Drug interactions and multiple drug administration. Effects of multiple drug administration on adverse drug reactions were studied in 10,518 patients hospitalized on a general medical service during a five-year period. Nine index drug groups, including analgesic, antacid, antiarrhythmic, antimicrobic, anticoagulant, antihypertensive, anti-inflammatory, diuretic, and sedative-tranquilizer drugs, were selected for study. The average number of adverse drug reactions for the anticoagulant and antihypertensive drug groups was higher (p less than 0.05) than for all other drug groups when classified by the number of drugs being taken concurrently (i.e., 0 to 5, 6 to 10, etc.). The rate of reaction for anticoagulant and antihypertensive drug groups was higher (p less than 0.001) than the rate for other drug groups studied. These data suggest a higher risk of adverse drug reactions for patients receiving multiple drugs. The increased risk may result from drug interactions.


Effect of phenobarbital on the disposition of intravenous theophylline. The disposition of intravenous doses of theophylline was determined in normal male subjects before and after treatment with phenobarbital 2 wk. Although there was some variation in disposition of the 2 drugs, there were no significant effects of phenobarbital on theophylline kinetics. We conclude that theophylline dosage need not be altered during concomitant administration of phenobarbital.


Effects of hexachlorobenzene feeding and iron overload on enzymes of haem biosynthesis and cytochrome P 450 in rat liver. 1. The effect of hexachlorobenzene feeding on liver delta-aminolaevulinate synthase, uroporphyrinogen decarboxylase and cytochrome P 450 was studied at various time-intervals in siderotic and non-siderotic rats. 2 In the non-siderotic group hexachlorobenzene feeding led to a progress decrease in liver uroporphyrinogen decarboxylase activity, accompanied by a progressive increase in delta-aminolaevulinate synthase activity. Cytochrome P 450 concentrations were above normal throughout but fell toward the end of the experiment. 3. Similar but more marked changes were found in the siderotic animals. The fall in uroporphyrinogen decarboxylase activity occurred earlier and was significantly greater in these animals, whereas the increase in delta-aminolaevulinate synthase activity was consistently larger. Liver cytochrome P 450 concentration also rose but to a lesser extent than that in the non-siderotic rats. 4. Hexachlobenzene-induced porphyria would seem to be attributable to inhibition or inactivation of hepatic uroporphyrinogen decarboxylase. Hepatic siderosis has a synergistic effect with hexachlorobenzene on this enzyme and may exert additional effects by promoting cytochrome P 450 turnover.


Effect of pharmacological inhibitors on urate transport during induced uricosuria. 1. The effect on urate excretion of administration of probenecid and pyrazinamide was observed in normal subjects under control conditions and after induction of uricosuria by exogenous urate loading by ribonucleic acid feeding in seven subjects, by volume loading with hypertonic sodium chloride solution infusion in 11 subjects and by partial inhibition of net urate reabsorption with uricosuric drugs in 20 subjects. 2. After ribonucleic acid feeding, the uricosuric response to probenecid was intact and ribonucleic acid feeding did not produce uricosuria after pyrazinamide. 3. After volume loading, the uricosuric response to probenecid was again intact, but infusion of sodium chloride solution still produced uricosuria after pyrazinamide administration. 4. After uricosuric drugs, the uricosuric response to probenecid was diminished. 5. These responses to probenecid and pyrazinamide may reflect different mechanisms of uricosuria. Response to pharmacological inhibitors of urate reabsorption or urate secretion may be useful for classification of induced and clinical uricosuric states.


The association between fasting hyperbilirubinaemia and serum non-esterified fatty acids in man. 1. The concentrations of plasma total and unconjugated bilirubin and of serum nonesterified fatty acids (NEFA) have been measured in two healthy subjects during fasts of up to 21 h. 2. Fasting was either continuous or interrupted by various procedures that altered the concentrations of NEFA and total bilirubin. 3. When NEFA concentrations were increased by the administration of noradrenaline, heparin or caffeine, bilirubin concentrations also rose. 4. When NEFA concentrations were lowered by insulin, bilirubin concentrations fell. 5. Meals of 3-138 kJ and more, taken during the fasting period, lowered total bilirubin and NEFA concentrations in both subjects, whereas the effects of smaller meals were less consistent. 6. These studies demonstrate a statistically significant correlation between total bilirubin and NEFA during uninterrupted fasting and an association between these variables under other experimental conditions. They suggest that the control of bilirubin concentrations in the blood is linked to lipid metabolism.


The variable-pressure neck-chamber method for studying the carotid baroreflex in man. 1. The variable-pressure neck-chamber method was analysed in ten healthy volunteer subjects to determine its suitability for the study of the carotid baroreceptor reflex in man. 2. Positive and negative pressures applied to the neck (range +/- 60 mmHg) were always transmitted linearly to a tissue catheter outside the carotid sinus, but only 86% of positive pressure, and 64% of negative pressure. Tissue pressures were confirmed by simultaneous measurement in the internal jugular vein adjacent to the carotid sinus. 3. Positive and negative pressure changes within the above range did not alter PO2 of internal jugular venous blood, suggesting that cerebral blood flow was unaltered. 4. Positive pressure changes induced reflex pressor responses of similar magnitude at arterial PO2 12-8 and 70-1 kPa (96 and 527 mmHg), suggesting that the carotid chemoreceptors were not involved. 5. It is concluded that the variable-pressure neck chamber is a valid method for selectively studying the carotid baroreceptor reflex in man. However, transmission of external pneumatic pressure to the carotid sinus is imperfect and greater for positive than for negative pressure. This must be recognized to avoid underestimation of gain and distortion of shape of the reflex.


The effect of disuse muscular atrophy on the forces generated in dynamic exercise. 1. Six patients were studied after prolonged immobilization of an injured leg resulting in muscle atrophy. 2. The forces exerted by the atrophied and normal legs during continuous dynamic exercise (one- and two-leg cycling) were examined by a specially adapted ergometer. 3. In one-leg cycling the peak force exerted on the crank at a given work rate, the net work rate performed on the crank, and the proportion of work rate performed in leg extension and flexion phases of the cycle were the same whether the atrophied or normal limb was used. 4. Despite these similarities there was an unexplained reduction in efficiency when using the atrophied leg to perform one-leg cycling. 5. In two-leg cycling the peak force exerted at a given work rate by the atrophied leg was reduced by about 40% as compared with the normal leg, which reflected a similar reduction in the contribution of that leg to the total net work rate. Possible reasons and implications for this disproportionate sharing of work between the normal and atrophied leg are discussed.


Renal clearance of unbound bilirubin in the rat. 1. Unbound or diffusible bilirubin in serum and urine was measured in rats with bile-duct ligation or after continuous infusion of unconjugated bilirubin. 2. The glomerular filtration rate was estimated by measuring the endogenous creatinine clearance and the unbound bilirubin in serum and urine was determined by a Sephadex gel filtration method. 3. Unbound bilirubin clearance was significantly lower than creatinine clearance. 4. The estimated rate of bilirubin reabsorption (calculated from the difference between the unbound bilirubin filtered load and the bilirubin excreted in the urine) was directly related to the serum unbound bilirubin concentration and the unbound bilirubin filtered load. 5. The results suggest that the main mechanism of urinary excretion of bilirubin in the rat involves glomerular filtration and tubular reabsorption by diffusion.


Camphorated and castor oil confusion and its toxic results. Three cases of camphorated oil ingestion occurring over a 20-month period are discussed. Two of the three ingestions resulted in hospitalization, and the clinical course of the ingestions are presented. Follow-up investigations were performed to determine the causes of the confusion between castor and camphorated oil. Also presented are descriptions of efforts made to improve labeling and packaging of this potentially lethal household product.


A completely automated fluorometric blood cyanide method: a specific assay incorporating dialysis and distillation. Discrete blood samples can be assayed at a rate of 20/hr. By means of a double lumen catheter, venous or arterial blood can be monitored continuously.


In vitro production of cyanide in normal human blood and the influence of thiocyanate and storage temperature. Normal human blood stored at room temperature (about 20 degrees C) may, over a period of weeks, undergo a slow transformation of its cyanide content. In contrast, when normal blood is stored at -20 degrees C there is formation of cyanide, usually occurring most rapidly during the first few days of storage. Peak concentrations are never greater than 20 microgram/100 ml, and although some fluctuation in concentration occurs over several months of storage at deep freeze temperature, levels are always higher than in the freshly drawn blood. The amount of cyanide produced appears to be a function of both the initial thiocyanate concentration and the freezing and/or thawing of blood. Blood stored at refrigerator temperature (about 4 degrees C) has the least fluctuation in cyanide concentration over a storage period up to three months. During this study it was found that there is significant difference in whole blood cyanide concentration between smokers and nonsmokers.


The influence of oral penicillamine and diet on lead poisoning in rats. In spite of continued lead intake, the oral chelate d-penicillamine was effective in reducing blood lead levels of lead-poisoned weanling rats on three different low-residue diets: a standard rat diet, a low calcium diet, and the trace metal salt modified EPA diet. A significant lessening of weight gain was evident in those on the low calcium diet.


Simultaneous identification and quantitation of diphenhydramine and methaqualone. Methods for the simulataneous identification and quantitation of diphenhydramine and methaqualone in urine have been investigated. Suitable thin-layer and gas chromatographic techniques have been developed. The extraction techniques were evaluated by extracting human urine after the ingestion of therapeutic dosages of the two drugs. A charcoal cartridge technique proved to be superior to direct solvent extraction. Although enzyme hydrolysis gave slightly better recoveries than the charcoal cartridge technique, it is a time-consuming procedure.


Chelation in metal intoxication. IV. Removal of chromium from organs of experimentally poisoned animals. In an attempt to find more reliable therapeutic or preventive agents for industrial chromium poisoning, some structurally different metal binding agents were screened for their ability to mobilize chromium from liver, kidney, brain, and testes (in vivo) and their subcellular fractions (in vitro), together with the blood corpuscles of experimentally intoxicated animals. Ethylenedinitrilotetraacetic acid (EDTA) and diethylenetriamine pentaacetic acid (DTPA) were quite successful in vivo, while ascorbic acid and 3,4-dihydroxy-L-phenyl alanine (L-DOPA) were more effective in vitro. No relationship could be observed between the structure or the molecular weight of the various chelating agents examined and their ability to remove chromium from either the tissue or their subcellular fractions.


