in reducing the effect of fire fighting on subjects who may be adversely affected by the inhalation of combustion products.


Hypertension: effects of social class and racial admixture: the results of a cohort study in the black population of Charleston, South Carolina. It has been hypothesized that genetic factors, as manifested by skin color, play in important role in the genesis of hypertension among Blacks. A community-based study was carried out in Charleston Country, South Carolina to test this hypothesis. The results of a ten year follow-up study suggest that social class and age were more consistently associated with the incidence of hypertension and levels of blood pressure. The association of hypertension with skin color was minimal and substantially less than that of social class. The incidence rate of hypertension (larger than or equal to 90 mm Hg) was three to four times greater when the study participants were of low social class than when they had higher social class scores at the beginning of this study. In contrast, the incidence rate was only 1.5 times higher for dark than for lighter skinned men, and the rates were almost identical when social class was comparable. Similar results energed when blood pressure was treated as a continuous variable; blood pressure levels and pressure changes over time were consistently and significantly (p less than .01) higher in those Blacks categorized as low social class, controlling for skin color.


The effects of the anti-smoking campaign on cigarette consumption. The impact of the anti-smoking campaign on the consumption of cigarettes is measured by fitting cigarette demand functions to pre-campaign dat, projecting "ahead" as if the campaign had not occurred, and then comparing these predictions with realized consumption. The analysis suggests that major "events" in the campaign (e.g., the Surgeon General's Report) caused immediate though transitory decreases of 4 to 5 per cent in annual per capita consumption. However, the cumulative effect of persistent publicity supported by other public policies, has been substantial: in the absence of the campaign, per capita consumption likely would have exceeded its actual 1975 value by 20 to 30 per cent. This is a conservative indication of the effectiveness of the campaign, for it ignores other potentially important and desirable behavior changes, such as the shift to low "tar" and nicotine cigarettes.


Morbidity and growth of infants and young children in a rural Mexican village. The relationship between childhood illnesses and growth increments in length and weight was investigated in a 13-month birth cohort of rural Mexican children. Increments in length and weight for each year from birth to three years were related to high and low frequencies of reported time ill during the same period. Seventy-two of the 276 children had already been characterized as exhibiting "growth failure" relative to other members of the cohorts, and this was considered as a separate factor in the study. We found that upper and lower respiratory infection did not affect incremental gain in height or weight. A high frequency of diarrheal infection was found to reduce weight gain, although gain in height was not affected. Relative to the total sample, the average child with a high frequency of diarrhea achieved only 95 per cent of expected body weight age three; a chidl with both growth failure and high diarrheal frequency reached only 90 per cent of expected body weight at age three.


The value of arteriography before abdominal aneurysmectomy. We believe preoperative angiography is a safe procedure with current technics. The importance of the lateral aortogram in identifying mesenteric or celiac artery stenosis is emphasized. Sixty per cent of all patients studied showed some abnormal arteriographic finding. Significant abnormalities include (1) associated arteriosclerotic occlusions, (2) multiple aneurysms, and (3) anomalous vessels. As we consider this preoperative data of great importance in the planning of the total operation, we strongly recommend the routine use of aortography as described in evaluating all nonruptured abdominal aortic aneurysms.


Low rectovaginal fistulas. Approach and treatment. Experience with thirty-two patients with a low rectovaginal fistula with or without attendant sphincter damage is reported. The technic used is advancement of the anterior rectal wall with excision of the infected anal glandular tissue and repair of muscle tissue when indicated. Anorectal infection and childbirth injuries were the common causes. An acceptable recurrence rate was achieved. Colostomy was not used in this series.


Criteria for selection of patients for emergency portacaval shunt. A computer program analysis of the effect on survival of 74 preoperative factors was performed as part of a prosepctive study of the emergency portacaval shunt in 146 unselected patients with bleeding esophageal varices due to alcoholic cirrhosis. Only ascites, a serum glutamic oxalacetic transaminase level of 100 units or more, and a requirement for 5,000 ml or more of blood transfusion were associated with a statistically significant decrease in survival. However, none of these factors are contraindications to operation because their presence permits a survival rate of 37 to 40%. The only contraindication to emergency portacaval shunt is the combined presence of ascites, jaundice, encephalopathy, and severe muscle wasting, a constellation that was incompatible with survival beyond one year.


Below-knee amputation: a modern approach. Immediate and long-term results of 113 below-knee amputations in 103 patients are presented to justify a comprehensive program of management that includes an objective method for determining amputation level with xenon 133 clearance, precise surgical technic, immediate postoperative prosthesis, and an aggressive program of rehabilitaion. Prediction of healing of the last 30 below-knee amputations was 100% successful, showing the value of 133Xe clearance for determination of amputation level. Zero per cent thirty-day mortality and 100% prosthetic rehabilitation of patients on below-knee prostheses justifies the use of immediate postoperative prosthesis. Long-term follow-up of our patients demonstrates that the five year survival rate of diabetic patients is poor (39%) compared with the nondiabetic amputee (75%) who approached the survival of the normal, age-adjusted male population (85%). The fact that 75% of patients were alive after five years and were still independently ambulatory on their prostheses is final testimony to the value of the program.


The modern enigma of radiation enteropathy: sequelae and solutions. With the extended indications for abdominal and pelvic radiation therapy, administered at higher dosage levels, an increased incidence of radiation injury to the intestine can be anticipated. Increased efforts are urgently needed to develop innovative methods in the detection, prevention, and management of radiation-induced intestinal injury. Fifty cases of radiation enteropathy have been reviewed to highlight problems in management and to suggest preventive and therapeutic measures, both surgical and nonsurgical.


A study of fundoplication disruption and deformity. Three distinct forms of postoperative breakdown after Nissen fundoplication have been discussed. Disruption and recurrent reflux is most common, with slipping occurring infrequently. For the first time, three patients developing a proximal gastric pouch deformity causing partial obstruction of the fundus without recurrent herniation are reported on. Two patients required remedial surgery.


Congenital arteriovenous fistula of the maxillofacial region. Long-term follow-up is essential to evaluate our present modalities of treatment of arteriovenous malformations of the maxillae. Embolization followed by surgical resection has produced long-term survival in our patient population.


Carcinoma of the gastroesophageal junction. A ten year experience with esophagogastrectomy. Eighty-six patients with carcinoma of the gastroesophageal junction were treated between 1966 and 1976. Adenocarcinoma was present in 62 patients and squamous cell carcinoma in 24. Surgical exploration was performed on 68 patients (79%) and 52 lesions (60%) were resected by combined midline laparotomy and right thoracotomy. There were 6 deaths (11%), 2 due to anastomotic leak. The mean survival for all resected patients was 2.1 years with a 22% three year life table survival (10/52). Five of 14 patients with negative nodes are alive more than five years. Palliative resection in 17 patients resulted in a mean survival of 10.5 months and no five year survivals. Esophagogastrectomy utilizing the Lewis technic reduces operative mortality and extends survival for patients with carcinoma of the gastroesophageal junction.


Kinking of the internal carotid artery. Clinical significance and surgical management. Observations of a series of fifteen surgically treated coiled and kinked internal carotid arteries are reported. The kinked internal carotid artery may be clinically significant and can cause cerebral infarction, even in the absence of atherosclerosis. Each patient must be thoroughly investigated and evaluated individually. One must distinguish simple tortuosity without blood flow obstruction from critical kinking of the internal carotid artery. If a patient with angiographic confirmation is symptomatic and other causes are eliminated, surgical correction should be carefully considered, especially if rotational cerebral ischemia is present. The surgical treatment of choice is resection of the redundant internal carotid artery with reimplantation and thromboendarterectomy of any associated plaque. Kinking of the internal carotid artery may lead to aneurysm formation requiring a difficult surgical resection. Although the evidence for a precise causal relationship between kinking of the internal carotid artery and cerebrovascular symptoms is sometimes difficult to establish, it is our belief that a more aggressive surgical approach may be warranted in this potentially disabling and even fatal condition.


