Neuroblastoma presenting with hematuria. A 3-year-old boy with neuroblastoma presented with gross hematuria, an unusual initial complaint with this malignancy. Renal findings associated with neuroblastoma are discussed.


Transurethral ureteroscopy in men using juvenile cystoscopy equipment. The inadequacies of current procedures to yield exact diagnostic information on the last portion of the ureter in men and the urologists' frequent frustration when manipulations are attempted in the lower ureter have prompted exploration of a direct endoscopic approach to diagnosis and treatment in the terminal ureter. In the last 3 years we have become accustomed to accomplishing ureteroscopy in women on a routine basis to discover and to treat with amazing ease ureteral tumors, calculi, obstructions and so forth. Ureteroscopy in men now has been practiced sufficiently to convince us that it also should join the urologists' armamentarium of diagnostic and therapeutic procedures. Herein is described the equipment and the technique to endoscope the lower ureter.


A 20-year experience with ileal conduits: the fate of the kidneys. During the last 20 years 242 patients have undergone ileal conduit urinary diversion at our hospital. Although only 11 per cent of the renal units showed damage after the ileal conduit there was a progressive risk of renal deterioration with increasing time and obstruction was its major cause.


Urologic complications of pelvic exenteration for gynecologic malignancy. We reviewed 43 cases of pelvic exenteration for gynecologic malignancies. Particular attention was paid to the postoperative urologic complications encountered in these patients. The major disease process was carcinoma of the cervix. Six patients had early postoperative complications and 2 of these patients died. Nine patients had late postoperative problems caused by urinary tract infections or stones. Nine other patients had problems related to the urinary diversion that necessitated a secondary operation in the majority of the cases and 2 of these patients died. Advantages of the ileal and colon conduits are discussed.


The incidence of bladder cancer after cyclophosphamide therapy. The records of 19,082 patients with non-uroepithelial cancers were reviewed to determine the incidence of de novo bladder cancer in patients treated with cyclophosphamide versus patients not treated with this drug. A 9-fold increased incidence of bladder cancer was found in the cyclophosphamide-treated group.


Suprapubic endoscopic vesical neck suspension. Experience with 20 endoscopic vesical neck suspensions (Stamey procedure) is compared to 20 matched anterior cystourethropexies (Marshall-Marchetti-Krantz procedure) performed by the same staff. The present procedure is a transvaginal vesical neck suspension, described in 1959 by Pereyra, modified in 1973 by Stamey and further modified in 1975 by Mason. The long-term success rate for relief of urinary stress incontinence was 90 per cent with either procedure. Advantages and disadvantages of the endoscopic vesical neck suspension are discussed.


Prostatosis, prostatitis or pelvic floor tension myalgia? Patients with symptoms suggestive of prostatitis or prostatosis who do not have pathogenic bacteria in the prostatic secretions may, in fact, not have prostatic problems. The possibility of pelvic floor tension myalgia should be considered in these patients.


Pelvic lymphadenectomy for staging prostatic carcinoma: is it always necessary? There were 100 patients with clinically localized prostatic carcinoma staged surgically for the evaluation of lymph node metastases. By correlating the incidence of lymph node metastasis with the level of serum acid phosphatase, and the stage and grade of the primary tumor, it was possible to identify 1 group of patients with less than 8 per cent incidence of lymph node metastases and another group with more than 92 per cent incidence of nodal involvement. It is in these 2 groups of patients that pelvic lymphadenectomy for the staging of prostatic carcinoma may not be necessary.


Reliability of bone marrow acid phosphatase as a parameter of metastatic prostatic cancer. The reliability of bone marrow acid phosphatase determination by a spectrophotometric assay and 2 immunochemical methods was evaluated in 40 patients: 20 men with known prostatic carcinoma and 20 men of comparable age without clinical evidence of prostatic cancer. The large percentage of falsely positive results obtained by the colorimetric assay invalidates this method as the sole parameter of metastatic prostatic carcinoma.


Radical prostatectomy for carcinoma: 30-year experience and 15-year survivals. Three strata of medical care are shown in this series of patients undergoing radical prostatectomy for carcinoma: (1) Medical School Hospital patients had an average age 4 years greater than patients in the other 2 groups and the lowest 15-year survival rate of 15 per cent. 2) The Veterans Hospital patients had an average age 4 years younger than patients in the Medical School Hospital group but there was little opportunity for preventive care by early diagnosis and they had a 15-year survival rate of 26 per cent. 3) The Emanuel series of private patients had good preventive private medical care, allowing for earlier diagnosis in a patient population without other serious medical problems, and a 15-year survival rate of 61 per cent. The 15-year survival figures for other modalities of therapy, including various types of radiation, chemotherapy and immunotherapy, are necessary for meaningful evaluation of efficacy.


Long-term survival after hormonal therapy for stage D prostatic cancer. Hormonal therapy occasionally produces long-term survival of men with metastatic carcinoma of the prostate. To identify which patients will benefit for long intervals a retrospective analysis was done on 56 men with stage D carcinoma of the prostate treated between 1963 and 1968. Of this group 5 patients lived longer than 10 years. We were unable to identify clinical or pathologic characteristics that would have indicated which patients would have done well.


Urethral and bladder responses to anal electrical stimulation. Urethral and bladder responses to anal electrical stimulation were evaluated by cystometry and urethral pressure profile measurements in 55 patients with different urethral-bladder dysfunctions. In 50 per cent of the patients examined the electrical stimulation caused normal reciprocal response, that is bladder inhibition with urethral contraction. In other patients the electrical stimulation caused almost all other possible bladder and urethral responses.


Urodynamic biofeedback: a new approach to treat vesical sphincter dyssynergia. Some children with vesical sphincter dyssynergia are refractory to conventional pharmacologic therapy. Three such patients were treated using a method of sphincter retraining, biofeedback. They observed the urinary sphincter electromyogram while voiding to appreciate visually the abnormality. Two children learned to suppress voluntarily the inappropriate sphincter contraction during voiding. This normalized the subsequent electromyographic recordings and offered subjective improvement in the voiding symptoms. Retraining the urethral sphincter dysfunction may be approached using biofeedback techniques in selected patients.


Male peak urinary flow rate: relationships to volume voided and age. We performed 126 studies of replicate voiding in 7 individuals and 552 observations in normal, abnormal or treated male populations with a disposable device that measures peak flow and volume voided. These observations have led us to suggest that a voided volume of 150 ml. be used as the minimum acceptable volume for studies of male subjects in which peak flow is used to define normal versus abnormal voiding. At volumes greater than 150 ml. a straight line describes the relationship between volume voided and peak flow as accurately as the previously suggested hyperbolic curve. Increasing age of men again reveals progressive decrease in peak flow rate no matter what volume is voided. Comparison of peak flow rate, volume voided and age by 3-dimensional graphing was attempted but was found unsuccessful for clinical use. However, 3 biaxial linear graphs may be used to chart effectively the 3 parameters (age, volume and peak flow) and thereby judge normality or abnormality of peak flow rate for any age and volume voided.


The value of the negative radionuclide scrotal scan in the management of the acutely inflamed scrotum in children. Torsion of the testis remains a clinical diagnosis and confirmatory testing is not required when the classic signs and symptoms are present. Conflicting laboratory data or adjunctive diagnostic studies should not dissuade the surgeon from exploration when the clinical index of suspicion is high. In those patients having equivocal clinical findings when the diagnosis of torsion is not clear-cut radionuclide scrotal imaging may be useful. In this series a negative scrotal scan at the time of acute scrotal pain did predict reliably the diagnosis of non-torsion, suggesting that in the appropriate clinical setting scrotal imaging is useful in avoiding surgical exploration.


Post-biopsy intrarenal arteriovenous fistula. We present 5 cases of intrarenal arteriovenous fistulas after renal biopsy. Of these cases 3 followed percutaneous needle biopsy and 2 occurred after open renal biopsy. A nephrectomy was necessary in 1 patient to control the severe hypertension secondary to a hydronephrotic kidney and 1 patient required a partial nephrectomy to control marked hematuria.


Treatment of traumatic renal arteriovenous fistulas by detachable silicone balloon embolization. A new technique of detachable balloon arterial embolization allowed non-operative occlusion of 2 patients with post-traumatic arteriovenous fistulas in the kidney. This approach was successful in controlling hemorrhage with minimal loss of renal tissue.


Atherosclerotic renal artery occlusion extending into branches: successful revascularization in situ with a branched saphenous vein graft. In some patients successful renal revascularization can be done after complete renal artery occlusion. We report on a patient with atherosclerotic occlusion of the renal artery and its branches in whom an aortorenal bypass with a branched saphenous vein graft was performed in situ, with cure of hypertension and reversal of azotemia. This is a useful and versatile technique for replacing the renal artery and its major branches.


Persistent fetal ureter.

Persistent fetal ureter. Six patients have been seen with a peculiar ureteral lesion that has not been described previously. The lesion is characterized by either local segmentation or convolution and may represent either a persistent fetal ureter or a form of ureteral dysgenesis. Proximal dilatation, when present, has been less than the original radiographic appearance of high grade obstruction would lead one to expect. The ureteral lesions have disappeared progressively, suggesting that a period of conservative observation is warranted in similar situations.


Pelvic lipomatosis: diagnosis using computed tomography. Pelvic lipomatosis is a rare, benign disease in which the characteristic roentgenographic findings may mimic those of pelvic malignancy. In the past more than two-thirds of reported cases have been explored surgically for diagnosis. We present 2 cases to demonstrate how the definitive diagnosis of pelvic lipomatosis can be made with the aid of computed tomography to avoid invasive techniques.


Transient neuropathic bladder following herpes simplex genitalis. A case of transient bladder dysfunction and urinary retention concomitant with herpes genitalis is presented. The protean manifestations of the herpes simplex virus, the similar neurotropic behavior of simplex and zoster, and the neurologic sequelae of the cutaneous simplex eruption are discussed. The possibility of sacral radiculopathy after herpes genitalis must be considered when evaluating acute or episodic neurogenic bladders.


Salmonella virchow testicular abscess.

Salmonella virchow testicular abscess. During the summer of 1977 an epidemic of salmonellosis traced to precooked, prepackaged roast beef occurred in the Northeastern United States. A case is reported of a testicular abscess, a rare manifestation of salmonellosis, in an adolescent boy who had a recent history of ingesting such roast beef. The type of Salmonella recovered from the patient was the same as a type in the epidemic.


