Rhinomanometry in myocardial infarction. In the curves obtained from rhinomanometry a mid-cycle rest (M.C.R.) is sometimes found to occur. The aim of this study was then to analyse the frequency of the M.C.R both in normal subjects and in subjects who had had a myocardial infarction. Rhinomanometry was therefore performed on 3 different groups of people, viz. 1 .32 normal subjects without any respiratory, cardial or any pathological problems. 2. 44 subjects who had had a myocardial infarction. 3. 34 subjects without any cardial problems. Rhinomanometry revealed that 50-60% of the second and third group had a poor nasal respiration. In the first group no M.C.R. was found in any of the subjects. In the second group over 50% of the subjects had a M.C.R. In the third group less than 50% of the subjects had a M.C.R. The x2 test was used to analyse these results as to their statistical significance. The x2 parameter was 3,84 with a significance of 95%, and 6,64 with a significance of 99%. Our result was x2=5,34 which seems to justify further study.


Inspiratory nasal obstruction.

Inspiratory nasal obstruction. Inspiratory nasal obstruction or collapsing alae is caused by a sucking in of the candal cartilaginous parts of the nose; this is followed by a partial or complete stoppage of the inspiratory air. The nose usually assumes a pinched appearance together with a widening of the nostrils during the inspiratory phase, in cases where the collapse is confined to the upper laterals. Weakening of the upper laterals can results from development anomalies, or atrophy of the tissue with aging. Fractures of the nasal framework may cause displacement or buckling, with subsequent thickening or scar formation. This will again result in poor function. In other cases both the upper and lower lateral cartilages become involved with a resulting collapse of the lobule, producing a silit-like appearance of the nostrils. Examination of patients with inspiratory nasal obstruction will often reveal poor support of the upper laterals, deformity of the lower nasal cartilage, columella and nasal spine or dislocation of the candal parts of the septal cartilage, all of which cause obstruction to the inspiratory air. Collapsing alae should be treated by nasal reconstruction, with removal of the obstruction and stabilization of the nasal framework. In children, it has been possible to enhance symmetric growth, and at times, increase growth-potentials by re-alignment of the cartilaginous structures of the nose.


A nasal functional test: the opeining of mouth during physical effort. Apart from rare exceptions (cf Voydeville's Thesis, Nancy 1951), nasal airflow resistance has so far been estimated irrespective of variations in air intake needs. The object of the test presented here is to offer a quick, simple and objective method for determining the level of muscular effort at which a given subject spontaneously switches from nasal to buccal respiration. A thin flexible tube (1,5 mm across) is stuck at one end on to the subject's lower lip and the other into a carbon dioxyde analyser. The subject is then made to pedal at a speed at least 30 rev./min. on an ergometric bicycle, while a braking force increasing by 20 W ever two minutes is applied. The emission of carbon dioxyde starts being detected, and graphically recorded, only when the subject starts breathing through his mouth. Results obtained so far show that this threshold can vary as widely as from 80 to 180 W among healthy individuals. Further aplications of this test to both healthy subjects and patients with impaired nasal function would contribute towards throwing light on the still obsure notion of "nasal comfort".


Nasal glands in newborn infants.

Nasal glands in newborn infants. The entire mucosa of the nasal septum from four newborn infants was removed, stained by the PAS-alcian blue whole-mount method, and the density of mucous glands was determined in 12 different localities. The interindividual median density was 30.7 glands/mm2 and the median count 13,500 glands. The glands were regularly distributed over the entire respiratory region, but with a significant decrease in density in the posterior half. It has been demonstrated that all glands are laid down before birth, that their density decreases with increasing age until it reaches 8.4 glandss/mm2 at an adult age, and that acute or recurrent acute catarrhal or inflammatory changes of the nose do not lead to the newformation of glands.


Macrophages in immunobiology.

Macrophages in immunobiology. Macrophages are now known to be important not only in resistance to infection but also in immunoregulation, in resistance to tumours and as secretory cells. Among problems requiring further investigation are the ways in which they destroy intracellular organisms, the ways in which they recognize and destroy tumour cells and the extent of their heterogeneity.


The true choanal polyp-a case report.

The true choanal polyp-a case report. Whether one could distinguish if a large polyp occupying the nasal pharynx derives from the mucosa of the posterior superior wall of the antrum, ethmoids, or the choanae is a matter not clearly understood. Existing literature is somehow confusing on this subject. One definite fact is that these polyps, whatever the site of their origin, are rare. From the histologic point of view, the general opinion among pathologists is that choanal polyps do not differ histologically from the simple mucous polyps of the nose. The case we are reporting concerns a 65-year-old caucasian male, who for many years had a sensation of fullness behind the nose. Examination revealed a polypoid growth protruding below the margin of the soft palate. Surprisingly roenthenograms were not contributory. This polyp was removed by threading a long soft wire over a regular nasal snare. The free loop of the wire was passed through the anterior nose down to the pharynx where the polyp was threaded into this loop, and by pulling the free end of the wires, the polyp was totally removed without any bleeding whatever. A pathology report is attached as well as a picture of the polyp.


Testings of the ostial patency and penetrance. In the present study, consisting of 118 cases of maxillary sinusitis with retention of secretion, ostial patency and penetrance were examined three times during each examination, natively, postsuctionally and postirrigationally, by using consecutive measuring technique. Results indicate that, when both ostial respiratory patency and sniff/blow penetrance were tested in these afore-mentioned three phases at each examination that the information gained about ostial patency and penetrance is most representative when the most normal of these results, i.e. the optimal result, is taken as the finding. This is particularly important when testing the ostial penetrance. Observed inconsistencies between the results of the patency and penetrance tests are apparently due to the different pressures used in testing ostial patency and penetrance.


A clinical evaluation of the Cottle rhinomanometry "flow" nozzle. A clinical study was undertaken to establish what changes in values were caused by the nozzle used in the Cottle flow-pressure technique of rhinomanometry. Cottle rhino-sphygmo-manometry was performed over seven hundred times, half with the nozzle and half without and the results analyzed using pattern, rate, amplitude, work co-efficient and four breath factor as outlined by Cottle. In many instances marked changes did occur but were unpredictable by examination prior to testing. It is suggested that Cottle rhino-sphygmo-manometry be carried out routinely with and without this nozzle in order to better evaluate results of flow-pressure relationship in which this nozzle is used.


Eustachian tube permeability during the nasal provocation test. The results of manometric study on the permeability of the Eustachian tube after a crisis has been produced by exposing 26 cases of perennial nasal atopy to the threshold-dose of the responsible allergen are reported. In 73% of the cases a reduction of the permeability (16 cases) or a stenosis (4 cases) of the ipsilateral tube were found. The importance of inquiring and specifically treating a nasal allergy in patients suffering from secretory otitis is underlined.


Pathogenesis of nasal polyps.

Pathogenesis of nasal polyps. On the basis of studies on the glands of the nasal mucosa and polyps as well as the structure of the latter, some previous pathogenetic theories are analysed. The authors advance their own theory of polyp formation: Infiltration and oedema in the nasal mucosa result in rupture of the epithelium and formation of granulations which gradually become lined with pseudostratified columnar epithelium. During growth of the polyp there occurs formation of mucous glands which owing to growth of the polyps become long and stretched.


The timing of ovulation by a method of direct basophil cells count. The variation of the basophil cells number during the menstrual cycle was studied by the method of Shelley and Parnes, slightly modified. The study comprised 29 women diagnosed as primary or secondary amenorrhoea (first group) and 38 women with normal menstrual cycle, twenty of them being fertile and 18 diagnosed as secodary sterility (second group), including also two women in the second month of pregnancy. The radioimmunological measurement of luteinizing (LH) and follicle-stimulating (FSH) hormone was applied for the second group. The data obtained on 34 women of the second group showed the precipitous decrease of the number of basophils from the level of 20--50/mm3 in the follicular phase, or even their disappearance. This decrease corresponded to the LH increase. Moreover, the morphologic examination of the basophils during the menstrual cycle allowed to classify these cells into three categories: intact, partially degranulated, and firing, the number of the latter type increasing on the day of ovulation at the expense of the first two types.


The serum and pituitary prolactin variations under the influence of a pesticide substance in the male rat. Prolactin was measured in the serum and hypophysis of the male rat after five days of oral administration of malathion in suspension (200 mg/kg body), alone or associated with pimozide (a psychotropic drug). The release of prolactin observed in the group treated with malathion was lower (19.97 +/- 7.27 ng/ml) than in the groups treated with malathion and pimozide or pimozide alone (26.65 +/- 3.17 and 26.49 +/- 2.57 ng/ml, respectively) but significantly higher than in the control group (10.08 +/- 5.82 ng/ml). The administration of two dose levels of pure malathion solubilized in alcohol/water (v/v) failed to reproduce the same results. The discussions are focussed upon: 1) the mechanisms involved in the release of prolactin under the influence of malathion (vagomimetic action) and 2) the lack of cumulative effects of malathion and pimozide (presumably different levels of their influence).


The release of LH and FSH during the thyroid surgery for hyperthyroidism. Serial blood samples, collected from 21 females and 9 males through the thyroid surgery procedures were assayed for LH and FSH by a radioimmunoassay (RIA) technique. During thyroid surgery the serum LH increased significantly in the male patients from the preoperative levels 20.66 +/- 11.67 to 45.49 +/- 18.50 mIU/ml (p less than 0.01), being unchanged or slightly lower in the female group. The serum LH progressively fell towards the end of the surgery, remaining over the preoperative levels i4 hrs after surgery; occasionally very high levels were observed. The release of LH seemed to be more precocious during the surgery in both sexes in patients belonging to the age group under 40 years by comparison to the older group. The serum FSH showed nonsignificant changes during and after surgery in both female and male patients excepting two menopaused female hyperthyroid patients and a woman of 60 years under laborious surgery for a cervicothoracic polynodular goiter. The data are suggesting the dissociated secretion of LH and FSH in both sexes excepting some cases of menopaused women.


Medullosclerosis, contralateral adrenalectomy and splanchnicosympathectomy in severe essential arterial hypertension and thromboangiitis. Part II. Operations were performed in 58 patients with severe essential hypertension and in 105 patients with Buerger's thromboangiitis. No postoperative deaths were recorded. The mean adrenalinemia value decreased by 70.91% and that of noradrenalinemia by 10.34%. Systolic pressure decreased by about 30--50 mm Hg and the diastolic pressure by 10--30 mm Hg. The delayed results (1--20 years) were good in 62% of the patients with IIIrd-degree eye lesions and in 17% of the patients in the organofunctional stage II, in 17% of the patients in stage II--III of restricted necrosis, and in 4% of the patients in gangrenous stage III.


