Sensory substitution and the design of an artificial ear. This paper is concerned with attempts at sensory substitution and in particular with devices that have been designed to substitute for hearing by using the skin as an alternative channel of communication. A review of the literature suggests that the failure or limitations of tactile substitution systems are due, not to the inadequacy of the skin's perceptual processing capacity, but to inappropriate displays, ineffective training methods, or insensitive testing techniques. Specifically, displays have been artificial in that they have typically failed to preserve the information relevant to the modality for which they are supposed to substitute. Furthermore, certain false assumptions and misconceptions have been manifest in testing techniques which have not taken into account the way in which perceptual processes normally develop and operate. The result has been that some important evidence has been ignored or has gone unnoticed and that some promising devices have been prematurely abandoned. In the final section of the review, some suggestions are made concerning the design, application, and evaluation of an artificial ear.


Physical attractiveness, personality, and social reactions to peer pressure. Following a hypo-deductive theoretical rationale, the relationship between physical attributes, personality development, and susceptibility to peer pressure was assessed. Male and female college students (N = 181) responded to several personality measures previously reported as characteristics attributed to physical attractiveness and a new measure designed to assess peer pressure influences (Dilemmas Test for College Students). Peer-ratings and self-perceptions of facial attractiveness, body form, and general appearance were gathered. Physically attractive persons, in comparison to their lesser attractive peers, were more likely to have internalized socially desirable personality characteristics and show resistance to peer pressure influences. Further, some evidence suggested that attractiveness was related to the internalization of cognitive-social characteristics for males and cognitive-evaluative characteristics for females.


Personality differences between kibbutz born and city born adults. Two hundred and thirty-two men and women students at the University of Haifa were administered a Hebrew version of the California Psychological Inventory. Half of the students were kibbutz born, and the others city born. The two samples were matched on sex, age, level of education, and economic level. Of the 18 scales, significant differences between the means were found in only two scales for each sex group: namely, Responsibility and Achievement via Independence for males, and Achievement via Independence and Intellectual Efficiency for females. The other comparisons of means for each sex group were not significant, nor were there any significant differences between the variances. It seems, then, that the differences in child rearing between kibbutz and city do not necessarily produce major differences in personality traits. An alternative hypothesis might be suggested: kibbutz child-rearing practices, different as they are from the city approach, do not create a "new" type of personality.


Melanin distribution and sensitivity to group therapy. Student participants in group therapy were hypothesized to improve on three dimensions of behavior as a result of therapy. It was further hypothesized that improvement would be related to participant eye color, with dark-eyed persons demonstrating greatest improvement and lighter-eyed individuals demonstrating lesser improvement. Differences were also expected from Ss by program. Ss were 35 male and female master's level students in clinical, counseling, and educational psychology programs, ranging in age from 23 to 39 years. Dependent measures were collected before and after therapy with the Vriend and Dyer Scale, an instrument yielding three factors: Self Defeating Behaviors, Fully Functioning Behaviors, and Personal Mastery Index. The design utilized a 3 (eye color) X 2 (program) two-way ANOVA, fixed effects model. Significant main effects were found for Fully Functioning Behaviors: by eye color (p less than .002) and by program (p less than .03). No interactions or other main effects were found.


Clinical applications of echocardiography. Echocardiography is helpful to the clinician in a number of situations. In a patient with the radiological finding of cardiomegaly, the possibilities of a pericardial effusion, left or right ventricular volume overload, or severe ventricular dysfunction, may readily and accurately be assessed. The technique is a useful adjunct in assessing the severity of many valvular lesions and in some cases establishing the aetiology of the lesion. The ability to diagnose left atrial myxomas is unique and invaluable. Mitral valve prolapse and hypertrophic cardiomyopathy are now being recognised more frequently, and may provide an "organic" reason for long-standing unexplained symptoms. Finally, while echocardiography is of value in certain clearly defined areas, it should not be regarded as a panacea for all cardiac diagnostic or management problems.


[Time factor in local radiotherapy (author's transl)]. This study was aimed at determining the influence of time factor in local radiotherapy in patients with spindle cell neoplasms of the skin or basal cell carcinomas of the face, treatable in a single plane. These neoplasma were treated using identical doses (6,000 rads distributed over the envelope isodose), but divided at random into two groups corresponsing to two different spreads (60 +/- 12 hours and 156 +/- 12 hours). The biological effects observed (rate of disappearance of the lesion, intensity of skin reaction, duration of skin reaction) showed no difference between the two types of treatment. This results is unexpected considering the important influence of time factor in the case of fractionated irradiation. In fact, if it is accepted that between 60 and 156 hours, cellular multiplication phenomena are equivalent to approximately 30 rads per day, the difference in spread the two types of treatment is not sufficient to give a significant result.


[The results of radiotherapy managements in Hodgkin's disease (author's transl)]. We reported the results of radiotherapy managements in Hodgkin's disease about 185 patients. From this study, it seems to appear possible to confirm or to note some particular facts: the real good prognosis of the forms begining in the right sus-clavicular fossa; the special staging of the long time survival patients (II Aa, type II); the small value in survival of chemotherapy done before and/or after radiotherapy in the I and II stages; in the other side, the true amelioration comming from chemotherapy in the III and IV stages; the value of irradiation by expanded fields; the particular interest of the total mode irradiation done at the beginning or during the course of the illness; the optimal dose of larger than or equal to 4 000 rads with a weekly dose of larger than or equal to 1 000 rads; the good tolerance of the radiotherapy. From this prelimary study, we hope dowing well in further with a greater number of patients.


[81 cases of Hodgkin's disease treated with extensive radiotherapy, including 65 with primary MOPP chemiotherapy (author's transl)]. Study 81 cases of Hodgkin's disease at stages I, II or III led to the following conclusions from a therapeutic standpoint (in relation to the apparent results obtained): The addition of chemotherapy on the form of three courses of MOPP before irradiation improved the results of the latter on the one hand and, principally, by reducing the number of failures and, secondly, by reducing the complications. The addition of chemoprophylaxis by MOPP in patients in complete remission as a result of initial treatment, involving an association of 3 courses of MOPP followed by radiotherapy, was not shown to be useful. A major factor in prognosis would to be the clinical and radiological situation after the first three courses of MOPP (in the context of combined MOPP and radiotherapy) since, despite the later radiotherapy,  numerous failures were noted in the absence of remission after the three MOPP treatments, whilst failure rarely occurred under the opposite set of circumstances. This is important, since modest treatment would seem to suffice in patients reacting well to three initial MOPP treatments, whilst it is essential to reinforce it when this is not the case.


[Results of treatment of carcinoma of the nasopharynx (author's transl)]. Study of survival amongst a group of 101 patients with epithelial tumours of the nasopharynx treated by cobalt irradiation between 1967 and 1972 indicates the prognostic significance of the following factors: the histological type, extension of the tumour, the degree of lymph node involvement, age and sex. The optimal dose is 1,800 to 2,000 rets NSD and should be modified in the light of these factors, and above all the histological type and the tumour category. Cumulative survival for all cases was 36% at 5 years, with a more favourable prognosis in lympho-epitheliomas in comparison with spindle cell epitheliomas.


[The results of cobalt therapy for carcinoma of the larynx (author's transl)]. The effectiveness of cobalt therapy for carcinoma of the larynx in demonstrated by the results obtained: 53% overall survival at 5 years, with 66% for carcinomas of the glottis, and 48% for supra-glottal lésions. The dose-time ratio used was adapted to the tumor category and to the individual reactivity of the patients, local control being obtained in 100, 87, 65 and 25% for T1, T2, T3 and T4 tumours respectively.


[Application of the Moving Strip Technique of Fletcher in the radiation treatment of primary malignant tumours of the ovary (author's transl)]. The moving Strip Technique for irradiation of the abdomen perfected by Fletcher and Delclos represents considerable progress in terms of radiotherapy for carcinomas of the ovary by virtue of its simplicity, good tolerance, the homogeneous dose delivered to the entire abdominal cavity and the absence of sequelae. It is possible to deliver a dose of the order of 2.500 rads in 10 days to each abdominal segment, this being equivalent of 3,500 rads in 3,5 weeks. This moderate dose is aimed only at dealing with micronodular invasion and the superimposition of added local doses is required for residual tumour, marked using clips. Of 18 cases treated, including. 15 et stages III and IV, overall survival at 4 years is 52.5%. Two patients at stage III survived for more than 2 years with radiotherapy alone, whilst all at stages I and II are still alive. Have survived for more than two years with radiotherapy alone, whilst all at stages I and II are still alive. From a histological standpoint, the worst group seems to be adenocarcinomas (all dead). Systematic sequential surgery for excision or reduction, chemotherapy to dry out ascites, moving strip irradiation with superimposed doses locally and long term chemotherapy should make it possible to improve the prognostic results of this tumour, for which the outlook remains poor.


[Proposals for common definitions of reference points in gynecological brachytherapy (author's transl)]. In May 1975 the report of European Curietherapy Group recommended in gynecological Dosimetry by computer. Use of reference points = lymphatic trapezoid figure with 6 points, Pelvic wall, all points are refering to bony structures. Use of critical organ reference points = maximum rectum dose, bladder dose mean rectal dose. Use of 6,000 rads reference isodose described by height, width, and thickness dimensions. These proposals are the basis of a common language in gynecological brachytherapy.


