Mechanism of morphine-induced miosis in the dog. It was observed that dogs under 50 percent nitrous oxide and succinylcholine exhibited a moderately large pupil, maintained a good pupillary light reflex and had a relatively high sensitivity to the miotic effects of morphine.  A cumulative dose of 1 mg/kg. i.v. of morphine caused marked and sustained miosis in these animals.  Morphine, 1 mg, was found to have no pupillary effect by intraocular administration.  Optic nerve section and cervical sympathectomy did not interfere with the miotic response in either acute or chronic preparations.  Conversely, a cumulative i.v. dose of 30 mg/kg of morphine failed to cause pupillary constriction when oculomotor innervation had been interrupted.  In addition, morphine, 0.2 to 0.6 mg/kg i.v., caused marked miosis in dogs whose occipital lobes or cerebral hemispheres had been removed.  These findings suggest that morphine acts on a subcortical region causing constriction of the pupil.  The possible location was ascertained by unit recording with microelectrodes.  It was observed that pupilloconstrictor neurons in the visceral nuclei of the oculomotor nuclear complex responded to morphine, 0.2 mg/kg i.v., by increased frequency of discharge.  Other neurons in the pupillary light reflex pathway showed depressed activity.  Levallorphan, 0.05 mg/kg i.v., but not phenylephrine (locally applied to the conjunctival sac) antagonized all of the actions of morphine on the pupilloconstrictor neurons.  The present findings demonstrate that the miosis induced by morphine is accomplished by an excitatory action of the narcotic on the visceral nuclei of the oculomotor nuclear complex.


Imipramine-caused interference with levodopa absorption from the gastrointestinal tract in rats. Rats treated for 3 or 30 days with imipramine (30 mg/kg) have impaired absorption of a single dose of 14C-levodopa. Treated animals retain larger amounts of radioactivity in their gastric lumen and this interfers with delivery of levodopa to intestinal absorptive sites. Tissues of treated animals have lower levels of radioactivity than controls and urinary excretion of radioactivity is also lessened. Imipramine does not interfere with uptake of levodopa by everted sacs of rat jejunum. Imipramine does, however, interfere with the transit of radioactivity through the gastrointestinal tract of rats, since treated animals have lower ileal radioactivity than controls. Lower relative concentration of levodopa metabolites in gastric fluid and tissue may reflect an interference of uptake of levodopa by gastric enterochromaffin-like cells.


Inhibitory actions of laxatives on motility and water and electrolyte transport in the gastrointestinal tract. Castor oil and magnesium sulfate were studied for their effects on gastrointestinal contractile activity in vivo.  Ricinoleic acid, the active ingredient in castor oil, magnesium sulfate and mannitol were studied and compared for their effects on net water and electrolyte absorption in vitro.  Extraluminal strain gauge transducers were implanted in dogs and used to monitor the circular smooth muscle activity of the antrum, duodenum, ileum and colon after water, castor oil or a 30 percent solution of magnesium sulfate.  Substances were tested during the interdigestive (fasted) and digestive (fed) states.  Decreases in total activity were found for both cathartics in the antrum and ileum.  Further analysis revealed that decreases in the ileum occurred primarily by a decrease in contractile rate, whereas antral decreases could be attributed primarily to a decrease in force per contraction.  Proximal colonic activity tended to decrease after laxatives and feeding.  The effects of ricinoleic acid, isotonic and hypertonic solutions of magnesium sulfate and mannitol on net water and electrolyte absorption were tested on everted segments of hamster jejunum.  Sodium ricinoleate (2.0 mM) reduced net water transport by 48 percent (P smaller than .01).  Magnesium sulfate, like mannitol, only reduced net water absorption when present as a component of a hypertonic mucosal solution.  The results suggest that both inhibition of water absorption and reduced circular smooth muscle activity may be important factors in castor oil- and magnesium sulfate-induced catharsis.


Negative reinforcing properties of some psychotropic drugs in drug-naive rhesus monkeys. Rhesus monkeys, previously trained to avoid electric shock, pressed a lever to extinguish a light associated with an intravenous drug infusion scheduled to occur 30 seconds after the onset of the light.  Each response when the light was on terminated the light for a 1-minute time-out period (avoidance); a response during the infusion terminated the infusion (escape).  Under these conditions the monkeys tolerated a high number of saline infusions.  Saline was replaced by different doses of chlorpromazine, lysergic acid diethylamide (LSD) and pentobarbital each for six successive daily 2-hour sessions.  Infusions of chlorpromazine (5.0-20 mug/kg/infusion) or LSD (1.0-2.5 mug/kg/infusion) generated and maintained avoidance/escape behavior, whereas most of the infusions of pentobarbital (10-100 mu/kg/infusion) were tolerated.  In rhesus monkeys with no previous drug experience, chlorpromazine and LSD, but not pentobartital, have negative reinforcing properties.


Cultivation of Acanthamoeba castellanii, Neff Strain, at high hydrostatic pressures. Log-phase cultures of Acanthamoeba castellanii, Neff strain, have been maintained at elevated hydrostatic pressures over periods of several days and the population has been recounted at the end of the experimental period.  A pressure of 2,000 psi (136 atm) depressed growth of the population, but was quickly reversed on release.  A pressure of 4,000 psi (272 atm) severly depressed population growth, and any increase was slight and short-lasting at 5,000 psi (340 atm).  Growth of the population was resumed only after an interval of 1 or more days after release.


Effects of thiamine deprivation and replacement on the mitochondrion of Polytomella agilis. Late log-phase cells of Polytomella agilis, grown with or without thiamine, were examined by electron microscopy.  The mitochondrial profiles of cells cultivated in the presence of thiamine are relatively few in number and irregular in shape.  The inner membranes, randomly dispersed in a light matrix, are elongated, vesicular, or branched in appearance.  In vitamin-deficient cells, numerous mitochondrial profiles are evident.  They have a regular circular or ovoid appearance.  The inner membranes are regularly arrayed in an electron-dense matrix and generally appear elongated.  By means of partial 3-dimensional reconstruction of whole cells the appearance of mitochondrial profiles in vitamin-deficient cells can be explained by the increased branching of a single structure.  Following transfer of vitamin-deficient cells to complete medium, normal mitochondrial structure is attained by similar to 3 hr.  Reduced-minus-oxidized difference spectra of suspensions of normal and vitamin-deficient cells, grown with gentle aeration, were recorded.  The concentrations of a- and b-type cytochromes are reduced by 80-90 per cent, and c-type cytochromes are reduced by 40 per cent in thiamine-deficient cells.


