The fine structure of cerebral capillaries in "overgrown" neural tissue. Cerebral capillaries in "overgrown" neural tissue of chick embryo brains ranging in age from 5-18 days of incubation were studied by means of electron microscopy. The vessels in the abnormal tissue showed more extensive and prolonged interdigitations and overlapping of adjacent endothelial cells than did those in normal control brains. In the abnormal neural tissue the appearance and distribution of endothelial cell organelles was similar to that in normal tissue; however, the Golgi complex was less highly developed, and there was an increased amount of coated vesicles in the capillaries of the abnormal brains.


Ultrastructural and electrophysiological features of meningioma whorls in tissue culture. Cultured cells derived from a psammomatous meningioma were induced to from whorls in vitro by deprivation of nutrients. The ultrastructural features of desmosomes and junctional complexes were similar to sections from the surgical specimen; also prominent were 9-10 nm cytoplasmic filaments. Microelectrode recording of whorled cells showed a larger resting membrane potential than that of similar isolated meningioma cells in culture. Whorl formation seen in this tumor may be a result of relative nutritional deprivation and the need for metabolic cooperation among tumor cells.


DNA content of meningiomas.

DNA content of meningiomas. Flow cytometric DNA analysis was carried out in 35 meningiomas. Thirty-three had diploid stem lines while two were aneuploid having a triploid DNA mode. Both aneuploid meningiomas were grossly huge nodular tumours and one had malignant histologic features. Flow cytometry in meningiomas is a rapid means of determining the DNA modes and adds objective information to microscopy. Appropriate cases may be selected for further cytogenetic studies.


Pigmentoarchitectonic pathology of the isocortex in juvenile neuronal ceroid-lipofuscinosis: axonal enlargements in layer IIIab and cell loss in layer V. Pigment preparations of 800 micrometer thickness and Golgi studies of the isocortex in juvenile neuronal ceroid-lipofuscinosis, morphologically proven by electron microscopy, revealed: 1. giant axonal dilatations of IIIab-pyramids. These expansions exceeded by far those found in pyramidal cell axons of other isocortical layers. 2. severe numerical reduction of neurons in the ganglionic layer.


Duration of labour with spontaneous onset. Among 2242 women with spontaneous onset of labour, the median duration of labour for those delivered vaginally was 8 1/4 hours in para 0, 5 1/2 hours in para 1 and 4 3/4 hours in para 2+ mothers. In the parity groups 0, 1 and 2+ 90% had delivered within 16 1/4 hours, 10 1/2 hours and 10 3/4 hours, respectively, while 10% of para 0 labours lasted less than 4 hours, 10% of para 1 labours less than 2 1/4 hours and finally 10% of para 2+ labours less than 2 hours. In the first stage of labour the latent phase (cervical dilatation less than 4 cm), was nearly 2.5 times as long as the active phase (cervical dilatation 4-10 cm). The second stage (cervical dilatation 10 cm-birth) had a median duration of 16 min in para 0 and approximately 10 min in para 1+ mothers. The length of the latent and active phases and the second stage for para 1+ mothers was 60-70% of that of para 0 mothers. In individual mothers there were weak correlations between the length of the phases and stages. For example, the length of the latent phase appeared to be a relatively poor predictor of the length of the active phase of labour. However, selection bias may have weakened these correlations somewhat.


Segmental epidural analgesia in labour: related to the progress of labour, fetal malposition and instrumental delivery. The effect of low-dose continuous segmental epidural analgesia given during the first stage of labour on the progress of labour, the frequency of fetal malpositions and the rate of vacuum extractions was studied prospectively in 100 parturients (epidural group). The results were compared with 100 parturients given none or conventional analgesia (control group). The results showed that in the primiparous epidural group the progress of labour before analgesia was induced was significantly slower than in the control group. After the block, however, the subsequent course of the labour was of equal duration in both groups. The durations of the second stages of labour did not differ significantly between the groups. The differences in fetal malpositions at delivery were statistically insignificant. Nor did the rate of vacuum extractions, 8% in the primiparous and 0% in the multiparous epidural group, differ statistically from the corresponding rate in the control groups. The results signify a normal progress and outcome of labour after low-dose segmental epidural analgesia.


Pregnancy complications following legally induced abortion with special reference to abortion technique. A study of 576 pregnant women, whose previous pregnancy had been terminated by legally induced abortion, has shown that the rate of pregnancy and delivery complications could not be correlated with the interval between the abortion and the subsequent pregnancy, nor with the gestational age at the time of abortion, nor the number of previous induced abortions. Neither was the abortion technique found to correlate with the frequency of complications in a subsequent pregnancy. It was found, however, that more infants with a birth weight below 2 501 grams were born to women whose cervical canal during abortion had been dilated more than 12 mm, and by women who had been submitted to récurettage. The latter group also demonstrated a higher frequency of retained placenta or placental tissue.


Ultrasound diagnosis of fetal abnormalities in multiple pregnancy. Over a period of four years, 41 cases of abnormal multiple pregnancies were diagnosed successfully by ultrasound. These include several rare combinations of abnormalities. The most frequent was a normal pregnancy and a synchronous blighted ovum. Others were twin blighted ova, blighted ovum and missed abortion, missed abortion in both gestational sacs, two embryonic echoes with the development of only one baby, normal fetus and an anencephalic twin, normal fetus and fetus papyraceous, and triplets with two fetuses papyraceous. The results suggest that one or more gestational sacs may be resorbed during pregnancy without any adverse effect on the coexisting normal fetus. From a practical point of view, it is important to be aware of these possibilities before giving the final diagnosis of multiple pregnancy to the patient. The more diagnostic ultrasound is used in obstetrics, the more rare abnormalities associated with multiple pregnancies will be revealed.


Placenta as an indicator of fetal postnatal prognosis. 468 placentas were studied microscopically and by gross examination. Velamentous insertion of the umbilical cord, placenta circumvallate, retroplacental hematoma in connection with ablation of the placenta, and cord prolapse were found to be causative factors in asphyxia of the newborn. The increased placental weight was characteristic in maternal diabetes, hepatosis and, sometimes, in cases of infant malformations and specific inflammations. So-called embryonal persistence was often found histologically in these changes. Small fibrous placentas and those with ramification defects were commonly encountered among cases of toxemia and prolonged gestation. Microscopical placental maturation defects were not indicative of the fetal condition. Thus, only the changes found at gross examination appeared to be a significant indicator of the fetal prognosis.


Menstrual regulation as a method for early termination of pregnancy. 116 women with documented or suspected pregnancy underwent an endometrial aspiration for early termination. Their menses delay was between 7 and 22 days. A standard 3 mm Vabra aspirator was used. 90.5% were actually pregnant. The success rate was 97.1%. The total complication rate was 6.8%, the most common complication being endometritis. Three patients required a re-evacuation because of prolonged bleeding. In this series there were two ectopic pregnancies and nine cases of ovum abortivum, of which one later turned out to be a hydatiform mole. The procedure was well tolerated by the patients. No sick-leave was given. The postoperative bleeding averaged 10 days in primigravid and 7 days in parous patients.


The treatment of postmenopausal syndrome by monthly oral doses of quinestrol. Seventy patients between the ages of 37 and 59 suffering from the menopausal syndrome were included in a clinical trial and treated for a period of 6 to 18 months. Out of the seventy, 43 were suffering from spontaneous and 27 from surgical menopause. Forty of them were given 1 mg of quinestrol and 30 received placebo. The drug was administered orally in a one-tablet dose once a month. An improvement took place in 35 (87.5%) of the women receiving quinestrol but in only 15 (50%) of those receiving placebo. Among the patients with spontaneous menopause an improvement was seen in 22 out of 25 (88%) receiving quinestrol, compared with 9 out of 18 (50%) receiving placebo. Tolerance of the drug was good and most of the laboratory tests as well as blood pressure and body weight showed statistically non-significant changes. This kind of treatment is expecially suitable when daily intake is undesirable.


Amniotic fluid phospholipid concentrations in pregnancies with pre-eclampsia and/or intrauterine growth-retardation of the fetus. Amniotic fluid lecithin/sphingomyelin (L/S) ratios were examined in 74 samples from 65 patients with preeclampsia. The median values were comparable to those obtained in a reference series up to 36 weeks of gestation whereas the median values after 37 weeks of gestation were found to be significantly smaller in the preeclamptic group (p less than 0.01). According to the present results a L/S ratio greater than or equal to 2 would in fact guarantee no development of respiratory distress syndrome (RDS) in the infants of preeclamptic mothers. On the contrary L/S ratios less than or equal to 1.6 may be of limited predictive value in these women since only 1/3 of the children developed RDS. When preeclampsia was combined with intrauterine growth-retardation of the fetus, RDS was found to be less apt to develop. In 21 samples of amniotic fluid from 13 women with idiopathic intrauterine growth-retardation of the fetus the L/S ratios were significantly below those in the reference series (p less than 0.05). No case of RDS was observed.


Effect of alkoxyglycerols on the frequency of fistulas following radiation therapy for carcinoma of the uterine cervix. The incidence of injuries following radiation therapy for carcinoma of the uterine cervix is markedly decreased by the administration of alkoxyglycerols. This is the case for less harmful injuries as well as for the more severe ones, i.e. the fistulas. Recto-vaginal and vesico-vaginal fistulas are reduced with 47 per cent when alkoxyglycerols are administered prior to radiation treatment.


Failure of fusion between an upper and a lower segment of the vagina. A unique malformation of the vagina with a tiny fistula between an upper and a lower segment of the vagina is presented with a brief summary of the theories concerning the development of the vagina.


A simple method for screening of children with strabismus, anisometropia or ametropia by simultaneous photography of the corneal and the fundus reflexes. A simple screening method for detecting strabismus, anisometropia and ametropia in young children by simultaneous photography of the corneal and fundus reflexes with a conventional camera and flashlight is presented. The method is the photographic application of the von Brückner Durchleuchtung test and static skiascopy. The objective document from the external part of the eyes and the face is obtained at the same time. Model photographs with certain gaze deviation angles are presented with the method.