The identification of ketamine and its metabolites in biologic fluids by gas-chromatography-mass spectrometry. A simple gas chromatography-mass spectrometric method for the identification of ketamine and its metabolites in urine, blood, serum, and plasma has been developed in order to investigate a coma due to overdose of the drug.


Occupational health properties of organic pigments. Certain terms and statements made by the author of Ref. [1] are criticized. Published evidence dose not support the term "probable carcinogen". "Possible carcinogen" is preferred. Extrapolation of conclusions of carcinogenicity to pigments not yet tested is unwarranted.


RX for social death: the cancer patient as counselor. Cancer patients frequently encounter psychological problems distinct from those with other serious illnesses. Cancer's deadly nature and its drastic treatment often alienate patients from relatives and caregivers. The CanCervive program trained cancer patients to counsel other patients. They functioned as role models and provided opportunities for catharsis. Yet their own unresolved conflicts often led them to overidentify with patients. Volunteers lacked insight into their own feelings of stress at seeing dying patients and their own guilt over their relatively advantaged medical status. Despite this, they helped patients cope with their insecurities and dependency needs, and assisted with professional education.


Who should be counselors in methadone maintenance programs: ex-addicts or nonaddicts? Counselors play a central role in most methadone maintenance programs. Yet the choice of who should be employed as counselors is based on little more than personal whims of decision makers. And in evaluating the effectiveness of this highly controlled rehabilitative therapy, the influence of the counselors as an important factor is often ignored. The total changeover of the counselors from an ex-addict to a nonaddict group in an otherwise stable clinic provided an unusual opportunity to compared the performance of the two groups. Both the objective and subjective data supported the hypothesis that ex-addicts as a group compared unfavorably with a similar group of nonaddicts when employed as counselors in a methadone maintenance clinic.


Creating new consultation programs in community mental health centers: analysis of a case study. A primary prevention program, initiated in a community mental health center, never became fully operational. Analysis suggests that failure to include recipients in initial planning, an unrealistic time table, insufficient institutional support for innovation, the project leader's organizational marginality, and the institutional constraints created by commitment to direct treatment of troubled individuals were factors that contributed to the project's failure. Several recommendations are presented. The most novel and important one is that systems-oriented, preventive mental health work should be based in a separate, distinct institution.


Consultation as a political process.

Consultation as a political process. Consultation may be viewed as a political-bargaining process in which actors seek to maximize at minimal cost expertise, organizational position, and organizational reputation. A view of consultation as political process allows for a shift in language in discussions of consultation. Such a language shift suggests shifts in the social meaning of the consulation process. Emphasis was placed on four suggested functions of consultation: definition and legitimation of a situation or of facts as "problematic"; raising the priority of an i5sue on the agenda of action in a consultee's agency; legitimation of deviant administrative behavior, and creation and sustenance of interagency linkages. A perspective is proposed that looks at the consequences as well as the intents of the process. This view of consultation can be studied emprically.


Impact of mental health facilities on property values. Community opposition to the establishment of a small-scale mental health facility is often intense. One frequently voiced fear is that the estabishment of a facility will cause property values in its vicinity to decline. This paper examines empirical evidence of the impact on property values in the neighborhood of 12 mental health centers in Philadelphia. It is concluded that such facilities have an indeterminate effect on property values in their vicinity, contary to popular opinion.


A halfway house in a mental health center. The functioning of Overing House, a halfway house established in organizational context produced a number of changes: The tenants became more representative of Overing's neighboring community; the availability of a network of services under one administrative structure improved the continuity of comprehensive care; a more productive relationship was established between house parents and therapists. Significant different in outcome between the two groups (precenter and center) was suggested by data related to course of employment, independent living, and reduction in long-term hospitalization.


The use of attainment scaling in the evaluation of a regional mental health program. The general evaluation of the success of a regional mental health program was attempted through the use of the Goal Attainment Scale. There were 278 goal guides scored for 96 sample patients at periods of 6, 12, and 18 months after admission. The interrater reliability between pairs of raters at follow-up interviews was high (.87). The intraclass correlation for goal guides constructed by three independent goal setters was moderate (r=.71). The mean scores of the three raters, when compared to a consensus goal score, attained an intraclass coefficient of .91. Thus the goal-attainment scoring procedure was found to be reliable. However, no evidence could be discerned to support its validity as a measure of a patient's treatment outcome.


Let's quit stalling and do program evaluation. Five issues have been identified as major impediments to program evaluation. Examination of these issues shows many of them to be resolved in the process of conducting evaluations. It is asserted that only by implementing evaluations will the field move foreward. At the present time much energy is wasted discussing or arguing the five issues and the ideal approach to making program evaluations. Examples are provided from ongoing evaluations that show how the issues are resolved.


A design for integration.

A design for integration. For nearly two decades, the development of computerized information systems has struggled for acceptable compromises between the unattainable "total system" and the unacceptable separate applications. Integration of related applications is essential if the computer is to be exploited fully, yet relative simplicity is necessary for systems to be implemented in a reasonable time-scale. This paper discusses a system being progressively developed from minimal beginnings but which, from the outset, had a highly flexible and fully integrated system basis. The system is for batch processing, but can accommodate on-line data input; it is similar in its approach to many transaction-processing real-time systems.


A short parameter-fitting routine for compartmental models. We have developed a program of 298 FORTRAN statements which obtains the inter-pool exchange rates and other parameters of a compartmental system, working directly from the time course of tracer activity after a bolus injection. The fitting problem - data and model - is specified by the user in a natural syntactic style. The program calculates least-squares estimates, confidence limits and intercorrelation estimates for the fitted parameters. Its small size and conceptual simplicity make the program a powerful practical tool for analyzing tracer studies.


A computer program for comparing irregular two-dimensional forms. A shape comparison of two forms requires a procedure that ensures comparability. A computer program has been written to compute a quantitative measure of shape differences between irregular bounded forms. The curve-fitting procedure, utilizing Fourier's series, is particularly well-suited for two-dimensional closed forms. The program provides several alternate methods to eliminate size difference, ensure a common or neutral center for superimposition and provide a rotational orientation which minimizes shape differences. The program contains numerous user-specified options which control input data transformations, algorithmic processing and output. The algorithmic processing provides: (1) generation of Fourier coefficients based on observed data, (2) two methods of producing Fourier coefficients adjusted for positional orientation, (3) two methods of producing Fourier coefficients adjusted for size standardization, (4) two methods of producing Fourier coefficients adjusted for rotational orientation, (5) a cross-correlation technique which rotationally adjusts two superimposed forms to minimize the shape difference, and (6) various standard statistical measures.


A method for evaluation of the electric potential field of a neuron with time-dependent surface potential. Results of the mathematical simulation of the extracellular electric field of the neuron are presented, yielding the formula describing the time and space dependence of the extracellular potential. The general method of the evaluation of the formulae is presented, which is applicable for any computation of the electric field surrounding a body having time-dependent surface potential. The implementation of the resulting formulae in FORTRAN IV for the special case of neuronal model is presented, including the list of input and output data. The possible applications of the suggested method are studied in concluding discussion.


A computerized approach to statistical quality control for radioimmunoassays in the clinical chemistry laboratory. Methods for statistical quality control for the clinical laboratory in general, and radioimmunoassay in particular, have been proposed for many years. Unfortunately, only a very small number of laboratories have adapted these procedures. By use of teletypes and other remote terminals, it is possible for all laboratories to access centralized computers where a general purpose quality control program can be stored. This relieves each laboratory of the costly task of developing software, provides some degree of inter-laboratory standardization and facilitates comparison of precision and accuracy between laboratories. A prototype program for this purpose is described. This program evaluates within-assay and between-assay variability, by means of an analysis of variance for a one-way classification random-effects model, and can monitor any assay parameter by use of control chart techniques. In addition, several tests are provided to evaluate the temporal stability of the assay system, and appropriate tests for outliers are included. Also, methods are described for combination of information from several quality control samples. This provides a valid basis for adjustment of assay results or for outright rejection of an assay. For convenience, this program is designed for output on a teletype or similar terminal located in the laboratory. Simplified versions of this program can be readily adapted to desk-top calculators. The original purpose for developing this system was to provide the clinical laboratory with a simple, general, and flexible method for assessing the performance of radioimmunoassays, but its usefulness should extend to virtually all assay methods.


MEDINFO--a medical information system.

MEDINFO--a medical information system. The MEDINFO (MEDical INFOrmation) system is a general purpose computer-based information storage, retrieval, and analysis system. It is designed for a time sharing, on-line computer system for the rapid and easy creation, maintenance, and analysis of general data files. A wide variety of types of information may be used. These include numeric, categoric, text, date, and multiple-response. The file structure allows several sets of data, including date-orientated data, to be used. MEDINFO permits a study to be created, a description of the data made, data to be entered and updated into records, and for the data to be displayed or analyzed by the investigator without programmer intervention.


A computer simulation of the growth of a tumour in vitro. This paper presents a computer model which simulates the growth of an in vitro tumour assumed to be a spheroid. Growth of the tumour is primarily affected by inward diffusion of ambient nutrients and outward diffusion of catabolites which tend to inhibit mitosis of living cells within this colony. In its final stages, the tumour consists of a necrotic core surrounded by a series of concentric shells which are comprised of non-proliferating and partially proliferating cells. Beyond this, an outermost shell of freely proliferating cells is in contact with the ambient medium which contains essential nutrients. The main purpose of this study is the qualitative study of the growth behaviour when various input parameters are altered. As noted in the final discussion, the main import of the paper is the observation that under certain conditions the initial monotonic growth of the tumour may give way to a series of temporary regressions alternating with growth periods. This behaviour eventually dampers out to yield a steady state situation when the amount of cell proliferation is exactly balanced by the decomposition of cells in the necrotic core.