A statistical and pathological correlative study of 434 thyroid carcinomas observed between 1967 and 1975. The authors studied 434 cases of thyroid carcinoma. The sex distribution showed a strong predominance of women (67%). The highest percentage (47%) appeared between 30 and 49 years. Histologically the folliculo-papillary aspect predominated. Thyroid cancer was associated with the following thyreopathies: in 75% of the cases with an anisofollicular adenomatosis, in 12% with a chronic thyroiditis, and in 0.4% with Graves's disease. Only in 13% of the cases no association was found with other thyreopathies. Between 1967 and 1975 no increase of the number of thyroid carcinomas was found.


Influence of a thymus polypeptide extract (TP1) on immunogenesis and on experimental influenza infection in x-rayed animals. The thymus polypeptide extract TP1 administered to X-rayed animals shows a protecting effect on the level of serum anti-influenza antibodies in the rats inoculated with A2 influenza vaccine and reduces the haemagglutinating titres in the mice inoculated with the A PR8 influenza virus.


Obstructive uropathy in chronic inflammatory bowel disease. On the basis of intravenous pyelography the frequency of ureteral obstruction was elucidated in retrospect in 140 patients with Crohn's disease and 88 patients with ulcerative colitis. The findings were related to X-ray examination of the gastrointestinal tract and to the clinical condition at the time of examination. 19% of the Crohn patients had ureteral obstruction, typically affecting the right ureter on a level with the linea terminalis. There was a close topographic relationship between radiologically demonstrated intestinal changes and a mass in the homolateral iliac fossa. There was no relation to duration or activity of the disease, urinary tract infections, surgery, or steroid medication. 14% of the patients with ulcerative colitis had ureteral obstruction of varying localization and nearly always arising after colectomy. Renal calculi were found in 13% of the patients with Crohn's disease and in 18% of those with ulcerative colitis. I.v. pyelography is recommended before and after intestinal resection in chronic inflammatory bowel disease to demonstrate the relatively common and often fairly silent urinary tract complications.


Elevated fecal levels of endogenous pancreatic endopeptidases after antibiotic treatment. Feces from normal and antibiotic-treated persons were analyzed for the content of immunoreactive trypsin and elastase. In the control group the mean concentration of immunoreactive trypsin was 13 microgram per g feces as compared to 147 in the antibiotic-treated group. Elastase was demonstrable in only 3 of 30 samples in the control group but in 20 of 26 in the antibiotic-treated group. The decreased inactivation of pancreatic proteases must depend on an altered intestinal microflora. The results suggest that reestablishment of a normal enteric flora may take months after the short time oral administration of antibiotics.


Drug absorption and hepatic drug metabolism in patients with different types of intestinal shunt operation for obesity. A study with phenazone. Seventeen patients with intestinal shunt for obesity and 11 control patients were given 15 mg phenazone per kg perorally to estimate the rate of absorption and hepatic metabolism of phenazone. The rate of absorption and the plasma clearance of phenazone as well as the 4-hydroxyphenazone excretion in the urine did not differ in the patients with intestinal shunt after the weight had stabilized. Thus, drug absorption and hepatic drug metabolizing capacity appear to be unaffected 12--57 months after intestinal shunting.


Gastrin concentrations in serum and gastric mucosa in patients with pernicious anaemia. Sessile polyps in the antrum were found in 12 of 51 patients with pernicious anaemia. During gastroscopy, mucosal biopsies for gastrin determination were taken from the antrum and fundus and from the polyps. Patients with high gastrin concentration in the antral mucosa showed high serum gastrin concentrations, while most patients with low antral gastrin concentrations also had low serum gastrin values. On an average, the gastrin concentrations in the antrum were approximately 10 times, and those in the fundus approximately 100 times, higher than the corresponding values obtained in a reference group. The gastrin content in the polyps was not different from that in the surrounding antral mucosa. This study suggests that the polyps are not due to a functional hypertrophy of the antral mucosa caused by locally increased production of gastrin.


Surgical treatment of primary liver carcinoma. Forty-five patients with primary liver carcinoma were treated between 1960 and 1975. Sixteen patients were less than 15 years of age. All patients underwent diagnostic laparotomy, while liver resection was performed in 16 (36%). Resectability was higher in children than in adults. Left lobectomy was performed in 8 patients, right lobectomy in 3, and an extended right lobectomy in 5 patients. One patient died postoperatively, i.e. mortality was 6%. Of the surviving 15 patients 4 died from metastatic tumor within 18 months after surgery. Patient survival at 2 years was 73%. The present material favors radical surgery of primary liver carcinoma whenever possible.


Crohn's disease. Recurrence after surgical treatment. A series of 76 patients who have undergone surgical treatment for Crohn's disease is presented. In 14 of the patients surgery was performed for recurrence after previous resection. In total, 91 intestinal resections and one bypass--operation were carried out. Postoperative mortality comprised 4 patients (5.3%), and there were 4 late deaths. Sixty-six patients were followed up for periods ranging from 2 to 11 years, with a median of 4.0 years. Recurrence rates and reoperation rates were determined by actuarial analyses. The yearly recurrence rate seemed constant during the observation period, averaging 15.2%, and the cumulative recurrence rate was thus 77% after 9 years. The reoperation rate also seemed to be constant, and on the average 5.5% per year, and the cumulative reoperation per cent after 9 years was 45. There was no significant difference between cumulative recurrence rates after primary operations and after operations for recurrence. There was a significantly higher risk of relapse during the first year after non-radical excision of the diseased part of the gut than after radical excision. The majority of the patients were in good general condition at time of review; only 3 patients suffered from marked symptoms with reduced working capacity.


Malrotation of the duodenum. Frequency in a radiographic control group. In a prospective radiographic study, abnormal configurations with kinking and torsion (malrotation) of the duodenum were found in 41% of 150 non-dyspeptic subjects. Malrotation of the duodenum (MD) was more frequent before the age of 30, and in the entire series the frequency decreased significantly with age from approximately 60% at 20 years to approximately 25% in individual aged 35 years or more. It should be considered whether the same radiographic configuration as in MD up to the age of 30--35 years is merely due to uncompleted disposition and fixation of the duodenum, so that the diagnosis of MD cannot be definitely established until after that age. In the presence of MD, the luminal diameter of the duodenum was larger than normal, and there was a greater tendency to gastric retention at 4 hours after the barium meal.


Malrotation of the duodenum and duodenal ulcer. In 173 patients with surgically confirmed duodenal ulcer, malrotation of the duodenum (MD) was found in the pre-operative radiographs in a total of 54% without significant differences in the age and sex distribution. As compared with a control group, the frequency of MD was significantly increased in men and in patients over 50 years (Table I). The luminal diameter in the presence of MD was larger in the ulcer patients than in the control group (Table II). Gastric retention at 6 hours after the barium meal was more frequent in ulcer patients with MD than in those with normal duodenal configuration, and in both groups more frequent than in the control group. At a follow-up examination at least 12 months after the operation for duodenal ulcer, a significant tendency to a poorer result was revealed in patients with MD, manifested by persistent or postoperatively developed postcibal pain, fullness, nausea and vomiting (Table III-V), except in patients who had undergone parietal-cell vagotomy without pyloroplasty. The latter observation suggests that, in the presence of MD, preserved pyloric function is of significance in the frequency of subsequent manifest symptoms of this anomaly.


Liver histology in a 'normal' population--examinations of 503 consecutive fatal traffic casualties. The liver histology of 503 consecutive victims of fatal (within 24 hours) traffic accidents submitted to medico-legal autopsy are used as a standard of reference. In 370 persons (74%) no pathological changes in the liver biopsies were observed. Fatty liver was found in 120 persons (24%), non-specific portal inflammation in 7 persons, alcoholic hepatitis in 6, and portal fibrosis in 5. No cases of cirrhosis, chronic aggressive hepatitis, changes compatible with chronic persistent hepatitis, viral hepatitis, or other internationally accepted morphological diagnoses were found. A significant positive correlation between the frequency of steatosis and age groups was demonstrable. Fatty liver was found in 1% of persons below 20 years, in 18% between 20--40 years, and in 39% of persons more than 60 years in this normal material. The persons with fatty liver had a higher body weight, but the overweight was not correlated to age. It is concluded that fatty infiltration in the liver is a normal observation in aged persons.


The functional state of the gastrointestinal tract after ulcer surgery. A ten-year prospective follow-up study. Of 35 patients operated upon for peptic ulcer and subjected to absorption tests before operation, 26 could be followed up with absorption tests for 1, 6, and 10 years after operation. The following operations had been performed on the latter: antrectomy with gastroduodenostomy in 10, antrectomy with selective vagotomy and gastroduodenostomy in 9, and other operations in 7. None had recurrence of the ulcer or disturbing abdominal complaints during the follow-up period. Ten years after operation there was an increase in the mean value of the Schilling test, and all patients had a normal serum B12 vitamin level. On the other hand, a decrease was noticed in the mean value of the d-xylose test and an increase in that of faecal dry-weight fat content. At the time of the 10th year follow-up examination, 6 patients had an impaired d-xylose absorption and 7 an impaired fat absorption. According to the increase in the mean body weight and the serum protein and haemoglobin concentration, the nutritional status had not worsened.


The synthesis and excretion of non-erythroid bilirubin in the dog. Between 10 and 20% of the bilirubin excreted in the bile is not derived from the breakdown of hemoglobin. When delta-aminolevulinic acid is given as a bilirubin precursor, 99% of the bilirubin formed is of this non-erythroid variety. The non-erythroid bilirubin has been supposed to be synthetized exclusively in the liver. Sequential samples of arterial, portal and liver vein blood, as well as of bile and thoracic duct lymph, were analyzed for bilirubin and non-bilirubin radioactivity following the injection of labeled delta-aminolevulinic acid in dogs. Radioactive bilirubin appeared in blood before it could be demonstrated in bile or lymph. The concentration differences between aortic, portal and liver vein blood displayed a considerable extrahepatic non-erythroid bilirubin synthesis. Most non-erythroid bilirubin synthetized in the liver is excreted directly into the biliary canaliculi.