[Evolution of the dosimetric criteria of the curietherapy in carcinoma of uterine cervix (author's transl)]. The difficulties which arise when comparing the different therapeutic attitudes concerning the treatment in the curable stages of cancer of the uterine cervix have led us to the formation of dosimetric criteria to be employed in the analysis of the intracavity therapy. We have established points of reference which can be utilized irregardless of the intracavitary technique therapy. We have established points of reference which can be utilized irregardless of the intracavitary technique employed. Furthermore, we have analysed those patients who have received the same dose of external irradiation in an effort to establish as the only variable the intracavitary treatment. Forty patients, receiving 4,000 rads tumor dose in 4 weeks, were reviewed and demonstrated a correlation between the reference volume of the intracavitary treatment (as defined by the three dimensions W, H, T) and eventual complications (4 cases of Rectitis 1). We now feel that with the utilisation of these dosimetric criteria we will be able to: minimize the risk of complication without augmenting the indicence of local-regional failures; facilitate the objective comparison of the efficacity of the different intracavitary techniques presently employed at the major treatment centers.


[The practical application of computer dosimetry in gynaecological radiotherapy. 1,200 cases studied between 1968 and 1976 of the Gustave-Roussy institute (author's transl)]. Experience gained since 1970 by the study of 1,200 cases in which computerised dosimetry was used has led to the proposition of a reliable and useful method. The results are expressed per 24 hours of exposure in numerical form with regard to reference points, as well as in the form of drawn isodose curves in three different planes of reference: sagittal, frontal oblique by sources and frontal oblique passing by the plane of pelvic lymphatics. The authers recall the definition of reference points: bladder, rectum and pelvic walls. Using three typical examples, the aid provided by dosimetry is described. The concept of a "radiotherapy identity card" as a means of expressing the dose given is discussed. Comparison between dosimetric results and the results of treatment is encouraging in terms of the continued and fore general use of the method.


[Technique for intracavitary radiotherapy using an iridium 192 wire ("umbrella") in the treatment of adenocarcinoma of the body of the uterus (author's transl)]. The description of an intrauterine device for the application of local radiotherapy in non-radioactive preparation. The device consists of polyethylene tubes froming two perpendicular loops joined and fixed and their topmost point by ligature. A traction wire is used to open these loops, therby obtaining a cuboid target-volume from four radioactive lines. Dosimetry for this technique (known as "umbrella") may be obtained using a computerised programme.


[Endocurietherapy for carcinoma of the penis (author's transl)]. 46 cases of epithelioma of the penis treated by endocurietherapy (Iridium 192) are analysed, with a minimum follow up to of 5 years. The local results appear to be excellent for small lesions, of the order of 20 mm, with only 2 recurrences out of 14 cases. With a slight potential of lymphatic spread, 12 of the patients are apparently cured. The organ has been preserved in perfect functional state. More extensive lesions, but less than 40 mm in size, have a less satisfactory prognosis by virtue of more frequent lymph node spread, difficult to control, and their general course. However local results remain quite respectable, despite 5 recurrences out of 25 cases, 3 of which were easily "salvaged" by surgery. 12 of these patients are apparently cured and in 9 the organ has been preserved in satisfactory functional condition. By contrast, massive forms, larger than 40 mm, recur or necrose and thus represent a poor indication for curietherapy. In conclusion it may be said that endocurietherapy for carcinoma of the penis, by virtue of a technique rendered opitmal by accurate prior dosimetry, is certainly an excellent therapeutic option for all small or moderately extensive lesions, avoiding mutilation. The presence of lymph node involvement has an unfavourable influence on prognosis.


Longterm evaluation of intermittent levamisole treatment in rheumatoid arthritis. Twenty-one patients with rheumatoid arthritis were treated discontinuously with levamisole overa prolonged period (150 mg/day, four days per week). Disease activity was completely suppressed or markedly improved in 18 patients, while three patients showed no improvement. Overall, a statistically significant improvement was recorded after six months in morning stiffness, Ritchie index, grip strength, and sedimentation rate. After 12 months treatment, the morning stiffness, Ritchie index, grip strength, and sedimentation rate were still significantly improved. After 18 months treatment, only the morning stiffness was still improved as compared to the initial evaluation. Improvement in the other indices was no longer significant. The beneficial effect of levamisole therapy occurred slowly, reaching a maximum after six months. Similar improvement was observed in patients with advanced disease as in the early stages. Intermittent levamisole administration would appear to be as effective as continuous treatment. While minor side effects occurred just as frequently as with continuous administration, the discontinuous treatment used in this study was free of serious side reactions.


Adult sexuality and juvenile rheumatoid arthritis. Fifty-eight adults, 37 females and 21 males, were examined and interviewed in a follow-up study, an average of 14.5 years from the onset of juvenile rheumatoid arthritis. Sexual activities of 52 patients were found similar to their peers in the general population. Thirty-eight per cent expressed a need for sexual counselling. Activity of disease rather than severity of joint deformity was found to be the more inhibiting factor in sexual activity. Sexual counselling can help to combat some of these limitations. Sexual counselling should be an integral part of the total treatment provided these patients.


Antirheumatic drugs, the ESR, and the hypohistidinemia of rheumatoid arthritis. The longterm administration of prednisone and gold to patients with rheumatoid arthritis (RA), in doses that decreased the sedimentation rate (p less than 0.05), did not alter the serum histidine concentration (p greater than 0.5). In patients with RA receiving various combinations of aspirin, prednisone, and gold, the regression lines relating the serum histidine concentrations to the sedimentation rates had similar slopes but different elevations compared to patients receiving no anti-inflammatory drugs. In the patients receiving anti-inflammatory drugs, the regression lines were displaced so that in patients with similar serum histidine concentrations, the stronger the antirheumatic therapy, the less abnormal the sedimentation rate. These observations are consistent with the hypothesis that hypohistidinemia contributes to the pathogenesis of RA.


Scleroderma with intestinal involvement: fatal in two of a kindred. The unusual occurrence is reported of scleroderma with intestinal involvement in a 59 year old women and her 19 year old nephew. Both died from causes related to this bowel disease.


Familial CRST syndrome with sicca complex. Two patients, a mother and daughter, each with the CRST syndrome, developed Sjögren's syndrome. Both patients had mitochondrial antibodies, smooth muscle antibodies, and a raised serum IgM without clinical evidence of liver disease. This family constitutes the first record of the familial coexistence of the CRST syndrome with Sjögren's syndrome, and the second evidence of vertical inheritance of scleroderma. It is suggested that patients with the CRST syndrome be studied for Sjögren's syndrome and for autoimmune liver disease.


Synovial reaction caused by adjacent malignant tumors: anatomicopathological study of three cases. Three patients are described, each having a malignant bone tumor associated with inflammatory episodes in the adjacent joint. Two of these were sarcomas of the lower end of the femur, and one a metastatic carcinoma in the distal end of the radius. Histologically, the synovium exhibited moderate and non-specific signs of inflammation near the malignant tissue. These cases illustrate the possibility of diagnostic error, either clinically or on microscopic examination of small specimens, especially in punch biopsies.


Aseptic necrosis of head of femur: presenting manifestation in Cushing's disease. Aseptic necrosis of bone is a known complication of corticosteroid therapy. We report a case of aseptic necrosis of the femoral head as a presenting symptom of Cushing's disease. The case demonstrates that endogenous steroids, like exogenous steroids, may bear the same relationship to the pathogenesis of aseptic necrosis of bone. It also indicates that Cushing's disease must be considered in every case of so-called idiopathic aseptic necrosis of bone.


Renal urate excretion in five cases of hypouricemia with an isolated renal defect of urate transport. Renal urate excretion was studied in two familial, one suspected familial, and two isolated cases of hypouricemia due to a renal defect. All had very low plasma urate concentrations. In four cases, the urate clearances were approximately the same as the creatinine clearances, and in one case reduced to about one-third. In all cases the urate clearances were minimally diminished by both pyrazinamide and probenecid. This renal response to the drugs is probably due to and isolated tubular defect in the reabsorptive transport mechanism of urate. Following intravenous administration of uric acid, one patient excreted uric acid in the urine more rapidly than a normal subject. In this patient, uric acid secretion from renal tubules was clearly demonstrated during infusion of uric acid. In de novo synthesis of purine, no definite abnormalities were found by incorporation of glycine-15N to uric acid.


Family study of Reiter's disease and HLA B27 distribution. Starting from index patients with confirmed Reiter's disease, a clinical and immunogenetic study was performed on 12 families in which there were further cases of arthritis. Altogether 51 family members were investigated and some information was available on 15 additional members. In most families there were two or three affected members in addition to the proband. The manifestations included acute polyarthritis (16 cases), which frequently followed urethritis or occurred as a complication of Yersinia or Shigella infection, and chronic arthritis (9 cases), either ankylosing spondylitis or peripheral arthritis. The latter characteristically had a remitting course, affecting mainly the large joints. Not a single subject had sero-positive rheumatoid arthritis. The HLA B27 gene was detected in all 12 families, and served as the main indicator of the familial trait for developing arthritis. In individual patients however, the association was not especially close, since there were members with this antigen who did not have arthritis in spite of a seemingly adequate triggering stimulus and others who had arthritis but not the antigen.


Faculty tenure in American medical schools. Advantages and disadvantages of academic tenure for clinical faculties, including an appraisal of its financial burdens, the utility of modified or alternative systems, and the issue of abolition of tenure, were examined through a questionnaire to which deans and faculty representatives of 106 American medical schools responded during 1975-76. Tenure is valued by most deans and faculty members. A flexible tenure policy permitting appointment of some faculty members to senior academic posts without tenure was endorsed by the deans of 10 selected medical schools who were interviewed. Growth of medical faculties is decelerating; a steady state has not been attained but is imminent. Financial pressures and demands for change will increasingly challenge the tenure system.


Can AHES really influence the distribution of physicians? In this report the author considers the potential of the "Area Health Education System" (AHES) to influence physician distribution, as reflected by a "core" surgical experience in a remote site of approximately 20,000 population. Although the long-term effects can only be theorized, the effectiveness of the undergraduate education process in a first-exposure situation discloses only slight advantage as measured on written examination for the student who remains in the university setting. Moreover, some favorable attitudinal alterations were noted among participants in AHES.