Metabolic changes in Trichomonas gallinae resulting from growth in various carbohydrates. The influence of the type of growth carbohydrate on the subsequent metabolic activity of Trichomonas gallinae was investigated. Washed suspensions of cells collected from CPL-glucose, CPL-maltose, CPL-galactose, and CPL-glucose-maltose media were examined in the warburg respirometer for their ability to utilize glucose, maltose, and galactose. Comparisons of the metabolic parameters of substrate consumption, changes in glycogen content, and CO2 and H2 production were made. The pattern of utilization of the sugars, both qualitatively and quantitatively, depended upon the type of carbohydrate in the CPL medium used to culture the cells and upon the time of exposure of the cells to a particular sugar in the medium.


Eimeria taterae sp. n. and other intestinal parasites from the antelope rat, Tatera indica in Baghdad District. Of 8 fecal specimens from the antelope rat, Tatera indica Hardwicke examined, 4 were found positive for intestinal parasites.  Among these was Eimeria taterae sp. n., sporulated oocysts of which are described, their characteristics serving for the diagnosis of this species.  Entamoeba coli cysts, as well as ova of Hymenolepis sp. and Trichuris sp., were also found.


Fine structure of Bodo curvifilus Griessmann (Kinetoplastida: Bodonidae). Bodo curvifilus Griessmann conforms in its fine structure to the criteria proposed for the genus Bodo, including the presence of subpellicular microtubules, a single large kinetoplast-mitochondrion, emergence of the 2 heterodynamic flagella from a subapical flagellar pocket, and the presence of a paraxial rod associated with the axoneme of each flagellum.  B. curvifilus possesses cytoplasmic bodies which resemble endosymbiotic bacteria.  These are similar to those found in Bodo saltans.  Bodo curvifilus can be distinguished ultrastructurally from Bodo caudatus and B. saltans by the presence in B. curvifilus of a hitherto unreported structure, "the microtubular prism," consisting of a bundle of 19 microtubules.  In cross section, 15 of these microtubules form a cross-linked prismatic array.  This microtubular bundle originates near the flagellar pocket and extends for several micrometers into the body of the organism where it follows the periphery of the cell and the long finger-like projections of the kinetoplast-mitochondrion.


Protein uptake and digestion in bloodstream and culture forms of Trypanosoma brucei. The mechanisms of ferritin uptake and digestion differ in bloodstream and culture forms of Trypanosoma brucei.  Ferritin enters bloodstream forms from the flagellar pocket by pinocytosis in large spiny-coated vesicles.  These vesicles become continuous with straight tubular extensions of a complex, mostly tubular, collecting membrane membrane system where ferritin is concentrated.  From the collecting membrane system the tracer enters large digestive vacuoles.  Small spiny-coated vesicles, which never contain ferritin, are found in the Golgi region, fusing with the collecting membrane system, and around the flagellar pocket.  Acid phosphatase activity is present in some small spiny-coated vesicles which may represent primary lysosomes.  This enzymic activity is also found in the flagellar pocket, pinocytotic vesicles, the collecting membrane system, the Golgi (mature face), and digestive vacuoles of bloodstream forms.  About 50 percent of the acid phosphatase activity of blood forms is latent.  The remaining nonlatent activity is firmly cell-associated and probably represents activity in the flagellar pocket.  The structures involved in ferritin uptake and digestion are larger and more active in the short stumpy than in the long slender bloodstream forms.  The short stumpy forms also have more autophagic vacuoles.  No pinocytotic large, spiny-coated vesicles or Golgi-derived, small spiny-coated vesicles are seen in culture forms.  Ferritin leaves the flagellar pocket of these forms and enters small smooth cisternae located just beneath bulges in the pocket membrane.  The tracer then passes through a cisternal collecting membrane network, where it is concentrated, and then into multivesicular bodies.  In the culture forms, acid phosphatase activity is localized in the cisternal system, multivesicular bodies, the Golgi (mature face), and small vesicles in the Golgi and cisternal regions.  The flagellar pocket has no acid phosphatase activity, and almost all the acitvity is latent in these forms.  The culture forms do not release acid phosphatase into culture medium during 4 days growth.  Uptake of ferritin by all forms is almost completely inhibited by low temperature.  These differences among the long slender and short stumpy bloodstream forms and culture forms are undoubtedly adaptive and reflect different needs of the parasite in different life cycle stages.


Fine structure of the endogenous stages of Eimeria labbeana.  I.  The first generation merozoites. The fine structure of the 1st generation merozoites of Eimeria labbeana from the ileal mucosa of artificially infected pigeons (Columba livia) was investigated and described.  The 1st generation merozoites which appeared between 36-48 hr after infection averaged 4.4 times 2.1 mum in size.  The 3-membraned pellicle was irregular in texture and harbored a single micropore, and many micropore-like invaginations.  Closely apposed to the inner pellicular membrane were seen 22 microtubules, each 22-25 nm in diameter.  An apical vesicle, 50 nm in diameter, seen at the anterior extremity, was connected with the common duct of the micronemes.  The conoid consisted of 9 spiral elements, each 30 times 25 nm.  The paired organelle (rhoptries) varied in length (1.4-2.2 mum), and the ductules (23 nm diameter) were composed of 2 inner tubules, each 6 nm in diameter.  A unit membrane enveloped the partially alveolar and differentially osmiophilic interior of the bulbous regions of the rhoptries.  The "rod-like structure" was found to be tubular and represented the common duct of the micronemes.


[Genesis of merozoites in the coccidia, Eimeria necatrix.  Ultrastructural study]. Second generation schizonts of Eimeria necatrix were studied with the aid of the electron microscope.  Differentiation of daughter merozoites is associated with the last mitosis, which is not significantly different from the earlier ones.  The merozoites develop at the periphery of the schizont.  The conoid and 22 subpellicular microtubules, probably induced by centrioles, and the inner membranes complex and the rhoptry anlagen which seem to be produced by the Golgi apparatus, appear close to each nuclear pole, just near the schizont membrane.  These organelles are the first to appear in the merozoite anlagen.  Then, nucleus, dictyosome and multimembranous vescles enter the budding merozoites.  Micronemes, probably originating from Golgi apparatus, and amylopectin granules are produced later, when daughter merozoites separate from the residuum.  The genesis of these various organelles and the relation between the last mitosis and differentiation are discussed.