The rabies information system--a model for a common information system in human and veterinary medicine. An information system is described in the field of rabies, which realizes the integration of information streams from human medicine as well as from veterinary medicine by help of computers. This rabies information system is based on a homogeneous and coordinated system of surveillance in connection with prophylaxis and control of rabies. It includes a modification of the case record, suggested by the WHO-Expert-Committee on Rabies. The aims of this rabies information system are: to make obvious the epizootiological situation with formation and change of foci, to show the epidemiological importance of special animals and to recognize the epidemiological situation. All this has to be fulfilled in an integrated system. Furthermore optimal treatment is guaranteed by express diagnostics and earliest possible special treatment of high-risk groups by the co-operation of human and veterinary medicine. The rabies information system was generally introduced in the GDR in 1970. It has proved to be practicable and effective especially by standardization of diagnostics, recording exposure of the patient, his treatment and partly automated evaluations of situation records and documentation of efficiency.


Finite element stress analysis of the human left ventricle whose irregular shape is developed from single plane cineangiocardiogram. The three-dimensional left ventricular chamber geometrical model is developed from single plane cineangiocardiogram. This left ventricular model is loaded by an internal pressure monitored by cardiac catheterization. The resulting stresses in the left ventricular model chamber's wall are determined by computerized finite element procedure. For the discretization of this left ventricular model structure, a 20-node, isoparametric finite element is employed. The analysis and formulation of the computerised procedure is presented in the paper, along with the detailed algorithms and computer programs. The procedure is applied to determine the stresses in a left ventricle at an instant, during systole. Next, a portion (represented by a finite element) of this left ventricular chamber is simulated as being infarcted by making its active-state modulus value equal to its passive-state value; the neighbouring elements are shown to relieve the "infarcted" element of stress by themselves taking on more stress.


Skin manifestations of mercury poisoning. Eight patients with skin lesions attributed to methylmercury exposure are reported. The outbreak of poisoning occurred in Iraq as a result of the handling and ingestion of treated grain and home-made bread. The skin manifestations were rather rare and varied in severity and histological appearance.


The vehicle tray revisited: the use of the vehicle tray in assessing allergic contact dermatitis by a 24-hour application method. Over 700 patients were screened by patch testing for sensitivity to the components of a vehicle tray from July 1974 through June 1976 at the Mayo Clinic. A modified version of the vehicle tray originally suggested by Fisher et al. (1971) was used, containing 14 substances commonly found in vehicles. Patches were applied for 24 rather than the usual 48 hours. Our percentage of reactivity compares favorably with the 48-h application method, thus demonstrating the efficacy of this time-saving technique. The method and usefulness of determining a percentage of irritancy are discussed. This was found to be a valuable tool in assessing false-positive reactions among our percentage of reactivity. Four irritants were demonstrated: phenylmercuric acetate (0.05% pet.), sodium lauryl sulfate (1% aq), thimerosal (0.1% aq) and hexachlorophene (1% pet.).


Phytophotodermatitis: an experimental study using the chamber method. Experimental phytophotodermatitis was produced using crushed leaves from the gas plant, Dictamnus albus. The tests were made using the chamber method and irradiated with ordinary black light tubes. An occlusion time of not less than 30 min was needed to give a phototoxic reaction in all test subjects. An occlusion time 30-120 min gave the optimal results, but contact for 24 h produced only weak and inconsistent reactions. The phototoxic substance was readily absorbed into the skin within 10-15 min. The phototoxic tendency already began to disappear within 30 min after the tests were removed. UVA energy of 0.3 J/cm2 was enough to evoke a phytophotoreaction in all of the test subjects when other conditions were optimal. The reactions were enhanced by adding water to the test sites. Deep-freezing of the plant material did not destroy the phototoxicity within a 4-month period.


Tobramycin-neomycin cross-sensitivity.

Tobramycin-neomycin cross-sensitivity. Fifty normal control volunteers were patch tested to 20% neomycin as well as tobramycin 1%, 10%, 20% and 30% in white petrolatum. Tobramycin is a new aminoglycoside antibiotic for prescription ophthalmologic use in the United States. There were no reactions on any of the control volunteers. Twenty known and proven neomycin-allergic patients were then tested to tobramycin 10% and 20% in white petrolatum, as well as to neomycin 20% aqueous and 20% in white petrolatum. All 20 reacted with a 2+ or greater response to the neomycin patch tests. Twelve out of the 20 or 60% of the neomycin-allergic patients reacted to the 10% tobramycin in white petrolatum. Thirteen out of 20 or 65% reacted to 20% tobramycin in white petrolatum. From these data, tobramycin (ophthalmic) should not be used to treat known neomycin-allergic patients without first patch testing the patient with 20% tobramycin in white petrolatum. It appears probable that 65% of neomycin-allergic patients would react with a dermatitic response to such therapy.


Behaviour of contact allergy and new sensitivities on subsequent patch tests. Patch tests repeated one or more times over periods of up to 3 years in 208 subjects with allergic contact dermatitis produced evidence of persistent specific sensitivities in almost 50% of cases. In about 25% the reactivity disappeared and over 25% developed new sensitivities. No new sensitivities appeared in 253 patients with non-allergic contact dermatitis or with other types of dermatitis in whom the same patch tests were carried out. The history and follow-up of patients with new sensitivities brought into focus the presumed aetiopathogenetic role of further contacts, especially occupational or after topical applications. Patch tests themselves, provided the correct technique is employed especially as regards the concentration of allergens, do not seem to be responsible for new sensitizations to any significant extent.


The role of sesquiterpene lactones in contact hypersensitivity to some North and South American species of feverfew (Parthenium-Compositae). Sixteen taxa of the genus Parthenium from North and South America and 20 sesquiterpene lactones derived from plants of the Compositae family were used for patch testing six volunteers who were known to be contact sensitive to plants and lactones of this family. The patterns of cross-sensitivity and structure-activity relationships of the allergenic lactones are evaluated and the clinical and ecological relevance is discussed.


Contact and bacterial allergy in children with atopic dermatitis. Cell-mediated immunity to bacterial antigens was studied by intradermal testing, and to contact antigens (cosmetics, environmental chemicals and topical medicaments) by patch testing in 270 children with atopic dermatitis. The incidence of delayed-type immune cutaneous reactions in these patients was lower than in the controls. Contact allergy is a rare finding in the first 4 years of life but its incidence increases subsequently. In subjects with atopic dermatitis the incidence of sensitization by contact with allergens contained in topical medicaments proved to be lower than in subjects with eczema of other types. The data collected points to a reduced cell-mediated immune reactivity in a proportion of subjects with atopic dermatitis.


Sickle hemoglobinopathy and the kidney.

Sickle hemoglobinopathy and the kidney. Individuals with sickle cell anemia manifest various functional and anatomic renal aberrations. Function of the renal medulla is uniformly affected as reflected in impaired urinary concentrating and acidifying ability. Disruption of normal blood flow patterns in the medulla with impairment of function of the loop of Henle (functional papillectomy), presumably because of sickling in the hyperosmolar and anoxic environment of the renal medulla, may mediate these abnormalities. Hematuria and frank papillary necrosis may result through the same mechanism. Nephrotic syndrome, glomerulonephritis, and progressive renal failure occur on occasion in sickle cell disease. Recent evidence strongly suggests an immune complex glomerulonephritis due to tubular injury with release of renal tubular antigen into the circulation of such individuals. Hemodialysis and renal transplantation appear to be reasonable modes of therapy for sickle cell patients in chronic renal failure.


Central hemodynamics and cardiac output control in essential hypertensive patients. Central hemodynamics were determined in 202 men including 101 normotensive and 101 permanent essential hypertensive patients of the same age. Cardiac output was identical in the two groups while blood pressure and total peripheral resistance were significantly different. Strong differences between the two groups are revealed by a systematic correlation study: (i) correlations of blood pressure (with respectively heart rate and total blood volume) were significant in the normotensive group but not in the hypertensive group; (ii) correlations of cardiac output (with respectively heart rate and total blood volume) were significant in both groups; (iii) correlations of renal blood flow (with respectively cardiac output and blood pressure) were significant in the hypertensive group but not in the normo tensive group. This study provided evidence that the volume and neural pressure controls are impaired in hypertensive patients while the cardiac output control is maintained and, suggested the existence of adaptive mechanisms involving the kidney in the maintenance of normal cardiac output in permanent essential hypertensive patients.


Role of sodium and water in hypertensive patients on maintenance hemodialysis. In 46 patients of the chronic hemodialysis program blood pressure regulation was studied according to variations of sodium and fluid balance. A strong relationship was observed between blood pressure and the amount of exchangeable sodium. In the hypertensive patients exchangeable sodium was increased depite fulfilled clinical signs of sufficient dehydration. The blood volume was found to be small and the plasma renin activity increased in those hypertensive patients, in which sufficient fluid depletion was inhibited by extreme fluctuations of the blood pressure during dialysis. A diminution of the sodium concentration keeping the fluid balance constant induced an increase of blood pressure and deteriorated the subjective feeling of the patients. By an increase of the sodium concentration up to 155 mEq/l severe blood pressure fluctuations during during dialysis could be prevented, although further fluid was taken off by ultrafiltration. This effect seemed to be mediated--at least partly--by an increase of the low blood volume and a suppression of plasma renin activity. After the patients became normotensive, dialysis procedure could be continued with normal sodium concentration. By a temporary high sodium regimen of the dialysis procedure some patients with renal failure and 'uncontrollable hypertension' can be preserved from bilateral nephrectomy.