Toward an holistic education in pathology and medicine. In an attempt to answer the criticism that medical education does not adequately prepare the student for his future profession, the basic course in pathology in the medical faculty of the Erasmus University in Rotterdam has been organized along the lines of Rogers' "student-centered teaching" (1), Mursell's "individualization in social learning situations" (2), and Brown's "confluent education" (3). These organizational factors, combined with a definition of pathology that is broader than the one tradionally given in that it includes the study of psychological, sociological, economic, and political factors related to the etiology of somatic disorders, result in a course that forms the basis of an education in "humanistic medicine." The basic principles in this approach are summarized, and a description of the course, with special attention to the application of confluent education in the medical setting, is given.


The integration of nutrition education in the basic biomedical sciences. At the Center for Biomedical Education at the City University of New York, nutrition is integrated into the chemistry-biochemistry sequence of a six-year B.S.-M.D. program. Students perform an actual analysis of a sample of their own food, learning a number of basic techniques and concepts. At the same time they carry on experiments with rats on diets similar to those used by some people. Those activities are complemented by a dietary survey on themselves and other college students. The fundamentals of nutrition are taught as part of the biochemistry course, while the interpretation of the nutrition survey will be conducted in the course titled Health, Medicine and Society, in which students become acquainted with health problems in the community they will serve as general practitioners.


A comparison of the clinical performance of students in three-and four-year curricula. The purpose of this paper is to report the clinical performance of medical students prepared in three-and four-year curricula. The students were evaluated in five categories: fund of knowledge, medical skills, problem-solving, professional standards, and reliability. The examination of the National Board of Medical Examiners were administered in three of the clinical clerkships. The results indicate that the students performed equally well in most areas, and little difference in clinical performance could be demonstrated between the groups.


Objectives of psychiatric education in a primary care curriculum. This paper gives the rationale, background, and outline of psychiatric curriculum development in the education of the primary care physician at one medical school. It is important to clarify the educational objectives, to develop specific teaching techniques to meet the objectives, and to have adequate assessment measures to evaluate the objectives and techniques. Additionally, it is necessary for an ongoing committee to continue to monitor and adjust the program as the assessment requires. The value of the program has been educational clarity, the development of a high esprit de corp among the faculty, student acceptance, and integration of psychiatry into the total medical school curriculum.


The use of student ratings in multiinstructor courses. In this study the authors examined the efficacy of using student ratings of teaching effectiveness in multiinstructor courses. Specific issues addressed included student ability to identify differences in faculty teaching effectiveness, the consistency of student rating obtained immediately following each lecture with those obtained at the conclusion of the course, and the relationship between individual faculty ratings and overall course ratings. A random sample of students rated each of 14 lectures in a psychopathology course using a 13-item rating scale immediately after each lecture and again at the end of the course. Results indicated that differences in faculty teaching effectiveness are measurable, ratings of individual faculty are relatively stable over over time, and rating of individual faculty are separable from those of the course as a whole. Implications of this research for use of student ratings are also discussed.


Study of U.S. medical school applicants, 1975-76. This annual descriptive study provides statistics on the demographic and background characteristics, academic ability, and career plans of applicants to the 1975--76 first-year class. Comparisons with the preceding year's applicant pool, traditionally the focus of the applicant study series, show a slight decline in the size of the pool, a continued increase in the number of women applicants and acceptees, and a slightly higher acceptance rate for all applicants. The study has been expanded by reinstating data on the socioeconomic background of applicants and by providing general summaries on topics such as career plan preferences of applicants. New to the series is an analysis of "in-phase" applicants, that is, undergraduate college seniors applying to medical school for the first time. The conclusion outlines those activities of the Association of American Medical Colleges over the past year that are related to the medical school admissions process.


Minority admissions to medical schools: problems and opportunities. The Congress and the Association of American Medical Colleges have the common objective of ensuring that all Americans will enjoy a high level of medical care. In furtherance of that objective, an AAMC task force in 1970 recommended that representation of minority groups in M.D. programs be increased from 2.8 percent (the level at that time) to 12 percent by 1975--76. While the goal was not realized, substantial progress has been made. Yet formidable barriers remain for many minority students who want to enter the health professions. Perhaps the greatest barrier consists of the subtle discriminatory pressures that manifest themselves in all institutions of the country. Today the phrase "reverse discrimination" poses a new political obstacle to the elimination of such pressures. And a series of court decisions has begun to erode the special admissions programs that are attempting to open up professional schools to members of minority groups.


A method for assuring continuity of care in residency training experience. A system of patient handling was devised at the University of Virginia to assure continuity of care in a residency training primary care setting. All unscheduled primary care patients as well as walk-in patients making their third visit were seen in the Attending Clinic to assure a proper disposition. The system was studied for one month. Data on the utilization of the system and its usefulness in maintaining continuity are presented. The Attending Clinic is a helpful tool in a teaching medical practice for provision of continuity of care and for systematically introducing patients into the primary care practice.


Continuing education in the community hospital: an interprofessional approach. The need for continuing medical education has been growing over the past decade but is largely unmet by, and within, most community hospitals. In this paper the author outlines the development of a systematic, interprofessional, self-directed approach to postgraduate education with a local community hospital. Also described is the format followed in assessing educational needs, evaluating resources, and initiating appropriate and necessary programs. Although care must be taken to avoid too much interdisciplinary involvement solely for the sake of the concept itself, the interprofessional model would appear to meet most educational needs, both individually and collectively, at the community hospital level.


Empathy in the doctor-patient relationship: skill training for medical students. This empirical study was designed to test the effects of a systematically designed training program intended to help medical students develop empathic responses to patients and to attend not only to disease symptoms but also to the patient as a unique individual with a disease symptom. This training was meant not to enable the student to conduct a complete medical interview but to facilitate initial rapport between the student and his patient. The subjects in this study were 43 medical student volunteers, 20 of whom received the training while 23 served as a control group. The experimental group, following training, was found to function at a significantly higher empathy level than the control group. The participants also were significantly more able to attend to the patient with a medical problem, while the control group response remained predominantly an impersonal discussion of the medical problem only.


The mechanical properties of bone cements. The mechanical properties of a number of commercially available bone cements have been investigated. Tests were carried out on specimens in compression, in bending and in tension. Using the compression test as a standard, the effects of the following variables were studied: the addition of antibiotics, strain rate, environmental temperature, and age. It was concluded that age, temperature and rate of straining have a marked effect on the strength of the cement, while the addition of small quantities of antibiotics only marginally weakens the cement.


The biomechanical design of a walking appliance for a paraplegic adult. One of the major requirements of the medical consultant treating paraplegic patients is to have them upright for at least a few hours a day associated, if possible with some physical exercise. This paper deals with the construction and operation of an appliance which makes this possible.


A preliminary analysis of the forces in screws in tibial fracture fixation. If a fracture of the tibia is incorrectly reduced and a plate fixed across the fracture site, then all of the load during subsequent weight bearing can be considered to be taken by the screws fixing the plate to the bone. An analysis of this extreme situation and determination of the magnitude of the consequent forces on the screws indicate that the screws are in danger of failing due to the shear forces but are in little danger from the tensile forces.


Studies in load carrying in BK amputees with a PTB prosthesis system. This study was undertaken to assess the effects of certain common modes of load carrying by hand in the BK amputee-PTB prosthesis system. The energy costs of a test group consisting of BK amputees using PTB prostheses were compared to those of a control group made up of normal able-bodied individuals and the difference between the two groups was observed to be more marked when walking was performed on the level with load in one hand only in comparison with the both-hand carrying conditions. Single handed load carrying by either hand did not seem to make any observable difference. Stair ascending with equal load in both hands did not produce any appreciable difference between the two groups. Indications were obtained that the BK amputee with a PTB prosthesis system is capable of performing industrial tasks of "moderate" grade.


Membrane permeability equations and their solutions for red cells. The mathematical equations for the transport of nonelectrolytes across cell membranes are critically examined and cast in forms suitable for solution which involve fewer approximations than has heretofore been commonly done. For the use of red cells, the equations are developed to include the effect of the variation in apparent nonosmotic water owing to the variation in hemoglobin concentration as the cell swells or shrinks. Two methods of solution of the equations are developed and studied and sample calculations are provided. It is shown that the solutions to the linearized equations commonly found in the literature are insufficiently accurate for some purposes and this inaccuracy is avoided by the methods given here. The importance of retaining the effects of variations in apparent nonosmotic water and in solute volume in the cell is demonstrated.


Reexamination of carbodiimide as a possible affinity label for the acetylcholine receptor at the frog neuromuscular junction. The effects of water-soluble carbodiimide were examined at the frog neuromuscular junction. Acetylcholine sensitivity was measured using a fluid electrode technique and intracellular recording of miniature end-plate potentials. The carbodiimide blocked synaptic sensitivity by a reversible, curare-like action. Irreversible blockade was also observed, probably due to covalent binding. The conditions of reaction and irreversibility suggest that several different residues may be attacked. The inability of cholinergic antagonists to protect the receptor from attack indicates that nonspecific sites, and not the acetylcholine binding site, are involved.


Adenosine stimulation of fluid transport across rabbit corneal endothelium. The rate of fluid transport across rabbit corneal endothelium has been measured with an automatic volumetric method. The present resolution of the procedure is 1-3 nanoliters, and intervals of measurement can be made as small as seconds. In the presence of glucose, oxidized glutathione (GSSG), and adenosine, the maximal rates were 6.2+/-1.0 microliter/hr cm2, and 8.2+/-0.8 microliter/hr cm2 if a large portion of the stroma was dissected away. In the presence of glucose and GSSG only, the rates were lower, namely 3.7+/-0.5 microliter/hr cm2. The rates consistently increased or decreased when adenosine was added or deleted, respectively, during given experiments. The stimulation of fluid transport by adenosine was in the order of 40-50%. The results raise the possibility that this transport mechanism might be subject to metabolic control.