Serological evidence of hepatitis B infection in patients with chronic liver diseases: radioimmunoassay of HBsAg and anti-HBs. The prevalence of hepatitis B surface antigen (HBsAg) and anti-HBs was determined by a sensitive double-antibody radio-immunoassay technique in a series of patients with chronic liver diseases. HBsAg was demonstrated in 37 out of 98 consecutive patients with chronic hepatitis (38%) and in 14 out of 108 patients with non-alcoholic cirrhosis (13%). HBsAg was not found in any of the patients with steatosis, alcoholic cirrhosis, or primary biliary cirrhosis. In the patients with chronic hepatitis HBsAg or anti-HBs was demonstrated in 83% of the patients below 40 years of age in contrast to 48% of the patients more than 40 years of age. It is concluded that a substantial part of the patients with chronic hepatitis has serological evidence of actual or past hepatitis B virus infection. This is in contrast to the groups of patients with other chronic liver diseases.


On the quantitation of Iso-amylases in serum and the diagnostic value of serum pancreatic type amylase in chronic pancreatitis. The object of this study is to elucidate whether the quantitative determination of serum pancreatic type iso-amylase can be used as a diagnostic test for exocrine pancreatic insufficiency. We describe the normal appearance of serum amylase zymograms produced with an agarose electrophoresis technique and the reference values from studies of 142 normal subjects for salivary and pancreatic type amylases. The patient group comprises 95 cases assumed to be representative of a patient population in which verification or exclusion of a diagnosis of chronic pancreatitis is of importance. In this group exocrine pancreatic function has been assessed by means of the Lundh meal test. We find that a low serum pancreatic type amylase value indicates the presence of a reduced exocrine pancreatic function (p = 0.96), and that a normal or elevated serum pancreatic type amylase value excludes the presence of a severe exocrine pancreatic insufficiency (p = 0.91). We also describe the occurrence of an abnormal amylase fraction which may be of diagnostic significance in pancreatic disease.


Time-related enzyme concentrations in duodenal aspirates after ingestion of a test meal. The concentration of trypsin, pancreatic iso-amylase, phospholipase, and lipase were determined in intestinal content during the first two hours of digestion of a test meal. In normal subjects the concentration curves for all enzymes displayed a typical biphasic pattern. In patients with chronic pancreatic disease, the typical variations of the enzyme concentrations were markedly diminished. In patients with celiac disease, the initial peak of the trypsin and phospholipase activities seemed to be delayed, and in patients operated upon with a Polya gastric resection the concentrations of trypsin and phospholipase increased gradually. In these two disorders the lipase concentration curve was of quite a different, uncharacteristic pattern. It is suggested that the concentration curves of the enzymes reflect pancreatic secretion. Furthermore, the secretion of lipase in celiac disease and following gastric resection seems to be 'non-parallel'. Owing to a fairly considerable variation in the values from different individuals, it seems reasonable to conclude that in clinical practice determination of enzyme concentration curves after a test meal probably does not improve the reliability of the conventional Lundh test.


Amylase thermolability in body fluids.

Amylase thermolability in body fluids. The thermolability of amylase was measured in saliva, pancreatic juice, urine, adult and neonatal sera. The mean percentage thermolability from these fluids was 100%, 99%, 87%, 44% and 23% respectively. In patients with acute pancreatitis and mumps the amylase was 84% and 83% thermolabile during the acute phase. On resolution of the pancreatitis this dropped towards normal. Patients with a pancreatic pseudocyst showed a high mean percentage thermolability (82%). These results could suggest that a component of amylase in human serum is not of pancreatic or salivary origin. In addition, this simple technique may be helpful in the diagnosis of pancreatic pseudocyst.


Serum ferritin and erythrocyte 2,3-DPG during quantitated phlebotomy and iron treatment. Serum  ferritin and erythrocyte 2,3-DPG levels were followed  in 3 healthy males who were phlebotomized to iron depletion and a moderate anaemia. In 2 of the subjects, the  expected rise in DPG levels was seen but not in the third, in spite of a Hb concentration of 95 g/1. Serum ferritin levels were found to reflect changes  in iron stores, and subnormal serum ferritin indicated depleted iron stores. However, there was no correlation between pre-phlebotomy ferritin levels and calculated iron stores. The conclusion is that no fixed ratio can be established between serum ferritin and iron stores. A single ferritin value within the normal range does not tell  how large iron stores a person has. Changes in an individual's iron stores can, however, be detected by repeated ferritin estimations.


Anorexia nervosa and polymorphonuclear (PMN) granulocyte reactions. 10 patients with anorexia nervosa were compared with controls with normal weight, regarding their peripheral blood polymorphonuclear (PMN) granulocyte reactions. The anorexia patients showed a statistically significant decrease in PMN bactericidal capacity and PMN adherence. The mean chemotaxis did not differ, but in two of the anorexia patients chemotaxis was almost absent. The intracellular activity of alkaline phosphatase was below the reference values in 5 of the 6  patients in whom it was investigated. It is concluded that changes in granulocyte function may be noted in anorexia nervosa, but their clinical significance is uncertain, as no patients had  recurrent or severe infectious diseases.


Studies on human preleukaemia. I. Erythroblast and iron kinetics in aregenerative anaemia with hypercellular bone marrow. In 34 patients with aregenerative anaemia and hypercellular bone marrow, a condition earlier suggested to be of a preleukaemic nature, erythroblast thymidine labelling indices (LI) were significantly decreased, as would be expected in preleukaemia. The 59Fe erythrocyte incorporation after 2 weeks was generally low. The 59Fe plasma clearance was fast in 22 of 31 patients, normal in 5 and moderately prolonged in 4. These 4 patients had  a low relative number of erythroblasts in the marrow. A significant relationship between the marrow erythroblast number and the 59Fe plasma clearance could be demonstrated. Cases with an increased number of mueloblasts in the marrow did differ significantly from the rest in LI and iron incorporation.


Complement-dependence of platelet serotonin release test in polytransfused  patients. The research of platelet isoantibodies in patients with Cooley's anaemia was performed by simultaneous determination of the platelet-complement fixation  test, platelet factor 3 availability assay and 14C-serotonin release test. In 93% of the examined patients we obtained positive results with the 5HT-release test, which appeared to be a complement-dependent reaction in most  of the sera-containing isoantibodies, different from sera of patients affected by  autoimmune thrombocytopenia.


Pirimicarb induced immune haemolytic anaemia in dogs. The feeding of pirimicarb (2-dimethylamino-5,6-dimethylpyrimidin-4-yl dimethylcarbamate) to normal beagle dogs resulted in anaemia in a small number of animals. Dosing studies confirmed pirimicarb as the causative agent and the anaemia was characterised as haemolytic. Serological tests revealed the presence of an IgG antibody active only in the presence of pirimicarb. The level of antibody detected was related to the dose of pririmicarb given.


The procoagulant activity of adipose tissue. Homogenates of several rat and human adipose tissues contain procoagulant activity mainly due to the presence of tissue thromboplastin. Intravenous injections in rats of the active fraction from such homogenates cause the accumulation of 51Cr-labelled platelets and 125I-labelled fibrin  in the lungs. The effect of phospholipase C and of specific antibodies against tissue thromboplastin on this procoagulant activity of adipose tissue has been studied in vitro and in vivo.


Stem cells and small lymphocytes of congenitally asplenic-athymic mice. Quantitative and autoradiographic results. A new type of animal: Mice with congenital absence of both the spleen and the thymus (ASAT mice)  have been investigated. Haemato- and lymphocytopoietic findings in these mice were compared to findings in cogenitally asplenic (AS), congenitally athymic (AT), and normal mice. Major findiings were: (1) Normal number of CFU-S in bone marrow of ASAT mice and presence of CFU-S in lymph nodes of these mice, (2) High numbers of theta-positive cells in the bone marrow of ASAT and AT mice, (3) Low numbers of bone marrow lymphocytes as well as thoracic duct lymphocytes in ASAT and AT mice, and (4) Comparable proliferative kinetics of small lymphocytes in all 4 groups of  mice, an exception being a rapid appearance  of newly-formed small lymphocytes in  thoracic duct and lymph nodes of ASAT mice.


[Ventricular tachycardia "with reversal of points" and electrolyte disorders]. Ventricular tachycardia "with reversal of points" is described and its occurrence in electrolyte disorders (hypokalemia, hypomagnesemia), particularly in combination with antiarrhythmic drugs, is discussed. This ventricular tachykardia occurs in cases of disturbed and prolonged repolarization and is typified by periodically changing amplitude in the ECG ("reversal of points"). From the therapeutic point of view acceleration of heart rate by use of either sympathicomimetic drugs or pacemaker has proved successful. This distinguishes the treatment from that of other ventricular arrhythmias.


[4 cases of potassium enteropathy].

[4 cases of potassium enteropathy]. The oral use of enteric-coated potassium chloride (and apparently of its slow-release form too) to compensate potassium loss during thiazide diuretic treatment may engender ischemic enteropathy. This iatrogenic condition is linked to the vaso-active properties of KCl, which act on blood vessels often damaged by hypertension or chronic heart failure. Four observations are presented involving stenosing ulceration or perforation of the small bowel following oral KCl treatment. The main clinical, pathological and therapeutic aspects are discussed.


[Scurvy in an adult].

[Scurvy in an adult]. The case is reported of a 29-year-old previously healthy female patient who developed the typical clinical picture of scurvy eight months after changing to a diet exclusively containing cooked cereals. Serum levels of B12, folic acid, and calcium were lowered and the alkaline phosphatase was slightly raised due to the dietary lack of vitamins A, D, B12 and folic acid. No clinical signs of these deficiencies could be observed. Addition of vitamin C to this diet resulted in complete cure in a matter of days. Signs and symptoms of scurvy are discussed in the light of the recent literature. This rare disease is particularly worth considering if one of the following situations is encountered: hemorrhages in the skin, muscles, joints or mucous membranes without apparent cause; therapy-resistant ulcers of mucous membranes in elderly patients; Sicca syndrome and/or wounds exhibiting poor healing.