Fundus fluorescein angiography in fundus flavimaculatus and Stargardts disease. Three siblings who had fundus flavimaculatus and two patients who had Stargardts disease were studied by means of fundus fluorescein angiography. The angiograms revealed in all cases an abolished visibility of the chorioidal circulation. New flecks are usually non-fluorescent. Later on, hyperfluorescent areas are seen at identical places both in the preretinal and retinal phases, strongly indicating a window effect of the retinal layer. The missing chorioidal flush is probably due to a blocking effect of the emitting and exciting light. Some of the retinal flecks may fade away, leaving corresponding areas of hyperfluorescence that usually persist. In some cases, however, a previous fluorescent area may become non-fluorescent. The similar angiographic picture may indicate that fundus flavimaculatus and Stargardts disease are different expressions of the same disease.


Retinal damage experimentally induced by microwave radiation at 55 mW/cm2. The action of 550 W/m2 (mean) 3100 MHz pulsed radiation on the rabbit retina in vivo was investigated by fundus photography, blood-retinal barrier tracers, light and electron microscopy, either after a single 1--1.5 h exposure or after a series of repeated 1 h exposures for up to 53 h during about 100 days. The electron microscopic investigation of the repeatedly exposed retinas revealed degenerative changes in the retinal neurons. The neurons appeared depleted of their cytoplasmic constituents and often contained phago-lysosomal structures with myelin bodies. There were many degenerating synaptic boutons. The glial cells displayed reactive changes. These ultrastructural changes could not be demonstrated by the other methods used. A single microwave exposure, followed by an induced 70--100% blood-pressure increase, did not enhance blood-retina barrier permeability to tracers. There was no evidence of blood brain barrier leakage. These studies show that the rabbit eye can be affected by microwave radiation at intensities lower than previously reported.


The effect of metoprolol on intra-ocular pressure in glaucoma. A pilot study. Eleven patients with previously untreated glaucoma of one eye were given metoprolol, 50 mg x 3 for one day. Intraocular pressure (IOP) and heart rate were significantly reduced during treatment, and increased after withdrawal of the drug. In the eyes with glaucoma, the mean IOP was reduced from 30.1 to 20.6 mmHg during treatment. Systolic and diastolic blood pressures were also reduced during treatment, but stayed at the same level after withdrawal of the drug. It is concluded that at least part of the reductions observed for IOP and heart rate are drug-induced, while the effect on blood preassure is mainly induced by factors other than the drug. The effect on IOP is considered large enough to be of clinical interest.


Corneal astigmatism after cataract extraction. A comparison of corneal and corneoscleral incisions. Corneal astigmatism after cataract surgery by way of corneal incision (C, n = 62) and corneo-scleral incision (CS, n = 61) was followed for six months. Corneal incisions were closed by continuous nylon 10--0 (7--25 loops, median 14). Corneo-scleral incisions were sutured with single knots (2--10, median value 5). Keratometric results in the C and CS groups are compared. Concerning the degree of astigmatism, pre-operative median values were 0.5 and 0.7 D, respectively. After one week they were 4.5 and 3.0 D; after two weeks 3.3 and 3.0 D; after four months 3.0 and 2.0 D; after six months (final status) 1.5 and 1.7 D, respectively. The differences between C and CS were not significant. For both, astigmatism after cataract surgery did not quite return to pre-operative levels. Concerning the axis (weaker meridian) of corneal astigmatism, the C cases retained their pre-operative distribution, while the CS cases showed the classical shift towards against-rule astigmatism. Final corrected visual acuity was of the same order in the C and CS group. Due to frequent shifts, also of the axis, it is recommended by early (preliminary) glass prescription not to correct the astigmatism, but to give only the best spherical correction.


Tranexamic acid and corneal deturgescence. Recent work has demonstrated decreased corneal thickness in patients with Fuch's dystrophy and in patients following cataract extraction who were given systemic acid. Although tranexamic acid is a known antifibrinolytic drug its mechanism in reducing corneal thickness is not known. This experiment demonstrated no increase in the rate of corneal deturgescence of swollen rabbit corneas in the specular microscope when they were perfused for three h with 1 mM or 10 mM tranexamic acid. Pre-treatment of rabbits with intravenous tranexamic acid for three days and subsequent perfusion of corneas with tranexamic acid 10 mM also did not increase the rate of corneal deturgescence when compared with controls.


Primary localized orbital amyloidosis.

Primary localized orbital amyloidosis. The present paper reports a case of primary localized amyloid tumour of the orbit in a 68-year-old woman in whom myasthenia gravis had been diagnosed 33 years before. An amyloid tumour with this location is very rare, and up to the present time only 13 cases have been recorded in the literature. The reported orbital amyloid tumour revealed a considerable accumulation of activity at orbital scintigraphy with 99Tc(m) and, compared with the conventional pseudotumours, a distinct rise in density at computed tomography after intravenous infusion of iodized contrast medium.


The ultrastructure of the normal conjunctival epithelium of the guinea pig. III. The bulbar zone, the zone of the fornix and the supranodular zone. Three adjacent zones of the conjunctival epithelium of the guinea pig are described: the three-layered bulbar zone with cuboidal superficial cells, the three-layered zone of the fornix with cylindrical superficial cells, and the four- to five-layered supranodular zone characterized by close association with a lymphoid nodule. The similarities and differences in the general morphology of the epithelium and in the ultrastructural features of the cells, as compared to those of the perilimbal zone, are pointed out. The functional significance of atypical mitochondria found in certain cells of the bulbar and fornical zones is commented upon. Particular attention is paid to the supranodular zone, containing a large number of intraepithelially located lymphocytes. The possible role of an epithelium associated with subepithelial lymphoid tissue in the immune defense is discussed.


The ultrastructure of the normal conjunctival epithelium of the guinea pig. IV. The palpebral and the perimarginal zones. The ultrastructure of the palpebral and perimarginal zones is described and compared to that of the other zones of the conjunctival epithelium of the guinea pig. The palpebral zone was characterized by frequently occurring goblet cells, the structure and function of which are discussed. The transition in the perimarginal zone from a four-layered epithelium with cylindrical superficial cells in the palpebral zone to a multilayered, squamous epithelium towards the lid margin is shown.


Heterotopic gastric glands in the submucosa of the stomach. The submucosal heterotopic gastric glands were found in 160 cases (10.7%) of 1500 resected stomachs; 15% in gastric ulcer, 9.9% in gastric carcinoma, 4% in duodenal ulcer and 11% in chronic gastritis. The heterotopic glands were usually found in the distal half of the stomach, diffusely or localized. Macroscopic submucosal tumor was found in 9 (5%) of 160 cases. Although the heterotopic glands were found with an intimate relation to the repeated mucosal damage and subsequent intestinal metaplasia, they had no specific relation to gastric carcinogenesis.


The effect of a low potassium diet on the glomerular zone of the adrenal cortex of rats. Rats were fed on low potassium diets in order to observe the effect of dietary low potassium on the adrenal cortex. The authors clarified morphological changes of the hypofunctional glomerular zone and compared these changes with those of the hyperfunctional glomerular zone. Three weeks after or 2 months after the start of a low potassium diet, slight narrowing of the glomerular zone of the adrenal cortex was observed followed by miniaturization of cells, presence of binuclear cells and an increase of lipid with enlarged lipid drops. Electron microscope mainly disclosed changes of mitochondrial cristae consisting of markedly reduced, enlarged and irregularly dilated cristae with shortening or elongation. Granules appeared in mitochondria. Lysosomes or dense bodies were enlarged. The Golgi's apparatus was atrophied but endoplasmic reticulum did not show remarkable changes. These changes were directly opposite to those of the hyperfunctional glomerular zone noted after a pottasium load or seen in sodium deficiency. Consequently, these changes were considered to be the changes of the hypofunctional glomerular zone associated with decrease of aldosterone production.


Primary malignant peripheral nerve tumors (malignant schwannomas). A clinicopathologic and electron microscopic study. A clinicopath-logic and electron microscopic study was performed on 35 cases of primary malignant peripheral nerve tumors, among which 12 developed in association with neurofibromatosis (von Recklinghausen's disease) and further 11 in keeping with anatomically discernible nerves in patients without neurofibromatosis. Depending upon the histologically predominant pattern, these tumors were subdivided into three groups: 23 compact spindle cell, 6 myxoid, and 6 epithelioid varieties of the tumor. The common ultrastructures in three of the 35 tumors were as follows: 1) The cell membranes manifested characteristic infoldings and lamellar configuation. 2) The tumor cell surfaces were coated by occasional basal lamina or homogeneously electron-dense membranous material. 3) The cytoplasms contained well-developed organelles and a few neurosecretory-type granules. Differential points from other soft-tissue sarcomas were briefly discussed on the histologic basis.


Infantile and adult fibrosarcomas of the soft tissues. Histologic sections of 68 soft-tissue sarcomas initially diagnosed as fibrosarcoma were reviewed, and 36 were excluded because of revised diagnosis. The tumors from the remaining 32 patients were analyzed clinicopathologically, and were classifed into two types; the adult type (22 cases) and the infantile type (10 cases). The adult type fibrosarcoma occurred in adults aged 25 to 67 years and consisted of spindle-shaped fibroblastic cells which formed interlacing bundles accompanied by variable amounts of collagen or reticulin fibers. The infantile fibrosarcoma affected children below the age of seven years in this series and was characterized by proliferation of immature fibroblasts forming indistinct bundles, frequently exhibiting areas of an angiosarcoma-like pattern and cavernous blood vessels. The authors expressed the view that infantile fibrosarcoma should be separated from adult fibrosarcoma, because between these two types of fibrosarcoma there were marked differences in the histologic feature as well as in the age, sex and anatomical distributions.


Thromboplastic and fibrinolytic activities in various organs of congenitally athymic nude mice. Thromboplastic and fibrinolytic activities in various organs of congenitally athymic nude mice were estimated. These activities varied from one organ to another and the organs were divided into six groups of possible combinations of these activities. The lung revealed high thromboplastic and high fibrinolytic activities, while the liver showed low thromboplastic and low fibrinolytic activities. The pattern of distribution of these activities in various organs of nude mice was almost similar to that of rats and mice with normal thymus. No plasmin activity was found in all organs.


