The effect of chronic ethanol administration on arachidonyl transfer to 1-acyl-glycerophosphorylcholine in rat brain synaptosomal fraction. Enzymatic transfer of arachidonate to synaptosomal diacyl-GPC in a group of rats (n=14) administered 30% ethanol by intragastric intubation for 21 days was 24% higher than controls (n=5) (P less than 0.05). No apparent difference in enzymic activity was observed with respect to different periods of withdrawal (8-24 hrs). The acyl transferase activity in another group of rats (n=5) which were given 15% ethanol as the sole drinking source for 13 months was 58% higher than controls (P less than 0.025). The increase in acyl transferase activity with respect to the two types of chronic ethanol administration may be due to an adaptive mechanism in brain to facilitate the increase in membrane transport activities which are known to occur under the influence of ethanol.


Influence of imipramine and various steroids on hepatic in vitro N-demethylation of tricyclic antidepressants. The effects of equimolar doses of imipramine (IP) and three catatoxic steroids, pregnenolone-16alpha-carbonitrile (PCN), spironolactone (SNL) and dexamethasone (DEXA), on hepatic mixed-function oxidases were investigated in female rats. Liver weight and N-demethylation of IP and amitriptyline (AMI) were significantly increased by 3 days of catatoxic steroid pretreatment. Repeated prior administration of IP enhanced N-demethylase activity and 9000g supernate protein, but diminished hepatic weight.


Microlesions on rumen papillae of sheep fed diets of wheat grain. Scanning electron microscope evidence of microlesions on the rumen papillae of lambs fed a wheat grain diet is presented. These represent an early and previously unrecognised stage of rumenitis.


Further studies concerning the toxicity of ingested ergot sclerotia (Claviceps purpurea) to young and growing pigs. In three experiments pigs were offered diets contaminated with milled ergot sclerotia. In a metabolism study 0-5 per cent (w/w) of American wheat ergot decreased urinary nitrogen losses and improved the efficiency of nitrogen retention. When early weaned piglets ingested a diet contaminated with 2-5 per cent of the ergot, feed intake was reduced and growth rate decreased. Reduction in growth rate was also evident in growing pigs given a diet containing ergotised English wheat. These latter pigs had lesions in stomach, intestine and liver, consistent with a toxic insult. With respect to feed intake and growth these results agreed with those of an earlier study, although a toxic response was produced by a lower dosage rate and there was additional internal evidence of toxicity. Improved nitrogen retention was contrary to earlier evidence at higher dose rates but may merely reflect a tonic action which, at higher doses, becomes toxic.


Isolation of encapsulated strains of Staphylococcus aureus from bovine mastitis milk. Among 1598 strains of Staphylococcus aureus isolated from bovine mastitis milk samples, 19 exhibited a diffuse-type growth using the serum-soft agar (SSA) technique. By the application of a capsular typing method using the SSA technique, they could be separated into five different serological types. Mouse virulence of individual strains varied significantly. Two strains showed high mouse virulence but the majority showed relatively low virulence or were avirulent. The avirulent strains and those of low virulence were capable of absorbing protective antibodies from rabbit antisera to type strains of human encapsulated S aureus. These results suggested that encapsulated strains of S aureus may play a part in the pathogenesis of bovine mastitis.


Fusiform erythrocytes resembling sickle cells in angora goats: light and electron microscopic observations. Fresh blood from nine mature non-pregnant angora goats was found to contain a varying proportion of spindle-shaped, fusiform, triangular, pear-shaped, and other bizarre forms of erythrocytes in addition to normal discoid biconcave erythrocytes. The number of spindled and fusiform erythrocytes varied from 2 to 66 per cent, with two goats having such cells in excess of 50 per cent. Other aberrant forms of erythrocytes ranged from 3 to 54 per cent. Although the aberrant erythrocytes seemed to be present intravascularly, all goats studied were clinically normal and exhibited no other haematological abnormality. Light and electron microscopic observations indicated that polymerisation of haemoglobin in the form of longitudinal tubular fibres was responsible for conferring the fusiform and spindle shapes to erythrocytes, a phenomenon akin to that seen in sickle-shaped human and deer erythrocytes.


Babesia major in Britain: infectivity for cattle of cryopreserved parasites derived from Haemaphysalis punctata nymphs. Babesia major-infected Haemaphysalis punctata nymphs, prefed for four days on rabbits, were ground in a modified Eagle's minimum essential medium containing N-2 hydroxyethylpiperazine-N1-ethane-sulphonic acid (HEPES) buffer using sterile sand or ground glass as triturating agents. The resultant supernatant fluids were shown to be infective for splenectomised calves. When attempts were made to cryopreserve the fluids using either dimethyl sulphoxide or glycerol to a final concentration of 10 per cent, only the former successfully maintained the intravenous infectivity of the organisms released by grinding with glass. A cooling rate of approximately 1 degrees C/min resulted in successful cryopreservation but a more rapid cooling rate did not.


Half-life, apparent volume of distribution and protein-binding for some sulphonamides in cows. The half-lives, apparent volume of distribution and protein-binding of 11 sulphonamides were determined in 89 experiments on 49 cows. The estimations of half-lives indicated the presence of a distribution phase (alpha-phase) for all the sulphonamides investigated with the exception of sulphachloropyridazine. The elimination half-life (beta-phase) of the sulphonamides in plasma varied from 70 to 1000 min and was positively correlated with the solubility of the compounds in organic solvents. This was explained by the greater reabsorption of the more fat-soluble compounds in the kidneys. All the sulphonamides except sulphadimidine had a shorter half-life in cows than previously reported from human investigations. The apparent volume of distribution was about one for sulphanilamide and lower for all the other sulphonamides investigated. The protein-binding estimated in vitro agreed well with the in vivo results. It was slightly lower than in humans and the degree of protein-binding decreased with increasing sulphonamide concentration in plasma.


Bovine leptospirosis: experimental infection of pregnant heifers with a strain belonging to the Hebdomadis serogroup. Twenty pregnant heifers were inoculated with a leptospire of the Hebdomadis serogroup. Leptospiraemia was accompanied by pyrexia which lasted from one to five days. Sixteen animals had relapses of fever. One of these aborted and two produced weak calves, one of which was premature. In the heifers, leptospires localised in the placentae, where they were demonstrable for 14-60 days after inoculation, and in the renal tubules for as long as 174 days. They were also demonstrated in liver, kidney and lung from the aborted fetus. Antibodies were detected in susceptible heifers six days after inoculation and maximum titres of up to 1:100,000 developed between 11 and 21 days. A titre of 1:10 was demonstrated in the serum of a premature live calf. These findings indicated that leptospires of the Hebdomadis group were capable of causing abortion in cattle.


The lens epithelium of American cocker spaniels with inherited and non-inherited lens cataracts. The normal lens epithelium of American cocker spaniels exhibits a monolayer of cells similar to that seen in other animals. The lens epithelium from spaniels with presumed inherited cataracts shows a lack of cell division and a decrease in cell density. Lens epithelial preparations from spaniels with presumed non-inherited cataracts show a multilayering of cells with several mitotic figures.


Post-transfusion purpura in a pig.

Post-transfusion purpura in a pig. A pig which was being immunised with thrombocytes from another pig developed thrombocytopenia and purpura. This appears to be analogous to the post-transfusion purpura syndrome which has been reported in humans and it is suggested that similar systems in pigs could be useful models for experimental studies on the human condition.


Attachment of Mycoplasma gallisepticum to the tracheal epithelium of fowls. An electron microscopical study of fowl trachea infected with Mycoplasma gallisepticum showed slight to moderate changes at the cellular level. Mycoplasmas were demonstrated extra-cellularly and showed triple membranes, intracytoplasmic spaces, fibrillar nuclear areas and blebs. Blebs were seen attached to the plasma membrane of the epithelial cells.


Cytotoxic antibody in the serum of cattle with squamous cell carcinoma. Sera from two cattle with ocular squamous cell carcinomas were cytotoxic for two different cultures of cells derived from bovine ocular squamous cell carcinomas. Sera from normal cattle, and from one tumour-bearing animal, were not cytotoxic. Cytotoxicity could be demonstrated in vitro only in the presence of guinea-pig complement.


Head injury admissions to a teaching hospital. A prospective study of head injury admissions to a city teaching hospital over one year has shown that most were minor. Of the 918 patients, 85% were discharged within 48 hours, only 3% required definitive neurosurgical care, and the overall mortality was 2%. Most cases came to hospital after 5.00 p.m. especially at the weekend. Head injuries accounted for almost one-third of emergency admissions to male general surgical wards.


Drug information centres: new role for pharmacists? In the last few decades there has been a great increase in the number of new drugs available for general use. In consequence, drug information centres have been developed, particularly in U.S.A., to disseminate information on the uses, toxicity and cost of these drugs. Such centres have been slower to appear in the United Kingdom, with the exception of certain specialised centres, e.g. Poisons Information Bureaux. The present report describes the development of a drug information centre in Glasgow and gives preliminary data on its use during the last year. It is proposed that such centres provide a valuable aid in encouraging rational drug use particularly in hospitals. The centres may be run by a variety of interested personnel but in our view the professional group most likely to fill this role adequately is hospital pharmacists.


Evidence for abnormal heart induction in cardiac-mutant salamanders (Ambystoma mexicanum). Homozygosity for simple recessive gene c in axolotl embryos results in the absence of a heartbeat. Gene c alters the morphology of the mutant anterior endoderm - the primary heart inductor.


Suckling as incentive to instrumental learning in preweanling rats. Neonatal rats as young as 7 days of age learned, reversed, and retained a left-right discrimination with a nonlactating nipple as the incentive. These results have implications for the ontogeny of associative processes and for their neurological and neurochemical mediators.


Heteromorphic sex chromosomes in male rainbow trout. A pair of subtelocentric chromosomes differs in the size of the short arm in male, but not female, rainbow trout (Salmo gairdneri). The morphological similarity of the X and Y chromosomes, and the observation of Y chromosomes intermediate between the X and normal Y, suggest that the sex chromosomes are at an early stage of differentiation in this species.


Hibernation and body weight in dormice: a new type of endogenous cycle. Under conditions unfavorable to hibernateion (22 degrees C), the body-weight cycles of dormice are only a few weeks long, but under conditions in which dormice hibernate (5 degrees C), the cycles can last many months; the more the animals hibernate, the longer are the cycles. Such cycles contrast with the relative independence from torpor of the period of circannual cycles in other hibernating rodents and with the temperature compensation of circannual and circadian cycles in general.


