The "lip shave" operation for pre-malignant conditions and micro-invasive carcinoma of the lower lip. The indications for a lip shave operation include actinic cheilitis with dysplasia, carcinoma in situ, or very early carcinoma with micro-invasion. In addition it may be combined with V wedge excision for larger carcinomas. The procedure consists in the excision of the vermilion epithelium with immediate repair of the lip by advancement of a flap of labial mucosa. The functional and cosmetic results of the operation are perfectly acceptable. The incidence of subsequent carcinoma in lips treated this way is very low.


Nickel carcinogenesis of the respiratory tract. The role of some nickel compounds and other chemical carcinogens in the causation of cancer of the nose and paranasal sinuses must be recognized. Preventive health measures taken by the nickel industry to eliminate the hazard of nickel carcinogenesis have included improved worker hygiene, reduction of refinery dusts and aerosols, and a strict monitoring of employees by regular examination and plasma nickel testing. The treatment of carcinoma limited to the naso-antral wall or ethmoid labyrinth by an en bloc resection is described, as well as the management of cribriform plate CSF leaks sometimes associated with the ethmoid resection. A subcutaneous cheek flap from the lateral rhinotomy is reflected inward against the cribriform plate to control cerebrospinal fluid rhinorrhea.


Childhood myxomas of the head and neck.

Childhood myxomas of the head and neck. Childhood myxomas of the head and neck are rare, benign, locally invasive tumors. They present great difficulties in histological diagnosis and because of their tendency to recur, present great difficulties in treatment. The combination of vital structures in the head and neck and longevity in children places the head and neck surgeon in a difficult position when determining how radical treatment should be. From a review of the literature and our own experience with four cases, the treatment of choice was found to be surgical resection with tissue margins checked by frozen section and modified by consideration of function and cosmetic appearance. Recurrence occurs in approximately one-third of these patients, but careful longterm follow-up will aid in early detection and local re-excision.


Hemangiopericytoma of the parotid gland with a review of the literature. Hemangiopericytoma, a rare vascular tumor characterized by pericytes, has been confused with benign lesions. The tumor cannot be identified clinically and requires histopathologic examination. Although the five year survival rate is good, the 10 year survival rate is poor for tumors in the head and neck region. Aggressive treatment with wide surgical margins appears warranted. Surgery in combination with radiotherapy has improved the poor prognosis. A case of hemangiopericytoma of the parotid gland, the eighth known in the surgical literature, is presented which illustrates the difficulty in the diagnosis and treatment of this lesion.


Needle aspiration of the prostate.

Needle aspiration of the prostate. Prostatic needle aspiration is rapid, safe and accurate. It should be used without fear of complication as a routine screening procedure in the office and should be considered a primary tool in the diagnosis of carcinoma of the prostate.


Hormone changes in patients with prostatic carcinoma during treatment with estramustine phosphate. Hormone analyses of plasma were done on 9 patients with prostatic carcinoma before, during and after treatment with estramustine phosphate. In previously untreated men estramustine phosphate suppressed the plasma testosterone levels. Furthermore, suppression of increased gonadotropins was obtained in irradiated or orchiectomized patients. These hormone changes were caused by high plasma levels of estradiol and/or total estrogens during treatment, with estramustine phosphate, which were still present 2 to 3 months after discontinuation of the drug. We conclude that estramustine phosphate acts, at least partially, as an estrogen and may cause estrogen-dependent side effects.


The effect of transurethral resection of the prostate on lymphocyte response in patients with prostatic cancer. The following study indicates that transurethral resection may affect the in vivo cellular aspects of the immune response in patients with prostatic cancer. This in vivo result seems to be supported by the fact that patients dying of carcinoma of the prostate at our institution usually had had an antecedent transurethral resection. Therefore, we emphasize that transurethral resection in patients with prostate cancer should be undertaken with clear-cut indications and with the knowledge that it may be an insult to the patient's immune system.


Detrusor-urethral sphincter dyssynergia. Inappropriate contraction or failure of relaxation of either the internal (smooth muscle) or external (striated muscle) urethral sphincter or both coincident with detrusor contraction results in a micturitional disorder known as detrusor-urethral sphincter dyssynergia. Based on our clinical experience with more than 200 spinal cord subjects and serial urodynamic observations on some of these individuals from the time of injury, various grades of dyssynergia (1 to 3) were recognized. The duration and completeness of suprasacral cord injury essentially determined the degree of dyssynergia. Internal sphincter dyssynergia was encountered less often in this group. A review in relation to pathophysiology and management of this micturitional dysfunction is presented.


Conscious dynamic versus unconscious static cystourethrography. Prior to treatment 30 urologically symptomatic subjects were studied with dynamic voiding cystourethrography while conscious and with single shot high pressure static cystourethrography while anesthetized. The former technique did not surpass the latter in demonstrating reflux, lower urinary tract disease or urethral anatomical detail. It is concluded that (problem cases aside) when management requires anesthetizing the patient only the high pressure, single shot static method should be used and that omission of premedication and manipulation of anesthetic planes to produce voiding are neither necessary nor desirable.


The adynamic terminal ureteral segment.

The adynamic terminal ureteral segment. Recently, we observed hydroureteronephrosis owing to an adynamic transmural distal ureteral segment associated with a thickened bladder, consequent to bladder outlet obstruction. Histological examination disclosed a loss of intrinsic musculature of the terminal ureteral segment with fibrosis. The importance of this entity is in the fact that upper tract dilatation and deterioration may progress, despite apparently successful correction of the bladder outlet uropathy.


Cerebrospinal fluid pseudocyst after urinary diversion. The development of an abdominal mass after urinary diversion in a patient with a ventriculoperitoneal shunt should alert the physician to the possibility of a cerebrospinal fluid pseudocyst. Two pediatric cases of cerebrospinal fluid pseudocysts are presented to illustrate this complication. The etiology, diagnosis and management of the pseudocyst are discussed and the literature is reviewed.


Extravesical reconstruction for ureterovesical obstructions in childhood. The blind empirical practice of ureteral reimplantation for all types of ureterovesical obstruction is founded on entirely speculative concepts of the nature of the obstruction. A significant proportion of ureterovesical obstructions are caused by a tilt-valve type of abnormality of the distal ureter with a normal juxtavesical segment. These can be corrected rationally by an extravesical ureteroureteroplasty. This procedure was done between 1968 and 1975 to relieve obstruction of 9 ureters in 8 children. The pathological anatomy found in these cases is defined and the technique of operative recognition and reconstruction is described. With adequate operative recognition and appropriate case selection relief of obstruction was achieved and maintained in 7 of the 9 ureters.


Allen-Spence repair for coronal and distal penile hypospadias with chordee. Our experience with the Allen-Spence procedure in 31 children with distal hypospadias is described. The surgical techniques and our results are reviewed and compared to those reported in the literature. This procedure is safe and simple, and provides excellent cosmetic and functional results.


Klinefelter's syndrome in identical twins associated with chordee without hypospadias. An unusual instance of concordant chordee without hypospadias in identical twins with 47 XXY Klinefelter's syndrome is reported. The etiology of coincidental chordee without hypospadias and Klinefelter's syndrome is unknown.


Renal vein compression.

Renal vein compression. Duodenal compression by the superior mesenteric artery is the postulated cause of the superior mesenteric artery syndrome. Our case, as well as 2 other cases of renal vein compression reported in the literature, suggests that this is uncommon but should occur more frequently in this syndrome because it is anatomically as vulnerable to compression.


Squamous cell carcinoma of the urachus.

Squamous cell carcinoma of the urachus. The third documented case of primary squamous cell carcinoma of the urachus in the English literature is reported. The interesting coincidental occurrence of the dermoid cyst of the right ovary and a complete longitudinal septum of the vagina and uterine cervix is described.


Malignant penile horn.

Malignant penile horn. The fifth case of carcinoma within a penile horn is reported in a patient who also had erythroplasia of Queyrat of the glans penis. Penile horns should be considered as pre-malignant lesions, since a third of them undergo malignant change and they may be associated with a pre-malignant condition of the glans penis.


Embryonal carcinoma of the testis in elderly men. A rare case of pure embryonal carcinoma of the testis in a black man in the tenth decade of life is presented, as well as a review of the literature on germ cell testicular tumors in men 60 years old or more. It is noteworthy that nearly 9 per cent of testicular tumors occur in this age group and a third of these tumors are of germ cell origin.


Staghorn renal stones: value of bench surgery and autotransplantation. Two patients with staghorn renal calculi underwent bench surgery and autotransplantation. A discussion is presented on the value of an extracorporeal procedure for patients with staghorn calculi associated with renal artery or pyeloureteral junction stenosis.


Tubular function impairment in patients with asymptomatic hyperuricemia. Renal function studies were done on asymptomatic hyperuricemic subjects and normouricemic controls matched as to age, sex and blood pressure. Abnormal urinary sediments and proteinuria were found more frequently in asymptomatic hyperuricemic subjects than in the controls. In addition, the maximal osmolar concentrating ability of urine was markedly reduced in the asymptomatic hyperuricemic subjects. There was no difference in renal function measured by phenolsulfonphthalein excretion between the groups. Our results suggest that hyperuricemia alone may contribute to renal tubular impairment.


Perinephric abscess: a review of 26 cases. Herein we review 26 cases of perinephric abscess, analyzed according to incidence, etiology, laboratory findings, signs and symptoms, diagnosis, radiographic findings, operative procedures, mortality and associated diseases. Of the abscess cultures 67 per cent were gram-negative organisms, most commonly Proteus, and 76 per cent of the abscesses were directly attributable to renal causes, mainly nephrolithiasis. Diabetes mellitus occurred in only 3 of the 26 cases.


Acute renal carbuncle.

Acute renal carbuncle. A renal carbuncle (cortical abscess) is an important and treatable consideration in the differential diagnosis of renal mass lesions. Diagnosis is accomplished using a combination of clinical, urographic, arteriographic and ultrasonographic findings. Ultrasound is an accurate and less invasive alternative to arteriography. Needle aspiration of the abscess contents may give a bacteriologic diagnosis. Non-surgical treatment with antibiotics alone may be curative. Five cases are presented, and clinical and radiologic features are reviewed.