Reproduction, structure and host specificity of Trypanosoma (Herpetosoms) tamiasi sp. n. from the eastern chipmunk, Tamias striatus. Trypanosoma (Herpetosoma) tamiasi sp. n. is described from blood and organs of the eastern chipmunk, Tamias striatus, and the least chipmunk, Eutamias minimus.  In experimentally infected Tamias striatus and E. minimus, Trypanosoma tamiasi reproduced by equal binary fission in the trypo-, sphaero-, epi-, or amastigote form, mainly in lymphoid organs.  Trypomastigotes developed from amastigotes through epimastigotes, or from sphaeromastigotes, mainly in the same organs.  The mean lengths of body and flagellum of trypomastigotes increased linearly until the organisms reached a maximum length of similar to 37-39 mum.  The distance between the nucleus and kinetoplast increased to a mean total length of similar to 33 mum, and thereafter remained constant.  Parasitemias of up to 2.5 times 10-7 trypanosomes/ml were produced in Tamias striatus by inoculation with bloodstream, culture, or flea gut forms of Trypanosoma tamiasi; natural parasitemias in Tamias striatus peaked at up to 2.1 times 10-7 trypanosomes/ml. One E. minimus and 2 Spermophilus tridecemlineatus developed parasitemias of more than 1 times 10-6 trypanosomes/ml after inoculation of bloodstream forms of Trypanosoma tamiasi; other experimentally inoculated rodents, including mice, rats, and Spermophilus richardsonii, proved refractory.  In chipmunk fleas, Megabothris acerbus, Megabothris quirini, and Tamiophila grandis, bloodstream forms of Trypanosoma tamiasi developed to metacyclic forms in 4-9 days; in rat fleas, Xenopsylla cheopis and Nosopsyllus fasciatus, they survived with little development for up to 2 days, and in kissing bugs, Rhodnius prolixus, up to 10 days.  Apparently, the speciation of this trypanosome involved adaptation to certain species of both fleas and rodents.


Influence of age of ewe and photoperiod on the intervals between parturition and first oestrus in lactating and non-lactating ewes at different nutritional levels. A total of 131 2- to 6-year-old Mutton Merino ewes in two experiments were maintained in pens during the post-partum period and were exposed either to an artificial photoperiod of decreasing daylength, or to the naturally increasing photoperiod. After lambing in July, the ewes either were deprived of their lambs or they reared one lamb for 40 days. In both groups, the ewes were fed at one of four nutritional levels until the first post-partum oestrus had been recorded. The proportion of ewes showing first oestrus within 90 days of lambing was 44% for those subjected to the artificial photoperiod compared with 67% for those exposed to the natural photoperiod. First oestrus in the ewes which showed first oestrus more than 90 days after lambing was less delayed in those exposed to the artificial photoperiod. Nutritional level had no effect on the time of resumption of oestrus. In the natural photoperiod, 67% of lactating ewes and 68% of non-lactating ewes showed oestrus in 56.3 and 42.1 days, respectively, and a similar effect was observed in those exposed to the artificial photoperiod. In the natural photoperiod, 33% of 2-year-old, 53% of 3-year-old and 84% of mature ewes showed first oestrus within 90 days of lambing. It was concluded that, in most periods of the year, many ewes of this breed can be remated within 2 to 3 months of lambing and may thus be able to lamb three times in 2 years.


Effect of dietary protein on the biosynthesis of inositol in rat testes. The presence of inositol in high concentrations in semen and the male reporductive organs of mammals suggests that it may have an important rôle in male reproduction. The present study is an attempt to investigate the effect of dietary protein restriction in the male rat on inositol synthesis in the testes and on the concentration of inositol in some of the accessory sex organs. The results show that marginal protein deficiency does not alter either the biosynthesis of inositol or inositol concentration in the testis, epididymis or seminal vesicles.


Variations in peripheral levels of LH and testosterone in adult male rabbits. Seasonal, diurnal and episodic patterns of LH and tests-sterone secretion in sexually mature male New Zealand rabbits were studied. Blood samples were obtained from the central ear artery by puncture or through an indwelling catheter, and were assayed for hormones using radioimmunoassay. Testosterone values appeared to be lower in the summer months while LH showed no seasonal cyclicity. There were no significant fluctuations when samples were taken at 10-min intervals, but specimens taken every hour for 24 or 36 hr revealed an episodic pattern of release. Peaks of both hormones occurred every 4 to 5 hr in most animals. Testosterone levels ranged from 0.5 to 10 ng/ml and LH from 15 to 200 ng/ml of WP360A standard. In general, a rise in LH preceded or coincided with an increase in testosterone. No specific diurnal rhythm could be demonstrated and the patterns appeared to be unrelated to external stimuli.


Induction of incubation behaviour in male ring doves (Streptopelia risoria): a behavioural analysis. Male ring doves (Streptopelia risoria) were treated with either progesterone or dexamethasone (a powerful ACTH inhibitor) and tested for incubation behaviour. Progesterone treatments shortened the latency of incubation response by facilitating nest-related pre-incubation behaviour patterns in the nest bowl and components of incubation behaviour. The accumulated rather than the daily dose level of progesterone injections appeared to be the determinant factor in mediating behavioural effects. Dexamethasone treatment at the dosage of 100 mug/day for 7 days inhibited the overall expression of male courtship behaviour. None of the dexamethasone-treated ring doves "sat" in 2 weeks. It is suggested that the hormonal and situational (non-hormonal) cues are not only important contributory factors but also complement one another in the induction of incubation behaviour.


Preimplantation development in vivo and in vitro in bank voles, Clethrionomys glareolus, treated with PMSG and HCG. Ovulation can be induced in the bank vole by PMSG and HCG and takes place 9 1/2 to 11 1/2 hr after administration of HCG. The number of eggs obtained varied from 1 to 30 (average 9.3). The highest ovulation rates were observed when PMSG and HCG were administered 41 to 43 1/2 hr apart. The embryos attained the blastocyst stage 96 hr after HCG injection. Bank vole eggs can be cultured in chemically defined media beginning with the eight-cell stage; only 25% of four-cell eggs developed to blastocysts in vitro.