Constrictive albuginitis: report of 3 cases. Three sterile patients with constrictive albuginitis are described. The most common presenting symptom is a long duration of scrotal pain and the testicles are small and firm. Testicular biopsy is characterized by peritubular fibrosis. Spermatogenesis may be complete but the cells are degenerated. The condition is bilateral. At operation the tunica albuginea is thick, yellowish and rigid and, microscopically, it shows excessive fibrosis and hyalinosis. Sterility is related to the constrictive effect of the tunica albuginea. Treatment by decompression albugineotomy was successful in 2 patients. The benefits derived from the operation are discussed. A primary degenerative process of the tunica albuginea is suggested as causal.


Urologic manifestations of the iliacus hematoma syndrome. Anticoagulated patients may have a characteristic syndrome of femoral neuropathy from an iliacus muscle hematoma. They may present with urologic signs and symptoms, including groin, flank and thigh pain, groin tenderness, an iliac fossa mass and hematuria. Urography may reveal an enlarged psoas shadow and hydronephrosis from ureteral obstruction. Prompt diagnosis is essential so that early operative decompression of the femoral nerve can be done. The urologist has an important role in the diagnosis and treatment of this syndrome.


Plasma biochemical values of clinically-normal Australian sea lions (Neophoca cinerea). Seventeen biochemical constituents were assayed in the blood plasma of clinically-normal Australian sea lions (Neophoca cinerea). The sea lions formed part of a breeding colony which inhabits the southern coast of Kangaroo Island, South Australia. Little variation was found in any of the values obtained from animals of different age and sex. The results were compared with values published for California sea lions (Zalophus californianus), Northern fur seals (Callorhinus ursinus), Harbor seals (Phoca vitulina) and Northern elephant seals (Mirounga angustirostris).


The occurence of coxiellosis among rodents and shrews in the Tarai area of Uttar Praedesh. Rodents and shrews were screened for serologic evidence of Coxiella burnetii. Attempts were made to isolate the organism from the spleen and liver. Seroreactors: total positive/total tested (% positive), in rats (Rattus rattus, R. norvegicus), ground shrews (Suncus murinus), bandicoots (Bandicota indica, B. bengalensis) and the house mouse (Mus musculus), respectively, were 13/105 (12.38), 6/42 (14.3), 2/15 (13.3) and 1/7 (14.3). Of the eight rickettsial isolants recovered including four from field and household rats, three from ground shrew and one from bandicoots, only three comprising one each from rat, shrew and bandicoot, could be typed as C. burnetii. This appears to be the first record of rodents and an insectivore as reservoirs of C. burnetii in India.


Blood characteristics of the African elephant (Loxodonta africana cyclotis). Mean corpuscular volume, hematocrit, hemoglobin concentration and red and white cell counts from five domesticated African elephants were measured. The results obtained are tabulated and compared with those from shot and chemically immobilized African elephants.


Hematologic and serum chemistry values of pen-raised coyotes. Blood samples obtained from 48, eighteen-month-old pen-raised coyotes (Canis latrans) were analyzed for 32 hematologic and serum chemistry parameters. Mean, standard deviation, and range were established for each parameter. No differences attributable to sex were observed for any parameter. The reported hematologic and serum chemistry values establish non-fasting baseline values for pen-raised coyotes.


Treatment of an acquired abdominal hernia in a polar bear (Thalarctos maritimus). A heart rate radio-transmitter was surgically implanted in the abdomen of a captive adult male polar bear (Thalarctos maritimus), but within five weeks a purulent discharge was observed at the incision site. The transmitter was surgically removed along with many fragments of the fractured encapsulation material. The skin incision healed, but a large hernia remained. Repeated localized trauma to the hernia sac necessitated surgical repair.


Wet versus dry weights for heavy metal toxicity determinations in duck liver. Determinations for heavy metals in duck liver using wet weight in lieu of dry weight produced errors that could not be quantitated. Weight loss through air-drying ranged from 10 to 21% in the first 2 h. for frozen tissue and 7 to 11% for fresh tissue. This difference becomes increasingly variable with time.


Some parasitic and infectious diseases in waterfowl in Oklahoma. Blood films and serum samples from free-ranging waterfowl wintering in and migrating through Oklahoma were examined for hematozoa and tested for antibody responses to Newcastle disease virus (NDV) and type-A influenza. One-hundred-eleven of 728 birds (15.24%) were positive for 1 or more hematozoa. Serologic testing revealed 11 of 280 (3.93%) positive for antibody to NDV and 5 of 171 (2.95%) positive for antibody to type-A influenza.


Poikilotherms as reservoirs of Q-fever (Coxiella burnetii) in Uttar Pradesh. Water snakes (Natrix natrix), rat snakes (Ptyas korros), cobras (Naja naja), pythons (Python molurus), tortoises (Kachuga sp.), plankton fish (Cirrhina mrigala), frogs (Rana tigrina), toads (Bufo sp.) and monitors (Varanus indicus) were screened for evidence of Q-fever infection by the capillary agglutination test on sera to detect antibodies and/or by attempts to demonstrate Coxiella burnetii in spleen and liver samples. Sero-reactors were observed among water and rat snakes, pythons and tortoises. The organism was isolated from the spleen and liver of the monitor, tortoise and python.


Avian cholera in waterfowl in Saskatchewan, spring 1977. Avian cholera was diagnosed in lesser snow geese (Anser c. caerulescens), Ross' geese (Anser rossii) and individuals of several other waterfowl species in a small area of south-western Saskatchewan over a 1 month period during the 1977 spring migration. Approximately 250 dead birds were found. This is apparently the first time avian cholera has been reported in migrating waterfowl in Canada. The site of the mortality was midway between the wintering and nesting areas of the two principal species, and the significance of the occurrence of the disease this far north is discussed.


Antibodies to Clostridium botulinum toxins in free-living birds and mammals. Naturally-occuring antibodies against Clostridium botulinum toxins were found in Cathartes aura (turkey vultures), Canis latrans (coyotes) and Corvus brachyrhynchos (crows) by the passive hemagglutination (PHA) test and verified by the serum neutralization (SN) test. The prevalence of IHA antibodies was 18 of 20 vultures (90%), 5 of 12 crows (42%) and 25 to 110 coyotes (23%). Vultures and coyotes were seropositive by the PHA test against A, B, C, D, and F toxins. The highest antibody titer 1:8192 was in vulture serum against type C. In descending order, the highest antibody levels were against type C, D, F, E, A and B toxins.


A summary of the prevalence of Parelaphostrongylus tenuis in a captive wapiti population. A total of 87 brains from harvested and collected wapiti and red deer (Cervus spp.) were examined grossly and microscopically between 1973 and 1977 in a 2104 ha. preserve. Prevalence of infection significantly increased from 26.6% of the sample in 1973 to 64.3% in 1975 (P less than .05). A decline to 47.7% in 1977 (P greater than .05) was not significant. However, the number of clinical cases was significantly higher in 1976-1977 (P less than .02) than previously reported in 1973-1975.


Cerebrospinal nematodiasis caused by Parelaphostrongylus tenuis in Angora goats in Texas. A natural infection of meningeal worm (Parelaphostrongylus tenuis) accounted for the death of 11 of 17 (65%) Angora goats in a study in South Texas during 1975. Clinical signs, gross pathology and histopathology in Angoras were similar to other abnormal hosts.


Prevalence of parasitism by Amblyomma americanum on wild turkey poults as influenced by prescribed burning. Captive-raised eastern wild turkey (Meleagris gallopavo silvestris) poults were allowed to forage on either recently burned plots or on plots that had not been burned during the previous 3 years. Following a two hour exposure on the study plots, external parasites were recovered from all poults. The louse (Menacanthus stramineus) and the lone star tick (Amblyomma americanum) were the only parasites recovered. Fifty-nine poults exposed to the burned plots had a significantly (P less than 0.001) lower prevalence of A. americanum infestation than did 57 poults exposed to the unbured plots. Thirty-five percent of the poults exposed to the unburned plots were infested by A. americanum. A single A. americanum was recovered from one poult exposed to burned plots.


Helminths recovered from black bears in the Peace River region of northwestern Alberta. A total of 91 free-ranging black bears (Ursus americanus) from the Peace River region of northwestern Alberta was examined for helminths. Four species, Baylisascaris transfuga, Taenia krabbei, Taenia hydatigena and Dirofilaria ursi, were found. None of the bears was heavily infected. Results are compared with other similar North American surveys.


Heart failure associated with unusual hepatic inclusions in a Deckert's rat snake. A juvenile Deckert's rat snake, Elaphe obsoleta deckerti, was presented with a circumferential enlargement of the body in the region of the heart. The heart was enlarged approximately twice normal size. Focal mineralized lesions were present in the tunica media of the right aorta and the right atrioventricular valve. The normal sinusoid architecture of the liver was disrupted with deeply eosinophilic to lightly basophilic granules of variable size in the cytoplasm and light eosinophilic intranuclear inclusions. Similar appearing intracytoplasmic granules were seen in the glomeruli and kidney tubules.


Selected clinicopathologic changes associated with experimentally induced Fascioloides magna infection in white-tailed deer. Six white-tailed deer (Odocoileus virginianus), less than one year of age, were divided into two groups of three each and administered 50, or 500 metacercariae of ascioloides magna. All six deer became infected. Three additional deer of the same age were uninoculated controls. All deer were monitored for up to 43 weeks after inoculation to investigate changes in weight, selected hematologic values, and blood chemistry values. Although clinical disease was not evident in the infected deer, a significant reduction (p less than .01) in hemoglobin and packed cell volume was detected throughout the experiment. A significant elevation (p less than .01) in the total serum protein level was detected in both infected groups from 0 to 5 months after inoculation. Increases were present in the beta and gamma globulin fractions. No differences (p greater than .05) were detected in the serum calcium, magnesium, or phosphorus levels, or in body weights between infected and uninfected control groups.


Reported causes of death of captive killer whales (Orcinus orca). Inquiries were made to all oceanaria that maintain killer whales in North America. Causes of death determined at necropsy included mediastinal abscesses, pyometra, pneumonia, influenza, salmonellosis, nephritis, Chediak-Higashi syndrome, fungus infection, ruptured aorta, cerebral hemorrhage and a perforated post-pyloric ulcer. Captive females appear to have a higher rate of mortality than males. Growth rates for whales that died were greater than for those that survived.