Autogenous arterial grafts in the treatment of renal artery stenosis. Twenty-three patients who underwent renal revascularization with autogenous arterial bypass grafts for renovascular hypertension are reviewed. The arterial autograft consisted of the hypogastric artery in 19 cases and a free splenic artery graft in 4. Eighteen patients were cured (78 per cent), 4 improved (18 per cent) and there was 1 failure (4 per cent). There were no cases of graft stenosis or occlusion. Postoperative morbidity was minimal and there was no operative mortality. When such grafts are available they provide an excellent means to achieve successful long-term renal revascularization.


Adenocarcinoma of the kidney and hypertension: report of 2 cases with special emphasis on renin. Renin studies were done on 2 patients with adenocarcinoma of the kidney and hypertension. In 1 case plasma renin activity was high in the peripheral and renal veins, with a renal vein ratio of 1.7 favoring the side of the tumor. Nephrectomy cured the hypertension and renin values became normal. Tissue renin was elevated in the tumor and surrounding parenchyma. Acidification studies of tissue extracts failed to demonstrate the existence of big renin. In case 2 all renin values were normal and the blood pressure remained elevated after the operation. Although renin-secreting tumors remain an uncommon cause of malignant hypertension the condition should be recognized because it is potentially curable.


Nephrectomy: indications and complications in 347 patients. The indications, complications and mortality rate in a recent 12-year experience with 347 nephrectomies were reviewed. Renal tumor is the most frequent condition requiring nephrectomy, probably because of the improved, non-ablative methods to treat inflammatory, obstructive, calculous and hypertensive renal disease. The over-all mortality rate was 1.4 per cent but was almost nil in the absence of malignancy.


Partial nephrectomy in the treatment of renal adenocarcinoma. During a 20-year period 17 patients underwent partial nephrectomy as primary curative therapy for renal adenocarcinoma. In 15 patients (88 per cent) partial nephrectomy was performed satisfactorily in situ with free margins of resection. Eleven patients are alive (65 per cent) and only 3 (17 per cent) died of recurrent malignant disease. There was no operative mortality and postoperative complications were minimal. A review of the literature reveals that partial nephrectomy is an effective form of therapy for patients with bilateral renal carcinoma or carcinoma occurring in a solitary kidney.


Experience gained from the management of 9 cases of bilateral renal cell carcinoma. Radical nephrectomy is the traditional therapy for renal cell carcinoma. However, modification of this technique is necessary when bilateral renal cell carcinoma occurs (3.8 per cent of all renal cell carcinomas at our institution). Special attention should be paid to the contralateral kidney when the diagnosis of renal cell carcinoma is made, since an inapparent contralateral tumor may also be present (2 of 9 cases). An aggressive approach, consisting of in vivo heminephrectomy and a contralateral procedure, has avoided operative mortality or bench surgery, maintained life-sustaining renal function and produced a reasonable long-term survival rate.


Sonography in the diagnosis of retroperitoneal fibrosis. The ultrasonic appearance of retroperitoneal fibrosis is characteristic: a smooth-bordered and relatively echo-free mass anterior to the sacral promontory. Sonography can be used to confirm the diagnosis, follow response to therapy and detect hydronephrotic changes in the kidneys.


Ballistics and the management of ureteral injuries from high velocity missiles. The management of 21 patients with 22 ureteral injuries from high velocity missiles is described and 6 cases are reported in detail. Ballistics should be considered in all wounds of violence. Débridement, internal stents, proximal diversion and thorough drainage are advocated.


Modified hutch I vesicoureteroplasty in paraplegia. The most common cause of renal deterioration in the spinal cord injured patient is irreversible vesicoureteral reflux. Of 39 unilateral vesicoureteroplasties done for this condition 33 have been successful (85 per cent). Of 51 bilateral vesicoureteroplasties the success rates remain at 55 percent of the patients and 72 percent of the ureters. Since these success rates are possibly acceptable and the complication rate minimal, indications and technique are stressed.


Preoperative bowel preparation in urologic surgery. A method is described for the preparation of patients undergoing urologic procedures in which a segment of bowel is to be used to reconstruct the urinary tract. The combination of mechanical and antimicrobial preparation is effective in the sterilization of the bowel and the prevention of wound sepsis.


Ileal loop stenosis: a late complication of urinary diversion. Stenosis of the ileal conduit was a late complication in 12 patients (10 adults) who underwent urinary diversion by this means at our hospital. The duration of the ileal loop at diagnosis ranged from 4 to 14 years, averaging 9 years. Loop stenosis was generally without symptoms and was suggested only by routine excretory urography, while loopography confirmed the diagnosis. The etiology of the condition is not clear. A variety of possible factors is considered, including microvascular ischemia, urine-borne toxic material, infectious and allergic stimuli and an immunologic defect. The pathogenesis of the condition appears to be based upon a chronic inflammatory reaction, with progressive fibrosis in the mucosa and submucosa of the ileal segment.


Bypass operation for post-cystectomy intestinal obstruction. A method for an intestinal bypass operation is presented. The procedure has been valuable in patients with post-cystectomy intestinal obstruction who did not respond to non-operative measures. A discussion on the possible means to prevent further obstruction is included.


Massive hematuria and perforation in a case of amyloidosis of the bladder: case report and review of the literature. To our knowledge this is the first time that perforation of the bladder has been reported in a case of amyloidosis. The perforation was caused by massive hematuria. Based on repeated cystoscopic observations we believe that this alteration of the bladder wall is progressive and caused by the damaging effect of a continuing growing clot on poorly vascularized tissues. A review of 5 other cases of secondary amyloidosis complicated by massive hematuria indicates that hemorrhage occurs in advanced stages of the disease, has a gloomy prognosis and may precipitate the final outcome.


Bladder cancer and squamous metaplasia in spinal cord injury patients. The influence of long-term indwelling urethral catheterization was studied by random bladder and urethral biopsies in 62 spinal cord injury patients. Six patients (10 per cent) had diffuse squamous cell bladder carcinoma, 4 of whom had no tumor visible endoscopically. Five of the patients with cancer were among 25 patients (20 per cent) managed with an indwelling urethral catheter for more than 10 years (average 21 years, range 15 to 30 years). The other cancer patient had been free of the catheter for 27 years after suprapubic cystotomy for 4 years. Gross and microscopic hematuria was associated with cancer. Squamous metaplasia of the bladder was significantly greater in patients who had been catheterized for more than 10 years (80 per cent), compared to those catheterized for less than 10 years (42 per cent) and patients without catheters (20 per cent). Urethral squamous metaplasia increased slightly in long-term catheterization patients. Urinary infection was universal and did not distinguish patients with inflammation, metaplasia or cancer. Therefore, the duration of indwelling catheterization seems to be the major factor in squamous changes in these patients.


Intravesical epodyl in the management of bladder tumors: combined experience of the Yorkshire Urological Cancer Research Group. Of 48 patients with bladder tumors treated with intravesical epodyl 17 have shown a complete remission at some stage of treatment, although several have relapsed later. Partial remission occurred in 20 patients and 11 have shown no improvement or the lesions have progressed. Epodyl is used best as an adjunct to transurethral resection or diathermy of T1 bladder lesions. Even in patients who do not show complete remission epodyl may reduce the incidence of recurrence and the number of lesions. It is useful when rapid recurrence of T1 bladder tumors prevents control by resection or diathermy and it also is beneficial as an emergency measure to control hematuria. Complications are not infrequent and may be severe occasionally. Bone marrow depression has been seen in 2 patients whose bladders showed extensive carcinoma in situ.


Lymphocyte response to transitional cell carcinoma: peripheral cytotoxicity and local tumor infiltration. The cytotoxicity of peripheral lymphocytes from patients with transitional cell carcinoma was evaluated and the results were compared to the degree of local lymphocytic infiltration in the bed of the primary tumor. Although a clear correlation was not established local lymphocytic infiltration was associated more commonly with tumor-related peripheral lymphocyte cytotoxicity.


Posterior urethral valves in adults: a report of 2 cases. Herein we review 2 cases of posterior urethral valves in adults. Significant secondary bladder neck obstruction occurred in both cases and required transurethral incision before the bladder outlet obstruction was relieved. The management is described of the secondary upper tract changes that occurred.


Personal technique for surgical repair of balanic hypospadias. A personal technique is described for the surgical correction of balanic hypospadias. The result of this technique is a large neourethra and satisfactory esthetics in 1 operation.


The study of the third heart sound in relation to the left ventricular filling and wall movement by echocardiography. The left ventricular filling and wall movement were investigated in subjects with a third heart sound or ventricular gallop by echocardiography. Nine patients with ventricular gallop, who had left ventricular volume overload disease, and 6 normal subjects with a third heart sound had higher normalized peak rate of increase of the left ventricular dimension (peak dD/dT/D) than 10 normal subjects without a third heart sound (p less than 0.01). The normalized lengthening rate in the rapid filling phase was also higher in patients with ventricular gallop than in normal subjects without a third heart sound (p less than 0.05). The time from the second heart sound to peak dD/dT/D and rapid filling time did not show statistically significant values between subjects with ventricular gallop or a third heart sound and those without a third heart sound. These results suggest that higher peak filling, larger filling volume in the rapid filling phase and more abrupt cessation of the outward movement of the left ventricular wall may be a cause of the production of ventricular gallop in patients with left ventricular volume overload and of the physiological third heart sound.


Pulmonary regurgitation following total correction of tetralogy of Fallot. A method is described for quantifying pulmonary regurgitation. This method is based on a comparison of the right and left ventricular stroke volumes which are determined from biplane angiocardiograms. These techniques were applied to study 18 postoperative patients with tetralogy of Fallot. In patients with an outflow patch, regurgitant fraction was well correlated with regurgitant area. The RVEDV/LVEDV ratio was also correlated well with regurgitant fraction. Although majority of patients maintained normal RV ejection fraction, there were small number of patients with large regurgitant fraction and decreased RV ejection fraction.