Effect of indomethacin on blood plasma levels of LH and testosterone in male rats. Treatment of adult male rats with indomethacin, an inhibitor of prostaglandin (PG) synthesis, caused a significant decrease in LH and testosterone levels in the blood plasma and in the weight of the seminal vesicles, but the weight of the testes and ventral prostate, the levels of FSH in the plasma and fertility were not affected. The concentration of PGF in the blood plasma of the treated animals was reduced, even though measurable amounts of PGs were present in every group. The results of this study, together with the known effects of PG administration on LH release, suggest that the reduction of plasma LH levels in rats injected with indomethacin was due to decreased PG synthesis. It appears that PGs are normally involved in the regulation of LH release.


The antifertility activity of 2-(isopropylamino) ethanol in the mouse. Intraperitoneal administration of 2-(isopropylamino) ethanol on the 3rd day of pregnancy reduces the extent of the decidual cell reaction induced by the blastocyst and can cause the death of the conceptus by the 6th day of pregnancy. Evidence is presented to support the theory that the compound administered in this way has a direct effect on the conceptus.


Plasma luteinizing hormone levels and testis diameters of ram lambs of different breeds. Plasma LH levels were examined at 1 1/2-hr intervals in ram lambs of the Finnish Landrace, Border Leicester and Cheviot breeds on three occasions at 3-week intervals by radioimmunoassay. On each occasion, the mean plasma LH concentration was found to be significantly higher in the Finnish Landrace than the other two breeds, although big variations occurred between individual samples in the same animal. This form of hormonal pulsatile release was most marked in the Finnish Landrace lambs. Testis growth was also measured and was found to be correlated, independently of body weight, with LH concentration on the final sampling occasion.


Induction of acrosome degeneration of mouse spermatozoa with blood serum collected from females in various hormonal states. Blood serum collected from female mice treated with oestrogen and progesterone was assayed for its ability to induce acrosome degeneration. The maximum activity was found in serum obtained from females treated with 1.0 mug oestrogen/day for 5 days. Lower doses did not produce any significant difference from the control group. Blood serum from pregnant or ovariectomized females treated with progesterone did not significantly depress the incidence of acrosome degeneration. The possibility that removal of the acrosome may not be a morphological concomitant of capacitation in mice has been discussed.


Effects of hormones on the maturation of rabbit oocytes recovered from follicles of various sizes. Progesterone stimulated oocytes to develop more rapidly in culture. The time-dependent effect was more pronounced on large preovulatory Graafian follicles than on small- and medium-sized follicles. Treatment with LH had no effect.


Lipid composition of buffalo spermatozoa: a cytochemical and biochemical study. Buffalo spermatozoa have been studied cytochemically and biochemically to investigate their phospholipids, which appear to be phosphatidyl choline, lysolecithin, phosphatidyl ethanolamine, phosphatidyl inositol, phosphatidyl glycerol and monogalactosyl diglyceride. Most of them form lipoprotein complexes in the regions of the plasma membrane, the post-nuclear cap and the mid-piece. The lipid composition of buffalo spermatozoa has been compared to and contrasted with that of bull and ram spermatozoa and species differences are indicated.


Luteinizing hormone concentrations in the plasma of laying hens exposed to a 27-hr cycle of light and darkness. The time of peak concentration of LH in the peripheral plasma of ten laying hens kept on a 14 hr light/13 hr dark cycle was determined by radioimmunoassay. A single peak of LH occurred in each hen 3 1/2 hr before oviposition or 4 hr before ovulation. These are similar intervals to those reported for laying hens kept on a 14 hr light/10 hr dark cycle. The mean time of the observed peak in plasma LH was 2 hr 9 min after the beginning of the dark period. This is about 3 hr earlier than corresponding LH peaks reported for hens under normal lighting.


Ultrastructural study of human sperm acrosome during acetic acid extraction of acrosin. During acrosin extraction from human spermatozoa by acetic acid treatment, severe ultrastructural alterations are observed: loss of the plasma membrane and of parts of the outer acrosomal membrane, total depletion of the acrosomal content, disappearance of the equatorial segment. The inner acrosomal membrane and the nucleus appear unchanged. The alterations are reduced by glycerol pretreatment in spite of improved extraction of the enzyme.


Different patterns of energy metabolism in the rat and mouse zygate. The development of rat zygotes in vitro to the two-cell stage occurred if lactate, phosphoenolpyruvate (PEP), pyruvate or oxaloacetate were present in the media. When rat and mouse zygotes were cultured in the same droplet of medium containing lactate or PEP, mouse zygotes did not develop to the two-cell stage but the rat zygotes cleaved.


Neurosecretory system of the American Dog Tick, Dermacentor variabilis (Acari: Ixodidae).  ii.  Distribution of secretory cell types, axonal pathways and putative neurohemal-neuroendocrine associations; comparative histological and anatomical implications. Histological observations using specialized techniques reveal neurosecretory cells in 18 centers throughout the rind (cortex) of the central nerve mass or synganglion of Dermacentor variabilis. Many cells contribute to complicated networks of neurosecretory pathways and tracts in pre- and post-esophageal portions of the synganglion. The four types of neurohemal-neuroendocrine associations found in Dermacentor resemble structures found in soft ticks (Argasidae) and in other Arachnida, but are more diverse than those described from any other single species. Neurosecretory terminals are distributed diffusely and in two concentrated associations within the perineurium of the synganglion and major peripheral nerves. Terminals are also distributed in the perineurial layers of lateral segmental organs which lie in the general hemocoel at the level of the pedal nerves. A retrocerebral organ complex surrounds the esophagus at its junction with the midgut. The complex includes dorsal and ventro-lateral lobes (containing neurosecretory terminals and intrinsic secretory cells1 and the proventricular (neurohemal) plexus. This plexus seems to be a modified (concentrated) cardioglial association. Cardioglial associations are also formed by the neurosecretory innervation of vascular walls of the dorsal aorta and circulatory sinuses which envelope the synganglion and major peripheral nerves. Inferential considerations of neurosecretory and endocrine interactions in the Acari are based on these anatomical and histological data which also provide the basis for evolutionary considerations of anatomical relationships and specializations in the neurosecretory systems of other Arachnida.


Therapy of advanced colorectal cancer with a combination of 5-fluorouracil, methyl-1,3-cis(2-chlorethyl)-1-nitrosourea, and vincristine. In a randomized, controlled study of 80 patients with advanced colorectal carcinoma, the combination of 5-fluorouracil (5-FU), methyl-1, 3-cis(2-chlorethyl)-1-nitrosourea, and vincristine produced an overall degree to toxicity comparable to that of 5-FU used alone. At 10 weeks, a positive objective response rate of 43.5% was observed with the three-drug combination compared to 19.5% with 5-FU alone (P less than 0.5).