Histopathological studies on experimentally induced pulmonary, pleural and peritoneal neoplasms in mice by intraperitoneal injection of chrysotile asbestos and N-methyl-N-nitrosourethane. The cocarcinogenic effects of asbestos are presented. In lung carcinomas induced in mice, the number of carcinomas and the time of detection of the first carcinoma per tumor-bearing animals were greater and faster in the group with chrysotile plus MNU than either chrysotile or MNU alone. This suggested that chrysotile asbestos had a promoting or cocarcinogenic effect on some carcinogens in the respiratory tract. In the group treated with chryotile alone, a tumor was found in the right pleural cavity at 15 months. This tumor microscopically was similar to the biphasic form of the human diffuse mesothelioma. Microvilli, basement membrane, and junctional apparatus were seen by electron microscope, but other cytoplasmic organelles of the tumor cells were relatively scanty. Two peritoneal tumors developed in gastric and intestinal serosa at 11 and 12 months. Light and electron microscopic studies suggested that the tumors were probably myosarcomas or fibrosarcoms.


Central fibrosarcoma of bone. Report of a case. A case of a 46-year-old Japanese male having fibrosarcoma of bone is reported. The tumor developed in the proximal metaphysis of the left femur. During the three years following onset of the disease with symptoms of local pain and mass, the patient was operated on three times (curettage and bone graft, curettage and bone graft with Jwett's nail fixation and disarticulation). The tumor was found to be an intraosseous translucent lesion on x-ray examiation. Histologically, the tumor consisted of compact or loose, atypical spindle cells, producing abundant collagen-fibers without any osteoid, bony or cartilage formation. From the clinical and pathological findings, this case is thought to be a typical central fibrosarcoma of bone.


Alterations of the thymus and peripheral lymphoid tissues in fatal measles. A review of 14 autopsy cases. As a result of re-examining 14 autopsy cases of fatal measles, neither aplastic nor hypoplastic thymuses were found even in a case with giant cell pneumonia, but there were degenerative and/or necrotic changes with giant cells mostly in the thymus and less in the peripheral lymphoid organs such as spleen, lymph nodes, Peyer's patches and tonsils. This damage of the lymphoid system was associated with the occurrence of complications, particularly of giant cell pneumonia and encephalitis. The lymphoid cell damage, which might be primarily due to virulence of the infected measles virus, seemed to prolong the viremia. Involvement of viremia in the process of complication is discussed.


Progesterone effects on the evolution of myometrial activity in vivo in the non-pregnant rabbit. In order to study the influence of progesterone on the myometrial activity ovarian secretion of progesterone was stimulated by intravenous injection of human chorion gonadotrophin (HCG, 75 IU) in 9 nonpregnant rabbits. 4 rabbits, used as controls, were given only saline. Plasma progesterone concentration in blood samples taken at frequent intervals (2-4 h) during the recording was measured by radioimmunoassay. In the controls, the myometrial activity and the plasma levels of progesterone did not change. After 1 h of HCG administration the amplitude of contraction began to decrease and the frequency began to increase after 3 h. After about 5 h the changes in amplitude and frequency were generally fully developed. This pattern of myometrial activity persisted throughout the recording period (12 h) and was also present in recordings made after 24 and 48 h of HCG injection. A maximal increase in plasma progesterone concentration (5.0 ng/ml) had already occurred by 2 h after the HCG injection and gradually decreased thereafter. It is concluded that an elevation in the level of progesterone in non-pregnant rabbits resulting from increased ovarian output (through HCG) has a pronounced and immediate depressing effect on the character of myometrial activity which is indicative of a shift from nonpregnant to pregnant type.


Pregnancy-induced alterations in the turnover rate of 3H-noradrenaline formed from 3H-tyrosine in guinea-pig uterus. The rate of noradrenaline (NA) turnover in the non-pregnant and pregnant guinea-pig uterus was determined after the administration of the labelled precursor, tyrosine. Endogenous NA was determined fluorimetrically. In non-pregnant animals the turnover of 3H-NA was slower in the uterine horns (t1/2 = 10 h) and cervix (t1/2 = 9 h) than in the reference organ, heart (t1/2 = 6 h). During pregnancy (60-65 days post coitum) endogenous NA in the heart increased in pace with tissue weight gain; yet, in the uterus there was a drastic reduction, down to zero levels. 3H-NA turnover increased significantly in the cervix, no 3H-NA formation remained in the uterine horn (a situation resembling that following 6-hydroxydopamine induced sympathectomy of non-pregnant animals), and the turnover was unaltered in the heart. The observations confirm the general idea, illustrated by the results in the heart, of a functional adaptation with a constant neuron-target relationship during increased physiological demands. They also confirm that a very peculiar and complex neuron-target relationship develops in the uterus during pregnancy--involving functional and structural denervation of the adrenergic nerve plexus in the uterine horn, whereas an increased activation might explain the changes in neuronal NA and its turnover in the cervix.


Effects of indomethacin on regional blood flow in conscious rabbits--a microsphere study. In an attempt to reveal the importance of prostaglandins in the control of regional blood flow 20 mg/kg b.wt. indomethacin was given i.v. in conscious resting rabbits. Regional blood flow determinations were made before and 20 min after the injection using the labelled microsphere technique. The blood flow in the stomach wall was reduced by 0.75 +/- 0.17 g . min-1 . g-1 from a level of 1.64 +/- 0.24 g . min-1g-1. In jejunum the corresponding figures were 0.44 +/- 0.12 and 1.26 +/- 0.17 and in the brain 0.29 +/- 0.10 and 1.24 +/- 0.10. The blood flow in the liver via the hepatic artery increased by 0.20 +/- 0.02 g . min-1 . g-1 from a level of 0.13 +/- 0.02 g . min-1 . g-1. In the retina there was a reduction in blood flow by 2.75 +/- 1.03 mg . min-1 from a starting level of 15.1 +/- 2.3 mg . min-1. In a number of other tissues investigated there were no significant effects of the drug. The results suggest that under resting conditions prostaglandins play a role in the control of blood flow in the gastrointestinal tract, the brain and the retina--tissues which are likely to be rather active under such conditions.


Studies on the enzymatic blood-brain barrier: quantitative measurements of DOPA decarboxylase in the wall of microvessels as related to the parenchyma in various CNS regions. The presence of DOPA decarboxylase in cerebral microvessels (capillaries and venules) impedes the passage of circulating amine precursors into the brain. The relative amount of DOPA decarboxylase in this trapping mechanism as compared to the parenchyma per se was estimated in various CNS regions, measuring the formation of dopamine from L-DOPA in vitro or in vivo in two experimental models on rats and rabbits: (1) On the basis of the treatment with a peripheral decarboxylase inhibitor (carbidopa, which inhibits also microvascular DOPA decarboxylase in the CNS) it could be calculated that the enzyme in the microvessels of the caudate nucleus (rich in catecholamine nerve terminals), cerebellum (poor in catecholamine nerves), and spinal cord comprised 25, 91 and 79 per cent, respectively, of the total enzyme activity. (2) Measurement of dopamine formation in the spinal cord following transection at the midthoracic level (which causes degeneration of the catecholamine neurons caudal to the lesion since they are all descending) indicated that a similar fraction as found in the carbidopa model, 71%, of the total tissue decarboxylase activity resided in the microvessel walls. The results show that a considerable portion of tissue decarboxylase in the CNS is present in the microvessel walls, where it represents part of an enzymatic blood-brain barrier mechanism.


Effects of vasoactive intestinal polypeptide on blood flow, motility and fluid transport in the gastrointestinal tract of the cat. The effect of close intraarterial infusions of vasoactive intestinal polypeptide (VIP) on gastric motility, intestinal fluid transport and colonic motility were studied in the cat. Regional blood flow was also followed in all experiments. In the stomach VIP produced a gastric relaxation and a blood flow increase. The motility response was similar to that observed when eliciting the vago-vagal reflex relaxation by distending the esophagus. In the small intestine a hyperemia and a decrease of net water uptake was observed. When infusing small amounts of VIP a decrease of net water uptake was seen without any change of intestinal blood flow. Large amounts of VIP produced a transient secretory state in the small intestine. In the colon a hyperemia was seen immediately upon starting the infusion of the drug. After 2-3 min of infusion a contraction of the colon was apparent. The administration of atropine to the animal did not significantly affect any of the responses produced by VIP. The results are discussed in relation to VIP as a possible neurotransmitter in the gastrointestinal tract.


Prevention of protein extravasation in the brain by an anion transport inhibitor in acute experimental hypertension in rats. Acute experimental hypertension induces protein leakage in the brain. The protein is thought to be, at least to a great extent, transported through the endothelial cells by pinocytosis. An anion transport inhibitor, 4 acetamido-4-isothiocyano-stilbene-2,2'-disulfonic acid, markedly reduced adrenaline or bicuculline-induced leakage of 125IHSA and Evans blue-albumin in all areas of the rat brain. The preventive effect of dexamethasone was less pronounced and no effect was seen of haloperidol.


Infantile hepatic haemangioendothelioma. Angiographic considerations. Angiographic abnormalities in infantile hepatic haemangioendothelioma are analysed on the basis of previos reports and on 3 new cases. It is emphasized that the high specificity of angiography of the hepatic artery should make other diagnostic procedures unnecessary.


Ossification of femoral head in infancy. I. Normal standards. Observations made in 455 Malmö infants with assumedly normal ossification of the femoral heads were used for establishing reference standards for the age at onset of the ossification and for the size of the ossification centers according to sex and age.


Hip joint instability after the neonatal period. II. The acetabular growth potential. In 26 girls with idiopathic hip joint instability, diagnosed after the neonatal period, the acetabular angle is measured before and after treatment. A mathematical analysis of the acetabular growth potential in these hip joints and normal ones is presented. During treatment the monthly reduction of the acetabular angle is greater than in normal hip joints. The age limit for sole treatment in immobilisation without operative procedures is discussed.


Triphalangism and pseudotriphalangism of the thumb in children. In 10 children with altogether 17 malformed thumbs radiography revealed true triphalangism in 13 of the thumbs and pseudotriphalangism in the remaining 4. Two varieties of triphalangism were distinguished, and clinically significant morphologic variation was recognized also in pseudotriphalangism.