Sodium excretion and sympathetic activity in relation to severity of hypertension. The relationship between the severity of hypertensive disease and sodium excretion and sympathetic activity has been studied in normotensive (n = 19) and hypertensive (n = 19) men of the same derived from screening a total population. Sympathetic activity was determined from noradrenaline excretion and the severity of hypertension was assessed by measuring resting diastolic BP, left ventricular hypertrophy on orthogonal ECG and the glomerular filtration rate. In the hypertensive group the resting BP correlated well both with signs of left ventricular hypertrophy, i.e. with the degree of severity of the hypertensive disease. Up to the level of 90 mm Hg resting diastolic BP, sodium excretion rose in agreement with theory of pressure diuresis. Above 90 mm Hg, however, both sodium and noradrenaline excretion fell with increasing BP. This indicated that in more advanced hypertension the sodium balance overrides the sympathetic activity in the long-term relation of BP. In another series of 49-year-old-men noradrenaline excretion fell with increasing renal vascular resistance indicating that the increase in the latter variable could not be explained by increased sympathetic tone. On the basis of the results a hypothesis on the sequence of events leading to development of hypertension, is presented.


The role of the kidney in hypertension.

The role of the kidney in hypertension. The role of the kidney in hypertension is reviewed in terms of sodium and water homeostasis, of the secretion of renin inappropriate to the state of sodium and water balance and of other renal humoral factors which might be implicated in the hypertensive process. Fundamental to the long-term maintenance of hypertension is an alteration in the relationship between renal perfusion pressure and the excretion of sodium and water. This alteration may be brought about as a result of renal structural damage, sympathetically mediated renal vasoconstriction or the action of renal or extrarenal hormones which modulate sodium and water excretion. When renin is secreted in excess of the prevailing level of sodium and water balance, the generated angiotensin contributes to the hypertension directly through peripheral and renal vasoconstriction. The level of blood pressure in two hypertensive patients with chronic renal failure was found to be highly correlated with the level of plasma renin activity as this was lowered by the administration of a beta-blocking drug. In rats deprived of sodium, renal artery constriction and contralateral nephrectomy was followed by hypertension without any elevation of plasma angiotensin and with a minimal expansion of plasma volume unaccompanied by expansion of extracellular fluid volume. The possible role of this small volume change and of other possible factors in producing hypertension is discussed. Studies in the nephrectomised rat confirmed eariler reports that renal medullayr auto-explants inhibited renoprival hypertension, but neither the identity nor mode of action of the medullary hypotensive factor were further clarified.


Feedback mechanisms of arterial pressure control. Arterial blood pressure varies very little among human beings and most other mammals for that matter. This suggests that a powerful control scheme is at work; it becomes more apparent when we break the various feedback loops and observe the excursions of blood pressure in the absence of any control. Two important control loops are found in the baroreceptor reflexes operating over the short term and the kidneys operating over the long term. The aortic and carotid baroreceptors stabilize pressure, preventing short-term fluctuations; when this control loop is surgically removed, lability increases with little change in the average pressure. Over the long term, the kidneys determine the average level of arterial pressure; when they are removed, pressure slowly drifts up and down as fluid is inadvertently accumulated or lost. There are several possible connections between the function of the kidneys and arterial pressure, including the release of vasoactive endocrines by the kidney and the adjustment of body fluids via salt and water excretion. Because salt excretion and water excretion often change in parallel, it has been difficult to identify the individual importances of each. However, we found that increasing the sodium stores of the body while holding volume constant does not produce hypertension, expanding fluid volume while maintaining or actually decreasing sodium concentration does lead to hypertension. Hence, when the kidneys are normal, long-term stability results from this loop: fluid volumes alter arterial pressure; pressure alters renal excretion; excretion alters fluid volumes.


Central and peripheral haemodynamic effects of angiotensin. In 10 normotensive subjects intravenous infusion of angiotensin was followed by a significant increase in the arterial pressure, total peripheral resistance, central venous pressure and by a marked reduction of the intravascular forearm volume and venous distensibility. Forearm circulation time was shortened. The cardiac index, heart rate, forearm vascular resistance and the forearm blood flow did not change significantly.


Low renin hypertension.

Low renin hypertension. Low renin hypertension probably does not represent a clinical entity. In many patients with low renin hypertension blood pressure is normalized by treatment with diuretics only; in these patients a (genetic?) sensitivity to salt might play a predominant role in the pathogenesis of hypertension and renin suppression. In another group of patients renin suppression appears to be secondary to the hypertensive process. This is indicated by the observation that prevalence of low renin hypertension increases with age and that it is more frequent in advanced stages of hypertension. Also a diminished sympathetic tone might play a part in the renin unresponsiveness. Finally, although no positive evidence was found, the possibility cannot be excluded that, at least in some cases, a mineralocorticoid other than aldosterone is involved. Neither in normotensive subjects nor in hypertensive patients, both with normal and with low plasma renin was a correlation between plasma renin concentration and plasma aldosterone concentration following stimulation by upright posture found. More detailed studies will be necessary to clarify the relationship between the renin-angiotensin system and aldosterone secretion during upright posture, in particular in patients with low renin hypertension.


Role of the vascular factor in hypertension. A survey is given of experimental results in both man and hypertensive rats, suggesting a rapid and hemodynamically important structural 'resetting' of the systemic precapillary resistance vessels, of the renal 'long-term' and carotid-aortic 'short-term barostats', as well as of the left heart, which together greatly affect both the initiation and maintenance of hypertension. Particularly the adaptation in design of the precapillary resistance vessels, being a per se normal, local response to more sustained changes in transmural pressure ('structural autoregulation'), implies the introduction of a potential vicious circuit once it affects the entire vascular bed. The reason is that this type of altered vessel design leads to a systemic precapillary hyperreactivity that forms a positive feedback interaction with functional excitatory influences as far as their long range, hemodynamic effect on the arterial pressure level is concerned. It is further discussed how various types of structural  and functional vascular changes may often coexist, then mutually interacting with each other, and how they may be experimentally separated for detailed analysis.


Recurrent multiple pyogenic granuloma with multiple satellites. Features of Masson's hemangioma. The case of a thirteen year old white girl who had multiple recurrences of pyogenic granuloma arranged in a satellite fashion is presented. The incidence and frequency of pyogenic granuloma with or without recurrences is discussed, stressing the unusual nature of the present problem. In addition to the microscopic features of pyogenic granuloma, the changes seen in Masson's hemangioma were demonstrable in some of the sections. The microscopic distinguishing feature of Masson's hemangioma is discussed, with emphasis on the importance of recognizing this as a benign structure rather than a malignant one. Opinions concerning the etiology of pyogenic granuloma as well as the reasons for the development of multiple satellites are presented, along with suggestions for therapy.


New look at pyoderma gangrenosum.

New look at pyoderma gangrenosum. Pyoderma gangrenosum cannot be viewed simply as "an ulcer with undermined bluish borders," since this description recognizes only one stage of the evolving process. Patients with this disorder often have cutaneous lesions including papules, pustules, and plaques that evolve and resolve without ever passing through an ulcerative stage. Moreover, such patients frequently have a variety of internal inflammatory and ulcerative disorders. The nature of these disorders as well as the increasing evidence of grossly altered immunity in pyoderma gangrenosum is also presented.


Leukonychia trichophytica caused by Trichophyton rubrum. A case of leukonychia is reported, in which Trichophyton rubrum was isolated from the nail plates and interdigital spaces of the toes. Treatment consisted of oral griseofulvin, which produced appreciable improvement after ten months' therapy.


Herpes simplex: treatment today.

Herpes simplex: treatment today. Past and current therapies for recurrent mucocutaneous herpes simplex infections are reviewed. At present, no topical or systemic therapy has been proved safe and effective in scientific double-blind studies. Recent treatment with flexible collodion is discussed.


Macrodactyly and epidermal nevus.

Macrodactyly and epidermal nevus. A case is presented of a child with the two congenital anomalies of macrodactyly and epidermal nevus. Macrodactyly was noted at birth; nevus unius lateris became apparent at three months. The chance association of these two rare anomalies as individual sporadic occurrences is exceedingly unlikely. The case is presented as a possible syndrome entity, if other case documentation exists.


Mountains, snow, and skin.

Mountains, snow, and skin. In summary, I believe that there has not been enough scientific investigation of the significance of skin function in relation to strenuous climbing in everchanging and adverse mountain conditions. Such investigation should include chemical study of sweat before, during, and after climbing, as well as study of the physical, chemical, and cellular changes of the skin itself. I believe first in prevention of climbing-related general and cutaneous medical problems before they appear. This certainly can be done with well planned and prepared programs. Our climbing should be as pleasant and comfortable as possible. Unless there is an emergency situation, there is no need for "heroic" suffering. In any unfavorable health or environmental condition, the mountaineer should turn back immediately. Certainly, painful skin lesions, whatever they might be, are no less important than is the general health in making this decision.


The athlete's foot.

The athlete's foot. In general, painful feet can affect the performance of an athlete in any sport. To prevent skin diseases of the feet, the "Athlete's Foot" should be kept clean and dry with toenails trimmed. Properly fitting athletic shoes should be worn to avoid the formation of blisters. Wearing of sandals in locker and shower rooms, which prevents intimate contact with infecting organisms, can alleviate many of the problems that affect the feet.


Dyshidrosis.

Dyshidrosis. The term dyshidrosis describes a nonspecific tissue pattern reaction characterized by a noninflammatory, pruritic (and sometimes burning) intraepidermal vesicular dermatosis involving selected areas of the fingers, palms, and soles. It should be distinguished from various pustular and vesicular dermatoses of the palms and soles with or without associated lesions elsewhere. When dyshidrotic lesions appear in areas where friction or pressure from the handling or wearing of sport gear occurs, the discomforting symptoms are noticeably accentuated and can thus interfere with the participant's effectiveness in the performance of the sport. A composite approach of dermatologic therapeutic acumen and physician-sponsored emotional support is essential in effectively handling this problem so that dyshidrosis does not "handicap" the patient.


Black heel a minor hazard of sport.

Black heel a minor hazard of sport. "Black heel" (calcaneal petechiae) is a traumatic lesion affecting the back or posterolateral aspect of the heel. It is seen almost exclusively in adolescentes or young adults engaged in active sports, notably basketball, but also football, lacrosse, tennis, and so forth. The lesion is disposed horizontally at the upper dege of the calcaneal fat-pad and consists of grouped punctate hemorrhages, the nature of which is revealed by repeated paring of the lesion. The nature of the pigment is shown by specialized stains. "Black heel" is probably more common than is realized. It is likely to be cuased by a shearing or pinching stress from abrupt contact of th foot with a floor or hard ground. As it si usually symptomless, it may be disregarded or only observed by chance. However, it has been confused clinically with a melaonoa, and as it is such a trivial self-healing process, it is important that it be recognized for what it is.