Signal to noise enhancement in dark field electron micrographs of vasopressin: filtering of arrays of images in reciprocal space. A technique for filtering arrays of images of dispersed molecules is presented which takes advantage of the crystallographic properties of regular arrays and the rapidity of optical treatment. A filter in reciprocal space consisting of perforations in a square or rectangular lattice, as determined by the image arrrangement, reduces noise and averages the images simultaneously by transmitting only regularly recurring image structure. The filter is universal for all image contents and introduces no additional biases. The signal to noise improvement approaches square root N for N independent images of the same molecule in the same configuration. The procedure which is simple, rapid and inexpensive, is demonstrated with the aid of dark field electron micrographs of the protein vasopressin and combined with iodination of that molecule to elucidate its structure.


Infidelity of DNA synthesis as related to mutagenesis and carcinogenesis. An assay system has been developed for measuring the fidelity of DNA synthesis in vitro by using synthetic polynucleotide templates and purified DNA polymerases. Nearest-neighbor analysis of the synthesized product indicates that noncomplementary nucleotides are incorporated as single base substitutions. The accuracy of DNA synthesis can be decreased by (1) prior alkylation of the template, (2) increasing the relative concentration of incorrect nucleotides, and (3) addition of specific metal salts to the reaction mixture. As an initial evaluation of the utility of this system, the effects of 31 metal salts on the fidelity of DNA synthesis have been determined. The results indicate that potential metal mutagens and/or carcinogens may be detected by measuring alterations in the fidelity of DNA synthesis.


Chemical mutation in human lymphoblasts. We have developed a facile and reliable assay for mutation by chemicals and other mutagenic agents induced in the hgprt locus of diploid human lymphoblasts. We discuss here the detailed protocol and summarize the experiments, reported elsewhere, in which we tested the method for possible systemic bias. The concentration dependence of mutation for methylnitronitrosoguanidine, methylnitrosourea, ICR-191, and bromodeoxyuridine are also summarized to demonstrate the responsiveness of the new system to alkylating agents, an intercalating agent, and a base analog, respectively.


Repair replication and sister chromatid exchanges as indicators of excisable and nonexcisable damage in human (xeroderma pigmentosum) cells. Alkylating agents cause damage to DNA which can be repaired by exicsion repair (repair replication) and which induces sister chromatid exhcanges (SCEs). During early times after exposure (within 5 hr) normal and xeroderma pigmentosum (XP) cells perform similar amounts of repair replication. At later times (after 20 hr) normal cells have completed repair replication but XP cells continue at a lower rate. This slowly repaired component of alkylation damage appears to be related to the higher frequencies of SCEs induced by alkylating agents in XP cells compared to normal cells. Therefore, whereas repair replication is an indicator of exicsed damage, SCEs may be indicators of unexcised damage and may show better correlations with the potentially mutagenic and carcinogenic effects of exposure to enbironmental agents.


Typhoid perforation.

Typhoid perforation. Out of 270 cases of enteric fever observed over a period of 5 years there were 30 cases of enteric perforation (11.1%). Their clinical features, mode of presentation and various diagnostic and prognostic parameters have been described. Out of 30 patients, 18 died (60%) and 12 (40%) survived. Various factors regarding conservative and surgical management have been briefly discussed.


Methyl group analysis of virion-associated high-molecular-weight RNA synthesized in vitro by purified vaccinia virus. The methylation pattern of virion-associated high-molecular-weight RNA synthesized in vitro by purified vaccinia virus has been determined. Analysis of purified high-molecular-weight RNA synthesized with S-[methyl-3H]-adenosylmethionine and alpha[32P]UTP as precursors gave the following results. (i) Eessentially all molecules contained blocked and methylated structures of the type m7G(5')ppp(5')Gm and m7G(5')ppp(5')Am. (ii) There was no detectable methylation at internal sites. (iii) Under several different conditions of synthesis, the ratio of molecules containing m7G(5')ppp(5')Gm to those containing m7G(5')ppp(5')Am was imilar for both the virion-associated high-molecular-weight RNA and the virion-released 8-12S mRNA.


Reovirus-specific enzyme(s) associated with subviral particles responds in vitro to polyribocytidylate to yield double-stranded polyribocytidylate-polyriboguanylate. In reovirus-infected cells, virus-specific particles accumulate that have associated with them a polyribocytidylate [poly(C)]-dependent polymerase. This enzyme copies in vitro poly(C) to yield the double-stranded poly(C).polyriboguanylate [poly(G)]. The particles with poly(C)-dependent polymerase were heterogeneous in size, with most sedimenting from 300S to 550S. Exponential increase in these particles began at 23 h, and maximal amounts were present by 31 h, the time of onset of exponential growth of virus at 30 degrees C. Maximal amounts of particles with active transcriptase and replicase were present at 15 and 18 h after infection. Thereafter, there was a marked decrease in particles with active transcriptase and replicase until base line levels were reached at 31 h. Thus, the increase in poly(C)-responding particles occurred coincident with the decrease in particles with active transcriptase and replicase. The requirement for poly(C) as template was specific because no RNA was synthesized in vitro in response to any other homopolymer, including 2'-O-methyl-poly(C). Synthesis was optimal in the presence of Mn(2+) as the divalent cation, and no primer was necessary for synthesis. In contrast, the dinucleotide GpG markedly stimulated synthesis in the presence of 8 mM Mg(2+). The size of the poly(C).poly(G) synthesized in vitro was dependent on the size of the poly(C) used as template. This suggested that the whole template was copied into a complementary strand of similar size. The T(m) of the product was between 100 and 130 degrees C. Hydrolysis of the product labeled in [(32)P]GMP with alkali or RNase T2 yielded GMP as the only labeled mononucleotide. This does indicate that the synthesis of the poly(G) strand in vitro did not proceed by end addition to the poly(C) template, but proceeded on a separate strand.


Carbohydrates of influenza virus. I. Glycopeptides derived from viral glycoproteins after labeling with radioactive sugars. The carbohydrate moiety of the influenza glycoproteins NA, HA(1), and HA(2) were analyzed by labeling with radioactive sugars. Analysis of glycopeptides obtained after digestion with Pronase indicated that there are at least two different types of carbohydrate side chains. The side chain of type I is composed of glucosamine, mannose, galactose, and fucose. It is found on NA, HA(1), and HA(2). The side chain of type II contains a high amount of mannose and is found only on NA and HA(2). The molecular weights of the corresponding glycopeptides obtained from virus grown in chicken embryo cells are 2,600 for type I and 2,000 for type II. The glycoproteins of virus grown in MDBK cells have a higher molecular weight than those of virus grown in chicken embryo cells, and there is a corresponding difference in the molecular weights of the glycopeptides. Under conditions of partial inhibition of glycosylation, virus particles were isolated that contained hemagglutinin with reduced carbohydrate content. Glycopeptide analysis indicated that this reduction is due to the lack of whole carbohydrate side chains and not to the incorporation of incomplete ones. This observation suggests that glycosylation of the viral glycoproteins involves en bloc transfer of the core sugars to the polypeptide chains.


Species identification and genome mapping of cytoplasmic adenovirus type 2 RNAs synthesized late in infection. Adenovirus type 2 cytoplasmic RNAs synthesized late in productive infection were resolved by electrophoresis on formamide gels. Regions of the adenovirus 2 genome specifying RNAs of distinct size were determined by hybridization to specific DNA fragments generated by cleavage with endo R.EcoRI and endo R.SmaI. From these studies 13 distinct viral RNA species were identified. A 26S to 28S size class and a 21S to 23S size class were each found to consist of four distinct RNA species. Three RNA species were identified in a 16S to 18S size class, and a fourth size class, 11S to 13S, was resolved into two components. The SmaI-D region (0.38 to 0.51 on the unit genome) and the EcoRI-F, D region (0.70 to 0.83) of the genome were found to code for multiple transcripts. Three RNAs (28S, 22S, and 18S) are specified by SmaI-D, and four components, 28S, 22S, 18S, and 16S, are encoded by EcoRI-F,D. The RNA represented by each set of multiple transcripts exceeds the coding capacity of the respective region, and the species within each set of RNAs appear to contain common sequences. The relationship between the cytoplasmic RNA species synthesized at late times and early cytoplasmic RNAs was determined by hybridization-inhibition experiments. The multiple transcripts encoded by the EcoRI-D fragment were found to contain sequences that are present in early cytoplasmic RNA. These studies enabled preparation of a map which accounts for transcription of approximately 67% of the r strand of the adenovirus 2 genome.


Persistent infections in L cells with temperature-sensitive mutants of reovirus. Serial passage of reovirus temperature-sensitive (ts) mutant C(447) produced by passage 9 (P9) a heavily defective population of virus from which the double-stranded RNA genomic segments L(1), L(3), and M(1) were largely missing. Viral cores obtained from this P9 population were heterogeneous with respect to buoyant density in CsCl gradients, suggesting that particles were present with different combinations of deleted segments. Similar observations were made with the E(320) ts mutant of reovirus. By serial passage P15, 90% of the E(320) viral population was defective and the major missing genomic segments were L(1) and L(3). Persistent infections were readily established in monolayer cultures of L cells with P9 of C(447) virus and P15 of E(320) virus and in Vero cells with P9 of C(447) virus. Under similar conditions persistent infections could not be initiated with defective-free populations of C(447) or E(320) viruses. The greater the capacity of defective virus in the population to interfere with viral growth, the more readily persistent infection was initiated. During their maintenance persistently infected cells were subcultured approximately twice a week. More than 80% of the cells continuously produced virus. By subculture 6 the original ts infectious viral component had been replaced by a small-plaque mutant with a ts(+) phenotype. Defective virus was always present in the carrier cells. In addition to the more commonly observed defectives whose cores banded at approximately rho = 1.40 to 1.415 g/ml in CsCl gradients, a new class of defective core was seen banding in the region of 1.34 to 1.36 g/ml. This latter particle, which has not been thoroughly characterized as yet, is termed "light defective." Persistently infected cells underwent periodic crises during their maintenance, during which the cultures partially lysed and then rapidly grew to confluence. Crises corresponded to a burst of infectious virus from the cells and a relatively low concentration of light defectives. During quiescent periods the concentration of light defectives amounted to as much as 98% of the total viral population. The function of light defectives is not yet clear, but it seems essential to assign major importance to defective virus in maintaining persistent infections in this system.