Lesch-Nyhan syndrome: low dopamine-beta-hydroxylase activity and diminished sympathetic response to stress and posture. Patients with Lesch-Nyhan syndrome with virtually no hypoxanthine phosphoribosyltransferase activity demonstrate significantly low plasma activity of dopamine-beta-hydroxylase but normal basal levels of norepinephrine. Under conditions of emotional or postural stress the plasma concentrations of norepinephrine in Lesch-Nyhan patients increased less than in a normal population.


The cell membrane sodium pump as a mechanism for increasing thermogenesis during cold acclimation in rats. Increased sodium pump activity is a major component of enhanced tissue thermogenesis in skeletal muscle, liver, and kidney of cold-acclimated rats. The sodium pump may play a major role in the thermoregulatory heat production during cold adaptation in mammals.


Lithium ion entry through the sodium channel of cultured mouse neuroblastoma cells: a biochemical study. Lithium ion entry at low concentrations (1 to 5 mM) into an electrically active adrenergic clone of mouse neuroblastoma cells was stimulated by veratridine; and this stimulation was blocked by tetrodotoxin, These data provide biochemical evidence that lithium ions enter by way of the sodium channel which may be a major pathway for entry of this ion into electrically active cells.


Duchenne dystrophy: alteration in muscle plasma membrane structure. Freeze fracture studies of skeletal muscle from eight patients with Duchenne dystrophy showed nonuniform distribution and depletion of particles on both protoplasmic and extracellular faces of the muscle plasma membrane. The findings support the view that the muscle surface membrane is abnormal in this disorder and indicate that alterations are present in the internal molecular architecture of the membrane.


Endothelial damage and thrombocyte adhesion in pigeon atherosclerosis. Scanning electron microscopy studies of spontaneously occurring atherosclerosis in pigeons reveal dramatic alterations in endothelial integrity. An irregular endothelium at the intimal cushion region of 5-week-old birds gives rise to extensive areas of pitted endothelium and subendothelial exposure. Thrombocytes, thrombocyte aggregates, and leukocytes are associated with the developing lesion.


Visual search in the pigeon: hunt and peck method. Pigeons pecked at small forms displayed on an oscilloscope screen under computer control. The birds were required to find a small o amid varying numbers of x forms. A photocell glued to the bird's beak provided a signal to the computer when the beak approached a form, and the computer recorded the time and target of the response. As in some similar studies with human subjects, erros and reaction times increased with number of x forms displayed. The method appears promising for further studies of search and of other processes related to perception and information-processing in birds.


Bombesin:potent effects on thermoregulation in the rat. Several vasoactive peptides administered intracisternally have been assessed for the effect of lowering the core temperature of rats exposed to cold. Peptides structurally related to neurotensin lower core temperature while those related to substance P do not. The tetradecapeptide bombesin, orginally isolated from the extracts of the skin of the frog Bombina bombina, is 10(4) times more potent than neurotensin in lowering core temperature, with a minimal effective dose less than or equal to 1 nanogram per 200 grams of body weight. Thus bombesin is one of the most potent peptides reported to affect the central nervous system.


Mercury emissions from geothermal power plants. Geothermal steam used for power production contains significant quantities of volatile mercury. Much of this mercury escapes to the atmosphere as elemental mercury vapor in cooling tower exhausts. Mercury emissions from geothermal power plants, on a per megawatt (electric) basis, are comparable to releases from coal-fired power plants.


Nuclear morphometry during the cell cycle. Directly measured and derived geometric and densitometric parameters were obtained by means of the automated image analyzer Quantimet 720-D in Feulgen-stained HeLa cells synchronized by selective mitotic detachment. These data indicate substantial alteration of nuclear morphology during the entire cell cycle, even during the G1 and G2 phases, and the late G1-early S and late S-G2 transitions.


Insecticide solvents: interference with insecticidal action. Several commercial solvent mixtures commonly used as insecticide carriers in spray formulations increase by more than threefold the microsomal N-demethylation of p-chloro N-methylaniline in midgut preparations of southern army-worm (Spodoptera eridania) larvae exposed orally to the test solvents. Under laboratory conditions, the same solvent mixtures exhibit a protective action against the in vivo toxicity of the insecticide carbaryl to the larvae. The data are discussed with respect to possible solvent-insecticide interactions occurring under field conditions and, more broadly, to potential toxicological hazards of these solvents to humans.


Stability of the individual globin genes during erythroid differentiation. The genes of sheep betaA, betaC, and gamma globin were all present in DNA from erythroid cells which synthesized only betaC globin. Similarly, selective excision of non-expressed genes was shown not to occur during human erythroid differentiation. In contrast, evolutionary deletion of the betaC gene accounts for the inability of many sheep to make this globin.


Infrared reflectance in leaf-sitting neotropical frogs. Two members of the glass-frog family Centrolenidae (Centrolenella fleischmanni, C. prosoblepon) and the hylid subfamily Phyllomedusinae (Agalychnis moreletii, Pachymedusa dacnicolor) reflect near-infrared light (700 to 900 nanometers) when examined by infrared color photography. Infrared reflectance may confer adaptive advantage to these arboreal frogs both in thermoregulation and infrared cryptic coloration.


Naloxone in chronic schizophrenia.

Naloxone in chronic schizophrenia. The specific narcotic antagonist naloxone (0.4 milligram) was given intravenously to seven chronic schizophrenics who reported that they had very frequent auditory hallucinations. Saline solution was used as a placebo. The coded study did not reveal any effect of naloxone on hallucinations or on global psychopathology.


Persistent adenopathy in coccidioidomycosis: an indication for therapy. Three patients seen recently at Wilford Hall USAF Medical Center emphasize the point that coccidioidomycosis may resemble lymphoma because of persistence of adenopathy on the chest roentgenogram after the initial infiltrate has resolved. Such a clinical picture strongly indicates dissemination and is probably sufficient reason to initiate therapy.


Value of polytomography in study of dysphagia due to vertebral osteophytosis. Polytomography is a simple, noninvasive procedure useful in the diagnosis, preoperative assessment, and follow-up examination of dysphagia due to vertebral osteophytosis. It is especially recommended for all elderly patients undergoing endoscopy to evaluate possible difficulties or hazards which may be encountered due to the presence of osteophytosis. Tomographic study of the esophagus is recommended for all lesions producing dysphagia at the level of the inherently narrowed space of the thoracic inlet, where routine radiography and fluoroscopy are inadequate.


Growing skull fractures.

Growing skull fractures. Four cases of growing skull fracture in children are presented and the reasons for poor surgical results are analyzed. The clinical presentation, causative factors, and operative findings are discussed.


Leukopenia and granulocytopenia after oxacillin therapy. Two cases of granulocytopenia and leukopenia developing after high-dosage oxacillin therapy given intravenously are described. One patient developed leukopenia and granulocytopenia after 17 days of therapy. The conditions were reversible when oxacillin therapy was discontinued. In the other case, the adverse reaction developed within 48 hours after therapy began and the patient died from heart failure. Leukopenia and granulocytopenia as adverse effects of oxacillin therapy should be kept in mind, especially when high dosages are used.


Increased serum calcium levels induced by furosemide. Thirteen male patients were treated with furosemide at a dosage of 40 mg by mouth daily for three weeks. Atomic absorption serum calcium determinations before and after treatment revealed a consistent elevation of the serum calcium level. It is suggested that at low dosages, furosemide is likely to raise the serum calcium level, while at daily dosages greater than 60 mg given orally, furosemide may depress the serum calcium level because of urinary losses.


Medial displacement osteotomy for unstable intertrochanteric femoral fractures. The charts and roentgenograms of 86 consecutive patients treated by medial displacement osteotomy between 1970 and 1974 were reviewed. All patients had unstable four-fragment intertrochanteric fractures and were treated by the residents and attending staff of the hospitals served by the University of Alabama Medical Center. Thirty patients had sufficient follow-up to be included in the preliminary retrospective study. There were complications of fixation in 11 patients (37%) and one superficial wound infection (3%). The most significant factors associated with complications of fixation were (1) placement of the nail in a superior and anterior position in the femoral neck and head, and (2) advanced osteoporosis. No correlation was noted with the distance of the tip of the nail from the femoral articular cartilage.


Systemic candidiasis following cardiac surgery: an improved outlook. Systemic candidiasis following cardiac surgery, previously regarded as fatal, has now a much improved prognosis. Prognosis depends largely on  early diagnosis and treatment. Four of five patients we recently treated for this disease survived. The presence of several predisposing factors in a febrile patient following cardiac surgery should alert the physician to the possibility of this disease.


Condyloma acuminatum and squamous carcinoma of the vulva. Reported is the association of condyloma acuminatum and squamous carcinoma of the vulva in three cases and condyloma followed by squamous dysplasia in a fourth case. This association has previously been reported in both male and female genitalia and in the perianal area. In our four cases, cancer or squamous dysplasia followed long-standing or extensive condyloma, but there was no evidence of transformation from condyloma to carcinoma. In one of the cases, areas of squamous dysplasia occurred in multiple foci within a large condyloma. It is not known whether condyloma acuminatum is a precancerous skin lesions, but long-standing or extensive condylomas should alert one to the possibility of carcinoma.


Failure to define death: the unsettled question. Many states have passed the Uniform Anatomical Gift Act, which places the burden of determination of actual death of the patient upon the physician. The House of Delegates of the Connecticut State Medical Society has endorsed a definition of death. The Kansas Legislature was the first to adopt a statute defining death, but many authorities believe that this is an area in which the medical profession should assume total responsibility. Failure of the medical profession to meet this responsibility will lead to the development of areas of liability with new and unexpected ramifications for physicians and hospitals.


Male infertility and 21/1 translocation. Cultured blood leukocytes of a 27-year-old infertile white man displayed evidence of an A/G translocation. All cells showed an identical abnormal karotype, 46, XY, t(1p-;21q+). The chromosome abnormality, a proposed mechanism for its production, and related chromosome translocations are discussed.


Skin blanching induced by hydrogen peroxide. Transitory blanching of nonacral skin has been observed after contact with a 3% solution of H2O2. This phenomenon was reproducible in all tested whites, but was not reproducible in black skin. Blanching developed within 30 to 300 seconds after contact with H2O2 and lasted from 10 to 30 minutes. It is proposed that the topical application of H2O2 induces a transient vasoconstriction of vessels in the superficial dermis.


