Radiation injury in the neonatal canine kidney. I. Pathogenesis. The effects of radiation on the developing canine kidney were investigated. Beagles were exposed to 330 R 60Co gamma-radiation on the 2nd postnatal day of life. The kidneys were examined at 2 days (6 hours after irradiation), 4, 8, 14, 22, 70, and 200 days of age with qualitative and quantitative light microscopy and scanning electron microscopy. The primary result of the radiation injury was a failure to form the normal number of nephrons. The kidneys of irradiated dogs had 42 per cent fewer nephrons (260,000) than the control dogs (445,000). In addition, extensive damage to forming nephrons produced dysplastic renal corpuscles and other corpuscles which were arrested in their development. Three mechanisms of radiation injury were identified. First, there was extensive mitosis-linked cell death in the nephrogenic zone. Second, mitotic delay resulted in only one-fifth of the normal mitotic activity in the nephrogenic zone through 2 days postirradiation. Third, there was an immediate and permanent cessation of nephron formation. The extensive injury in the outer renal cortex was compounded by the development of intercapillary glomerulosclerosis in some middle and inner cortical corpuscles by 200 days of age.


Pilocarpine stimulation of the bronchiolar Clara cell secretion. Fasted rats were given a single cholinergic subcutaneous injection of pilocarpine and sacrificed from 30 minutes to 24 hours later. Secretory granules were extruded by Clara cells as early as 30 minutes after pilocarpine administration. Simultaneously and thereafter, Clara cells displayed dilated cisternae of endoplasmic reticulum and active assembly of secretory granules at the Golgi complex. After 1 to 2 hours, new secretory granules reached the cell surface and were discharged into the bronchiolar lumen by exocytosis. At 4 hours the Clara cell organelles appeared quiescent. Complete cell recovery apparently occurred by 12 to 24 hours after pilocarpine administration. The accelerated secretion by Clara cells with pilocarpine provides an evidence of their exocrine character and the exocytotic secretory mechanism. The morphologic data indicate that the production and secretion by Clara cells may be controlled by neurohumoral mechanism.


The effect of chronic low level lead intoxication on the Haversian remodeling system in dogs. The greatest portion of lead ingested by human beings or experimental animals is stored in bone. Once in bone, lead is difficult to remove. It may have a half-life of 20 years or more and could interfere with bone metabolism. The effects of lead intoxication on the production of intercellular matrix have been reported previously but the effects of lead on bone turnovers rates were not reported. In this paper we reported the results of a study of the effects of lead on bone turnover in dogs. Differences between experimental and control dogs were found when measuring appositional rates, radial closure rates, activation frequencies, osteon formation times, and bone formation rates. We found that dogs subjected to a low dose (1.3 mg. per kg. per day) of lead over a long period of time (201 days) showed a statistically significant decrease in bone formation activity at the cell (90 per cent), tissue (85 per cent), and organ (78 per cent) levels when compared to controls. Although these observations were made on a small experimental and control sample (four dogs), they suggest that chronic low dose lead intoxication does alter normal bone physiology.


Uptake and transport of Imposil by the glomerular mesangium in the mouse. The mesangial uptake and transport of particulate material has been studied using an iron-dextran complex, Imposil, as a tracer particle. The tracer was given as a single dose into the tail vein of the mouse, and animals were killed at intervals from 5 minutes to 48 hours. Light and electron microscopy showed that the iron-dextran complex was initially taken into the matrix channels of the mesangium from which it progressed over the course of 8 hours to the matrix of the juxtaglomerular apparatus and intercellular spaces of the macula densa. This delineated a continuous functional pathway from the glomerular capillary lumen to the macula densa cells of the distal tubule for material taken up by the mesangium. It is suggested that the products of inflammatory lesions in the glomerulus could affect the secretory function of the granular cells of the juxtaglomerular apparatus as it would appear that such products must circulate in the immediate environment of these cells.


The reliability and validity of the comfort level method of setting hearing aid gain. The comfort level method (Carhart, 1946) probably is the most widely used procedure for setting the acoustic gain of hearing aids. A series of experiments were conducted to determine the test-retest reliability of the comfort level method and the relationship between the comfort settings established in a clinical test suite and the comfort settings utilized in more realistic daily listening situations. Adults with bilateral sensorineural hearing impairments were subjects. The results suggest that the comfort level method has good test-retest reliability for most clinical purposes. Further, clinically established comfort settings may accurately represent typical daily-use settings if the input level used to establish the comfort settings in the clinical environment is 70 dB SPL.


A cineradiographic investigation of children's w/r substitutions. Articulatory positioning and movement characteristics were compared between /w/ and intended /r/ productions in three children exhibiting w/r substitutions and one normal control subject. High-speed lateral-view cineradiography was utilized. It was found that only the control subject demonstrated significant differences in lip, jaw, and tongue positioning for /w/ compared to /r/. However, systematic patterns of articulatory variability within and between subjects suggested that the experimental subjects were possibly differentiating between /w/ and intended /r/ even though the articulatory target configuration appeared to be nondiscriminatory. Perceptual judgmnets of the tape-recorded utterances mirrored the physiological data in that only those intended /r/ productions involving articulatory positioning clearly different from that of /w/ were perceived as /r/.


The verbal environment of a language-impaired child. A child with a language handicap presents a potential conflict for the adults with whom he interacts. In terms of age and physical development, he may present cues that ordinarily elicit complex speech from adults. His language performance, however, may be comparable to that of a much younger child. This study involves a detailed analysis of the speech addressed to a 4.7-year-old language-impaired boy and to his normal-speaking female cousin (4.6 years) by the boy's mother, father, and baby-sitter. Each adult interacted with each child in a five-minute free play and a five-minute story-telling situation. Quantitative measures of the speech of the adults included word rate, disfluencies, type-token ratio, and mean length of response. There was a strong tendency to present the language-impaired child with fluent, short, and simple sentence patterns, as compared to his peer. Qualitative analyses of sentence types again showed that simplifications were made in speech to the boy, and that the adults used sequential sets of sentences with the language-handicapped child that were similar to those used by mothers of normal, but much younger children.


Time-compressed speech discrimination in central auditory disorder: a pediatric case study. Audiological data are presented for an 11-year-old aphasic girl with confirmed left-hemisphere damage. Pure-tone audiometry, impedance measurement, and speech discrimination testing were completed. Discrimination testing included presentation of the Word Intelligibility by Picture Identification (WIPI) test at 0 and 60% time compression. Results indicated significantly poorer speech discrimination in the ear contralateral to the site of lesion at 60% time compression. This case study supports the use of time-compressed speech discrimination testing in the assessment of central auditory function of children and as a diagnostic tool for determination of site of lesion.


Tympanometric assessment of eustachian tube patency in children. Eustachian tube patency was assessed tympanometrically in a group of otologically normal children at a pediatric outpatient clinic. A pressure-swallow technique of assessing eustachian tube patency was administered. The results indicated the importance of the examination of both middle ear pressure and function changes in the evaluation of eustachian tube test results.


Patterns of dysfunction in schizophrenic patients on an aphasia test battery. Twenty-seven schizophrenic patients free of any known neurologic deficit were tested with an aphasia test battery. The objective of the research was to derive a profile of schizophrenic language performance to permit its comparison with the profiles characteristic of aphasia, apraxia of speech, generalized intellectual impairment, and confused language. Results indicate that schizophrenic patients exhibit a profile of language performance distinctive from those found in aphasia, apraxia of speech, confusion, or generalized intellectual impairment and demonstrate that the disruption of language in schizophrenia is not aphasic in nature.


Clinical acoustic reflex threshold measurements in infants. Acoustic reflex thresholds elicited using clinical acoustic impedance techniques were obtained on normal infants between one month and one year of age. Reflex activating signals of 500, 1000, 2000 Hz, low-pass, high-pass, and white noise were used. Less intensity was required to elicit the acoustic reflex to the noise than to the pure tones, with the 500-Hz tone requiring the greatest intensity. Inference of auditory thresholds from the acoustic reflex indicated the presence of normal hearing in the infant group.


Reliability of hearing-impaired children's responses to oral and total presentations of the Test of Auditory Comprehension of Language. The Test of Auditory Comprehension of Language (TACL) (Carrow, 1973) was administered on two occasions to two groups of hearing-impaired children. The test was administered in the usual manner (face-to-face, spoken) to children who were being educated by oral methods. The test was also simultaneously spoken and signed to children who were being educated by total-communication methods. Reliability of responses was high for both groups (r = 0.96 for oral-aural and 0.90 for total-communication children) and error patterns were similar. The TACL appears to be an appropriate and reliable instrument for use with hearing-impaired children.


Effects of sophistication on four tests for nonorganic hearing loss. Three groups of 15 normal-hearing subjects were asked to simulate a hearing loss in one ear. Each subject was then tested on four measurements often used in determining the presence of pseudohypacusis (a comparison of the SRT to the pure-tone average, ascending vs descending pure-tone tests, the Stenger test, and pure-tone delayed auditory feedback). Results showed that as practice and sophistication on each of the procedures increased, there tended to be more improvement in the subjects' ability to "beat" some of the tests than others.


Disorders of nonverbal communication.

Disorders of nonverbal communication. The idea that nonverbal communication can be disordered is explored, and several types of nonverbal communication disorders are described. The characteristics of these disorders and a number of possible explanations for their acquisition are offered. Finally, suggestions for therapeutic procedures are made.


Aphasia testing: a second look at the Porch Index of Communicative Ability. It has been claimed that the Porch Index of Communicative Ability (PICA), through its multidimensional scoring system, corrects for lacks in other tests for aphasia. Specifically, the PICA is said to specify the details of the response and indicate the nature of the response; detect and describe small changes in the patient's responses; indicate the patient's level of communicative ability; and eliminate the subjectivity and bias present in descriptive methods of scoring. It is argued here that the PICA does none of these things and that the multidimensional scoring system as applied in the PICA is invalid.


Blissymbolics-a nonverbal communication system. Until recently, speech-language pathologists have shown little interest in seeking alternate forms of communication when functional verbal communication is not attainable. There is a paucity of literature dealing with nonverbal communication systems for people lacking functional verbal communication for reasons other than deafness. Blissymbolics is a logical, visual language that has provided functional communication for nonverbal cerebral-palsied children. The full potential and application of Blissymbolics has only begun to be realized, and there is much need for experimentation and research. This paper describes the system and suggests areas for future application and development.