Radiology of the ear in mandibulo-facial dysostosis--Treacher Collins syndrome. Deformities of the external and middle ear with conductive deafness are common in mandibulo-facial dysostosis but cochlear function is nearly always normal. Twelve patients with the typical appearance and characteristics of the lesion are described. All had some degree of atresia of attic and antrum with absent or deformed ossicles but 4 had external auditory meatuses of normal calibre. The characteristic tomographic appearances of the ear are described.


Vesicoureteric reflux and pyelonephritis. Long time effect on area of renal parenchyma. The effect of gross vesicoureteric reflux in combination with urinary tract infection on the area of the renal parenchyma was analysed in 8, non-selected, girls during 3 to 6 years. A progressive significant decrease of the relative size of the kidneys with vesicoureteric reflux occurred as compared with that of kidneys with normal ureters. The decrease was mainly due to scars in the upper and lower poles. A positive correlation was found between the reduction of parenchyma and the number of episodes of pyelonephritis.


Acute hemiplegia of childhood.

Acute hemiplegia of childhood. Acute hemiplegia of childhood is briefly reviewed with examples of various etiologies. The role of brain scans in diagnosing and following children with this syndrome is emphasized. Cerebral angiography and computer tomography represent complementary examinations in the evaluation of these patients.


Computer tomography of the head in children. Technical aspects. A modified routine for computer tomography of children, avoiding general anesthesia is discussed. The patients were sedated and examined in a supporting plastic cradle. Radiation doses to various parts of the body were measured during the scanning and the results confirm that the dose levels are within generally accepted limits.


Fatal reactions to drugs. A 10-year material from the Swedish Adverse Drug Reaction Committee. Drug-induced deaths (n = 274) in Sweden during a 10-year period have been analyzed. The incidence has been remarkably constant, with 25--30 reported cases per year. There is a marked increase with age in the incidence of fatal reactions, more so than for all drug reactions. Women consume more drugs than men and get more reactions, but not more fatal reactions. Anti-inflammatory drugs (antibiotics and sulfonamides) are responsible for 21% of the fatal reactions, followed by oral antidiabetics (9%), oral contraceptives (9%) and antiphlogistic drugs (8%). The blood and the bone marrow are the most susceptible organs, responsible for 40% of the fatal reactions, followed by thromboembolism (10%) and hepatocellular damage (9%). It is important to note that rapid changes have occurred with regard to responsible drugs as well as to the types of adverse reactions encountered.


Drug-induced blood dyscrasias. A ten-year material from the Swedish Adverse Drug Reaction Committee. Drug-induced dyscrasias (agranulocytosis, aplastic anemia, hemolytic anemia and thrombocytopenia) in Sweden during a 10-year period (1966-75) have been analyzed. The overall occurrence is remarkably constant, although marked changes have occurred with regard to offending drugs. Drug-induced thrombocytopenia and agranulocytosis are about twice as common as hemolytic anemia, which in turn is twice as common as aplastic anemia. There is a marked increase with age in the incidence of all drug-induced cytopenias. Women predominate and make up close to 70% of the material. With regard to responsible drugs, the most remarkable finding is the high frequency with which sulfonamides appear as responsible for all types of drug-induced cytopenia.


Hyperthermia and rhabdomyolysis in self-poisoning with paracetamol and salicylates. Report of a case. A young women ingested large amounts of different analgesics, mainly salicylate and paracetamol. On admission about 17 hours later, clearly toxic serum levels of both drugs were demonstrated. She was comatose with respiratory failure for 5 days. During the first day there was a period of several hours of therapy-resistant hyperthermia. A severe bleeding tendency was probably related to profound coagulation defects. Persistingly elevated serum levels of ASAT and ALAT for two weeks were presumably caused by a toxic effect of paracetamol on the liver. When consciousness was regained, widespread pareses of skeletal muscles, predominantly of the lower limbs, were demonstrated. These were related to extensive rhabdomyolysis as evidenced by extremely elevated serums levels of CPK for 6 weeks, and by muscle necrosis in biopsy specimens. There was a gradual improvement, but walking disturbances were still present after one year. The hyperthermia was probably related to the cerebral effects of salicylates or the combination of multiple drugs. The rhabdomyolysis might be related to a deleterious effect of hyperthermia on the muscles or to an effect of paracetamol on the skeletal muscles similar to that which might occur in the myocardium, or to a combination of these mechanisms.


Blood pressure reduction and vascular adaptation. A study on long-term effects of treatment with mefruside or atenolol. Systemic BP reduction, calf blood flow and vascular resistance in the calf were determined in forty-two previously untreated patients with mild to moderate essential hypertension (WHO I-WHO II) before and after 6 weeks, 6 months and 18 months of BP-lowering treatment with mefruside (25 mg daily) or atenolol (100--400 mg daily). Blood flow was determined with venous occlusion plethysmography using a mercury-in-rubber strain gauge technique in the supine patient. Auscultatory BP was measured on the right arm simultaneously with the flow determinations and resistance was calculated from the flow and pressure. BP was reduced significantly and to the same extent by the two drugs. In the atenolol group a rise in resting resistance and a corresponding fall in resting blood flow was seen initially. These changes were entirely normalized during continued treatment for 18 months. In the mefruside group no significant haemodynamic changes during treatment were observed at rest apart from the BP fall. None of the drugs reduced resistance at "maximal" vasodilatation, indicating that no regress of the hypertensive structural changes of the calf blood vessels had taken place.


Mortality and morbidity during 13.5 years' follow-up in relation to blood pressure. The study of men born in 1913. A total of 973 50-year-old men, randomly selected from the general population in Göteborg, Sweden, were invited to a survey in 1963. Altogether 855 men (88%) participated. They have been followed up for 13.5 years, and this report presents mortality and morbidity during this time in relation to BP at the time of the initial examination. BP was strongly associated with mortality regardless of its cause. This was due to a close relation of BP to mortality from ischaemic heart disease and a weak but significant relation to mortality from cancer. BP was also strongly related to morbidity from myocardial infarction, stroke and angina pectoris, showed a tendency towards relation to morbidity from intermittent claudication and kidney stone, and was negatively related to morbidity from neoplasm for survivors. BP was also related to pension but not to sick leave. There is no indication of a decreasing importance of BP as a risk factor in this age period.


Platelet survival and platelet production in acute myocardial infarction. Thrombokinetic studies were carried out on 26 consecutive patients with myocardial infarction (MI) admitted to a coronary care unit in the acute stage during a two-month period. The results were compared with those of an age-matched control group. In the MI patients, platelet mean life-span was 5.0 +/- 0.3 days and significantly shorter (p greater than 0.01) than in the controls (6.4 +/- 0.4 days). The mean platelet production rate for the patients with MI was significantly higher (p greater than 0.005) than for the controls. On the basis of results reported by others as well as the present data, it is suggested that during the acute phase of MI there is no additional measurable reduction in platelet survival above that observed in chronic coronary artery disease.


Peripheral hemodynamics in assisted circulation with intra-aortic balloon pumping in patients with cardiogenic shock. Seven patients treated for cardiogenic shock were studied with and without intra-aortic balloon pumping (IABP). Calf and forearm blood flows were determined with a Dohn plethysmograph and arterial pressures were registered intra-arterially and in the great toe and thumb with the cuff method. During IABP, an augmented flow was registered in the arms and legs and accurate arterial BPs could also be determined from the extremities. The findings demonstrate a beneficial effect of IABP on peripheral flow, expecially in patients who could be weaned off the pump.


Verapamil-induced ventricular regularity in atrial fibrillation. Effects of exercise, isoproterenol, atropine and conversion to sinus rhythm. The effects of physical exercise, isoproterenol and atropine upon the ventricular rate and regularity were studied in 12 patients with atrial fibrillation (AF) during verapamil-induced regular ventricular rhythm. Physical exercise, isoproterenol and atropine all caused a gradual loss of ventricular regularity during AF. Verapamil caused a reduction of exercise heart rate during AF and, to a minor extent, even during sinus rhythm. The regular ventricular rhythm induced by verapamil during AF is interpreted as a total AV-nodal block with nodal escape rhythm. Possible clinical benefits of this rhythm are discussed.


Follow-up studies of joint complications in yersiniosis. In 1971-73, 60 patients were hospitalized for an infectios disease caused by Y. enterocolitica serotypes III and IX or Y. pseudotuberculosis serotype I. In the spring of 1977 a follow-up study was carried out with 52 of these patients, one patient having died from intestinal perforation evidently resulting from yersiniosis-induced amyloidosis and colitis. The follow-up study showed that two patients had symptoms of sacroilitis, one had developed an apparent rheumatoid arthritis after yersiniosis and one had joint plans and a high serum rheumatoid factor titer with no objective joint changes. All results from kidney and liver studies were normal. No brucellosis antibodies were found in the follow-up study. Twelve patients had antibody titers against Y. enterocolitica serotype III.


Left atrial myxoma moving from right atrium to left ventricle. Non-invasive and invasive techniques and surgical findings. A case of left atrial myxoma, prolapsing through a large atrial septal defect during systole and through the mitral valve orifice during diastole, is presented. To our knowledge this is the third such case and only the second one in which the diagnosis was made before operation. Echocardiography and phonocardiography were of great value in establishing the diagnosis of left atrial myoxoma; the features before and after operation are presented. In this patient the "swinging" of the tumor in the left atrium and in the left ventricle was echocardiographically visible. Correlations of tumor movement and heart sounds could be made. The diagnosis of a 36% left-to-right shunt on atrial level could not be made with the help of non-invasive techniques alone; cardiac catheterization revealed the shunt. The role of non-invasive techniques and of cardiac catheterization is discussed, together with a review of the relevant literature.


Acquired factor XII Deficiency in a patient with nephrotic syndrome. A patient with nephrotic syndrome and an acquired factor XII deficiency associated with a factor XII-like procoagulant activity in the urine was investigated. The urinary protein with procoagulant activity was isolated and comparative investigations revealed similar properties to plasma factor XII. It is suggested that the acquired coagulation defect may result from an insufficient biosynthetic capacity to compensate for the loss of factor XII in the urine.


Compression of the inferior caval vein--a rare complication of a large non-parasitic liver cyst. A patient with massive edema of the legs and scrotum is presented in whom non-parasitic cysts of the liver were found. Surgical evacuation of one large lobulated liver cyst completely relieved the patient of his edema. It is concluded that in this patient the peripheral edema was caused solely by cystic obstruction of the inferior caval vein.