Intracranial hypertension resulting from a cerebrovascular malformation. A vascular malformation caused prominent intracranial hypertension by impairing CSF resorptive capacity rather than by its mass effect or ventricular obstruction. It was successfully treated by diversionary shunt.


Pulmonary talcosis as a result of massive aspiration of baby powder. Progressive diffuse pulmonary fibrosis as a sequel to massive aspiration of baby powder (talc) is documented. The diagnosis should be considered in "idiopathic" pulmonary fibrosis in childhood and adult life.


Preoperative diagnosis of hypernephroma in a renal cyst wall by selective renal angiography. Presented is a case in which preoperative diagnosis of a hypernephroma in the wall of a renal cyst was made by selective renal arteriography. Reviewed are the incidence and possible causative relationship between the two lesions and the potential and limitations of presently available diagnostic procedures for this entity.


Levodopa in parkinsonism.

Levodopa in parkinsonism. In 20 patients suffering from parkinsonism, L-dopa produced maximal benefit after 3 years. A decline in the response then occurred, but considerable benefit was still derived after 5 years by patients who had improved initially. The effect of the drug on the symptomatology is reviewed. Whether the mortality rate in parkinsonism is improved by L-dopa is undecided, but recent publications and the present study indicate that the life expectancy is prolonged.


Narrow-needle cholangiography.

Narrow-needle cholangiography. Recent modification of percutaneous transhepatic cholangiography has resulted in success rates of 100% in opacifying obstructed biliary systems and of 50% in unobstructed systems. The authors use a 23-gauge needle with a 2- or 5-ml syringe for injecting contrast medium at high pressure. Only one puncture of the liver surface is usually required. Complications have not occurred in unobstructed cases, but early operation is still recommended in obstructed cases.


Human trypanosomiasis in Southern Africa. Five cases of human trypanosomiasis are presented. The clinical picture and course of the disease, and the results of haematological, immunological and other special examinations, are presented. The persistence of decreased total haemolytic complement, increased serum igM levels, decreased plasma fibrinogen levels, raised plasma and urinary fibrinogen split products, cryofibrinogenaemia and significant proteinuria in the presence of apparent clinical cure, tends to indicate the continuation of an immune complex process in spite of eradication of the parasite.


Prazosin alone and combined with a thiazide diuretic in the treatment of hypertension. We conducted an uncontrolled study of the efficacy of prazosin in the treatment of hypertension in 45 patients. In 25 patients only prazosin was used and in 20 patients prazosin was combined with a thiazide diuretic. Control of blood pressure was obtained in 22 of the 25 patients (88%) on prazosin alone, and in all the patients on the combined treatment. Adverse effects occurred in 15 of 25 patients (60%) on prazosin alone, and in 13 of the 20 patients (65%) on combined treatment. However, in 18 patients (40%) adverse effects disappeared or were tolerated with continued therapy. In 10 patients (22%) therapy was stopped because of the adverse effects. The median dose of prazosin was 5,73 mg twice a day. Prazosin is a useful alternative to hydralazine in the treatment of hypertension.


Biliary atresia in a twin.

Biliary atresia in a twin. The occurrence of biliary atresia in one of a pair of male twins is reported. The current concepts regarding the aetiology of biliary atresia are examined in relation to this case; and neither  the concept of a transplacental agent nor that of a genetic trigger mechanism seems probable. It is concluded that, as with many congenital defects, biliary atresia is probably the end-result of different aetiological factors, among which viruses and other agents may cross the placenta to cause it, whether or not there is a genetic predisposition in the individual fetus, or the biliary system may simply fail to develop.


Le Fort III osteotomy in Crouzon's disease. The features of Crouzon's disease are craniostenosis and maxillary hypoplasia. A patient with Crouzon's disease is presented, on whom Le Fort III osteotomy and osteotomy of the mandible were performed, involving the insertion of 9 bone grafts to maintain the correction and to improve the facial appearance.


The diagnosis of bilharziasis.

The diagnosis of bilharziasis. In addition to the classical manifestations, bilharziasis may present with features which are atypical and which may simulate other conditions. In such cases the value of the previous history cannot be overemphasized, immunodiagnostic procedures are useful pointers in diagnosis but in general treatment should be undertaken only after ova of the parasites have been found.


History of mental health services in South Africa. Part XV. The future of mental health services. Four important developments which can favourably influence the future of mental health services in South Africa are discussed. Financial stringency will probably prevent the erection of new mental hospitals in the foreseeable future.


Lomotil poisoning in children: two case reports. Lomotil is a proprietary antidiarrhoeal agent in common use. Two cases of Lomotil poisoning, one of them fatal, are described. Symptoms are those of central nervous system depression and atropinism. Treatment consists of gastric emptying, administration of specific narcotic antagonists, cathartics and activated charcoal.


Axillary micrometastasis and macrometastasis in carcinoma of the breast. A retrospective analysis was made of 105 patients with primary operable carcinoma of the breast with positive axillary nodes who had been observed for a 14 year period after radical mastectomy. Patients with micrometastasis alone, especially if only level I is involved, have a good prognosis with 85 and 77 per cent survival rates at ten and 14 years, respectively. No patients had more than three micrometastasis. Patients with four or more positive nodes have a much worse prognosis than do those with three or less positive nodes. Macrometastasis at any level carries a poor prognosis. Since these data show no significant difference between the ten and 14 year survival rates, the ten year survival rate is, therefore, a valid one for long term evaluation of the treatment of carcinoma of the breast.


Effects of hypoxia, acidosis and peripheral vascular resistance on endocardial viability ratio. In view of the increasing frequency in which cardiac output is pharmacologically altered, the endocardial viability ratio was evaluated experimentally in the dog as an additional means by which cardiac function might be monitored. The endocardial viability ratio provided useful information for cardiac function in situations of decreased peripheral resistance. The limitations of the endocardial viability ratio were evident in conditions of acidosis, hypoxia and increased peripheral resistance. Additional work is indicated prior to firmly establishing the endocardial viability ratio as a useful clinical monitor.


Pathogenesis and treatment of plunging ranulas. Three patients with plunging ranula, two of which occurred spontaneously and one of which followed removal of the submandibular gland, were treated by excision of the sublingual gland. The sublingual gland is removed through the mouth or through a cervical submandibular incision. No dissection of the cervical ramifications associated with the ranula is undertaken, and these disappear once the source of the extravasating saliva has been removed. Results of considerable experimental work reported by others, support the concept that plunging ranulas are extravasations of saliva from the sublingual glands.


Major hepatic resection and portal pressure. Although other reports have stressed the inevitability of portal hypertension and splanchnic pooling following major liver resections, clinical observations during 30 major hepatic resections and measurements of portal pressure in three consecutive trisegmentectomies fail to support this contention. If the remaining liver is normal and careful anatomic dissection is used, major resections can be performed without inducing portal hypertension.


Evaluation of ureteral obstruction by early intravenous pyelography. Acute ureteral obstruction was studied in dogs by intravenous pyelography at two, four, six, nine, 12, 24, 48 and 168 hours after total occlusion of the ureter. Ureteral obstruction was correctly diagnosed in all instances, if intravenous pyelography was performed within nine hours from the time of obstruction and if a two hour sequence roentgenogram was obtained. A variably diagnostic rate of 36 to 75 per cent occurred when intravenous pyelography was delayed until 12 hours or later. In ureters with a positive diagnosis, 65 per cent were correctly identified on the 15 minute film, 98 per cent on the one hour film and 100 per cent on the two hour film. Intravenous pyelography should be performed immediately after the onset of renal insufficiency to obtain maximal information, as deterioration in renal function from total ureteral obstruction rapidly causes inadequate excretion and concentration of contrast material and prevents visualization of an obstructed collecting system.


Acute pancreatitis of rare causation.

Acute pancreatitis of rare causation. From a review of 800 patients with acute pancreatitis, eight having rare causation were selected. Definite obstruction of the common pancreatic duct was noted in four patients, and direct injury of the parenchyma, vascular lesions of pancreatic vessels and presumed autoimmune factors were responsible in the remaining four patients. Although the definitive treatment of nonobstructive pancreatitis remains controversial, surgical relief of obstruction of the pancreatic duct provides the most appropriate therapeutic approach for obstructive pancreatitis.


Tissue pressure gradients in spinal cord injury. Using cotton wick catheters, local tissue pressure was measured in the dorsal white matter of the impacted feline spinal cord. Twenty gram and 30 gram weights dropped 20 cm did not produce statistically significant elevations in tissue pressure adjacent to and remote from the site of injury. Forty gram weights dropped 20 cm produced pressure gradients of less than 10 mmHg between areas near and remote from the injury and between parenchyma and cerebrospinal fluid. In a group studied 18-24 hours after similar injuries, no gradients were found, although edema formation as indicated by Evan's blue migration had progressed. These findings indicate that gradients of pressure within parenchyma are associated with edema spread following high impaction forces and that edema spread can continue after dissipation of these gradients.


Suprasellar arachnoid cyst diagnosed preoperatively by computerized tomographic scanning. True arachnoid cysts of the suprasellar region are uncommon and have rarely been diagnosed pre-operatively. An histologically verified suprasellar arachnoid cyst producing hydrocephalus and visual loss in a 19-year-old man was diagnosed by a combination of pneumoencephalography and computerized tomographic (CT) scanning prior to surgery. The incidence, pathogenesis, signs, and treatment of suprasellar arachnoid cysts are discussed.