Women and men problem drinkers. Sex differences in patients served by Iowa's Community Alcoholism Centers. The development of and recovery from alcoholism was examined in 3132 men and 395 women alcoholics. Drinking by the women was more often a response to crises and emotional stress, while more men gradually drifted into ever greater dependence on alcohol to cope with everyday problems.


A longitudinal analysis of alcohol use, environmental conduciveness and normative structure. The social environment and normative structure surrounding drinking have a reciprocal relationship in determining adolescent drinking patterns in high school and college.


Alcoholics admitted to four hospitals in England. III. Criminal records. Among 935 hospitalized alcoholic patients, 32% of the men and 17% of the women had a criminal record. Correlates of criminality are explored. Recidivism rates are established and compared with those of approximate controls.


Short-term consumption effects of a lower minimum alcohol-purchasing age. Multiple-regression analysis revealed that apparent short-term increases in consumption of distilled spirits after reductions in minimum legal purchasing ages were not statistically significant.


Reevaluation of the disulfiram-alcohol reaction in man. The intensity of the disulfiram-alcohol reaction is found to depend on the blood acetaldehyde level, a disulfiram-induced predisposition reflected by alkalosis, and an individual predisposition reflected by dopamine-beta-hydroxylase activity.


Hypothesis testing in younger and older alcoholics. Older alcoholics used less systematic approaches to problem solving and were not able to solve as many problems as younger alcoholics or controls.


Non-help-seeking wives of employed alcoholics. A multilevel interpersonal profile. Interpretation of personality test scores reveals that non-help-seeking wives of employed alcoholics are dominant persons whose ideal self-images are of dependent or masochistic women.


Voluntary versus involuntary abstinence in the treatment of alcoholics. During the first 6 months after their discharge from a Fixed Interval Drinking Decisions Program patients who had been compelled to abstain did significantly better than the drinkers but significantly more poorly than those who had voluntarily abstained during the program.


Prediction of relapse in men alcoholics. Cognitive impairment, as measured by the Patterned Cognitive Impairment Test, was the best predictor of relapse in a group of patients after treatment for alcoholism.


Reinvestigation of the chemical reaction between disulfiram and ethanol. A claim that disulfiram and ethanol react to produce a quaternary ammonium compound, and that this product may be involved in the pharmacogenesis of the disulfiram-ethanol reaction, is shown to be in error.


Bias in calculated rate of alcohol metabolism due to variation in relative amounts of adipose tissue. Individual and group variations in the proportion of body fat relative to total body mass influence statistical calculation of rates of alcohol metabolism, and may affect conclusions about comparative rates. Ways of minimizing the effects of variations in adiposity are presented.


Consequences of retrospective measurement of alcohol consumption. Estimates of the effects of forgetting on the results of retrospective interviews varied according to the measures of past and present consumption--absolute alcohol or Quantity-Frequency-Variability scores.


Alcoholism in schizophrenics and their relatives. The possible interrelation of schizophrenia and alcoholism was examined by comparing schizophrenic adoptees and their biological relatives with control adoptees and their biological relatives. Neither schizophrenics nor their relatives had higher rates of alcoholism than did controls.


Effects of two liquor store strikes on drunkenness, impaired driving and traffic accidents. Liquor store strikes in Newfoundland and Nova Scotia did not reduce total accidents, driving-while-impaired charges or traffic fatalities; but arrests for public drunkenness declined in Newfoundland.


The relationship of alcohol withdrawal experiences to impaired cognitive function. Analysis of the scores of alcoholics on five tests of withdrawal, alcohol craving and cognitive function failed to support the hypothesis that the severity and frequency of alcohol withdrawal are related to impaired cognitive function.


Characteristics of volunteers for a controlled drinking training program. Patients who volunteered for a controlled drinking training program had more severe alcohol problems and less social and family stability than those who opted for abstinence-oriented programs.


Cricopharyngeal myotomy as a method of treating cricopharyngeal dysphagia secondary to gastroesophageal reflux. Food obstruction at the cricopharyngeal level is a common symptom of gastroesophageal reflux. In selected patients, cricopharyngeal myotomy is effective in relief of symptoms. We have used myotomy in patients whose only symptom was dysphagia, in patients too debilitated for major surgery, and in patients with persistent pharyngoesophageal dysphagia following hiatal hernia repair. All were studied by barium esophagogram, endoscopy, and manometry. Radiologic aspiration of barium was apparent in five of 19 patients. High-speed manometric tracings showed intermittent cricopharyngeal incoordination in the six consecutive patients most recently studied. This finding of incoordination has been shown to be present in 38 patients with reflux and in all with major cricopharyngeal symptoms. Myotomy was effective in relieving symptoms in patients in whom this was the only reflux symptom and in the five patients too debilitated for major surgery. Good symptomatic improvement was obtained in nine of the 12 with persistent dysphagia following hernia repair, but in three relief was partial, with persistent symptoms being secondary to distal esophageal obstruction. Investigation is necessary to exclude other causes of dysphagia. However, withcareful selection, myotomy has proved to be an effective method of treatment.


Complications and failings of the combined Collis-Belsey operation. Eighty-three patients with risk factors predisposing to recurrent reflux after standard hiatal hernia repairs have undergone the Collis-Belsey operation. There were two postoperative deaths. Complications related to multiple operations on the lower esophagus included injury to the spleen (three patients); gastrocutaneous fistula (two patients), and localized ischemic necrosis of esophagus two patients). There were two esophageal perforations. In four of 15 patients, the combination of esophagomyotomy and the Collis-Belsey operation produced functional esophageal obstruction. Three patients have experienced late major lower esophageal bleeding from ulceration of mucosa adjacent to the gastroplasty tube; two the these patients have no demonstrable gastroesophageal reflux. In addition to postoperative interviews and barium swallows, 77 patients have been evaluated with esophageal manometry and acid reflux testing. After an average follow-up of 12 montsh, 19 percent have symptomatic reflux, but 30 percent have moderate-to-severe reflux with pH reflux testing. The recent enthusiasm for the combined Collis-Belsey operation should be tempered by continued, cautious, objective assessment of its long-term results.


Diffuse spasm of the esophagus. Clinical manometric, and surgical considerations. Extended esophagomyotomy was performed on 11 patients with diffuse spasm of the esophagus (DSE). Preoperative and postoperative clinical, manometric, and roentgenographic findings are reviewed. Preoperative manometry performed in all patients disclosed a mean deglutitive pressure of 70 mm. Hg in the diseases areas and indicated the required length of myotomy. The lower esophageal sphincter (LES) was within normal limits in most instances, with a mean amplitude of 20 mm. Hg, and its exclusion from the myotomy eliminated the need for additional antireflux procedures. Postoperative manometry in 10 patients disclosed a 70 percent reduction in deglutitive pressures in the myotomized segments, and the mean LES amplitude of 13 mm. Hg remained within the normal range (10 to 20 mm. Hg). Ten of the 11 patients were clinically improved, and postoperative reflux developed in only one patient. These results support the continued use of extended esophagomyotomy in selected patients with DSE and suggest that exclusion of the LES from the myotomy affords satisfactory antireflux protection without ancillary sphincter-enhancing maneuvers.


Intraoperative and postoperative esophageal manometric findings with Collis gastroplasty and Belsey hiatal hernia repair for gastroesophageal reflux. The combination of a Collis gastroplasty with a Belsey Mark IV fundoplication has proved clinically effective in the management of certain patients with complications of gastroesophageal reflux. The present study measured the effect of gastroplasty and Belsey repair on intraluminal pressure changes in the gastroplasty and lower esophagus. Manometric studies were performed preoperatively, intraoperatively, and postoperatively. In each case the gastroplasty segment of the esophagus was found to function as a high pressure zone (HPZ). The pressure in this zone further increased following the fundoplication. It could be diminished with intravenous administration of Buscopan and augmented with intravenously given pentagastrin. The original lower esophageal sphincter in most instances was included in the upper segment of the gastroplasty tube, but the entire length of the gastroplasty tube functioned as an HPZ, and pressures in the tube were considerably higher than those originally present in the lower esophageal sphincter. These studies provide a physiological rationale for the effectiveness of gastroplasty and fundoplication.


Replacement of the trachea with dura mater. Experimental work. Results in a series of 30 dogs subjected to tracheal resection and repair are described. The dogs were divided into three groups. Seven to ten rings of the trachea were resected and then were replaced by a prosthesis made of dura mater and stainless steel wire. Different aspects of the procedures for respiratory support in the three groups are evaluated, as are the different kinds of prostheses used. Our results with ventilatory studies showed taht the mose effective means of respiratory support was insertion of an endotracheal tube after thoracotomy. Among the prostheses, the one used in the third group of dogs, a stainless steel spring covered with only one layer of dura mater, allowed a longer survival period but eventually caused late scarring and stenosis.


Systemic air embolism in experimental penetrating lung injuries. Several reports have described systemic air embolism in association with penetrating lung injuries. We produce lung lacerations in 18 dogs ventilated with air containing charcoal powder. An ultrasonic bubble detector was positioned over the carotid artery in six dogs. Evidence of arterial air embolism was found in every case of pulmonary laceration in open-chest, tension pneumothorax, and hypovolemic preparations. The quantity of air was small, producing only transient arrhythmia. No air was detected under control conditions. We conclude that systemic air embolism is a frequent accompaniment of penetrating lung injuries, that it is rarely recognized clinically because of its generally small quantity and minor, nonspecific effects, but that the potential for dangerous air embolism does exist with lung wounds and warrants precautions in management.


Method for resection and prosthetic replacement of aneurysm of aortic arch. We shall describe a case of aneurysm of the transverse aortic arch. The patient was operated upon successuflly. Severe respiratory distress owing to tracheal compression was the indication for emergency surgical therapy. A method is described comprising total cardiopulmonary bypass, hypothermia (28 C.) and local deep myocardial hypothermia. Catheters to cerebral vessels are brought off the main arterial line beyond the pump. Cerebral vascular resistance regulates local blood flow. Coronary perfusion is omitted.