[Clostridium infections with and without manifest gas gangrene. Report on 77 infections in 76 patients]. Systematic microbiological research and correlation of the histopathological findings obtained from random autopsies revealed 23 hitherto undetected clostridial infections including 11 cases of gas gangrene, 4 of septicemia, 3 of bacteremia, and 5 other clostridial infections. The knowledge gained from this study led to clinical diagnosis of several cases of gas gangrene which were confirmed bacteriologically and histologically. Of 8 hospital patients who were thus diagnosed in this surgical clinic, 7 recovered, including a case of gas gangrene of the abdominal wall. The problem in gas gangrene is timely clinical diagnosis. Little is known about gas edema illnesses which are not traumatically conditioned. Recognition of the local and general symptoms (local, violent, yet inappropriate pain in the wound, "unexplained" postoperative secondary bleeding, appearance of tachycardia wholly unrelated to the patient's temperature, sudden shock, rapid deterioration of patient's general condition, jaundice and rise in CPK) makes it possible to diagnose postoperative gas edema in time. 77 infections with isolation of clostridia, seen in 76 patients, are reported. On the basis of clinical and histopathological criteria they have been classified as follows: 22 cases with gas gangrene (clostridial myonecrosis), 16 cases with anaerobic cellulitis, 20 wound infections, 8 cases of septicemia, 5 of bacteriemia, 1 of tetanus, and 5 other clostridial infections.


[Fertility of semi-castrated and irradiated patients with testicular tumors]. The fertility of 62 patients has been followed up by spermatographic analysis. The patients had had malignant testicular tumors treated by semicastration and postoperative X-irradiation between 1957 and 1975. Only 52 patients produced utilizable ejaculates, and these were divided into 8 groups according to the X-ray field arrangement employed. In this way a direct correlation could be established between the field arrangement (viz. field magnitude and gonad load) and the ejaculate findings. From the results it is concluded that azoo- and oligospermia are not a hormonal change induced by the tumor but rather the consequence of X-ray damage of the spermatophores. Azoo- and oligospermia are dependent on the X-ray load on the remaining testis and on the time which has elapsed since the terminaination of treatment. About 15-20% intact fertility can still be found in these patients.


[Liver pathology in juvenile chronic polyarthritis]. Besides lymphodenopathy and splenomegaly, hepatomegaly may also be detected in 25-50% of children with juvenile rheumatoid arthritis. This is particularly evident in patients with complete Still's syndrome. The hepatomegaly increases during relapse situations and disappears during remissions. Transient icterus, elevation of aminotransferases and delayed bromsulfalein excretion have been reported, particularly in patients with complete Still's syndrome, and indicate impairment of liver function. Liver biopsies have been performed only rarely and show nonspecific infiltrations of portal fields with lymphocytes and, in a few cases, "autoimmune" hepatitis and even cirrhosis with portal hypertension. Plasma cell hepatitis with affection of joints can be readily differentiated from juvenile rheumatoid arthritis: the synovitis is merely transiet and disappears with institution of steroid therapy. As in the adult, severe liver dysfunction leads to remission of arthritis. Amyloidosis should be considered in every case of long-lasting hepatomegaly.


[Paraneoplastic eosinophilic leukemoid with eosinophilic parietal thromboendocarditis in malignant melanoma]. A case of an eosinophilic leukemoid reaction associated with metastasizing malignant melanoma and thrombotic eosinophilic parietal endocarditis in a 58-year-old white male is reported. No similar cases were found in the literature. The leukemoid reaction with leukocytosis of up to 102 300 white cells per microliter , 65% of which were eosinophils, was observed during the last two months of life of the patient, who died of multiple metastasis of malignant melanoma. The primary malignant melanoma had been excised four years before death. The parietal endocarditis was localized on the posterior wall of the left ventricle and was found incidentally at autopsy. The association of leukemoid eosinophilic reaction with consecutive eosinophilic thrombotic parietal endocarditis is believed to be part of a paraneoplastic syndrome. 63 published cases of paraneoplastic eosinophilic leukemoid reaction and 6 published cases of malignant tumor with eosinophilia and additional parietal endocarditis were found. The pathogenesis of these conditions is discussed.


[Complications in null-diet].

[Complications in null-diet]. Total starvation is effective for acute weight reduction in obesity. However, in 200 patients, most of whom also had internal diseases, 8% exhibited sometimes severe complications, i.e. reversible cerebral ischemia in 3 hypertensive patients when the blood pressure was lowered to the normal range by natriuresis of fasting; breakdown of water and electrolyte homeostasis with circulatory collapse, vomiting and vertigo; acute crises of paroxysmal nocturnal hemoglobinuria and porphyria respectively and increase of transaminases up to 200 mu/ml, or cardiac arrhythmias. Relative (?) contraindications for total fasting appear to be clinical sings of arteriosclerosis such as vascular bruits, angina pectoris and intermittent claudication. In case of doubt, the method should only be used in hospital.


[Echocardiography in the evaluation of ventricular function]. The ultrasonic beam used for quantitative assessment of left ventricular (LV) function traverses the heart in a projection similar to the familiar angiographic left anterior oblique projection. It crosses the anterior wall of the right ventricle, the right ventricular cavity, the interventricular septum, the LV cavity and the posterior wall of the left ventricle. Whereas the cyclic changes of the right ventricular diameter are rarely clearly determined by echocardiography, the easily assessed cyclic changes of the LV endocardial transverse diameter are useful measure of LV FUNCTION. Of practical importance are the percentage of systolic shortening of the LV diameter (%Sh) and the mean velocity of circumferential fiber shortening (VCF). There are several factors, such as placing of the ultrasonic transducer, the shape and size of the LV cavity and rotational movements of the heart as a whole, that influence echocardiographic determination of the transverse LV diameter. In patients with asynergic contraction, %Sh and VCF cannot be used as measures of overall LV performance, but localized contraction disturbances of the septum and the posterior wall may be detected from the reduced extent of wall motion in a given LV segment during a full sweep from the base to the apex. The most important indications for echocardiographic assessment of LV function are valvar diseases with chronic LV pressure or volume overload, and congestive cardiomyopathy. Echocardiography has proved useful in serial evaluation of LV function in patients undergoing valvar heart surgery. Assessment of LV volume by standard echocardiography using the cubic formula is not satisfactory. More accurate determination of volumes is provided by formulas that include the actual ratio of the LV long axis to the minor axis.


[The value of acetylsalicylic acid for the prevention of postoperative thromboembolic complications]. All studies on the value of acetylsalicylic acid for the prevention of postoperative thromboembolic complications have been evaluated. Controlled, prospective and randomized studies have been analyzed only where the incidence of postoperative deep vein thrombosis or pulmonary emboli was proven by objective diagnostic methods such as the fibrinogen test, phlebography or autopsy. In 6 studies there is no significant reduction in the incidence of deep vein thrombosis in general surgical and orthopedic patients after acetylsalicylic acid prevention. One study, though it has definite methodological defects, does suggest a significant reduction in the number of postoperative fatal pulmonary emboli in 120 patients with fractures of the upper end of the femur. On the basis of all these data, the prevention of postoperative thromboembolic complications by means of acetylsalicylic acid cannot be recommended.


[Microcirculation studies on rat small intestine villi in vivo]. A method of observing and studying the microcirculation in the jejunal villus of the living rat is described. It permits measurement of the velocity of plasma gaps and of the diameters of the various vessels, and is based on transillumination of the exposed mucosa. The motility of the gut is overcome by allowing the intestine to adhere to the water-immersion lens. The problems of mucous secretion are resolved by administration of N-acetyl-L-cystein. A direct arteriovenous connection between arterioles and the venous system of the villus is postulated. Plasma gap velocity is 1.78 +/- 0.62 mm/sec in the arterioles and 0.42 +/- 0.08 mm/sec in the capillaries. The measured diameter of the of the erythrocyte column in the vessels is: central artery: 9.14 +/- 1.89 micron; "arcade" arteriole part I, II and III respectively: 5.88 +/- 1.05 micron, 6.69 +/- 1.04 micron, 8.86 +/- 1.63 micron; venule: 13.58 +/- 2.67 micron; capillaries: 4.56 +/- 0.57 micron. The method also allows puncture of the villus vessels.


[Electrocardiographic modifications in candidates for medical examinations]. 17 medicine undergraduates sitting their final examinations underwent continous ECG recording during a period of 3 h. Their usual heart rate was 71 +/- 9 per minute, accelerating to 149 +/- 13, most often at the moment of entering the examination room. This reaction was usual in all candidates despite their knowledge that the failure rate at the exams is always very low; all of this group likewise passed. Two subjects exhibited marked alterations in the terminal phase compatible with myocardial ischemia. In 6 cases severe sinus rhythm variations evidenced an unstable balance of the vagal and adrenergic stimulations. No other arrhythmias, augmentation in the number of premature beats or atrio-ventricular blockade were observed. Analysis of the results shows that the heart response to psychic aggression differs from that to physical effort.


[Alcohol-induced hyperlipoproteinemia].

[Alcohol-induced hyperlipoproteinemia]. Tests on 100 alcoholic patients revealed increased lipoprotein levels in 24%. Type IV was the most frequently ecountered (80%), followed by type II or V. The average plasma triglyceride level of the alcoholic group was significantly increased in comparison with a control population. The causal mechanism of alcoholic hyperlipoproteinemia remains poorly understood. The combination of a genetic defect of lipid metabolism, nutritional factors and acute alcohol excess may have an essential bearing on the incidence of hyperlipoproteinemia. Acute excessive intake of alcohol was significantly increased in comparison with alcoholic subjects wihtout hyperlipoproteinemia. The critical dose may be a daily ethanol consumption of about 200 gm. There appeared to be no correlation between acute pancreatic injury or active liver disease and serum lipid elevation. On the other hand, the observation was confirmed that alcoholic patients with hepatic cirrhosis usually do not develop hyperlipoproteinemia. Ethanol-induced hyperlipoproteinemia may be a risk factor for the development of atherosclerosis and pancreatitis.


[Cytostatic pneumopathy following chemotherapy for metastasizing breast neoplasm]. A 69-year-old patient treated with anticancer polychemotherapy for metastatic breast carcinoma died of respiratory distress and cardiac failure 3 months after commencement of therapy. At autopsy only a few pleural micrometastases were found. Microscopic study revealed early lung lesions due to cytotoxic drug treatment. While the earlier literature described different lesions associated with different antineoplastic drugs (busulfan, bleomycin), today there is more emphasis on the common pathological features. Therefore, instead of the expressions "busulfan lung" or "bleomycin lung", we suggest the use of the term "Zytostatika-Pneumopathie" (cytostatic drug induced lung disease).