Oligosaccharides of the glycoprotein of rabies virus. The number of oligosaccharide side chains on rabies virus glycoprotein (G-protein) was investigated. Analysis of glycopeptides obtained by protease digestion of desialated G-protein revealed three discrete glycopeptides. Comparison of the protease digestion products from desialated and from untreated G-protein indicated a heterogeneity among the glycopeptides in the sialic acid content. Two major tryptic glycopeptides were isolated from desialated rabies virus G-protein and analyzed after protease digestion; one contained two oligosaccharide side chains and the other contained a single oligosaccharide side chain.


Two infectious forms of bacteriophage phi X 174. Infectious particles with S values of 114 and 132 were isolated from cells infected with bacteriophage phi chi 174. Electron micrographs of the 132S particle revealed a spherical structure with a diameter of about 40 nm. The 114S particle had spikelike projections and a diameter of about 32 nm. The 132S particles could be converted to 114S particles in vitro. However, pulse and pulse-chase experiments indicated no precursor-product relationship between these two particles in vivo.


Clinicopathological evaluation in the surgical treatment for ischemic heart disease. Discrepancy in coronary stenosis between angiogram and pathological specimen was moderately found. It is of a problem what is meaning by a significant narrowing. Coronary capacity per heart weight markedly reduced in multi-vessel disease and revealed an intimate relationship to sudded death and cardiac failure. Much of sclerosis in the arterial wall was relatively severe in spite of patency in lumen of the terminal artery. Intramuscular arterioles were intact even when severe extramuscular coronary atherosclerosis was seen. Well-developed collaterals were seen in much of multi-vessel disease. Muscle prevervation was relatively good even in the advanced sclerosis. It is reasonable to make an attempt on a newly construction of a vessel to introduce into preserved arteriola with well-developed collateral, and preserved myocardium.


Responses to the postural change and orthostatic dysregulation symptoms: a population study on Japanese junior and senior high school students. Unselected 580 male and 779 female junior and senior high school students were subjected to the tilting test and informations on 11 autonomic dysregulation symptoms and complaints were taken by interviews. Results of the analyses of the data are summarized as follows: 1) Number of symptoms and complaints possessed by each individual distributes continuously but nonrandomly among testees; that is, individuals having no symptom and those having 5 or more symptoms are significantly more numerous than those expected from random distribution, indicating accumulation of the symptoms into some individuals. 2) Some specific symptoms tend to coincide with each other. 3) Principal component analyses disclosed that the first principal component can explain only 16-20% of the observed variation in the presence or absence of symptoms and complaints, suggesting that numerous factors are responsible for the occurrence of the symptoms. 4) Measurements of the blood pressures and the pulse rate, and their responses to the postural change show continuous, normal distributions, and significantly correlate to each other. 5) The responses to the tilting test are increased with the increase of number of symptoms and complaints possessed by the testees.


Correlative studies on electrocardiogram and histopathology of the conduction system. (1) Right bundle branch block with left axis deviation and prolonged P-R interval. The conduction system was examined histologically in three cases whose electrocardiograms showed right bundle branch block and left axis deviation with or without PR prolongation. In two cases histological lesions were found in the right bundle branch and anterior division of the left bundle branch. In the third case histological lesions were found in the right bundle branch and anterior and posterior divisions of the left bundle branch. This case sufferred an Adams-Stokes attack. In the two patients with right bundle branch block and left axis deviation with PR prolongation, the PR prolongation was attributed to delay in atrioventricular node or His bundle in one case and to delay in left bundle branch in the other.


Effects of calcium-antagonistic coronary vasodilators on myocardial contractility and membrane potentials. To clarify the relation between the negative inotropic effects of "calcium-antagonistic" vasodilators and their calcium-antagonistic effects, the effects of nifedipine, verapamil and diltiazem on isolated electrically-driven left atrial preparations of the guinea pig were studied. The ion-specificity of the antagonistic effects was also studied. In normal Tyrode's solution, all three vasodilators produced a shift to the right to the dose-response curve for calcium, the pA2 values being 5.90 for nifedipine, 4.88 for verapamil and 4.07 for diltiazem. The maximum rate of rise of action potentials recorded as a measure of the sodium permeability of the membrane was found to be reduced by verapamil and diltiazem, while this rate was unaffected by nifedipine. All three vasodilators suppressed the contractile activities induced in potassium-depolarized atria by isoproterenol and the dose-response curves for calcium were shifted to the right, the pA2 values being 8.24 for nifedipine, 6.67 for verapamil and 6.57 for diltiazem. In another set of experiments, calcium-dependent action potentials were evoked in the potassium-depolarized atria either by isoproterenol or aminophylline. These action potentials were suppressed by the above three vasodilators at dosage levels comparable to those producing suppression of the isoproterenol-induced contractile response of the depolarized atria.


Absence of blocking effect of burimamide and metiamide on positive chronotropic and inotropic responses to histamine in isolated dog atrium. When histamine was injected into the sinus node artery of isolated dog atrium perfused with arterial blood led from a carotid artery of the heparinized support dog, positive chronotropic and inotropic effects were dose-relatedly induced at a dose range of 0.1 to 100 microgram. The threshold dose for ind1cing these positive effects was approximately 0.3 microgram. These positive responses to histamine were not blocked by tetrodotoxin, desmethylimipramine and alprenolol. These positive effects of histamine were also not significantly influenced by treatment with a histamine H2 receptor antagonist, tripelennamine or diphenhydramine, which enhanced the actions of norepinephrine. From these results, it is suggested that in the dog atrium, histamine causes positive chronotropic and inotropic effects via histamine H1 receptors.


Inhibitory action of sodium salicylate on the growth of upper jaw and tibia in rats. The inhibitory effect of sodium salicylate on the growing upper jaw and tibia was examined by the morphological measurement by radiography at different dose levels. The longitudinal growth of the tibia was greater than the sagittal growth of the upper jaw in young normal rats. The increment in length was approximately 10 mm a month in the former and 3 mm a month in the latter. Growth of these bones was reduced by successive subcutaneous injections of sodium salicylate, and the reduction of growth increased with increase of the dose administered. Sagittal growth of the upper jaw was much more sensitive to the action of salicylate, and was significantly reduced by the drug even at a dose of 100 mg/kg (P less than 0.01).


Major trauma in the rural mountain West. A disproportionately high percentage of trauma fatalities occur in rural areas. Almost half of these fatalities occur after arrival at a community hospital. A review of the initial evaluation and management of major trauma victims in rural community hospitals in the intermountain West revealed a surprisingly high incidence of departure from well defined standards. Reducing the magnitude of this rural hospital component of trauma facilities will require application of the same standards of initial evaluation and management which have proved effective in major medical center emergency department settings.


Emergency nurse practitioner: an answer to an emergency care crisis in rural hospitals. During the last three years, a nine-month training program at the University of Virginia was designed and implemented to prepare the nurse to assume an expanded role in the emergency department. The course provides the student with sufficient knowledge and skill to diagnose and treat patients in the emergency department setting while under the supervision of a physician. Graduates of the program are certified by the State of Virginia as "emergency nurse practitioners". Qualified candidates who had identified a physician preceptor or were from an area with embryonic emergency medical systems were given priority in the selection process. The training program was divided into three-month modules which dealt first with teaching interview techniques and physical assessment skills, then clinical experiences in rural and urban emergency departments, and finally a preceptorship in the community hospital where the nurses work with the physician preceptors.


Priapism as a sequela of chlorpromazine therapy. A patient developed priapism following a single intramuscular injection of chlorpromazine for hiccups. Conservative management was unsuccessful. During surgical intervention on the 15th hospital day, the corpora cavernosa of the turgid penis was irrigated and aspirated with heparinized saline using No14 gauge needles. The patient did well postoperatively. The physiology of the erection and the pathophysiology of priapism are discussed.


Delayed splenic rupture: diagnosed by culdocentesis. Culdocentesis is a valuable asset in the diagnosis of hemoperitoneum in women. A case report of delayed splenic rupture diagnosed by this means emphasizes its usefulness. When compared to paracentesis and peritoneal lavage, culdocentesis is more rapid, theoretically more sensitive, and easier to perform. It is a valuable diagnostic tool.


Topical ethyl ether therapy of herpes simplex lesions. A simple and effective method of treating herpes simplex lesions using topical application of ethyl ether relieves pain almost immediately and aborts progression of the lesion. The therapeutic rationale for using this modality is based on the ability of ether to penetrate the epidermis and to destroy the ether sensitive envelope of the virus. A decrease in frequency and even elimination of recurrences has been suggested.


[Ways of using saccharose under conditions of insufficient muscular activity]. Under conditions of a limited motor activity an excess of administered saccharose is used not to compensate for the energy expenditures, that are below the control level, as shown by the glycolysis and oxygen uptake data, but to participate in the synthesis processes entering the glucosoaminoglycanes, cholesterol and triglycerides. The increasing amount of lipids is favoured by an activation of the pentose cycle (in the liver, heart, brain), due to which the depot of NADP-H2 in the body increases and the limit of liposynthesis is thus lifted.