Optimal size of outflow patch in total correction of tetralogy of Fallot. Hemodynamic and angiocardiographic studies were performed in postoperative patients with tetralogy of Fallot. Pressure gradient between the right ventricle and pulmonary artery was correlated with the narrowest area in the pulmonary arterial pathway. Regurgitant fraction was also correlated with regurgitant area which was determined by preoperative area of the pulmonic annulus and width of the outflow patch. Follow-up study of postoperative patients with tetralogy indicated that those with pressure gradient less than 20 mmHg and regurgitant fraction less than 15% could be considered ideally corrected. A table was constructed for determining the most appropriate width of the outflow patch for the ideal correction.


Systolic time intervals in patients with progressive muscular dystrophy of the Duchenne type. Systolic time intervals (STIs) were measured in 57 patients with progressive muscular dystrophy (PMD) of the Duchenne type, and were correlated with the stages of physical disability. The total electromechanical systole (Q-A2), pre-ejection period (PEP), and left ventricular ejection time (LVET) were corrected for heart rate using the linear regression equations calculated from 91 normal subjects. Each systolic time interval index (STII), i.e. corrected STI, was analyzed. In 15 ambulatory patients (Group P-1), the STIIs did not differ significantly from those in normal controls. In 37 patients who were unable to walk (Group P-2) and 5 patients who were confined to bed (Group P-3), there was a significant increase (p less than 0.001) in the PEP index (PEPI), a decrease (p less than 0.001) in the LVET index (LVETI), and an increase (p less than 0.001) in the PEP/LVET compared with those in controls. The PEPI (p less than 0.001), LVETI (p less than 0.025), and PEP/LVET (p less than 0.001) in Group P-2 differed significantly from those in Group P-1. In Group P-3, the PEPI (p less than 0.005), LVET (p less than 0.001), and PEP/LVET (p less than 0.001) were significantly changed in comparison with those in Group P-2. Remarkable myocardial histopathologic changes suggestive of dystrophy were revealed in autopsies of 3 patients who had been in the severely disabled stage and had shown impaired STIs. It is suggested that cardiac function in patients with moderate to advanced PMD of the Duchenne type is deteriorated in proportion to the disability stages, i.e. the severity of changes in the skeletal muscles.


Mechanism of production of midsystolic click in a prolapsed mitral valve. In order to examine the production mechanism of the midsystolic click in cases of a midsystolic click and a late systolic murmur, the relationship between the click and the motion of the mitral apparatus was studied by means of ultrasono-cardiotomography and the simultaneous recording of phonocardiograms and ultrasono-cardiograms (UCGs). It was found that the systolic click occurred in exact coincidence with the time at which the hump of the echo of the unusual early systolic anterior motion (early SAM) took its backmost position. This coincidence was found when the click was shifted either by postural changes or inhalation of amyl nitrite. The present ultrasono-cardiotomographic study demonstrated that the echo source of the early SAM could be attributed to the protrusion into the left ventricular outflow tract of the slackened elongated chordae tendineae in systole. The anterior leaflet moved suddenly to the position of maximal prolapse when the slackened chordae tendineae were stretched taut in midsystole. In other words, the midsystolic click occurred when the anterior leaflet prolapsed and the tension exerted on the chordae tendineae was at its maximum.


A morphometric study of the aortomitral valve apparatus in the embryonic and adult chicken heart. Implications on the developmental hypotheses of the transposition of the great arteries. A comparative morphometric study was performed on the aortomitral valve apparatus of the embryonic and adult chicken hearts. It was found that the thickness of the aortic and mitral valve cusps diminishes dramatically as the embryo matures, however the relative length of the aortic valve, mitral valve and subaortic conus remains constant. A comparison of the aortomitral valve apparatus in chicken and man revealed that the subaortic conus is not completely resorbed in the fowl, whereas this process is well documented in the mammalian hearts. The implications of this observation on "the differential conal growth hypothesis" of transposition of the great arteries are discussed.


Gel electrophoretic analysis of structural proteins of the normal canine and human hearts. 1. Gel electrophoretic analysis of structural proteins extracted from myocardial tissues in the presence of sodium dodecylsulfate (SDS) is applicable to study the relative amount of structural proteins from less than 1 Gm of heart tissue. 2. The compositions of structural proteins of the right and left atria and ventricles of the normal canine heart were identical and similar to those of skeletal muscle. 3. The compositions of structural proteins of the atrium and ventricle of the normal human heart were also identical.


Peri-ureteric collateral vessels in rabbits with experimental renal hypertension. The development of collaterals to an ischemic kidney was studied in rabbits with two-kidney Goldblatt hypertension. Hypertension was produced by applying a silver clip of 0.9 mm in internal diameter on the left renal artery with the right kidney intact. Peri-ureteric collaterals were found at autopsy in 27 (32.9%) of 82 animals that were killed 7 days (early stage) and in 30 (40.5%) of 74 animals that were killed in more than 70 days (late stage) after clipping. The average blood pressure was 123.8 +/- 2.6 (SE) mmHg in animals with collaterals vs. 125.3 +/- 2.1 mmHg in animals without them in the early stage, and 142.5 +/- 4.4 mm Hg in animals with collaterals vs. 122.6 +/- 3.3 mmHg in animals without them in the late stage. These results indicate that the collaterals to an ischemic kidney develop independently of the rises in blood pressure during the first week and the presence of collaterals is associated with moderate to severe hypertension in the late stage.


Changes of cardiac structural proteins in myocardial infarction. 1. Changes of structural proteins in experimental and human myocardial infarction were studied by the determination of myosin- and actomyosin-ATPase activities and gel electrophoretic analysis in the presence of sodium dodecyl sulfate (SDS). 2. In animal experiments using dogs, the relative amounts of myosin and alpha-actinin decreased at 24 to 48 hours after coronary ligation, became lowest at 72 hours, and remained at this level for 2 weeks and returned to almost normal value at 28 days. 3. Myosin- and actomyosin-ATPase activities decreased rapidly during 24 to 48 hours after ligation with temporary increase in their activities in the initial stage of ischemia and followed the similar time course as that of the amounts of myosin and alpha-actinin. 4. SDS gel electrophoretic analysis of structural proteins of infarcted tissues of the human hearts obtained from 5 cadavers showed also marked decrease of the contents of myosin and alpha-actinin with relative preservation of actin, tropomyosin and troponin-T.


Behavior of asynergic ventricle.

Behavior of asynergic ventricle. Effect of increased left atrial pressure and a positive inotropic agent upon asynergic left ventricle which was produced by acute occlusion of LAD were examined in 8 open-chest dogs. Systolic bulging in ischemic area was qualified by ESL/EDL in percentage. Left atrial pressure was controlled by the reservoir connected to left atrial appendage with a large bore tubing. Cardiac output and aortic pressure were decreased following coronary occlusion without change in isometric developed tension in nonischemic area of left ventricle. Increase of left atrial pressure from 5 mmHg to 14 mmHg produced rise in stroke volume to 191% and rise in aortic pressure to 156% in asynergic left ventricle respectively. These increases were not accompanied by change in ESL/EDL. Therefore, extracardiac factors were assumed to explain the prominent increase in left ventricular stroke work by elevation of left atrial pressure in asynergic left ventricle. Isoproterenol enhanced total cardiac performance by increasing the function of nonischemic area without deterious effect on the ischemic area.


Suppression of repeatedly occurring ventricular fibrillation with nifedipine in variant form of angina pectoris. It is reported that nifedipine, a newly developed antianginal agent, was dramatically effective to suppress the repeatedly occurring ventricular fibrillation in 2 cases of variant form of angina pectoris.


Studies on the fresh water cercariae in Leyte island, Philippines. 3. Cercariae from Thiaridae. From 1975 to 1976, about three thousand snails of Thiaridae were examined for cercarial fauna in the northeastern part of Leyte Island, Philippines. The thiarid snails examined were Melanoides tuberculatus, Thiara (Plotiopsis) scabra, Antemelania dactylus and A. asperata, and a total of 13 species of cercariae including some important human parasites were found. These cercariae are consisted of one philophthalmid cercaria, two echinostome cercariae, three heterophyid cercariae, five xiphidiocercariae, one paragonimid cercaria and one unknown cercaria. In this paper a description of their morphology, infection rate, locality, and some remarks on the presumptive life cycle are included with illustrations and photographs.


Reactivity of snail agglutinin from Helix pomatia (anti-AHP) to non-A meconium glycoproteins. Investigations have been made on the reactivity of snail agglutinin from Helix pomatia (anti-AHP) with blood group active neutral and acid glycoprotein (NGP and AGP) prepared from non-A meconium. It is clearly demonstrated that anti-AHP reacts only with NGP, but not with AGP, in anti-AHP-non-A meconium system. After desialization, however, the AGP was reactive to anti-AHP. The effects of alpha-N-acetyl-D-galactosaminase, blood group decomposing enzymes and mild alkaline treatment on the reactivity of NGP and desialized AGP (DAGP) were studied by the immunochemical techniques and the structure responsible for the reaction is briefly discussed: the occurrence of terminal or subterminal alpha-D-GalNAc residues as reactant to anti-AHP may be deduced.


Enzymatic solubilization of membrane immunoglobulin (M-Ig) from rabbit lymphocytes with phospholipase A2 (PL-A2) and phospholipase C (PL-C). Enzymatic solubilization of M-Ig from rabbit lymph node cells was investigated using highly purified PL-A2 and PL-C. The combined treatment with PL-A2 (50 I.U./ml) and PL-C (20 I.U./ml) caused optimal solubilization of the membrane components from the 125I-labeled lymphocytes, but the treatment with either enzyme alone did not. The solubilized M-Ig was isolated and characterized as the membrane component which was specifically co-precipitable with homologous antigen-antibody complex. The solubilized M-Ig associated with some other membrane constituents was eluted in a void volume fraction by gelfiltration on a column of Sepharose 6B, and recovered at the interface between 30 and 40% sucrose layers by the density gradient centrifugation. The isolated component could be further separated by SDS-polyacrylamido gel electrophoresis into four radioactive polypeptides with apparent mol wt of 7 approximately 8 X 10(4), 4 approximately 5 X 10(4), 3 approximately 3.5 X 10(4) and 2 approximately 2.5 X 10(4), respectively. The results suggest that the enzymatic solubilization of lymphocyte M-Ig is a useful procedure to investigate further characteristics of M-Ig and their biological function related to the intracellular mechanisms of immune response.