Leiomyosarcoma of artery and vein.

Leiomyosarcoma of artery and vein. Five cases of leiomyosarcoma of blood vessels--three venous, two arterial--are reported. Treatment was surgical alone in two patients with involvement of the internal mammary artery and the long saphenous vein. The other three were treated initially by surgery, followed by radiation therapy, and surgery aimed at either total or partial removal of metastases. Two patients are alive and well, free of disease. Two patients have died of their disease despite all modalities of treatment, and one patient has a life-threatening metastases and is not expected to survive.


Electrical injuries, with special reference to the upper extremities. A review of 182 cases. A twenty year experience in the management of 182 patients with electrical injuries has been reviewed. Males predominate. The average age is thirty-six years. Bodily contact with high tension wires by linemen constituted the most common accidents. High voltage injuries were sustained by 67% of patients. Burns were sustained by 74% of our cases and of these, 71% involved the upper extremities. Complications developed in three fourths of patients, and one third of patients suffered some degree of permanent disability. Mortality (2.1%) was largely due to septicemia, pneumonia, and renal failure. The wide variety of injuries necessitates individualization in treatment. Prevention offers greatest hope in management.


Airway closure and pregnancy.

Airway closure and pregnancy. During pregnancy there is a fall in functional residual capacity and expiratory reserve volume. The point of airway closure in relation to vital capacity and the expiratory reserve volume was determined in 11 post-partum patients who had previously been studied during pregnancy. The lung volume at which airway closure occurred in pregnancy and the post-partum period did not change in relation to the vital capacity whereas the expiratory reserve volume did, so that airway closure became imminent in the pregnant women during tidal ventilation, especially whilst in the suping position. The significance of this alteration in pulmonary function to obstetric anaesthesia is discussed.


Oxygen uptake following deep hypothermia. Oxygen uptake of the body (Vo2) was measured in 9 children undergoing surgical correction of congenital heart lesions using cardiopulmonary bypass and deep hypothermia at 20 degrees tc with circulatory arrest. Initial levels of Vo2 following circulatory arrest were found to be four times greater than would have been expected from the normal relationship between Vo2 and body temperature, but within 8-10 minutes had fallen to normal levels. The quantity of oxygen taken up by the body during this time is similar to theoretical values for the quantity of oxygen inphysical solution, at 20 degrees C, in the tissues. It is postulated that during deep hypothermia the increased amount of oxygen in physical solution in the body plays an important part in preventing tissue damage during circulatory arrest.


Adult coarctation of the aorta: Anaesthesia and postoperative management. The complications following surgery for the correction of aortic coarctation are reviewed. The immediate postoperative increase in blood pressure is associated with a very high (750%) increase in plasma noradrenaline concentrations. The pre-operative management and preparation of the patient, the use of induced hypotension during surgery with careful haemodynamic control to prevent the hypoperfusion of the lower segment of the aorta, and the postoperative management with special reference to adequate control of blood pressure are discussed.


Neurobehavioural responses of the newborn. The effect of different forms of maternal analgesia. A neurobehavioural assessment made of infants within 4 hours of delivery revealed that infants born to mothers receiving pethidine and promazine showed significantly worse overall scores than babies of mothers receiving either no analgesia or a lumbar epidural using bupivacaine.


Laryngeal oedema associated with pre-eclamptic toxaemia. Pre-eclamptic toxaemia is a common complication of late pregnancy. However, the occurrence of clinically unsuspected laryngeal oedema has not, to the authors' knowledge, been described previously. Experience of such a case leads them to recommend that a selection of tracheal tubes ranging from 8 to 4-5 mm, be available when anaesthesia is undertaken in patients who have oedema associated with pre-eclamptic toxaemia.


A technique for sealing glass syringes.

A technique for sealing glass syringes. A device is described for the sealing of glass syringes, which allows the removal of multiple aliquots from the syringe. There is no demonstrable deterioration in the oxygen content of the sample 1 hour after multiple aliquot removal, when the sample syringe is stored in an ice/water mixture.


Throat packs for surgery. An improved design based on anatomical measurements. A method of measuring the static dimensions of the human pharynx is presented. An entirely new approach to the design of both an oropharyngeal, and a pharyngeal throat pack is described. The new throat packs have been tested in clinical practice and found to have advantages. Pollution within the dental surgery by anaesthetic gases is discussed and the influence of the oropharyngeal pack on this problem is illustrated.


Entonox analgesia--a method of reducing the delay between demand and supply. Mothers in labour using a self-administered 50% N2O and 50% O2 (Entonox) demand system, experience a time lag between making a demand at the onset of a contraction and pain relief. A practical method is described of reducing this time lag by supplementing the intermittent supply from the demand valve system with a continuous nasal flow of N2O and O2. Consequently a basal arterial N2O tension is maintained and when a demand is made, a higher level of N2O is attained in any time interval compared with that using the demand system alone. In six trained volunteers under laboratory conditions, the N2O levels measured at the mouth on a breath-by-breath basis using a mass spectrometer, showed a substantial and statistically significant reduction in the time taken to attain end-tidal N2O concentrations in the range 10-25%. This method seems worthy of a clinical trial.


Analgesia in patients with fractured shaft of femur. Patients who have suffered from a fracture of the shaft of the femur require urgent pain relief and this is most effectively achieved by block of the femoral nerve.


[Influence of modern inhalation anaesthetics on haemodynamics, myocardial contractility, left ventricular volumes and myocardial oxygen supply (author's transl)]. The cardiocirculatory responses to equianaesthetic concentrations (MAC 0.5 and MAC 1.0 plus 67% N2O) of halothane, methoxyflurane, enflurane and isoflurane were studied in a total of 35 closed-chest dogs during ventilation controlled to produce normocapnia. Each anaesthetic produced a dose-related decrease in mean arterial pressure and in values reflecting cardiac function. These included cardiac output, stroke volume, left ventricular max dp/dt and ejection fraction. Isoflurane seemed slightly less depressant to the heart than the other 3 anaesthetics. Total peripheral resistance remained nearly unaffected during halothane and methoxyflurane anaesthesia but decreased significantly with MAC 1.0 enflurane and isoflurane. There was no change in heart rate at low anaesthetic concentrations. The deeper levels of anaesthesia were associated with moderate increases in heart rate. In spite of the obvious depression of myocardial contractility there was a fall in pulmonary artery and left ventricular end-diastolic pressures and in left ventricular end-diastolic volumes with each of the agents. We take this as an expression of decreased ventricular filling resulted from pooling of blood in peripheral capacitive vessels. With the exception of isoflurane, each of the other three anaesthetics reduced coronary blood flow. Coronary vascular resistance was not substantially influenced by halothane and methoxyflurane, but decreased with MAC 1.0 enflurane and isoflurane. Myocardial oxygen availability was always found to be adequate. Isoflurane even produced a significant rise in coronary venous oxygen saturation indicating coronary vasodilation. Parallel with the depression in cardiac performance and blood pressure as two of the main predictors of energy demand, myocardial oxygen consumption was found to be significantly reduced by each of the anaesthetics. The ratio of the external work of the left ventricle to its oxygen consumption indicated that myocardial efficiency deterioated. The clinical implications are discussed.


[Combination of etomidate and fentanyl. Haemodynamics, inotropic state, myocardial oxygen consumption, and vascular reactions (author's transl)]. The influence of a combination of fentanyl (0.1 mg) and etomidate (0,15 mg/kg and 0.3 mg/kg) on haemodynamics, inotropic state, myocardial oxygen consumption and vascular reaction has been investigated in 60 patients with congenital or acquired heart diseases--mostly functional class III according to NYHAC. Because of minor changes in haemodynamics (decrease in mean arterial pressure, left ventricular pressure, peak dp/dt, cardiac index, stroke index) the combination of 0.15 mg/kg etomidate and 0.1 mg fentanyl seems to be of great value for induction of anaesthesia in patients with cardiac disease compared to other intravenous induction agents such as propanidid, thiopentone or althesin. In accordance with the changes in haemodynamics there was a 12% and 18% decrease in myocardial oxygen consumption, respectively.