Why do crystalline precipitates in plasma cells always coalesce with parallel light and dark lines strictly end-to-end and side-to-side? During transmission electron microscopy of plasma cells from two patients with plasma cell proliferative disorders, we observed a large number of small crystals, most of which showed a striation with alternating light and dark parallel lines. Ultraphotos strongly suggested that smaller crystals often coalesced to larger ones. The coalescence occurred in such a way that the parallel lines of the respective smaller crystals always met each other end-to-end and hardly ever end-to-side. A similar pattern can be seen on previously published ultraphotos from other patients with plasma cell proliferative disorders and intracellular crystals, although not commented upon by the respective authors. The parallel lines of the smaller crystals certainly must correspond to defined structures of the crystal. The stability of a certain configuration is therefore in all likelihood due to electrical potentials created by the crystal structure.


The septation of the arterial pole of the heart in the chick embryo. III. Development of the truncus arteriosus of the heart of chick embryos from 5 1/2 to 7 days of incubation. At the end of the fifth day of incubation the mesenchymal truncus arteriosus is completely divided into aorta and pulmonary trunk. During the first half of the sixth day the septation process starts in the distal part of the myocardial truncus by the ingrowth of the dense mesenchyme of the aortico-pulmonary septum into the dorsal and ventral-right truncus ridges. During the second half of the sixth day this septation process extends into proximal direction. Proximally to the ingrowing aortico-pulmonary septum the dorsal and ventral-right ridges fuse. In these fused ridges the aortico-pulmonary septum extends proximally for some distance. During the first half of the seventh day the left ventricular outlet is separated from the right ventricular inlet by the downward extension of the right caudal side of the atrioventricular cushion-mass, which continues into the right proximal truncus ridge (at the transition into the distal ventral-right ridge). In the meantime the fusion of the dorsal and ventral truncus ridges continues in proximal direction. This process comes to be completed in the second half of the seventh day by the fusion of the left (dorsal) and right (ventral) truncus ridges up to the level where the left one continues along the free border of the interventricular septum into the right limb of the dorsal extension of the atrioventricular cushion-mass. During the sixth and seventh day the origins of aorta and pulmonary trunk rotate from their right and left positions in younger stages to an almost dorsal and ventral position respectively in older stages. The septum trunci lying in between the left and the right ventricular outlet in the truncus appears to be a straight septum and does not rotate.


The morphology of the mouse cerebellum.

The morphology of the mouse cerebellum. In this description of the morphology of the mouse cerebellum, the main landmarks for subdivision were the discontinuities of the cortical sheet. In certain cerebellar sulci in the posterior lobe, the cortex is absent. Within the paramedian sulcus the cortex is interrupted rostral and caudal to the copula pyramidis. Rostrally, this discontinuity between vermis and hemisphere occupies a position corresponding to the intercrural sulcus of the ansiform lobule of other mammals. A subdivision into the simple lobule (VI and HVI), ansiform and paramedian lobule (HVII) and vermal lobule VII is proposed for this region, which accounts for the position of this cortexless area in the intercrural sulcus. Caudal to the copula pyramidis is the cortex is interrupted at the bottom of the paramedian sulcus between lobules X, IX and caudal VIII medially, and the paraflocculus and flocculus laterally. In most mammals, this area, devoid of cortex, extends much farther in the interparafloccular sulcus between the dorsal paraflocculus and the flocculus with the ventral paraflocculus. From the medullary surface of the cerebellar peduncles an area without cortex extends in between the ansiform lobule and the paraflocculus onto the copula pyramidis and the paramedian lobule. The nomenclature of the distal, foliated part of the paraflocculus in mouse, rat and rabbit is discussed.


The effects of experimental unilateral anotia on skull development in the chick embryo. V. The development of the brain and its meningeal envelope in embryos of 9-20 days of incubation. In a total number of 27 normal and 27 unilaterally anotic chick embryos, varying in age from 9-19 days, the morphogenetic relationships between the neurocranium on the one hand and the brain and its meningeal envelope on the other were studied. The results showed that, in general, unilateral anotia slightly interferes with the development of the bain. Only the homolateral nucleus tangentialis and cerebellar auricle proved to be underdeveloped. However, the brain of the anotic embryos progressively develops asymmetrically: In an antero-posterior and a ventro-dorsal direction abnormal flexures are present, and various components of the brain on the anotic side undergo changes in shape and position. These changes in brain morphology are interpreted as secondary features. Hence, the conclusion is drawn that the neurocranium, through the intermediary of the meningeal envelope, controls--or at least is capable to control--the general morphological development of the brain.


Morphological and histochemical observations on the ovarian surface epithelium during the reproductive cycle of crow (Corvus splendens) and myna (Acridotheres tristis). A morphological and histochemical study has been made of ovarian surface epithelium during the sexual cycle of seasonally breeding birds: crow (Corvus splendens) and common myna (Acridotheres tristis). The surface epithelium is composed of a single layer of compactly arranged columnar and flat cells in the quiescent ovary. It develops numerous villi during the breeding season. The formation of villi has been correlated with the proliferation of cells which are subsequently incorporated into the ovarian stroma where they appear to form follicle and thecal cells around the growing oocytes as evidenced by the close similarities in the morphological and histochemical characteristics of these cell types. As the ovarian activity increases, the surface epithelial cells show increasing amounts of RNA and proteins, which are indicative of their rapid multiplication. No lipids and enzyme activities of acid and alkaline phosphatases, ATPase. DPN- and TPN- diaphorases and delta5-3beta HSDH have been detected in the surface epithelium of both quiescent and active ovaries.


The dorsal arterial network of the wrist with reference to the blood supply of the carpal bones. The gross examination of 50 minium injected specimens showed us the various patterns of the posterior arterial network of the wrist. This is chiefly provided by the radial artery which gives off a constant dorsal carpal branch over the posterior aspect of the trapezium. This vessel crosses the carpus transversely to the inner border of the hand and is joined in half of the cases by the interosseous artery; contribution of the posterior carpal branch of the ulnar artery was more rarely found than usually described (25%). From the arch thus formed are given off short branches which run upwards along the intercarpal joints and enter the posterior aspects of the proximal carpal bones whose lower halves seem to be the most favorably supplied. On the contrary, the distal carpal bones receive several short twigs which penetrate their posterior surfaces. Although the arrangement of the pedicles may undergo many a variation, attention must be drawn to the fact that the dorsal arteries are smaller but denser than the volar, except for the hamate. Therefore 2 different patterns of arterial supply can be described at the carpus: the blood supply of the outer and axial bones--scaphoid, trapezium, lunate, capitate--derives from the radial and the interosseous arteries and is probably shared equally by volar and dorsal branches; the inner bones--triquetrum, hamate--are primarily supplied by volar or medial branches coming almost exclusively from the ulnar artery.


Stimulus-response spatial contiguity vs. S-R spatial discontiguity in auditory spatial tasks. I. Acquisition by normal dogs. Twelve dogs were trained in spatial tasks with auditory location cues. One group, tested on delayed response with stimuli and responses spatially contiguous, solved the task at once, whereas the other group, trained with actual stimuli and responses spatially discontiguous, attained criterion after errors. The differences in behavior of these groups suggest that two learning strategies may be involved. In the first group - approaching a specific (directly determined by auditory targeting reflex) feeder by an unspecific directional response. In the other group - approaching a non-specific feeder by a specific directional response, established in the differentiation learning.


The effect of distractor on memory for pitch: trace distortion or interference with retrieval? The effect of the time of presentation of an interpolated stimulus on dynamic memory for pitch of pure tones of 900-2000 Hz was investigated by comparison of successive stimuli. The test tone followed the sample tone after 25, 40, 60, 80, 160 or 320 s. The interpolated stimulus (a pure tone of 220 Hz) was timed either 20 s before the test tone (Experiment I) or 20 s after the sample (Experiment II). The effect of the interpolated stimulus on memory for pitch was found to vary with the time interval between this stimulus and the test tone. An interfering effect was observed when this interval did not exceed 40 s. No variation in effect occurred within this time limit. These findings suggest that the distracting stimulus interferes with the retrieval of the memory trace of the sample tone rather than with the trace itself.


On the functions of the cortical motor area in precise movement organization. The effects of unilateral ablation of the cortical motor forelimb area on instrumental avoidance responses consisting of lifting the forelimb and holding it within a 4 cm wide "safety zone" were studied in dogs. It was found that the surgery irreversibly impaired the search for the safety zone, while the ability to maintain the limb at a certain height was not affected. The surgery also impaired the corrective movements, especially if their direction was opposite to the inborn unconditioned reaction. The ability to perform corrective movements of small amplitude was also transiently diminished Widening of the safety zone markedly improved the post-operative performance.


Intrahypothalamic microinjections of noradrenaline with and without induction of the alimentary drive as a reward in a T maze learning in rats. Noradrenaline injected into the perifornical region of the anterior part of the lateral hypothalamus in rats can serve as a reinforcement in a T maze learning, whether it induces the activation of the alimentary drive or not. It follows that the main role of noradrenaline in this brain area consists not so much in induction of the alimentary drive as in activation of the very process which is essential for the reinforcement. It is claimed that intrahypothalamic microinjections of noradrenaline evoke pleasurable states which constitute a virtual reinforcement of motivated behavior.


Connections of the posterior thalamus with the amygdaloid body of the rat. The thalamo-amygdaloid connections arising in the posterior thalamus were studied in the brains of rats by the Nauta-Gygax and Fink-Heimer methods. They begin mainly in the neurons of the supero-medial area of the posterior segment of the pulvinar and in the peripeduncular nucleus. The amygdalopetal fibers of this pathway pass through the zona incerta, cerebral peduncle, and the lateral hypothalamus. They end in the lateral nucleus and in the lateral part of the central nucleus of the amygdaloid body.