Serum levels of N2, N2-dimethylguanosine and pseudouridine as determined by radioimmunoassay for patients with malignancy. A sensitive, rapid, and specific radioimmunoassay procedure was used to determine levels of N2,N2-dimethylguanosine and pseudouridine in sera of patients with acute leukemia and breast cancer. Elevated levels of both nucleosides were above standard deviations of the normal mean for patients in both disease categories.


Parachuting injuries: a retrospective study of 83,718 jumps. In a retrospective study of 83,718 consecutive parachuting jumps effected in the Israeli Defence Forces, an injury rate of 6.26/1,000 jumps was observed. About two-thirds of the injuries were light. Injury rates were calculated according to type of jump (free jumps, basic course, refresher jumps, and maneuvers jumps) and time of jump (day or night). A significant difference was found between the injury rate by day (4.62/1,000) and night (11.25/1,000). The lowest injury rate was observed among free jumpers (2.96/1,000) and highest during maneuvers jumps at night (25.75/1,000). The injury rate during the basic parachuting course was 4.04/1,000, and 8.24/1,000 in refresher jumps. Clinical data collected on 723 parachuting injuries included the site and type of injury. More than 90% of the injuries were caused during the landing impact. The most vulnerable sites were the ankle (35.6% of all injuries) and the spinal vertebrae (14.5% of all injuries).


Accidental high-pressure injection-gun injuries of the hand; the role of the emergency radiologic examination. High-pressure injection-gun injuries of the hand are serious accidents and constitute a surgical emergency. Radiography is an important part of the pre-operative evaluation. Without adequate films, it is frequently impossible to estimate the extent of underlying trauma. It is imperative that physicians who initially care for injection-gun accident patients be aware of the unique features of these injuries. Delay in the institution of adequate therapy may result in needless and permanent disability.


Extrication of the hand from a meat grinder. A case is presented in which a patient arrived in the emergency room with his forearm firmly entrapped in a large commercial meat grinder. The arm was extricated without sacrificing additional forearm stump length by reversing the worm mechanism of the meat grinder.


Wounding capacity of rotary lawn mowers. The rotary lawn mower possesses a powerful wounding mechanism. A typical 26-inch rotary mower blade rotating at 3,000 revolutions per minute develops a kinetic energy of 2,100 ft lb. Wounds may be inflicted by direct strike or by missile action due to a broken blade or other mass. Other serious injuries due to crushing or upset are commonly seen with self-propelled mowers. Ways of reducing these risks are enumerated.


Cerebral etiology of the acute respiratory distress syndrome: diphenylhydantoin prophylaxis. Beagles and rats were subjected to hemorrhage regimens that induced the pulmonary complex of the Acute Respiratory Distress Syndrome (ARDS) in 6:6 dogs and 7:8 rats. Pretreatment with diphenylhydantoin (DPH), 5 mg/kg 1-2 hours preceding hemorrhage, resulted in complete prevention of the lung lesions in 8:8 dogs. (P smaller than 0.005). It also provided significant (P smaller than 0.01) protection to 8:11 rats. We offer this as circumstantial evidence that the ARDS has a centrineurogenic etiology.


The classification of trauma. Lessons leaned in classifying injuries of 1,797 patients from civil disturbances in Northern Ireland, 1969-1971. The difficulties of applying the rules of the International Classification of Diseases to trauma cases are discussed on the basis of coding the injuries of 1,797 injured patients from civil disorders in Northern Ireland, 1969-1971. Certain inadequacies of the code are indicated and suggestions made about ways to modify it and make its applications more informative.


Factitial mesenteric avulsion.

Factitial mesenteric avulsion. Colon exteriorization procedures were done in two patients who also were, or became, psychotic. Each patient pulled on the exteriorized loop, causing severe bowel injury. In known or potential psychotics some other form of colonic injury management--other than exteriorization--should be utilized, or extreme caution should be taken to prevent inadvertent self-injury by the patient.


Fractures of the femoral neck after healed intertrochanteric fractures: a complication of too short a nail plate fixation. Report of three cases. Three cases are described in which a femoral neck fracture developed at least 1 year after a healed intertrochanteric fracture of the femur. Trauma via osteoporotic bone is felt to be the cause. To prevent this complication, a nail extending just to the articular cartilage of the hip joint is needed. This can be accomplished by the displacement osteotomy technique or by the use of the sliding nail-plate into the more stable posterior inferior quadrant of the head.


Maturation of rabies virus by budding from neuronal cell membrane in suckling mouse brain. Two strains of tissue culture-grown rabies virus developed in suckling mouse brain predominantly by the process of virus budding from the neuronal cell membrane.


Novel rII duplications in bacteriophage T4. The properties of two rII complementation heterozygotes (D5B and D7A) of bacteriophage T4 are described. These strains are characterized by their stability, each forming less than 10-3 r segregants among their viable progeny, and by their segregation of only one of the two parental types. No increase in r progeny was found on crossing D7A or D5B with T4r+, indicating that the duplications in these strains are not separated by an essential region of the phage genome. Both D5B and D7A from h-2+/h-4+ heterozygotes at frequencies similar to T4r+, suggesting that the duplicated regions in these strains are short. The progeny of these h-2+/h-4+ heterozygotes retain heterozygosity for rII but not for h: therefore, D5B and D7A are not stabilized terminal redundancy complementation heterozygotes. We conclude that D5B and D7A contain very short tandem duplications and we present structures consistent with the observed characteristics of these phages.


Murine oncornavirus high-molecular-weight RNA structure thermal stepwise dissociation of 70S murine leukemia-sarcoma virus to subunits and low-molecular-weight associated RNAs. The thermal dissociation into subunits and low-molecular-weight (LMW) associated RNAs of the aggregate structure of 70S RNA of a murine leukemia sarcoma viral complex was studied. By polyacrylamide-agarose gel electrophoresis, it was found that at low temperature a fraction of the genome was converted into an intermediate population of RNA (Im.P) with an apparent molecular weight of 6.6 times 10-6. At higher temperature, the 70S RNA and the Im.P RNA were successively dissociated into two RNA subunits called "I" and "II" and 70S-associated LMW RNAs. The apparent molecular weight of subunit I was about 5 times 10-6 and that of subunit II was about 3.2 times 10-6. The release of 4S, 5S, 5.5S, and 8S RNAs from 70S RNA at various temperatures was studied by composite polyacrylamide gel electrophoresis. It was found that the nature of hydrogen bonding to the 70S RNA was different for each LMW RNA species. A possible relationship of the association between the subunits and each 70S-associated LMW RNA, based on their T-m values, is discussed.