[Effect of high dosages of morphine and meperidine on haemodynamics, coronary blood flow and myocardial oxygen consumption in comparison to fentanyl and piritramide (author's transl)]. Although morphine is one of the oldest drugs known to man, it has only recently been used in large doses as an anesthetic agent. The main advantage is the cardiovascular stability. The purpose of this investigation was to study the circulatory response to high equianalgesic doses of morphine and meperidine. In 10 closed chest dogs during normoventilation and light background-anaesthesia (0.5 Vol. % halthane; N2O:O2 = 2:1) 2.0 mg/kg morphine and 15.0 mg/kg meperidine were given at random. Morphine produced a decrease in mean arterial blood pressure by 28%, which was paralleled by an identical fall in total peripheral resistance. No negative inotropic effects were found. In contrast to this, the severe hypotension developing with meperidine (decrease in blood pressure by 54%) was the result of peripheral vasodilatation (46%) and of myocardial depression indicated by a sharp drop in dp/dtmax (59%), dp/dtmax/IP (14%) and in left ventricular ejection fraction (33%). Utilizing the thermodilution technique, the cardiac output remained largely unaffected with both narcotic analgesics, as the increase in heart rate (morphine 27%; meperidine 101%) compensated for the fall in stroke volume (morphine 19%; meperidine 55%). In spite of the altered haemodynamics there was no change in the myocardial energy demand, which was adequately met by the coronary blood flow measured with the pressure-difference technique. Both, morphine and meperidine, produced initially an increase in coronary blood flow and coronary venous oxygen saturation indicating coronary vasodilation. While the mechanism for the change in cardiovascular status with high doses of morphine is vasodilatation probably due to histamine release, the results of this study suggest a peripheral as well as a central (myocardial depression) site of action with meperidine. The results obtained from this study were compared with the data from a previous investigation on equianalgesic doses of fentanyl and piritramide and their clinical implications were discussed.


[The cardiovascular effects of the inspiratory N2O-concentration during piritramide anaesthesia in the dog (author's transl)]. Administration of nitrous oxide following large doses of narcotics has been reported to impair myocardial performance. In this investigation the effect of the inspiratory N2O-concentration (F1N2O = 0.0; 0.2; 0.4; 0.6; 0.8) upon haemodynamics, inotropism of the heart, coronary blood flow and myocardial oxygen consumption was studied in 8 dogs, which were normoventilated and narcotized with piritramide infused continuously (2.5 mg/kg-h). While 40% N2O(F1N2O = 0.4) decreased cardiac index (18%) and mean arterial pressure (5%) and increased total peripheral resistance (11%) significantly, the remaining inspiratory N2O-concentrations did not affect these parameters considerably. Load data, heart rate and the continuous decrease of LVdp/dtmax from 3170 mm Hg/s (F1N2O - 0.0) to 2175 mm Hg/s (F1N2O = 0.8) indicated negative inotropic properties of high concentrations of nitrous oxide. The myocardial oxygen demand, which was adequately met by the coronary blood flow, decreased with increasing N2O-concentrations initially by 18% (F1N2O = 0.4) due to bradycardia, slight hypotension and reduction in inotropism. Inhalation of 80% N2O, however, returned the energy demand of the heart to control levels (F1N2O = 0.0) resulting from increased myocardial wall-tension (increase in left ventricular end-diastolic pressure by 30%). The efficiency of left ventricular external work decreased from 18.6% (F1N2O = 0.0) to 14.7% (F1N2O - 0.8) indicating that myocardial performance was uneconomically influenced by high inspiratory N2O-concentrations and large doses of narcotics. The clinical implications of the results were discussed.


[The effects of the vasodilator nitroprusside on haemodynamics and myocardial oxygen consumption during drug induced myocardial depression (author's transl)]. The effect of the vasodilator nitroprusside (NP) on haemodynamics and myocardial oxygen consumption during drug induced myocardial oepression was examined in dogs (n = 7). The investigations were performed on closed chest dogs lightly anaesthetized with piritramide and N2O/O2 (ratio 2:1) under controlled ventilation and after beta-adrenergic blockade (1.5 mg/kg propranolol). After a loading dose and a continuous infusion of 0.3 mg/kg X min of pentobarbitone left ventricular maximum dp/dt was reduced to 50% of the control level, which was taken for granted as a standardized myocardial depression. Using an infusion of NP at a mean rate of 7 microgram/kg X min mean arterial pressure was then lowered to 80 mmHg for 20 min. The vasodilator therapy led to an increase in cardiac output and in stroke volume by 16%. Since the calculated endsystolic volume of the left ventricle decreased simultaneously (19%), the ejection fraction increased from 38% to 46%. There was also a significant reduction in left ventricular enddiastolic pressure (46%), which is supposed to result from the combined effects of an improved myocardial performance, a pooling of blood in peripheral vessels (indicated by decreases in enddiastolic volume by 6%, in mean pulmonary arterial pressure by 25% and in central venous pressure by 45%) and an increased ventricular compliance. Since the myocardial wall tension, a major determinant of myocardial energy demand, was lowered by increased ventricular compliance and reduced pre- and afterload, the oxygen consumption of the heart decreased by 22%. The smaller demand was supplied by an unchanged coronary blood flow. The narrowing of the a-v oxygen difference of the heart indicated a coronary dilatation (10%). The results obtained from this study support the clinical observations that NNP may improve an imbalanced ratio between myocardial oxygen supply and demand, in patients with impaired cardiac performance.


[So-called juxtaglomerular benign tumor of the kidney with renin secretion. Optical and ultrastructural study]. Benign renin secreting tumors of the kidney, of which the authors report a new case, are an uncommon cause of arterial hypertension. The lesion is unique, benign, richly vascularized and constituted by epithelioid cells similar to those seen in the normal juxta-glomerular apparatus. Noteworthy and of great diagnostic value is the massive infiltration of the tumoral tissue by mastocytes. The ultrastructural examination clearly shows the differentiation of the secretory cells from the smooth muscular fibresof the vessel walls. The other types of renin secreting tumours are briefly considered.


[Eosinophilic granulomatous hepatitis. Apropos of a case of toxocariasis]. The author reports an anatomoclinical observation of eosinophilic granulomatous hepatitis due to toxocariasis. The problems of the histologic differential diagnosis are discussed. Human cases of parasitic infestation by Toxacara canis--larva migrans syndrome--are quite uncommon (1, 2). In the acute stage the hepatic lesion most often consists in eosinophilic granulomatous hepatitis. The chance finding of an eosinophilic granuloma in a puncture biopsy of the liver may rise problems as concerns the histological differential diagnosis, especially when there is no clinical evidence of a parasitosis and when no parasite is found in the biospy specimen.


Bovine peripheral blood monocyte cultures: growth characteristics and cellular receptors for immunoglobulin G and complement. Bovine peripheral blood monocytes were cultured in vitro for as long as 60 days. Although mitotic figures were not observed, the amount of cytoplasm was observed to increase; most cultures developed multinucleated cells, some containing as many as 200 nuclei. In multinucleated cells, the nuclei were peripherally distributed around a cytoplasmic matrix and surrounded by an undulating membrane. Receptors on macrophages were identified with erythrocytes sensitized with various immunoglobulins and complement (C'). A receptor for immunoglobulin G, but not immunoglobulin M, was detected. By the use of freshly prepared equine serum, a C' receptor was detected; however, by the use of freshly prepared bovine serum, C' receptor was not detected.