General purpose cryosurgical units. The WSL Nitrosprays I and II. Lightweight, hand-held, inexpensive cryosurgical instruments are described that combine the desirable features of most available units into a single instrument. As these units are capable of treating the entire spectrum of cryoresponsive lesions, they are believed to be general purpose instruments.


Assignment of the gene for enolase to mouse chromosome 4 using somatic cell hybrids. Somatic cell hybrids between mouse peritoneal macrophages (MPM) and human fibrosarcoma cells (HT-1080) or Chinese hamster cells (A3) were analyzed by starch-gel electrophoresis for the expression of murine enolase. Data obtained indicate that the locus for enolase is on chromosome 4 in the mouse.


Standardized karyotype of deer mice, Peromyscus (Rodentia). The Committee for Standardization of Chromosomes of Peromyscus. A standard G-band karyotype is proposed for the genus Peromyscus. G-banded chromosomes of Peromyscus boylii glasselli (NF=56), numbered and arranged according to euchromatic lengths, serve as the standard. It is suggested that rearrangements of the standard pattern which occur in other species of Peromyscus be described using the general methods of the PARIS CONFERENCE (1971).


Hemodynamic, ventilatory and blood gas changes during infusion of sodium nitroferricyanide (nitroprusside). Studies in patients with congestive heart failure. Simultaneous hemodynamic, ventilatory, and blood gas studies were performed in 16 men with congestive heart failure before and during infusion of sodium nitroferricyanide (nitroprusside). The cardiac index increased from 2.00+/-0.16 L/min/sq m (SE) to 2.38+/-0.14 L/min/sq m, and the total pulmonary and systemic peripheral resistances fell from 928+/-123 to 494+/-57 dynes sec cm-5 and from 2,208+/-210 to 1,558+/-121 dynes sec cm-5, respectively. Both systemic and pulmonary arterial decreased during infusion of sodium nitroferricyanide, and the mixed venous oxygen pressure increased. There was no change in total or alveolar ventilation, arterial carbon dioxide tension, pH, or base excess; however, the mean arterial oxygen pressure (PaO2) decreased from 74+/-3 mm Hg to 68+/-3 mm Hg and the venous admixture effect increased from 8+/-1% to 13+/-2%. We conclude that the decrease in PaO2 during infusion of sodium nitroferricyanide resulted from a worsening of the ventilation-perfusion relationships due to increased perfusion of underventilated pulmonary units.


Cryosurgery of bronchopulmonary structures. An approach to lesions inaccessible to the rigid bronchoscope. Cryonecrosis of the upper lobe of the lung and bronchi was safely inudced in healthy dogs by application of the cryoprobe to serosal surfaces or, through a bronchotomy, to the mucosal surfaces under direct vision. Seven days after cryosurgery, hyperemia of the bronchus was seen. By 14 days the bronchus at the target site was covered with cuboidal epithelium. Reappearance of normal ciliated epithelium occurred by 180 days after cryosurgery. Cartilage remained intact, and there was no evidence of formation of a stricture or other gross alteration of bronchial architecture. In the lung there was coagulation necrosis; and by 14 days after cryosurgery, there was fibrosis in the target area. There were no complications of the pleural space. Cryosurgery of tissues at the margins of the bronchotomy does not impair healing. Cryosurgery may reduce the necessity for extensive surgery in selected patients with bronchopulmonary tumors, including those inaccessible to the rigid bronchoscope. Clinically, eight patients with recurrent bronchogenic tumors have received palliation by transbronchoscopic cryosurgery.


A multipurpose catheter for electrophysiologic and hemodynamic monitoring plus atrial pacing. A new multipurpose flow-directed pulmonary arterial catheter has been developed and evaluated in 30 patients with acute cardiopulmonary dysfunction. The catheter permits monitoring of the bipolar atrial electrogram, pulmonary arterial or wedge pressure, central venous pressure, and cardiac output, plus atrial pacing. The standard Swan-Ganz thermistor-equipped catheter was modified to incorporate two ring electrodes on the shaft at 25 and 26 cm from the tip. With the pair of electrodes positioned in the right atrium at the junction with the superior vena cava, stable electrograms of high quality were recorded in all 30 subjects, some for as long as six days. These high-fidelity atrial electrograms permitted rapid and accurate diagnosis of many complex dysrhythmias in these unstable patients. Because of the limited noise in the signal of the electrogram, continuous quantitative measurements of intervals by a computerized system was feasible. Furthermore, the stable intracavitary position of electrodes provided a reliable site for atrial pacing, with pacing thresholds (2 to 12 ma; average, 5 ma) that remained stable for up to four days. Atrial pacing was used to treat sinus bradycardia, atrial tachyarrhythmias, digitalis intoxication, and ventricular dysrhythmias.


Comparison of the bronchodilator effects of oral therapy with fenoterol hydrobromide and ephedrine. Fenoterol hydrobromide (Berotec; formerly Th 1165a) is a sympathomimetic bronchodilator drug. Twenty subjects with mild to moderate reversible bronchospasm completed a double-blind multiple crossover study of single doses of 5 mg, 7.5 mg, and 10 mg of fenoterol hydrobromide, 24 mg of ephedrine, and placebo. Spirometric and body-plethysmographic measurements were performed sequentially prior to administration of drug or placebo and each hour up to eight hours afterwards. No significant drug-response relationship was noted for pulse rate or blood pressures, and side effects (eg, shakiness, nervousness) were minimal. Administration of fenoterol resulted in bronchodilation; a peak effect was noted at two to three hours after administration, and the duration of action was up to eight hours. A statistically significant dose-response relationship was observed; therapy with 5 mg of fenoterol hydrobromide was superior to placebo and equal to ephedrine, and doses of 7.5 mg and 10 mg of fenoterol hydrobromide were significantly better than placebo or ephedrine.


Nodular pulmonary sarcoidosis. Clinical, roentgenographic, and physiologic course in five patients. Five cases of nodular pulmonary sarcoidosis are presented. That nodular infiltration represents a reversible stage of sarcoidosis is suggested by the fact that all patients demonstrated roentgenographic resolution of these infiltrates. In four of the five subjects, tests of pulmonary function showed restrictive disease which remained unchanged or worsened despite radiologic clearing, suggesting persistence of active disease or development of residual pulmonary fibrosis. Evidence of obstruction of airways that was unexplained by a history of smoking was present in all of the five subjects.


Exercise-aggravated hypoxemia and orthodeoxia in cirrhosis. A syndrome characterized by hypoxemia aggravated by exercise, orthodeoxia, hypocapnia, and evidence of hyperdynamic circulation, but otherwise normal indices of pulmonary air flow, volume, and distribution of ventilation has been observed as an infrequent complication of hepatic cirrhosis. An illustrative case is described, the features of which support the presence of a shunt or shunt-like mechanism consisting of low-resistance vascular communications within the lung. We suggest that this may represent the existence of a hepatopulmonary syndrome analogous to the hepatorenal syndrome.


Administration of nitrous oxide in normal subjects. Evaluation of systems of gas delivery for their clinical use and hemodynamic effects. Nitrous oxide (concentrations of 30 to 50%) was administered to 22 healthy volunteer subjects via nasal prongs, rebreathing mask, and an airlines mask to assess the efficiency of systems of delivery and the hemodynamic effects. The end-expired concentration of nitrous oxide, expressed as a percentage of the inspired concentration of nitrous oxide, was 19% for nasal prongs, 34% for the rebreathing mask, and 95% for the airlines mask (most accurate delivery). The pulse rate fell from a mean of 79+/-3 beats per minute to 67+/-2 with nasal prongs, to 64+/-2 with the rebreathing mask, and to 64+/-2 with the airlines mask. Both systolic and diastolic pressures fell from means of 122+/-4 and 74+/-2 mm Hg, respectively, to 98+/-3 mm Hg and 64+/-2 mm Hg, respectively, with the airlines apparatus. The fall in systolic blood pressure (slope, -0.79) exceeded that in the diastolic (slope, -0.35). In additional eight normal subjects, administration of 30% nitrous oxide via airlines mask produced identical changes in blood pressure and pulse rate, but there was no effect from 30 minutes of administration of 30% nitrous oxide on the end-systolic volume index, cardiac index, ejection fraction, normalized wall velocity determined echocardiographically, ejection time, or the ratio of preejection period to ejection time.


Radiographic appearances of implanted transvenous endocardial pacing electrodes. It is important to ensure correct positioning of long-term pacing electrodes. Electrocardiograms and the radiographic appearance of pacing electrodes are conventionally used to confirm the site of the pacing electrode. Electrocardiographic patterns from stimulation of the right ventricle and left ventricle of the heart through the coronary venous system and the limitations in the interpretations of these patterns have been well documented in the past. The appearances of chest x-ray films can also be misleading. In the present study performed on cadavers, detailed appearances of pacing electrodes placed electively in different sites in the right ventricle and in the coronary sinus and its radicles are described, and the limitations in the interpretations of such appearances are discussed.


The radiologic spectrum of cardiopulmonary amyloidosis. Amyloidosis, either primary or related to other pathologic states, may mimic a variety of disorders and produce a multitude of appearances demonstrable on radiographic examinations of the chest. All intrathoracic tissues and organs may be affected, but the major abnormalities most commonly involve the heart and lungs. The radiographic appearances in ten patients are described and correlated with the underlying gross and microscopic pathologic findings. No specific pattern of pulmonary involvement could be determined, aside from tracheobronchial amyloidosis. The final diagnosis is dependent upon the awareness of the clinical and radiologic spectrum and the final microscopic examination of involved tissue.


Aspects of chronic airflow obstruction.