[Hyperbaric oxygenation (current state and perspectives of its use in heart surgery)]. The current status of hyperbaric oxygenation (HBO) permits a preliminary determination of the optimum regimen with reference to the particular type of pathology to be treated and the method of treatment involved (surgery, resuscitation, therapy). The experimental section presents an analysis of the results of the combined effect of hyperbaric oxygenation and hypothermia, HBO and extracorporeal circulation. An extended series of experiments was conducted determining the optimum regimens of HBO in different types of hypoxia (circulatory, including cardiogenic shock, anemic, hypoxic). The clinical section presents the experience with HBO in 136 patients (118 cardiac procedures, and 18 emergency cases). The authors have the world's greatest experience with extracorporeal circulation under HBO. The priority is using this method  for childbirth by women with severe heart diseases belongs to Soviet medicine. HBO was successfully used for the management of air embolism complicating openheart surgery.


[Effect of hyperbaric oxygenation on the circulatory function in rheumatic mitral valve disease]. The effect of a hyperbaric oxygenation course (10-14 exposures, one exposure daily at 0.7-1.0 ATA) upon the circulation function was studied in 61 patients with rheumatic mitral valve disease combined with systemic circulation insufficiency. The obtained results (reduction of the heart volume, acceleration of the blood stream within the heart and the body, increase of the stroke index, of the blood flow in the muscles of the extremities, reduction of the arterial and central venous pressure) demonstrate that the contractility of the myocardium and redistribution of the cardiac output between separate vascular regions is improved under the effect of hyperbaric oxygenation. The authors suggest that the increase of contractility in the right or left heart predominantly depends on the prevalence of mitral stenosis or circulatory insufficiency.


[Renal angiography with the use of vasoactive drugs and its value in the diagnosis of vasorenal hypertension]. The results of 76 selective renal angiographies in 33 patients with the use of adrenalin and acetylcholine are presented (17 cases of renovascular hypertension, 7-chronic pyelonephritis, 5-essential hypertension, 2-nephroptosis, 1-kidney tumor). The pecularities of the method essential for the success of the examination and prevention of complications are described. The importance of pharmacoangiography with adrenalin for the determination of the length of renal vessels lesion in cases of fibrous dysplasia was demonstrated, as well as that of the acetylcholine test for examining the state of the vascular bed of the contralateral kidney, the same procedures being applied in cases of chronic pyelonephritis. Typical pharmacoangiographic symptoms of different forms of nephrogenic hypertension are described.


[Transthoracic rheography in clinical studies of hemodynamics]. The possibilities of transthoracic rheographic examinations with the aid of conventional rheographs were studied with reference to the stroke volume and minute cardiac output. A high percentage of coinciding results was found in comparison with similar studies performed on a tetrapolar rheograph. On the basis of the examinations of 60 normal individuals normal values of the systolic and minute cardiac outputs were found, as well as those of several other important haemodynamic parameters that permit a most precise noninvasive measurement of the parameters characterizing the functional state of the cardiovascular system under various conditions.


[Methodical study of multifactorial prevention of ischemic heart disease]. The purpose of the investigation was to study the possibilities of involving the population at large in mass screening procedures, the possible classification of the population with regard the degree of risk of ischaemic heart disease, and the potentials of its preventive therapy. The examined contingent was classified with due regard to some risk factors (arterialy hypertension, hypercholesterolemia, imparied glucose tolerance) and pathological states. The final grouping of the contingent was as follows: the group of "normal" was comprised by 53.4% of the examined, the "intermediate"-18.6%, the "pathological"-28%. The "intermediate" group comprised 350 persons selected for preventive therapy by a double blind method. Surveillance of 10% of those in the "normal" group and the whole "pathological" group was arranged.


[Ischemic heart disease and arterial hypertension in Yakutsk (clinico-epidemiologic study)]. In order to study the incidence of ischaemic heart disease and arterial hypertension among different groups of population in the Yakut Republic and the peculiarities of their course among the indigenous inhabitants of the city of Yakutsk and of rural areas of the Yakut Republic, and among migrants, living in the Yakut Republic for at least 10 years, 1003 males, aged 50-59 years, were examined. The clinical course of ischaemic heart disease and arterial hypertension was also studied in the 2 mentioned groups of population treated in internal medicine clinics, and the data of 650 autopsies were examined. The epidemiological study was conducted in strict conformity with the WHO program.


[Diagnosis of hyperventilation for elimination of false-positive results of physical exercise test]. The study was conducted in 55 patients with cardiac pains. Electrocardiography was used successively prior to, during and following physical exercises, followed by Seldinger selective coronary angiography, and electrocardiography prior to, during and following hyperventilation tests. In 2 of 55 patients the result of the exercise test was interpreted as false-positive, since the coronary angiography demonstrated intact vessels, and during hyperventilation ECG recorded a decreased ST segment. To avoid false-positive results in patients with suspected angina pectoris the physical exercises tests can be considered positive only in cases in which hyperventilation caused no ECG changes typical for angina pectoris.


[Indicators of general insulin activity and free insulin of blood serum in myocardial infarct]. Data are presented on the base-line level of general insulin activity and free serum insulin determined by biological techniques in 45 patients during the acute and subacute phases of their myocardial infarction. Patients with normal body weight demonstrated a reduction of the insulin activity parameters during the initial days of the disease, the reduction being most distinct in a complicated course of the acute period. The indices of free insulin varied widely, and the mean values were close to the controls, although the majority of patients had a reduced level of free insulin in blood. During the subacute phase of myocardial infarction the indices of insulin activity and free insulin did not differ from the control figures in the majority of patients. The general insulin activity remained reduced during the subacute period as well if the course of the disease was complicated by the development of circulatory insufficiency. In obese patients the indices of insulin activity and free insulin exceeded during the acute period of myocardial infarction those of the control, and during the subacute stage of the disease they became even higher.


[Effect of exclusion of neural regulation on the contractile function of the myocardium of animals adapted to physical exertion]. The results of experiments conducted with the nervous regulation of the heart intact indicate that body adaptation to physical exercises results in an increased capacity of the cardiac mechanisms responsible for the regulation of both the force of the contractions, and the rate of adapted animals, revealed when the neuroregulation was switched off, in contrast to those of non-adapted animals, indicate the enhancement of the autoregulation mechanism of the heart muscle under the effect of physical training.


[Effect of electric stimulation rate on the indicators of systolic and diastolic activity of the left ventricle]. The interrelationship of the indices of the systolic and diastolic myocardial activity with reference to the cardiac contractions rate was studied in acute experiments in isolated feline hearts. The study had demonstrated that moderate tachycardia (a 30% increase of the cardiac contractions rate) produced a beneficial inotropic effect, and increased the diastolic compliance of the myocardium. Severe tachycardia (a 80--100% increase of the contractions rate) produced a negative inotropic effect decreasing the myocardial compliance. Proceeding from the obtained results a conclusion is drawn that the cardiac contractions rate is an important factor in the regulation of not only the systolic, but also the diastolic myocardial activity.


[Automatism of the sino-atrial node and sinoatrial conduction of excitation in hypoxia]. The effect of experimental hypoxia on the automatic activity of the sinus node and sinoauricular transmission of excitation was studied in 17 isolated preparations of rabbit hearts. A greater frequency of the shifts of sinoauricular delay was noted under hypoxia. Local electrophoretic applications of adrenalin demonstrated that the shifts of the delay occur because of the shifts of pacemakers. The mean frequency of the automatic activity recorded in the atria falls to zero between 6 and 20 min of hypoxia. Hypoxia causes the development of sinoauricular blocks and atrial arrhythmias in the form of individual extrasystoles, high-frequency discharges, or alternations of series of impulses with "mute" periods. The increased tendency towards arrhythmias in the sinoauricular zone is, according to the authors, due to the growing heterogeneity of the duration of action potentials that increases more than three-fold by the 10th minute of hypoxia. The possible reflection of the excitation wave ("echo") from the sinus node zone with an inhibited excitability was demonstrated.


[Parallel study of the fibrillation and excitation thresholds in the cardiac ventricles in experimental animals]. To find the fibrillation threshold under rapidly changing conditions a method of its determination with long-lasting stimuli (100--300 msec) far exceeding the period of the highest vulnerability is described. The figures of the fibrillation threshold found by way of stimulating the heart with short and long impulses were partically identical. Intravenous administration of 4 mg/kg Lidocaine resulted in an increase of the fibrillation threshold in the experimental dogs, without changing the projection of the stimulus producing the fibrillation onto the force-interval curve and at the same time increasing the excitability of the myocardium. Intravenous 1 mg/kg Propranolol elevated the fibrillation threshold causing a parallel rightward shift in the projection of the stimulus on the force-interval curve and decreasing the exitability of the heart.


[Experimental study of successive range of excitation of the heart ventricles]. The succession of excitation spreading about the cardiac ventricles was studied in 28 dogs using the intramural multipolar technique. The primary foci of excitation were found in the zones of the subendocardium on the borderline between the lower and middle portions of the left side of the ventricular septum, and under the base of the anterior papillary muscle on the right side of the ventricular septum. The excitation of the interventricular septum throughout its thickness occurs first of all in the anterior part of its mid-portion where the depolarization waves moves exclusively from left to right. Lastly the posterior lateral subendocardial layers of the bases of the free walls and the upper portion of the ventricular septum are depolarized. In some parts of the interventricular septum and of the left free wall the excitation wave first reaches the zones located deeply under the endocardium, then spreads towards the endo- and epicardium, changing its direction several times.


[Content of prostaglandins E and A in the blood serum and kidneys of rabbits with vasorenal hypertension (study by radioimmunoassay)]. The content of depressor prostaglandins E and A was studied in the blood serum and cortical layer of the kidneys of 52 chinchilla rabbits with renovascular hypertension by way of radioimmunoassay using reagent kits of "Clinical Assay, Inc." (USA). The experimental and control rabbits were sacrificed in batches 1, 4, and 8 weeks after surgery. Some mechanisms of the participation of prostaglandins E and A in the pathogenesis of renovascular hypertension are discussed.