Radiation-induced alpha-thalassemia in mice. The clinical hematologic change in 2 groups of progeny from mice carrying radiation-induced strain SEC alpha-chain deficiencies was found to be similar to the hematologic alterations in persons with alpha-thalassemia. The heterozygous deletion or inactivation of the alpha-chain gene in mice caused an anemia similar to alpha-thalassemina minor in persons. The alpha-chain deficiency in mice created an erythrocytosis, reticulocytosis, and microcytic, hypochromic anemia comparable with the changes in human alpha-thalassemia minor resulting from deletion of the alpha-chain gene. These mouse mutants are the only known animal models of human thalassemia. A comparison of hematologic values obtained from progeny possessing an alpha-chain gene deficiency and from progeny possessing a beta-chain duplication suggested that the deficiency of alpha-chain synthesis, rather than a simple imbalance between the amounts of alpha- and beta-chains produced, was primarily responsible for the altered hematologic characteristics in these alpha-thalassemic mice.


Asynchronous growth of the canine radius and ulna: effects of cross pinning the radius to the ulna. Kirschner wires were introduced into the diaphyseal region of the radius and the ulna in 4 Australian shepherd crossbred pups, and change in relationships between the bones during growth was demonstrated. The contributions to longitudinal growth of the radius from proximal and distal growth plates were also calculated. Over the period of growth, the proximal growth plate contributed approximately 40% of the length of the radius. A marked shifting of the radius in relationship with the ulna occurred. This normal shifting between radius and ulna was prevented in 6 dogs by cross pinning the radius to the ulna at 90, 111, 142, and 168 days of age. Marked change was produced in the elbow joint, where altered relationships of articular surfaces of the radius and the ulna resulted in displacement of the humeral condyle from the trochlear notch of the ulna. Changes in dogs cross pinned at 90 and 111 days of age were most severe and consisted of severe degenerative changes which were most marked on the lateral side of the distal half of the trochlear notch of the ulna.


Hair follicle cycle and shedding in male beagle dogs. Skin biopsy samples were collected from the thoracolumbar region of 9 male Beagle dogs ranging in age from 2 weeks to 32 months. The highest percentages of anagen hair follicles were present in samples collected during the winter and the summer seasons, and highest percentages of telogen hair follicles were present in samples collected during the fall and the spring seasons. Catagen, never exceeding 7% of the follicles, was found during a brief transitory stage. Peak shedding of hairs combed from the coats of dogs occurred in the spring and fall--these peaks appearing simultaneously with peak percentages of hair follicles in the telogen phase. Dogs younger than 1 year of age had 10% fewer follicles in the telogen stage than did older dogs. In dogs 2 weeks of age, 12 to 16% of the hair follicles were in the telogen stage.


Efficacy of nithiamide in preventing and treating swine dysentery in experimentally inoculated pigs. In a series of experiments, weanling pigs (12 to 18 kg av weight) were inoculated by means of feed with scrapings and contents of dysenteric colons. Mucohemorrhagic diarrhea developed in 97% of the infected, nonmedicated pigs, and 80% of these pigs died. Prophylactic feed medication with nithiamide at dose levels of 600, 300, or 150 ppm beginning 2 days before inoculation to 28 days after inoculation prevented the development of swine dysentery and permitted performance equal to that of the noninfected nonmedicated pigs. Morbidity and mortality were reduced by medication with 100 ppm of nithiamide but these were not influenced by medication with 50 ppm. Therapeutic feed medication with nithiamide at a dose level of 150 ppm beginning the day after diarrhea first occurred was not effective. A single oral dose of nithiamide (25 mg/kg of body weight), when diarrhea first occurred in each pig, produced rapid remission of the signs of dysentery; relapses occurred 1 to 2 weeks later, however, and mortality followed. The combination of oral dosage and feed medication was highly effective in treating dysentery, preventing its recurrence, and maintaining performance.


Finite purification of Anaplasma marginale: serologic inactivity of the anaplasma body. Anaplasma bodies finitely purified by affinity chromatography to eliminate all traces of erythrocytic stromata were not agglutinated by serum from calves having acute anaplasmosis. The stromata which were associated with the anaplasma bodies were also finitely purified and agglutinated with such serum. The evidence indicates that the antibody in anaplasmosis that is detected by agglutination tests is directed against the erythrocytic stromata and not against the finitely purified anaplasma bodies.


Serum electrolytes in normal pygmy goats. Serum from pygmy goats was analyzed to determine normal base lines for electrolytes. Animals of both sexes were used. Influence of age on these variables was also investigated. The electrolyte values were as follows: sodium, 147 +/- 6.0 mEq/L; potassium, 5.6 +/- 1.0 mEq/L; chloride, 106.0 +/- 4.2 mEq/L; calcium, 4.9 +/- 0.3 mEq/L; magnesium, 2.1 +/- 0.3 mEq/L; and inorganic phosphorus, 4.8 +/- 0.9 mEq/L. Most of the serum electrolyte values for pygmy goats were similar to reports for other ruminant species and human beings.


Serum proteins and protein electrophoretic pattern in normal pygmy goats. The values of total protein and protein electrophoretic patterns for pygmy goats were studied to establish normal basic values. The values obtained in the present study were as follows: alpha1-globulin, 0.6 +/- 0.1 mg/dl; alpha2-globulin, 1.0 +/- 0.3 mg/dl; beta-globulin, 0.5 +/- 0.1 mg/dl; gamma-globulin, 1.6 +/- 0.1 mg/dl; total protein, 7.3 +/- 0.7 mg/dl; albumin, 3.2 +/- 0.6 mg/dl; A/G ratio, 0.8 +/- 0.3 mg/dl; and globulin, 4.5 +/- 0.6 mg/dl. Goats were divided into groups on the basis of age and sex to determine if any significant differences were present in these groups. Of the 8 variables studied, only albumin and A/G ratio showed significantly different values due to sex; castrated males showed significantly lower values than thos for intact males and females (P less than 0.05). Also, A/G ratio values for females and castrated male pygmy goats were significantly lower than those for intact males (P less than 0.05). Total serum protein values studied in female pygmy goats at various ages were also significantly different (P less than 0.05).


Prevalence of Echinococcus granulosus and other cestodes in dogs on the Navajo reservation in Arizona and New Mexico. Fecal specimens from 429 dogs purged with arecoline hydrobromide at 131 rural camps on the Navajo Reservation in Arizona and New Mexico were examined for cestodes. Echinococcus granulosus was found in feces from 3 dogs at 3 different camps. Other cestodes present were Taenia hydatigena--45.5%, Taenia pisiformis--21.0%, Taenia serialis--11.9%, and Taenia ovis--1.6%.


Scanning electron microscopy of equine synovial membrane. The scanning electron microscopy of synovial membrane from the radiocarpal and intercarpal joints near the lateral and medial borders of the tendon of the extensor carpi radialis muscle was studied in 5 ponies. Three different morphologic types of synovial membrane were observed. Type 1 synovial membrane was folded and had a surface mat of fibers separated by 1- to 5-micron-diameter holes. The 2nd and 3rd types of synovial membrane were both villous. The surface of type 2 synovial membrane was fibrillar but the surface of type 3 synovial membrane was cellular. The type of synovial membrane present was related to the function of the joint capsule region rather than to the type of subintimal connective tissue. Normal equine synovial membrane was found to be more villous in some regions of the joint capsule than synovial membrane of other species.


Critical tests of the antiparasitic activity of thiabendazole and trichlorfon sequentially administered to horses via stomach tube. Thirteen critical tests were conducted in horses naturally infected with helminths and bots. Single doses of thiabendazole (44 mg/kg of body weight) and trichlorfon (40 mg/kg of body weight) powder formulations were administered as suspensions sequentially given via stomach tube to evaluate the efficacy of the combination against the large parasites of horses. Parasite removal efficacies were 100% against 2nd instar Gasterophilus intestinalis and 2nd and 3rd instar Gasterophilus nasalis and 82 to 100% against 3rd instar G intestinals. There were complete removals of mature and immature Parascaris equorum and mature Oxyuris equi. Removal efficacies against Strongylus vulgaris were 89 to 100% and against Strongylus edentatus, 82 to 100%. Of 2 horses infected with Strongylus equinus, removals were 72 and 100%. Seven of the 13 horses treated had transient, semi-liquid feces during the posttreatment hours 1 through 24.