Difference of anti-complementary effect of double stranded DNA and single stranded DNA. Anti-complementary effect of both native double stranded DNA and denatured single stranded DNA was examined by the use of phage DNA of microgram level. The distinct difference of anti-complementary effect was detected between the double and single stranded DNA, that is, only single stranded DNA showed the anti-complementary effect. It is supposed that that the anti-complementary effect of single stranded DNA revealed by the present study is different from the anti-Clq effect which reported on both double and single stranded DNA by Agnello et al.


Effects of Panax Ginseng root on conditioned avoidance response in rats. Pole climbing and shuttle box tests were employed to study conditioned avoidance response (CAR) and discrimination behaviour in Wistar male rats given extracts from Panax Ginseng root intraperitonealy. Neutral saponins (GNS), a water soluble fraction (GF4) which does not contain saponins, and a lipid soluble fraction (GNo. 5) inhibited CAR and discrimination ability between 500 Hz sound with electric shock (SD) and 1000 Hz sound without shock (Sdelta). Small doses of GNo. 5 and ginsenoside Rg fraction (GRg) produced a slight shortening of the response latency (RL) to the conditioned stimulus in CAR. GNo. 5 produced the incorrect response to Sdelta. Significant changes in the extinction of CAR were not evident with any fraction. Data from these tests indicate that Panax Ginseng root contains at least three sedative compounds.


Effects of ID-540 on averaged photopalpebral reflex in man. Effects of ID-540, a recently introduced benzodiazepine derivative, on the averaged photopalpebral reflex (PPR), subjective symptoms and serum levels of ID-540 and its principal metabolite, N-desmethyl-ID-540 following an oral dose of 0.5 mg were investigated in 4 healthy male Japanese students in their early twenties. Both the latencies of PPR, P1 and P2 latency, showed a prolongation and maximum level at 2-2.5 hours after administration and tended to decline thereafter to control levels. The serum concentration of ID-540 showed a peak level at 2 hours after dosing, then showed a decline at 4 hours. The N-desmethyl-ID-540 exhibited a slow, gradual rise in the serum over the first 4 hours and there was a tendency toward a continued rise even at 24 hours. These parameters were of striking resemblance in the time-course of changes after oral dosing. Thus the PPR test may be a useful means of determining the clinical effects of anxiolytic agents. ID-540 appears to be an agent with remarkable anxiolytic effects.


Effect of methylmercury on the ethanol elimination from the blood and the activity of alcohol dehydrogenase. In an attempt to assess the effects of methylmercury on ethanol metabolism, Sprague-Dawley rats were treated with a daily dose (10 mg/kg i.p.) of methylmercuric chloride for 2 consecutive days and given a test dose (0.4 g/kgi.v.) of ethanol 24 hr after the last treatment. Blood ethanol levels were measured using gaschromatography by the direct introduction of blood samples into the sample vaporizing apparatus attached to the chromatograph. While treatment with methylmercury elicited a slight retardation in the ethanol elimination from the blood during 30 to 90 min, methylmercury did not essentially alter ethanol metabolism. There was no significant change in hepatic alcohol dehydrogenase activity of methylmercury-treated rats. By contrast, the activity of alcohol dehydrogenase purified from liver or yeast was remarkably inhibited by methyl-mercury and the type of inhibition proved to be non-competitive. Moreover, the inhibited activity was reactivated easily by sulfhydryl agents. From these results, it is conceivable that methylmercury has little influence on ethanol metabolism in vivo because of its non-specific binding with sulfhydryl groups in the organism.


Further observation on the lack of active uptake system for substance P in the central nervous system. Crude mitochondrial P2 fractions from bovine hypothalamus and substantia nigra, slices from rabbit spinal cord and mesencephalon and glial fractions from rabbit brain were incubated with [3H]-substance P and the uptake was measured and compared with those for 5-HT and GABA. Substance P was to some extent taken up into the fractions but this uptake was neither temperature nor time dependent and the pellet/medium ratios were less than 1. Similar results were obtained in high potassium treated slices from rabbit mesencephalon. The rate of uptake for [3H]-substance P increased linearly in proportion to the medium concentration, suggesting a non-saturable binding. These results, together with our previous observations provide strong evidence that nerve terminals and glial cells lack a temperature sensitive, active uptake system capable of terminating transmitter action of substance P at the synapse.


Anal complication in Behçet's syndrome.

Anal complication in Behçet's syndrome. A 12 year-old boy suffering from Behçet's syndrome with an anal complication was presented. He had several anal ulcers with surrounding polypoid proliferations. Operative treatment and local application of steroid hormone to anal ulcer failed, whereas the general administration of steroid hormone improved his allover state so that the anal lesion almost completely healed. Dose of steroid hormone was gradually tapered off and finally stopped without any signs of recurrence. Anal ulcer seems to represent a rare complication of Behçet's syndrome.


Evaluation of the risk of postoperative pulmonary complications. Ten of 40 patients who underwent major thoracic or abdominal operations developed postoperative pulmonary complications, consisting of six massive atelectasis, three pneumonias and one edema. They were mostly thoracotomy cases and cigarette smokers. Many of these complications would have been prevented, if reliable pulmonary function tests are available to predict preoperatively such occurrence. Flow-volume curve tracing and closing volume measurement were evaluated in this respect. Both flow at the point of functional residual capacity on flow-volume curve, and the closing capacity subtracted from functional residual capacity were found to be well correlated with the occurrence of postoperative complications and can be used to evaluate the risk of pulmonary complications developing in postoperative period.


The role of the liver in the changes of acid-base balance and plasma lipids during surface-induced deep hypothermia. The role of the liver in the changes of acid-base balance and plasma lipids in surface-induced deep hypothermia for open-heart surgery was investigated clinically and experimentally. The metabolic acidosis generally observed in open-heart surgery under surface-induced deep hypothermia is derived from lactacidemia. Although the accelerated anaerobic glycolysis is partly responsible, the depressed acidic metabolite-disposing ability of the liver also plays an important role. The evidence which is presented to show the decrease of plasma lipids other than NEFA under hypothermia is probably due to the hepatic accumulation of lipids and the decreased lipids release from the liver.


Operative procedures for choledochal cyst. Fifty one operations for choledochal cyst were carried out upon 46 patients: 41 as a primary operation and 10 as reoperation. An excision of choledochal cyst with hepaticojejunostomy in Roux-en-Y fashion at the second laparotomy gave a favorable results in all patients who suffered recurrent symptoms after the previous anastomotic procedure. Comparing operation time, blood loss and operative results of the reoperations with those of the primary, it was concluded that all choledochal cyst should be excised at the first operation unless other reason avoiding excision exists. Hepatic portojejunostomy is recommended for choledochal cyst with an associated distal atresia and the hypoplastic hepatic duct.


Hernia through the foramen of Winslow.

Hernia through the foramen of Winslow. A case of hernia through the foramen of Winslow diagnosed preoperatively is reported. Although the preoperative diagnosis is difficult to make because of the nonspecific symptoms presented and the rarity of the disease, careful evaluation of the plain abdominal X-ray and barium enema study gave the clue in the present case. Review of the literature including those from Japan revealed 115 cases up to 1976, of which diagnosis was established preoperatively in 11 cases.


Modified Heineke-Mikulicz pyloroplasty as an effective gastric drainage procedure. Rats were prepared with modified Heineke-Mikulicz pyloroplasty with longitudinal seromuscular incision, centering at pyloric ring, separation of submucosal layer around the pylorus and addition of transverse closure. This procedure combined with vagotomy was applied to the rats with cortisone administration and obstructive jaundice or exposure to the restraint plus cold water stress. Pyloroplasty and vagotomy seemed to prevent the occurrence of the severe damage on gastric mucosa without any suture line leakage whereas. Control rats had often erosive gastritis or hemorrhage.


Cardiac arrest in the Emergency Medical Service System: guidelines for resuscitation. A two-year study of 198 consecutive patients treated for cardiac arrest in the emergency department at Stanford University Medical Center was undertaken. The relatively poor overall survival rate of 3% and the complexity of deciding how to treat cardiac arrest victims suggest the need for guidelines to assist the emergency physician when resuscitating cardiac arrest patients. From the above study and a survey of the literature, the authors formulated the following guidelines of when resuscitation should be discontinued or not attempted: Cases of apnea and pulselessness known to have exceeded 10 minutes, no response after more than 30 minutes of advanced cardiac life support (ACLS), no ventricular EKG activity after more than 10 minutes of ACLS, and preexisting terminal illness.


Perichondritis (Tietze's syndrome) at the xiphisternal joint: a mimic of severe disease. Tietze's syndrome (peristernal chondritis or perichondritis) is a self-limited, painful inflammatory condition of the costochondral, sternoclavicular, manubriosternal or xiphisternal junctions. It is benign, and affects all ages, sexes and races equally. The principal manifestations are pain and, frequently, a mass most commonly at the costochondral junctions. In 1974, C.J. described the first cases to be reported at the xiphisternal junction. We describe here 24 cases at that site. These patients' presenting symptoms suggested cardiac, pulmonary, intraabdominal and other severe disease processes. Diagnosis was made on clinical grounds based on a high index of suspicion. Treatment comprised infiltration of local anesthetic to the afflicted joints with prompt, complete and prolonged relief in 21 (87.5%) of the cases, and complete temporary relief in three (12.5%). We suggest that a possible mechanism for the referral of pain is the relationship of the xiphisternal joint to a variety of structures including autonomic nerves that accompany the internal mammary arteries.


Use of laboratory animals in the teaching of emergency procedures. The Division of Emergency Medicine, University of Chicago Hospitals and Clinics uses animal laboratory sessions to train emergency medicine residents in manipulative skills. Certain animals realistically represent the human for these purposes and are delineated for various procedures. On the other hand, animal tissue characteristics and anatomical landmarks generally differ from those of humans. How procedures such as cricothyreotomy; tracheostomy, tube thoracostomy, thoractomy, cardiac repair, aortic cross clamping, venous cutdown, peritoneal lavage, abdominal stab wound exploration and laparotomy can be performed and must be modified is discussed. A rational procedural sequence is required to maintain the animal's vitality through the end of the session.