The risk and cost of coronary angiography. I. Cost of coronary angiography in Washington State. The National Guidelines for Health Planning require 300 cardiac studies per year in cardiac catheterization laboratories for adequate economic use and safety. To study how these guidelines would affect existing laboratories, data were collected on the cost of coronary angiography and use of all cardiac catheterization laboratories in Washington. The average cost of coronary angiography was $1,363, with the total cost affected by the duration of hospital stay, cardiac laboratory charges, and professional fees. Total angiographic use ranged from 293 to 791 studies per room, but eight laboratories did not perform 300 cardiac studies during 1977. Health planners recommend high use rates based on the theory that there is an inverse correlation between the number of studies and cost. In this study, the regression equation showed no fall in charges with increased number of studies. Therefore, while it may be reasonable from an economic point of view to expect 300 angiographic cases per year in existing laboratories, there is no economic justification for requiring a certain number of cardiac studies per year.


The risk and cost of coronary angiography. II. The risk of coronary angiography in Washington State. The risk of coronary angiography has been decreasing since development of the procedure 19 years ago. Deaths resulting from angiography now occur only in high-risk clinical circumstances. Whether a certain case load per angiographer or laboratory is necessary for adequate safety is still a question. Even though little available data exist on the relationship of case loads to risk, the National Guidelines for Health Planning now require 300 cardiac catheterizations per laboratory per year and forbid development of new laboratories in hospitals without heart surgery programs. Data collected from all 16 laboratories in Washington showed 26 deaths (0.19%) during 14,050 coronary angiograms. Eighteen of those who died had a severe left main coronary obstruction, and three had severe triple-vessel disease. There were 18 myocardial infarctions (0.13%) and nine strokes (0.06%). The risks in hospitals without cardiac surgery programs and in hospitals performing fewer than 200 cases per year were no higher than in the other hospitals studied. The National Guidelines should be reevaluated before they are used to change the existing pattern of health care.


El Paso revisited. Epidemiologic follow-up of an environmental lead problem. Increased lead absorption was found in 1972 in 56% of 256 children aged 1 to 18 years who lived within 1.6 km of a lead-emitting ore smeltery in El Paso, Tex. Engineering improvements have subsequently reduced emissions from the smeltery, and levels of lead in air, dust, and soil have declined. To evaluate the impact of these environmental improvements on lead absorption, we conducted a follow-up study in 1977 of blood lead levels in 140 children aged 1 through 18 years who lived within 1.6 km of the smeltery. Mean blood lead levels were found to have decreased from 41.4 to 17.7 microgram/dL in children living within 0.8 km of the plant and from 31.2 to 20.2 microgram/dL in children living at 0.8 to 1.6 km. These data argue for the feasibility of reducing children's lead absorption near primary lead smelteries.


The myth of involutional melancholia.

The myth of involutional melancholia. Depressions occurring in the menopausal years do not fit the description in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, edition 2. Depressed patients who are in the menopausal years do not have a distinct symptom pattern, an absence of previous episodes, or an absence of life-stress precipitants. The evidence thus far supports the decision to exclude involutional melancholia, as currently defined, from the forthcoming Diagnostic and Statistical Manual of Mental Disorders, edition 3.


Plasma ADH levels during heart surgery.

Plasma ADH levels during heart surgery. 1) Plasma ADH levels measured by bioassay in the group with extracorporeal circulation were 2.3 +/- 0.6 muu/ml before surgery and 6.6 +/- 1.8 muu/ml during anesthesia. They increased to 196.5 +/- 62.3 muu/ml or about 100 times greater than before surgery during cardiopulmonary bypass. 2) In the group without extracorporeal circulation, plasma ADH levels were 1.5 +/- 0.9 muu/ml before surgery and increased to 44.1 +/- 15.2 muu/ml during operation. 3) After operation decrease in plasma ADH level was relatively rapid in both groups. It became three times that of the control level in the morning of the next day. 4) Marked increase in plasma ADH level during cardiopulmonary bypass was much the same as it was during hemorrhagic shock in dog experiments. 5) Fall in mean arterial blood pressure and loss of pulsatile blood flow will play main roles in this marked increase in ADH during cardiopulmonary bypass through stimulation of arterial baroreceptors and probably chemoreceptors. 6) In two cases with mitral stenosis, increase in plasma ADH during cardiopulmonary bypass was lesser than the other heart diseases.


A morphological study of atherosclerotic lesions occurring at the root of aorta. While studying morphological changes in heart 1-3 cm of Aorta was also removed and incidence of atherosclerosis in that portion was studied. In all 110 aortas were examined. Atherosclerotic lesions were observed in 77 aortas (70.0%). The incidence increases with the age and beyond 4th decade all the aortas were affected. Fatty streaks were observed in 2nd decade involving only 7.5% of the total intimal surface and reaching to a maximum of 22.2% in the 3rd decade, followed by a gradual rise to 9.2% in 7th decade. Complicated lesions though occurred in 3rd decade involving 0.7% surface but a maximum coverage (4.5%) was seen in 7th decade. These findings have been discussed in the light of observations of other workers. There is slow progression of fibrous plaques and paucity complicated lesions in Indians as compared to white population. The study has further revealed that the encrustation of mural thrombi is probably the main basis for the progression of the atheromatous lesion.


Acid phosphatase activity of the brain in SHR-- the first report of enzyme histochemical studies of spontaneously hypertensive rat brain. Changes in acid phosphatase activity in the cerebrovascular system and brain parenchyma in SHR were investigated histochemically. An increased activity of the enzyme was demonstrated in the SHR endothelial and medial smooth muscle cells of the cerebral arterial system as compared to the control. The pericytes of intraparenchymal blood vessels also showed an intensified enzyme activity. The enzyme activity increased with advancing age. In SHR brain parenchyma, the enzyme activity was decreased in the cortical nerve cells. Glial cells with the enzyme activity were increased in number and showed an intensified activity. Causative factors of changes in acid phosphatase activity in SHR cerebral arteries and parenchyma were discussed.


Diagnosis and classification of the mitral valve prolapse by the ultrasoundcardiotomography and the evaluation of the M-mode technic. Eighty cases with mitral valve prolapse excluding the secondary prolapse of the mitral valve caused by known underlying diseases were studied by real-time ultrasoundcardiotomography and M-mode technic. It was thought that observation of the left ventricle with long axis sector scan was useful and sensitive technic to diagnose the mitral valve prolapse. By comparative study of M-mode technic and ultrasoundcardiotomography, echo sources and the mechanism of so called prolapse patterns such as pansystolic bowing, mid-systolic buckling and multilayered echoes were explained. Pansystolic bowing and mid-systolic buckling were considered as the reliable signs for diagnosis of anterior leaflet prolapse, but were not contributory to diagnose posterior leaflet prolapse and ultrasoundcardiotomographic technic was needed to detect the posterior leaflet prolapse. According to the mode of prolapsing findings by ultrasoundcardiotomograms classification of severity of mitral valve prolapse was undertaken and its grade was expressed as AmPn in which A and P designated prolapse of the anterior and posterior leaflet respectively and m and n indicated the grade of severity in number from zero to five.


[Clinical study of bacampicillin granules in pediatrics (author's transl)]. Clinical study on bacampicillin (BAPC) granules was performed in 20 children with infectious diseases. Patients treated with BAPC granules were 10 cases of scarlet fever, 3 cases of pertussis, 3 cases of Salmonella enteritis and 4 cases of acute enteritis. Clinical results were excellent in 2, good in 9, fair in 3, poor in 4 and unknown in 2. No side effect was observed.


[An investigation on bacampicillin granules (author's transl)]. We investigated bacampicillin (BAPC) granules in the field of pediatrics. 1) Average serum levels after administration of BAPC granules at a dose of 10 mg/kg as ABPC were 6.8 mug/ml at 1 hour, 1.4 mug/ml at 6 hours. Average urinary excretion rate till 6 hours was 84.5%. Those results were almost same as those obtained with BAPC tablet. 2) We treated patients with acute tonsillitis, lacunar tonsillitis and acute bronchitis by BAPC granules at a dose of 30 approximately 40 mg potency/kg for 3 approximately 5 days, and excellent results were obtained. 3) In the case of streptococcal infections including scarlet fever, pharyngeal streptococci disappeared 1 approximately 2 days after administration and did not reappeared. 4) BAPC granules were easy to intake for children and no abnormal laboratory finding was observed. 5) BAPC granules seem to be useful for treatment of pediatric infections.


[Effect of fosfomycin-calcium on reproductive performance of rat and rabbit: teratogenicity test (author's transl)]. The teratogenicity study of fosfomycin-Ca (FOM-Ca) was undertaken in Wistar strain rats and JW strain rabbits. Rats were treated orally at dose levels of 140,700 and 1,400 mg/kg/day from 7th to 17th day of gestation, and rabbits were treated orally at dose levels of 80, 140 and 420 mg/kg/day from 6th to 18th day of gestation. In the case of rats, two-thirds of pregnant mothers in each group were sacrificed on 20th day of gestation and then their fetuses were examined for external, visceral and skeletal observation. The remaining mothers were allowed to deliver naturally, and then their offsprings were examined for postnatal development. In the case of rabbits, all pregnant mothers were sacrificed on 29th day of gestation and their fetuses were examined. No effect of FOM-Ca treatment to rat and rabbit mothers was found except soft stool was seen with maximum dose in rats. Dead or resorbed rate of fetuses increased, external anomalies (short tail, abdominal hernia) were found and skeletal anomalies slight increased with maximum dose in rats. However, there was no significant difference from the control or background data. While, no effect of FOM-Ca treatment was observed in rabbits and rat offsprings. Consequently, it can be concluded that FOM-Ca has no teratogenicity effects on rats and rabbits.


[Therapeutic effect of midecamycin on Mycoplasma pneumoniae pneumonia in adults (author's transl)]. The clinical efficacy of a macrolide antibiotic, midecamycin, was studied in 12 adult cases with Mycoplasma pneumoniae pneumonia. The therapeutic effects were excellent or good in 9 cases and fair in 2 cases. On defervescence and disappearance of shadows on chest X-ray the therapeutic effect was satisfactory, but on disappearance of cough therapeutic effect was not clear in some cases. Taking into consideration the antimicrobial activity of midecamycin against Mycoplasma pneumoniae, serum concentration and side effects of midecamycin, this antibiotic is expected to be effective in the treatment of Mycoplasma pneumoniae pneumonia.