Cardiac output, left ventricular ejection rate, plasma volume, and heart rate changes in equine laminitis-hypertension. Acute laminitis-hypertension was produced experimentally by carbohydrate overloading of the gastrointestinal tract in 8 horses, and the resulting hemodynamic changes were measured. Statistically significant (P less than 0.01) increases in cardiac output, left ventricular ejection rate, heart rate, and arterial pressure were related to statistically nonsignificant changes in peripheral resistance and a delayed (Obel grade 3 plus 24 hours) decrease in plasma volume. When compared with control values, the doubling of cardiac output and left ventricular ejection rate simultaneous with little or no change in either peripheral resistance or plasma volume (16 hours after the occurrence of Obel grade 3 lameness) was suggestive of an increase in myocardial contractility. Because these pathophysiologic phenomena have important time relationships to the onset of Obel grade 3 lameness in acute laminitis, the results of this investigation are discussed in light of their relationship to clinical signs, serum electrolyte changes, plasma L-lactate alterations, and histologic deterioration of the digit.


Vitamin E enhancement of Venezuelan equine encephalomyelitis antibody response in guinea pigs. Immune response potentiation by vitamin E was studied in guinea pigs with Venezuelan equine encephalomyelitis attenuated live-virus vaccine as the antigenic stimulus; antibodies were measured by the hemagglutination-inhibition (HI) test. Significantly higher (P less than 0.01) HI antibody titers resulted when guinea pigs were given intramuscular injections of dl-alpha-tocopherol, 33 IU/kg of body weight, before and after immunization. The HI antibody titers to Venezuelan equine encephalomyelitis virus were not increased when guinea pigs were given dl-alpha-tocopheryl acetate orally. This is the first report on vitamin E humoral immune response enhancement to an attenuated live-virus vaccine.


Physical optics of the equine eye.

Physical optics of the equine eye. The equine eye was treated as a general lens system and calculations were done to determine image position in relation to the retina for objects at a distance of infinity, 100 m, and 1 m. The retina is 19.1 mm behind the posterior surface of the lens; therefore, the image appears 14.6 mm posterior to the retina at infinity and at 100 m, and 16.3 mm at 1-m distance on a horizontal axis. The animals studied were hyperopic. It is evident that the horse must move its head or eye, or both, for optimal visual acuity. At the same time, some objects in the total field of vision are imperceptible or indistinct.


Metabolism of [14C]glucose in Haemobartonella-like infected erythrocytes in splenectomized calves. A quantitative relationship was established between glucose utilization by Embden-Meyerhof glycolytic pathway and hexose monophosphate shunt in erythrocytes from splenectomized calves infected with a Haemobartonella bovis-like organism. Parasitized erythrocytes metabolized glucose 3.69-fold above normal. Embden-Meyerhof glycolytic pathway accounted for 99.4% of glucose utilization, and the remainder, by hexose monophosphate shunt.


Isolation and identification of Staphylococcus hyicus. A selective medium for the isolation of Staphylococcus hyicus, with potassium thiocyanate as selective substance and the polysorbate 80 reaction as elective marker, was developed. The organism could be identified during the routine examination of samples derived from pigs, using 2 relatively simple tests: the slide coagulase (clumping factor) and the deoxyribonuclease plate reaction. The S hyicus was isolated from 54% of 684 samples collected from nares, external ears, and skin covering the nose of pigs not affected by exudative epidermatitis. Isolates from these animals did not appear to differ in pathogenic potentials from those obtained from lesions.


Enhancement of phytohemagglutinin and concanavalin A responses of splenic lymphocytes by adherent cell removal. Removal of glass wool-adherent cells resulted in an enhancing effect on DNA synthesis as measured by increased [3H]-thymidine uptake by normal swine spleen cells stimulated with phytohemagglutinin or concanavalin A (Con A). Depletion of nylon-adherent cells caused decreased DNA synthesis in response to Con A, except at high doses of Con A, whereas similar cultures stimulated with phytohemagglutinin showed enhanced DNA synthesis throughout the dose range employed. Titration experiments revealed that enhancing effects of adherent cell removal are most pronounced at higher cell and mitogen concentrations. Glass wool was more efficient than nylon in the enhancement of mitogen-induced DNA synthesis.


Developmental arrest of Haemonchus contortus larvae in lambs given larval inoculum exposed to different temperatures and storage conditions. The temperature (15 or 30 C) at which Haemonchus contortus larvae were allowed to develop to the infective (3rd) stage and the temperature at which they were subsequently stored (4, 15, or 30 C) had no effect on the occurrence of developmental arrest (larval impasse) of the larvae in infected lambs. If a large inoculating dose (10,000 larvae) was given to the lambs, a smaller percentage of nematodes was retained (14.2%) then if a small dose (1,000 larvae, 25.8% retention) was given, but the percentage of larvae in developmenttal arrest was greater (7.7% of the retained nematodes vs 0.02%). The temperatures of larval development and storage had no effect on the sex ratio of the adults that developed (46.3% male nematodes).


Albendazole as a fasciolicide in experimentally infected sheep. The new drug albendazole (methyl [5-(propylthio)-1H-benzimidazol-2-yl]carbamate) was tested in 90 sheep experimentally infected with Fasciola hepatica. Dose rates of 10, 15, and 20 mg/kg of body weight were active against adult flukes, with efficacies of 98, 95, and 100% respectively. The drug was less active against immature F hepatica at 3 weeks after sheep were inoculated. The drug given at dose rates of 20, 30, 40, and 50 mg/kg had efficacies 24, 47, 63, and 76%. Flukes were not found at posttreatment hour 48 in bile ducts of sheep given a dose of 20 mg/kg. Evidence of drug toxicity was not seen.


Characterization and treatment of water, electrolyte, and acid-base imbalances of induced urethral obstruction in the cat. Urethral obstruction induced in adult male cats caused clinical signs identical with those observed in naturally occurring disease. Central nervous system depression, anorexia, dehydration, vomiting, muscle weakness, and hypothermia occurred. Weight loss (due to water loss and catabolism), metabolic acidosis, mild hyponatremia, hyperkalemia, hypermagnesemia, hypocalcemia, hyperphosphatemia, hyperglycemia, azotemia, and hyperproteinemia were also observed. Serum amylase, alkaline phosphatase, and alanine aminotransferase activities were normal. Ten of 13 cats (group 1), with 72 hours' induced obstruction but not treated with parenteral fluids, died either before the obstruction was relieved or within 8 days afterward. Eight cats (group 2) with induced obstruction for 49 to 98 hours developed severe clinical and biochemical alterations. Treatment with a multiple-electrolyte solution, in addition to relief of urethral obstruction, resulted in favorable clinical and biochemical responses. These cats survived and were clinically healthy at 9 to 10 days after relief of obstruction. It was concluded that use of a multiple-electrolyte solution to correct acidosis, restore circulatory volume, and enhance renal excretion of potassium was effective supportive therapy after urethral obstruction was removed.


Cardiovascular effects of atropine on acupuncture, needling with electrostimulation, at Tsu San Li (St-36) in dogs. Acupuncture, needling with electrostimulation, at Tsu San Li (St-36) produced (1) significant decrease in cardiac output, (2) decrease in stroke volume, (3) increase in total peripheral resistance, and (4) minimal changes in heart rate, mean arterial pressure, pulse pressure, and central venous pressure in dogs under halothane anesthesia. Atropine given alone and given before acupuncture at Tsu San Li (St-36) produced (1) early significant increase in cardiac output, (2) early significant increase in heart rate, (3) increase in mean arterial pressure, (4) decrease in total peripheral resistance, and (5) minimal changes in stroke volume, pulse pressure, and central venous pressure in anesthetized dogs. It was concluded that the effects of acupuncture at Tsu San Li (St-36) were parasympathomimetic-like and that these effects could be blocked by atropine, a parasympatholytic drug.