Trauma centers: a pragmatic approach to need, cost, and staffing patterns. Based on the recommendations of the Health Services Administration and the Committee on Trauma of the American College of Surgeons, optimal staffing patterns for a trauma center are unrealistic in cost and personnel needs for all but a few large, urban teaching hospitals. As an alternative, the staffing pattern for a trauma program for a nonuniversity community hospital consists of one general surgeon, an anesthesiologist and one emergency physician. In addition, surgical subspecialists in thoracic surgery, urology, obstetrics and gynecology, ophthalmology, otolaryngology and plastic surgery would be on call within 30 minutes. A paid, part-time program director and paid coordinator of nursing and allied health personnel would be on staff. Need for trauma centers versus trauma programs can be assessed by using 5% of the number of motor vehicle accidents in an area to forecast the number of traumatic injuries. This is done in California as an example.


Prehospital cardiac care: illusion of consensus. To judge standard practice for managing arrhythmias, what an EMT should be able to do in the field, drugs of choice, the success of EMT training, and the quality of EMT performance, clinical algorithms were developed. Branching logic, forcing yes/no decisions and delineating actions for all contingencies helped formalize and systematize EMT management of urgent and emergency cases. The algorithm set was sent to 19 consultants for review of content, sequence, drug dosage, and drug usage. The results indicated lack of consensus on appropriate prehospital cardiac care, but the approval of the algorithm approach.


Accidental hypothermia: peritoneal dialysis. Accidental hypothermia may develop within a few minutes by immersion in cold water, in a matter of hours by exposure to cold weather, and in a matter of days in debilitatted victims by continuous exposure to milder cold stress. The prognosis in accidental hypothermia depends on the patient's premorbid condition, the depth and duration of the hypothermia and the degree of exhaustion and metabolic acidosis that result from physiologic attempts to compensate for the heat loss. For deep hypothermia (deep body temperature below 20 C [82.4F]), internal rewarming is strongly recommended as a means of supporting function in body core organs and minimizing the risk of "rewarming shock". For lesser degrees of hypothermia, recoverability depends more on the adequacy of supportive care than on the method of rewarming. The rapid and complete recovery experienced in the case presented is not surprising since the patient's premorbid condition was good, chilling had been rapid, metabolic exhaustion was mild, and internal rewarming was accomplished without delay, using heated peritoneal dialysis.


Traumatic acute pericardial tamponade.

Traumatic acute pericardial tamponade. Pericardial tamponade should always be suspected in the clinical setting of any  penetrating wound to the thorax or upper abdomen. The most reliable diagnostic criterion is the triad of hypotension, tachycardia and an elevated central venous pressure. Pericardiocentesis should be performed as a temporizing measure until definitive surgical therapy can be carried out. If the patient suddenly decompensates or arrests in the emergency department, immediate thoractomy with evacuation of the pericardial clot and open chest cardiac massage should be performed. Four case reports are presented. The pathophysiology and treatment are reviewed in detail.


Measurement of alcohol-related effects in man: chronic effects in relation to levels of alcohol consumption. Part A. The effects of chronic alcohol ingestion are quantitatively related to intake, but little information is available on the topic. In part A of this review, intake-effect relationships are examined for chronic dysfunctions of the liver, pancreas, cardiovascular system, testis and fetus. Part B considers central nervous system effects such as the withdrawal syndrome, psychosis, brain damage, memory loss, alterations of attention, sleep disturbances and EEG changes. Alcohol and the elderly, evidence of favorable effects of alcohol and the question of alcoholism are also discussed. In the vast majority of studies the documented daily intake levels have been over 150 g of ethanol (the equivalent of one pint of 80-proof spirits), often in the range of 250-300 g. Other potential risk factors such as malnutrition are rarely considered, and little information is available on the effects of more moderate daily intake. The liver emerges as the most vulnerable organ to regular alcohol use with the hazardous range beginning at a daily intake of 80-100 g of ethanol. There is some evidence beneficial  effects, especially in the elderly, of daily intakes of 15-30 g and epidemiological evidence of a lower incidence of myocardial infarction in those with a daily intake approximating 56 g. More information is needed on chronic intake-effect relationship, particulary at levels below 150 g.


Proximal inferior vena cava obstruction without portal hypertension. A case of symptomatic proximal inferior vena cava obstruction was corrected successfully by surgery. Though the nature of the obstruction was not definitively verfied, it probably resulted from persistence of the inferior vena cava valve, or possibly from congenital proximal membrane obstruction. The case illustrates that promimal obstruction of the inferior vena cava may be a surgically correctable lesion but may be overlooked because signs of portal hypertension may be absent and because the usual tests to evaluate edema in the lower extremities may not detect such lesions.


[Metabolic and structural characteristics of myocardial mitochondria in patient with acquired heart defects, operated on under conditions of artificial circulation]. Considering the significance of the unity distinguishing the level of aerobic energy generation in the myocardium, the morphological integrity of the mitochondrial membranes and the regulating influence exercised upon them by the hormones and mediators of the sympathoadrenal system the authors undertook a synchronous study of these factors in patients with rheumatic heart diseases when subjected to the cardiac valves prosthetics. These factors were found to play a key role in ensuring the contractility of the myocardium, this being confirmed by the results of clinico-biochemical comparisons. In a group of patients with dissociated processes of oxidative phosphorylation and a well-marked disintegration of membranous mitochondrial structures, as well as with a low adrenalin, noradrenaline and their precursors level in the myocardium, almost as a rule, in the early post-operative period there appeared symptoms of cardiac incompetence.


[Clinical course and diagnosis of congenital heart defects]. An indefinitely formed heart is a compound lesion of the cardiovascular system in which an anatomical examination of the atria does not permit any decisive interpretation of the formation of the heart. The disease can be subdivided into two pathological syndromes. The first syndrome includes a partially patent atrioventricular canal with a joint atrium, an absence of the hepatic segment of the inferior vena cava, a partally anomalous drainage of the pulmonary veins, bilobular lungs, abdominal heterotaxy and polysplenism. The second syndrome is characterized by an open atrioventricular canal with a joint atrium or a cor biloculare, an abberant superior vena cava, or varilateral position of the superior and inferior venae cavae, a completely anomalous drainage of the pulmonary veins, transposition of the major vessels with a stenosis or atresia of the pulmonary artery, trilobular lungs, abdominal heterotaxy and asplenism. The leading role in the diagnosis of the pathology belongs to heart catheterization and angiocardiography.


[Effect of prostaglandin E1 on the systemic and regional hemodynamics of dogs]. The effect of prostaglandin E1 (PGE1) on the cardiovascular system of the dog has been studied in experiments with anesthetized dogs. After intravenous injections of PGE1 (5 microgram/kg) arterial hypotension, tachycardia, increase of cardiac output, increase of myocardial contractility were observed. PGE1 induced dilatation of pulmonary vessels. Peripheral resistance reduced. The work of the left ventricle after PGE1 injection underwent two-phase changes: it increased for a short period of time and then reduced. The work of the right ventricle was activated. PGE1 caused a significant increase of the volume flow rate in the coronary (44%), femoral (83%) and superior mesenteric (59%) arteries.


[Prognosis of the outcome of macrofocal myocardial infarct with the aid of the recognition program]. Methods used in solving the problem of prognosing favourable or unfavourable outcomes of a transmural (or macrofocal) myocardial infarction, based on the data covering the first 3 days of the hospital stay for patients admitted to it not later than 2 days after the onset of myocardial infarction and who did not develop during this period extremely serious complications, are described. The prognosis covered the entire period of the institutional treatment of the patients. The data underwent computer processing. The obtained solution rule was checked on 178 patients. In 143 of them the machine prognosis proved favourable with only 2 of these patients having met a sudden death. The forecast turned out unfavourable in 35 cases and 16 of these patients died. The machine made prognosis is of a great help in pronouncing medical judgments.


[Study of the electric activity of the heart atria in auricular fibrillation with the aid of the instrumental correlation analysis]. The autocorrelation funtion of the electrocardiographic signal in the V1 lead is approximated by the formula of an attenuated consinusoid. Parameters are singled out (median period, attenuation factor) to characterize the atrial activity. A procedure for recording the auto correlation function is described and optimal conditions of its registration are studied. First results following clinical application of the method are reported.


[Analysis of recording  of cardiac rhythm and myocardial function after exercise test]. A continuous telemetric registration of the cardiac contraction rate was made in 534 persons performing various physical exertions. The ensuing epxerimental graphs of changes in the rhythm obtained under the effect of physical loads are described by mathematical formulas. Three types of changes in the rhythm in effort have been established, viz. linear, exponential and logarithmic. To determine cardiac function quantitative coefficients, reflecting the rate of the cardiac rhythm coming up to the working level and relationship between the areas of the steady state cardiac contractions frequency phase and that of its rapid increment, are proposed.


[Study of a multifield equivalent cardiac generator]. The electric field of the isolated dog heart immersed into a liquid volumetric conductor was subjected to a thorough investigation. Measurements and subsequent calculations showed that in precordial leads the quantitative description of the cardiac generator by a multipole equivalent generator of the 1st order (dipole) is rough approximation. Addition of a multipole component of the 2nd order (quadripole) to the equivalent generator increases but relatively little the accuracy of description. It is suggested that in this problem the multipole expansion proves to be a slowly convergent series. For this reason, application of multipole equivalent cardiac generator fixed in the electrical center of the heart in the clinical electrocardiography is to be considered as having no prospect.


[Prognosis of the effectiveness of electroimpulse therapy of auricular fibrillation according to the roentgenocardiometric data]. The purpose of the work was to investigate the relationship between immediate results of the electroimpulse therapy and such roentgenocardiometric data as the voloume of the heart, the cardio-thoracic index, Moore's coefficient, the extent of the left atrium enlargement and of the radius of the contrasted esophagus deviation. An analysis of the experience gained with 197 defibrillation of the heart in patients with rheumatic heart diseases complicated by auricular fibrillation bears proof to a high degree of reliability achieved through inclusion of roentgenocardiometric data in prognosing the resultant effect of the electroimpulse therapy.