Aspects of chronic airflow obstruction. This report questions several commonly used definitions and commonly accepted concepts. It suggest that the term, "chronic airflow obstructions," should replace the terms, "chronic obstructive pulmonary disease," "chronic obstructive lung disease," or "chronic airway obstruction," because it is flow that is obstructed. It is suggested the term, "chronic mucous hypersecretion," be used, rather than "chronic bronchitis," and that the latter be avoided. Chronic bronchitis should not be equated with narrowing of the airway and emphysema with loss of elastic recoil. Chronic bronchitis, emphysema, and lesions of the small airways probably occur together more frequently than chance will allow because of a common etiologic agent, tobacco smoke. Chronic mucous hypersecretion without other airway or parenchymal lesions seldom produces airflow obstruction and does not impair prognosis significantly. Central airways are important in chronic airflow obstruction. It is time that someone found out what is happening in subjects with abnormal results on tests of the function of small airways. The definition of "destruction" as it occurs in emphysema is deceptive, and loss of recoil and emphysema may be separate conditions. The dysfunction that occurs in emphysematous lungs is due mainly to associated airway lesions and may perhaps be due in part to the site and nature of emphysematous lesions (as opposed to loss of elastic recoil).


Clinical significance of pulmonary function tests. Pulmonary function after uncomplicated myocardial infarction. Derangement of pulmonary function following myocardial infarction is related to the severity of hemodynamic dysfunction. Abnormalities of pulmonary function appear even in patients without clinical or radiologic evidence of congestive failure. There is a reduction in vital capacity and rates of air flow. There is evidence for dysfunction of "small airways" and diminished ventilation to dependent parts of the lung. Total lung capacity may be normal or reduced, and residual volume may be increased slightly in uncomplicated myocardial infarction. Residual volume falls with more pronounced pulmonary congestion and edema. Distribution of pulmonary perfusion is altered after myocardial infarction, with a shift of perfusion away from the dependent parts of the lung (bases) towards the apices. Pulmonary gas exchange is impaired, with hypoxemia (due to both ventilation-perfusion inequality and increased shunting); and the diffusing capacity for carbon monoxide is diminished. Dead space is increased. The basic pathophysiologic mechanism responsible for abnormalities of pulmonary function is increased pulmonary water, which may be very minimal with uncomplicated myocardial infarction and stay primarily in the pulmonary interstitial space, but becomes progressively more severe with eventual alveolar flooding and marked impairment of pulmonary function.


Pulmonary infiltration with eosinophila. Recurrence in an asthmatic patient treated with beclomethasone dipropionate. We present the findings in a young woman diagnosed as having pulmonary infiltration with eosinophilia and asthma who was treated with beclomethasone dipropionate. Although the aerosol corticosteroid controlled bronchospasm, it did not prevent recurrent pulmonary infiltration with eosinophilia when the patient was not receiving oral therapy with corticosteroids. It is postulated that when administered in the usual dosage, an adequate amount of beclomethasone dipropionate does not reach the alveoli or interstitium to prevent or resolve the process of pulmonary infiltration with eosinophilia. This case suggests that patients with pulmonary infiltration and eosinophilia who are treated with inhaled corticosteroids for asthma must be closely observed physiologically or roentgenographically for pulmonary infiltration. These patients may need to be protected from recurrent pulmonary infiltration by the concurrent oral use of corticosteroids.


Integrated electronic display model for teaching bronchoscopy. The integrated electronic display model for teaching bronchoscopic technique has been most helpful in guiding the student-bronchoscopist, especially in the early stages of reorientation in both the procedure for insertion and the practice of identification of the individual segmental orifice. The display board is electronically integrated with the lung model (Zavala) in the manikin (Laerdal), which displays the position of the tip of the exploring flexible bronchoscope. This helps the student to approximate his distance and gauge movement and deflection from bronchial orifice to orifice. Simultaneously, he can also learn how to centrally position the tip of the instrument in the lumen, which is essential in brushing biopsy, and how to prevent mucosal injury. Instruction in open bronchoscopic examination has also been used successfully in this teaching model.


Pulmonary cavitation, allergic aspergillosis, asthma and bronchocentric granulomatosis. Pulmonary cavitation is a rare complication of allergic bronchopulmonary aspergillosis in patients with chronic asthma. Such patients frequently manifest mucoid impaction of a bronchus, "central" saccular bronchiectasis and bronchocentric granulomatosis, a specific microscopic pathologic entity. Early recognition of this syndrome in asthmatic patients and vigorous treatment with steroids may obviate surgery.


Intermittent complete atrioventricular block masquerading as epilepsy in the mitral valve prolapse syndrome. A 24-year-old white man had a history of "epilepsy" since the age of eight years. Prolapse of the mitral valve was documented by auscultation and echocardiographic and left ventriculographic studies. At 120 hours after stopping therapy with phenobarbital and diphenylhydantoin (Dilantin) sodium, continuous electrocardiographic monitoring (Holter monitor) revealed episodes of complete atrioventricular block lasting up to 23 seconds. The results of hemodynamic studies were normal. The patients' symptoms were all totally corrected by implantation of an epicardial demand pacemaker. This report raises the possibility that sudden death in association with the mitral valve prolapse syndrome may be due to intermittent severe disturbances in conduction, in addition to ventricular arrhythmias.


Pulmonary fibrosis after prolonged therapy with 1,3-bis (2-chloroethyl)-1-nitrosourea. A 43-year-old man with metastatic malignant melanoma was treated with 1,3-bis(2-chloroethyl)-1-nitrosourea (BCNU) in combination with imidazole carboxamide and hydroxyurea. He achieved complete remission. After 22 months of chemotherapy, the patient developed bilateral pulmonary infiltrates. Open lung biopsy showed sclerosing alveolitis. Long-term therapy with BCNU may cause pulmonary fibrosis, as has been seen with other cytotoxic drugs.


Treatment of acute aortic insufficiency with sodium nitroferricyanide. Documentation of beneficial effect by noninvasive means. The findings in a patient with acute aortic insufficiency who was treated with sodium nitroferricyanide (sodium nitroprusside) prior to aortic valve replacement are presented. Administration of the drug resulted in clinical improvement, which was reflected in changes in systemic and pulmonary arterial pressures and in noninvasive measurements. Sodium nitroferricyanide is useful in the management of patients with severe acute aortic insufficiency, and its effect may be monitored by noninvasive means.


Two active junctional pacemakers manifested by atrioventricular dissociation and junctional captures. A case of atrioventricular dissociation with RP-dependent abrupt prolongation of ventricular cycles is presented. The prolongation was less than expected with concealed junctional captures. It is assumed that resetting of an upper junctional pacemaker allowed impulses from a lower one to escape.


Intracranial arterial aneurysms in infancy and childhood. Eleven cases of intracranial arterial aneurysms in patients under 15 years of age, treated from 1959 to 1976, are presented. The preponderance of aneurysms at the internal carotid artery bifurcation and the peculiarities of the defects in this location are remarkable.


Hydrodynamic factors in Dandy-Walker and Arnold-Chiari malformations. The Dandy-Walker malformation (DWM) is hydrocephalus that primarily affects the fourth ventricle, whose overdistention involves also the aqueduct and third ventricle. However, just the opposite is true in the Arnold-Chiari malformation (ACM) since the hydrocephalus is limited to the lateral ventricles which squeeze the third ventricle between them and compress the aqueduct and fourth ventricle. The evidence indicates that both result from hydrodynamic stresses in embryonal and early fetal life. This communication is offered in rebuttal to some statements in an otherwise authoritative and comprehensive article.


Organizing hematoma in a child presenting as a 'doughnut lesion' on nuclear scan. Case report. We report a 4 1/2-year-old boy who presented with a 4-week history of frontal headaches and fever, and generalized convulsion 5 months previously. Papilledema, an abnormal EEG and a brain scan with a frontal mass and 'doughnut' sign were found. The association of the clinical history with brain scan findings strongly suggested a brain abscess. At surgery the lesion proved to be an encapsulated hematoma; Histological findings suggest underlying microangiomata.


Congenital anomaly of the odontoid in children. A report of four cases. The embryologic origins of congenital abnormalities of the odontoid process are reviewed. Four cases of odontoid dysgenesis in childhood are presented. All of our cases were associated with a head injury, which subsequently led to the diagnosis. Pain was the most common presenting complaint in our patients. Decreased cervical mobility was the most consistent physcial finding. There was no major neurological defect implicating spinal cord compression in any of our patients. This is not true of adults with congenital abnormalities of the odontoid, particularly those with atlantoaxial instability. The diagnosis of odontoid dysgenesis is a radiographic one. Flexion-extension films, tomograms and cineradiograms are often required to make the diagnosis. C1-C2 subluxation, either anterior or posterior is often found. Prompt posterior cervical fusion is recommended as the treatment of choice.


Dissemination with malignant changes from a pineal tumor through the corpus callosum after total removal. Within the germinal neoplasms of the central nervous system, the embryonal carcinoma is a very rare tumor. The authors report such a lesion arising on the corpus callosum in a child 8 months after a differentiated teratoma was totaly removed from the pineal region. The classification of the germ cell tumors of the central nervous system and their relation with similar tumors of the gonads are discussed. The treatment of the pineal tumors is also discussed.


Cerebral angiography and evaluation of functional status of shunts in hydrocephalic children. It is generally possible to evaluate a malfunctioning shunt on the basis of clinical signs. Neuroradiologic evaluation is recommended for the difficult cases when this is not possible. The neuroradiologic procedure of choice is cerebral angiography since it permits the determination of ventricular size, an estimate of the presence of intraventricular hypertension, and an evaluation of the nature and degree of brain shift or herniation. Furthermore, such complications of hydrocephalus as porencephaly or subdural accumulations of fluid may also be diagnosed.


Instrumentation of the spine for fracture dislocations in children. 13 children, ages 11-16 years, sustained severe compression fractures or fracture dislocations of the thoracolumbar spine. All cases were treated with Harrington instrumentation with fusion and six also had decompressive laminectomy. All injuries had significant instability and neurologic deficits (nine complete). Follow-up of 2-10 years is provided for analysis of maintenance of reduction and neurologic improvement. This technique appears to offer stability, reduction of orthopedic defects, and assumption of a more aggressive rehabilitation program without introducing significant operative morbidity or neurologic deficit.