Studies on the pathogenesis of Rickettsia rickettsii in the dog: clinical and clinicopathologic changes of experimental infection. Beagle dogs inoculated with the agent of Rocky Mountain spotted fever, Rickettsia rickettsii, developed a clinical syndrome that extended from febrile exanthema to death and appeared to be dose related. Infected dogs were anorectic and lethargic and developed cutaneous lesions characteristic of Rocky Mountain spotted fever, including petechia, ecchymosis, edema, and necrosis. Hematologic changes after inoculation included anemia, leukopenia proceeding to leukocytosis, and thrombocytopenia. Changes in blood chemistry values included increases in serum alkaline phosphatase and cholesterol, and hyponatremia and hypochloremia. The prominent histopathologic change was necrotizing vasculitis. The canine disease is comparable with human Rocky Mountain spotted fever on a clinical, hematologic, biochemical, and pathologic basis, and may provide a model system for this disease in man. The results suggest the dog may be involved in the epidemiology of R rickettsii infections.


Occurrence and fate of corpora amylacea in the bovine udder. The presence and location of corpora amylacea were studied quantitatively by biopsy technique in separate glands of a normal cow during a lactation cycle. Corpora amylacea were present in alveoli throughout lactation without any evidence of an abnormal bacterial flora or an inflammatory reaction. The corpora amylacea were most numerous during the decline in lactation, approximately 95% being in the alveoli. During the nonlactating (dry) period, there was approximately a 50% decrease in the number of corpora amylacea, with about 90% of those remaining being in the interstitial tissue. They appeared to enter the interstitial tissue passively coincident with atrophy of alveoli.


Production and characterization of Moraxella bovis hemolysin. Moraxella bovis hemolysin was produced in trypticase soy broth and maximum hemolytic activity of the culture was observed during the logarithmic phase of growth. The hemolysin was filterable through a 0.22-micrometer (APD) membrane filter, heat labile, and destroyed by treatment with formalin or trypsin. There was no difference in the amount of hemolysin production by rough or smooth colony types of an isolate, although differences were observed between 2 different isolates. Partial requirement of a sulfhydryl group and divalent cations were suggestive of an enzymatic nature of M bovis hemolysin.


Parasitism (Trichostrongylus colubriformis and Eimeria ninakohlyakimovae) in sheep: relationship between wool fiber diameter changes and feed conversion efficiency. Twenty-five lambs, 5 months of age, were used to compare the infection pressure of Trichostrongylus colubriformis with that of Eimeria ninakohlyakimovae. Effects of the parasitic infection pressure were assayed by determining body weight gains, feed conversion efficiencies, and wool fiber diameter changes (reflecting changes in protein metabolism) in lambs fed a good ration and those given a marginal diet (dehydrated alfalfa pellets). Significant differences in weight grains or feed conversion efficiencies of nematode- or coccidia-infected lambs and noninfected controls were not found, but significant differences due to the parasites' effect on wool fiber diameters and in lamb response to different feeds were found. Protein uptake or assimilation, or both, were apparently affected by a combination of infection with E ninakohlyakimovae and a marginal diet.


Feline factor XII (Hageman) deficiency.

Feline factor XII (Hageman) deficiency. A coagulation profile from a clinically normal female cat revealed an intrinsic coagulation defect characterized by prolonged activated partial thromboplastin time, with normal bleeding time, platelet count, and prothrombin time. Subsequent correction studies, utilizing activated partial thromboplastin time, confirmed factor XII deficiency. Hematologic and clinical studies on the cat failed to reveal an underlying disease process that might result in acquired factor XII deficiency.


Kidney in the aging cat: neutral lipid and adenyl cyclase histochemistry. Neutral lipid and adenyl cyclase were evaluated to determine their concentrations in the kidney of the aging cat. Kidneys from 24 domestic cats 2 months to 7.5 years old in 6 age groups were examined by light microscopic and histochemical methods. Activity in anatomic components of the kidney was assessed on a quantitative basis for evaluation of mean activity between the age groups. Renal components generally were stable in activity in the cats with advancing age. A significant increase in lipid concentration occurred in the convoluted segments of the proximal tubules with advancing age. In contrast, the straight segments of the proximal tubules displayed a significant decrease in lipid concentration with aging. Significant increases in adenyl cyclase activity were evident with aging in the ascending thick limb of Henle's loop and distal tubules.


Simplified method for studying mechanical properties of healing linear skin wounds in the dog. A tensiometric technique was devised for measurements of the breaking and tensile strengths, extensibility, and the energy absorption of healing linear skin wounds in the dog. The tensiometer was inexpensive to construct, mechanically simple to operate, and could be used on the anesthetized animal. Precision of the instrument was evaluated on 30 skin wounds, made on the backs of 8 dogs, 7 days after the surgical procedure. Wounds had a mean breaking strength value of 1.40 kg, mean tensile strength  value of 0.80 kg/cm2, mean extensibility value of 6.00 cm, and mean energy absorption value of 2.48 cm-kg/cm3. Results obtained with the tensiometer compared with a statistically rigid system were +/-0.09 (+/- standard error of mean, kg, +/-0.01 kg/cm2, +/-0.28 cm, and +/-0.25 cm-kg/cm3, respectively.


Prolonged renal failure after rifampin.

Prolonged renal failure after rifampin. A 45-year-old man treated for pulmonary tuberculosis with daily drug therapy, including rifampin, developed acute renal failure manifested by ebinophilia, skin rash, and increased serum blood urea nitrogen and creatinine. The renal failure was marked by a prolonged course and incomplete recovery. Renal biopsy showed tubulointerstitial nephritis with nonspecific glomerular mesangial proliferation. Fluorescence staining showed the presence of IgG, IgA, AgM, and C3 deposits in glomeruli, as well as IgE deposits along the tubules. This report describes a new hazard of rifampin therapy that might have developed, in part, because of coexisting hepatic dysfunction.


Pulmonary and articular sporotrichosis.

Pulmonary and articular sporotrichosis. A 46-year-old man presented with swelling and pain in the right knee and a history of nonproductive cough and weight loss. Sporotrichum schenkii was cultured from synovium, synovial fluid, sputum, and bronchial washings. No other pathogens were cultured. Neither skin lesions nor history of exposure to S. schenckii was present, but 7 years before this admission the patient had been treated for suspected pulmonary tuberculosis despite negative mycobacteriology. The case is believed to represent systemic spread from chronic pulmonary sporotrichosis and supports the hypothesis that the lung may serve as a portal of entry in noncutaneous systemic sporotrichosis.


Prevalence of fungal complement-fixing antibodies in sarcoidosis. The prevalence of fungal complement-fixing antibodies in sera from 58 patients with sarcoidosis was determined and compared to complement-fixing antibody titers in 50 sera from a normal control group and 50 antinuclear antibody-positive sera. Sera from 9 patients with sarcoidosis had complement-fixing antibody titers greater than 1:8 to Histoplasma yeast antigen; serum from one normal control subject had a titer greater than 1:8; and none of the antinuclear antibody-positive sera demonstrated titers greater than 1:8. There were no significant complement-fixing antibody concentrations observed against histoplasmin, blastomycin, and coccidioidin antigens in any serum from the 3 groups studied. The increase in antibody titers to the Histoplasma yeast antigen might have been related to the generalized increase in immunoglobulin concentrations noted in patients with sarcoidosis.


Cell-mediated immunity in silicosis.

Cell-mediated immunity in silicosis. Selected parameters of cell-mediated immunity were determined in a group of 16 patients with silicosis. The results were compared with those of a control group of 13 subjects without silica exposure. There were no group differences in the mean number of delayed hypersensitivity skin tests to a battery of recall antigens (purified protein derivative, candida, streptokinase-streptodornase, and trichophyton) or in the mean number of peripheral blood lymphocytes. Lymphocyte responsiveness to phytohemagglutinin, pokeweed mitogen, and the antigens listed, and the percentage of lymphocytes that formed sheep red blood cell rosettes (t cells) and complement rosettes (B cells) were also similar in both groups; however, the silica-exposed group demonstrated depressed lymphocyte stimulation in response to low concentrations of concanavalin A.