Post-haemorrhagic subarachnoid fibrosis in dogs. Scanning electron microscopic observation and dye perfusion study. Scanning electron microscopic observations of the subarachnoid space were made in dogs focussing upon the fibre components in both the normal subarachnoid space and in areas of post-haemorrhagic fibrosis. It was concluded that the fibrous tissue originates from the arachnoid membrane itself, while organized haematoma is considered to form a component of the fibrosis. Perfusion of the subarachnoid space of dogs with a solution of 0.1% Toluidine Blue was also done. This showed that cerebrospinal fluid (CSF) is carried from the subarachnoid space directly to the dural sinuses through a fine string-like structure, which is conceivably one of the collateral CSF absorptive pathways.


Late post-irradiation necrosis of the brain. Three examples of late post-irradiation brain necrosis are reported. In two cases operation was performed on account of the space-occupying effects of the lesions, and in the third case the lesion was found post-mortem. The aetiology and pathology of the condition are discussed. Our findings in the three cases described are contrasted with those in 29 patients who had been submitted to similar doses of irradiation, but had not developed necrosis. The literature on pathogenesis is briefly reviewed.


Neurogenic hypernatraemia: case report.

Neurogenic hypernatraemia: case report. A 49-year-old man was submitted to neurosurgery for a cranio-pharyngioma. The lesion, which appeared to involve the antero-inferior wall of the third ventricle, caused lack of appropriate antidiuretic hormone (ADH) release in response to hypernatraemia and plasma hyperosmolality. The probable mechanism of this hypothalamic syndrome is suggested.


Some scanning electron microscopic observations of the ependymal surface of the ventricles of hydrocephalic Hy3 mice and a human infant. Two hydrocephalic Hy 3 mice and an infant with hydrocephalus and the Arnold-Chiari malformation were examined with the scanning electron microscope. Both mice had advanced hydrocephalus but had normal appearances in the basal regions of the ventricles. However, as the ventricular walls were ascended first the cilia gradually disappeared, then the microvilli, and finally on the roof of the ventricle the ependymal cells disappeared leaving the subependymal layers exposed. The infant had mild hydrocephalus and normal ependymal appearances. The most likely explanation of these findings is that they are a consequence of raised intracranial pressure, and are not the cause of hydrocephalus.


The effect of decerebrate rigidity on the intracranial pressure: an experimental study. The mechanical effect of acute decerebrate rigidity upon the ICP and the mechanisms underlying the relationship between them have been investigated with experiments performed on 26 cats. It has been shown that: a) Extreme rigidity of the peripheral musculature with or without partial activation of the trunkal muscles produces no change in ICP, b) the simultaneous elevation of the intra-thoracic and intra-abdominal pressures is the factor primarily operative in raising and maintaining the elevated ICP, c) when cerebrovascular homeostasis is already defective a subsidiary but not unimportant role is played by the elevation of the systemic arterial pressure, d) under conditions of normal brain elastance mild and short-lasting spasms produce no effect on the ICP. In an animal, however, in which the brain elastance had been increased by inflating a small air-filled balloon, similar spasms produced a marked increase in ICP.


Carcinoembryonic antigen (CEA) levels in patients with brain tumours. Plasma and cerebrospinal fluid CEA determination was done in 97 patients with neurosurgical disorders. Elevated titres were found in 14 of 64 patients with brain tumours. CEA levels were elevated significantly in patients with metastatic brain tumours. Following treatment, the values fell in three patients with ependymoma, medulloblastoma, and unverified brain tumour. This study suggests that CEA levels may be of value in the differential diagnosis of primary and metastatic brain tumours, and useful in the evaluation of patients with brain tumours after treatment. CEA in the cerebrospinal fluid was absent in eight patients with brain tumours.


Clinical and morphological studies of pineal tumours. This is a report of clinical, morphological, diagnostic, endocrinological and therapeutical experiences with 18 patients with tumours in the pineal region. The histological diagnosis was verified in four cases by autopsy, in seven cases by biopsy, and in one case by microscopical verification of tumour cells in the CSF. In all biopsy cases we are dealing with typical germinomas. In the other clinical cases diagnosis was made by neuroradiological and endocrinological methods. The localization was possible by encephalotomography or CT scan, according to Kageyama, Particular attention was given to the endocrinological dysfunctions which originate in the hypothalamus. Also the hypothalamic dysfunctions after irradiation were discussed. Since the results of primary surgical approach and biopsy have been unsatisfactory, we preferred a non-operative schedule for treatment of pineal tumours.


Malignant glioma: its initial presentation as intracranial haemorrhage. Malignant glioma presenting as an intracerebral haematoma is very rare. Two patients having malignant gliomas, initially presenting as intraparenchymal haematomas, are discussed. One patient survived, but the other patient rapidly deteriorated and died.


Early intracranial operations for ruptured aneurysms. During the period between June 1961 and September 1975 320 patients with saccular aneurysms were operated on by intracranial procedures within 14 days of their last subarachnoid hemorrhages. Overall operative mortality rate for the 14 year period was 10.6%, being 18.9% for 143 cases operated on within 7 days of rupture and 4.0% for 177 cases operated on between the 8th and 14th days. The mortality was reduced to the zero level by 1975 in the groups operated on within 48 hours and 8 to 14 days by selection of the patients as well as by improvements in surgical techniques and adjuncts, but did not reach a satisfactory level in the group operated on between the third and seventh days mainly because of fatality due to postoperative vasospasm. The quality of survival after surgery performed within seven days was better than that of surgery performed at eight days or later. Based on these results, the rationale for and technical problems concerning the early stage operations are discussed.


De Quervain's disease.

De Quervain's disease. This is a tenosynovitis of the abductor pollicis longus and extensor pollicis brevis tendons contained within the osseofibrous tunnel of the distal radius. Multiple tendons for the abductor pollicis longus and a separate, severely narrowed sheath for the extensor pollicis brevis make nonsurgical treatment difficult at times. While avoiding damage to nerve branches, surgical treatment is aimed at release of both tendon sheaths.


Therapeutic nerve blocks for chronic pain. Nerve blocks are an effective treatment in patients with many types of acute pain. However, they are much less effective in patients with chronic pain. Candidates for therapeutic nerve blocks should be carefully screened by: assessment of organic disease; evaluation of psychologic and behavioral disorders, and differential nerve blocks. The best candidates for therapeutic nerve blocks have known or inferred organic disease, minimal psychologic or behavioral disorders, and evidence of sympathetic or somatic pain mechanisms.


The hemolytic anemias.

The hemolytic anemias. Hemolytic anemias usually present with persistent reticulocytosis, a characteristic that differentiates them from other types of anemia. Once the presence of a hemolytic process has been documented, simple observation of red blood cell morphology will yield important etiologic information. Hemolysis may result from inherent defects in the red cell or from excessive environmental stress on normal cells. Immune mechanisms of hemolysis should be investigated early because of the frequency of their occurrence.


The prognostic value of the P wave morphology in the discharge ECG in a 5-year follow-up study after myocardial infarction. The discharge ECG's of 641 patients with acute myocardial infarction (AMI) (WHO categories "definite" and "possible" AMI) were studied to assess the prognostic value of P wave morphology as an index of left ventricular dysfunction. Of 69 patients with abnormal P terminal force (PTF), i.e., --0.03 mm.sec. or more negative, 53.6 per cent died within the next 5 years of ischemic heart disease, compared with 20.4 per cent of 558 patients with normal PTF. The odds ratio (age-corrected risk to die, Mantel-Haenszel test) was 4.1 (95 per cent confidence limits 2.4 to 7.0). The mortality curve of patients with normal PTF was linear whereas there was an abrupt rise in mortality rate during the first six months if PTF was abnormal. Of a group of 15 patients with the frontal axis of the terminal P wave --30 degrees or more negative, 8 died (Odds ratio 4.7; 1.3 to 17.1). Ten patients had atrial fibrillation, and five of them died (Odds ratio 2.; 0.5 to 12.9). In 14 cases the duration of the P wave in Lead II was 0.12 sec. but it showed no relationship to mortality (p less than 0.10). The significance of the P wave morphology on the discharge ECG to long-term survival after MI has been demonstrated. These simple ECG variables, related to left ventricular failure, can easily be put to clinical use to differentiate MI patients who are in greater risk of dying during the chronic phase.


Effect of somatic nerve stimulation on coronary blood flow in anesthetized dogs. Left circumflex coronary blood flow was increased significantly (20 per cent) during stimulation of somatic afferent fibers. The change in CBF was associated with significant increases in heart rate and arterial pressure and significant decrease in coronary vascular resistance. Controlling heart rate or preventing cardiac beta-adrenergic effects with propranolol during somatic nerve stimulation resulted in increases in CBF and arterial pressure with no change in coronary resistance. These results indicate that stimulation of a somatic nerve elicited an increase in CBF which could be explained on the basis of an increase in perfusion pressure plus a decrease in CVR resulting from the increased metabolic demand secondary to the increase in heart rate. There was no evidence of a significant neural component directly affecting CVR, even in the presence of beta-adrenergic blockade.


Mitral valve commissurotomy versus replacement. Considerations based on examination of operatively excised stenotic mitral valves. Among 164 patients who underwent mitral valve replacement because of mitral stenosis (with or without mitral regurgitation) and had radiographs taken of their operatively excised mitral valves, 20 had absent or minimal calcific deposits in the excised valves and absent or minimal mitral regurgitation as determined, except for one patient, by left ventricular angiography preoperatively. This report focuses on these 20 patients to ask if mitral valve replacement was preferable to mitral valve commissurotomy. Although in the pre-valve replacement era, all 20 patients almost surely would have been considered good candidates for mitral commissurotomy, other factors, namely, the need to replace one or more other cardiac valves (13 patients), the utilization of cardiopulmonary bypass allowing visual inspection rather than simple palpation of the diseased mitral valve (all 20 patients), relatively little experience with mitral commissurotomy in four of the five surgeons (17 patients), displeasure with attempted commissurotomy (three patients), previous mitral commissurotomy (11 patients), and incorrect identification of mitral calcific deposits (two patients), each contributed in one or more patients to the final decision of replacement versus commissurotomy. Even though mitral commissurotomy has been in use for 30 years, the mere alternative of valve replacement may have altered somewhat the definition of the stenotic mitral valve previously considered ideal for mitral commissurotomy.