Effects of methylprednisolone on coronary blood flow and myocardial metabolism during cardiopulmonary bypass. Corticosteroids frequently are used during cardiopulmonary bypass (CPB) to enhance total body perfusion and myocardial preservation. The mechanisms by which steroids might provide protection to the myocardium have not been clearly defined, however. Therefore this study was performed to measure the effects of methylprednisolone (M-P) on coronary flow and distribution, and on myocardial metabolism and contractility. Twenty-three dogs underwent 1 hour of total CPB, 80 cc/kg/minute at normothermia with beating hearts. Alternate animals received M-P, 30 mg/kg. Myocardial blood flow (microspheres technique), myocardial tissue lactate and adenosine triphosphate, lactate extraction, coronary sinus flow (CSF), and coronary vascular resistance (CVR) were measured before, during, and 60 minutes after bypass. LV dp/dt and cardiac output (CO) were measured before and after bypass. Total coronary flow was significantly higher in the M-P group after 10 and 30 minutes of bypass (93 vs 56 ml/100 gm/minute, p less than 0.05, and 96 vs 71 ml/100 gm/minute, p less than 0.05). Right ventricular flow was higher in the M-P group at 10 and 30 minutes of bypass (98 vs 66 ml/100 gm/minute, p less than 0.05, and 90 vs 78 ml/100 gm/minute). Left ventricular flow was higher in the M-P group at 10 minutes of bypass (79 vs 52 ml/100 gm/minute, p less than 0.08). Septal flow also was higher in the treated group at 10 minutes of bypass (64 vs 49 ml/100 gm/minute) and at 30 minutes of bypass (92 vs 67 ml/100 gm/minute, p less than 0.05). CVR after 10 minutes of bypass was lower in the steroid group (88 mm Hg/ml/100 gm/minute vs 1.39 in the control group, p less than 0.03). It is concluded that M-P increases coronary blood flow and decreases CVR in the empty beating heart during normothermic CPB without altering myocardial metabolism or contractility.20


Crystalloid vs colloid in the etiology of pulmonary failure after trauma: a randomized trial in man. One possible cause of pulmonary failure after trauma is the type of asanguinous fluid used for resuscitation, i.e., crystalloid or colloid. To investigate this issue, patients having a laparotomy for trauma randomly received either Ringer's lactate (RLS) alone or Ringer's lactate with albumin (ALB). Both groups received washed red cells. Test fluids and red cells were given before and during operation to restore vital signs and hematocrit to normal. Pulmonary function tests were performed for 5 days after operation. One hundred and forty-one cases were studied (84 RLS, 57 ALB). The volume of asanguinous resuscitation fluid infused was 5.37 +/- 3.38 liters (-x +/- SD) for RLS and 5.87 +/- 3.05 liters for ALB. ALB cases received 213 +/- 130 gm of albumin. Red cell transfusions were 1.5 +/- 2.9 units for RLS and 2.0 +/- 3.1 for ALB. Six patients died (three RLS, there ALB). Three RLS and six ALB patients received intermittent mandatory ventilation or continous positive air pressure after operation. Pulmonary function results were not significantly different between the two groups for any parameter on any day after operation. Results of a randomized trial in human subjects of resuscitation with crystalloid and colloid solutions for acute trauma requiring laparotomy did not reveal significant differences in (1) survival rate, (2) incidence of pulmonary failure, or (3) postoperative pulmonary function.


Surgical continuing medical education: format and impact. A survey of 140 continuing medical education (CME) offerings in surgery for 1975-1976 was undertaken. In no instance was there evidence of evaluation of learning or behavior changes after the experience on the part of the sponsors. Estimated cost from the data obrained, 83 courses, was approximated at two million dollars. There is no evidence that this modality achieves the objective of improved patient care. A change from the education-based existing system to a competency-based evaluation system is proposed. The latter, a multicomponent system, has an objective cognitive skills measurement and a measurement of behavior as major elements. Computer simulation-modeling using patient-problems is proposed to define deficits and to be used as an active participatory educational modality. Development of practice profiles, establishment of a data base for determining patient outcome, including morbidity and mortality data, and identification of measures to determine rate of adoption of innovation and loss of obsolescent concepts are required to define behavioral changes. Under the guidance of academic and professional societies working in the community, an effective competency-based educational system dedicated to improved patient care can be specified and implemented.


Adverse cardiodynamic effects of vasopressin not avoided by selective intra-arterial administration. In this study, lysine-vasopressin, administered either as a continuous, intravenous infusion (1 unit/kh/hour) or as a selective infusion into the superior mesenteric artery (0.2 unit/minute), produced equal (25%), significant (p less than 0.05), and sustained (60 minute) reductions in portal pressure. Compared to intravenous administration, selective intra-arterial infusion of vasopressin resulted in similar reductions incardiac output (38%), myocardial contractility (23%), and coronary flow (53%). Since these adverse cardiodynamic effects were not avoided by selective intra-arterial infusion, it would appear that administration of vasopressin as a continuous infusion through a peripheral vein remains the most rapid and practical method of administering the drug.


[Protothecosis in cattle. Report of a case (author's transl)]. A brief review of the classification of the genus Prototheca is followed by a report on a case of protothecosis in cattle. A pure culture of Prototheca was isolated from the milk of the affected quarter. Despite the fact that the alga showed some sensitivity of nystatin in vitro, the mastitis failed to disappear on treatment with this agent. In the discussion, the incidence of Prototheca infection in man and animals and the appearance of infections with this facultatively pathogenic alga are reviewed.


[Tuberculosis among Japanese deer in a deer-park in Goes (author's transl)]. Severe infection with tubercle bacilli of the avian type was detected among Japanese deer in Goes. All animals were disposed of and post-mortem studies were done, which showed that only two specimens were culturally negative. After thorough cleaning and decontamination of fecings and cages and burning of the mown grass during the period from August 1971 to April 1972, the park was repopulated with deer free from tuberculosis. The herd was continued to be free from tuberculosis ever since. Well over one hundred children who occasionally visted the deer-park as well as the attendants of the deer were examined twice (at a four-month interval) using avian tuberculin, the results of the tests being negative.


HLA antigens in 16 families with xeroderma pigmentosum. Xeroderma pigmentosum is an autosomal recessive disease. HLA-A and -B typing was performed on peripheral blood lymphocytes and platelets. Sixteen Tunisian families were typed with 37 patients and 108 relatives. Genetic transmission of the disease and of the HLA system seemed to be independent in this study. Comparison of HLA gene frequencies between (unrelated) parents of patients and a control population showed no difference, proving that there is no clear association in populations between deleterious XP genes and a particular HLA gene. However, an excess of identical HLA among pairs of diseased siblings would suggest that the disease is polymorphic and a form of the XP could be linked to HLA.


Relative importance of 5alpha reduction for the androgenic and LH-inhibiting activities of delta-4-3-ketosteroids. The significance of 5alpha reduction of c19, delta1,4-3-ketosteroids in regulating growth of the rat ventral prostate (VP) was examined. The androgenic and LH-inhibiting activities of a C19 delta1,4-3-detosteroid which does not undergo appreciable 5alpha reduction were compared with those of its 5alpha reduced analogue and those of testosterone (T). In intact rats M (17beta-hydroxy-17alpha-methyl-androsta-1:4-dien-3-one) caused a suppression of VP weights and plasma testosterone concentrations, and in castrated rats suppressed plasma LH concentrations. M was considerably less androgenic and moderately less potent as an inhibitor of LH secretion than either T or the 5alpha reduced analogue of M [17beta-hydroxy-17alpha-methyl-5alpha-androst-1-ene-3-one; (5alphaM)]. 5alphaM was found to be at least as androgenic and as active as an inhibitor of LH as T, suggesting that the weak activity of M may be attributable to a lack of reduction to 5alphaM. Following incubation of 3H-M with VP minces, over 96% of the radioactivity recovered corresponded with M by TLC. Under identical conditions 32-48% of the radioactivity recovered from incubations with 14C-T corresponded with 5alpha reduced metabolites of T. This study demonstrates the importance of 5alpha reduction for both the androgenic and LH-inhibiting activities of delta4-3-ketosteroids.


Evidence that "embryonic estrogen" is a factor which controls the development of the mouse preimplantation embryo. 4- to 8-cell mouse PIE's (preimplantation embryos) were cultured in vitro for 48 hr in media containing various concentrations of the anti-estrogen CI-628. Graded effects of the various concentrations were observed with the highest concentration (1.5 microng/ml) being 100% effective in blocking development to the blastocyst stage. The deleterious effects of the drug were prevented to some extent by including estradiol-17beta in the medium. Our interpretation is that the effect of CI-628 was due to its anti-estrogenic properties. If this interpretation is correct, then the results support our hypothesis that the development of mouse PIE's depends upon estrogen which originates in the PIE.


An ultrastructural assessment of an embolic method of producing cerebral ischemia. This study presents ultrastructural confirmation of the embolic method of producing an ischemic lesion. The embolic method was shown to produce more advanced parenchymal changes than those reported for the same postocclusion period following vascular clipping. With this method there was less alteration in the morphological intergrity of occluded extraparenchymatous areas of the arterial bed, especially in the associated nerve bundles.


Effect of cerebrospinal fluid removal on cerebral blood flow and metabolism in the baboon: influence of tyrosine infusion and cerebral embolism on cerebrospinal fluid pressure autoregulation. Cerebral blood flow (CBF) and metabolism were measured before and after withdrawal of 5 to 6 ml of cerebrospinal fluid (CSF) in 17 baboons. The measurements were made before and after infusion of tyrosine, the precursor amino acid of the putative neurotransmitters, dopamine and norepinephrine, in the brain. The same observations were made in another experimental group, i.e., before and after acute cerebral multiembolization induced by microfil emboli. In the steady state CBF was unaltered following reduction of intracranial pressure by removal of CSF. After infusion of tyrosine, CBF was decreased, and cerebrovascular resistance increased significantly on removal of CSF. Cerebral embolization did not influence changes in CBF at reduced intracranial pressure. It appears that the cerebral resistance vessels constrict following reduction of intracranial pressure by removal of CSF and that cerebrospinal fluid pressure-CBF autoregulatory mechanisms are resistant to cerebral ischemia induced by middle cerebral artery embolization.


Basilar artery occlusion: clinical and radiological correlation. Twenty patients with basilar artery occlusion and three patients with bilateral vertebral artery occlusions have been studied. The clinical data at the time of the ictus and the long-term follow-up data have been correlated with the site and extent of the basilar artery occlusion and the type of collateral flow. Patients with hypertension and with coma at the outset have a grave prognosis. The presence of surface collateral flow may not indicate adequate perfusion of the paramedian penetrating branches of the basilar artery or the thalamoperforating branches of the posterior communicating or posterior cerebral arteries. It is these vessels which supply the territory regulating the level of consciousness and containing some of the control mechanisms for respiratory function.


Lymphatic patterns of cats infected with Brugia malayi and streptococcus. Approximately 50% of the hind legs of cats infected with Brugia malayi and insulted with a beta haemolytic streptococcus became elephantoid in appearance after four to six weeks. This condition was found to be reversible. Collateral lymphatic vessels were seen by lymphography in most of the Brugia-streptococcus-infected legs. The popliteal draining systems in two of three cats, which harboured no worms, appeared normal by lymphography at 18 weeks.