[Efficiency of the blood cell separator Haemonetic 30 in the separation of platelets from single donors]. By means of the Haemonetic 30 separator we were able to collect 4.1 +/- 0.94 X 10(11) (X +/- 1 SD) platelets in 57 procedures consisting of 5-6 cycles. The platelet yield was significantly influenced by the blood volume processed and by initial platelet counts in donors. Augmenting platelet collection volume in the red colored part of the buffy-coat from 10-20 ml did not increase the yield. Transfusion of collected platelets into 27 non-sensitized patients showed normal recovery of 43% at one hour and shortening of bleeding time from over 30 min to a mean of 5 min 20 sec in 12 patients tested. Autotransfusion of 51Cr-labeled platelets into 8 healthy donors revealed identical recoveries (42 +/- 12%) and a normal survival time (9.2 +/- 0.7 days).


[A family with hereditary hypofibrinogenemia]. A family with congenital hypofibrinogenemia (fibrinogen levels of 60-90 mg%) has been studied. Out of 19 members tested, 11 exhibit this trait, which follows a strictly autosomal-dominant pattern of inheritance. Congenital hypofibrinogenemia appears to be a separate entity which can be distinguished from heterozygous individuals of congenital afibrinogenemia and from congenital dysfibrinogenemia. A bleeding tendency of clinical significance is observed only during major surgery or after severe injury.


[Characteristics of nucleic acids excreted by non-stimulated normal human lymphocytes]. Unstimulated human blood lymphocytes have been shown to release in vitro a complex containing DNA and RNA. These nucleic acids are composed of newly synthesized material and appear to be released according to a homeostatic mechanism. Extracellular synthesis of the released DNA has been demonstrated by using a nearest neighbor analysis technique. The characteristics of the extracellular nucleic acids have been investigated biochemically and by electron microscopy.


[The effect of various cryoprotective agents on the human bone marrow]. The following combinations were evaluated as cryoprotectors of human CFU-c enriched bone marrow frozen for one hour at -190 degrees C: 10% DMSO, 1% DMSO + 9% dextran (Dx), 1% DMSO + 9% HES, 15% glycerin (Gc), 1% Gc + 9% Dx, 1% Gc+ 9% HES, 5% Gc + 4% glucose. Cell counts and CFU-c content were compared with controls left at 4 degrees C. Highest values were observed with 10% DMSO and with 1% DMSO + 9% Dx. These studies confirm the superiority of DMSO to Gc as a cryoprotector. With the combination of 1% DMSO + 9% Dx the removal of DMSO prior to reinfusion of the marrow is obviated. This should facilitate the clinical use of autologous marrow transfusion.


[Distinction between benign and malignant monoclonal gammopathies on the basis of bone marrow and serum studies]. Studies were performed on bone marrow and serum from 28 patients with clinically benign gammopathy and 41 patients with the malignant monoclonal form. In the bone marrow samples, the total number of plasma cells and the monoclonal fraction of these cells were determined by immunofluorescence. Serum samples were analyzed for monoclonal immunoglobulin components and for the total serum protein content. The data could be used for discriminant analysis. The variables had to be transformed and were included in the discriminant function in a stepwise procedure. The resulting function made possible a clear distinction between benign and malignant monoclonal gammopathies.


[ABO compatibility and isoimmune neonatal thrombopenia]. 25 families with serologically documented isoimmune neonatal thrombopenia were investigated for ABO-antigens of mother and child. In all cases mother and child were ABO-compatible. It is concluded that feto-maternal ABO-compatibility is a prerequisite for the development of isoimmune neonatal thrombopenia; hence, platelets must have ABO-antigens or be covered by soluble ABO-antigens.


[Anti-phospholipid antibodies as a cause of immunologic thrombopenia and thrombopathies]. The simultaneous occurrence of platelet antibodies (ab) and a circulating "antithromboplastic" anticoagulant in a patient with thrombocytopenia led to the hypothesis that antiphospholipid ab may be causing both phenomena. Of 55 sera obtained from thrombocytopenic patients exhibiting a positive microtest for complement fixation (CFT) with platelets, 37 also gave positive results with highly purified phospholipids (Phl) used as antigen. In order to further evaluate the role of Phl, 40 different liposome suspensions obtained by sonication of various mixtures of Phl (with/without addition of cholesterol) were tested as antigen in the CFT with 11 selected sera, and as platelet factor 3 (PF3) reagent in the partial thromboplastin time test with normal plasma. Eight liposome preparations with PF3 activity (all containing phosphatidyl-serine) were equally active as antigen (ag) in the CFT. Liposomes composed of phosphatidyl-ethanolamine and sphingomyeline delivered ag-activity only. Since the two substances are accessible components of the outer membrane surface of thrombocytes, anti-Phl-ab may well bind to platelets in vivo, causing thrombocytopenia. Coagulation-inhibiting activity of these ab could be directly demonstrated in a PF3-test system (thrombocytopathy caused by PF3 inhibition). The identity of antithromboplastic anticoagulant and anti-Phl-ab was further substantiated by immunoabsorption, since both activities were simultaneously eliminated from the sera with a Phl-charcoal adsorbent.


[Fibrinogen Zürich I: defective fibrinopeptide-A release]. Fibrinogen Zurich I (FZI) is characterized by delayed fibrin monomer aggregation. It has been previously shown that the patient fibrinogen is composed of two populations of molecules, one aggregating normally and the other not aggregating at all but interfering with the aggregation of the normal population. By use of a radioimmunoassay for fibrinopeptide A (FPA), only approximately half of the expected FPA could be recovered after thrombin and Defibrase proteolysis. Even after exhaustive proteolysis with 2 thrombin units of Defibrase, no further release of FPA could be obtained. The defective FPA release was confirmed by measurement of the N-terminal Gly/Tyr ratio. It may be assumed that the abnormal aggregation of one fraction of FZI is due to the defective FPA release from this fraction.


[The effect of low fibrinogen concentrations on human blood viscosity]. Simultaneous studies of viscosity, red cell aggregation and deformation were carried out on human blood with different fibrinogen concentrations using a Brookfield viscometer fitted with a reflection photometer. Fibrinogen progressively increased rouleaux formation, while decreasing viscosity at low and increasing it at higher concentrations. This antagonism is explained by the specific hemodynamic effects of the rouleaux formed under either condition.


[Effect of alcohol on iron absorption].

[Effect of alcohol on iron absorption]. The authors have investigated the assumption that alcohol increases iron absorption. Using the whole body counter technique, they show that iron absorption is lowered significantly by addition to the test dose of either normal or dealcoholized whisky, but that there is no difference between these two latter groups. Wine has a similar effect. The use of ethanol added to a test meal demonstrates that it is organic iron, and not the inorganic form, whose absorption is diminished by alcohol.


[The therapeutic scope of oral anticoagulation]. Evaluation of the therapeutic range of oral anticoagulation for different commercial thromboplastins in comparison with Quick's human brain thromboplastin and Thrombotest is based on simultaneous performance of all methods for each blood sample, on strict adherence to the manufacturer's instructions and on adequate statistical analysis.


[Residual pulmonary hypertension after surgical correction of left-right shunts. Therapeutic implications (proceedings)]. Late closure of left to right shunts with pulmonary hypertension may leave residual pulmonary hypertension. To determine the best period for total repair, a large number of factors must be taken into account: --the spontaneous evolution of left to right shunts; --the prognosis or residual pulmonary hypertension after total repair; --the probability of total recovery after surgery of the various types of shunting, related to the age of operation. From these factors, it appears that: --the closure of atrial septal defects (where pulmonary hypertension is never major in the child) can wait till childhood or adolescence; --ductus arteriosus must be repaired before the age of 2 years; --in ventricular septal defects with pulmonary hypertension, the best chance of recovery is secured when surgery is performed between the ages of 1 and 2. Earlier intervention should be considered only if medical therapy is ineffective. After that period, it may leave pulmonary hypertension in being.


[Experimental myocardial infarct in the pig: effect of temporary ligation and revascularization on the ST segment in the epicardial ECG and on the incidence of ventricular fibrillation]. A short period of myocardial ischemia induced by temporary ligation of 2 min duration prior to occlusion of the left anterior descending branch of the left coronary artery (LAD) in the pig does not have a beneficial effect on epicardial ST-segment alterations or on the incidence of ventricular fibrillation. One-stage ligation therefore seems to be the procedure of choice in occluding the porcine LAD. In 14 of 24 animals an isolated alternans of the ST-T segment was observed during the first few minutes of occlusion. Reperfusion after 60 min caused temporary increase of the ST-segment alterations, in contrast to the findings in the dog, where revascularization causes prompt return of the ST-segment to the pre-occlusion level. In addition, ectopic rhythms were frequently observed after removal of ligation.


[The role of reduction of the heart rate in the favorable effect of the beta blockers on myocardial ischemia due to isoprenalin in patients with angina pectoris]. In the patient suffering from angina, the protective effect of oxprenolol in the isoprenaline test is demonstrated by the reduction of disappearance of ischemic-type electrocardiographic alterations and of angina and rhythm disturbances. In our study, these results were obtained in spite of neutralization of the negative chronotropic effect of the beta-blocker through the use of an endo-auricular pacemaker. This points indirectly to the role played by the contractile state of the myocard in catecholamine-induced modifications of the oxygen intake of cardiac muscle.


[Modifications of the coronary blood flow and of myocardial lactate metabolism due to pacing in coronary disease]. The variation of coronary sinus blood flow during pacing-induced tachycardia shows no direct correlation with the number of affected coronary arteries. As a functional test, total coronary blood flow is a parameter with low sensitivity in characterizing patients with coronary artery disease and thus appears unsuitable in the selection of patients for medical or surgical treatment. The thermodilution technique remains useful for the assessment of the effects of new drugs on the heart, for the evaluation of a therapeutic intervention, and for the selective measurement of regional myocardial perfusion in the anterior interventricular vein.


[2 years of clinical experiences with lithium pacemakers]. Between January 1974 and December 1976, 470 mercury-cell pacemakers and 353 lithium-cell pacemakers were implanted at Surgical Clinic A of the University Hospital of Zurich. Within the first 24 months 15.5% of the mercury-cell pacemakers had to be exchanged because of premature battery depletion and 1.3% due to dysfunction of electronic components. None of the lithium-cell pacemakers had to be removed for these reasons. In 6 lithium-cell pacemakers, however, overhaul was necessary because of sensing failure. One unit had to be removed after one year for local decubitus. In two cases, repositioning of the batteries was necessary because of local muscle stimulation.