[Disorders of nitrogen metabolism in circulatory insufficiency]. The state of nitrogen metabolism was studied on the basis of clinical observations and nitrogen metabolism indices in 102 patients with circulatory insufficiency occurring against the background of rheumatic heart diseases, atherosclerotic cardiosclerosis and chronic corpulmonale. Nitrogen metabolism disorders were found in all stages of circulatory insufficiency. These disorders may be the cause of these patients' resistance to therapy.


[Correction of cardiac metabolism in acute myocardial infarct]. Proceeding from an analysis of the results of studies conducted during the recent years the rationale of using an insulin-glucose-potassium mixture during the initial hours of myocardial infarction was substantiated on the grounds that it may result in a reduction of the necrosis zone at the expense of restoration of the damaged zone. The employment of this mixture in 13 patients with acute myocardial infarction demonstrated its beneficial effect upon the clinical state of the patients, ECG changes, dynamics of concentration of free fatty acids and glucose in blood.


[Rhythm disorders and their correction in connection with mitral valve prosthesis]. The course of the operative procedure of mitral valve prosthetic replacement was analyzed in 180 cases. All patients during perfusion developed certain disorders in the processes of excitation and myocardium conductivity that manifested themselves in different kinds of arrhythmias. In 23 cases ventricular fibrillation was recorded during the intervention, in 4 cases--a full atrioventricular block. The main causes of the severe arrhythmias consisted in coronary circulation disorders caused by temporary cross-damping of the aorta, air embolism, inadequacy of the perfusion, compression of the circumflex branch of the left coronary artery by a ligature or haematoma. Severe rhythm disorders usually occurred in patients with cardiomegaly and distinct dystrophic changes in the myocardium. Electric defibrillation was conducted after mitral valve prosthetic replacement in 57 patients for the management of chronic cardiac fibrillation, a positive effect being achieved in 47 of them. The most reasonable period for electroimpulse therapy in patients with IIA stage of circulation disorders is 3-4 weeks after surgery, while in those with IIB stage--5-6 months therafter.


[Prognostic value of the state of the heart atria in determination of the time of sinus rhythm preservation after correction of auricular fibrillation]. Data are presented from atrial vectorcardiograms of 130 patients with different forms of auricular fibrillation including an analysis of their parameters and a study of the catamnestic data following the elimination of auricular fibrillation, which permitted to develop prognostic criteria for determining the period of sinus rhythm preservation after this type of arrhythmia had been eliminated.


[Prevention of supraventricular tachysystole with anti-arrhythmia agents]. The paper substantiates the necessity of using a set of antiarrhythmic drugs for the prevention of supraventricular tachysystoles. In the development of supraventricular tachysystoles an important role is attributed to the disorders in automatic regulation of the sinus node. Cases are described in which the development of paroxysmal cardiac fibrillation with approximately equal intervals of time was caused by an inhibition of the sinus node activity. The set of antiarrhythmic drugs included beta-adrenergic blockers, isocholinic-type drugs, cardiac glycosides, Rauwolfia serpentina preparations, parasympatholitic drugs.


[Recording of the potentials of the bundle of His for precise location of conductivity disorders in patients with partial atrioventricular block]. The presented results are based on the recording of potentials of the bundle of His during cardiac catheterization in patients with partial atrioventricular blocks, stage II, Samoilov--Wenkebach-type, and Mobitz type II. In all cases a narrow QRS complex on ECG indicated to a proximal localization of the block. However, the recording of an electrogram of the bundle of His permitted to establish the actual level of the block that appeared to be located proximal to the H potential on the electrograms in 2 patients, and in the common trunk of the bundle of His in one. The authors emphasize the advantages of the bundle of His electrography over the routine ECG recording.


[Differentiated treatment and prevention of arrhythmias in myocardial infarct]. Monitoring and electrocardiographic observations were conducted in 900 patients during the acute and subacute periods of myocardial infarction. It was found that without preventive therapy arrhythmias develop in 85% of the patients, and with preventive antiarrhythmic treatment--in 75.5%. A combination of two and more types of arrhythmias was encountered in 42% of the cases. In the presence of routine therapy for myocardial infarction individual antiarrhythmic drugs displayed different efficacy. In supraventricular forms of arrhythmias the most effective drugs are Chinidin and Chinidin-Durules, Inderal and Hiluritmal, in ventricular forms--Lidokaine, Chinidin, Novocainamide, Inderal, Hiluritmal. A combined employment of these drugs against the background of potassium and magnesium salts administration, Inosie-F, water-soluble camphor and Cocarboxylase promoted the restoration of a normal sinus rhythm in 85% of the cases. When the drug therapy produced no antiarrhythmic effect and ventricular fibrillation developed, electroimpulse therapy was employed. In persistent atrioventricular blocks only cardiostimulation was effective.


[Differentiation of intraventricular blocks by means of electrocardiography and vectorcardiography]. The examination was conducted in 270 patients with ischaemic heart disease and signs of intraventricular conductivity disorders. The most demonstrative signs were singled out in ECG and VCG recordings that permit one to differentiate unifascicular, bi- and trifascicular blocks. Emphasis is made on the diagnosis of focal changes in the myocardium in the presence of excitation conduction disorders in the above mentioned branches of the bundle of His.


[Partial atrioventricular dissociation caused by paroxysmal nodal tachycardia with outlet tract block]. Two cases of partial atrioventricular dissociation caused by paroxysmal nodal tachycardia with outlet track block are described. One of the episodes was discovered with the aid of ECG bronchial leads that permit distinct determination of atrial and ventricular "trapped" contractions, as well as combination complexes.


[Electrocardiographic classification of total atrioventricular block]. The introduced systematization of full atrioventricular blocks is a new method of analysis of ECG data in such patients. Singling out the arrhythmic form of a full atrioventricular block serves as a means of early diagnosis of the possible complications of making the prognosis of the patient's state, and as a method of choice of surgical or medical treatment; it permits timely implantation of a pacemaker, reduces the period of examination and therapy, which ensures an economic effect.


[Disorders of intraventricular conductivity in primary myocardial infarct]. Recent knowledge of the system of intraventricular conductivity permits to diagnose much more often the different variants of blocks of the main branches of the bundle of His that develop in acute primary myocardial infarction (41.42%). Clinical and electrocardiographic examinations of 239 patients with acute primary myocardial infarction revealed unilateral conductivity disorders in the right ventricle in 19.24% of the cases, in the left ventricle -- in 13.39%, and bilateral conductivity disorders -- in 8.79%. The main branches of the bundle of His blocks were combined with atrioventricular conductivity disorders in 19 patients (20.21%), in 12 of them the atrioventricular block being a manifestation of bilateral intraventricular conductivity disorders. Patients with various conductivity disorders developed with significantly higher incidence other rhythm disorders (atrial flutter and fibrillation, paroxysmal tachycardia), which indicates to a close relationship between the functions of conductivity and excitation of the heart.


[Changes of echocardiographic data in auricular fibrillation of patients with rheumatic mitral valve defect]. Echocardiography was employed in 39 patients with rheumatic mitral valve disease and atrial fibrillation prior to and following electric defibrillation. Patients under 60 years of age, mainly those subjected to a surgical correction of the disease, with a history of fibrillation under 3 years and without signs of thromboembolic complications in the past were selected for sinus rhythm restoration. The peculiarities of echocardiograms in different frequency of the ventricular rhythm are described. A correlation was found between the end diastolic and stroke volumes and the duration of the diastole in the preceeding cycle. The relationship of the ejection fraction and of the heart contractions rate was demonstrated: in sudden rhythm accelerations in 2 successive cycles the ejection fraction decreases in the 3rd cycle, and in sudden rhythm decelerations it increases. The echocardiographic manifestations of mechanically ineffective systoles are described. Sinus rhythm was restored by defibrillation in 80% of the cases. The haemodynamic parameters prior to and following the elimination of cardiac fibrillation are presented. It is concluded that an echocardiographic enlargement of the left atrium over 60 mm is an unfavourable prognostic sign for sinus rhythm restoration.


[Analysis of the structure of cardiac rhythm during treatment of auricular fibrillation with digitalis]. The structure of cardiac rhythm was studied with the help of specialized computers during digitalization in 60 patients with atrial fibrillation of different etiology. The reduction of the heart contractions rate under digitalization is accompanied by certain changes in the structure of cardiac rhythm: the arrhythmic pattern of the ventricular contractions increases with a predominant growth of the number of long R--R intervals, the transitions from short intervals to longer ones become sharper, and portions of a relatively stable ventricular rhythm appear. Three main types of dynamics of the rhythm structure were distinguished on the basis of the changes in the interval R--R histogram. The described changes in the structure of cardiac rhythm are not specific, but when Digitalis drugs are used alone they can be used as additional criteria for digitalization.


[Effect of various anti-arrhythmia agents on phase structure of cardiac cycle and ballistocardiograph]. A comparative assessment is presented for the effect of Obsiden, Isoptine, Novocainamide, or Chinidin on the phase structure of the cardiac cycle and on the ballistocardiogramme in 125 patients with arrhythmias of varying forms and genesis. A combined employment of Obsidan or Novocainamide with cardiac glycosides was associated with a worsening of the phase structure of the cardiac cycle; with a similar therapy with Isoptine the poly- and ballistocardiographic data improved significantly. The administration of Isoptine without cardiac glycosides resulted in a distinct impairment of these parameters, although prior to the administration of the drug these patients had no circulatory insufficiency. The observed negative effect of Chinidin upon the indices of poly- and ballistocardiography was substantial following preceeding therapy with Isoptine, and less distinct--following Obsiden treatment.