Ultrasound and abdominal hydatid disease. Twenty-two hydatid cysts have been accurately located in the abdomens of seven patients by ultrasound B-scanning. Lapartomy has confirmed the presence of 19 of these cysts. Grey-scale techniques do not appear to add appreciably to the ease of diagnosis in this condition. Ultrasound can give the clinician a good idea of the extent of the disease process and has the advantage of being completely non-invasive.


Psychiatric morbidity in a tropical diseases unit. A sample of 208 consecutive admissions to the Hospital for Tropical Diseases was screened for psychiatric illness. A psychiatric morbidity of 31-8% was found. If severe personality disorders are included in the figures then the overall psychiatric morbidity rises to 49-6%. The reasons for these findings are discussed.


The release of soluble vasoactive material from Trypanosoma congolense in intraperitoneal diffusion chambers. Millipore diffusion chambers containing living or lysed Trypanosoma congolense cause a local inflammatory reaction when implanted intraperitoneally into rats. Empty chambers do not do this. The active material is of low molecular weight and is possibly peptide in nature. It appears to act by increasing local vascular permeability. It was found to be neither chemotactic nor cytotoxic in several assay systems. It is considered that this material may contribute to the pathogenesis of T. congolense infection in animals.


Blood pressure distribution in a rural Ghanaian population. Hypertension and related complications appear, from clinical impression, to be increasing problems in urban Ghanaians. In early 1973 we conducted a blood pressure survey in 20 rural Ghanaian villages to determine the prevalence of hypertension, in comparison with studies done in Accra residents and black Americans. Rural Ghanaians had mean systolic and diastolic blood pressures which were lower at all ages than the urban groups. 2-5% of the subjects aged 16 to 54 years had diastolic blood pressures of 95 or higher mm Hg. These findings are discussed in view of the proposed hypertension control programme in Accra. We conclude that hypertension is not a significant health problem in rural Ghanaians and that large-scale hypertension case-finding and intervention programmes should be confined to urban populations.


Lethal damage to Simulium metallicum following high intakes of Onchocerca volvulus microfilariae in Guatemala. High intakes of microfilariae of a Guatemalan strain of Onchocerca volvulus by Simulium metallicum proved lethal to a considerable proportion of the flies within 24 hours of taking an infecting blood-meal. The gross histopathological changes resulting from infection were compared in groups of moribund and of apparently healthy flies during this period. The marked morbidity of the flies could be related to certain events occurring in the alimentary tract and haemocoele of the fly soon after ingestion of the parasitized blood. The rapid death of the flies may be ascribed to one or more of the following reasons: (i) reverse migration of numerous microfilariae from the expanded- to the tubular-part of the mid-gut, where they cause serious injury and disintegration of the gut epithelium; (ii) abrasive damage to the stomach epithelial cells by the invading microfilariae with occasional release of the gut contents into the haemocoele; (iii) interruption of the formation of the peritrophic membrane, particularly at its anterior and posterior ends, with subsequent failure of the flies to digest the blood in the stomach; (iv) passage of large amounts of parasitized blood from the stomach backwards into the hind-gut, leading to its mechanical obstruction and (v) invasion and injury of various organs of the fly, among them the ventral nerve-cord, brain, optic nerve, eye, halteres, fat-body and flight musculature by excessive numbers of microfilariae.


[The efficacy of mebendazole and praziquantel on larval taeniids from mouse, rabbit and pig (author's transl)]. The efficacy of Mebendazole (Janssen) and Praziquantel (Bayer) on Cysticercus fasciolaris, C. tenuicollis resp. C. pisiformis was studied in 125 mice, 63 pigs and 30 rabbits. All mice were infected naturally with C. fasciolaris. The pigs were infected experimentally with 2000 resp. 5000 eggs of Taenia hydatigena and the rabbits with 1500 eggs of Taenia pisiformis. 8 weeks p.i. animals were divided into groups and received 25 mg/kg Mebendazole or 50 mg/kg Praziquantel on 5 consecutive days as well as 5 mg/kg Mebandazole resp. 10 mg/kg praziquantel for 14 days. The applied doses of 62.5 and 12.5 mg/kg Mebendazole to mice for 10 days or 14 days showed almost no efficacy against C. fasciolaris whereas 250 and 125 mg/kg Praziquantel given for 10 days gave 100% good results. We found that Mebendazole is highly efficient only against C. tenuicollis at a concentration of 25 mg/kg in the pig, whereas in the rabbit the 5 mg dose over 14 days still revealed good results. Praziquantel showed a virtually 100% success using 50 mg/kg for 5 days and 10 mg/kg for 14 days, whereas the efficacy of Praziquantel against C. pisiformis in rabbits administering the same dose was not satisfying.


Serological investigations on patients with schistosomiasis with special reference to circulating antigen. Serological tests on patients with S. haematobium and S. mansoni indicated that both antibody and schistosome antigen can be detected. The possible role of these in immune-complex nephritis is discussed.


The concentration of microfilariae in the skin near the eye as a simple measure of the severity of onchocerciasis in a community and as an indicator of danger to the eye. The parsitological and ophthalmological findings in an onchocerciasis survey in 8 villages (832 persons) and 5 primary schools (285 children) in Cameroon are reportedl The use of the coneoscleral punch/microtiter plate quantitative skin snip technique greatly facilitated this study, and its advantages over the weighed skin snip method are discussed. This simple technique could be used by paramedical personnel to detect the number of people in a community who have more than 15 microfilariae in a snip near the eye. This is shown to be a measure of the intensity of infection, and a good indicator of the number of people at risk of developing ocular pathology.


[Extravascular localization of Trypanosoma vivax in cattle (author's transl)]. In 2 cattle experimentally infected with Trypanosoma vivax, strain EATRO 1695, trypanosomes were found in the marginal sinus of one of several lymph nodes examined. One animal showed trypanosomes in a small focus in the interstitial tissue of the heart. It is concluded that Trypanosoma vivax can not be regarded as a strict plasma parasite.


[Methods for population sampling of the immature stages of Simulium damnosum Theobald, 1903 (Diptera, Simuliidae) in West Africa. I. Preliminary observations on the vertical distribution of larvae and pupae (author's transl)]. Three techniques for sampling larvae of Simulium damnosum in different water depths are described. Preliminary results prove that the larvae can settle much deeper, i.e. up to 3 m, than reported before (0-30 cm). Without impairment pupation takes place in any depth.


Micromorphology of the larval and nymphal cuticle of Simulium (Diptera: Simuliidae) of Zaire, Near or included in the Simulium damnosum complex (author's transl). A stereoscan electron microscopy study of two forms of Simulium of Kivu, Zaire, apparently belonging to the Simulium damnosum complex, revealed some morphological particularities: the presence of microvillosities on the enormously enlarged scales of a larval form from a western tributary of lake Tanganyika, and the presence of spine-combs and comb-shaped scales on the nymphal cuticle of this form and a form from the equatorial rain forest of Irangi.


The echocardiophone: a new means for observing spatial movement of the heart. The paper describes a new pocket size instrument called the "Cardiophone" for the diagnosis of cardiac dysfunction. It is a continuous wave swept frequency ultrasonic echo-location system which produces dynamic auditory signals corresponding to the positional change of internal structures of the heart. The four valves are relatively easy to locate compared with conventional ECG machines. Preliminary clinical evaluation results are presented indicating the potential of the instrument for the general practitioner.


Tapered ileum as ureter substitute in severe renal damage: antireflux technique for bladder implantation. Three cases are reported in which ileum has been used to replace irreparably damaged ureters despite preexisting moderate to severe pyelocaliectasis. Two cases have had satisfactory results while one had increasing pyelocaliectasis and azotemia requiring subsequent cutaneous diversion. The rationale for using ileum to replace ureter is presented with a discussion of objectives to be achieved surgically to assure the success of the procedure.


Benign ureteral lesions: rare causes of hydronephrosis in children. Three unusual cases of hydronephrosis in children secondary to ureteral lesions, (1) congenital abnormality and (2) due to benign tumor, are presented. The radiographic findings and management are discussed. Conservative surgical management is suitable for these lesions.


Urologic manifestations of Henoch-Schönlein purpura. Henoch-Schönlein purpura involves the kidneys in about 50 per cent of cases. In adults the classic signs are usually absent. Open renal biopsy is valuable from a prognostic standpoint since the severity of the renal lesion can be correlated with the future clinical course.


Supraclavicular node biopsy in testicular tumors. Fifty-seven patients with germinal cell carcinoma of the testis were evaluated routinely, with the addition of a supraclavicular node biopsy as a final staging procedure. Five patients showed more extensive disease with the addition of this staging modality.


Idiopathic scrotal edema.

Idiopathic scrotal edema. An eight-year experience consisting of 30 cases of idiopathic scrotal edema has been analyzed. The condition is characterized by a minimally painful scrotal swelling produced by subcutaneous edema. A normal testis and cord enable one to differentiate it from some other causes of scrotal swelling such as torsion of the testis and epididymo-orchitis. A connection with trauma, periurethral disease, or streptococcal disease appears unlikely. A localized allergic phenomenon, perhaps a local form of angioneurotic edema appears to be the most likely etiologic factor.


Priapism in preterm infant.

Priapism in preterm infant. This report of transient priapism in a preterm newborn with respiratory distress syndrome discusses clinical course, therapy, possible etiologic factors, and previously reported cases in newborns. Possible causes include use of arterial catheter, red cell transfusion, hemodynamic changes from a patent ductus arteriosus, and hypoxia.


Blue nevus of the prostate: ultrastructural study. A case of blue nevus of the prostate in a sixty-five-year-old black patient was studied by light and electron microscopy. In the melanocytes only fully melanized melanosomes were present; melanosomes in early stages of development were entirely absent. It was concluded that the formation of melanosomes within the melanocytes in blue nevus of the prostate is probably under genetic control.


Fish farming trends.

Fish farming trends. The Food and Agriculture Organisation has estimated that fish farming will increase heavily within the next few decades. This paper gives a general view of fish farming and its prospects for the future.