The influence of cigarette smoking and sex on theophylline disposition. The effects of cigarette smoking and sex on theophylline clearance, elimination rate constant, and apparent volume of distribution were examined in 28 healthy, young adults given single oral doses of theophylline or aminophylline. Two-way analysis of variance showed no sex effect but a significant effect of smoking habit on theophylline clearance and elimination rate constant. Neither sex nor smoking had an effect on the apparent volume of distribution. The respective mean clearance, elimination rate constant, and volume of distribution were, in nonsmokers, 0.040 +/- 0.008 (SD) liter per hour per kg, 0.084 +/- 0.015 hr-1, 0.47 +/- 0.08 liter per kg; heavy smokers, 0.063 +/- 0.019 liter per hour per kg, 0.129 +/- 0.045 hr-1, 0.50 +/- 0.06 liter per kg; and ex-smokers, 0.051 +/- 0.10 liter per hour per kg, 0.108 +/- 0.025 hr-1, 0.49 +/- 0.08 liter per kg. Cigarette smoking appeared to induce theophylline metabolism as reflected by the mean theophylline half-life in smokers (5.4 hours) versus nonsmokers (8.3 hours). The effect of cigarette smoking on theophylline clearance may be an important consideration in the clinical use of the drug.


Normal human bronchial immunoglobulins and proteins: effects of cigarette smoking. Selected proteins were compared in bronchial lavage fluids recovered from 36 healthy nonsmokers and 19 healthy cigarette smokers. Although fluids lavaged from smokers contained 4 times as many cells (more than 80 per cent macrophages) as fluids from nonsmokers, there were no quantitative differences between the two groups in immunoglobulin A, a1-antitrypsin, a2-globulin, transferrin, or albumin content. However, immunoglobulin G content of bronchial fluids from smokers was twice as high as that from nonsmokers. This selective increase in immunoglobulin is compatible either with stimulated local bronchial immunoglobulin production or the selective exudation of plasma immunoglobulin into alveolar spaces in response to inhaled cigarette smoke.


Pulmonary impairment from chronic exposure to sulfur dioxide in a smelter. The pulmonary function of 113 copper smelter workers was measured in 1973 and again in 1974 to asses the effects of chronic exposure to sulfur dioxide. Respiratory symptoms, smoking history, occupational history, and pulmonary function as measured by forced vital capacity and 1-sec forced expiratory volume were recorded. Exposures to sulfur dioxide, respirable particulates, sulfates, and copper were sampled at intervals throughout the year by personal monitoring. Exposure to 1.0 to 2.5 ppm of sulfur dioxide was associated with excessive loss of 1-sec forced expiratory volume during the year and an increase in respiratory symptoms, after controlling for smoking. No significant interaction between sulfur dioxide and concurrent exposure to respirable particulates on pulmonary function was found. Workers with 1-sec forced expiratory volume below normal on initial measurements (based on their age and height) showed evidence of even greater losses of pulmonary function related to sulfur dioxide exposure.


Studies on the fate of pancreatic elastase in the hamster lung: 14C-guanidinated elastase. Intratracheal instillation of pancreatic elastase in hamsters produces emphysema, which progresses for up to one year after the insult. To study this process in more detail, a guanidinated derivative of porcine pancreatic elastase labeled with carbon-14 was prepared that was indistinguishable from unmodified elastase with respect to physicochemical properties and in vitro enzymatic activity. Guanidinated pancreatic elastase exhibits the same emphysema-inducing potency as unmodified pancreatic elastase. Two hours after intratracheal instillation of the [14C] guanidinated elastase, the whole lung retained only 40 per cent of the instilled radioactivity, but after 96 hours one per cent was still present. At 2 hours approximately 90 per cent of the radioactivity in the lungs could be removed by bronchopulmonary lavage, and at 96 hours 28 per cent was removable by this method. More than half of the radiolabeled elastase recovered in the lavage fluid at 2 hours was enzymatically active; enzymatic activity diminished to very small amounts by 96 hours. These data support the concept of the long-term binding of active elastase to lung tissue, a phenomenon that may be involved in the progressive nature of elastase-induced emphysema.


Ventilatory response and drive in acute and chronic obstructive pulmonary disease. We measured hypercapnic ventilatory responses using the rebreathing technique and ventilatory drive using mouth occlusion pressure in 15 normal subjects (6 with added external inspiratory resistance), 11 asthmatics, and 17 patients with chronic obstructive pulmonary disease (9 with chronic CO2 retention and 8 with normal values for arterial pco2). normal subjects, obstructed normal subjects, asthmatics, and patients with chronic obstructive pulmonary disease without CO2 retention had overlapping ventilatory responses. Ventilatory drive was increased in asthmatics and obstructed normal subject. Patients with chronic obstructive pulmonary disease without CO2 retention maintained a ventilatory drive similar to that of normal subjects, whereas patients with chronic obstructive pulmonary disease with chronic CO2 retention demonstrated blunted ventilatory drives as a group, even though 5 of 9 had normal drives. Patients with CO2 retention also had the greatest obstruction when compared to other groups. In some patients, chronic CO2 retention is primarily a consequence of mechanical end-organ limitation rather than a blunted neurorespiratory center output. Acute airway obstruction is associated with an increased drive, which may become reduced with chronic obstruction.


Peripheral vascular trauma: a civilian experience. A detailed review of 106 vascular injuries seen at the Mt. Sinai Hospital of Cleveland in a period of six-and-a-half years is presented. The type and location of the vascular injuries, the concomitant injuries, the preoperative evaluation, operative and post operative management, the complications and their management are discussed. The overall amputation rate in our cases was 4.7%, and for popliteal artery injuries 20%. The mortality rate was 5.6%.


Use of expanded polytetrafluoroethylene grafts for vascular access in hemodialysis: laboratory and clinical evaluation. Vascular access for chronic hemodialysis has evolved considerably over the past 10 years with development of vascular substitutes. The bovine heterograft is the choice of most dialysis centers when a subcutaneous conduit is needed in lieu of an in situ arteriovenous fistula. Bovine grafts have solved some problems, but further improvement in blood access prostheses is needed. Polytetrafluoroethylene (PTFE) grafts were evaluated in a laboratory and clinical study. In animals, PTFE proved to be satisfactory for fistula construction based on patency, incorporation into tissue, and ease of puncture. Ten patients underwent 11 vascular access procedures using PTFE grafts as a conduit. There were no technical operative complications. One graft was occluded by extravasation during dialysis and flow could not be restored. Otherwise, all grafts are patent 9 to 18 months postoperatively. Grafts of 8.0 mm in diameter have not given desirable flow rates, whereas 6.0 mm grafts have. Prolonged bleeding from puncture has been a problem in some cases. Otherwise, PTFE appears to be a satisfactory conduit for hemodialysis vascular access.


Acute diaphragmatic hernia caused by blunt trauma. Traumatic diaphragmatic hernia is being more frequently diagnosed in the acute phase because of a higher degree of alertness. Over a period of eight years the authors treated 16 patients. Associated injuries were present in eight cases and were responsible for the two deaths. The chest roentgenogram was diagnostic in most cases, but serial films and contrast examinations eventually were necessary. In order to attain a low morbidity and mortality rate, early surgery is recommended.


Axillo-axillary bypass for complications of an axillary arterial aneurysm: a case report. A case of peripheral embolization from an axillary aneurysm is presented. This was successfully treated by thromboembolectomy, ligation of the axillary artery distal to the aneurysm and an axillo-axillary bypass graft. The patient has resumed full activity and his normal upper extremity pulses and pressures.