[Clinical studies on PC-904 in biliary tract diseases (author's transl)]. The clinical effects of PC-904, a new semisynthetic penicillin, were studied in patients with biliary tract diseases, and the results were as follows: 1) PC-904 showed an average peak serum level of 40.7 +/- 11.6 microgram/ml 2 hours after an intravenous drip infusion of 1 g of the agent. The biliary level showed a peak value of 126.5 +/- 85.4 microgram/ml 2 hours to 3 hours after the infusion. 2) Isolated organisms from bile before the treatment were E. coli, Klebsiella, Proteus, Pseudomonas, Enterococcus and Bacteroides. MIC of PC-904 on 18 strains of isolated organisms was almost 6.25 microgram/ml or less. All isolated organisms except one strain of Klebsiella oxytoca disappeared after the treatment. 3) Six patients with cholelithiasis were medicated with PC-904 to prevent post-operative infections. The clinical effects were good in 4, poor in 1 and unknown in 1 case. 4) As to side effects no adverse reactions and allergic reactions were noted. Also no significant abnormalities of laboratory findings were observed.


The natural history of rheumatic fever and rheumatic heart disease in the Orient. Studies published in the past 10 years suggest that group A streptococcal infections are frequent in the Orient and lead to a high incidence of rheumatic fever (RF) and rheumatic heart disease (RHD). In the present study, streptococcal infections were found to be more prevalent in Japan and Taiwan, whereas RF and RHD were more common and severe in the Philippines, Thailand, and Indonesia, particularly among the socioeconomically less privileged populations. The pattern of childhood RF varied: Carditis was the most common manifestation, occurring in 57% to 94% of the patients; polyarthritis was generally atypical and less common in the tropics; chorea minor and erythema marginatum were much more common in Japan, less common in Taiwan and rare in the tropics. RF recurrences were quite common and led to the development of new carditis, and deterioration or persistence of the pre-existing heart disease. The 5 year mortality rates differed greatly, ranging from zero to 42%. There was disappearance of the heart murmur in 16.5% to 37.5% of patients. Such apparent recovery was related to adherence to chemoprophylaxis. The major risk factors adversely affecting survival were the severity of carditis, inadequacy of medical service, non-compliance to chemoprophylaxis, RF recurrence, poor socioeconomic status, and high prevalence of group A streptococci. It is concluded that there is no uniform "Oriental-type" of natural history of RF and RHD. The natural history varies greatly among countries as is true in other parts of the world.


Hemodynamic effects of pentazocine in acute myocardial infarction. In 12 patients with acute myocardial infarction the hemodynamic effects of a single intravenous injection of 30 mg of pentazocine were investigated. The administration of pentazocine resulted in no significant hemodynamic changes. In particular, there was no increase in peripheral vascular resistance and no evidence of decreased left ventricular function or respiratory depression. In the occasional patients who demonstrated an elevation of pulmonary arterial pressure, it was probably due to a direct effect of the drug on the pulmonary vasculature.


The effect of propranolol on left ventricular function at rest and during exercise in patients with ischemic heart disease. Twelve patients with ischemic heart disease were investigated by right and left heart catheterisation. All patients were studied at rest and during exercise, both before and after administration of beta-blocker propranolol, Inderal (ICI). Left ventricular function decreased after administration of propranolol, but these changes were significant only during exercise. Contractility was depressed after administration of propranolol already at rest. On the other hand, left ventricular filling pressure decreased after administration of propranolol. Our results show the poor reliability of the evaluation of the left ventricular function based solely on the left ventricular filling pressure.


Electrophysiologic effects of lidocaine in children. The effects of intravenous lidocaine on the refractory periods of the atrium, AV node and right ventricular myocardium were studied using His bundle recordings and the extrastimulus technique with and without atrial and ventricular pacing. The drug was administered in an intravenous bolus dose of 1 mg/Kg followed by an infusion of 100 micrograms/Kg/min. The AH, HV intervals and resting sinus cycle length as well as functional and effective refractory periods of atrium, AV node and right ventricle were measured before and 5 min afrer bolus injection of lidocaine. Neither of the refractory periods nor AH and HV intervals changed significantly following administration of lidocaine. The result of this first study in children is in agreement with previous reports of the effects of lidocaine on the cardiac conduction system in adults.


Echo- and phonocardiographic studies in patients with Lillehei-Kaster aortic valve prostheses. Simultaneous echo- and phonocardiographic studies were performed in 17 patients with normally functioning Lillehei-Kaster (LK) tilting disc prosthesis in the aortic position. The LK aortic valve prosthesis was well recorded by echocardiography with a disc excursion of 14 to 25 mm and very fast opening and closing velocities, too rapid for quantitative assessment. On phonocardiography the opening click of the prosthesis was only rarely observed (2 out of 17 cases), while the closing sound was consistently present in all patients, occurring within 5 msec of the point of complete closure of aortic disc prosthesis by echocardiography. Systolic time intervals (STI) measured by combined echo-and phonocardiography were similar to the predicted values in 15 patients who had no evidence of residual cardiac dysfunction. In the remaining 2 patients, one or more components of the STI differed by more than 2 standard deviations from the predicted values, and in these there were associated findings to explain the discrepancies. This study illustrates the echo- and phonocardiographic features of the normally functioning LK aortic valve prosthesis. In addition, precise measurements of the isometric contraction and relaxation periods as well as standard systolic time intervals are possible with these techniques.


Technique of echographic examination of right ventricular wall thickness from the right sternal border. Right ventricular wall motion was readily accessible for echocardiographic recording along the right sternal border in 27 pediatric patients (age: 24 hrs--12 yrs). Right ventricular epicardial and endocardial wall motion could be recorded only at the right sternal border in 10 of these patients, emphasizing the need for a new, alternative examination site. Calculated measurements of right ventricular wall thickness recorded from both right and left sternal borders (7 pts) were similar (range of diff.=0--0.6 mm; mean of diff.=0.26 mm). Autopsy confirmation of right ventricular wall thickness was obtained in 2 patients. Epicardial motion could not be identified at the left sternal border in 10 patients. In these patients, right ventricular wall thickness was estimated by measuring from the inner chest wall to the endocardium. These measurements were compared to right ventricular wall thickness obtained from the right sternal border. Wall thickness obtained from the left sternal border was significantly underestimated in the absence of a definite epicardial interface (range of diff.=0.2--2.6 mm; mean of diff.=1.3 mm).


Reflex vasoconstriction to a cold stimulus for non-invasive evaluation of neurovascular function in man. The response of limb blood flow to cold stimulus was determined by venous occlusion technique in 30 healthy subjects. The stress was applied by immersing one hand into ice-floating water for 35 sec, and the blood flow was measured serially in the contralateral upper limb. The change of blood flow at the 15th sec of stress was the largest among the intermittent measurements, and decreased by 48+/-8% of the control value. A significant rise in plasma dopamine-beta-hydroxylase was found in response to the same stress. This simple cold stress test may be used to evaluate the function of the reflex arc involved in reflex vasoconstriction. A significantly diminished vasoconstriction was observed in 12 uremic patients with a concomitantly smaller rise of plasma dopamine-beta-hydroxylase activity in the test.


The fast Fourier transform in the analysis of the normal phonocardiogram. The present study is focused on spectrum analysis as a useful method of processing the PCG in order to obtain the frequency spectral distribution of normal heart sounds. Thirty normal subjects aged from 17 to 34 were studied. PCG was recorded on the fourth intercostal space at the left sternal border using a sound level meter coupled with a standard 6 ml cavity. The microphone had a linear response from 0.2 to 8,000 Hz. The signal was filtered with the standard B network according to the ANSI specifications and was registered on a four track FM tape recorder. A four channel analyzer with a microprocessor for off-line elaborations was used with 10 KHz sampling frequency. The PCG signal was triggered by a QRS detector on the R wave of the simultaneously recorded ECG. Fast Fourier transform was performed employing either a four channel analyzer with a microprocessor, or an A/D converter with a computer. Finally the results of the analysis were statistically elaborated. The described procedures permit to obtain a direct and exact tracing of the acoustic features of the heart, thus representing an attempt to come closer to the standardization and automatic analysis of the phonocardiographic technique.


Onion, garlic, and experimental atherosclerosis. Forty-two healthy male albino rabbits weighing around 1 Kg were divided into 4 groups. Group I (8)- fed on normal stock diet, Group II (8)- fed on stock diet plus cholesterol (0.5 gm in 5 ml of olive oil). Group III (15)- received stock diet plus cholesterol plus garlic (0.25 gm) juice. Group IV (11)- received stock diet plus cholesterol plus onion (2.5 gm) juice. The animals were closely observed and followed for 16 weeks. Approximately every 4 weeks, blood samples were collected for estimation of various parameters (S. cholesterol, S. triglycerides, S. lipoproteins, S. phospolipids, and fibrinolytic activity). At the end of experiment, animals were sacrificed and degree of aortic atherosclerosis was graded (grade 0 to 4) in different groups and compared. Experimental study revealed that both garlic and onion (garlic more than onion) had significant effect in inhibiting the rise in S. cholesterol, S. triglycerides, S. beta lipoproteins, and S. phospolipids and significant effect in enhancing the fibrinolytic activity. The beta: alpha ratio was altered favourably and the ratio was kept close to normal. As regards the degree of aortic atherosclerosis as seen on post mortem, it was significantly less in garlic and onion group when compared with pure cholesterol group.


Comparison of ejection fraction and segmental circumferential fiber shortening velocity in the anesthetized and conscious canine. A chronically and transseptally implanted left atrial catheter was utilized to perform repeated cineangiography in the conscious dog. The advantage of this preparation is that catheter placement does not require a thoracotomy. Left ventricular function was compared in the same pentobarbital-anesthetized and conscious dog. Anesthesia significantly depressed myocardial function as was demonstrated by a decrease in ejection fraction and segmental circumferential fiber shortening velocity (VCF) and an increase in end-diastolic volume. In addition, no difference in Vcf occurred between the base and the apex. Since anesthesia produced regional difference in the degree of depression of VCF, we conclude that anesthesia will produce patterns of ventricular contraction which are variable and unpredictable. Consequently, we recommend the use of the conscious dog and this preparation in order to evaluate myocardial function.


Foreign body in the main pulmonary artery. An unusual complication of Pudenz-shunt. A dislodged Pudenz ventriculo-atrial shunt catheter removed from the main pulmonary artery by arteriotomy is reported in a 21-year-old man.


Diuretic action of metolazone in dogs.