[Determination of serum digoxin: a path to better control of therapy?]. The usefulness of serum digoxin measurements in the diagnosis of digitalis toxicity was studied prospectively in hospitalized patients. Serum levels were increased above 2 ng/ml in 28 of 32 cases with digoxin-induced arrhythmias and/or gastrointestinal symptoms, whereas only 1 of 35 non-toxic patients had an abnormal serum concentration. There was, however, no direct relationship between the type of toxic manifestation and absolute values of serum digoxin.


[Hypersensitive carotid sinus reflex in older patients. Incidence and significance for the diagnosis of sick sinus node]. Carotid sinus massage was performed in 100 consecutive patients over the age of 50 years: 63 showed a normal reaction and sinus bradycardia occurred in 12, whereas sinus arrest was registered in 22 and total AV block in 3. With atrial pacing only 2 patients with sick sinus syndrome could be detected. Intravenous administration of atropine did not help to identify them. We conclude that in 1/4 to 1/3 of these elderly people the sinus node reacts in a hypersensitive manner to carotid sinus massage, but this does not imply the diagnosis of sick sinus syndrome.


[Myocardial function and metabolism during local coronary flow reduction]. In 6 open chest dogs, regional myocardial function und metabolic changes (ATP, creatine phosphate, lactate) were studied during coronary flow reduction in LAD by ultrasonic dimension gauges and transmural biopsies. After reduction of the perfusion pressure from 108 to 50 mm Hg the ischemic segment showed a marked dyskinesis: the enddiastolic segment length increased by 7%, and segment shortening and segment stroke work decreased by 22% and 63% respectively. Left ventricular (LV) enddiastolic pressure rose from 5 to 8 mm Hg (p less than 0.05). Heart rate, LV systolic pressure, LV max dP/dt and Vpm did not change significantly.


[Usefulness of echocardiography in the diagnosis of bacterial endocarditis]. Echocardiographic demonstration of vegetations has been achieved in 11 out of 19 patients with bacterial endocarditis. The present study shows that echocardiography is particularly useful in patients in whom the duration of symptoms before treatment is greater than 6 weeks. It also shows that a positive echocardiogram is indicative of a poor prognosis.


[Echocardiography in infectious endocarditis]. The effectiveness of echocardiography was evaluated in 36 cases of anatomically documented infective endocarditis during the period 1972 to 1976. Valvular vegetations were found in 47% and destructions in 58% of this group. Echocardiography is a valuable tool in the certification of clinically suspected infective endocarditis and in the delineation of a subgroup of patients with valvular vegetations and destruction of aortic and mitral valve leaflets. Echocardiography may therefore play a decisive role in the selection of patients for surgical intervention despite active infection.


[Methodology of myocardial scintigraphy with thallium 201: limits of pathological findings]. Thallium 201 is a useful agent for demonstrating ischemic myocardia. It is injected during maximum stress, the stress situation is then continued for a further 2 min and a series of scans are carried out 5-25 min after injection. The series is repeated 3-5 h after injection, thereby obtaining pictures of myocardial resting and stress perfusion. Repitition of the study without stress reveals no further data. In follow-up examinations under the same stress situation the perfusion defects remain the same. 27 normal subjects were evaluated and the limits between normal and pathologic scans established.


[1 year's experiences with the 201 thallium myocardial scintigraphy for the evaluation of coronary circulation disorders]. 68 patients with a history of angina pectoris (AP) and/or myocardial infarction, 35 patients with atypical chest pain and 27 healthy volunteers underwent 201Tl myocardial perfusion imaging (201Tl-MPI). In a preselected group of 71 patients with coronary arteriograms, sensitivity was 98.3% and specificity 71%. In patients with AP and positive exercise ECG, 201 Tl-MPI only serves to confirm the diagnosis of coronary artery disease (CAD) (46 pathological 201Tl-MPI of 47 patients). Perfusion defects are a useful adjunct for the diagnosis of CAD in patients with AP and normal or uninterpretable exercise ECG (20 of 21 patients), and in those with atypical chest pain and positive or uninterpretable exercise ECG (25 of 39 patients). A negative 201Tl-MPI virtually rules out CAD.


[Prognosis for coronary patients with low ejection fraction. Comparison between a medically and a surgically treated group]. Two groups of coronary patients whose ejection fraction was depressed (less than or equal to 0.30) were studied. Twelve patients received drug treatment only and 25 others underwent surgery. Life expectancy appears to be slightly improved in the surgical group, but the differences are not statistically significant. Since operative mortality is relatively low (8%) and clinical improvement following surgery may be impressive, a revascularization procedure should be considered even in patients with markedly impaired ventricular function.


[Initiation and termination of ventricular tachycardia with orthorhythmically programmed stimulation a week after experimental myocardial infarct in the pig]. The initiation and termination of ventricular tachycardia by means of programmed orthorhythmic endocardial stimulation has been studied in pigs with subacute experimental myocardial infarction. Successful stimulation implied limited variation of the number, interval, prematurity and intensity of electrical impulses.


[Protective effect of pyridoxilate on the hypoxic myocardium. Experimental studies]. The protective action of piridoxilate on hypoxic myocardium has been studied on rats in acute hypoxia (isolated heart, perfused with a non-oxygenated solution) and in prolonged hypoxia (3 days at high [3454 m] altitude). Piridoxilate maintained a higher ATP level with a much lower production of lactate. The mechanisms of action of piridoxilate are probably fairly similar to those of Na dichloracetate.


[Effect of pindolol (Visken) on the size and hemodynamics of the exerimental myocardial infarct in the pig]. In a comparative study the effect of pindolol (Visken, Sandoz) on experimental infarct size and left ventricular function in the pig has been investigated. Pindolol was given 30 min prior to the ligation of the left anterior descending coronary artery and on the following 5 days twice daily in a dosage of 0.05 mg/kg body weight. For morphometric assessment of infarct size the ventricular myocardium was cut into slices and stained with nitro-benztoluene. There is a significant reduction of infarct size (by one third) in the pindolol-treated group as compared to the controls. In addition, deterioration of left ventricular function is less marked in the pindolol-treated group.


[Study of systolic ventricular volume changes by means of current measurement of contrast media]. Systolic changes of left ventricular volume were estimated after left ventricular contrast injections in dogs by roentgen-videodensitometry with adjustable windows. Good correlations were found between densitometric volume changes and the integral of electromagnetic aortic flow, as measured every 20 msec (r greater than or equal to 0.95 in 118 of 124 systoles analyzed). Videodensitometry avoids the time consuming frame-to-frame analysis with the errors inherent in geometric assumptions in ventricular volume measurements.


[The percutaneous dilatation of chronic coronary stenoses--experiments and morphology]. Since 1971, percutaneous transluminal angioplasty of peripheral arteries has been performed in 225 patients. There was an overall patency rate of 70-80% after 2 years. Our technique was then adapted and modified to perform coronary dilatation. This was performed successfully in 8 dogs in which selective coronary artery stenosis war induced by silk ligature and secondary inflammatory changes. The technique was then applied to the coronary lesions in postmortal humans and tested in the operating room during A-C bypass to evaluate vessel patency, peripheral debris etc.


[Left ventricular function in chronic pulmonary hypertension]. 10 patients with chronic pulmonary hypertension (PH) consequent to primary or secondary pulmonary vascular disease and 12 control subjects were studied by left ventricular (LV) micromanometry and cineangiography. At rest, LV "total pressure" Vmax and volumetric parameters (RAO position) of the patients with PH were within normal limits. LV end-diastolic pressure, was, however, significantly increased. Biplane cineangiographic evaluation in 6 patients with PH revealed a significantly reduced LV transverse diameter in the LAO as compared to the RAO position. This finding was confirmed by echocardiography. The thickness of the LV lateral and posterior wall was normal, whereas septal thickness was significantly increased in the patients with PH. During isometric exercise Vmax increased significantly in PH but not in the controls. It is concluded that (1) in chronic PH LV function is normal at rest, (2) LV contractile reserve is inpaired and (3) apparent LV compliance is reduced due to both septal hypertrophy and abnormal LV geometry.


[Abeurysm of the septum membranaceum].

[Abeurysm of the septum membranaceum]. Between 1968 and 1977 5000 angiocardiographies revealed an aneurysm of the membranous septum (AMS) in 20 patients. In 11 patients the AMS was accompanied by a usually minor ventricular septal defect, in 4 by aortic valve disease, in 3 by coronary heart disease and in the remainder by some other rare heart disease. The diagnosis of AMS was established by angiocardiography, but in 3 patients it was detected by echocardiography. In one case a sepsis lenta with cerebral embolization was observed.


[First clinical experiences with the new intracardial electrode "Helifix"]. A new pervenous non-traumatic screw-in electrode has been developed and tested in 61 patients. Dislocation of this electrode occurred in 2 instances (3.3%) and an increase in threshold (exit-block) in 3 cases (5%) necessitated repositioning of the electrode.


[Liver circulation during dopamine therapy]. Intravenous dopamine (4 and 8 microgram/kg/min) causes an increase of hepatic flow and cardiac index, while the ratio hepatic flow:cardiac index remains unchanged. The increase of renal flow after dopamine therefore does not occur at the expense of hepatic flow.


[Sequential cardiac szintigraphy: a methodological contribution to the evaluation of local cardiac dynamics]. A non-invasive technique is described in which the initial passage of a radionuclide is followed through the heart using an tanger camera after intravenous bolus injection. This method allows analysis of the regional and global wall motion of the left ventricle as well as estimation of the regional distribution of stroke volume and ejection fraction. Supplementing radionuclide angiocardiography with gradient scintigraphy permits the diagnosis of left ventricular aneurysms, intracardiac shunts and av-valve insufficiency. Initial comparisons show fair agreement between the radionuclide technique and left ventricular contrast angiography.


[Effect of droperidol on the creatine phosphokinase activity in acute myocardial infarct]. In 141 patients with acute myocardial infarction, creatine phosphokinase isoenzyme (CPK-MB) was determined by the activation method with dithiothreitol (RAO et al.: Clin. Chim. Acta 21, 1612 [1975]). 15 out of 16 patients with atypical negative CPK-MB values within the first 3 days after infarction had been treated with 5-10 mg droperidol, a neuroleptic drug dispensed for its antiemetic effect. In a prospective study in 7 patients, CPK-MB determined serially showed a decrease or persistently low or negative values within 1 minute after injection of 5 mg droperidol and lasting 24-36 hours after injection. In contrast, CPK-MB determined by immunoprecipitation did not change its typical pattern after use of droperidol. Hence, negative or low values of CPK-MB in acute myocardial infarction must be expected after droperidol if determination is by the activation method with dithiothreitol.