Pneumatosis cystoides intestinalis following intestinal bypass. Two cases of pneumatosis cystoides intestinalis occurring in the bypassed small bowel following intestinal bypass are presented. These cases and the recent recording of four others in the literature indicate this may be a common association. Etiology of the pneumatosis is unknown, but it is probably related to fecal reflux into defunctionalized bowel with the attendant alteration of bacterial flora.


[Renal venous thrombosis treatment in the newborn (author's transl)]. Based on the experience of 61 cases, the recommended treatment for R.V.T. in newborns and infants is described. A historical review of its management is made. Therapeutic evolution and exposition of conservative therapy, founded on the following points: Close control of the hydrosaline disorder, early peritoneal dialysis and heparinization is given. Eventually thrombectomy can be advisable when the thrombous invades the inferior vena cava. A decreasing incidence of R.V.T., after a good prophilaxis and an evident improvement of the survival of children with R.V.T. is confirmed.


[Lung scintigraphy after diphragmatic hernia (author's transl)]. Recuperation of pulmonary function after surgical repair of Bochdaleck's hernia is considered. Gasometric and radiologic features as well as scintigraphy are related in order of prognosis. Of 16 cases, seven had sudden fatal outcome. Survivals achieved total pulmonary recuperation, but some in two to three years.


[Ventricular septal defect in the first year of life (author's transl)]. Thirty cases of CIV in the first year of life are presented. Association with prematurity and other malformations anticipate cardiac failure. Left ventricular hypertrophy is more frequent in conal defects. Repolarization disturbances were found in 73% of the cases in left precordial derivation with significative relief after surgical repair (banding). Conduction disturbances after surgical closure of ventricular septal defect was found in 15% of the cases. Surgical treatment during the first year was needed in 86% of patients. Only one case had good evolution without surgery. After four months of life total correction of septal defect as prefered. In patients with previous pulmonary artery banding, correction must be made one or two years later.


[Newborn resuscitation (author's transl)]. The technique of resuscitation of the asphyxiated newborn with one minute Apgar score of less than three and the results of the revision of 27 of the 55 resuscitated newborns are presented. Eighteen of the 55 patients (32%) needed to be transfused with blood, albumin, Ringer, due to hypotension but in eight of them this hypotension was only detected after the correction of the acidosis. In all the other patients ventilation and bicarbonate were only required for resuscitation and two of them received small doses of atropine, isoprenaline or adrenaline. Even though six of the 55 patients died, their death did not happen during resuscitation and so, the immediate results were 100% successful. Twenty seven patients were seen within six to 18 months after resuscitation and only 14% of them presented serious pathology. Therefore the organisation of a resuscitation team in each hospital not only would reduce neonatal mortality but morbidity also.


Etiology of sporadic hepatitis B surface antigen-negative hepatitis. We studied serologically 45 adults who had sporadic acute viral hepatitis that was hepatitis B surface antigen (HBsAg) negative. Two cases were due to hepatitis B virus, as demonstrated by the appearance of antibody to hepatitis B core antigen. In three other patients, the serologic pattern was inconclusive. Of 40 non-B cases, 20 were type A hepatitis and 20 were non-A, non-B hepatitis. Clinically, type A and non-A, non-B hepatitis were indistinguishable; one case of fulminant disease occurred in each group. The type A cases were more frequent in young adults; non-A, non-B disease predominated in women 35 years or older. Epidemiologic backgrounds were generally similar, including illicit self-injection; but four transfusion-associated cases were limited to the non-A, non-B group. We conclude that relatively few HBsG-negative cases are due to hepatitis B virus, and that hepatitis A virus and non-A, non-B viruses are both important in acute non-B disease.


A musculoskeletal syndrome in intravenous heroin users: association with brown heroin. During a recent 5-month period, 16 intravenous heroin users were hospitalized with a previously unrecognized complication of drug abuse. The characteristic symptoms were similar in all patients and included fever, paraspinal myalgias, and periarthritis. There was no evidence of bacterial infection, hepatitis, or drug abstinence as the cause of these musculoskeletal symptoms. Continued heroin use was associated with progressive musculoskeletal symptoms, while discontinuation of heroin use resulted in complete recovery. Antibiotics did not affect the outcome, and the syndrome was self-limited in all hospitalized patients. The pathogenesis of this syndrome is unknown but may be related to the heroin, which was described as brown by the patients, or an adulterant.


Saralasin infusion in the recognition of renovascular hypertension. Saralasin, an angiotensin II antagonist, was infused into 49 patients with renal artery stenosis, 10 patients with essential hypertension and normal renal arteriograms, and five patients with "low-renin essential hypertension." Renal venous renin and differential renal function studies were used to assess the functional significance of arterial stenoses. "Response" to saralasin, evidenced by a fall in blood pressure during infusion, occurred in no patients with "low renin" hypertension and in only 20% of patients with normal renal arteriograms. In contrast, saralasin "response" occurred in more than 80% of patients with renal artery stenosis and lateralizing functional studies and 100% of cases of "proven" renovascular hypertension (cure or improvement of hypertension after operative treatment). We suggest that saralasin infusion might be a valuable screening test for the recognition of renovascular hypertension.


Intravascular coagulation in fresh-water submersion: report of three cases. We describe three cases of fresh-water drowning that were complicated by disseminated intravascular coagulation. Close observation for clinical bleeding, laboratory investigation of the coagulation system, and therapy for disseminated intravascular coagulation, when appropriate, seem indicated in patients hospitalized after fresh-water immersion.


Hepatitis type A and hemodialysis: a seroepidemiologic study in 15 U.S. centers. Four hundred sixty patients and staff from 15 U.S. dialysis centers were surveyed by the immune adherence hemagglutination technique for antibody to hepatitis A antigen (anti-HA). The age-standardized anti-HA prevalence was 42.9% in patients and 42.1% in staff. These rates are almost identical to those of socioeconomically comparable urban volunteer blood donors never exposed to dialysis settings. There was no correlation between anti-HA prevalences and duration of dialysis treatment or employment. Among 100 patients and staff followed for 1 year 92% to 94% did not change their anti-HA status. The prevalence of anti-HA was identical in subjects with past histories of multiple blood transfusions or accidental inoculations with blood-contaminated instruments and in those without such histories. We conclude that hepatitis A virus rarely if every spreads by parenteral mechanisms, that there is no epidemiologic evidence confirming the existence of chronic hepatitis A viremic carrier states, and that hemodialysis does not play a significant role in the spread of type A hepatitis.


[Adhesive otitis: 30 surgical cases (author's transl)]. Adhesive otitis accounts for 3% of all cases of chronic otitis. It is characterized by the attachment of the entire epidermal layer of the drum to the inner wall of the cavity. Three causative factors are identified: abnormal permeability of the auditory tube; absence of the fibrous layer of the tympanic membrane; a predisposing milieu. This is a very different condition from tympanosclerosis and its scleroadhesive sequelae. It can, however, be associated with cholesteatoma. An analysis of 30 cases in which surgery was performed points to the real progress brought about by the use of tympanic homografts. One problem remains: permanent aeration of the new tympanic cavity.


Cryosurgery of the prostate gland.

Cryosurgery of the prostate gland. This personal review of the use of cryosurgery in prostatic disorders aims to put in perspective the value of the technique, establishing its place in the urologist's armamentarium mainly in the unfit subject but pointing to other applications as well. "Blind" perurethral cryosurgery has been used and has been shown to be effective in relieving urethral outflow obstruction, particularly in the second series of 178 patients with benign prostatic disease in which a simple "rule of thumb" technique was used.


Watson-Jones Lecture, 1976. Some lesions of the brachial plexus. Three types of lesion of the brachial plexus are discussed: entrapment syndrome; tumours; and traumatic lesions. In the first the importance of the pathological anatomy is stressed; in the second the rewarding results of accurate diagnosis and careful treatment are noted; and in the third the expanding possibilities of neural reconstruction and of specific treatment for pain are described.