Diuretic action of metolazone in dogs. Metolazone, the sulfonamide diuretic was investigated to determine the sites of action. We used a radioactive microsphere, clearance and stop-flow method in anesthetized dogs. Urine flow and urinary excretion of sodium and potassium were increased at 5--60 min when metolazone was given intravenously at doses of 0.2--5.0 mg/kg, while total renal blood flow, distribution of cortical renal blood flow and GFR did not change. The urinary excretion rate of sodium to potassium (Na/K) increased from 5.69 +/- 0.82 to 8.07 +/- 0.76 in a dose of 1.0 mg/kg, i.v. Osmolar clearance and free water reabsorption increased almost proportionally, indicating that metolazone has little effect on the medullary portion of the ascending limb of Henle and may have a proximal site of action. In stop-flow experiments, a significantly raised U/PNa/U/Pcreatinine was observed at the dip situated distally to the ascending limb of Henle. These findings indicate that the diuretic action of metolazone may be due to the inhibition of sodium reabsorption in the distal nephron segments, in addition to the absence of modification of the cortical regional blood flow.


Effects of vasodilators on microcirculation of the rat cremaster muscle: a microscopic method for screening drugs. Effects of vasodilating drugs on microcirculation of the rat cremaster muscle were investigated microscopically. Topical application and intravenous injection of papaverine produced dilatation of arterioles. Cyclandelate applied topically dilated the arterioles to a considerable extent. Topical application of bamethan induced arteriolar dilatation while bamethan given intravenously constricted the arterioles. Kallikrein applied topically induced a slight dilatation of arterioles, and intravenous administration of kallikrein produced an appreciable vasodilatation. Topical administration of bradykinin produced a vasodilatation of arterioles of the rat cremaster muscle. These results indicate that direct action of a drug on the microcirculation can be properly evaluated by the microscopic method in the rat cremater muscle, if the drug is applied topically, in the vicinity of small vessels under study.


Hydrolysis of ester-type drugs by the purified esterase from human intestinal mucosa. Esterase from human intestinal mucosa was purified 210 fold by solubilization with Triton X-100, chromatography on DEAE-cellulose, Sephadex G-100 and hydroxylapatite, and isoelectric focusing. The purified esterase showed a single band by polyacrylamide gel electrophoresis. The molecular weight of the purified esterase was estimated to be about 55,000 by gel filtration on Sephadex G-150, and the isoelectric point was 5.02. The purified esterase was strongly inhibited by diethyl p-nitrophenyl phosphate (E-600) and diisopropyl fluorophosphate (DFP), and was not inhibited by eserine sulfate and p-chloromercuribenzoate. The purified esterase from human intestinal mucosa was found to be one of the carboxylesterases. The purified esterase hydrolyzed ester-type drugs, i.e., aspirin, clofibrate, indanyl carbenicillin and procaine, but did not hydrolyze amide-type drugs and choline-type drugs.


Rhythmic contractions induced by vagotomy in the fundus of rat stomach. Continuous rhythmic contractions were observed in longitudinal muscle strips of fundus obtained from the chronically vagotomized rat stomach. These vagotomy-induced rhythmic contractions (VRC) were not blocked either by tetrodotoxin (3 x 10(-6) M) or atropine (3 x 10(-7) M), indicating that the VRC was myogenic in origin. It was also found that the VRC had the following characteristics. 1) The VRC blocked either by 10(-5) M D600 or by Ca2+ deprivation from the medium. 2) On replacement of Na+ with sucrose or of K+ with Na+, the tone of fundus strips was concomitantly elevated with the cessation of the VRC. 3) 10(-5) M ouabain blocked the VRC. 4) The VRC was blocked by cooling. 5) The VRC disappeared under anoxic conditions. Based on these results possible mechanisms of the VRC are discussed in relation to an energy dependent activity of the cell membrane.


Effects of intraventricularly administered serotonin, noradrenaline, dopamine and metaraminol on the reserpine-induced spikes recorded from the medial nucleus trapezoides in rabbits. Effects of intraventricularly administered serotonin (5HT), noradrenaline (NA), dopamine (DA) and metaraminol on the reserpine-induced spikes recorded from the medial nucleus Trapezoides (Trap. m.) in rabbits were investigated. 5HT (30, 50 micrograms) produced marked decreases in the amplitude and discharge rate of the spikes 3 to 5 min after intraventricular administration. NA (30, 50 micrograms) also produced similar effects to those of 5HT, but DA at the same dosage produced no significant changes in the amplitude and discharge rate of spikes. Metaraminol, a metabolite of alpha-methyl-m-tyrosine, produced gradual and long-lasting, potent suppression of spikes. Ninety min later, spikes were completely suppressed, and no recovery was observed within 6 hours after intraventricular administration. These results indicate that NA has a similar suppressing action to that of 5HT on the generation of the reserpine-induced spikes.


Effects of 2-[4-(2-imidazo[1,2-a]pyridyl)phenyl] propionic acid (Y-9213) on in vivo release of lysosomal enzymes from rat polymorphonuclear leukocytes during phagocytosis of particles. Intraperitoneal administration of carrageenin-zymosan suspension into rats induced an increment of the free activity and its ratio of aryl sulfatase in the exudate and such was accompanied by protein exudation and polymorphonuclear leukocyte emigration. Each test solution was orally administered twice, 1 hr before and 2 hr after, or once 2 hr after injection of the irritant. The peritoneal fluid was withdrawn 5 hr after the injection. 2-[4-(2-imidazo[1,2-a]pyridyl)phenyl] propionic acid (Y-9213) and other anti-inflammatory drugs tested inhibited the increment of the ratio of the free activity (aryl sulfatase) in the peritoneal fluid at the same dose which showed anti-inflammatory activities such as prevention of protein exudation. These results suggest that Y-9213 inhibits the phagocytic secretion in vivo of lysosomal constituents from leukocytes.


Ocular anti-inflammatory and systemic immunosuppressive effects of topically applied fluorometholone. Anti-inflammatory and systemic immunosuppressive effects of topically applied steroidal and nonsteroidal anti-inflammatory agents on experimental immunogenic uveitiis in rabbits were studied. The onset of the immunogenic uveitis induced by a single intravitreous injection of bovine serum albumin (BSA) was significantly correlated with the appearance of anti-BSA antibody in the serum. A significant correlation was also found between the maximum serum level of antibody and the maximum severity of uveitis. Suspensions of fluorometholone, dexamethasone or indomethacin were applied topically twice a day for a month to eyes injected with BSA. Ocular inflammation was suppressed by fluorometholone and dexamethasone, fluorometholone having the greater anti-inflammatory activity. The circulating antibody titer was also suppressed by both these steroids, but conversely fluorometholone had the lower systemic immunosuppressive activity. Indomethacin did not suppress the uveitis or circulating antibody production. The results of these investigations indicate that the anti-inflammatory effect of the steroid fluorometholone surpasses the immunosuppressive effect, unlike usual anti-inflammatory steroids.


[Spectral analytical study on the developmental properties of EEG in children: variability of EEG in normal and mentally retarded children (author's transl)]. The present study aimed at clarifying the characteristics of variability of the resting arousal EEGs in normal and mentally retarded children. Their ages ranged from 3 to 15 years in 58 normal and from 7 to 18 in 63 retarded. The EEG was recorded monopolarly from six regions of the scalp. The data analysed by a multipurpose digital computer comprised auto-power spectra and a coefficient of variation of power at each frequency. The variability of power at peak within the theta frequency band in both groups of children showed a notably higher value as compared with other frequency bands in all regions. We discussed some of the problems of treating this variability of power as a general characteristic of theta waves or as a developmental one.


His electrocardiographic characterization of terminal arrhythmias of hemorrhagic shock in dogs. Pulseless idioventricular rhythm is the agonal arrhythmia identified in three models of hemorrhagic shock used in this study. This arrhythmia is preceded by atrial and then junctional arrest demonstrated by His electrocardiography in all nine dogs studied. Two additional dogs were used as controls. Acid-base and electrolyte changes were not sufficient to cause the progressive failure of conduction system function seen so consistently. Patients receiving cardiopulmonary resuscitation who have profound bradycardia without pulses may have been in shock prior to cardiopulmonary arrest.


CPK-MB isoenzume determinations in blunt chest trauma. To identify the most sensitive screening test for cardiac contusions, a series of 35 patients with blunt chest trauma was evaluated with serial electrocardiograms (ECGs)- creatine phosphokinase isoenzymes, and serum enzymes (serum glutamic-oxaloacetic transaminase, lactic dehydrogenase, and creatine phosphokinase). Twenty of the 35 patients had diagnoses of cardiac contusions by ECG. Three with contusions developed complications. Although isoenzyme elevation was present in most patients sustaining blunt chest trauma, no complications of the injury were seen in patients with elevated enzymes and normal ECGs. The ease of obtaining ECGs and their reliability in identifying patients who will have complications make it the best screening procedure for the diagnosis of cardiac contusions.


Extinguishing the flaming burn victim.

Extinguishing the flaming burn victim. The multipurpose dry chemical fire extinguishers are unusually efficient in extinguishing many classes of fire: A) ordinary combustible; B) flammable liquids and C) electrical equipment. This exemplary performance of multipurpose extinguishers is associated with minimal toxic effects to humans. Following contact of soft tissue with the multipurpose dry chemical, the tissue exhibits a remarkable ability to resist infection and a normal capacity to heal following injury. This negligible toxicity of the multipurpose dry chemicals makes them safe for extinguishing the flaming clothes of human burn victims.


Abdominopelvic injury associated with pelvic fracture. A retrospective study of 117 cases of pelvic fracture was undertaken to determine the incidence of associated abdominopelvic injury. Fractures of the pubic rami were found to be most common. Seventeen patients (15%) had significant intra-abdominal or genitourinay injury. The bladder and spleen were injured most often. Clinical evaluation, or peritoneal lavage, gave an impression of abdominopelvic visceral injury in the presence or absence of demonstrable injury. Seventy-three of 84 (87%) patients who had urinalyses in the emergency department had microscopic or gross hematuria. Of these, only those with gross hematuria had significant urologic injury. There were four fatalities.


Peritoneal lavage with low morbidity.

Peritoneal lavage with low morbidity. Peritoneal lavage has proven to be a useful tool for evaluating abdominal trauma. However, morbidity levels associated with the technique have inhibited its wide acceptance. A technique has been developed that avoids the complications associated with use of a standard dialysis trocar or a mini-laparotomy. The technique uses an 18 gauge needle, a wire guide with soft tip and a number 9 French Teflon catheter. The test can be completed in 20 to 30 minutes and has been done in as little as seven minutes. This technique has been used by 51 different physicians in 132 cases with a single avoidable complication which occurred when one of the contraindications was violated.