Characterization of the inhomogeneous DNA in virions of bacteriophage Mu by DNA reannealing kinetics. The DNA of bacteriophage Mu has been studied to characterize a region of inhomogeneous sequence that occurs at one end of the molecule. The kinetics of reassocation of tracer amounts of labeled host DNA in the presence of Mu DNA show that Mu DNA contains a complete selection of host sequences. These host sequences are shown to be covalently attached to phage-specific sequences and are present at a concentration that accounts for the inhomogeneity observed in the electron microscope. The significance and possible function of the host DNA attachment is discussed.


Adenovirus type 2 DNA replication. I. Evidence for discontinuous DNA synthesis. Isolated nuclei from adenovirus type 2-infected HeLa cells catalyze the incorporation of all four deoxyribonucleoside triphosphates into viral DNA. The observed DNA synthesis occurs via a transient formation of DNA fragments with a sedimentation coefficient of 10S. The fragments are precursors to unit-length viral DNA, they are self-complementary to an extent of at least 70%, and they are distributed along most of the viral chromosome. In addition, accumulation of 10S DNA fragments is observed either in intact, virus-infected HeLa cells under conditions where viral DNA synthesis is inhibited by hydroxyurea or in isolated nuclei from virus-infected HeLa cells at low concentrations of deoxyribonucleotides. Under these suboptimal conditions for DNA synthesis in isolated nuclei, ribonucleoside triphosphates determine the size distribution of DNA intermediates. The evidence presented suggests that a ribonucleoside-dependent initiation step as well at two DNA polymerase catalyzed reactions are involved in the discontinuous replication of adenovirus type 2 DNA.


Bacteriophage-associated spherical bodies in Bacteroides fragilis. Unique spherical bodies with multilayered walls were observed by electron microscopy in cells of a single strain of Bacteroides fragilis subsp. fragilis. Phage-like particles were present in the same cells, both free in the cytoplasm and within the spheres. The proportion of cells containing the phage-associated spherical structures ranged from less than 0.01% to about 7% depending on the culture conditions. Phage particles of morphological type B and spherical bodies were also found free in the medium surrounding the cells. Spherical bodies with discontinuities in their walls, through which phage-like particles sometimes appeared to be escaping, were also found both intra- and extracellularly. The biological significance of these distinctive spherical structures is a matter of conjecture.


Hexon peptides of type 2, 3, and 5 adenoviruses and their relationship to hexon structure. Peptides of hexons from type 2 and 5 (subgroup III) and type 3 (subgroup I) adenoviruses were produced by treatment with cyanogen bromide and were separated by isoelectric focusing in polyacrylamide gels containing 8 M urea. Peptides with identical isoelectric points, but from different hexon types, were considered to have structural similarities. According to this criterion for chemical relatedness, about two-thirds of the type 2 and 5 hexon peptides may be considered similar. In contrast, the majority of the type 3 hexon peptides differed chemically from peptides of type 2 and 5 hexons. Virions and free hexons were iodinated with 125-I in the presence of lactoperoxidase and H-2-O-2. When 125-I-labeled virions were disrupted and the hexon was purified, the highly labeled cyanogen bromide peptides were labeled. When purified hexons from the excess cellular pool were iodinated, peptides common to types 2, 3, and 5 (peptides 12 and 14) were most extensively labeled. Thus, hexons assembled in virions and those free in solution were iodinated differently. The data suggest that immunologically the hexons in viral capsids react differently from unassembled hexons because the polypeptide chains assume slightly different folding configurations in the two hexon forms and therefore expose different regions of the protein to antibodies.


Complementation of defective reovirus by ts mutants. Defective reovirions lacking the largest (L-1) of the normal 10 genomic segments grow only in association with helper reovirus. Because of the similarity in properties of defective and infectious virions, separation of the two populations by physical methods has been unseccessful. Controlled digestion of purified virus removes the outer capsomeres of the virions. The resulting core particles containing the viral genome have a buoyant density of 1.43/ml if derived from infectious virions and of 1.415g/ml if they originate in defectives, and this difference permits ready separation of the two types of cores. With the purpose of obtaining a pure population of defective virions, L cells were co-infected with defective cores and a class E temperature-sensitive mutant which has a mutation in an early function. After three serial passages at the permissive temperature (31 C) to build up the defective population, a fourth passage was made at 39 C, the nonpermissive temperature. The virus purified from this passage was predominantly defective; it contained practically no E mutant and had a low background of wild-type virus. Complementation was thus asymmetric; the L-1 function required for growth of defective virus was supplied by the E mutant and is thus a trans-function, while defective virus did not complement the E mutation which is thus in a cis-acting function. Defective virions were indistinguishable from infectious virions except for the absence of the L-1 genomic segment in the defectives. Such defective virions could be complemented at 39 C by class A and B temperature-sensitive mutants, both of which have lesions in late functions.


Ligation of the renal vein in the solitary kidney: effects on renal function. Three patients with right renal tumors extending into the inferior vena cava underwent ligation of the left renal vein coincident with right nephrectomy and en bloc resection of the vena cava. Two patients exhibited no postoperative renal dysfunction while the third demonstrated renal dysfunction which cleared by 9 days postoperatively. Features of the temporary renal dysfunction included proteinuria, elevated serum creatinine levels, oliguria, hypertension, elevated peripheral venous renin level, as well as radiographic evidence of swelling the kidney. The collateral venous drainage of the left kidney makes it possible to ligate the main vein of a solitary kidney with survival of the patient. However, postoperative temporary renal dysfunction may occur and a plan to deal with this problem should be fromulated.


Colonic urinary diversion: 10 years of experience. Experience with 46 colon urinary conduits is summarized. The transverse colon was used in 39 patients and the sigmoid in 7. Initially, we considered widened uretercolic anastomosis with free reflux desirable but later, upon realizing the dangers of reflux, antireflux procedures were incorporated into the operation. Among the advantages of the colon conduit are minimal stomal stenosis, little residuum, less electrolyte disturbance and availability for high and low diversions.