Acute respiratory distress in the dog associated with paraquat poisoning. An acute respiratory distress syndrome in 10 adult dogs was usually preceded by vomiting, anorexia and lethargy followed, after a short interval, by dyspnoea. The dyspnoea became increasingly severe, despite oxygen therapy, and cyanotic respiratory failure ensued. All 10 dogs died or were killed after illnesses lasting between one and eight days. Necropsies revealed pulmonary congestion, oedema, collapse and haemorrhage with loss of alveolar epithelial cells. Early alveolar fibrosis was also found. Paraquat was identified in post mortem samples from four of the 10 dogs.


Phenytoin toxicity: a fatal case in a dog with hepatitis and jaundice. Pheyntoin (Epanutin: Parke, Davis) is widely used for the control of chronic convulsive disorders in the dog because it exerts an anti-epileptic effect without causing general depression of the central nervous system. To our knowledge fatal cases of phenytoin sensitivity in the dog have not been reported. A case is described in which hepatitis, jaundice and death followed the administration of the drug.


A survey of patent nematode infestations in dogs. A survey of faecal samples taken from 1000 suburban dogs revealed an infestation of 7-2 per cent Toxocara canis, 2-7 per cent Toxascaris leonina, 1-3 per cent Trichuris vulpis and 1-3 per cent Uncinaria stenocephala. The faecal material examined was obtained per rectum from well cared-for pet dogs resident in an area of north-west suburban London. The age of the dogs examined, both male and female, ranged from three weeks to 18 years. The clinical picture of the dogs affected by ascariasis and in particular Toxocara canis is described and some advice on treatment is included.


Tyzzer's disease in rabbits in Britain.

Tyzzer's disease in rabbits in Britain. Tyzzer's disease seems to be a not uncommon cause of diarrhoea in rabbits in Britain. It may occur either epizootically or enzootically in affected rabbit units. The more acute form may present difficulties in diagnosis.


The use of ketamine anaesthesia to milk two tropical rattlesnakes (Crotalus durissus terrificus). A series of five experimental milkings using ketamine as anaesthetic are described. The drug produced effects which, depending upon the dose, ranged from tranquillisation to deep anaesthesia. No apparent side effects were observed. It is concluded that anaesthesia could play an important role in the safe milking of venomous snakes.


[Changes in the granula of type II pneumocytes corresponding to the oxygen content of the air]. The morphology of granula of type II-granulocytes from lungs of rabbits and rats was studied. In pneumocytes of rabbits dense bodies predominated with high lipoprotein content, whereas in rats the majority had lamellar structure. Under treatment with hyperbaric oxygen the granula showed increased lipoprotein content, suggesting that the emanation of the content of granula to the alveolar surface is inhibited. Under hypoxia the release from the granula was enhanced, and after 16 hours of hypoxia the amount of granula was decreased as well as their lipoprotein content.


[Cryogenic injuries of the rabbit abdominal aorta and the iliac artery]. In rabbits, cryogenic injuries of the walls of abdominal aorta and iliac arteries were histologically examined after application of a cryoprobe ob -160 degrees C for 1 minute. Seven days thereafter the animals were killed. Extended partial and circular necroses and calcifications of the vascular walls were found. The alterations were less expressed when the blood stream was maintaimed during the freezing. Maximal changes occured at additional centripetal pinching the vessels.


[Duodenal fistula for long term animal studies]. The author modified the duodenal cannula -- first described by Tuckermann in 1883 -- obtaining a safe long-term access to the duodenum with almost no complications in animal experiments. This technique reveals the possibility to obtain duodenal fluid from the animal without anesthesia, or pancreatic juice by cannulating the duodenal papilla.


[Local tissue reactions to subplatysmal implants of cold polymerizing silastic as bladder prostheses in the animal experiment]. In animal experiments silicone rubber bodies of various volumes and weights were implanted under the platysma. The grafts were completely tolerated by 6 rabbits and partially by a minipig, but not at all by 4 dogs. The primary reason for the failures were chronic inflammation by motion of the graft, heaviness of the plastic material, and stromal weakness.


[Significance of in-vitro studies ofr the evaluation of gastrointestinal motility]. To study the function of the smooth muscles taken from the gastrointestinal tract the simple organ bath or various superfusion techniques can be used. With the aid of these methods it is possible to measure contractile and electrical phenomena of the isolated muscles. In addition the reactivity to various stimuli can be tested. Such in-vitro-systems elucidate principal questions of physiology, pathophysiology, and pharmacology. However, there is no direct clinical significance of in-vitro-investigations of gastrointestinal motility up til now. The clinical benefit of such investigations can be seen in the better understanding of the pathophysiology and in the discovery of new drugs in the field of gastrointestinal motility.


[Radiologic demonstration of esophageal and gastric motility phenomena]. Indication and significance of roentgenological procedures referring to esophageal and gastric motility are discussed with special reference to a number of functional disorders. Cinematography and tape-recording are necessary for fast peristaltic motion as in vascular, neurological and myogenic diseases of the upper esophageal sphincter. Pharmacological response may for instance help to differentiate functional from morphological disorders or postoperative complains. Combinations of roentgenological and radioisotopical studies or manometry may be usefull for special diagnostic problems.


[Manometric study on the effect of proximal vagotomy on the lower esophageal sphincter]. Selective proximal vagotomy (SPV) decreases the LES pressure (resting pressure and pentagastrin-stimulated pressure), significantly 6 months postoperatively without achieving LES insufficiency by clinical means. Immediately after stimulation LES pressure is identical, compared to preoperative measurements. The postoperative significantly increased concentration of basal gastrin seems not to be a major determinant of LES tone in humans.


[Serum level of 25 hydroxy vitamin D3 in patients with gastric and duodenal ulcers and following billroth II gastric resection]. Serum 25-hydroxyvitamin D3 levels were determined in patients with gastric ulcer, duodenal ulcer, and subtotal gastrectomy (Billroth II); 35 healthy persons served as controls. 25-hydroxyvitamin D3 levels were correlated with the signs of osteopenia determined radiologically. 25-hydroxyvitamin D3 serum level was not different from normal in subjects with gastric or duodenal ulcer. Those who underwent gastric surgery had significantly lower values. Within this group those with osteopenia had lower values than those without.


[Effect of afferent abdominal vagus nerve stimulation on the blood circulation and respiration in the guinea pig]. In 38 urethan anesthetized guinea-pigs low frequency (1--30 Hz) electrical afferent stimulation of the abdominal vagus elicited cardiovascular and respiratory reflexes, which were eliminated by bilateral cervical vagotomy: 1. 2/3 of the animals showed a bradycardia with arrhythmia. 1/3 had no heart rate alteration. 2. Biphasic blood pressure alteration with an initial decrease and a following increase was the most common blood pressure response. Longlasting (10 sec) stimulation resulted in a blood pressure increase of 25 to 30 mmHg in 75% of the animals. 3. Acceleration of respiratory rate. A vago-vagal and/or vagosympathetic reflex is considered. It is assumed that the blood pressure curve is composed of adding both the depressor and pressor component. Two functional fibre groups in the afferent abdominal vagus are considered to be the anatomic substratum. Atropine had no effect on the alteration of respiratory rate and blood pressure; only the bradycardia could be eliminated.


Protein profiles as an aid to taxonomy in the genus Diphyllobothrium. Specific and distinct protein profiles were demonstrated by isoelectric focusing performed on soluble whole-body proteins of four Diphyllobothrium species. The protein patterns differed in number, position and relative density of the fractions separated. Altogether 31-36 protein bands per species were separated by isoelectric focusing in thin-layer polyacrylamide gels. The results show that sensitive chemotaxonomic methods can be used to help characterize and delimit species in the troublesome Diphyllobothrium group.


Setaria cervi: enzymes of glycolysis and PEP-succinate pathway. Setaria cervi, the filarial parasite inhabiting the Indian water buffalo (Bubalus bubalis Linn.) contained almost all the enzymes involved in glycogen degradation. Significant activities of glycogen phosphorylase, glucokinase, phosphoglucomutase, phosphoglucose isomerase, phosphofructokinase, FDP-aldolase, glyceraldehyde-3-phosphate dehydrogenase, phosphopyruvate hydratase, pyruvate kinase, lactate dehydrogenase glucose-6-phosphate dehydrogenase and 6-phosphogluconate dehydrogenase were detected in cell-free extracts of whole worms. The presence of PEP-carboxykinase, malate dehydrogenase, fumarase and fumarate reductase revealed the functioning of the PEP-succinate pathway in addition to phosphorylating glycolysis and pentose phosphate pathway in the parasite. Excepting fumarate reductase all other enzymes were localized in the particulate-free cytosol fraction, although small amounts of glycogen phosphorylase, aldolase and lactate dehydrogenase were also detected in the mitochondrial fraction.


On the use of the scrotum for feeding larval ixodid ticks on hosts. The efficacy of feeding larval stages of Amblyomma variegatum, Hyalomma rufipes and Boophilus decoloratus on the ears and scrotum of sheep is compared. The effect of age of larvae on the number that engorged on the animal was also investigated. A significantly greater number of larvae fed on scrotum than on ears. The greatest number of larvae engorged when they were fed on the scrotum or ear within 1-4 days of hatching. The older the larvae, the less the number that fed. The economic advantages of adopting the scrotal method for rearing larval tick stages as well as the implication under natural conditions of younger larvae feeding in large numbers are discussed.


Consecutive stages of arthropathy progression in patients with gout. During observation of 250 patients with gout in the Institute of Rheumatology in Warsaw in the years 1962-1975 several patterns of joint destruction stages in gouty arthropathy have been recognized on the basis of serial roentgenograms. Histological examination of joints and bones suggests with a considerable probability that the progression of arthropathy depends on the extension of sodium urate deposits in articular tissues. Histological documentation of consecutive stages of joint distruction corresponding to the above mentioned patterns of radiological changes is presented.


[Treatment of osteoporosis with a delayed-action sodium fluoride preparation]. 40 patients with various types of osteoporosis, aged 17 to 76 years, were treated for 12 months with a new NaF-drug (Ossiplex-Retard, film tbl. 25 mg NaF plus 200 mg vitamine C). Daily dosage was 50-100 mg. Clinical symptoms, X-ray-status of the axial skeleton, alkaline serum phosphatase and the consumption of analgetics were used for assessment. 2/3 of the patients with presenile and steroid induced osteoporosis responded well to treatment, while those with osteogenesis imperfecta, idiopathic osteoporosis and plasmocytosis did not show clinical or radiological improvement. In senile osteoporosis, a physiological process of aging, should only be given NaF-treatment, if fractures without callus formation are present. Harmless side effects, (gastrointestinal intolerance in 15% and a painful tendoperiostosis syndrome in 12.5%), necessitated discontinuation of treatment in 3 cases. The NaF-drug with added vitamine C has less side effects than other NaF-containing compounds and should therefore be included as part of the therapeutical regimen of certain types of osteoporosis.