[The cell membrane: a frontier between 2 worlds]. The structure and function of the plasma membrane is reviewed. Three of its main functional roles are discussed, i.e. of 1. selective, physico-chemical barrier; 2. key regulator of cell tolerance and cell recognition; 3. effector organelle for long range and short range cell communication. From the structural viewpoint, the fluid mosaic model is presented as a particularly dynamic picture of the membrane machine and its components (pathways for active and passive transport, enzymes, hormonal receptors and other active sites). Some recent aspects fo the modulation of membrane permeability by hormonal or pharmacological agents are discussed by considering two examples of the author's own research: the hydrosmotic action of vasopressin and the vasopressin-like effects of a hallucinogenic drug, harmaline. Finally, the growing list of anomalies of membrane transport and membrane receptors found both in rare and in common clinical entities emphasizes the importance of membrane research in the understanding of human disease.


[A case of benign recurring intrahepatic cholestasis (Tygstrup-Summerskill and Walshe syndrome)]. The case of a 23-year-old male patient with benign intrahepatic recurrent cholestasis of Summerskill-Tygstrup and Walshe type is presented. The patient had suffered 9 attacks up to 1974. The clinical and histological data of this patient were compared with those in the 65 cases described previously. The most characteristic signs were that the disease began before puberty and the attacks of jaundice with direct hyper bilirubmemia were induced by infections. Histology obtained in acute phase of the disease revealed intrahepatic cholestasis, and there were signs of a non-specific mesenchymal reaction of the liver tissue while the patients were asymptomatic. The serum activity of alkaline phosphatase was increased, gamma-glutamyltranspeptidase and transaminases being normal or close to normal. The pattern of the biochemical findings was characteristic and the patient was recognized among 19,035 other patients hospitalized from 1972-1975 by means of a special computer program. This program may be helpful in detecting patients with this disease from computerized data of hospitalized patients and avoiding unnecessary surgical intervention.


[Polyneuropathy and epileptic seizures in a family with acute intermittent porphyria]. Report on clinical and electrophysiological findings in four members of a family with acute intermittent porphyria in the remission period. One patient had suffered from repeated epileptic seizures of the grand-mal type since the age of 24 years. Generalized and multifocal epileptic potentials were found in her EEG. Two other members of the family, a man and a woman, were found electromyographically and neurographically to have a florid neuropathy with damage to the axon and the myelin sheath. Only the female patient showed manifest clinical signs of the polyneuropathy. The 4th member, who years previously had had abdominal colics and suspect biochemical signs of acute intermettent porphyria, was not striking either neurologically or in electromyographic and neurographic polyneuropathy screening at the time of the examination. Epileptic seizures and the symptoms of the polyneuropathy had a close connection with the menstrual cycle (two cases). Before and at the beginning of the menstruation a deterioration of the disease was observed. Problems of antiepileptic therapy in acute intermittent porphyria are discussed.


[Osteomyelofibrosis syndrome 33 years after thorotrast angiography]. 33 years after carotid arteriography with thorotrast a 69-year-old patient died from osteomyelofibrosis with severe hematopoietic hypoplasia and myeloid metaplasia detected in liver, lymph nodes, kidney and epicardium. Twenty years before death he underwent "prophylactic" splenectomy; histologically the spleen merely showed hypoplasia, fibrosis and deposits of thorotrast. It is assumed that the osteomyelofibrosis syndrome is a specific complication of thorotrast application which has only rarely been described in the past. This suggestion is supported by observations suggesting that osteomyelofibrosis syndrome may be induced by radiation and by the fact that thorotrast gives rise to foreign body reactions associated with subsequent severe fibrosis. The development of myeloid metaplasia is assumed to be secondary to chronic hematopoietic insufficiency.


[Absenteeism due to alcoholism in a federal installation]. Absence due to sickness of 25 chronic alcoholics in a Swiss Federal company was compared with that of 75 control subjects parallelized as far as possible. Only those alcoholics were studied who worked in the company throughout the observation period (1966-1975) and whose records with the Federal Medical Service bore the diagnosis "chronic alcoholism". Through shortterm absences (up to 3 days) the alcoholics lost 1.7 days annually compared with 0.9 days for the control group. The average number of shortterm absences among the alcoholics was 0.8 and 0.4 in the control group. Through absences due to illness or accidents (absences of more than 3 days) the alcholics lost 22.3 days annually compared with 7.0 days for controls. The average number of longterm absences was 0.7 for alcoholics and 0.4 for controls. The average cost of absenteeism was 3193.10 Swiss francs for the alcholics and 790.80 Swiss francs for each member of the control group. First notification of alcohol problems of an employee came from within the company in 80% of cases. Striking features were mainly drinking before and during work and erratic time-keeping. In 88% of cases the treatment was disulfiram cure and supportive psychotherapy in 12%. In the next 3 years 4 alcoholics (30.7%) had further episodes of drinking, while 9 (69.3%) showed no sign of alcohol abuse. 12 alcoholics could not be assessed asfollow-up was too short.


[Clinical study and evolution of various biological parameters (Pb, ALA-D, FEP) in 14 cases after ingestion of lead containing beverages]. Clinical and biological evolution is reported in 14 individuals (adults, teenagers, children) who had ingested lead-containing beverages stored in glazed pottery. There are marked differences between adults and children regarding the half lives of lead in blood. Almost two years after the discovery of the risk, abnormal amounts of Pb, ALA-D and FEP remain in the absence of any other clinical disturbance. The hazard of glazed pottery is reemphasized.


[Urinary infection and reflux nephropathy in children]. Urinary tract infection (UTI) is relatively frequent in children. The symptoms are often atypical; the more so, the younger the child. UTI is often associated with functional or malformative uropathy, such as vesico-ureteral reflux or obstruction. Radiological investigation should be carried out in every child presenting with his first UTI. The prognosis of uncomplicated UTI is good, but is less favorable when UTI is associated with urological abnormalities. Development of pyelonephritic lesions can lead to kidney scarring for which the occurrence of intrarenal reflux, associated with a specific type of papilla, is probably responsible. Short-term treatment is recommended for uncomplicated UTI. Uncomplicated UTI with frequent relapses, or UTI associated with vesio-ureteral reflux, requires prophylactic chemotherapy. Worsening of reflux and/or the development of pyelonephritic lesions while on prophylactic treatment are an indication for surgical intervention. Surgery is always indicated in the presence of a major urological malformation. Be it medical or surgical, treatment of UTI should always be followed by regular urine cultures for several years.


Human blood samples as indicators of occupational exposure to persistent chlorinated hydrocarbons. The value of using human blood as an indicator of occupational exposure to persistent organochlorine compounds is demonstrated. Blood samples from a total of 35 persons divided into three different groups, with and without exposure to chlorinated hydrocarbons in the work atmosphere, have been investigated by gas chromatography using electron capture detection. It is shown that  the group of workers with an occupational exposure to pentachlorobenzene, hexachlorobenzene, heptachlorostyrene and octachlorostyrene had a higher level of these chlorinated hydrocarbons in their blood samples than did the other groups. On the average, the concentration of hexachlorobenzene is about 20 times higher in blood samples from the occupationally exposed workers than from the control group. The level of hexachlorobenzene in blood samples of the control groups is low compared to recent studies of blood samples from the general population in other industrialized countries. Furthermore, the average value obtained for the exposed workers is of the same magnitude as the general population in these industrialized countries.


Blood mercury concentration in an urban population. Mercury concentrations in whole blood of 210 patients admitted to two urban hospitals ranged from 0 to 298 ppb with a mean of 14.2 ppb. When corrected by omission of nine values over 50 ppb the mean was 8. 1 ppb. Althouth mean values for men were slightly higher than  those for women, this difference was not significant. Results of a 12-test blood chemistry screening profile were available for 196 subjects, but no correlation between mercury concentrations in blood and those chemistry measurements could be detected. Simultaneous determinations of mercury in whole blood and plasma were performed for 65 subjects; the mean for plasma was 5.0 ppb. somewhat below the mean of 6.3 ppb for whole blood in the same group. Other surveys have shown corrected values of 13.3 and 6.7 ppb for normal populations. These values are very much higher than current estimates of 0 to 2 ppb for normals. Levels are higher in urban residents than in rural probably because of increased exposure to combined industrial and environmental sources. The mean level appears to be 8 ppb with a range of 0 to 30 ppb.


Some current aspects of environmental fluoride. This review  presents a Total Environment evaluation of current inorganic fluoride intake by human populations. Inorganic fluoride is a persistant bioaccumulator, and the ever-increasing use (and release) of fluoride compounds in the environment should be of long-term concern  in population sub-groups who are most susceptible, and therefore, most "at risk". One of these sub-groups consists of people with impaired kidney function, including subjects with nephorphatic diabetes. The diabetes factor is of particular relevance, not only because the incidence of diabetes has increased by 6%/yr during the period 1965-1975, but also because subjects with nephropathic diabetes can exhibit a polydipsia-polyurea syndrome that results in increased intake of fluoride, along with greater-than-normal retention of a given fluoride dosage. People with inadequate dietary intakes (particularly of Ca and/or Vitamin C) are also likely to be more "at risk" as a consequence of low-dose long-term fluoride ingestion. Evidence is presented, showing that there has been an escalation in dialy fluoride intake via the total human food-and-beverage chain, with the likelihood that this escalation will continue in the future. Recent observations, relating to an increasing incidence of chronic fluoride intoxication among humans, is also emphasized.


Regeneration of plants from tobacco protoplasts and some factors affecting the plant differentiation. Protoplasts were isolated from the cell suspension culture derived from leaf and stem calli of tobacco (Nicotiana tabacum cv. Ko Hsin No. 1) haploid pollen-plants. After 12 hr in the liquid culture medium, the protoplasts became oval-shaped, and produced a new cell wall. The first division of the newly formed cells was completed after 24 hr in culture. After 4 weeks in culture, the yellowish calli reached 1 mm in size were then transferred to an auxophyton. 18 days later, the calli became 3-4 mm in size. After the calli were transferred to a differentiation culture medium, shoots and roots soon turned up. Regeneration of whole plants was obtained thereafter. The division and differentiation of regenerated cells were affected not only by the calli originated from different organs and their, age, but also by the basic components of the differentiation culture medium and the type of cytokinin used.