The chromosome fiber: evidence for an ordered superstructure of nucleosomes. Chromosome fibers isolated from lymphocyte nuclei and prepared for electron microscopy by techniques designed to preserve their native structure have a distinctly knobby appearance, suggesting that DNA and protein are not distributed evenly along the fiber axis. Individual knobs (superbeads) are arranged in tandem and have an average diameter of about 200 A. Mild nuclease digestion of isolated nuclei releases apparent monomer superbeads that are composed of nucleohistone particles with the properties of nucleosomes. The kinetics of digestion indicate that the superbead is a discrete structural unit containing, on the average, about eight nucleosomes.


[Primary amenorrhoea, hypertension, and hypokalaemia in 17-hydroxylase deficiency, a not uncommon condition (author's transl)]. Five phenotypic female patients with primary amenorrhoea, mild hypertension, and hypokalaemia are described. The condition originates from 17-hydroxylase deficiency in both adrenals and gonads. Two cases had a XY chromosome pattern, two cases were familial. It is suggested to determine serum potassium in all cases with unexplained primary amenorrhoea.


[Transvenous xero-arteriography of the limbs (author's transl)]. Well-visualised arteriograms of the limbs can be obtained by xeroradiography after rapid manual injection of contrast-medium into an arm vein, as demonstrated in 28 patients. The technique is suitable for the diagnosis of circumscribed vascular lesions. It is simple to do and does not significantly distress the patient.


[Treatment of photodermatoses with carotinoids (author's transl)]. 39 patients were treated with carotinoids (beta-carotene alone or combined with canthaxanthine) with an oral dose of 50-150 mg/d, some of them for a period of several years. 23 of these were patients with porphyria (erythropoietic protoporphyria [EPP] 20, congenital erythropoietic porphyria 2, erythropoietic coproporphyria 1); 16 patients were suffering from various photodermatoses (solar urticaria 6, actinic reticuloid 5, UV-A intolerance 1, unclassified photodermatoses 4). Tolerance of the carotinoids was very good; no side effects were seen except for a yellow discoloration of the skin. In 19 of 20 EPP patients the result of the treatment was good, whereas no improvement was seen in the other kinds of porphyria. Of the 16 cases of photodermatoses not caused by porphyrinopathy, 6 responded to the therapy (solar urticaria 2, actinic reticuloid 2, UV-A intolerance 1, unclassified photodermatosis 1). Some cases showed great improvement as a result of the treatment.


[Plasma-digoxin concentration in patients at time of hospital admission (author's transl)]. Plasma-digoxin and serum creatinine concentrations were determined on admission in 145 unselected patients previously digitalized as outpatients. Adequate digitalization was found in 62.7%, inadequate doses in 15.9% of patients. In the latter group the daily dosage reported by the patients failed to correlate with the plasma-digoxin concentration by radioimmunoassay. One-fifth of all patients had clinical evidence of digitalis intoxication. Of these, 69% had plasma-digoxin concentrations of more than 2.0 ng/ml and 31% less than 2.0 ng/ml. Mean digoxin concentration for all patients with signs of digitalis intoxication was 2.5+/-0.9 ng/ml. In patients simultaneously receiving spironolactone or canrenoate-K+ there was danger of falsely high values for digoxin because of interference of those drugs with the radioimmunoassay.


[Magnesium concentration in erythrocytes and plasma in childhood (author's transl)]. In 243 children of various ages the magnesium concentration was determined simultaneously in erythrocytes and plasma. The analysis began in the mother immediately after delivery, in the umbilical vein and in the newborn infant, and ended at school age (6-14 years). The magnesium concentration in plasma as well as in the erythrocytes showed a constant tendency to increase. Statistically significant differences occurred between the age group 1-7 days on the one hand and 2-6 weeks on the other, and also between school children and adult controls (n=20). The adult controls also differed statistically from mothers following delivery.


[Carcinoembryonic antigen (CEA) in patients with lung cancer: correlation with tumour extent and response to treatment (author's transl)]. Carcinoembryonic antigen (CEA) was determined at the time of diagnosis in 90 patients with lung cancer. CEA levels were elevated in 47 (52%). High CEA levels were often associated with the presence of metastases. Serial CEA determinations in 40 patients, before and after radiotherapy and chemotherapy, revealed that patients who responded to treatment had a decreased CEA level, whereas those with progressive tumour growth had increased ones. CEA assay may, therefore, be useful in detecting metastases and in helping to assess the effect of treatment in patients with lung cancer.


[Carcinoembryonic antigen (CEA) (author's transl)]. Serial determinations of CEA concentrations in serum were performed postoperatively in 303 patients with histologically confirmed adenocarcinoma of the gastrointestinal tract. The trend of the time course of computerised CEA curves made early diagnosis of recurrence or metastases possible. Diagnosis of recurrence by means of a rise in CEA concentration preceded positive clinical diagnosis by up to 10 months. In all 26 cases confirmation was obtained by second-look operation or other diagnostic means. Analysis of serial CEA measurements made it possible to distinguish between generalised metastasization and local recurrence of the tumour, on the one hand, and limited metastasization at the site of recurrence, on the other.


[Epidemiological effect of influenza vaccination (author's transl)]. No influenza-A virus epidemic occurred in the Federal Republic of Germany during 1971-1975. The neighbouring countries, however, reported up to three such epidemics. The vaccines used had differences: contrary to neighbouring countries, in the FRG largely those were used which had mineral adjuvants, and they more frequently had viral subgroups. Comparison between the USA and FRG with respect to influenza death-rates over 20 years revealed a strict correlation from 1956 up to 1965. But since 1966 the death-rate has decreased progressively in the FRG while it has remained unchanged in the USA. Immunisation methods in the two countries have differed since 1966 in that the Public Health Authorities of the two countries have recommended immunisation of different population groups: in the USA it has been only for patients at risk, while in the FRG the rest of the population has also been urged to be immunised. As a result, immunisation rates differ markedly between the two countries. Absence of an influenza epidemic, accompanied by a reduction in death-rate due to influenza, strongly suggests that the two phenomena are the result of a break in the infection chain. This seems to be more successful when both part of the total population and the risk groups are immunised.


[Poisoning after ingestion of mussels (mytilus edulis) (author's transl)]. Symptoms of poisoning occurred in 19 persons in the Rhein-Main region in October 1976, after they had eaten mussels (Mytilus edulis) imported from Vigo, Spain. Mild oral paraesthesias, tingling in the fingertips and feet were followed by generalised numbness and dizziness. All symptoms disappeared within 48 hours. They had been caused by saxitoxin which is produced by a dinoflagellate and accumulated in the mussels, as confirmed by testing confiscated samples of mussels. Toxin concentration ranged from 6000 to 20 000 MU (mice units) per 100 g mussel meat.


[Abnormal postvaccination course after oral smallpox immunisation (author's transl)]. Five instances of side-effects after oral smallpox immunisation (out of 2568 persons orally immunised) are reported. Vaccinal lesions on the tongue, gums and (once) nares predominated and had been caused by biting open the vaccine-containing capsule or tablet with release of the virus.


[Chronic tonsillar hypertrophy as a cause of cor pulmonale, pulmonary oedema, and hypersomnia in children (author's transl)]. Chronic hypertrophied tonsils and adenoids causing partial airway obstruction produced serious illness and a confusing clinical picture in a 51/2-year-old boy. Cardinal signs were cor pulmonale, pulmonary oedema and marked cardio-respiratory changes due to hypoxaemia and hypercapnia, in addition to hypersomnia. Marked improvement of the clinical picture and the abnormal signs followed directly upon tonsillectomy and adenoidectomy. Chronic alveolar hypoventilation is presumably the main cause of the described condition and of others of extracardiac origin with similar signs and symptoms.


[Myocardial involvement in a special form of Erb's muscular dystrophy (type Becker-Kiener) (author's transl)]. A 22-year-old man with cardiac symptoms had been treated for myocarditis for two years. But the clinical course and special tests, including isoenzyme measurements, electromyography, peripheral muscle and myocardial biopsy, established the diagnosis of X chromosome-linked muscular dystrophy (type Becker-Kiener) with an associated cardiomyopathy (raised left-ventricular end-diastolic pressure). Light- and electron-microscopic studies of the (right ventricular) myocardial biopsy revealed degenerative changes like those seen in peripheral muscle.


[Serum ferritin in iron deficiency anaemia (author's transl)]. Red cell indices, plasma iron, total iron-binding capacity and serum ferritin levels were measured in 73 patients with iron deficiency anaemia. There was decreased plasma iron and MCHC with an increased total iron-binding capacity in 38 patients (type I iron deficiency anaemia). There was no hypochromia in 18 patients with decreased plasma iron and normal total iron-binding capacity; haemoglobin concentration was higher than 90 g/l (type II). Normal MCHC, plasma iron and total iron-binding capacity were found in 17 patients with haemoglobin values higher than 105 g/l (type III). Serum ferritin measurements were made by the immunoradiometric assay. The ferritin concentration was less than 40 micron/l in 66 patients with iron deficiency anaemia. The test proved reliable in diagnosing mild iron deficiency anaemia (types II and III) without bone marrow aspiration.


[Serum ferritin as a control parameter for oral iron therapy (author's transl)]. Ferrritin can be measured in blood serum radioimmunometrically. Serum ferritin is directly correlated to body iron stores. In comparison to other parameters of storage iron (bone marrow iron, intestinal iron absorption) this quantitative diagnostic parameter is easily available. Thus it can be used to judge body iron status. In 20 patients with chronic haemorrhagic and 7 patients with posthaemorrhagic iron deficiency anaemia as well as nine blood donors with latent iron deficiency serum ferritin was used to control oral iron therapy. The continuous determination of serum ferritin during therapy gives a quantitative value of the relevant level of body iron stores. This value shows whether therapy was effective and when iron stores are replenished. The results demonstrate that oral iron therapy should be continued for at least 3 months from the time of normalisation of haemoglobin to obtain a sufficient restoration of iron depots.