Endomyocardial fibrosis in a European woman and its successful surgical treatment. A case of endomyocardial fibrosis of the right ventricle in a European woman is presented. The patient had no history of travel or residency outside of the United Kingdon, Echocardiography was helpful in defining the abnormality. Excision of the fibrotic tissue in the right ventricle and tricuspid valve replacement resulted in symptomatic relief. There was also coincidental absence of the right pulmonary artery.


Melanotic malignant schwannoma of the right atrium. A melanotic malignant schwannoma of the right atrium occurring in a 14-year-old girl is described. No previous such tumors in this location have been reported.


Oxygen consumption and the use of metabolic reserves during starvation and aestivation in Bulinus (Physopsis) africanus (Pulmonata: Planorbidae). Aestivating Bulinus (Physopsis) africanus (Krauss) snails are shown to have a lower oxygen consumption rate than those starving in water. This lowered oxygen uptake may possibly be brought about by change to a different metabolic pathway, since the slope of the log rate/temperature regression for oxygen consumption by aestivating snails is significantly different from those for fed and starving individuals. Starving snails use metabolic reserves in the form of protein, carbohydrate and lipid more rapidly than do aestivating snails, and this economy is commensurate, at least over a period of 21 days, with the reduction in oxygen consumption which characterises aestivation. The ability to effect this change upon being removed from water, although linked to the ability to survive exposure, high temperatures and starvation, is not shared by all individuals in the population studied. This can account for reported variations, both within and between populations of planorbid species, in their ability to survive out of water.


Sequential polypeptides. 2. Helix--coil transition in poly(gamma-benzyl epsilon-carbobenzoxy-L-lysyl-L-glutamate). Helix--coil transitions of an alternating copolypeptide poly(gamma-benzyl epsilon-carbobenzoxy-L-lysyl-L-glutamate) (poly[Lys(Z)-Glu(OBzl)]) in binary mixtures of dichloroacetic acid (DCA) and ethylene dichloride (EDC) were investigated by optical rotatory dispersion (ORD). The ORD data obtained were analyzed to evaluate the equilibrium constant s for helix formation and the cooperativity parameter sigma. The values of sigma1/2 are substantially independent of temperature and solvent composition, yielding 0.4 X 10(-2) on the average. The transition enthalpy deltaHc at the transition point decreases from 291 to 154 cal mol-1 as the DCA content is increased from 56 to 64 vol%. At about 20 degrees C and at 58 vol% DCA, poly[Lys(Z)-Glu(OBzl)] in binary mixtures of DCA and EDC undergoes a solvent-induced transition. This DCA content is intermediate between those for poly(gamma-benzyl L-glutamate) and poly(epsilon-carbobenzoxy-L-lysine) in the same binary solvent and close to that of an equimolar random copolymer of the two peptides. However, the s of poly[Lys(Z)-Glu(OBzl)] is not a geometrical mean of those of the parent homopolypeptides. This fact suggests that the helical conformation of the copolypeptide is stabilized by a conformational induction operative between adjacent residues.


Vibrational analysis of peptides, polypeptides, and proteins. 3. alpha-Poly(L-alanine). Starting with a force field transferred from our earlier studies on beta-polypeptides, we have calculated the optically active normal vibration frequencies of alpha-helical poly(L-alanine) and poly(L-alanine-N-d). The 47/13 helical structure was used, and all atoms were included. Only small modifications to the force field were required, and most of these could be justified. The analysis indicates that amide II' is in Fermi resonance with one component of CH3 asymmetric bend, thus leading to a small modification of C-N and C=O stretching force constants. The agreement between calculated and observed Raman and infrared bands is quite good. This has encouraged ls to calculate the influence of small structural changes on the spectrum as a means of explaining the observed effects of temperature changes.


The structure of alpha-keratin.

The structure of alpha-keratin. Known structural principles (close packing, maximum hydrogen bonding, the tendency of like groups to be surrounded in like manner, and the approximate constancy of interatomic distances and bond angles) are used, with meridional and equatorial x-ray data, to deduce and check the structure pattern for alpha-keratin. Internally hydrogen-bonded polypeptide helices are grouped into "3-stacks", in which each chain is rotated and shifted vertically a distance equal to the helix pitch (5.15 A, average), relative to the other two. This shift accounts simply for the meridional x-ray reflection at this spacing. The 3-stack structure repeats after three turns, except for differences in the R groups and a slight twist, required to give satisfaction of both intrachain and interchain forces. The 3-stacks are grouped into 9-stacks and these into 27-stacks (all twisting), giving a crystallographic unit containing 81 chains, with the chain axes spaced approximately like those of close-packed cylinders. When the twisting reaches the limit of stability for good interchain contacting and cross-linking, the residue/turn ratio in each chain helix shifts to another, with twisting in the opposite direction. The twisting reversal mechanism keeps all the helix axes approximately straight, parallel, and in a close-packed arrangement. Interchain distances and orientations are suitable for cystine cross-linking. The dimensions of the 27-stacks agree well with estimates of the "effective radius" of microfibrils. X-ray measurements of spacing changes during fiber extension are explained as due to alternation of zones with much cross-linking and zones with few cross-links.


Viscoelastic properties of very dilute paramyosin solutions. The storage and loss shear moduli, G' and G'', have been measured for dilute solutions of paramyosin from the clam Mercenaria mercenaria in water and glycerol--water mixtures containing potassium chloride and phosphate buffer. The Birnboim--Schrag multiple-lumped resonator was used in the frequency range from 150 to 8100 Hz; the concentration range was 0.7 to 2 X 10(-3) g/mL and the temperature range was 0.0 to 6.0 degrees C. The intrinsic moduli were obtained by extrapolation to infinite dilution. When compared with predictions of Yamakawa for a rigid cylindrical molecule, they agreed at low frequencies but diverged at high frequencies. Excellent agreement was obtained with calculations for a hybrid model whose relaxation times are attributed to rigid-body end-over-end rotation together with some internal modes of motion, probably flexural. The rotational relaxation time agreed rather well with that determined by DeLaney and Krause from electrical birefringence measurements. From the ratio of the rotational to the longest flexural relaxation time, the flexural rigidity and Young's modulus of the paramyosin molecule were estimated by relations derived by Wada and collaborators; the modulus was 1.2 X 10(10) dyn/cm2.


Neural and endocrine control systems acting on the population kinetics of the intestinal epithelium. Mechanisms for the control of cell proliferation in those tissues where continuous cell loss is balanced by continuous cell production are still poorly understood. In this paper the factors influencing cell proliferation in the intestinal epithelium are reviewed and it is hypothesised that cell division in the intestinal crypt is regulated by two interacting systems. One of these systems is highly localised, mediated by autonomic nerves and responsive to changes in the rate of cell loss, whereas the other system is generalised throughout the intestine, mediated by hormones and responsive to the nutritional needs of the organism. Experiments to disprove these hypothesis are then suggested.


Growth of locus coeruleus neurons in oculo independent of simultaneously present adrenergic and cholinergic nerves in the iris. Fetal brain tissue pieces containing locus coeruleus (LC) neurons were grafted to the anterior eye chamber alone or together with other grafts (irides, sympathetic ganglia or additional LC) in the presence of the sympathetic and parasympathetic part of the autonomic ground plexus of the iris. Specimens were analyzed with quantitative fluorescence microscopy and uptake of [3H]metaraminol. LC neurons were shown to grow independently of the simultaneous presence of sympathetic fibers in oculo in the following three experimental situations: 1. Fetal LC grafted to normal eyes, analyzed after cessation of the production of the halo of fluorescent fibres on the host irides. 2. Maturated LC neurons in which growth is reinitiated by addition of an iris transplant which becomes completely innervated. 3. Fetal LC neurons placed on or opposite to iris transplants that in turn were introduced into the eye chamber 1 month before. All LC grafts produced halos of fluorescent fibres on both host irides and iris transplants in a restricted zone. Fetal LC grafts produced fluorescent nerve fibres on host irides independent of the removal of the parasympathetic fibres in the irides. Fetal LC grafts were not significantly inhibited in their fibre production on irides where maturated LC grafts had already formed a halo of densely packed fluorescent fibres. When two fetal LC grafts were introduced simultaneously into the same eye chamber both were able to produce fluorescent fibres together on the host iris. Sympathetic ganglion transplants formed normal looking adrenergic plexuses on host irides that were already carrying LC grafts with halos of fluorescent fibres. In conclusion, the fibre production of LC neurons in oculo is independent of the presence of sympathetic, and probably also parasympathetic, and maturated central NA nerves.


Effect of steroid contraceptive drug treatment on the catecholamine metabolism in the guinea pig central nervous system. In an attempt to establish the biochemical basis of the neurological side-effects of steroid contraceptive drugs, the effect of chronic administration of lynestrenol-mestranol, a widely employed contraceptive combination, on the catecholaminergic system of the guinea pig striatum, brainstem, and hypothalamus, was investigated. The effect of these drugs on the transformation of tyrosine into dopamine and norepinephrine was investigated after cerobroventricular injection of a tracer dose of [3,5-3H]L-tyrosine. Treatment increased the conversion of [3H]Tyrosine into [3H]norepinephrine in the lower brainstem and hypothalamus was the same in treated and control animals. These findings confirm results previously obtained in female rats.


Nicotine in the crude synaptosomal fraction of the rat brain. The in vitro uptake of nicotine into the crude synaptosomal fraction of rat brain and spinal cord was studied. The tissue/midium ratio was low and the changing of incubation time or [14C]nicotine concentration did not affect the ratio, nor did a metabolic inhibitor, sodium fluoride. A lowered ratio was obtained at 0degrees C, but this decrease may be attributable to an altered pKa of the drug at low temperature. Nicotine antagonists, mecamylamine and hexamethonium, did not affect the ratio when incubating the crude synaptosomal fraction of either adult or infant rat brain. These results suggest that the uptake of nicotine into the synaptomal fraction is not an active process. When mecamylamine and nicotine were injected in vivo, the mecamylamine antagonism was also demonstrated as lowered nicotine concentrations in infant ray synaptosomes. Since the newborn rat cortex lacks glial tissue, the nicotine concentrations in the crude synaptosomal fraction of infant rats may reflect the receptor level effects better than in adult brains. The pretreatment of infant rats with mecamylamine also lowered blood nicotine levels, suggesting that mecamylamine affected nicotine brain levels also in an unspecific way.