Noninvasive monitoring of vascular compromise in trauma. Many types of trauma may lead to vascular compromise unless treated effectively and promptly. In addition to direct trauma to a major vessel are the crushing injuries, fractures, and burn injuries which give rise to an ischemia-edema cycle and subsequent muscle necrosis and tissue loss. Objective adjuncts to clinical impressions, such as isotope clearance muscle blood flow or the ultrasound Doppler flowmeter are generally not suitable for continuous, uninterrupted monitoring of the degree of vascular compromise. A technique that appears promising in this respect is that of photoplethysmography. This technique uses a small LED infrared emitter/detector array. Blood volume changes in an illuminated vascular bed produce variations in the amount of reflected light sensed by the detector, which after appropriate electronic amplification results in pulsatile blood flow (if present) and its change with time being displayed on the monitor. This technique was used with 25 trauma patients with good results, avoiding unnecessary compartmental decompression in some cases. It has proved to be a simple technique that requires little or no training for interpretation, provides continuous monitoring, is noninvasive and atraumatic in nature, is portable for easy set-up, and is relatively inexpensive.


Benign intracranial hypertension in pregnancy. Benign intracranial hypertension, an unusual case of headaches, was associated with pregnancy in a gravid female with the chief complaint of headache. Symptoms resolved after three days of prednisone therapy. In benign intracranial hypertension, the possibilities of intracranial mass lesions, intracranial infection, obstruction of the cerebral ventricles, and hypertensive encephalopathy are excluded by evaluation with skull films, computerized axial tomography, electroencephalography and lumbar puncture. The only symptom may be headache and the only physical sign, papilledema. Therefore, neurological examination must include visualization of the fundi.


Diagnostic peritoneal lavage.

Diagnostic peritoneal lavage. A technique for peritoneal lavage which has increased accuracy and eliminated complications is described. A curved incision is made to one side of the umbilicus at the level of the infraumbilical ring extending over the linea alba for 4 cm. The advantages of the site are its avascularity, paucity of peritoneal fat, and adherence of the peritoneum. By placing the incision at the infraumbilical ring, the rectus muscle is avoided. By adhering to the technique described, false lavage results and iatrogenic injuries to abdominal structures have been significantly decreased.


Non-candidal infections in children with chronic mucocutaneous candidiasis. Chronic mucocutaneous candidiasis (CMCC) is a clinical syndrome characterized by persistent and recurrent Candida albicans infections of the mucous membranes and skin often associated with immunodeficiency. In order to gain insight into the frequency and severity of non-candidal infections in children with CMCC, four patients with CMCC are described in detail and 60 previously reported cases are reviewed. Fifty percent of children with CMCC had significant infections with other fungi, bacteria and viruses. Recurrent bacterial pneumonias and bronchiectasis were a major cause of morbidity and mortality. In addition, there were a large number of infections, in both the lung and other sites, due to opportunistic organisms. Thus the clincial syndrome of CMCC includes not only mucocutaneous candidiasis, endocrine failure and autoimmune phenomena, but patients with CMCC also show a remarkable susceptibility to non-candidal infections. These non-candidal infections represent a serious cause of morbidity for patients with CMCC.


Iatrogenically induced hypertensive encephalopathy. A 49-year-old female with a 30-year history of untreated essential hypertension was noted to have a blood pressure of 290/175 mmHg during evaluation for elective gynecological surgery. At the time of hospitalization she complained chiefly of chronic frontal headaches. Physical examination revealed grade two hypertensive retinopathy, and laboratory studies showed left ventricular hypertrophy. Over the next 12 days the patient's blood pressure was successfully lowered to 178/106 mmHg. During revision of her therapy her mean blood pressure rose to 244/144 mm Hg (88% of the admission level) over 36 hours and she developed hypertensive encephalopathy with papilledema, headaches and projectile vomiting. Concomitant resolution of neurological symptoms and control of blood pressure occurred over the next nine days. The course of this patient suggests that autoregulation of cerebral blood flow may be acutely reversed and that the occurrence of hypertensive encephalopathy depends not only on the magnitude and duration of the blood pressure elevation but, more important, on the rate at which that blood pressure is attained.


"Nature's soft nurse": a sleep-promoting factor isolated from brain. A sleep promoting factor has been extracted and purified from cerebrospinal fluid of sleep-deprived goats, from whole brains of sleep-deprived rabbits and from brainstems of slaughterhouse cattle. Intraventricular infusion of the purified material into rats, cats, rabbits or squirrel monkeys induces excess slow-wave sleep in the recipients for several hours following the infusion. The excess sleep appears similar to the deep slow-wave sleep which normally follows sleep deprivation; it is characterized by EEG slow waves of greater than normal amplitude and an increase in both the number and duration of sleep episodes. The sleep factor appears to be a small peptide of molecular weight 350--500 daltons and the effective dose is of the order of a few picomols per gram brain. A similar, perhaps identical, factor is present in human urine.


[Various mechanisms of disorders of carbohydrate metabolism in myocardial infarct]. A group of 112 patients with acute myocardial infarction was studied. Methods for determining the content of immunoreactive insulin, uric acid, triglycerides, and sugar in blood on a fasting stomach and under conditions of carbohydrate load in dynamics were used. The data obtained show that patients, mainly those with uncomplicated myocardial infarction, are marked by relative insulin insufficiency as well as by a high level of triglycerides and uric acid in the acute period of the disease. The causal relationship between hyperuricemia, hypertriglyceridemia, and carbohydrate metabolism disorders is discussed.


[Catecholamines and 17-hydroxycorticosteroids in the blood of patients with myocardial infarct in the surgical and internal disease clinics]. The blood of 131 patients with myocardial infarction and of 131 patients who underwent operation and had no necrosis of the cardiac muscle was tested for the content of adrenaline, noradrenaline, and 17-oxycorticosteroids (17-OCS). In 20 patients with postoperative myocardial infarction the level of adrenaline, noradrenaline, and 17-OCS rose during the operation and before and after the development of the disease. In patients with myocardial infarction the level of catecholamines was found to be increased in the first 10 days and the level of 17-OCS only in the first 3 days of the disease. In patients who underwent operation but had no myocardial infarction, the content of adrenaline, noradrenaline, and 17-OCS increased before and during the operation and on the 1st postoperative day. The authors believe that the increase in the level of catecholamines and 17-OCS may be one of the mechanisms of the development of postoperative myocardial infarction.


[Prognosis of the outcome of recurrent myocardial infarct]. The authors developed a method for prognosticating the outcome of recurrent myocardial infarction with the use of the Bayes formula. The diagnosis of recurrent myocardial infarction was made when necroses recurred in the myocardium during in-patient treatment for acute myocardial infarction. The prognosis was determined 72 hours after the recurrence of the necrosis. The prognostic signs characterized predominantly the degree of congestive circulatory failure and the frequency of disorders of cardiac rhythm in the acute period of myocardial infarction and recurrent myocardial infarction as well as in the interval betwen them (10 signs with informativeness of 0.117 to 0.05 were used.) The prognosis was erroneous in 8 of 70 patients who recovered from the disease and in 1 of 17 who died.


[Dopamine in the treatment of coronary shock]. The results of the use of a potent inotropic agent dopamine in the treatment of 12 patients with acute myocardial infarction in a state of severe shock are discussed. It is shown that dopamine may prove effective in some patients because its administration by intravenous drip is followed by an increase and stabilization of arterial pressure and mitigation of the manifestations of cardiac insufficiency. In the small group of patients discussed, three recovered from severe shock. From analysis of the material with authors assume that the clinical effect of dopamine is linked with its property of causing a favourable effect on organ blood circulation.


[Characteristics of clinical course of myocardial infarct in young persons under conditions of an industrial city in the Far North]. Study of the clinical course of myocardial infarction, the mortality of ischemic heart disease and its morphological manifestations showed the "rejuvenation" of myocardial infarction and an increase in its incidence depending on the duration of residence under conditions of Norilsk. The pecularities of the clinical course of myocardial infarction are determined and attention is drawn to the essential pathogenetic role of arterial hypertension in the formation and manifestation of ischemic heart disease in young residents of Norilsk.


[X-ray diagnosis of cardiac insufficiency in acute myocardial infarct]. Practical medicine needs a simple method for detecting the presence and severity of left ventricular insufficiency in acute myocardial infarction. Radiography of the lungs may help in solving this problem. Our idea of the X-ray picture of the lungs in pulmonary circulation congestion is now almost complete. The X-ray picture is determined by the degree of left ventricular insufficiency. The results of lung radiography of 225 patients admitted to the intensive care department for acute myocardial infarction are discussed. Alveolar pulmonary edema was diagnosed in 22.7%, interstitial pulmonary edema in 42.7%, pulmonary plethora in 27%, and mild abnormalities in 7.6% of cases. Comparison of the findings of clinical and X-ray examination in 111 patients showed that severe disorders of pulmonary circulation are detected by the X-ray method four times more frequently.


[Disorders of lipid metabolism in sudden death from ischemic heart disease]. Type IV hyperlipoproteinemia and sharp increase in the concentration of free fatty acids in blood were revealed in most individuals who had died suddenly of ischemic heart disease. Beside increased lipolytic activity of the myocardium, accumulation of free fatty acids and triglycerides in the muscle tissue of the heart was revealed. The authors presume that the increase of the concentration of free fatty acids and tryglycerides, just as of their source in the affected myocardium, stimulates hypoxia and promotes electrical instability of the heart and sudden death.


[Tolerance to physical exertion after myocardial infarct as a method of evaluation of coronary circulation and cardiac function]. Twenty healthy individuals and 61 persons who had suffered from myocardial infarction 3 to 18 months previously were examined. They were all males under the age of 50. Tolerance of healthy persons to physical load on a treadmill (according to a standard program) was 3.6 steps of the treadmill test with maximum pulse rate of 166 +/- 2 per minute. The tolerance to load of persons who had a history of myocardial infarction was much lower and varied mainly with the severity of coronary insufficiency. An inadequate reaction of the cardiovascular system to the load was revealed in most of them.


[Word association test in myocardial infarct]. The distinguishing feature of associative reactions of patients with myocardial infarction is the marked predominance of egocentric response and the lesser variance of the reactions to critical verbal stimuli. As compared to patients with myocardial infarction and normal psychic condition and to healthy individuals, patients with psychopathological changes due to myocardial infarction gave disordered associative answers to emotionally meaningful verbal stimuli significantly more frequently and with a more marked affective coloration. These signs may serve in different diagnosis in appraising the psychic status of patients with myocardial infarction.