[Determination of cardiac output by the method of tetrapolar chest rheography and evaluation of its metrological possibilities]. Tetrapolar chest rheography is an up-to-day, convenient and bloodless method of determining the cardiac stroke volume (CSV) and cardiac output (CO) in dynamic observations. The paper presents and analysis of the method and considers the possibilities and limits of its application in determining the stroke volume and cardiac output. Advantages of the Kubicek procedure as modified by the authors by comparison with other rheographic methods are shown, along with methodological procedures employed for dtermining the CSV and CO and a nomogram that significantly facilitates the calculation of the values under study is offered. Results of contrasting the cardiac ejection values in patients with congenital heart diseases and an increased pulmonary circulation as against those in patients with ischemic heart disease, obtained by means of tetrapolar chest rheography and direct Fick's method are cited. The possibility of applying tetrapolar chest rheography in assessing the effect operative treatment in patients with congenital cardiac defects and also when investigating compensatory reactions of the cardio-vascular system in patients with hypertensive disease in the course of the orthostatic and Valsalva tests is demonstrated.


[Method of early activation of patients after heart surgery]. Methods employed in an early activation of patients operated on a "closed" heart and under extracorporeal circulation are described. The authors began activating theri patients 2--3 hours after surgery and 16--20 hours therafter inst tuted a physical effort test (walking) over a distance of 50--100 m for 2.5--5 minutes). It was shown that the re-establisment of the hemodynamics indices, factors of external respiration and internal environment in patients managed post-operatively in accordance with the routine methods took much longer time than with the active method of managing the early post-operative period. The abolishment of a protracted hypodynamia regimen against the background of a quick normalizatiion of homesotasis is conducive to an earlier adaptation of patients to new conditions reduces the incidence of post-operative complications and curtails the patients' staty in hospital.


[Calculation of the size of the population group necessary for evaluation of the results of measures for the prevention of cardiovascular diseases (on the example of the Kaunas survey)]. A method for estimating the size of the group necessary in evaluation of the efficacy of preventive intervention among the population is described. The parameters for calculating the necessary size of the sample from an equation and the fundamentals of compiling tables by means of electronic computers are discussed. The data of the Kaunas survey conducted according to the WHO program illustrate the statistical approach. The material of the Kaunas survey is also used to estimate the size of the population necessary for testing the hypothesis on the possibility of preventing myocardial infarction by reducing the risk factor.


[Changes in the end part of the ECG ventricular complex under the effect of digitalis preparations and their combination with metabolic preparations]. Analysis of the dynamics of changes in the end part of the ECG ventricular complex in 311 patients with rheumatic heart disease and stages IIA, IIB, and III circulatory insufficiency after treatment with preparations of digitalis and their combination with biologically active substances (orotic acid, vitamin B12, calcium pantothenate, ATP, methionine, inosi-F) is presented. When digitalis glycosides are used with preparations that have an effect on the nucleic acid synthesis and energy production, the "digitalis--induced" changes in the end part of the ECG ventricular complex are less marked while the clinical effect of treatment is more appreciable


[Causes of lethal outcome in hypertension]. Comparative analysis of the causes of fatal outcomes in hypertensive disease is presented on the grounds of postmortem findings in 2,091 patients who had died in hospitals in the period between 1953 and 1975. It was established that the mortality of disorders of cerebral circulation reduced significantly in 1973--75 as compared to that in 1963--05 and 1953--55. One fourth of patients with hypertensive disease died of myocardial infarction. It was noted that death of renal failure among patients with hypertensive disease decreased progressively.


[Characteristics of glucose absorption by the adipose tissue in renal and spontaneous hypertension in rats]. In vitro glucose-14C uptake by the epididymal adipose tissue was studied in young rats with spontaneous hypertension (SHR), in rats with two-kidney Goldblatt hypertension, and in control rats with normal pressure. Some of the animals were subjected to bilateral adrenalectomy one week before the study. Rats with either type of hypertension and intact adrenals did not differ from the controls in the intensity of glucose-14C uptake by the adipose tissue both with and without stimulation of its transmembranous tranport with insulin. Adrenalectomy revealed that the response of the adipose tissue to insulin in rats with hypertension differed from that in the controls. In the control animals adrenalectomy causes marked decrease in insulin "sensitivity" of the fat cells, whereas in adrenalectomized rats with hypertension the level of glucose-14C in stimulation of its transport with insulin does not change. The results of the study testify to qualitative changes in the membranes of the fat cells in rats with chronic arterial hypertension and may be proof of extensive alteration of the cell membranes in this disease.


[Electron-microscopic study of changes in the myocyte ultrastructure under the effect of hyaluronidase in experimental myocardial infarct]. The myocardium of 60 rabbits with experimental myocardial infarction induced by ligation of the anterior interventricular branch of the left coronary artery was studied by electron microscopy. The main group of animals received hyaluronidase. The size of the infarct was judged by the ECG recorded with 15 precordial leads. Normalization of myocytes in the non-ischemic zone of the left ventricle in the treated animals revealed. Better intactness of myocytes in the peri-infarction and non-ischemic zones was noted, which may apparently accelerate ECG dynamics, change the total balance of necrotic material in the direction of its decrease, and, consequently, influence the indices of blood plasma creatine phosphokinase.


[Morphological and biochemical changes in the myocardium after sudden death from ischemic heart disease]. The myocardium was examined in 44 persons who had suddenly died of ischemic heart disease, in 37 who had died of injury, and in 28 who had died of alcohol poisoning. Those with ischemic heart disease  had foci of necrosis of the muscle fibers, severe disturbances in microcirculation, changes in the activity of certain myocardial enzymes and in the content of lipids in the myocardium. Biochemical changes similar to these in many respects were revealed in individuals who had died of alcohol poisoning, in view of which alcohol poisoning may be a factor conducive to sudden death in ischemic heart disease.


[Role of microcirculatory changes in contractile insufficiency of the intact myocardial zones in acute period of myocardial infarct]. To determine the role of the microcirculation channel in the genesis of contractile insufficiency of "intact" myocardial zones in infarction the ultrastructural organization of the blood capillaries and the myocardial myocytes was compared in 14 patients between the ages of 51 and 85 who had died in the acute period of the disease. Myocardial tissue of 26 areas of the left and right ventricles and the right atrium was collected for examination during biopsy of the heart in the zone supplied by the "intact" coronary artery 15-30 minutes after death of acute transmural myocardial infarction. The reduction in the microcirculation channel and the degree of myocyte damage down to the development of foci of micronecrosis were most manifest in cases with vast transmural infarction complicated by pulmonary edema and true cardiogenic shock.


[Participation of the population in mass screening and the role of complete population surveillance for detection of the disease studied (from the experience of the methodical measures for the prevention of ischemic heart disease in Kaunas)]. A comparison of the results of examination of 100 individuals, some of whom had taken part in the survey while the others had refused it and information about them was specially obtained by other means (in some cases by collecting the medical documentation), is presented.  Factors conducive to the development of ischemic heart disease predominated among individuals who refused to take part in the survey. The incidence of ischemic heart disease and arterial hypertension was also higher among them. It is concluded that individuals who refuse examination during preventive survey form a group with a high risk of the development of ischemic heart disease; this group should be taken into account when therapeutic and preventive measures are conducted among the population.


[Relationship between certain risk factors, age and ischemic heart disease according to simultaneous epidemiological study]. The measure of the difference according to certain risk factors and their combination in population subgroups differing in age and health (with or without ischemic heart disease) is appraised. The lowest measures of difference were revealed between elderly subgroups (55--59 years) with or without ischemic heart disease, as well as between young and middle-age subgroups with ischemic heart disease. Risk factors associated with lipid metabolism and also those such as the blood sugar level on a fasting stomach and the blood fibrinogen level carried more information when subgroups with ischemic heart disease and those without it were compared, while factors associated with arterial pressure proved more informative in comparison between subgroups of elderly and young individuals. When all the subgroup pairs were considered, significance proved to be highest for the levels of pulse, systolic pressure and blood serum triglycerides and lowest for the levels of blood fibrinogen and blood sugar on a fasting stomach.


[Detection and treatment of persons with arterial hypertension]. By screening unogranized and organized male population, groups of individuals with relatively stable arterial pressure were chosen, which accounted for approximately 70% of all those with increased pressure. Three groups were formed among persons with increased arterial pressure; one received intensive hypotensive therapy on a multistage schedule and two were placed under observation, one being examined once in 2 months and the other once in 6 months. Two-year follow-up and treatment showed that long-term hypotensive therapy on a multistage schedule leads to a statisticaly reliable reduction of arterial pressure in individuals with relatively stable and moderate hypertension as compared to the initial level and to the pressure in the control group. In planning hypertension control it should be borne in mind that 1/4 of patients discontinue treatment in the first year.


[Organization of collecting and analysis of the data on nutrition in epidemiological study of cardiovascular diseases]. The principles of collecting and analysis of information on nutrition in epidemiological study of cardiovascular diseases by means of electronic computers are described. A special program computes the consumption of 11 nutrients, the calorific value of the diet, and the calorie percentage of different nutrients with the exception of cholesterol. Certain coefficients are estimated, such as the ratio between the poly-unsaturated and the saturated fatty acids in the diet, and the ratio between the amount of starch and the total amount of refined and unrefined sugar, Well-trained technical personnel may be entrusted with the collection of the information, its coding, perforation, and feeding into the computer and with the obtainment of the data, which reduces the cost of the study considerably.


[Population surveillance and its importance in the study of the effectiveness of primary and secondary prevention of ischemic heart disease among the population]. The results of epidermiologic surveys conducted in the USSR and in other countries are briefly analysed. It is noted that study of the effectiveness of the elaborated measures for primary and secondary prevention of ischemic heart disease is the principal object of long-term surveys among the population. The author believes the term population surveys to be most justified. The general principles of the organization of population surveys are described. Approaches to the evaluation of the effectiveness of intervention among the population are briefly characterized.