Completion of hemagglutination inhibition test by solid-phase radioimmunoassay test in routine diagnostic rubella serology. A solid-phase radioimmunoassay (RIA) test for rubella virus IgG and IgM class antibodies was used for completing the hemagglutination inhibition (HI) test in routine diagnostic serology. During a six-month period 80 serum specimens from 47 patients were tested by RIA because the HI test result was either unreliable or gave insufficient information. This was approximately 5% of the total number of serum specimens tested for rubella antibodies in our laboratory during the study period. The main indications for using the RIA test were improper timing in the taking of serum specimens, which accounted for IgM determination, and nonspecific agglutinins or nonspecific serum hemaglutination inhibitors, which disturbed the HI test. In all cases an unambiguous result was obtained by the RIA test, and five recent rubella infections, not diagnosably by the HI test, were detected. Based on these findings we consider the RIA test to be a good alternative among the methods proposed for diagnostic rubella serology.


Evaluation of diatrizoate meglumine (Hypaque) in treatment of sudden hearing loss. Thirty patients with sudden hearing loss were treated with diatrizoate meglumine (Hypaque) and a vasodilator regimen. Of these patients, 30% had a good response, 23% had a moderate response, and 47% had no response. These results were superior to the results obtained in a group of patients with sudden hearing loss treated with vasodilators alone. A possible mode of action is discussed and the details of a new study outlined.


Intralaryngeal surgery 1977.

Intralaryngeal surgery 1977. A very brief history of laryngoscopy and intralaryngeal surgery up to the present time is outlined. A simple comparison of some of the conventional laryngeal instruments with CO2 laser capability is made, and the common one-handed and two-handed surgical techniques are outlined. Four cases are presented, each of which demonstrates a significant feature of laryngoscopic surgery.


Tympanosclerosis.

Tympanosclerosis. Tympanosclerosis is a pathological condition which results in deposits of dense hyaline tissue or even bone in the lamina propria of the middle ear mucous membrane. It is induced by chronic inflammation in the middle ear, and is likely a Type III immune complex disease. Clinical tympanosclerosis results in decreased sound conduction by fixing ossicles or the tympanic membrane, or by obstruction to ventilation of the middle ear or mastoid. Management is dictated by the location and extent of the tympanosclerotic involvement. Ossicular problems are met by removal of the tympanosclerosis and reconstruction of the chain. The exception to this is in involvement of the stapes and oval window where stapedectomy is usually necessary. Tympanosclerosis is not expected to recur, but in the oval window fibrous scarring usually refixes a mobilized stapes. A greater incidence in recent years is due to an increased awareness and interest.


Long-term middle ear ventilation.

Long-term middle ear ventilation. Successful long-term middle ear ventilation was established in 12 patients with chronic eustachian tube hypofunction that had failed to respond to repeated myringotomy and tympanotomy tube insertions by conventional techniques. The 12 patients (13 ears) had insertion of an untrimmed large flange "Per-Lee" type tube through a posterior-inferior tympanomeatal flap approach. The flange extended under the long process of the malleus, and into the hypotympanum and middle ear opening of the eustachian tube. The stem of the tube was brought out through the inferior central pars tensa. All tubes have remained in place for more than three years without serious complications providing adequate middle ear ventilation and preventing adherence of the tympanic membrane to the promontory.


Surgical correction of dural herniation into the mastoid cavity. A temporoparietal craniotomy as the approach of choice employed by the authors is presented for the surgical correction of dural herniation into the mastoid cavity in our series of four cases of middle fossa defects caused by previous operative procedures (mastoidectomy for removal of cholesteatoma) performed elsewhere. At the Triological Meeting a color movie accompanied the presentation of this paper.


Ventilating tubes in tympanoplasty.

Ventilating tubes in tympanoplasty. The successful surgical treatment of chronic otitis media or its sequela is frequently related to a ventilated tympanic cavity. Tubes at tympanoplasty have been recommended to assure ventilation until eustachian tube and middle ear mucosal functions have been restored and to prevent the complications of graft loss, atelectasis, cholesteatoma and ossicular destruction. This presentation reviews the literature on the subject and documents our results in 40 patients treated by tympanomastoid surgery with ventilating tubes. The types of tubes used, the surgical technique involved, and the selection of cases suitable for this method are described. Cholesteatoma was the primary disease in 32 patients, 6 had chronic otitis media, 1 cholesterol granuloma, and 1 eosinophilic granuloma. Complete healing of grafts following extrusion or removal of the tubes occurred in 34 patients, 2 tubes remain in place, 3 patients had persistent tube site perforations, and 1 was lost to follow-up. None of the patients had graft breakdown as a result of tube placement, and there has been no recurrence of cholesteatoma. In all cases, the follow-up period is a minimum of 18 months and extends to 92 months.


The problem mastoid cavity: medical and surgical management. The patient with persistent foul drainage from a previously operated-on mastoid cavity has a serious problem that requires aggressive attention from the otologic surgeon. The ear must be carefully evaluated in the office. Careful cleaning of the cavity and effective application of medication will dry up many of these cavities. Revision surgery of the ear requires a systematic approach using all the techniques of modern otologic surgery. This means the use of a post-auricular incision and wide bone removal combined with bone removal combined with obliteration techniques and grafting of the middle ear. This approach was used in 29 ears in 27 patients. Rapid healing and a trouble-free, dry ear was obtained in 26 patients or 90% of the operated-on cases.


Trigeminal neuralgia: retrolabyrinthine selective posterior root section. Experience gained from the treatment of 41 patients with 42 operations for the relief of Vth nerve pain over the past 5 years is reported. For the selective section of the posterior root of the trigeminal nerve 28 retrolabyrinthine procedures were performed for typical tic douloureux with complete lasting relief in 25; 1 was relieved with the addition of aspirin; and 2 were relieved by Tegratol even though it was ineffective before surgery. There were no deaths and no serious complications. None had facial paralysis or anesthesia dolorosa. The retrolabyrinthine approach to the posterior root of the trigeminal nerve is ideally suited for those patients with refractory tic douloureux or patients with facial pain secondary to other causes such as tumor. Because of its effectiveness and low morbidity, this procedure offers advantages over other surgical techniques.


Old and new in Ménière disease.

Old and new in Ménière disease. The clinical experience is increasing, but still there is no uniform understanding in the substrate of Ménière's disease. The criteria of the diagnosis is loose and great controversy exists in the therapeutic efforts. A bewildering number of concepts and methods have been suggested and praised as the best answers in solving the problem until the next claim of success shatters the popularity of earlier allegations. The array of articles in the world literature for the past 25 years treats the entity of Ménière's disease in general and from the viewpoint of etiology, pathology, histology, clinical diagnosis and treatment. This review is concerned primarily with the treatment aspect of the literature. All the published ideas, regimens and techniques have one significant feature in common. They all claim success but not in 100% of the cases. Recovery varies from about 60% to 80%. Those cases considered "improved" are 20% to 30% and the rate of failure is between 10% and 25%. The diagnostic tools and capabilities have improved considerably. For treatment, except for reasonable medical or surgical palliation, nothing more can be offered than was offered a half century ago.


Middle ear ventilation in conjunction with adenotonsillectomy. If the tonsils and adenoids are causing eustachian tube dysfunction with middle ear effusion, the need for a ventilation tube at the time of the T&A and myringotomy is unresolved. Thirty-one patients with bilateral symmetrical middle ear effusion had T&A and myringotomies. In one ear, a ventilation tube was inserted; the other ear acted as a control. In addition to the clinical impressions, preoperative and serial postoperative audiograms and tympanograms are compared through a 12-month time frame. Discussion is presented regarding middle ventilation at the time of the primary operation.


Pharyngeal reconstruction after laryngectomy. A method of pharyngeal reconstruction following laryngectomy is described. In 44 successive laryngectomies using this technique, no postoperative pharyngocutaneous fistulas occurred. Ten of the patients had received full courses of radiation therapy prior to the surgical procedure and had recurrent carcinomas. Other reports have noted that laryngectomy following full courses of "unplanned preoperative" radiation therapy is usually associated with a high incidence of postoperative pharyngeal fistula. The pharyngeal fistula problem, and the pharyngeal repair that was used in our series, are discussed. The pharynx was closed carefully in three layers with fine, absorbable sutures, and a submucosal inverting technique was used for the important mucous membrane closure. Tube feedings were used for two weeks after surgery. A high incidence of pharyngocutaneous fistula after laryngectomy in the irradiated patient can be prevented.


The firm salivary mass in children.

The firm salivary mass in children. The firm salivary gland mass arising in a child is uncommon, representing only 3.2% of all such salivary tumors at the University of Iowa. However, the fact that 57.1% of these tumors are malignant demands thorough diagnostic evaluation by the head and neck surgeon. Histologic diagnosis is strongly recommended. In view of the fact that most of these tumors have a favorable prognosis, lateral parotid lobectomy or total submandibular gland excision represented both an effective diagnostic and adequate therapeutic procedure for benign and low-grade malignancies. High-grade malignancies necessitate adjunctive therapy which is based on the biologic behavior of the particular histologic type.


Limitations of pathologic diagnosis in salivary gland tumors. The pathologist's diagnosis of mucoepidermoid tumor, acinic cell tumor, or oncocytoma may lull the surgeon into a false sense of security about the biologic potential of these tumors. A small percentage of low-grade mucoepidermoid carcinomas pursue an aggressive biologic course leading to metastases and death of the host. There are also acinic cell tumors and oncocytomas which biologically behave malignantly, metastasizing and causing death. Histologically and cytologically, these malignant varieties cannot be separated from those which pursue a benign course and would theoretically require only conservative excision. It is suggested that when the surgeon receives one of these three diagnoses, the extent of surgical resection be determined by the patient's clinical presentation, as well as knowledge of the tumor's potential, rather than the histopathologic appearance. Evidence from the literature is presented to support this concept.