[Electrophysiologic effect of ethmosine on the dog's myocardium]. The electrophysiologic effects of ethmozin on canine myocardium were studied in anesthetized open-chest animals and in superfused Purkinje fibers. On selective injection into the sinus node artery and the posterior septal artery the drug caused no changes in the sinus node length and atrioventricular conduction, respectively. Intravenous infusion of 4 mg/kg ethmozin led to an increase of right and left ventricular diastolic excitability threshold and refractory period. Intravenous administration of 3--5 mg/kg ethmozin caused marked increase in conduction delay in which the ischemic zone of the left ventricle during acute coronary artery occlusion, which was associated with ventricular fibrillation in 50% of the dogs. In vitro, 1 x 10(-6) g/ml ethmozin shortened the Purkinje fibers' action potential duration whereas a dose of 1 x 10(-5) g/ml reduced the rate of phase 0 rise and slightly reduced the action potential amplitude. Ethmozin in a dose of 1 x 10(-7) g/ml increased transiently the isometric developed tension of false-tendon preparations. Higher concentrations caused marked depression of contractility. These observations suggest depression of the fast current by ethmozin. However, further studies are needed to elucidate its effect on action potential duration and false-tendor contractility.


[Various mechanisms of cardiogenic shock under experimental conditions]. Study of the mechanisms of compensation derangement in cardiogenic shock in 70 anesthetized and nonanesthetized dogs irrespective of the type of its course showed that extracardiac shifts are of essential importance. In "fulgurating" shock, marked cardiac disorders may be aggravated by stimuli induced by hyperactive humoral and vascular (peripheral) reactions. In cardiogenic shock of a longer duration, the extracardiac mechanisms of decompensation are usually manifested by disorders of peripheral circulation associated with increasing hyporeactivity. With timely control the character of decompensation in cardiogenic shock may be prognosticated, which predetermines the principles of rational, pathogenetic therapy.


[Fluorescence of "intact" human myocardium in myocardial infarct]. Fluorescence analysis was used in comparison with other methods to study the morphologic-functional changes in the intact parts of the myocardium in 48 persons who had died of infarction and acute coronary insufficiency. The irregular intensity of primary and secondary cardiomyocyte fluorescence, the diversity of fluorescence, and the character of its colour and dynamics of its replacement are manifested in the earliest stages of ischemia. Quantitative measurements reveal diminution of primary fluorescence intensity at the onset of the disease and its gradual increase eventually.


[Informative value of morphological changes in the adrenal gland in myocardial infarct]. Gradual growth of disorder in the structural organization of the adrenal gland in myocardial infarction on the background of hypertension is shown on the grounds of an integral assessment by means of the information theory (entropy, relative entropy, and coefficient of information redundancy). The mass of the adrenals in 3 patients proved to be larger than that in practically healthy individuals of the same age. This was due to an increase in the mass of the cortex at the cost of the hypertrophied zona fasciculata. With an increase in the duration of myocardial infarction, the mass of the zona fasciculata, the cortex, and the whole adrenal became less than at the early periods, while the mass of the medullary substance hardly changed. The information characteristics is an objective integral test which demonstrates the degree of the growth of morphollogic and functional disorganization in the organ involved in a pathologic process.


[Various problems of diagnosis of the pre-infarct state]. The clinical course of preinfarction states was studied in 246 in-patients. The informativeness of 128 signs of preinfarction state was checked and the most informative ones were used to compile a diagnostic-tactical algorithm for the recognition of preinfarction states and a prognostic algorithm for prognosticating the development of myocardial infarction.


[Analysis of ultrastructural myocardial changes in the pathogenesis of post-resuscitation circulatory insufficiency]. The article deals with the electron-microscopic characteristics of morphofunctional changes in the myocardium of dogs resuscitated by means of donor extracorporeal circulation after 13--15 minutes of clinical death caused by an electrical trauma. Damage to the energy and contractile apparatus of the myocytes and structures of the microcirculatory channel was revealed in different postresuscitation periods (in 1, 4--5, 9 hours and in 3 days). The revealed morphofunctional changes were marked by phases. Previous study of changes in the main parameters of hemodynamics in the same animals showed that the hemodynamic shifts occurred in phases; sharp hemodynamic disorders were determined 4 to 5 hours after life had been restored. The authors conclude that the damage to the intracardiac mechanisms responsible for the pump activity of the heart plays an essential role in the genesis of postresuscitation circulatory insufficiency.


[Differential diagnosis of myocarditis from a number of cardiovascular system diseases]. The work is based on the analysis of 206 patients with myocarditis of whom 168 had infectious allergic myocarditis and 38 had idiopathic myocarditis. A wide variety of clinical laboratory and instrumental methods of examination was used and intravital puncture biopsy of the myocardium was conducted. The article discusses the criteria of differential diagnosis which make it possible to distinguish the form of myocarditis from a large group of cardiovascular diseases following a similar course, i.e. primary rheumatic carditis, ischemic heart disease, valvular diseases, pericarditis and others.


[Clinical morphological characteristics of a heart lesion in drug allergy]. Observation of 40 patients with drug myocarditis developing in the presence of acute manifestations of drug allergy, and morphological examination of the myocardium of 15 patients who had died of different manifestations of allergy and drug myocarditis show that drug myocarditis develops quite often in acute manifestations of allergy. This is confirmed by the clinical symptoms, the electrocardiographic findings and the results of immunological study with the use of the leukocyte migration inhibition test with the cardiac antigen. In contrast to persons of the control groups, patients with drug myocarditis showed positive results beginning with the 4th-5th day of the development of the pathological process in the myocardium. The migration index was 40.6% on the average (normal value 80%). The morphological findings indicated the development of delayed and immediate allergic processes in the heart manifested by reaction of the myocardiocytes, stroma and vessels. The degree of severity and character of the morphological changes corresponded to the clinical picture of myocarditis.


[Use of the bicycle ergometric test in the differential diagnosis of climacteric cardiopathy]. Bicycle ergometry on the "Elema" electrical bicycle ergometer was conducted on 6, patients of climacteric age (41 to 55 years) with pain in the region of the heart and ECG changes. The method made it possible to confirm the diagnosis of climacteric cardiopathy in 39 and to reveal climacteric cardiopathy and concurrent ischemic heart disease in 23 patients. It was noted that physical load had a favourable effect on processes of repolarization in the myocardium of patients with climacteric cardiopathy.


[Disorders of myocardial contractile capacity in patients with an interatrial septal defect complicated by bacterial endocarditis]. After performing 242 operations on patients with secondary atrial septal defects under conditions of moderate hypothermia, the authors studied the contractile capacity of the myocardium by means of long-term catheterization of the heart chambers in 56 patients. In 35 patients of this group intravital biopsy of the right ventricle was carried out. The bioptic material was subject to light and electron microscopy and histochemical examination. Considerable changes in intracardiac hemodynamics were revealed in patients with bacterial endocarditis. In such cases the diastole changes most sharply: the phase of isometric relaxation was prolonged, and there was a sharp rise in the maximum rate of intraventricular pressure decrease and in the relaxation index, which indicated to disorders of metabolic processes in the myocardium, conducive to the manifestation of myocardial insufficiency.


[Mitral valve prolapse syndrome in athletes]. The syndrome of mitral valve prolapse was diagnosed by means of echocardiography in 11 of 28 top-class athletes with functional systolic murmurs and in 4 of 16 athletes examined irrespective of the physical findings and complaints. The echocardiographic manifestations of the prolapse consisted in delayed systolic flexion of the posterior cusp (3 cases), early systolic prolapse of the posterior cusp (4) and holosystolic prolapse of both cusps (8). It is concluded that the syndrome of mitral valve prolapse occurs in athletes far more often than generally supposed and may be the cause of systolic murmurs, and the development of myocardial dystrophy due to chronic physical overstrain and disorders of cardiac rhythm.


[Plasma prostaglandin reaction to furosemide in healthy persons and in hypertension patients consuming salt in an excessive amount]. The content of prostaglandins A, E, and F in healthy individuals and in persons with hypertensive disease who had taken salt in excess throughout life was studied by the radioimmune method. The reaction of blood prostaglandins to intravenous infusion of 40 mg of furosemid was watched. It was found that excessive intake of salt is attended with a decrease in the blood prostaglandin E content in healthy individuals and in persons suffering from hypertensive disease. The prostaglandin A content increases simultaneously, evidently for compensation, while the level of prostaglandin F is reduced. The changes in the prostaglandin content of a compensatory character disappear with the development of hypertensive disease. In healthy persons taking salt in excess, the reaction to the furosemid infusion was directed at providing maximum diuresis and natriuresis; in individuals of the control group it was aimed at arresting excess excretion of sodium and water from the body. In patients with hypertensive disease who took salt in excess, the reaction of prostaglandins to furosemid diminished and was practically absent in patients with a stable arterial pressure level.


[Interrelationship between the basic parameters of hemo- and cardiodynamics in hypertension patients]. In examination of 541 patients with hypertensive disease and 98 practically healthy persons by means of mechanocardiography, rheography of the aorta and lung, rheovaso-, hepato-, and encephalography, and encephalography, and polycardiography, 4 types of disturbed hemodynamics were distinguished: hyperkinetic, hypokinetic, mixed, and normokinetic. Each type has characteristic signs distinguishing it from the other types and from the normal age parameters. Compared to the normal age parameters the changes in the parameters of the contractive function of the right and left ventricular myocardium and the disorders of blood supply to the liver, brain, and limbs are the most marked in the mixed and hypokinetic hemodynamic variant and less in the normokinetic hemodynamic variant.


[Arterial pressure in cattle breeders living in different climatic and geographic zones of Mongolia]. Arterial pressure was studied in 2,540 cattle-breeders (1289 men and 1251 women) living in three different climatogeographical zones of Mongolia. It was found that the mean values of arterial pressure in cattle-breeders living in alpine regions, both according to age groups and both sexes, were higher than those in cattle-breeders living in mountain regions of middle and low height. The number of cases with systolic, and diastolic hypertension as well as the number of persons with arterial pressure in the dangerous zone are significantly increased in the alpine region as compared to these data in the other regions. In alpine regions and in mountain regions of medium height in Mongolia, the incidence of hypertension among women is higher than that among men.