[Histomorphometric study of pelvic-crest biopsies during long-term fluoride treatment of osteoporosis (author's transl)]. In 14 patients being treated with fluoride preparations for osteoporosis histomorphometric analysis of iliac biopsies showed that the volume of the mineralised spongiosa had increased by more than 20% above initial level in eight instances. The volume of the osteoid in ten cases had also increased, generally most markedly in the first year. In some cases the clinical symptoms corresponded to the histomorphometric findings. The results suggest that fluoride treatment of osteoporosis can be continued beyond one year. But this should only be done under precise control also of histological bone studies because in three of the patients the spongiosa volume had reached high normal values already after one to three years of treatment.


[Radiological evidence and removal of tablet conglomerates in intoxication with bromide-containing hypnotics (author's transl)]. If large amounts of bromide-containing hypnotics are taken together, the tablets may conglomerate in the stomach. Because of the bromide, this is radiologically demonstrable. Conventional gastric lavage does not remove such conglomerates. In order to prevent long-term late absorption with serious complications such as hypothermia, shock-lung and renal failure, previously only gastrotomy had been an effective treatment. But using gastroscopy with lavage and aspiration, such conglomerates can be removed within one to three hours. Fifteen patients in whom this technique was used were rousable within 24 hours, significantly shortening the period of intoxication. At the same time, complications may be avoided. This is also true in instances where the tablet dosage would otherwise have been fetal.


[Airway resistance and lung volumes (author's transl)]. Whole-body plethysmography for measuring airway resistance and intrathoracic gas volume is a valuable tool for diagnosing pulmonary and airway functions. It is desirable to know momentary airway resistance in the course of a forced expiration and vital capacity in relation to predicted and actual thoracic gas volume as well as predicted and actual total capacity. This is a reliable means of discovering limitations of lung ventilation despite normal airway resistance during normal ventilation. With a computer and plotter attached to a whole-body plethysmograph such volume-airway resistance curves can be rapidly and well reproduced without stressing the test person. In addition, it also makes it possible to measure routinely the volume resistance breaking point (largely comparable to "closing capacity") even in ill patients.


[Basis for designing a medical course curriculum]. This article sets forth the reasons for the structure given to the Division of Biology and Health on the Xochimilco campus of Metropolitan Autonomous University in Mexico: to adjust the university to the process of social change going forward in the country and gear the university to the problems of the present by avoiding the rigidity of its structure. The basic aspects of curriculum design are cited against a background of an historical analysis of the socioeconomic structure of education and health. The principles underlying the curriculum and the course work are then described on the basis of that analysis.


[New challenges in health education. Medical genetics]. The article examines the reasons for the accelerated development of medical genetics in the last 30 years. It dwells on why hereditary diseases have become so prominent in the vital statistics of many countries, and reviews the biological and social aspects of these diseases. It is further noted that, despite the new importance of these diseases, the medical schools in which medical genetics is taught are relatively few, and physicians are turned out without even a rudimentary grounding with which to face problems in this field. The author concludes that there is urgent need to plan and develop an extensive program of education in medical genetics on both the under and postgraduate levels, and in the community itself.


[Innovative approach of teaching-learning of histology and embriology]. The paper presents an innovative approach to the teaching-learning of histology and embryology. The traditional teaching of the subject in the Faculty of Medical Sciences of Rosario National University, Santa Fe, Rosario, Argentina, up to 1974 is subjected to critical analysis, and on this basis the need for the innovation is propounded and the method for applying it proposed. A detailed account is given of the theoretical framework of the experiment reported, of the general and specific objectives of the teaching-learning technique, and of the thematic units into which the curriculum was divided. In the teaching-learning plan followed--described in the article--the conventional professorial lecture and its accompanying practical demonstrations are replaced by round tables and theoretical-practical tasks requiring active involvement and integrating theory and practice, in which teams tackle problems under teacher coordination. It also provides for evaluation of the students, teachers and course and eliminates the conventional examination.


[Normal hemostatic indices in experimental animals]. On the basis of the studies conducted by the authors on 19 nonbred dogs and 25 rabbits of the strain Cincilla and Belgium giant the normal values of the basis indices of hemostasis were determined: thromboelastography (r+k and ma), amount of fibrinogen, number of thrombocytes, thromoboplastic time, time of recalcification. The obtained data are shown on a table. The obtained data could serve as orienting data in examining hemostasis in dogs and rabbits under various experimental conditions and models for investigating various human pathology.


[Thymectomy of adult mice and hamsters]. The author describes a method for thymectomy of adult mice and hamsters, in which he uses a new operative approach at the initial stage of the operation. The common longitudinal median skin section is replaced with semioval section of the skin which begins from the surface transversly to the median line over xiphoid process of the chest bone, passes parallely and lateralily to both sides of the chest bone in the direction to the neck and ends at the level of the clavicle. Semioval cut skin, returned to its place after comrlition of the thymectomy, forms a peculiar subcutaneous pocket in the cavity of which the mediastimum and the risk of pneumothorax, while the usage of skin sutures is replaced completely by the tissue glue.


[Collagen biosynthesis in the arterial wall in experimental atherosclerosis]. The authors examined collagenous neosynthesis in the aortic wall of rats with experimental atherosclerosis after application of 3H-proline, a precursor of collagen, as well as subsequent determination of the radioactivity in the aortic wall by means of scintiliation counting and localization of the incorporated radioisotope by radioautography (optical and electron microscopic). There was a great increase of the incorporation of 3H-proline in the atherosclerotic aortas in comparison with controls, a manifestation of raised neosynthesis of collagen in the cellular elements of the aortic wall in atherosclerosis. The elevated collagenogenosis was due mainly to an increased synthetic activity of the modified smooth muscle cells, forming fibrous atherosclerotic plaques. This was proven by their more intensive radioisotopic marking in comparison with medial smooth muscle cells in the optical and electrone microscopic radioautograms.


[Changes in the microcirculation of the myocardium in pulmonary embolism]. The author induced experimental lung embolia by venous administration of liquid fat or licopodium spores in 26 rabbits. Materials, obtained from myocardium of the experimental animals, were examined histologicaly and histochemicaly. The method of Lie et al. (1971) was used for establishing early ischemic changes in myofibers. The author recommended licopodium embolia as a good model for examining changes in myocardium after lung embolia. She indicated development of shock phenomena in animals with lung embolia, presenting signs of coronary insufficiency, including formation of sites of ischemic myofibers. With these changes the author explained the serious difficulties at the clinic in diagnosing and differentiating lung embolia from myocardial infarction even after electrocardiographic control.


[Spontaneous chromosome aberrations in the lymphocytes of human peripheral blood]. The authors carried out cytogenetic studies on lymphocytes from human peripheral blood of 105 persons--49 women and 56 men in order to examine spontaneous frequency of the structural chromosomal abberations in the somatic cells. There were 191 cells with abberations (1,17%), out of 16,267 analyzed metaphasic plates. They found 0,39% of chromatid fragments, 0,71% of chromosomal fragments, 0,06% dicentricets, 0,01% of  symetric and asymetric chromatid exchanges and 0,006% of rings. There were no statistically significant differences in the discovery of the spontaneous abberations in the examined persons at various age and sex.


[Vibrations as an experimental factor affecting intestinal resorption]. The authors treated white rats daily at one and the same time for a period of one hour with vibrations. One of the groups of animals were treated with vibrations and examined after that, but the other two groups were treated respectively for 45 and 90 days. Examination was carried out during vibration, immediately after that and three hours after the vibrations. They used the method of the turned bags of Wilson and Waisman, by means of which they checked the resorption of glucose through the intestinal wall in vitro, it was established that during continuous vibration action the values of the resorption glucose were statistically lower than those of the control group. There were statistically significant differences in the values of the resorbed glucose in the subgroups examined during the vibration immediately and there hours after that. The authors discuss the obtained results in the light of the current concepts for the action of vibrations as a stress factor and their influence on intestinal resorption.


[Morphological changes in the liver of rats treated with phenobarbital, methylphenobarbital and their N-substituted morpholinoethyl derivatives]. The authors carried out histologic and electrone microscopic studies of liver in rats, treated with phenobarbital, methylphenobarbital, with their N-substituted morpholinoethye derivatives as well as in rats from the control group of animals. It was established that phenobarbital and methylphenobarbital caused hypertrophy and vacuolization of endoplasmatic reticulum, but the first preparation of the myelin degeneration of mitochindria as well. Morpholinethyl derivatives of the mentioned two compounds induced above all activation of lysosomes as well as reaction of Goldgi apparatus in the parenchymatous cells of liver. The observed ultrastructural changes were connected with differences in the induced drug-metabolizing enzymic properties of the two groups of compounds, established by the authors in their previous studies.


[Relationship between blood zinc level and EEG changes under the influence of hyperpnea in normal subjects]. The red blood cell and serum zinc levels have been determined by atomic absorption spectrophotometry on 27 human subjects in apparent good state of health, tested monthly for five months successively. The subjects who present a decreased frequency of the E.E.G. pattern during hyperventilation, also show a diminished red blood cell Zn level, by comparison with the other subjects. This phenomenon suggests a possible relationship between red blood cell zinc concentration and E.E.G. signs of cortical hyperexcitability. These findings are discussed in the light of the recent literature.


[Marinesco-Sjögren syndrome].

[Marinesco-Sjögren syndrome]. The case of a severely mentally-retarded man who congenitally presents a cerebellar syndrome and a serious myopia, is discussed: his unilateral cataract showed at 25, and two presenile cataracts among his relatives. Besides, this case involve an epilepsy, an insufficient somato-genital growth and an hyperostosis frontalis interna. A dyslipoïdosis was called up by d'ANGELO and al. (1967) in the MARINESCO-SJOGREN syndrome; an excess of lipids seems actual in the CSF of our case. So the rare MARINESCO-SJOGREN syndrome's diagnosis criteria may remain no restrictive.