Carcinoma of the pyriform sinus a comparison of treatment modalities. One hundred four patients with epidermoid carcinoma of the pyriform fossa were reviewed retrospectively. Survival, local recurrence and metastatic rates were all compiled for the purpose of comparing the efficacy of combined therapy with radiation therapy and surgery alone in treating such lesions. Combined therapy consisted of 4500 rad Cobalt60 therapy at 200 rad per day preoperatively. All lesions were staged according to AJC classification. There was a similar stage distribution of patients in each therapeutic category. Three-year determinate survival rates were as follows: radiation therapy --10%, surgery--56%, and combined therapy--40%. Evaluation of the local recurrence rate revealed it to be: radiation therapy--19/33 (58%), surgery--1/19 (5%), and combined therapy--9/32 (28%). We interpret this data to suggest that preoperative irradiation impaired the determination of adequate resection margins, despite the use of frozen sections from those margins at the time of surgery. The incidence of late contralateral palpable nodes was greatest in the surgery group--5/19 (26%), compared with radiation therapy--0/33, and combined therapy--1/32 (3%). This supports other studies which indicate that radiation therapy is very effective in controlling subclinical nodal metastases.


Closure of nasal septal perforation with composite flaps. A procedure for closure of symptomatic nasal septal perforations is described. The procedure combines the advantages of the good vascular supply of a rotation flap with the strength of a composite graft.


Nasal airway resistance computer.

Nasal airway resistance computer. An analogue computing system for the measurement of nasal airway resistance (Rn) has been developed. The instrument operates on the principle of measuring the transnasal pressure required to generate a measured nasal airflow rate. The system computes and displays inspiratory or expiratory nasal airway resistance measured at a preselected flow rate. The values are updated on a breath-by-breath basis and presented to a multi-channel recorder and a digital panel meter for visualization. The continuous Rn (at all inspiratory and expiratory flow rates above zero) can also be recorded. Use of the instrument for the evaluation of nasal decongestants has been demonstrated.


"Practical suggestions on counseling how I do it": counseling the laryngectomized patient. A laryngectomee's home environment may be a critical motivating factor for successful rehabilitation. Results from questionnaires to 45 wives of laryngectomees are discussed. The wives evaluated the adequacy of their preparation for the surgery and the type and severity of ensuing problems. Judgments as to the type and adequacy of counseling and the wives' factual understanding of the laryngectomy procedure and its consequences are reported. Results of the survey underscored the need for more counseling before and after laryngectomy. Wives of older laryngectomees were more optimistic post-operatively since their primary preoperative fear had been death. Younger wives' spirits are often lowest after surgery when the impact on daily living was more fully realized. The need for a team approach to total medical, speech, and vocational rehabilitation is indicated.


Nutritional effects of partially hydrogenated low erucic rapeseed oils. The incidence of cardiac lesions in male rats fed rapeseed oil (Brassica campestris, cultivar "Span") was lower with partially hydrogenated oil (iodine value 78) than withe the liquid oil which had been treated in various ways. Another rapeseed oil (Brassica napus, cultivar "Tower") was similarly improved when hydrogenated to iodine value 76.6, but not at iodine value 97.1, as demonstrated in both Sprague-Dawley and Wistar rats. The improved nutritional quality of hydrogenated oil appeared not to be related to the decreased concentration of linolenic acid, because that fatty acid in linseed oil with or without erucic acid did not increase the incidence of lesions. A relatively high concentration of docosahexaenoic acid in the cardiac fatty acids was observed in adversely affected groups, but a lower concentration was found with the appropriately hydrogenated rapeseed oil.


Acylglycerol structure of peanut oils of different atherogenic potential. Detailed investigation was made of the triacylglycerol structure of native, simulated, and interesterified peanut oils, which had previously been shown to differ markedly in their atherogenic potential. By means of chromatographic and stereospecific analyses, it was shown that the more atherogenic native oil contains a significantly greater proportion of triacylglycerols with linoleic in sn-2-position and arachidic, behenic, and lignoceric acids in sn-3-position that the synthetic oils. It is suggested that the atherogenicity may arise from a relative metabolic unavailability of the linoleic acid from the native oil, which may be due in part to the presence of long chain saturated acids in the outer position. This might render the oil metabolically more saturated that the interesterified oils of the same total fatty acid composition, which contain a much greater proportion of the linoleic acid in the primary postions of the triacylglycerol molecule. The identification of specific triacylglycerols may allow the experimental testing of this hypothesis by feeding synthetic triacylglycerols incorporating the potentially atherogenic features.


Skin surface lipids of the dog.

Skin surface lipids of the dog. The skin surface lipid of the dog has been reported to contain a high proportion of diol diesters having a lower mobility on thin layer chromatography than diesters from other species in spite of containing similar fatty acid and diol components. In the present study, dog skin surface lipid was separated by preparative thin layer chromatography into sterol esters (42%), wax diesters (32%), free sterols (9%), polar lipids (7%), and unidentified components (10%). The diesters contained 1,2-diols, each estrified with one long chain fatty acid and one isovaleric acid moiety. The diols were principally branched chain C21 and C22 compounds while the long chain fatty acids esterified with them were mainly C20 and C21 branched compounds. The fatty acids from the sterol esters were mostly saturated, branched chain C19 TO C23, together with 7% of straight chain monoenoic acids, principally C21 and C22. There were only trace amounts of free sterols other than cholesterol, while the esterified sterols contained 96% cholesterol and 4% lathosterol.


A new system for lipid analysis by liquid chromatography-mass spectrometry. A simple system for interfacing liquid chromatography with mass spectrometry for the analysis of lipids is described. The system is based on the moving chain transport principle and employs an endless stainless steel belt of perforated construction that gives it superior surface properties and capacity to entrain solvent. The entire column eluent is collected on the belt which transports it into an evaporator where the solvent is removed. The solute, which remains as a residue on the belt, is transported into a reactor where it is converted to hydrocarbons by reaction with hydrogen at 400-450 C. The hydrocarbons, which are characteristic of the structures of the parent compounds, are swept into an outlet tube where ca. 15% are drawn into the ion source of a mass spectrometer operating in the chemical ionization mode using methane as the reagent gas. The spectrum is recorded on an oscillographic recorder for identification purposes. Detection and quantitative analysis is performed by single ion monitoring of the most intense ion using a conventional analog recorder. The system is domonstrated by application to a standard mixture of tripalmitin, cholesteryl palmitate, and cholesterol separated on a 3.2 x 250 mm silica column, and exhibited a sensitivity of ca. 1 nanogram per component injected on the column.


Lipid metabolism of the yellow clam, Mesodesma mactroides: 3-saturated fatty acids and acetate metabolism. The fate of labeled palmitate, stearate, and acetate administered to the yellow clam, Mesodesma mactroides, was investigated. 1(-14)C palmitic and 1(-14)C stearic acids were oxidized to CO2 to a limited extent. They were mainly incorporated in diacylglycerols and triacylglycerols and were converted to higher homologs. After administration, palmitic acid was converted to stearic and oleic acids, whereas administered stearic acid was converted to 18:1, 18:2, 20:1, and 20:2 acids. Labeled acetate was readily included by the clam in 12:0, 14:0, 14:1, 15:0, 16:1, 16:1, 16:2, 18:2, 18:1, 18:2, 20:1, 20:2, and 20:3 acids.


Inhibition by 5-(tetradecyloxy)-2-furoic acid of fatty acid and cholesterol synthesis in isolated rat hepatocytes. Fatty acid and cholesterol synthesis in isolated rat hepatocytes were strongly inhibited by 5-(tetradecyloxy)-2-furoic acid. With either 3H2O or [2(-14)C] acetate as the labeled precursor, the concentrations of inhibitor causing 50% decrease in fatty acid and cholesterol synthesis were, respectively, less than 0.005 mM and 0.020 mM. At 0.1 mM inhibitor, citrate concentration in cells from fed rats was increased by 75%; lactate and pyruvate concentrations were decreased by 30%; ethanol oxidation was decreased by 20%; with cells from starved rats, the mitochondrial [NAD+]/[NADH] was decreased. Other parameters were unaffected. Both its potency and its specificity indicate that 5-(tetradecyloxy)-2-furoic acid will be useful in studies on the regulation of lipid biosynthesis.


Arylsulfonate esters as hypocholesteremic agents: III. Mechanism of action studies. The mechanism responsible for the hypocholestermic action of arylsulfonate esters of long chain fatty alcohols has been studied with rats fed either normocholesteremic or hypercholesteremic (1% cholesterol plus 0.5% glycoholate) diets. Linoleyl tosylate is more effective in lowering plasma and liver cholesterol levels of rats on the hypercholesteremic diet than several other hypocholesteremic agents tested. Linoleyl tosylate does not redistribute cholesterol to extrahepatic tissues nor inhibit hepatic cholesterol biosynthesis. Linoleyl tosylate is not effective in counteracting Triton-induced hypercholesteremia nor in lowering plasma cholesterol levels of the suckling rat. Linoleyl tosylate increases the fecal elimination of dietary [4(-14)C] cholesterol and prevents its accumulation in blood and liver. Oleyl p-(n-decyl) benzene sulfonate also prevents the apparent absorption of [26(-14)C] cholesterol from the gastrointestinal tract. Linoleyl tosylate increases the fecal excretion of neutral sterols but not of bile acids. The results indicate that the arylsulfonate esters of long chain fatty alcohols lower body cholesterol levels by inhibiting cholesterol absorption from the gastrointestinal tract. Exactly how absorption is inhibited is not clear, but linoleyl tosylate was found to stimulate the activity of cholesteryl esterase prepared from the intestinal mucosa.


The occurrence and distribution of furan fatty acids in spawning male freshwater fish. Furan fatty acids (F acids) have been found in the livers and/or testes of 20 species, representing 9 families, of male freshwater fish. In 9 species they are major components of the lipids while in the remaining 11 species they occur to a much lesser extent. The F acids in some species reach a maximum concentation in the testes lipids, and minimum liver lipid concentration, at spawning. In all species in the testes, the F acids are confined almost exclusively to the triglyceride fraction while, in the liver lipids, they are found, in order of decreasing concentration, in the cholesteryl esters, the triglycerides, and the phospholipids. In the lipids of many individuals F6, 12,15-epoxy-13,14-dimethyleicosa-12,14-dienoic acid, is the major fatty acid present. It is presumed that these acids perform some as yet unidentified metabolic function. Isolation technology and identification of F acids by a specific thin layer chromatographic spray reagent are discussed.