Sequential changes of orthogonal electrocardiograms in progressive muscular dystrophy of the Duchenne type. Sequential changes of orthogonal electrocardiograms in 70 patients with progressive dystrophy of the Duchenne type (PMD) were investigated. The patients were classified into eight stages from the mildest, S(1), to the severest, S(8), according to Swinyard-Deaver's criteria. The most prominent finding was a progressive reduction in R wave amplitude in Lead X (Rx) with advancing severity. It was considered that loss of electrical activity in the left ventricular free wall might be mainly responsible for the reduction in the Rx amplitude. An abnormal Q wave was frequently observed in each stage. Its occurrence remained essentially unchanged with the progression of PMD. Thus, the presence of a deep Q wave cannot serve as an index for assessing the heart involvement, but rather, we conclude that a reduction of the Rx amplitude can be a useful criterion for estimating the extent of cardiac involvement in PMD.


Echocardiographic study on diastolic posterior wall movement and left ventricular filling by disease category. The diastolic characteristics of the left ventricle with special reference to the patterns of left ventricular filling and diastolic posterior wall movement were studied echocardiographically in 95 patients with various cardiac conditions including constrictive pericarditis, idiopathic cardiomyopathy (CCM, HCM), valvular aortic stenosis (AS), mitral stenosis (MS), hypertension (HT), aortic insufficiency (AI), mitral insufficiency (MI), and in 20 normal subjects. 1. Various types and severities of LV diastolic abnormalities were revealed by analyzing the patterns of posterior wall movement and LV filling in three diastolic phases--rapid filling period, slow filling period, and atrial filling period, respectively. 2. Disturbances of posterior wall distension and LV filling during the rapid filling period with a compensatory augmentation of atrial contribution to LV filling were observed in most patients. These patients also showed a markedly decreased posterior wall velocity and LV filling rate during rapid filling period. 3. E-F slope was significantly decrease in patients with MS, AS, and HCM. E-F slope correlated well with DPWV and RFR in most patients. In MS, however, DDR decreased to a disproportionate degree with a decrease in DPWV and RFR, probably due to the structural changes and decreased mobility of the mitral valve. From this study, we conclude that the patterns of the left ventricular filling and posterior wall movement during three phases of diastole obtained by echocardiography is useful in detecting left ventricular diastolic abnormalities.


The significance of carotid bruits in children: transmitted murmur or vascular origin, studies by pulsed Doppler ultrasound. Forty-four youngsters with precordial murmurs and carotid bruits were evaluated clinically and independently, using pulsed Doppler ultrasound. The precordial murmur was evaluated with M-mode echocardiography combined with Doppler flow evaluation, and the carotid bruit was evaluated with peripheral vascular sector scan with Doppler flow evaluation. These ultrasonic techniques can identify abnormal blood flow at anatomic sites such as the aortic valve and in the carotid arteries. The patients had no symptoms and their condition, except for six, was mild enough that catheterization was not indicated. The clinical diagnosis of aortic stenosis was made in 30 children, and nine were thought to have no heart disease. On the basis of the ultrasonic examinations, 28 patients were diagnosed as having aortic stenosis and seven subjects had no intracardiac turbulence. However, there was disagreement in 14 instances; four of the six clinical "normals" were found to have aortic stenosis by pulsed Doppler echocardiography; six patients diagnosed as having mild aortic stenosis on a clinical basis were found to have no aortic abnormality. The results confirm that aortic stenosis usually presents as a murmur maximal in the aortic area, which is associated with a carotid bruit. Unfortunately, in at least one-fourth of the cases the murmur was not maximal at the aortic area, and a carotid bruit was found in several normal subjects. Since the consequences of over- or under-diagnosis of aortic stenosis are substantial, careful thought should be given to the differential diagnosis, and if possible, pulsed Doppler echocardiography should be utilized for a definitive statement of aortic valve-induced turbulence.


Sensitivity and specificity of echocardiography in the assessment of valve calcification in mitral stenosis. Eighty-seven patients (64 females and 23 males) with mitral stenosis were studied by M-mode echocardiography to assess the sensitivity and the specificity of the echocardiographic technique in the identification of valve calcification. The mitral valves were examined at operation, and the amounts of calcium were graded as heavy, light, or absent. We compared this with the amount of calcification assessed by radiographic, previously accepted echocardiographic, and newly derived echocardiographic criteria. In identifying the presence or absence of valve calcification, radiography was the least sensitive (53.7 per cent), but the most specific (90.9 per cent) technique, and has the highest predictive accuracy (90.6 per cent). Previously accepted echocardiographic criteria had the highest sensitivity (92.6 per cent), but the lowest specificity (12.1 per cent), and the lowest predictive accuracy (63.3 per cent). The newly derived echocardiographic parameter MT/ST (ratio between the maximal thickness of the left ventricular margin of the interventricular septum) was both sensitive (75.9 per cent) and specific (81.8 per cent) and also had a predictive accuracy (87.2 per cent) similar to that of radiographic techniques. The MT/ST ratio is demonstrated to be the most useful non-invasive method for assessing valve calcification in mitral stenosis.


Changes in the QRS complex and ST segment in transmural and subendocardial myocardial infarctions. A clinicopathologic study. The QRS complex and ST segment in the ECGs of 80 patients who died of an acute myocardial infarction (MI) were studied in relation to the extent of the MI (subendocardial vs. transmural). Changes in the QRS complex developed in nine out of the 15 cases with an acute subendocardial MI. Five of these cases fulfilled the conventional QRS criteria for a myocardial infarction. A definite ST segment depression (a J point depression of 2 mm. or more in at least one lead, and a horizontal or downward sloping ST segment with a minimum duration of 0.08 sec.) occurred most frequently in connection with a circumferential subendocardial MI (88 per cent), but it was also found in a regional subendocardial (43 per cent) and transmural MI (43 per cent). In 17 per cent of the cases with a transmural MI, this was the only ECG abnormality. It is concluded that cases with a subendocardial MI cannot always be distinguished from transmural MI on the basis of the presence or absence of the QRS changes, and that an ST segment depression, as defined in this study, can give additional information in the evaluation of an acute phase of an MI.


Electrocardiographic and serum enzymic alterations associated with cardiac alterations induced in dogs by single transthoracic damped sinusoidal defibrillator shocks of various strengths. The safety margin between the strength of shock needed to defibrillate the ventricle and shocks which produce cardiac damage has not previously been reported. This study quantitates the shock intensity required to produce ECG alterations, serum alpha-1LDH and MB CPK isoenzyme elevation and myocardial damage using single transchest damped sinusoidal defibrillator shocks. Shocks of 1 to 20 amperes per Kg. of body weight were applied. Fifty-six dog weighing 2.4 to 15 kilograms were shocked with defibrillator pulses via 10 centimeter diameter electrodes applied to the thorax. Electrocardiograms were taken to be analyzed for arrhythmias, S-T segment changes, and T wave changes. Serum enzyme levels were determined in 25 dogs. Macroscopic and histopathologic studies were conducted on the hearts. Transchest single damped sine wave shocks did not produce microscopically detectable cardiac damage until at least a threefold current overdose was applied. No macroscopic morphologic alterations were observed until at least a sixfold current overdose was applied and no deaths occurred until a twelvefold or greater current overdose was delivered. Incidence and severity of ECG changes, increase in serum enzyme activity, incidence and severity of cardiac damage, and incidence of mortality all correlated positively with shock strength. However, these four adverse effects did not correlate well with each other. Transient ECG changes were very frequent following shock application regardless of the morphologic damage produced, and hence the transient changes have little value as indicators or predictors of damage. Persistent ECG changes were predictive of morphologic changes but were not sensitive enough to detect damage in mildly injured hearts. Likewise, elevated serum cardiac isoenzyme activity was a reliable but insensitive indicator of damage.


The normal anatomy of the atrial septum in the human heart. The atrial septum is a blade-shaped structure with a concave anterior margin that reflects the curve of the ascending aorta, a convex posterior margin, and an inferior margin along the mitral annulus. The fossa ovalis comprises an average of 28 per cent of the total septal area, or 43 mm.2 in infants and 240 mm.2 in adults. The channel that persists between the fossa ovalis and the muscular atrial septum is patent except at the limbus, providing a useful explanation for the success of blunt transseptal atrial catheterization and right-to-left shunts in individuals with elevated right atrial pressure.


Reduction in ventricular endocardial and epicardial potentials during acute increments in left ventricular dimensions. Unipolar potentials were recorded from the endocardium (Endo-Pot) and the epicardium (Epi-Pot) of the left and right ventricles of anesthetized open-chested dogs during acute changes in left ventricular dimension by blood transfusion. A pair of implanted ultrasonic crystals were used to detail changes in left ventricular (LV) anteroposterior diameter. When the diameter increased by an average of 11 per cent, LV Endo-Pot decreased by 28 per cent and LV Epi-Pot decreased by 15 per cent. Right ventricular Endo-Pot and Epi-Pot concurrently decreased by similar magnitude (-36 per cent). The relationship between potentials and LV diameter showed negative linearity over the ranges examined, and was not influenced by changes in hematocrit. No inverse relation between changes in Endo-Pot and Epi-Pot was observed. It is suggested that potentials when recorded directly from the endocardium or epicardium mainly reflect the electrical activity of the tissues in the immediate vicinity of the electrode. It is postulated that an increase in ventricular volume by producing stretching and thinning of ventricular walls, reduces the effective tissue mass represented in the electrode signal, thereby accounting for a reduction in both endo and epicardial potentials. Although the precise mechanisms of changes in ventricular potentials remains unclear, such changes, nevertheless, may indicate, in clinical circumstances, an acute shift in left ventricular volume.


The electrophysiologic effects of intravenous propranolol in the Wolff-Parkinson-White syndrome. Fourteen patients with the Wolff-Parkinson-White (WPW) syndrome were studied by means of intracardiac stimulation techniques, before and after the intravenous administration of propranolol, 0.1 mg./Kg. There were no significant change, or only a slight increase, in the effective refractory periods of all parts of the re-entry tachycardia circuit studied, in either anterograde or retrograde directions. Re-entry tachycardia was initiated in nine patients in the control state, and in 10 patients after propranolol. The rate of re-entry atrioventricular node-accessory pathway tachycardia was decreased, but by only 10 per cent. The duration and outer limit of the tachycardia zone of atrial extrastimuli were not significantly decreased. Propranolol, by rapid intravenous infusion administration, is unlikely to be effective primary therapy for PSVT in the WPW syndrome.