[Myocardial contraction in ischemic heart disease]. The indices of contractility of the left ventricular myocardium were studied by means of ventriculography and catheterization in 84 patients with ischemic heart disease according to the extent of damage to the coronary arteries and the course of the disease. Changes in the coronary arteries were encountered twice as frequently among patients with postinfarction cardiosclerosis as among patients with angina pectoris and no history of infarction. The main cause of disorders of myocardial contractility in patients with ischemic heart disease is post-infarction cardiosclerosis (56% of cases). Signs of impaired functional capacity of the left ventricle appeared in segmental asynergy involving 20 to 25% of its circumference. Changes in the indices of contractility were revealed in 13% of patients with angina pectoris.


[Certain characteristics of central hemodynamics in acute period of myocardial infarct]. Changes in the indices of central hemodynamics and contractility of the heart muscle in the acute period of macrofocal myocardial infarction were studied. In many cases heart ejection and performance of the left ventricle in the first 24 hours of the disease were greater than those in the control group of patients with ischemic heart disease in the period of remission. The increase coincided in time with sharp activation of the sympathico-adrenal and other systems of the organism in myocardial infarction, occurred on a background of deteriorated cardiac contractility, and ended by the third day of the acute period. Such changes in the first day of the disease were less manifest in the group of individuals in whom preceding cardiac failure had been more severe.


[State of the sympathetic-adrenal system in angina pectoris attacks]. In 14 patients with ischaemic heart disease the plasma noradrenaline and adrenalin levels were determined during anginal attacks and in the attack-free period, and daily catecholamines excretion was studied in 11 of them. The blood plasma and urine noradrenaline and adrenalin levels were determined with the help of the trioxyindol, fluorimetric method. The content of noradrenaline and adrenalin in the blood plasma during anginal attacks was statistically significantly higher than during the attack-free period. At the same time, in urine samples collected during 24 hours after the attack and during an attack-free period no significant differences in the concentration of both catecholamines was found. Consequently, hypercatecholaminemia observed during anginal attacks is brief. An elevation of the activity of the sympathodrenal system may favour the development of rhythm disorders and hamper the therapeutic measures.


[Hyperglycemia and the glucose tolerance test in the acute period of myocardial infarct and in the remote post-infarct period]. The blood sugar content was determined in 142 patients with myocardial infarction on the 1--3rd, 7-10th, 28--30th days of the disease by the Hagedorn-Jensen method. The standard glucose tolerance test was conducted in 64 patients on the 30th day of the disease and repeated in 20 patients 18 months after infarction. It was concluded that transient hyperglycemia developed in 47.8% of patients with myocardial infarction in the acute period, predominantly in those with a sugar curve of the diabetes-decipiens type. Carbohydrate tolerance was reduced in two thirds of the patients. In some of them this disorder was attended with clinical signs of diabetes and a severe course of myocardial infarction. In patients with diminished carbohydrate tolerance the sugar curve remained abnormal 18 months after the disease. Obvious diabetes developed in 6 out of 20 patients examined. Among relatives of patients with disturbed carbohydrate metabolism diabetes mellitus was encountered more frequently and the incidence of ischemic heart disease and hypertension was higher.


[Carbohydrate tolerance in patients with myocardial infarct according to prednisolone-glucose tolerance test]. Sensitivity to carbohydrates was studied in 100 patients in the subacute period of myocardial infarction by the prednisolne-glucose tolerance test with parallel determination of the content of sugar and pyruvic and lactic acids. Latent, predominantly mild disorders of carbohydrate metabolism were revealed in most patients. Considerably diminished glucose tolerance (diabetic-type sugar curve) was encountered in 12.5% of patients with normal and in 17.9% of those with excessive body weight. The prednisolone-glucose tolerance test and the tests for the content of pyruvic and lactic acids conducted in dynamics showed a statistically reliable increase in the pyruvate level on a fasting stomach and after glucose loads and of the lactate level on a fasting stomach and at the end of the examination. In diabetictype glycemic curves, however, the peak sugar levels were paralleled by normal content of pyruvic and lactic acids. The glycemia indices revealed in dynamics of the prednisolone-glucose tolerance test were significantly higher in patients with an increased blood sugar content in the acute period of myocardial infarction.


[Evaluation of the condition of the peri-infarct zone in acute myocardial infarct according to 35 precordial leads]. The condition of the peri-infarction and the necrotic zones was assessed by cartographic analysis of ECG recorded from 35 precordial leads. During a 4-week follow-up functional mobility of indices characterising the prenecrotic zone and the stability of the zone of necrosis was noted. The indices sigma ST (overall index of ST segment elevation), AST (area of ST segment elevation), and AQS (area of QS recording), as well as the AST/AQS ratio possess definite prognostic significance: the lower the value of sigma ST, AST, and AQS and AQS and the greater the AST/AQS coefficient, the more favourable is the prognosis in myocardial infarction.


[Ergometry and the risk factors in ischemic heart disease]. The correlational connection between some factors of risk and ergometric indices in patients with ischemic heart disease was studied. The results of an examination covering 188 patients and 56 practically healthy persons which  involved the use of a graded stepwise increasing loading on a veloergometer under a monitored control of the pulse rate, ECG and arterial pressure were analyzed. To the risk factors were referred hypercholesterinemia, hypertension, smoking, obesity and hypodynamia. With a rising number of risk factors a significant and progressive decline of the patients' physical performance capacity was ascertained. The most essential correlational connection between the risk factors and the maximally tolerable load and chronotropic and aerobic reserves was educed.


[Effect of oral contraceptives on the blood lipid level]. Secretion of estrogens in the urine and the content of cholesterol and triglycerides in blood plasma were studied in 36 healthy women 24 of whom took oral contraceptives including estrogenic and gestagenic components to prevent conception. It proved that after the first course of medication the overall estrogen excretion reduces at the expense of all fractions but more so at the expense of the active fraction. Beginning with the 2nd week the cholesterol level in the blood plasma increases and the level of triglycerides grows considerably. The increase in these indices was observed in the first 6 months when the oral contraceptives were taken. With the preparations taken for a longer time the blood plasma cholesterol and triglyceride levels became stable.


[Myocardial metabolism in experimental adrenal gland pathology]. The effect of cortisone, desoxycorticosterone, and their combination on the myocardial content of pyruvate, citrate, coenzyme A, thiamine, riboflavin, Ca2+ and Mg2+ in animals with resected or intact adrenals was studied on 320 male albino rats. Experimental adrenal insufficiency was attended with deep metalolic disorders which were not normalized completely after the administration of cortisone or DOCA alone or in combination. The trend of the metabolic effects of these hormones under conditions of experimental adrenal insufficiency differed from that in rats with intact adrenals. It is pointed out that in substitution and pathogenetic hormonotherapy it is necessary to take into account the "background" activity of the adrenal cortex and that additional prescription of agents of nonspecific correction of myocardial metabolism is expedient.


[Differential diagnosis of supraventricular rhythm disorders and the tactics in the treatment with cardiac glycosides]. The article discusses the possibilities of differential diagnosis of supraventricular arrhythmians by means of carotid zone stimulation, atrial VCG and ECG recorded from right-bronchial leads. Atrial VCG can reveal the character of the ectopic P-wave and thus helps in the diagnosis of arrhythmias with conspicuous atrial activity. ECG recorded from bronchial leade makes it possible to obtain a large atrial wave and determine elements of decisive importances in the diagnosis of many rhythm disorders: junctional and combined contractions, various types of ectopic P-waves, the character of antero- and retrograde conduction. The tactics of treatment with cardiac glycosides is determined by precise diagnosis of the arrhythmia and its connection with digitalis toxicosis.


[Clinico-electrocardiographic, morphological and biochemical manifestations of glycoside poisoning in patients with myocardial infarct]. The clinical manifestations of glycoside toxicosis were compared with the character of myocardial ultrastructural changes and the electrolyte shifts outside the infarction zone. Accumulation of glycogen in the cytoplasm of the muscle cells with simultaneous gross destruction of the myocardial ultrastructure in the pre-infarction zones are morphological manifestations of glycoside toxicosis on the ultrastructural level. The administration of strophanthin to patients with extremely severe cardiac insufficiency due to myocardial infarction may lead to disturbance in the mitochondrial energy-producing activity and the development of nodes of myofibril over-contractility with subsequent death of the cell, even to the development of smallfocal necrosis in the myocardium. The use of lidocaine and panangin in sufficiently high doses is an effective measure in the prevention and elimination of extrasystolic arrhythmias caused by glycoside toxicosis.


[Clinical value of determination of digoxin concentration in blood during treatment of cardiac insufficiency]. The concentration of digoxin in blood was determined by the radio-immunologic method in 41 patients with circulatory insufficiency and permanent form of auricular fibrillation who were treated with the drug. In 85.5% of cases the therapeutic digoxin concentrations did not exceed 2 ng/ml. The therapeutic concentrations ranged from 0.3 to 3.6 ng/ml, the toxic from 0.9 to 6 ng/ml. A relationship was established between the dose of digoxin and its concentration in the blood of patients with normal renal filtration. It is concluded that the blood digoxin concentrations alone, without the clinical data being taken into account, cannot be a reliable criterion in assessment of the level of saturation with cardiac glycosides. Study of the dynamics of blood digoxin concentration in each patient allows its determination to be used to assess the tolerance to the drug, choose the adequate maintenance dose and the time for its correction, and to confirm the clinical signs of digitalis intoxication if the concentration of digoxin is above 2.5 ng/ml.


[Use of glucagon in cardiac glycoside poisoning in patients with congestive circulatory insufficiency]. The use of glucagon in 25 patients with congestive circulatory insufficiency of stage IIB-III (according to the classification suggested by N. D. Strazhesko and V. Kh. Vasilenko) on the background of intoxication due to cardiac glycosides showed the drug to be effective as a cardiotonic and antiarrthythmic agent in 12 patients with stage IIB circulatory insufficiency. The data obtained also bear evidence that glucagon may be used in combination with cardiac glycosides, this treatment in some cases having a more marked positive effect on the hemodynamics in patients with decompensation than that encountered in treatment with glucagon alone. When used together with glucagon, cardiac glycosides did not induce intoxication.