A mass spectrometric survey of some biologically important lipids. The mass spectra of lipids are reviewed with emphasis on characteristic fragmentation patterns of each general class of compounds. Recent developments in the area of field ionization and field desorption mass spectrometry are discussed relative to each class of lipids.


Studies on the hydrogen belts of membranes: I. Diester, diether, and dialkyl phosphatidycholines and polyoxyethylene glycerides in monolayers with cholesterol. The hydrogen belts of membranes are defined as the regions consisting of hydrogen bond acceptors, i.e., the C=O groups of glycero- and sphingolipids, and hydrogen bond donors, i.e., cholesterol-OH, sphingolipid-OH, proteins, and water. Lipid-lipid hydrogen bonding in these belts has been suggested. The connection of such hypothetical bonding with the condensation effect, i.e., the apparent reduction of surface area occupied by phospholipids in mixed monolayers with cholesterol, has been tested with lipids possissing and lacking C=O groups: diester, diether, and dialkyl phosphatidylcholine, and analogous polyoxyethylene diglycerides. Condensation by cholesterol was observed for all lipids. Consequently, the hypothetical lipid-C=O-cholesterol hydrogen bonding is not a prerequisite for the condensation effect.


Chain length specificity in the utilization of long chain alcohols for ether lipid biosynthesis in rat brain. A mixture of cis-9[1(-14)C] octadecenol and [1(-14)C] docosanol was injected into the brains of 19-day-old rats, and incorporation of radioactivity into brain lipids was determined after 3, 12, and 24 hr. Both alcohols were metabolized by the brain but at different rates; each was oxidized to the corresponding fatty acid, but oleic acid was more readily incorporated into polar lipids. Substantial amounts of radioactivity were incorporated into 18:1 alkyl and alk-1-enyl moieties of the ethanolamine phosphoglycerides and into 18:1 alkyl moieties of the choline phosphoglycerides. Even after the disappearance of the 18:1 alcohol from the substrate mixture (12 hr), the 22:0 alcohol was not used to any measurable extent for alkyl and alk-1-enylglycerol formation.


Studies on the hydrogen belts of membranes: II. Non-electrolyte permeability of liposomes of diester, diether, and dialkyl phosphatidylcholine and cholesterol. We have postulated the existence of lipid-lipid and protein-lipid hydrogen bonding in the hydrogen belts of membranes, i.e., the regions of hydrogen bond acceptors (carbonyl oxygens of esters and amides) and hydrogen bond donors (hydroxyls of cholesterol, sphingosine, proteins, water). To assess the possible effects of modifications of the hydrogen belts on membrane permeability, we prepared a diester phosphatidylcholine and two analogs lacking carbonyl oxygens, a diether and a dialkyl phosphatidylcholine, care being taken to synthesize lipids of identical efficient hydrophobic chain length. Relative permeation rates for glycerol and urea were determined by osmotic swelling of liposomes containing the phospholipids alone or with an equimolar quantity of cholesterol, with 4 mole % of dioleylphosphate added. The permeation rates of both solutes were similar for all three lipids, with Arrhenius activation energies deltaE* around 16 kcal/mole. Cholesterol reduced the permeability of all three membranes. The activation energy deltaE* of permeation did not change for diester and dialkyl phosphatidylcholine with cholesterol, but was lower by about 5 kcal/mole for the diether lipid with cholesterol. This corresponds to a reduction in the entropy of activation deltadeltaS*approximately-16 cal/mole/degree. We interpret the results as supporting the hypothesis of interaction between cholesterol hydroxyl and phospholipid carbonyl.


[Semi-automatic device for measuring relative distribution of doses of ionizing radiation]. During operation and adjustment of ionizing radiation sources it becomes necessary to determine relative distribution of the radiation doses. A semiautomatic device for taking and registering relative distribution of doses in any of the 3 aqueous phantom coordinates, based on an analogue recording of the 2 signals ratio on the self-recording potentiometer tape and upon synchronous movement of the transducer relative to the recording tape. A 0.05 cm3 ionization chamber was used as the transducer.


[Apparatus for medico-physiologic studies of the functional state and work capacity of civil aviation pilots]. It has now become possible to study the functional state of the pilots and to appraise their performance capacity by using a complex set of equipment. During the pilot's operation this equipment provides for obtaining electrocardiograms, information on the heart rate, respiration rate, maximum arterial pressure measured on the finger, skin temperature at 4 points, ambient temperature, taking electromyograms, registering dermato-galvanic reactions after Tarkhanov and the rate of the reaction in response to light and sound. In addition to the mentioned data it is also possible to study during off-duty time the electroencephalogram in 2 leads, arterial pressure after Korotkov, dynamogram, critical fusion frequency, as well as data on the coordination of movements and thresholds of audio-sensitivity. The possibilty of using the described apparatus with other electric facilities will enable it to broaden the field of its application, up to an including its utilization in large-scale examinations of the population, occupational examinations and occupational screening.


[Creation of an optimal production-technological structure in automated systems for managing the technological preparation of a product]. Issues concerned with improvement of the operational-engineering pattern and organization of production processes in manufacturing individual articles through an effective combination of product-parts, product-subassemblies and technological forms of specializing the plant subdivisions are considered. As an optimization criterion the minimum of incurred expenditures and also a system of point ratings are taken. The optimum is shown to be an operational-engineering pattern with predominance of a product-wise specialization of the plant departments. Problems that have to be solved in constructing a suitable model for the operational-engineering pattern within the framework of automated systems designed to monitor technological pre-arrangement for producing an adequate model of the object in dynamics are discussed.


[Creation of a system for monitoring the technologic quality of medical instruments and apparatus]. Arguments in favor of possible construction in this industrial branch of systems capable of monitoring technological effectiveness of medical instruments and apparatus are put forward. Introduction into the industry of a system for monitoring technological effectiveness will help improve the designing of medical instruments and apparatus in so far as their technological effectiveness is concerned and, by the same token, reduce labour- and metal-consumption, as well as the cost of preparatory work and to cut down the time spent in mastering batch production of new articles.


Membranous lupus nephropathy: a clinicopathologic study. Twenty-eight patients with SLE and distinct, well-defined renal morphologic lesions of membranous nephropathy were followed up for 4 years. These patients comprised approximately 8% of the patients evaluated for SLE during a 12-year period. The patients with membranous lupus nephropathy had typical systemic features of SLE, and most of them had positive LE cell tests and ANA, low serum complement concentrations, and mildly elevated serum antinative DNA levels. Proteniuria and microscopic hematuria were usually discovered years after systemic symptoms of SLE had developed, Only two patients had slowly progressive renal failure, and most patients continued to have proteinuria. Prednisone treatment did not influence either proteinuria or renal function. In only one patient, the renal character of the disease changed drastically, demonstrating membranoproliferative glomerulonephritis. Six patients died (21%); most of these died of cardiovascular illnesses. The relatively benign and stable renal course of membranous lupus nephropathy in patients with otherwise typical SLE suggests that the renal pathogenesis is different from that of proliferative lupus nephritis.


[Variation of morphometric measurements in bone biopsies (author's transl)]. The variation of histomorphometric data in a bone biopsy cylinder of the iliac crest was determined in order to derive a rule of the sampling procedure in such a biopsy specimen. Measurements in different cylinders of a biopsy zone in the right and the left iliac crest were obtained in order to determine the magnitude of change necessary for the recognition of therapeutic or spontaneous alterations performing sequential biopsies.


[Experimental assessment of the resistance of grounded electrocardiographs to outside line electrically synphasic interference]. By studying the problem of the electrocardiographs resistance to synphasic interferences it became possible to recommend measuring the noise-stability through the use of an equivalent resistor of synphasic noises and by applying the coefficient of synphasic rejection. Patterns for measurement of these parameters are proposed and several measuring circuit assessed. Principles underlying search for quantitative values for parameters of electric skin resistances used in the circuits are given.


The use of the phosphorescence microscope for the study of the phosphorescence of various cells. The phosphorescence microscope (i.e. a microspectrophosphorimeter) was used for recording the phosphorescence of microobjects. The general optical scheme of the reflecting phosphorescence microscope is described. The recordings of the phosphorescence spectra of cells of various types (bacteria, yeast, protozoa and human fibroblasts) were carried out both at room temperature and deep cooling. It will be shown that the phosphorescence spectra of the microorganisms are specific for every species of cells. The changes of the spectral parameters and triplet decay times after X-irradiation of Tetrahymena pyriformis cells were demonstrated. The decay time of phosphorescence of the fibroblasts at low temperature was also obtained.


Photogrammetric calibration of electron microscopes. Attention is drawn to sound mensural calibration of the electron microscope system. A general understanding of the inherent distorsions is imperative. By using the collinearity condition and a photogrammetric self-calibration technique, one obtains the patterns of scale, radial, tangential and spiral distorsions. These are discussed and fundamental concepts involving such calibrations are presented. Some actual data are presented for illustration purposes.


Freeze-fracturing of dispersions.

Freeze-fracturing of dispersions. In the last few years freeze-fracturing has proved to be a useful method for the investigation of dispersions. The freeze-fracture technique provides, above all, information on the arrangement of the colloidal particles in the liquid medium (e.g. on the state of agglomeration). Furthermore, it leads to conclusions about the structure, shape and size of the colloidal particles. The principles and applications particularly of the so-called drop-freeze-fracture technique are briefly described.


Freezing technique for microtoming long specimens of small width and/or depth. A technique is described for sectioning long but thin and/or narrow biological specimens using a freezing stage and sliding microtome. A water-saturated wood veneer platform is frozen to the stage and a saturated specimen is frozen to the veneer. The technique, which is inexpensive, permits cutting sections or viewing surfaces from specimens up to 8 cm long, while protecting the microtome knife from damage.