Left atrial myxoma: false negative echocardiographic findings in a tumor demonstrated by coronary arteriography. A report of left atrial myxoma discovered at coronary arteriography by virtue of unusual tumor "vascularity" is presented in which establishing the diagnosis by means of echocardiography proved difficult. The difficulty may have been due to the highly vascular nature of the tumor with resultant loss of the acoustic reflectivity required for echocardiographic demonstration. Previous cases in which left atrial myxomas have shown arteriographically demonstrable "tumor vascularity" are reviewed.


Atrial induction of ventricular tachycardia: reentry versus triggered automaticity. Atrial stimulation induced a sustained ventricular tachycardia in two patients with mitral valve prolapse and in one patient who had mild hypertension without cardiac abnormalities. Exercise-induced sinus tachycardia also started the ventricular tachycardia in one patient. Evidence is presented to suggest that the mechanism of ventricular tachycardia in one patient was reentrant excitation and in another patient triggered automaticity. It is likely that the origin of the ventricular tachycardia was confined to a relatively protected small area near the posteroinferior portion of the left ventricle and was not due to macroreentry.


Congenital bilateral subclavian steal: ductus-dependent symptoms in interrupted aortic arch associated with ventricular septal defect. There are two types of congenital bilateral subclavian steal. The first type is accompanied by severe coarctation or interruption of the aorta in which both the right and left subclavian arteries have their origin distal to the obstruction in the aorta. In most cases with complete interruption of the aorta there is a large ventricular septal defect. The second, less common type of steal is associated with isolated atresia of the proximal segment of the subclavian arteries. In the first type of steal, the anatomic predisposition for the steal is present from birth but clinical symptoms frequently do not appear until childhood or adolescence. In the newborn the presence of a widely patent duclus arteriosus and its capacity to transmit the flow and pressure from a hypertensive pulmonary artery to the descending aorta and thus to the subclavian arteries prevents cerebral symptoms and angiographic signs, but in the older infant and child, the internal diameter of the ductus has usually decreased, leading to symptoms of the subclavian steal syndrome.


Cardiocirculatory effects of afterload reduction with oral trimazosin in severe chronic congestive heart failure. Because improved long-term oral vasodilator therapy for chronic congestive heart failure is needed, the cardiocirculatory effects of the new antihypertensive quinazoline derivative, trimazosin, were evaluated with use of concomitant cardiac catheterization and forearm plethysmography in nine patients with severe chronic congestive heart failure due to coronary disease. After ingestion of 100 to 300 mg (average 172 mg) of trimazosin, the greatly elevated left ventricular filling pressure decreased from 30 to 23 mm Hg and the lowered cardiac index rose from 2.02 to 2.59 liters/min per m2. Considerable improvement in cardiac function occurred within 1 hour after ingestion of trimazosin; peak efficacy was achieved after 2 hours and persisted in the 3rd hour. Heart rate was unchanged and systemic blood pressure was mildly reduced. Because pump performance was enhanced while indexes of myocardial oxygen consumption declined, ventricular efficiency increased. Vascular relaxation was produced in both the systemic resistance and capacitance beds, with venodilation slightly more prominent. This clinical investigation of the acute hemodynamic effects of trimazosin objectively demonstrates that the drug provides considerable hemodynamic benefit in cardiac dysfunction and is therefore a potentially salutary agent for treatment of patients with chronic severe congestive heart failure.


Acute effects of oral propranolol on hemodynamic responses to upright exercise. Noninvasive measurements of maximal oxygen intake and invasive measurement of systemic and pulmonary arterial pressures, arterial and mixed venous oxygen contents and direct Fick cardiac output are reported for 3 healthy men and 14 men with coronary heart disease. Observations were obtained at supine and sitting rest, during graded levels of upright exercise on a treadmill up to symptom-limited maximal effort and in two periods of recovery. The effects of 40 mg of propranolol orally were ascertained by repeating the measurements 1 to 1 1/2 hours later. The most consistent effect of propranolol was reduction of pressure-rate products at all phases; slowing of heart rate was significant only during exercise and recovery, and the greater slowing was accompanied by a significant increase in stroke volume. These changes were similar in patients with and without evidence of left ventricular impairment greater than 15 percent on exercise testing. Maximal oxygen intake decreased in healthy subjects and decreased slightly in patients with coronary heart disease with less than 15 percent left ventricular impairment or percent deviation of pressure-rate product from age-predicted normal values during the control study. Maximal oxygen intake increased in patients with more than 15 percent left ventricular impairment. Arterial-mixed venous oxygen difference increased after propranolol because of a reduction of mixed-venous oxygen content attributed to greater peripheral extraction of oxygen.


Coronary calcification in the diagnosis of coronary artery disease. Clinical, postmortem and angiographic studies of coronary calcification are reviewed to define the value of fluoroscopy in the diagnosis and management of coronary artery disease. Autopsy studies consistently show a unique association between calcification of the coronary arteries and atherosclerosis. The relation of coronary calcification to the presence of major stenosis is more variable but is strong enough to be of clinical value, particularly in the younger subject. The diagnostic value of fluoroscopy can be improved by attention to the detailed features of calcification observed with the technique. Combined use of fluoroscopy and exercise testing appears to be a valid and as yet unexploited approach to the noninvasive diagnosis of coronary stenosis. Fluoroscopy has been a neglected method of noninvasive diagnosis and is sufficiently promising to warrant greater clinical use.


Echocardiographic findings in patients with left superior vena cava and dilated coronary sinus. Three patients with a left superior vena cava draining into a dilated coronary sinus were studied with cardiac catheterization and echocardiography. The diagnosis was confirmed at operation in two patients. A posterior echo-free space was filled with echoes during injection of contrast medium into the left but not the right arm. This echo-free space was localized to the left atrioventricular groove. This technique established the presence of a left superior vena cava communicating with the coronary sinus and excluded pericardial effusion as the source of the posterior echo-free space.


Multiple reentrant tachycardias due to retrograde conduction of dual atrioventricular bundles with atrioventricular nodal-like properties. A patient is presented who had two paroxysmal supraventricular tachycardias, one slow and incessant and the other fast. Both paroxysmal tachycardias appeared to be atrioventricular (A-V) reentrant, with anterograde conduction by way of a normal A-V pathway. Two pathways conducting in retrograde manner were demonstrated, characterized by different conduction times (fast and slow), identical abnormal atrial activation sequence and A-V nodal-like properties (retrograde Wenckebach periodicity with rapid ventricular pacing, and depression with ouabain and propranolol). Thus, there appeared to be two anomalous A-V bundles with nodal-like properties conducting in retrograde fashion. Whether the paroxysmal tachycardia was fast or slow depended on which of these pathways was utilized. Spontaneous cure of incessant paroxysmal tachycardia was observed and coincided with unexplained total loss of ability for ventriculoatrial conduction.


Massive coronary arterial aneurysm.

Massive coronary arterial aneurysm. The pathologic and echocardiographic findings of a massive right coronary arterial aneurysm in a 62 year old man are presented. The thrombosed aneurysm simulated a cardiac tumor, destroying one pulmonary valve cusp. It also caused marked pulmonary stenosis with elongation and narrowing of the outflow tract of the right ventricle and fixation of half of one cusp of the tricuspid valve.


Submitral calcification or sclerosis in elderly patients: M mode and two dimensional echocardiography in "mitral anulus calcification". Submitral calcification or sclerosis was visualized with M mode echocardiography in 84 elderly patients, 35 of whom were also studied with two dimensional echocardiography. Posterior submitral calcification, commonly referred to as "mitral anulus calcification," was present in 82 patients and was located in the angle between the posterior mitral leaflet and left ventricular posterior wall, rather than in the mitral anulus proper. M mode scans from the left ventricle to the left atrium showed that posterior submitral calcification ended abruptly in 66 cases, and in these it became contiguous with the posterior atrioventricular junction (true mitral anulus) in only 14 instances, in 16 patients the posterior submitral calcification sloped anteriorly to merge with the posterior aortic root. Anterior submitral calcification was visualized in 12 patients, 10 of whom also had posterior submitral calcification. Anterior submitral calcification was usually located immediately anterior to the base of the anterior mitral cusp. In two cases, if appeared to arise in the region between the aortic and mitral rings; in one instance, it was located in the mid left ventricle, in the mitral chordal region. We suggest that the terms anterior and posterior submitral calcification are more appropriate than "mitral anulus calcification" because in most cases such calcific deposits do not appear to be located in or to arise from the true mitral anulus.


Assessment of drug intervention on the ischemic myocardium: serial imaging and measurement with computerized tomography. Computerized tomography was evaluated as a technique for imaging and measuring the effect of an intervention on acutely ischemic myocardium. Because cell edema occurs with acute myocardial ischemia and decreases the X-ray attenuation coefficients (tissue density) of myocardium, computerized tomographic images were used to quantitate the effect of hyperosmotic mannitol on ischemia-induced edema. Canine hearts were arrested and scanned after (1) temporary occlusion of the proximal circumflex artery followed by reflow of blood, or (2) continued occlusion of the distal left anterior descending coronary artery. X-ray attenuation values (Hounsfield units) were linearly related to tissue wet/dry weight ratios (r = 0.87, P less than 0.001). After 2 hours of occlusion of the left anterior descending coronary artery the hearts that received mannitol manifested a significant reduction (P less than 0.05) in the volume of left ventricular wall involved with edema. Although the area of edema measured with computerized tomography tended to be smaller in the hearts treated with mannitol than in untreated hearts subjected to a 6 hour occlusion of the left anterior descending coronary artery, the size of the lesion was variable and did not differ significantly from that in untreated hearts. With either short periods of circumflex arterial occlusion followed by blood reflow or with 2 or 6 hours of prolonged occlusion of the left anterior descending coronary artery, the difference in mean attenuation coefficients between the ischemic and nonischemic areas of myocardium in mannitol-treated and untreated hearts was significantly less. These results indicate that computerized tomography in the arrested heart can detect and quantitate the lesion of early acute myocardial ischemia and can quantitate the effect of drug intervention.