[Monoclonal gammopathy in chronic polyarthritis]. Disturbances of immunoglobulin production have often been observed in preclinical multiple myeloma and have led to the question of a pattern of reactive formation of monoclonal gammopathies. In the documented rare case of coincidental Ig-G-myeloma and rheumatoid arthritis some possible similar pathogenetic mechanisms in both diseases are discussed.


[Method of combined surgical treatment of compression forms of lumbar osteochondrosis with alloprosthesis of damaged intervertebral disks]. A method of surgical treatment of compressive forms of osteochondrosis of the lumbar portion of the vertebral column is described, the said method being based on the employment of a prosthetic replacement of the intervertebral disks with a promptly hardening polyurethane SKU-PFL. Along with the decompression of nervous and vascular structures in the vertebral canal the introduced technique permits to correct the stato-dynamic incompetance of the spine. 62 patients were followed-up for up to 5 years. Better results were noted in patients with a clinical pattern of radicular compression. A less distinct therapeutic effect was achieved in a group of patients with the caudal syndrome, and was due to persistent gross neurological deficits.


Fetal development of the human cervical spine and cord. The growth of the human vertebral canal and the spinal cord during normal fetal development was studied. The results suggest that these two parts of the developing body exhibit a similar developmental pattern. Computer analysis also revealed that the rate of this parallel growth is considerably lower than that of the body as a whole but similar to that reported for the brain. These results are discussed in relation to the pathogenesis of certain neurological diseases.


[Assessment of reinnervation of the muscles of facial expression following plastic repair of the facial nerve with the descending branch of the hypoglossal nerve (according to electromyographic findings)]. The data of electromyographic studies of the bioelectrical activity of the facial muscles following plastic repair of the facial nerve with the aid of the descending branch of the hypoglossal nerve permit to interpret the succession and quality of the reinnervation of the muscles. Myoelectrogenesis, as shown by the examinations of 13 patients, develops earlier and with greater completeness in the muscles around the mouth than in the orbicular eye muscle and the frontal muscle, which corresponds to the clinical observations. In the process of reinnervation the activity of the zygomaticus muscle favoured the formation of joint and voluntary movements of the orbicular muscle of the eye and of the frontal muscle.


Growth and skeletal development of the rat during prolonged undernutrition and subsequent rehabilitation. Male rats of 150 g body weight were given restricted amounts of their normal diet up to the age of 85 weeks, such that they showed no significant change in body weight. They were then rehabilitated by allowing them unlimited access to the normal diet. During rehabilitation, the experimental rats reached a maximum body weight that was only 70% of that normally attained. Body length, however, exhibited better recovery, the experimental animals achieving 96% of the normal body length. The skeleton continued to grow during the first 7 weeks of undernutrition, but thereafter only the caudal half of the pelvic girdle continued to grow. On rehabilitation all skeletal dimensions increased, and all eventually reached the normal range of mature skeletal dimensions. Although the pelvic girdle returned to a normal size, it still manifested some alterations in shape.


[Surgical treatment of para-stem tumors by a transtentorial approach]. The scope of the interventions and their results, as well as some aspects of the approach are analyzed in 24 cases. Tentoriotomy from the posterior cranial fossa proved technically complicated; its results are unsatisfactory. Somewhat better results were obtained with a combined approach including an incision of the tentorium. The most favourable results were received with the supratentorial approach and incision of the cerebellar tentorium. This method created optimum conditions for a radical excision of some paratentorial tumours of the posterior cranial fossa with minimum mortality.


Stature, limb and jaw growth.

Stature, limb and jaw growth. From a study of four Caucasoid population samples, aged 1-20 years, a linear relationship was established between stature and jaw or limb growth. However, the correlations between the various parameters varied between the different samples, which suggested that caution must be applied to the interpretation of growth data.


Pituitary-testicular function changes in hypo- and hyperthyroid male rats. The influence of thyroid deficiency and the administration of thyroxine on pituitary-testicular function were studied in male albino rats from weaning age (22 days old) up to 82 days of age. The results showed that the hyperthyroid state induced by a daily injection of 2.5 or 5 microng L-thyroxine resulted in acceleration of growth, a comparative increase in size and number of spermatogenic and interstitial cells, an increase in the STH cells, particularly at the earlier age (42 days old), and in a decrease in the number and size of TSH cells. Gonadotrophic FSH and LH and prolactin cells exhibited an increase in their granular content. The hypothyroid state induced by thyroidectomy or thiourea feeding, at the levels of 0.1 and 0.2% resulted in the depression of growth rate, destructive changes of the spermatogenic and interstitial cells and also in the lumen of the seminiferous tubules. A decrease in the STH, gonadotrophic FSH and LH and prolactin cells and hypertrophy of TSH cells accompanied by degranulation were also observed.


Embryonic and postnatal growth of rat and mouse. V. Prenatal growth of organs and tissues, general principles: allometric growth, absence of growth, and the genetic regulation of the growth process. (1) The investigation yielded several general growth principles, i.e., types of growth occurring rather frequently: (a) allometric growth, (b) a non-changing growth rate, persisting when the growth rate changes in the majority of tissues, (c) a growth rate equal to that of the whole embryo, (d) absence of growth and (e) jumps, i.e., changes in the volume or surface of organs completed within about half a day or less and probably due to changes in the cell volume or surface area; these histological changes tend to start simultaneously with the changes in growth rate. (2) Growth constants tend to have a value of about 2.0 in the prenatal period, as in the post-natal period. During development, however, their value increases slightly but significantly. (3) Further arguments are given for the mitosis-regulating model described in Part III. (4) The mitosis-regulating model combined with the general growth principles derived here and in earlier parts of this report constitute a comprehensive model for the genetiv regulation of the growth process.


Morphological and cytochemical studies on the shrew prostate gland. Columnar epithelium in Suncus murinus is secretory and the secretory product is rich in proteins and polysaccharides; it is devoid of lipids. The secretion is discharged into the lumen by a process of blebbing from the acinar tips of the columnar cells. The basal cells only replace the worn-out columnar cells.


Comparative histological and histochemical studies on the adrenal gland of the albino and the Egyptian desert rats. The adrenal gland of the albino rat and the Egyptian desert rodents Gerbillus pyramidum and Gerbillus gerbillus was subject to histological and histochemical studies. Compared to the albino rat, the adrenal gland of the Egyptian desert rat had a thicker capsule, its zona glomerulosa was thinner and more vacuolated, its cortex was sharply demarcated from the medulla which appeared in the form of packets of cells. Lipid droplets were larger and more numerous in the zona glomerulosa and no subglomerular zone was detected. Cholesterol and its esters were less marked in the outer cortex. Succinic dehydrogenase activity was more marked in the zona reticularis. The cholinesterase-reactive nervous network in the medulla was more complex and dense and the nerve cells were fewer. The significance of these differences is discussed.


Morphological observation of idiopathic cardiomyopathy consisting of 9 cases encountered in sudden and unexpected death. The present study consists of 9 cases of idiopathic cardiomyopathy which were divided into two types, i.e. 6 cases of the hypertrophic type and 3 cases of the dilated type. The former type was found in school-children and relatively younger adults, and the latter in various ages. In both types the hearts showed marked enlargement. The characteristic gross changes of the hypertrophic type were hypertrophy of the anterior wall of left ventricle and of the ventricular septum. Microscopically, the hypertrophied myocardium demonstrated a bizarre arrangement showing different size and shape of muscle fibers. In addition, the wall of small arteries and arterioles revealed circumscribed elastosis here and there. In the dilated type, the hearts showed marked dilatation of both ventricles, and microscopy revealed coagulation necrosis of the myocardial fibers and marked scar formation with slight inflammatory cell infiltration. The gross and microscopic changes in both types of idiopathic cardiomyopathy differed from one another in several respects, and the authors assumed that the differences indicate an independent etiology of both types in man.


Thrombosis of the intraorbital veins and cavernous sinus. Eight cases with phlebographic appearances consistent with aseptic thrombosis of the cavernous sinus or of the posterior part of the superior ophthalmic vein are presented. The clinical course is briefly described and the phlebographic findings and possible differential diagnoses discussed. Even if recent methods may obviate the need for phlebography in the demonstration of orbital tumors in certain cases, the possibility of intraorbital or cavernous sinus thrombosis constitutes an important indication for phlebography.


Retention of the water-soluble contrast medium in the urinary and genital tracts. Retention of contrast medium in the renal pelvis for several days after urography is illustrated in 2 cases of obstructing urinary stones. In a third case water-soluble contrast medium was used for retrograde pyelography before nephrectomy and was retained in the stenotic ipsilateral ureter 7 1/2 months after the operation. A further case exemplifies retention in the seminal vesicles 2 months after vasoseminal vesiculography.


Measurements of total and regional renal blood flow by videodensitometry. Videodensitometry has made it possible to determine not only total but also regional blood flow within the kidney. In animal experiments good agreement was found between the measurements by videodensitometry and isotope technique, taking vein samples, using 125I-labelled Angiografin. The blood flow in 21 human kidney has been determined by both videodensitometry and Xe wash-out method. The correlation was fairly good.


Polycystic disease of the liver. Angiographic diagnosis. Three cases of the syndrome of polycystic disease of the liver and kidneys are present. The definite diagnoses were established by means of angiography. Exploratory laparotomy was avoided. The incidence and symptoms of the syndrome and the diagnostic potentials of the methods of examination are reviewed. It is concluded that detection of either polycystic liver or kidney disease should initiate examination of the other component of the syndrome as well.


Method for comparing films and processing procedures in photofluorography. A method for comparing measurements of films and processing procedures is described. A stepped wedge is developed on basis of density measurements in defined areas of chest photofluorographic films. Quality criteria for films and processing procedures are established by systemization of film evaluation. Minor modifications of the method are necessary for application elsewhere in diagnostic radiology.