Primary obstructive megaureter in adults. The clinical features, diagnosis and treatment of 26 adults with primary obstructive megaureter have been reviewed. The histological features and the urodynamics of this disease are discussed. The clinical picture of primary obstructive megaureter in the adult may be deceivingly unimpressive. In this series 2 kidneys were destroyed because of progressive disease in the absence of clinical symptoms. We support Creevy's findings that the pathology involved is an obstructive segment of the ureter on the basis of a thickened muscularis and mild inflammation of the mucosa and submucosa. Urodynamic studies performed by one of us (M.K.H.) suggest that these ureters may remain in a balanced state indefinitely, owing to a low resting pressure. However, there may be relatively little reserve capacity and, with increased urine production rates, the pressure transmitted to the renal collecting system may produce renal atrophy. The radiologic features of the disease may reflect its clinical course, that is those showing a bulb and tail have a more benign course than ureters with a sharp cutoff. High dosage cine-pyelography is valuable in confirming the diagnosis and in studying the contractility of the ureter. Initially, we treated these cases conservatively. The presence of calculi and planned pregnancy are strong indication for surgical interference. Of the 26 patients 15 ultimatley required an operation. We recommend ureteral remodeling and reimplantation whenever possible since 11 of our cases had a most gratifying result from this procedure.


Clinical experience with the Mentor bladder stimulator. III. Patients with urinary vesical hypotonia. The Mentor bladder stimulator has been implanted in 5 patients with vesical hypotonia. Of these patients 3 empty the bladder with low residua and sterile urine postoperatively. Pain is the primary side effect in patients with incomplete lower motor neuron lesions or vesical hypotonia of unknown etiology.


Clinical application of electronic bladder stimulation in paraplegics. Ten patients have received bladder stimulators in a clinical trial to reduce urologic complications of neuropathic bladders. Preoperative evaluation and surgical techniques are discussed. Several patients void with the stimulator, and maintain low residual urine and a reduced incidence of infection. Two patients are total failures and 1 is in the early postoperative period. The physiological mechanisms involved are discussed. Additional investigation is  needed for a means to deliver the stimulus to a more precise localization. Further clinical trials are warranted.


Electrohydraulic lithotripsy: experimental study and case reports with the stone disintegrator. Electrohydraulic lithotripsy with the SD-1 for crushing bladder stones was performed experimentally, in vitro and in vivo. The results of this experiment in laboratory animals and in 19 patients revealed that the procedure is safe and superior to the conventional methods with blind or optical lithotriptors. The methods is easy to learn and application of the technique may be combined in the same session with other urological operations. This procedure was done more than 50 times in toto without any complication.


Complete external sphincterotomy: correlation between endoscopic observation and the anatomic sphincter. Longitudinal cuts of various lengths and depths were made in the area of the external urethral  sphincter in 18 male cadavers. The Iglesias resectoscope and the Collings knife electrode were used. Histologic sections of the prostate and of the membranous and bulbous urethra demonstrated that a cut of 2 cm. in length beginning from the verumontanum and 6 mm. in depth was necessary to completely incise the external urethral fibers. This procedure, when performed according to these criteria, effectively decreases urethral resistance, permits adequate bladder emptying and probably eliminates the need for a catheter.


Gonadoblastoma associated with embryonal carcinoma in an anatomically normal man. A case of gonadoblastoma associated with embryonal carcinoma in a normally decended testis of an anatomically normal 20-year-old man is reported. The patient had enlargment of the supraclavicular lymph nodes, which contained metastatic yolk sac tumor. Pulmonary and abdominal metatases were present. Despite chemotherapy and radiotherapy the patient died 9 months after presentation. Review of the literature concerning gonadoblastoma in phenotypic male patients is presented.


An evaluation of lymphangiography in staging carcinoma of the prostate. Pedal lymphangiography was done on 38 patients with stages O, A and B carcinoma of the prostate. The lymphangiograms were positive in 19 cases and negative in 19. Of 18 patients who underwent lymphadenectomy (9 with positive and 9 with negative studies) operative findings confirmed the lymphangiogram in 15 (83 per cent). In the 6 patients with osseous metastases and/or enzyme elevation, the lymphangiogram was positive. Furthermore, 13 patients with positive lymphangiograms had negative osseous and enzyme survey, emphasizing that nodal involvement may be the earliest finding in disseminated carcinoma of the prostate. The value of lymphangiography in staging carcinoma of the prostate prior to radical prostatectomy or irradiation seems well established.


Intrarenal reflux and its relationship to renal scarring. Intrarenal reflux found during voiding cystourethrography in children has been suggested to be a significant factor in the production of renal damage. To investigate its incidence and effect on renal growth the records and roentgenograms of 150 children with known vesicoureteral reflux were reviewed. Of these children 15 had evidence of intrarenal reflux. Their IVPs were studied for signs of renal parenchymal damage at the time of the initial voiding cystogram as well as up to 4 years later. Evidence of renal damage was seen in 4 of the 15 patients with intrarenal reflux. These same 4 children had gross vesicoureteral reflux.


131I hippuran quantitative scintillation camera studies in the evaluation and management of vesicoureteral reflux. A study was made of 136 patients with vesicoureteral reflux with the conventional radiologic modalities of voiding cystourethrography and IVP. In addition, a 30-minute quantitative scintillation camera study was used. Comparison of these studies indicates that most periodic re-evaluations with IVP can be eliminated in favor of the scintillation study with its markedly reduced radiation dosage and lack of allergic type reactions. Unfortunately, as the quantitative scintillation camera study has been performed in these patients, it has been impossible to diagnose the presence of vesicoureteral reflux. Therefore, voiding cystourethrography or direct radionuclide cystography must be repeated at some time to determine if conservative management has been successful. The benefit of the routine use of the quantitative scintillation camera study in the early postoperative period seems to be strongly supported even by the small group of patients studied.


Anesthesia considerations during nephrolithotomy with slush. A retrospective study was made of 113 patients who underwent nephrolithotomy between 1962 and 1973. Multiple parameters from a surgical and anesthesia viewpoint were tabulated. The main findings were a high incidence of pulmonary complications (37 per cent), a general lowering of body temperature during anesthesia and operation and initial decreases in blood pressure, apparently related to the use of d-tubocurarine. Currently, prospective studies are underway to more clearly delineate these problems and perhaps find ways to eliminate them.