[Effect of treatment with cardiac glycosides and biologically active substances on the state of the lesser circulation according to the electrokymographic data]. Electrokymography was used to assess by pulmonary densograms and pulmonary artery pulse curves treatment-induced changes in cardiac contractility and lesser circulation in 455 patients with rheumatic heart disease and stage IIA, IIB, and III circulatory insufficiency. Treatment with cardiac glycosides in combination with metabolic preparations (ATP methionine, vitamin B12, inosine-F, and extract of the heart muscle) leads to a more conspicuous reduction in the symptoms of congestion in the lesser circulation than that encountered in treatment with cardiac glycosides alone. The reduction in these symptoms following treatment with ATP and heart-muscle extract may be explained not only by improved myocardial contractility but also by the direct vasodilating effect of adenyl compounds.


[Effect of rapid digitalization on the left-ventricular myocardial function according to the echocardiographic data]. The article deals with the data of echocardiographic examination of 61 patients (37 with rheumatic heart disease and 17 with atherosclerotic cardiosclerosis) subjected to rapid stage-by-stage digitalization by intravenous administration  of various rapidly acting glycosides. In 10 patients with ischemic heart disease echocardiography was performed following a single strophanthin injection. Decrease in the volumes of the left ventricle and increase in the indices of central hemodynamics were noted as a result of rapid stage-by-stage saturation with strophanthin. The maximum inotropic effect of strophanthin does not coincide in time with the maximum chronotropic effect. The increase in the stroke volume noted in maximum deceleration of cardiac contractions is probably realized due to the Frank-Starling mechanism. Strophanthin increases the rate of myocardial contractions without changing the duration of the systole. The rate of diastolic relaxation grows, the phase of rapid filling becomes shorter and the phase of slow filling longer, which creates favourable conditions for the next contraction.


[Spiroergometric evaluation of the effectiveness of treatment of cardiac insufficiency with cardiac glycosides]. There were 29 patients with rheumatic heart disease and early stages of cardiac insufficiency under observation. Spiroergometry with the "Ergotest" device was conducted in dynamics to check whether the proper dose of the cardiac glycoside had been chosen. The results attest to the considerable improvement in the spiroergometric indices in patients with early stages of cardiac insufficiency who had been treated with digitalis. Spiroergometry yielded important additional criteria of the effectiveness of digitalization, particularly in individuals with normal or diminished rate of cardiac contractions.


[Evaluation of the clinical effect of treatment with cardiac glycosides under conditions of ambulatory observation]. Thirty-four patients with rheumatic heart disease and 22 with atherosclerotic and post-infarction cardiosclerosis, signs of stage I-IIB circulatory insufficiency, and disorders of cardiac rhythm (auricular fibrillation) were kept under out-patient care for periods of 6 to 42 months. They all received cardiac glycosides per os in a maintenance dose determined in the clinic after intravenous digitalization. Clinical and echocardiographic examination of the patients was conducted every 4 to 6 months. Depending on the effect of long-term digitalization, all patients were divided into clinical groups in which the causes of the disturbed compensation were determined. The importance of regular doctor's control over proper intake of the maintenance dose of glycosides and its correction depending on each concrete clinical situation is stressed.


[Clinico-experimental evaluation of therapeutic effectiveness of 1-dihydroxyphenylalanine in circulatory insufficiency]. The indices of central hemodynamics and myocardial contractility were studied by poly- and mechanocardiography in 25 patients with stage I-IIA circulatory insufficiency prior to and after treatment with 1-dioxyphenlalanine. The content of lactic and pyruvic acids in the blood and erythrocyte permeability to 32P were determined at the same time. The activity of the redox enzymes was studied in rats with experimentally induced circulatory insufficiency on the background of 1-DOPA medication. It was established that contractility of the heart and indices of central hemodynamics improved due to the effect of 1-DOPA. A decrease in the lactate concentration and an elevation of the pyruvate level in the blood of patients were noted. In animal experiments increased activity of cytochrome oxidase, succinic dehydrogenase, and alkaline and acid phosphatase in the myocardium was demonstrated.


[Effect of cardiac desympathization, stimulation of the central adrenergic structures and blockade of beta-adrenergic receptors on cardiotonic and cardiotoxic effect of cardiac glycosides]. The object of study were rabbits who had been subjected to ligation of 3 or 4 large branches of the left descending coronary artery 14-20 days before the experiment. In experiments with surgical desympathization of the heart it was established that the inotropic effect of cardiac glycosides did not depend on the concentration of catecholamines in the myocardium. In stimulation of adrenergic structures of the posterior hypothalamus attended with an increase in sympathetic innervation of the cardiovascular system the cardiotoxic threshold of cardiac glycosides was considerably reduced. Propranolol (Inderal) administered in a dose which blocks the beta-adrenergic apparatus of the heart prevents the development of the positive inotropic effect of therapeutic doses of strophanthin K on a hypodynamic left ventricular myocardium.


[Insulin secretion and catecholamine content in the blood plasma in initial stages of cardiac insufficiency]. Test for glucose tolerance was performed in 28 patients with ischemic heart disease and stage IIA circulatory insufficiency and repeated in 17 of them after treatment with cardiac glycosides. The blood collected on an empty stomach, 60 and 120 min after oral administration of 50 g of glucose was tested for the sugar content and the plasma for the content of immunoreactive insulin. In some of these patients the plasma of blood collected on an empty stomach was tested for the contents of noradrenaline and adrenaline. No statistically reliable difference was revealed in the plasma immunoreactive insulin level in patients with ischemic heart disease and stage IIA circulatory insufficiency before and after treatment and also as compared to that in patients with ischemic heart disease but no clinical signs of circulatory insufficiency. In patients with circulatory insufficiency the content of noradrenaline and adrenaline in blood plasma was higher before treatment than after it, but the difference was statistically reliable only in the case of noradrenaline. The degree of intensification of the activity of the sympathicoadrenal system in patients with ischemic heart disease and initial stages of circulatory insufficiency is evidently not sufficient for inhibiting insulin secretion.


[Circulatory insufficiency in the light of neuroendocrine and metabolic disorders]. Certain metabolic disorders characterizing disturbances both in neuroendocrine control and in metabolic processes at the cell and tissue levels were revealed in 472 patients with rheumatic heart disease, atherosclerotic cardiosclerosis, and cor pulmonale. The disturbance in the adrenal function was of a dissociated character, manifested by increase in sympathoadrenal and decrease in glucocorticoid activity. The indices of pentosophosphate cycle and erythrocyte and blood serum enzymes studied testify to deep changes in the state of the erythron, marked both by breaks and by adaptation to hypoxia caused by circulatory insufficiency.


[Analysis of causes of death of patients with chronic circulatory insufficiency]. The presented analysis is based on the case reports of 166 patients who had been treated in the A. L. Myasnikov Cardiology Institute, USSR Academy of Medical Sciences, for rheumatic heart diseases (97), postinfarction cardiosclerosis (35), myocardiopathies (24) complicated by Stage III or IIB circulatory insufficiency. Chronic circulatory insufficiency free of complications was the cause of death of only 1/3 of the mortality cases. The rest of the patients' death was considered to be caused by thromboembolism, predominantly to the pulmonary artery system, pneumonias, haemorrhages from acute and subacute gastric ulcers, etc. The factors most frequently complicating the chronic circulatory insufficiency in patients suffering either from heart diseases, cardiosclerosis, or myocardiopathy, were thromboembolisms.


[Twenty-two year's experience with intraocular lenses (author's transl)]. The employment of the intraocular lens is an acceptable procedure in selected cases. It has great optical and practical advantages over conventional treatment. In the evaluation of suitable cases, clinical considerations, indications and contraindications are of major importance. The extraction of the opaque cataractous lens from the human eye is an eternally new, ever exciting operation which always has challenged the skill of the ophthalmic surgeon. It is not easy and it always involves a risk. The additional demands of technique incurrent in the insertion of the intraocular pupillary lens render the operation still more difficult and increase the risks. The results presented and the advantages achieved justify, in my opinion, the use of an intraocular lens in selected cases of cataract extraction.


[Complications after photocoagulation and cryotherapy (author's transl)]. A report of 3 cases is given. Following a photocoagulation because of a retinal tear a rapidly maturing cataract developed. The same occured in a patient after treatment with equatorial transconjunctival cryotherapy (according to Haut) because of dense vitreous turbidities. Though the vitreous cleared, 6 weeks after surgery a mature cataract had developed which had to be removed. In the third case a peripheral retinal hole was surrounded by dryo applications. 6 weeks later a severe proliferative macular detachment developed. Brief case reports and a discussion follow.


[Cataract operations and glaucoma - a study (author's transl)]. This study reports on the favourable influence of lens extraction alone on intraocular pressure levels in different kinds of glaucoma (wide angle, angleclosure, secondary). Out of 2000 eyes undergoing cataract surgery 162 had medically treated glaucoma prior to surgery. Follow-up examinations of the intraocular pressure could be carried out in 118 eyes over a year. There resulted from this study no certain indications for a combined operation, whose value is discussed.


[Long-acting local anesthetics - an enrichment in ophthalmosurgery? (author's transl)]. In 300 cases the effectiveness of the long-acting anesthetic Meaverin-ultra for retrobulbar anesthesia was systematically investigated. The duration of analgesis and immobilisation for the globe as well as for the eyelids runs over hours; they are considerabley more effective than with other common local anesthetics so far. 91% of the patients got free of pains for more than 24 hours after the operation. As to the interruption of pain attacks in cases of haemorrhagic glaucoma painless intervalls of more than 30 hours were reached. Special advantages result in cases of buckling operations for retinal detachment, which have to be followed by photo-(xenon)-coagulation. On the whole, long-acting anesthetics are an extraordinary gain for ophthalmosurgery.


[Exudative senile maculopathy, clinical picture, pathogenesis, prognosis and therapy (author's transl)]. From the literature and our own experience it is evident that choriogenic subretinal vascular proliferation is the most important symptom of senile exudative maculopathy. Prior to proliferation a certain percentage of cases develops an isolated detachment of the retinal pigment epithelium. However, there are cases where already in the predisciform stage vascular proliferations are proved histologically. Photocoagulation can be applied to isolated pigment epithelial detachment, to cases with beginning vascular proliferation, and to late stages in order to accelarate the final scaring.