[Treatment of congestive heart failure with beta-methyldigoxin (lanitop)]. Methylated Digoxin preparation--beta-Methyldigoxin (Lanitop) was used in 50 patients with congestive heart failure of different etiology (tablets of 0.3--0.6 mG per day). Its employment proved very effective in the treatment of congestive heart failure. It is not contraindicated to patients with chronic coronary insufficiency with underlying athrosclerotic cardiosclerosis with signs of congestive circulatory insufficiency. Side-effects of beta-Methyldigoxin are mild and noted rather seldom.


[Clinical importance of evaluation of the effect of bicycle exercises  on cardiodynamics of patients with ischemic heart disease]. An analysis of the results of polycardiographic examinations conducted during muscle work done by patients with ischaemic heart disease extends our knowledge of the functional state of the myocardium and is of certain prognostic importance; besides, such an analysis permits to make the prognosis of the effect of cardiac glycosides on the heart rhythm.


[Relationship between serum cholesterol content, arterial blood pressure and the ABO blood group phenotype in middle-aged men]. The diagnosis of arterial hypertension among male volunteers, aged 40 to 49 years, depended to a great extent on the ABO group phenotype. Among those with AB phenotype the chances to have arterial hypertension are 46% higher than among those with the remaining 3 groups of blood. The ABO phenotype appeared to produce no significant effect upon the level of hypercholesterolemia. Males with A and AB phenotypes tended to have hypercholesterolemia more often than others. The obtained data may serve as an additional criterion for early detection of the most vulnerable contingents of individuals so that preventive measures against ischaemic heart disease and arterial hypertension could be taken.


[Clinical evaluation of the hypotensive drug catapresan]. A clinical and laboratory examination was conducted with a hypotensive drug Katapresan used alone and in combinations with Reserpine and saluretics in 30 patients with stage II and III of essential hypertension. Katapresan was shown to be an active hypotensive agent, often effective in patients resistant to other drugs. For long-term therapeutic courses the most effective combination is Katapresan with Hypothiazide and Reserpine. Katapresan may result in a deceleration of atrioventricular conduction, a slowing down of the electric systole, a reduction of the contractile function of the myocardium. The drug does not affect the metabolism of potassium and sodium ions.


[Various electrocardiographic criteria of cardiac hyperfunction in sportsmen]. An attempt was made to reveal the possible relationship between ECG changes and the isotonic type of myocardial hyperfunction observed in sportsmen training to develop their endurance. Two groups of sportsmen were studied. Group 1 included 45 sportsmen of a high qualification developing their endurance. Group 2 consisted of control sportsmen with other trends in their training. The obtained results demonstrated that Group 1 sportsmen developed a significantly higher incidence of partial right bundle branch block and syndrome of delayed excitation of the right supraventricular crest, than Group 2 sportsmen. They also had a significantly higher amplitude of Q, R and T-waves and local electronegative period in the left thoracic leads. This permitted to conclude that the isotonic type of hyperfunction of the right or left ventricles in sportsmen training for higher endurance is reflected in their ECG.


[Effect of hydrocortisone on mobilization and restoration of glycogen depot in the myocardium]. The mechanism of glycogen content changes in the heart muscle was studied in rat experiments by radio-isotope techniques 30, 60 min. and 3 hours following hydrocortisone administration. It was found that early after hydrocortisone administration (30 min.) the glycogen content in the myocardium decreases, and the incorporation of glucose-1-14C into glycogen increases, i.e. the process of mobilization and resynthesis of glycogen is activated. Proceeding from experiments with Propranolol the role of adrenergic factors in the mechanism of glycogen metabolism disorders in the heart muscle is discussed. Later, 3 hours following hydrocortisone administration, the concentration of glycogen and the incorporation of the radioactive label into the myocardial glycogen and blood glucose from the aminoacid glycine-1-14C is increased. The role of gluconeogenesis in the mechanism of corticosteroid regulation of glycogen metabolism in the heart muscle is discussed.


[Disorders of automatism, excitability and conductivity under long-term effects of subthreshold concentrations of various chemical substances]. Examinations of 689 persons engaged in the production of phenol, nitrone, nitrile of acrylic acid revealed disorders in automatism, excitability and conductivity. These changes reflect the effect of industrial agents upon the conductivity system of the heart.


[Circulatory dynamics in the conjunctival vessels in ischemic heart disease with and without hypertension]. The circulatory dynamics was studied in the conjunctival vessels of 45 patients with ischaemic heart disease without hypertension (12 patients with myocardial infarction including) and in 24 patients with ischaemic heart disease and hypertension. The method of biomicroscopy of the conjunctiva permits to examine the shape of the microvessels, the vascular background and the density of the pattern, as well as the nature of the blood flow. The patients with ischaemic heart disease without hypertension had more distinct changes, in some cases -- with irreversible discontinuity of the flow (aggregation of the erythrocytes in myocardial infarction). In ischaemic heart disease with hypertension the flow in the venules restores completely by the end of therapy. Reversible changes in the microcirculation were demonstrated in cases of a good effect of therapy, as well as the possibilities of timely diagnosis of complications in repeated examinations of the conjunctival vessels.


[Rheographic properties of blood in acute myocardial infarct and cardiosclerosis]. The changes in the seeming and inner viscosity and fluidity of blood in 46 patients with acute myocardial infarction were studied during 15 days after the onset of the disease. For comparison, the same parameters were studied in 30 normal individuals and in 20 patients with cardiosclerosis. The studies were conducted with the aid of a rotational viscosimeter with a speed shift range from 8.8 to 140 sec.-1. The viscosity and fluidity of blood in patients with cardiosclerosis was found not to differ from those of normals. Acute myocardial infarction is accompanied by the development of extended intravascular coagulation that manifests itself most distinctly in cardiogenic shock. The extended intravascular coagulation manifests itself in a decreased blood viscosity observed either soon after the onset of the disease, or 4-5 and 11-15 days following a preceeding increase in blood viscosity.


[Types of hyperlipoproteinemia and thrombocyte survival in ischemic heart disease]. The life-span of methionie-Se75-labelled thrombocytes was studied in 46 patients with ischaemic heart disease and in 5 control individuals. In ischaemic heart disease patients the platelets life-span comprised 6.6+/-0.14 days, this period being smaller in patients over 60 years of age and in males, in contrast to younger patients and females. The presence of arterial hypertension and excessive body weight did not affect the life-span of the thrombocytes. Smoking, hypercholesterolemia and hypertriglyceridemia caused a statistically significant reduction of the circulation time of labelled thrombocytes. In patients with frequent attacks of angina pectoris and with postinfarction cardiosclerosis the life time of the platelets was shorter then in patients with painless forms of the disease and in those free of myocardial infarction. In Type II hyperlipoproteidemia the circulation period of labelled platelets comprised 6.3+/-0.16 days; in Type IV -- 6.7+/-0.29 days and in normolipemia -- 7.4+/-0.30 days. A distinct inverse correlation was established between the blood plasma cholesterol and thriglycerids level and the thrombocytes life-span. It was concluded that the reduction of the life-span of thrombocytes is attributed to the consumption of platelets by the processes of atherogenesis and chronic intravascular thrombus formation.


[Importance of tolerance to physical exercise in the study of the blood coagulation and anticoagulation systems after myocardial infarct]. The results of dynamic studies of some indices of the blood coagulation and anticoagulation systems are presented for 130 male patients surviving myocardial infarction and examined during the first year after this development. Along with signs of hypercoagulation, a high activity of the anticoagulation system was noted throughout the period of observation. 90 patients were examined before and after a tolerance test (with threshold physical exercises on a bicycle) 3, 6 and 12 months following acute myocardial infarction. The physical exercises permitted to reveal the compensatory reserve of the anticoagulation system that manifests itself most clearly 6 months following the onset of the infarction.


[Study of blood viscosity for evaluation of peripheral circulation in ischemic heart disease]. An important role in the characterization of the functions of the circulatory system belongs to the interrelationship between blood viscosity and central haemodynamics. Blood viscosity was studied in comparison with the pulse rate, arterial pressure and Robinson's index in patients with chronic forms of ischaemic heart disease. The examinations were conducted at rest and at the peak of sub-maximal bicycle tests. In normal individuals blood viscosity increases along with the increasing workload of the exercise. In patients with ischaemic heart disease performing threshold exercises the shifts in blood viscosity were varidirectional. In patients without circulatory insufficiency blood viscosity was changing in the same way as in normal individuals. In patients with cardiac insufficiency it either remained unchanged, or decreased. An increasing blood viscosity in normals under physical exercises may be interpreted as a mechanism of homeostasis preservation. A lack of growing blood viscosity under threshold exercises in patients with ischaemic heart disease and circulatory insufficiency indicates to disorders in the mechanisms of homeostasis preservation. Increasing blood viscosity may be due to impaired tissue oxygenation.


[State of microcirculation in angina pectoris (according to conjunctival biomicroscopy)]. By way of conjunctival biomicroscopy the state of microcirculation was studied in 107 patients with angina pectoris and in 140 normal middle-aged individuals. All the examinees were tested for bicycle test tolerance. Patients with angina demonstrated important disorders in the terminal blood flow. The tolerance of physical exercises distinctly drops along with the growing severity of angina, and microcirculatory disorders are increasing. Microcirculatory disorders are postulated to play a certain role in the pathogenesis of angina pectoris.


[State of microcirculatory hemostasis in arterial hypertension and its changes under the effect of heparin]. The state of microcirculatory haemostasis was studied in 145 patients with essential hypertension with reference to the severity of their disease. It was noted that along with the growing duration and severity of the disease the aggregation activity of the platelets is decreasing. Intravenous administration of Heparin, 5, 10, 15, 20 and 25 thousand units, significantly activates the platelets of normal individuals (30 persons) and of hypertonics. The activation develops by the end of Heparin infusion, persists for 2 hours and is clearly perseptible 48 hours following a course of Heparin therapy. The sanogenic role of Heparin-induced activation of the microcirculatory haemostasis in the adaptation-haemostatic reactions is discussed.