[Morphology of fibromuscular dysplasia of the renal arteries]. Fibromuscular dysplasis of the renal arteries was revealed in 35 patients with renovascular hypertension. Histological examination revealed the following forms of this lesion: fibroplasia of the intima, hyperplasia and fibroplasia of the media, subadventitial fibrosis, as well as their combination. It was found that not only the main branch of the renal artery but also the small intrarenal branches are affected. A decrease of the elastic elements in the middle layer and degenerative changes of various degree in the inner elastic membrane were noted in the wall of the involved artery. This was attended with fibrosis of the intima and disorder of the shape and orientation of the smooth-muscle cells. It is presumed that a local defect in the elastic framework of the artery forms the basis of fibromuscular dysplasia, while the fibrous changes in the vascular wall are evidently secondary and may be associated with the increased synthetic activity of the smooth-muscle cells.


[Reconstructive surgery in the subclavian steal syndrome]. On the basis of reports in the literature and the authors' personal experience, reimplantation of the subclavian artery into the common carotid artery is recommended as a method of extrathoracic correction of the subclavian steal syndrome. The results of intraoperative flow measurement indicate the hemodynamic efficacy of the suggested reconstructive operation. The advantages of reimplanting the subclavian artery into the common carotid artery are pointed out, one of which is the marked decrease in the number of postoperative complications.


[Lipid peroxides and atherosclerosis. The enzymatic detoxication of lipid peroxides in the blood in ischemic heart disease due to coronary artery arteriosclerosis]. It was established that in blood of patients with ischemic heart disease due to atherosclerosis of the coronary arteries (the diagnosis was verified in selective coronaroangiography) the content of acylhydroperoxides grows while the activity of glutathione-peroxidase II decreases. In blood of patients with no damage to the coronary vessels (according to the results of angiography), glutathione-peroxidase II activity does not differ significantly from the values in the control group. The decrease of glutathione-peroxidase II activity was most marked in patients with ischemic heart disease and hypercholesterolemia. It is suggested that the increase in the peroxide content in blood of patients with ischemic heart disease may be due to the sharp decrease in the activity of glutathione-peroxidase II.


[Serial echocardiographic studies of the function of the left ventricle in acute myocardial infarct]. The results of serial echocardiographic examination of 51 patients with primary myocardial infarction are discussed. Echocardiography was performed on the 1st, 3rd, 5th, 7th, 10th, and 20th days of the disease and before discharge. Thirty patients had infarct of the anterior wall and 21 of the posterior wall. The dynamics of left ventricular asynergy, end diastolic index, and volume/pressure coefficient suggested by Corya et al. were studied. The findings were compared with the indices of 20 healthy persons. The indices of regional and general contractile function of the left ventricle grew worse beginning with the first hours of the disease, the changes were most marked on the 3rd day while in cases with a fatal outcome they progressed or did not change. In cases with a fatal outcome they progressed or did not change. In cases with a favourable outcome, the indices improved gradually, first the volume/pressure coefficient and later the end diastolic index. The zones of asynergy disappeared before discharge in only 5 patients. Differences were found depending on the presence and severity of cardiac insufficiency and the localization of the myocardial infarction.


[Modelling of measured restriction of the coronary blood flow]. Experiments were conducted on dogs under conditions of closed chest catheterization and autoperfusion of the coronary vessels to study the methods and manipulations providing reliable reproduction of previously planned direct restriction of coronary blood flow, strictly dosed in degree and duration, simulating coronary insufficiency of various severity. The use of this complex of methods and manipulations makes it possible to avoid the shortcomings and undesirable consequences of denervation of the coronary arteries and their extravascular mechanical compression and the need to open the chest. The simulated restriction of coronary blood flow is reversible owing to which it may be reproduce many time in one experiment.


Acetate transfer across membranes of artificial kidneys in vitro. To determine the rate of acetate transfer across hemodialysis membranes and to investigate the factors which influence acetate dialysance, we performed experiments with Dow-4, Gambro-13.5, and Travenol UF-II artificial kidneys using 14C-acetate. The rate of acetate dialysance was influenced strongly by the rate of fluid flow through the blood path, similar to the dialysance of other low-molecular-weight solutes. The ultrafiltration of fluid from the blood path to dialysate reduced the rate of transfer of acetate from dialysate to blood. The dialysance of acetate was significantly less than that of urea, despite their nearly identical molecular weights. This was not due to the direction of solute transfer. Experiments with a Kaufman-Leonard dialyzer demonstrated that the permeability of Cuprophane membranes to urea was greater than that to acetate was; this may be due to the charged nature of acetate.


Urinary excretion and tissue accumulation of gentamicin and paraaminohippurate in postischemic rat kidneys. Unilateral renal ischemia was induced in rats by clamping the left renal artery for 20, 60, and 120 min, respectively. One hour after the arterial clamp was removed, renal handling of gentamicin and paraaminohippurate (PAH) was studied over the next 2 hours; the kidneys were removed at the end of the experiments for determination of gentamicin and PAH content. The ischemic damage was evidenced by morphologic and functional changes. The glomerular filtration was decreased in proportion to the severity of ischemic injury. The excretion of gentamicin was highly correlated with GFR in normal and postischemic kidneys. In the cortex, ischemic injury resulted in reduced concentrations of gentamicin but markedly augmented those of PAH. The finding is consistent with the hypothesis that gentamicin is reabsorbed by the epithelial cells through the luminal membrane, whereas PAH enters via the peritubular membrane. In contrast, medullary concentrations of both compounds were similar, with suppression of uptake seen only after 120 min of ischemia. Conclusion. Ischemic damage impairs urinary elimination of gentamicin and the ability of renal parenchyma to retain the drug. Difference in uptake between gentamicin and PAH were unmasked in the postischemic kidneys.


Ultrastructural events in early calcium oxalate crystal formation in rats. A model system is described for the induction of renal calcium oxalate crystals with intraperitineal injections of sodium oxalate in rats. Early crystals are formed predominantly in cortical areas. Massive amounts of calcium are associated with this process, as demonstrated by potassium pyroantimonate staining. Actual crystal formation appears to be an involved process associated with calcium, oxalate, and cellular membranes. Although overt stone formation was not observed, we feel that the intimate involvement of membranes during crystal formation may be similar to that found in renal stones.


Disposition of intravenous potassium in anuric man: a kinetic analysis. The disposition of a constant-rate (0.3 mEq/kg/hr) intravenous potassium load was studied in anuric, chronic hemodialysis patients. Changes in plasma potassium concentration could be adequately described by a two-compartment kinetic model under both isohydric conditions and during acute metabolic alkalosis. From 63 to 92% of the infused potassium left the extracellular fluid (ECF) in isohydric studies, and from 73 to 97% left the ECF in alkalanizing studies. Cellular uptake of the infused potassium was less when the plasma potassium concentration was higher. Plasma aldosterone levels rose but insulin levels did not increase during infusions. In a juvenile-onset diabetic subject, the impairment of cellular potassium uptake at higher plasma potassium was magnified so that infused potassium was virtually confined to the ECF compartment until exogenous insulin was given. This implies a permissive rather than a regulatory role for endogenous insulin in facilitating cellular entry of excess potassium.


beta blockade with pindolol: differential cardiac and renal effects despite similar plasma kinetics in normal and uremic man. Cardiac and renal effects (measured as the reduction in exercise-induced tachycardia and PRA, respectively) and circulating drug concentrations after acute beta blockade with intravenous pindolol were compared between seven normal volunteers and six patients with terminal renal failure. Kinetic parameters were similar in both groups (total body clearance, 450 mg/min), indicating enhanced extrarenal elimination in patients. For any given drug concentration, however, the uremic patients responded to beta blockade with a greater decrease in pulse rate than did normal volunteers (P less than 0.001). Moreover, in the same group, the decrease of PRA was more marked (from 13.3 to 5.7 vs. 3.3 to 1.9 ng/ml/hr) and lasted longer (8 hours and more vs. 2 hours). Plasma aldosterone remained unchanged. These data reveal an increased dependency of both heart rate and renin release on beta adrenergic-mediated mechanisms in uremic man. They also show that kinetic findings in normal subjects cannot always be extrapolated to predict kinetic behavior in disease, and that similar kinetics do not imply similar effectiveness.


[The prism loupe spectacles used as low vision aid and in microsurgery (author's transl)]. In 1970 Biessels developed and constructed the new binocular prism loupe spectacles, mainly as improved low vision aids. They were derived from the Zeiss 8 x 20 prism binoculars, however, with different lenses and mechanical parts. They are quite different from the Galilean telescopic spectacles, hitherto available, with their lower mangifications, short working distances, chromatic aberration, and peripheral unsharpness. The Biessels prism loupes with variable magnification up to 12 times, and working distances of 18 to 30 cm, are mounted into spectacles. They provide for a comfortable stereoscopic vision with normal convergence. The visual field is virtually 20 cm at 25 cm distance, and sharp to the edges. The weight of a complete binocular prism loupe, including the frame, is from 100 to 110 grammes. In the past 7 years more than 500 of such visual aids have been delivered to low vision patients, half of them binocular, also 40 operating spectacles for microsurgery, all of them with great success. Here we report on the technical details and good results.


[Fluorescence-angiography, infrared-photography and histology in malignant melanoma of the papilla (author's transl)]. In a 60-year-old female a juxtapapillary malignant melanoma of the choroid invading and strangling the prelaminary section of the optic nerve head, and being masked by a massive papilledema, could be revealed by combined application of ultrasonography, fluorescenceangiography and infrared-photography. The histological examination confirmed the clinical diagnosis.


[Extraction of an encapsulated foreign body by means of pars plana vitrectomy (author's transl)]. Pre- and intraretinally  encapsulated foreign bodies can be removed by means of pars plana vitrectomy, incision of the capsule and extraction of the foreign body with a forceps. Case reports of 3 patients are presented.


[Retinal surface wrinkling and epiretinal membranes in hemorrhagic secondary glaucoma (author's transl)]. Wrinkling of the retinal surface was found histologically in 54,5% of 88 globes enucleated because of hemorrhagic secondary glaucoma. In 92% of these cases the wrinkles were associated with epiretinal membranes. These were divided into: cellular, fibrous and mixed fibrocellular membranes. The combination of surface wrinkling and pure cellular membranes, interpreted as glial in nature, was found in only 6% of cases while fibrous and mixed membranes occurred in 85% of cases. The fibrous component seems therefore to be an important factor in surface wrinkling retinopathy. Age, sex, intraocular pressure and previous surgery did not influence the frequency or type of these spontaneous epiretinal fibroplasias of vascular etiology.