Material balance analysis of trichlorofluoromethane and carbon tetrachloride in the atmosphere. Using the historical worldwide emission and monitoring data on trichlorofluormethane, a transfer constant (0.03 yr-1) was evaluated for the movement of the gas from the troposphere to the stratosphere. The movement between the northern and southern troposphere was estimated from literature data on other gases to be 0.6 yr-1. The flux between the ocean and air was calculated using water solubility and vapor pressure measurements. These transfer constants were then combined in a dynamic material balance model which has the capability of predicting furture trends. The procedure was then applied to a similar set of data for carbon tetrachloride. The agreement between the calculated atmospheric and water concentration for carbon tetrachloride was within 20% of the actual experimental observation thus lending credence to this type of budgetary analysis.


Effect of stimulation of bulbar reticular formation on long latency discharges in the region of nucleus centralis lateralis of thalamus. Electrical stimulation of medial medullary reticular formation of rabbits was found to have marked inhibitory effect on nociceptive discharges of neurons in the region of centrolateral nucleus of thalamus. Among the 32 nociceptive units tested, 15 showed the inhibitory effect, 3 the facilitatory, and 14 no effect. Comparison between the effect of direct stimulation of medial medullary reticular formation and that of the electric needling on the same neurons revealed a general resemblance of the two in many respects. These findings suggest that the nucleus reticularis gigantocellularis in medial bulbar reticular formation may serve as an important relay station in the transmission of the analgesic effect of acupuncture.


The inhibition effect and the mode of action of electro-acupuncture upon discharges from the pain-sensitive cells in spinal trigeminal nucleus. Acupuncture, one of the important branches of Chinese traditional medicine, is unique in its capability of treating many kinds of diseases. Owing to its pain-relieving action, it has been much used for the treatment of pains since ancient times and is used recently for surgical operations, major or minor, to replace drug anaesthetization. As to the mechanism of its action, there is much to be learned and this is the problem that we are now tackling.


[Particulate distribution of heavy hydrocarbons associated with suspended particles in the air of Belgium]. In order to study in more detail the possibility of transporting aerosols produced by combustion over long distances, the distribution of heavy hydrocarbons (polycyclic and paraffinic) on atmospheric particles has been studied according to their diameter. For this purpose the Anderson cascade impactor has been used. The results show that the hypothesis, that hydrocarbon aerosols are transported over long distaces, is perfectly  plausible and thus, that aromatic polycyclic hydrocarbons are more accurate and specific indicators than the total hydrocarbon matter.


The metabolic fate of daidzein.

The metabolic fate of daidzein. A method using thin layer chromatography and ultraviolet spectrophotometry for isolation and quantitative determination of daidzein from biological specimens was developed. This method was found to be sensitive and specific and was used in this study for the observation of the metabolic fate of daidzein in animals and human bodies.


Virus transfer from surf to wind.

Virus transfer from surf to wind. Bubbles in the sea surf adsorb and carry viruses to the surface where they are propelled into the air on tiny jets of seawater when the bubble bursts. The ejected jets become tiny drops of aerosol. The buble adsorption and virus concentration in the surf is analagous to industrial bubble levitation processes that concentrate metallic ores, enzymes, and finely divided organic crystals. Bubble levitation of viruses delibrately injected into the surf produced 200 times more virus per milliliter in the aerosol than were present in samples from the surf. Some aerosol drops created by the surf and carried by the wind fall out on the beach. The frequency of virus-bearing drops, that is, the number of plaques on seeded plates exposed on the beach, decreased exponentially with the distance downwind from the surf.


Cell-free modulation of proinsulin synthesis. In vivo, glucose preferentially stimulates proinsulin biosynthesis; at least part of this process is independent of new RNA synthesis and is accompanied by increases in the overall rate of polypeptide chain initiation. The cell-free translation of proinsulin messenger RNA is very sensitive to changes in the protein-synthesizing system. Proinsulin synthesis is preferentially inhibited by the addition of increasing quantities of polyadenylate-containing RNA from the fetal bovine pancreas or by the addition of the drug, aurintricarboxylic acid, which blocks polypeptide chain initiation. These results suggest that proinsulin messenger RNA completes less efficiently for rate controlling initiation factors. We propose that glucose stimulates proinsulin biosynthesis by allowing the less competitive proinsulin messenger RNA to be translated more efficiently.


Visual association cortex and vision in man: pattern-evoked occipital potentials in a blind boy. In a 6-year-old child who had been blind since the age of 2 years, occipital potentials of normal amplitude and waveform could be evoked not only by diffuse light flashes but also by alternating checkerboard ans sinusoidal grating patterns of low spatial frequency. Computerized tomography demonstrated destruction of the occipital lobes except of the primary visual projection area. Thus, in man, destruction of visual association cortices may result in loss of vision with partial preservation of pattern-evoked occipital potentials.


Behavioral choice: neural mechanisms in Pleurobranchaea. In the marine mollusk Pleurobranchaea, it is known that feeding occurs and withdrawal from tactile stimuli is suppressed when the sensory stimuli for feeding and withdrawal are presented simultaneously. This "dominance" of feeding behavior over withdrawal behavior occurs because the central nervous network controlling feeding inhibits the central nervous network controlling withdrawal. The inhibition is mediated by a bilaterally symmetrical pair of reidentifiable feeding neurons that are members of the "corollary discharge" population in the buccal ganglion. This study supports the hypothesis that inhibitory interactions between competing motor systems are responsible for the "singleness of action" that characterizes animal behavior.


First suckling response of the newborn albino rat: the roles of olfaction and amniotic fluid. Washing the nipples of anesthetized parturient rats virtually eliminated nipple attachment by their young. Normal attachment was induced only by painting the washed nipples with a distillate of the nipple wash, parturient-mother saliva, or her amniotic fluids. Reinstatement was not achieved by coating the washed nipples with the saliva of virgin females eating the same diet, the parturient mother's urine, isotonic saline, amyl acetate, or vanilla extract. These experiments also provide behavioral evidence for olfactory function in the newborn albino rat.


Pulmonary metabolism during diving: conditioning blood for the brain. During experimental diving by the awake Weddell seal, blood glucose concentration falls consistently. A large fraction of the glucose consumed from the central circulating blood appears as lactate. During diving, the lung utilizes blood lactate in preference to blood glucose as a source of both carbon and energy, and it is able to release glucose into pulmonary venous blood to supplement the supply available for brain metabolism.


Postnatal development of the human lateral geniculate nucleus: relationship to a critical period for the visual system. The cross-sectional areas of 31,800 dorsal lateral geniculate nucleus cells were measured in 53 human brains ranging in age from newborn to 40 years. Geniculate cells increase in size rapidly during the first 6 to 12 months of postnatal life, with cells in the parvocellular layers developing faster than cells in the magnocellular layers. At least 2 years are required before all cells have reached their adult size.


Degenerating nerve fiber products do not alter physiological properties of adjacent innervated skeletal muscle fibers. Partial denervation of rat extensor digitorum longus and soleus muscles resulted in the appearance of denervated and innervated surface muscle fibers lying adjacent to one another. The denervated muscle fibers showed the typical signs of denervation while the innervated muscle fibers were similar to those of control muscles. We conclude that denervated fibers do not induce substantial physiological changes in adjacent innervated muscle fibers.


Phototoxic keratoconjunctivitis from coal-tar pitch volatiles. Roofers working with coal-tar pitch develop burning eyes and conjunctivitis which they subjectively associate with sun exposure. A coal-tar pitch distillate instilled in the conjunctivae of rabbits produced minimal or mild irritation in the absence of ultraviolet radiation, but irradiation with long-ultraviolet produced marked photophobia and severe keratoconjunctivitis.


Odor-aversion learning in neonatal rats. Two-day-old rats were exposed to a novel odor and injected with an illness-inducing drug, lithium chloride. When tested at 8 days of age, these pups avoided pine shavings scented with the odor, whereas control pups did not. These results imply that rat pups are capable of associative learning at a much earlier age than was thought possible.


Benzodiazepine receptor: demonstration in the central nervous system. Diazepam, a potent minor tranquilizer, binds with high affinity to a specific benzodiazepine receptor that occurs exclusively in the central nervous system. The receptor is mainly localized in the synaptic membrane fraction. Binding to the receptor is stereospecific. Competition for the receptor by various benzodiazepines closely parallels their pharmacological potency.


Eye contact and face scanning in early infancy. Visual fixations of 3- to 5-week-old, 7-week-old, and 9- to 11-week-old infants were recorded as they scanned an adult's face which was stationary, moving, or talking. A dramatic increase in face fixations occurred between 5 and 7 weeks for all conditions. Talking produced an intensification of scanning in the eye area in the two older groups.


Methods for comparing the performance of different gamma cameras. Meaningful comparisons of different gamma cameras require the acquisition of numerical data characterizing each of the characteristics of interest. These include resolution, contrast, sensitivity, uniformity, dead time (and the resulting percent loss), and the maximum counting rate. Resolution is best determined by using a line source to measure the linespread function, from which the modulation transfer function can be calculated. Bar patterns are useful in showing the effect on resolution of different collimators and different source distances. Sensitivity comparisons depend on collimator choice, and require counting the same object under identical conditions. Accurate comparisons of dead times and maximum counting rates require extreme care that measurements are taken under identical conditions of scatter, source volume, window setting, etc. Comparisons of the intrinsic dead times should be made with the collimator off, while actual counting losses should be determined using the collimators and appropriate phantoms. With today's high resolution and high-speed gamma cameras, the conditions under which a camera is used would appear to play a larger role in determining its performance than would the small differences in inherent capabilities between the cameras of various manufacturers.


Large-field-of-view (LFOV) scintillation cameras. Large-field-of-view scintillation cameras are general purpose, cost effective, imaging devices if one maximizes the use of the crystal with respect to the size of the object under study. This means using parallel-hole collimation for large-organ systems to reduce the number of views necessary to complete a study or to obtain a better appreciation of continuity of structure. A further increase in photon utization is gained for small-organ imaging with converging collimators, which produce images with superior resolution and sensitivity to that obtained with equivalent parallel-hole collimators. The disadvantages of converging collimators, including decreasing field of view and distortion with depth, have been insignificant in light of the advantages gained. Larger detectors with converging collimation result in much  higher photon input rates to the scintillation crystal in routine clinical studies than has occurred in the past. This requirement places added burdens on electronic circuitry of the cameras. Count rate processing capabilities of 200,000 counts per second are currently available and are necessary for present generation first-pass cardiovascular studies.