Reduction of absorbed dose in radiography of the breast. Experience with a new screen-film combination. The mean absorbed dose in radiography of the breast with industrial film (Mamoray T3, Agfa-Gevaert), the Lo-dose system (Du Pont) and a new screen-film combination (MR 50-Mamoray RP 3, Agfa-Gevaert) was determined. The mean values were 17,2 and 1 mGy, respectively. Thus, the absorbed dose was considerably reduced by using the screen-film combination. This is of utmost importance as the potential risk of inducing malignancy is remarkably reduced, probably negligible.


A study about the possible characteristics of cardiovascular histamine receptors of the turtle. Histamine produced pressor, depressor or biphasic responses in the systemic blood pressure of the turtle. The pressor response or component reversed to depressor effect after the injection of mepyramine, an H1 receptor blocker. It was thought that this response is mediated through the H1 receptors. The depressor response or component was abolished by the treatment of metiamide, a new histamine H2 receptor blocker. Also, the effect reversed after metiamide. These results indicated the presence of H2 receptors in the turtle.


Modification of adriamycin toxicity in rats fed a high fat diet. Rats fed a diet containing a high percentage of butter, cholesterol, cholic acid and proply thiouracil (HFD) showed weight loss and developed hyperlipidemia, marked fatty infiltration of the liver, moderate elevation of SGPT, degenerative changes of the heart muscle, bradycardia, alterations of the QRS complex in the electrocardiogram, and initial hemoconcentration followed by moderate anemia. Treatment with adriamycin (18 X 1 mg/kg i.p.) resulted in significant augmentation of the cardiotoxic effects of this drug demonstrated by electrocardiographic measurements and myocardial histopathology. Adriamycin-induced atrophy of the lymphatic tissue was seen only in rats fed HFD and not in animals receiving ground chow. Adriamycin levels in the heart after single i.p. injection were higher in rats receiving HFD. This effect was present already after 10 days on HFD. At this time histopathological liver changes were present and SGPT was elevated. It is concluded that the increase in adriamycin toxicity is, at least in part, due to diminished excretion by the liver. These experimental findings are in accordance with clinical observations which have identified liver disease as one of the important risk factors for the development of adriamycin cardiomyopathy.


Cholinergic link in the histamine-mediated increase in homovanillic acid in the rat striatum. Administration of 500 microng of histamine into the lateral brain ventricle of the rat produced a 50% increase in striatal HVA. The DA level remained unchanged. The histamine-mediated elevation of HVA was abolished by pre-treatment with the antihistaminic drug - mepyramine. Moreover atropine significantly reduced the histamine-induced increase of HVA. It is concluded that histamine primarily activates cholinergic neurons and that the changes in DA metabolism are a consequence of an increased cholinergic activity.


Dimaprit, (S-[3-(N,N-dimethylamino)propyl]isothiourea). A highly specific histamine H2-receptor agonist. Part 2. Structure-activity considerations. Dimaprit, S-[3-(N,N-dimethylamino)propyl]isothiourea, appears to be a highly specific histamine H2-receptor agonist. Further indications of specificity are obtained from chemical considerations. Dimaprit has two basic centres (pKa values respectively 8.23 and 9.23, at 40 degrees) and at pH  7.4 about 5% of the molecules will be present as the monocation analogous to histamine monocation. Chemical comparison suggests that the --N+HMe2 group corresponds to the --N+H3 of histamine, and that the isothiourea group of dimaprit (which can undergo 1,3-prototropic tautomerism) may simulate the imidazole ring of histamine and function as a proton transfer agent at H2 receptors. Simple structural analogues of dimaprit are only weakly active, indicating a high degree of chemical specificity for H2-receptor stimulation; such compounds (e.g. the lower homologue, SK & F 91487) may serve as useful chemical controls when studying the actions of dimaprit.


Distortions in infant electrocardiograms caused by inadequate high-frequency response. Frank lead ECG's from infants were studied for frequency content by introducing low-pass filters of 50, 75, 100, and 150 150 Hz bandwidths before obtaining computer measurements. Results indicated that a minimum bandwidth of 100 Hz is required to avoid amplitude error of 10 per cent or greater. This bandwidth requierement is essentially the same as that required for adult ECG's despite the fact that infant QRS durations are usually about half those of adults. Although the average infant ECG spectrum is likely to contain higher frequencies than the average adult ECG spectrum, duration values for Q, R, and S waves overlap in these populations to such an extent that bandwidth requirements are practically identical.


The narrow aortic annulus. A technique for inserting a larger prosthesis. A surgical method is described which enables a relatively larger aortic prosthetic valve to be inserted. This consists of widening the aortic root with pericardium and inserting the prosthesis slightly obliquely. The technique has been successfully applied in all 12 patients on whom it was attempted.


Mitral valve prolapse with atrioventricular and sinoatrial node abnormalities of long duration. A 20-hear-old patient with mitral valve prolapse and minimal mitral regurgitation associated with intermittent marked sinus bradycardia and sinus arrhythmia, and atrioventricular block, proximal to the bundle of His, varying from first-degree to high-grade, is described. Both the murmur and the atrioventricular block had been documented since the age of eight years, and probably since the first year of life, and has shown no subsequent progression. The patient's symptoms of chest pain and severe lightheadedness and near syncope have been shown by telemetry electrocardiogrphic monitoring to be unrelated to changes in cardiac rhythm.


A study of methods for the determination of lead and cadmium. This paper describes laboratory comparisons of precision and accuracy of some widely used methods for the determination of lead in blood and for lead and cadmium on filters. With the exception of the tantalum boat atomic absorption technique, the methods studied were found to be rugged for a variety of minor procedural changes. Recovery of cadmium from spiked filters was quantitative over a wide range of dilutions and for a variety of instrumental readout and calculation combinations.


Time as a factor in atmospheric sampling. Differences in results of simultaneous air monitoring of ozone with three different methods in the field are described. The argument is advanced that the differences are due largely to sampling turbulent atmospheres with instruments utilizing different sampling intervals and time constants. It is concluded that when sampling natural turbulent atmospheres, a stable mean value can only be achieved through integrated sampling periods of greater than ten minutes.


Hemodynamic changes at the onset of spontaneous versus pacing-induced angina. To determine the origin of angina pectoris at rest hemodynamic monitoring was performed for 24 to 72 hours in 25 patients with unstable angina who had pacing-induced angina during cardiac catheterization. During the monitoring period, seven patients had spontaneous epidsodes of angina at rest that could be compared with the pain-free periods and periods of pacing-induced angina. At the onset of spontaneous angina, the patients had a significantly lower mean double product (P is less than 0.005) and triple product (P is less than 0.025) than at the onset of pacing-induced angina. The mean double product (heart rate x systolic blood pressure) was 9,411 +/- 2,815 mm Hg/min during pain-free rest, 10,635 +/- 2,587 at the onset of spontaneous angina and 16,623 +/- 3,904 during pacing-induced angina. The mean resting pain-free triple product (heart rate x systolic blood pressure x ejection time) was 3,023 +/- 703 and 3,536 +/- 931 mm Hg/sec per min during, respectively, pain-free rest and spontaneous angina, and 4,350 +/- 938 mm Hg/sec per min during pacing-induced angina. These marked differences in the double and triple products were associated with a mean increase in pulmonary arterial diastolic pressure (from 10.7 mm Hg at rest to 14 mm Hg) at the onset of both spontaneous and pacing-induced angina. Although indirect, these data suggest that transient changes in coronary blood flow, rather than changes in myocardial work, may be primarily responsible for spontaneous angina at rest in certain patients with the syndrome of unstable angina.


Cardiac Death in the first 6 months after myocardial infarction: potential for mortality reduction in the early posthospital period. In a prospective postmyocardial infarction study of 759 patients aged less than 66 years, 42 posthospital cardiac deaths (42 of 759; 6 percent) occurred during a 6 month follow-up period. The average age of those who died was 53.5 +/- 8.8 (+/- standard error) years, and postmortem examination was obtainedon 36 percent. Almost 60 percent of the 6 month posthospital mortality occurred within 2 months after hospital discharge. Fifty-five percent of the cardiac deaths occurred either outside th ehospital or within hospital emergency departments, and 62 percent of the deaths were sudden (within 12 hours) or unwitnessed. The suspected mechanism of cardiac death was a primary arrhythmia in 62 percent, and a definite or probable myocardial infarction was diagnosed in only 41 percent. Use of digitalis and diuretic and antiarrhythmic agents was significantly (P is less than 0.025) greater in this group during the week before death than in a comparison survivor group; no difference in use of propranolol or tranquilizers was noted between the two groups. Fifty percent of the group that died had two or more of the following factors: death outside the hospital, sudden death, primary arrhythmic death. These findings indicate that a considerable potential exists for reducing cardiac death in the early posthospital phase of myocardial infarction.


Patients admitted to the coronary care unit for chest pain: high risk subgroup for subsequent cardiovascular death. Approximately 300 persons a year who are admitted to the Stanford University Hospital coronary care unit because of prolong ischemic chest pain and transient S-T changes do not manifest evidence of a myocardial infarction during their hospital stay. In a retrospective study carried out in 170 such patients, follow-up data obtained during a mean of 17.9 months revealed rates of mortality from cardiovascular causes of 4.2 percent for 1 month, 10.1 percent for 1 year and 19.7 percent for the entire follow-up period. Ten (40 percent) of the 23 deaths that occurred were sudden and 13 were due to acute myocardial infarction or its complications. Another 21 patients had a nonfatal myocardial infarction during this follow-up period. The data confirm the impression that patients with suspected myocardial infarction who do not have an infarction in the coronary care unit are at high risk for cardiovascular deaths after hospital discharge. Efforts are under way to define further a high risk subgroup on the basis of clinical indications before discharge.


Exertional hypotension and postexertional ventricular fibrillation in stress testing. Six men, clinically diagnosed as having coronary heart disease, had postexertional ventricular fibrillation after maximal exercise testing. The common featureof their treadmill performance was "exertional hypotension," that is, a decrease or a limited increase (10 mm Hg) in systolic blood pressure. All six men were successfully resuscitated with electircal defibrillation. The major indication for electrocardiographic monitoring is the detection of major ventricular arrhythmias and changes in QRS-ST-T of acute myocardial infarction or severe ischemia, all of which are urgent indications for stopping exertion. Close supervision both during and after exercise testing is essential, particularly in men with severe coronary artery disease; monitoring of changes in systolic pressure during and shortly after exercise testing is as important as searching for changes in the -S-T segment.