Perspectives on cardiovascular monitoring in 1977. During the past several decades, cardiovascular monitoring has been used with increasing frequency. Measurement of pressures, flows, cardiac rhythm, and blood gases permits the physician and surgeon to apply physiological concepts for treating patients with disease. More complex surgical procedures are now possible. Higher postoperative survival rates have resulted directly from careful monitoring and treatment in the postoperative care units. Operations may be performed with greater safety because of cardiovascular monitoring in the operating room. The relationship between the respiratory system and the circulatory system in managing patients with disease and in patients who are postoperative has been elucidated by new monitoring techniques. The value of extending monitoring to ambulatory patients is just being appreciated, and techniques to do so have been developed. The future offers much promise for an improved quality of medical care, with advanced techniques in cardiovascular monitoring that will be developed for use in the very near future. It is our hope that this symposium will provide useful information for those responsible for selecting such systems in future years.


Monitoring in the operating room: current techniques and future requirements. Review of a recent lawsuit and study of operating room cardiac arrests reveal that ventilatory problems are a major source of intraoperative morbidity and mortality. Tidal volume and airway gas composition are critical to the anesthesiologist who must determine the depth of an inhalation anesthetic. Yet, current instrumentation does not permit these variables to be measured conveniently. In this paper, current techniques for monitoring cardiovascular physiology are review, and considerable attention is focused on the problem of and the requirements for ventilatory monitoring in the operating room. The high dollar cost of infrequent untoward events is discussed, as well as the additional problem this creates because individual anesthesiologists may receive little positive reinforcement in encouraging the development of more sophisticated monitoring techniques.


Cardiovascular monitoring in the medical intensive care unit. The need for and development of computer-based monitoring in medical intensive care are discussed. The critical care ward system at the University of Southern California's Center for the Critically Ill is described. Basic monitoring routines include measurement of heart rate; arterial, venous, and pulmonary pressures; core and peripheral temperature; and urine output. Other application programs handle cardiac output determinations, laboratory tests, narrative data entry, and process control. Data retrieval provides for tabular, textual, and graphic displays both at the bedside and in hard copy, as well as data printouts for research purposes. Computer control covers the vascular interface, automated pressure calibration, peristaltic pumps for fluid infusion and blood sampling, and urine collection and disposal. Using automated fluid challenge as a prototype, servo operations should be extended to mechanical ventilation and fluid therapy.


Initial experience with prazosin in New Zealand. A multicentre report. New Zealand Hypertension Study Group. Data are presented on 282 patients who began taking prazosin before March, 1975, and whose progress was followed until March, 1976. The following conclusions can be drawn. (i) Prazosin is an effective and useful antihypertensive agent, best used with a diuretic and a beta-blocker. (ii) For patients with suspected or definite coronary artery disease, prazosin should not be used without a beta-blocker. (iii) In patients suspected of having incipient heart failure, prazosin should not be used without a diuretic, and the latter should be given first. (iv) many patients have little or no rise in heart rate with prazosin. However, patients with sinus tachycardia or a history of arrhythmias should preferably not be treated with prazosin. (v) The initial dose should be kept small (0-25 to 0-5 mg). Subsequent increments should also be small, not more than 2 mg/day. (vi) If prazosin is added to a regimen containing an adrenergic neurone-blocking drug, the dose of the latter should first be reduced. (vii) Prazosin should not, in the meantime, be used concomitantly with a phenothiazine, as the combination appears to be capable of causing agitation and confusion. (viii) There seems to be no long-term toxicity.


Open studies with prazosin in the treatment of essential hypertension. Prazosin Research Group in Japan. The clinical usefulness of prazosin was investigated in 67 patients with mild to moderate essential hypertension for 6 to 12 weeks. The daily doses were increased from 3 to 9 mg according to the responses of the patients. The average reduction of mean arterial blood pressure by 6 weeks' prazosin treatment was 13-4 +/- 1-7 mm Hg. Thirty-three patients (49-3%) showed good or excellent responses to prazosin. Serious side effects or laboratory abnormalities did not appear in this trial, through postural dizziness was found in 6-0%. Prazosin seems to be a useful antihypertensive agent in the treatment of patients with mild or moderate essential hypertension.


Monitoring electrocardiographic data in ambulatory patients. Sustained periods of extremely rapid or slow heart rate or initiation of the heartbeat from an ectopic focus can lead to serious clinical impairment or even death. Because disturbances of cardiac rhythm are ofter intermittent and evanescent, the development of systems for recording electrocardiograms in ambulatory patients for later analysis has been of clinical utility in diverse forms of heart disease. The basic components of such systems include a compact portable tape recorder for recording electrocardiographic data and a playback system with facilities for data analysis. Recently, semi-automated, computer-assisted analysis of this electrocardiographic data and quantitative analysis of the frequency of abnormal rhythms have become possible. In addition to widespread application for diagnostic purposes, ambulatory electrocardiographic techniques are now being used to evaluate new drugs for the treatment of cardiac rhythm disturbances and to define subsets of cardiac patients in whom treatment of rhythm disturbances may be desirable.


The Unibed patient monitoring system: a new approach for a new technology. The Unibed patient monitoring system represents a new approach to the design of medical instrumentation based upon recent advances in microcomputer and related large-scale integration technology. This system is intended to replace an entire range of traditional monitoring devices with a single general-purpose unit capable of recognizing the nature of the signal source and performing appropriately. All of the usual switches, knobs, dials, and meters have been replaced by a touch-sensitive character display. The hardware responsible for physiological signal analysis, information display, and user interaction is actually a set of firmware modules implemented in terms of microcomputer programs. This firmware gives the system its functional personality and transforms it from a compact process-control system into a useful medical instrument. Prototypes are now being clinically tested and evaluated at the Dijkzigt Academic Hospital, Rotterdam, Netherlands.


Prazosin in the treatment of patients with hypertension and renal functional impairment. Prazosin was used as an additional antihypertensive agent for treating 38 patients with hypertension and renal functional impairment. The drug was effective in 29 of these patients at a mean daily dose of 7 mg. The mean blood pressure fall in these 29 patients was 28/22 mm Hg. The most frequent (10 patients) and important side effect of prazosin treatment was dizziness, which occurred on standing of after exertion and was seen either after the first dose or after a large dose increase. The "first-dose phenomenon" was a result of severe postural hypotension and was eliminated by using a starting dose of 0-5 mg every 12 hours, with the first dose being given before retiring to bed. Dosage increments were limited to 0-5 mg, beginning late in the evening. Eleven patients had a significant improvement in renal function, while a further eight patients had stable renal function. In no patient was there a deterioration in renal function which could be attributed to prazosin.


Automation of measurements and interventions in the systematic care of postoperative cardiac surgical patients. Since July of 1967, a computer-based system has been employed in the observation and treatment of 8500 patients following cardiac surgical procedures. Of the 12 beds in the University of Alabama Hospital Cardiac Surgical Intensive Care Unit, 10 are equipped with biomedical instrumentation interfaced with digital computer systems. These systems perform the automatic acquisition, display, storage, retrieval, and charting of measurements; computation and evaluation of acid-base balance from manually entered blood gas data; analysis of the data for the detection and treatment of impaired cardiac performance; automatic control of blood infusion and vasodilating agents by closed-loop feedback control techniques; hourly evaluation of chest tube drainage patterns to detect excessive blood loss in the early hours following operation; and computation of the infusion rate (ml/hr) of pharmacologic agents according to a specified dosage (microgram/kg/min). Automatic control of left atrial pressure by blood infusion has been applied to 8000 patients during the past 10 years. Regulation of mean arterial pressure by computer-controlled infusion of vasodilating agents has been performed in 400 patients in the last 2 years. The use of the system has contributed to the reduction of patient time spent in the unit to 24 hours or less for the majority of the patients.


Cardiopulmonary monitoring in the respiratory intensive care unit. Respiratory monitoring using airway measurements of flow, pressure, and oxygen and carbon dioxide concentrations is practical and useful for intensive care patients on respirator support. End-tidal PCO2 minute and tidal volumes, and compliance are the most useful simple measurements. On-line plots of pressure against volume and flow against volume are helpful in early detection of difficulty. More sophisticated pulmonary function tests such as maximum flows and volumes, functional residual capacity, and measurement of fast space and slow space can be easily automated under computer control. Respiratory monitoring provides painless, nonpenetrating measurements which are immediately available, and which reduce the incidence of undetected life-threatening respiratory accidents.


A cost-effective system for obtaining comprehensive cardiovascular information on the critically ill patient. A relatively simple and inexpensive data management system is described with which comprehensive physiologic and cardiovascular profiles are produced. The system is comprised of a desk-top programmable calculator interfaced with an acoustic digitizer input, and an X-Y plotter, with alphanumeric printing output capability. Numerical clinical data such as intracardiac pressures and blood gas values are entered into the calculator via the keyboard, and graphical data such as dye-dilution curves or ventricular contours are digitized with a pen stylus on the acoustic tablet. The data are processed in the calculator and the results charted in familiar and readily interpreted bar-graph format on preprinted charts on the X-Y plotter. The entire system is inexpensive and compact enough to be applicable to small- and medium-size community hospitals.


Heart disease and pregnancy at the Royal Women's Hospital. The management of 542 women with heart disease and pregnancy during the years 1950 to 1975 is described. All were classified according to their cardiac function at the onset of pregnancy. The incidence of heart failure is recorded and the factors which determined this are discussed. Mitral valvotomy was performed during pregnancy in 13 women, however 31 had had mitral valvotomy before pregnancy. There were 10 maternal deaths, eight of these occurring during the puerperium.


Application of a minicomputer-based system in measuring intraocular fluid dynamics. A complete, computerized system has been developed to automate and display radionuclide clearance studies in an ophthalmology clinical laboratory. The system is based on a PDP-8E computer with a 16-k core memory and includes a dual-drive Decassette system and an interactive display terminal. The software controls the acquisition of data from an NIM scaler, times the procedures, and analyzes and simultaneously displays logarithmically converted data on a fully annotated graph. Animal studies and clinical experiments are presented to illustrate the nature of these displays and the results obtained using this automated eye physiometer.


Hypertrophic osteoarthropathy--an important differential diagnosis. A case of hypertrophic osteoarthropathy associated with carcinoma of the lung is presented. The symptomatology of the former usually dominates the clinical picture so that early diagnosis of the underlying carcinoma often depends on recognition of hypertrophic osteoarthropathy. A brief review of the literature is given.


[Morphology of histological subgroups of Hodgkin's disease (author's transl)]. The morphological criteria for the subclassification of Hodgkin's disease were studied in order to obtain a better appreciation of their diagnostic value. We could not separate a specific criterion which would alone permit the diagnosis of a subgroup of Hodgkin's disease. However, the combination of different morphological features including form and frequency of the diagnostic Reed-Sternberg-cells improves the reproducibility of subgrouping Hodgkin's disease. According to their diagnostic significance we consider important: for the LD diffuse infiltration of the lymphnode with few Reed-Sternberg-cells and discret inflammatory reaction; for the MC heavy inflammatory reaction, occasionally with necrosis, numerous diagnostic Reed-Sternberg-cells, occasionally focal involvement in the lymphnode and appearence of birefringent collagen fibers; for the NS the lacunar cells and nodular arrangement of birefringent collagen fibers; for the LP the pleomorphism of the Reed-Sternberg-cells, collagen fibers without birefringency. Based on morphological ressemblance of the nuclei we assume that the tumor cells represent malignant lymphocytes; we consider therefore Hodgkin's disease as a lymphocytic lymphoma.


[Nitroblue tetrazolium test in Hodgkin's disease (author's transl)]. Nitroblue tetrazolium dye (NBT) test was performed in 60 patients suffering from Hodgkin's disease. The control group consisted of 60 healthy adults. 23 patients with inactive lymphogranulomatosis had a mean NBT-balue of 30 +/- 9% formazan cells. There was no difference compared with controls (32 +/- 10% formazan cells). 37 patients suffered from active Hodgkin's disease. In this group 31 patients showed an elevated value, 6 had normal levels. On average the level was significantly raised with 59 +/- 20% formazan cells (p less than 0,01). A correlation between the extent of the disease and the height of the NBT figure could not be demonstrated. The same applies to the different histological types. In comparison between the NBT value and the simultaneously examined ALP it was found that ALP is a more sensitive parameter but that an increased ALP is not indicative of an active stage. It is therefore advisable to determined both parameters to get more security whether there is active or inactive Hodgkin's disease.


[Eosinophilic granulomatosis: a case report on a rarely found disease of the hypereosinophilic syndrome (author's transl)]. This ia a case report on a eosinophilic granulomatosis. This disease falls nunder the hypereosinophilic syndrome as well as the eosinophilic leukemia, the disseminated eosinophilic collagenosis, and the endocarditis fibroplastica parietalis Löffler. These diseases are characterized by cardiovascular, pulmonary, abdominal and cerebral symptoms. An increased number of eosinophilic granulocytes constitutes the obligatory hematologic feature. Eosinophilic infiltration and vasculitis especially of the small vessels in heart, lung, liver, spleen, lymphnodes, and cerebrum are typical pathological findings. The eosinophilic granulomatosis shows in addition extravascular granulomas with abundant eosinophilic granulocytes. It is assumed that the hypereosinophilic disorders result from the same basic disease. We would suggest to described this basic disease as allergic eosinophilic collagenosis. This term implies both the supposed etiology and the histologic localisation of the disorder.


[Heparin dosage in chronic hemodialysis (author's transl)]. Over a period of 10 months hemodialyses in 20 patients with chronic renal failure were performed with a 40% lower heparin-dose. Blood coagulation was controlled from the activated partial thromboplastin time (APTT). There were no unfavourable side-effects, also the effectivity of the hemodialyses was not changed. However, we measured a significant increase in the hemoglobin-concentration and in the packed cell volume. Bleeding from the punctures was significantly shortened.


[Quantitative assessment of drug-induced prophylaxis of postoperative thromboembolism. Comparison of frequencies of deep vein thrombosis and pulmonary embolism using acetylsalicylic-acid, dextran, dihydroergotamine, low-dose heparin and the fixed combination of heparin and dihydroergotamine (author's transl)]. 2136 patients in general surgery, gynaecology and urology were investigated by the 125I-fibrinogen-uptake-test for detection of postoperative deep vein thrombosis (DVT). They received at random one of low-dose heparin, dihydroergotamine, the fixed combination of both drugs (Heparin-Dihydergot), low molecular weight dextran and acetylsalicylic-acid (ASS). When DVT was detected repeated lung perfusion scintigraphies were carried out for diagnosis of embolic pulmonary perfusion defects. Results demonstrate the outstanding effect of Heparin-Dihydergot, which is not only 2-3 times better than the anti-thrombotic standard low-dose heparin but also eliminates almost completely the risk of postoperative embolism. The preventive efficacy of ASS and dextran must be considered to be poor and not comparable to that obtained when using heparin, dihydroergotamine or the combination. Now Heparin-Dihydergot is the new standard with which all prophylactic procedures should be compared.


[Changes of venous hemodynamics by thermic stimuli (author's transl)]. Measurement of the venous capacity by means of strain-gauge-plethysmography when performed under standardised conditions produces reproducible values in chronic test also. Acutely, the venous capacity of the healthy can be reduced by cold water and increased by warm water appplication. When measuring pressure in the great saphenous vein, which was performed during stress test and after cooling down, a clear improvement of the valvular function in the shank coud be ascertained. The healthy lying down, a distinct increase of the venous tonus takes place after application of cold water. With respect to primary varicosis, in addition to the acute reduction of volume, a chronic training effect, in the sense of a reduction in the venous capacity, significantly can be a convenient means for the treatment of primary varicosis and of less severe forms of chronic venous insufficiency.


[Behaviour of oxytetracycline and doxycycline serum levels under forced diuresis in severe bromcarbamide intoxication (author's transl)]. A dose of 500 or 1000 ml respectively was infused at hourly intervals over 12 or 24 hours respectively, using a standardised infusion schedule. It was found that this enormous increase in renal function did not cause any changes in the behaviour of the serum levels of oxytetracycline and doxycycline as compared to normal renal excretion. This result comes hardly as a surprise in the case of doxycycline due to its high degree of protein binding, it is, however, unexpected for oxytetracycline.


[Electrocardiographic changes in hypothermia]. Survey of electrocardiographic changes in hypothermia, especially the pathognomonic J wave, and report of a case of accidental hypothermia in a 83-year-old woman.


[Clinical course and pathogenesis of oral contraceptive hypertension (author's transl)]. Oral contraceptives are of pathogenetic importance in hypertension of women aged 26 to 35 years. The hypertensive reaction occurs predominantly in those women who have hereditary predisposition in hypertension or diabetes mellitus, who suffer themselves from diabetes mellitus or who showed toxemia in preceding pregnancies. Experimental studies in rats indicated that oral contraceptive hypertension could be due to vascular lesions, produced by estrogen, and sodium retention, caused by progestogen. Our findings are not in agreement with the proposal that the hypertensive reaction in women is always reversible. It would be of advantage if oral contraceptives could be used, which contain no estrogen or at least estrogen in the lowest possible dose and which comprise progestogens without sodium-retaining effect.


[Significance of liver volume for the early survival of patients with liver cirrhosis operated on porta-caval anastomosis: Clinical data and relation to pathophysiological implications (author's transl)]. It is thought that the early outcome of patients with liver cirrhosis after end-to-side porta-caval anastomosis not only depends on their clinical situation but also on the postoperative haemodynamic state of the liver. The postoperative haemodynamics can be estimated if the relation of liver volume and the predicted hepatic arterial perfusion is focused. The maximum of arterial liver perfusion seems to be 1200 ml/min in the absence of a portal liver blood supply. Thus, a postoperative perfusionindex between 0.8-1.2 like in normal subjects seems to be the best situation to prevent postoperative hepatic underperfusion. 25 patients were investigated, in which the clinical situation was classified as recommended by Child, and liver volume was estimated by means of ultrasonography. Those patients having liver volumes between 1000 and 1500 ml providing a postoperative PI between 0.8-12 survived in 100%. The early mortality rate of those, having liver volumes more or less these thresholds died in 69%. It was concluded that hepatomegaly or extreme liver atrophy are situations not to be recommended for classical porta-caval anastomosis. Other procedures are dissussed which "seem to be some good news" by clinical data and by means of experimental results. The techniques discussed consist in procedures preventing the pancreatic venous blood to shunt away from the liver.


[Stenosis of the celiac artery as cause of chronic recurrent pancreatitis (author's transl)]. Report on three clinical examples of the interrelation between chronic recurrent pancreatitits and external compression which cause a stenosis of the celiac artery. If clarification of the etiology of recurrent pancreatitis with the usual examinations is impossible, angiography is very important. A causal therapy is only possible by means of surgical treatment of the stenosis.


The influence of some metabolic inhibitors on in vitro phagocytizing macrophages. I. The behaviour of human macrophages. In the present work the uptake of foreign materials by macrophages has been studied in order to elucidate its possible energy-dependent mechanisms. We used monolayer cultures of macrophages from human peripheral venous blood, treated with the following metabolic inhibitors: iodoacetic acid, fluoroacetic acid, sodium fluoride, sodium malonate, sodium azide, 2-4-dinitrophenol, cycloheximide, and ouabain. The test assay was performed by using a zymosan particles suspension in Mc Coy 5 A medium supplemented as follows. The quantitation of phagocytosis was obtained by direct count of intracellular zymosan particles by oil 100X microscopy and the results were submitted to a statistical evaluation. The most effective inhibitor we found was iodoacetate, an inhibitor of anaerobic glycolysis, but fluoride, which acts on the same metabolic pathway at a different site, was quite ineffective. The same ineffectiveness we found for fluoracetate and malonate which act on the Krebs cycle. On the contrary, dinitrophenol (uncoupler of oxidative phosphorylation), azide (inhibitor of cytochrome linked-phosphorylation), ouabain (inhibitor of membrane ATPase activity) and cycloheximide (inhibitor of protein synthesis) give a remarkable decrease of index of phagocytosis after a 3h incubation. In conclusion, we can suppose that the energy-dependent phagocytosis is first depending on transport across the cell membrane (ATPase activity and protein synthesis) and second both on anaerobic glycolysis and oxidative phosphorylation.