Renal artery aneurysms.

Renal artery aneurysms. The various types of renal artery aneurysms are described, the most common one being the congenital saccular aneurysm. Usually asymptomatic it may be associated with hypertension and generally undergoes atherosclerotic degeneration. An arteriovenous fistula may form and rupture into the renal pelvis or retroperitoneal space in some rare instances. Small, well calcified saccular aneurysms should be left alone and followed; larger, incompletely calcified or non-calcified aneurysms should be removed. Fusiform aneurysmal dilatation of the renal artery occurs distal to a focal fibromuscular dysplastic stenosis. This type is almost invariably found in hypertensive young people. Thrombosis of a branch may occur distal to the aneurysm. These aneurysms should be treated surgically, usually by excision of the stenotic area and its aneurysm, and anastomosis of branches back to the main renal artery. Dissecting aneurysms of the renal artery are the most damaging to the kidney. Complications are thrombosis of the branches, infarction of the kidney and a virulent form of hypertension. An operation should be done to correct the dissection and to remove part or all of the kidney when infarction is severe. Intrarenal arterial aneurysms are prone to hemorrhage and should be removed by local excision or partial nephrectomy.


The Page kidney: a correctable form of arterial hypertension. The Page kidney is a remediable form of renal hypertension. It is usually seen in young male patients with an antecedent history of blunt renal trauma, followed by a subcapsular or perirenal hematoma causing compression of the renal parenchyma and hypertension. Radiographic studies demonstrate the presence of an extrinsic mass compressing the kidney. Divided function studies and renal vein renin determinations confirm the functional significance of this process in the etiology of hypertension. Treatment may initially consist of observation. However, if hypertension persists then decortication and evacuation of the encysted fluid are indicated. In long-standing cases, although nephrectomy may be necessary, the chance of relieving hypertension is excellent.


Ferromagnetic silicone necrosis of hypernephromas by selective vascular occlusion to the tumor: a new technique. Arterial vascular occlusion of hypernephromas may be performed by obstructiing the tumor vascular tree with the injection of ferromagnetic silicone microspheres. The powerful superconducting electromagnet confines the embolized iron-silicone compound to the neoplastic target organ. Radioactive material may or may not be added to the iron-silicone compound to give local direct radioactive radiation therapy to the tumor area. In experimental dogs up to 70,000 rad of beta radiation from the P32 source had been delivered homogeneously within the kidney when mixed with the ferrosilicone. This technique may well be used in cases in which a major operation is contraindicated or when preoperative necrosis of the tumor is advisable. Since the entire procedure can be done with the patient under local anesthesia in a radiology department it may be a valuable new technique in the future management of urological tumors, unilateral renal hypertension, solitary kidney pathology and so forth. Ferrosilicone material has not been found to be toxic. The application of a powerful superconducting electromagnet to the technique provides a means of confining the embolized iron-silicone compound to the target organ.


Treatment of multiple superficial papillary tumors of the bladder by intracavitary yttrium-90. Intravesical Y-90 was used in 38 patients with multiple papillary T1 tumors considered beyond control by cystodiathermy. Of the 32 patients available for 3-year observation 19 (60 per cent) were alive after 3 years, 6 had died of progression of the tumor and 7 had died of other causes. Prolonged imporvement was noted in 23 patients (72 per cent). The complication rate was moderate and only 2 patients required cystectomy for symptoms caused by radiation damage alone.


Failure of ascorbic acid to inhibit FANFT-induced bladder cancer. L-ascorbic acid has been shown to reduce the elevated level of urinary chemiluminescence found in patients with bladder cancer. Thus, it has been suggested that vitamin C might be efficacious in bladder tumor prophylaxis. However, there is no clinical evidence to support this thesis. We evaluated whether L-ascorbic acid given concomitantly with the urinary carcinogen FANFT was capable of reducing the incidence of subsequent bladder tumors. No inhibitory effect was observed. Unless evidence is obtained demonstrating bladder tumor prevention by L-ascorbic acid its routine administration to patients with bladder cancer is not indicated.


Lactic dehydrogenase isoenzymes in human bladder cancer. The lactic dehydrogenase isoenzymic patterns of normal, atypical and neoplastic urothelium were studied. In comparison to normal, the atypical urothelium had a significant increase in the LDH-V/I ratio. In neoplastic urothelium the LDH-I per cent was increased in low grade tumors, while the LDH-V per cent and LDH-V/I ratio was increased in high grade tumors. The findings in high grade tumors are thought to represent altered genetic expression with activation of the gene locus controlling M subunit synthesis.


The corpus cavernosum intercommunicating venous drainage system. A series of cavernosograms were used to study the corpus cavernosum superficial and deep dorsal venous system. Within this drainage system exists an intricate circumflex venous interconnective network of vessels. In addition, each corpus cavernosum intercommunicates with its opposite corpus cavernosum through median septal apertures. The cavernosum venous system, unlike the venous drainage from the glans penis, delays venous drainage and in doing so assists in maintaining erections.


Comparative responses of the isolated human testicular capsule to autonomic drugs. The testicular capsule of the human has been prepared for the first time as an isolated tissue suitable for pharmacological investigation. Cholinergic and adrenergic agents caused a contraction of the isolated testicular capsule. In addition, periodic spontaneous contractions of the isolated testicular capsule had been observed in the absence of any added pharmacological agents. The present experiments have demonstrated that the testicular capsule contains smooth muscle, thereby offering a reasonable anatomical explanation for spontaneous and drug-induced contractions of the testicular capsule. Therefore, it appears likely that the rhythmic contractions and relaxations of the testicular capsule provide a pumping action capable of explaining the transport of non-motile sperm out of the testes into the epididymis where they can attain their motility.


Infertility and semen non-liquefaction.

Infertility and semen non-liquefaction. Semen non-liquefaction is common and was present in 11.8 per cent of our patients. The diagnostic test is simple and treatment is not difficult. Thus, it appears that treatment of non-liquefaction of semen with alpha-amylase may be a useful aid in the treatment of infertility.


Prostatic fluid lactic dehydrogenase isoenzyme patterns of prostatic cancer and hyperplasia. LDH isoenzyme patterns were determined in prostatic fluid from 286 patients with a prostate gland judged to be normal, the site of benign hyperplasia on clinical evidence or the site of benign hyperplasia or carcinoma on the basis of histologic evidence. Fluid from 12 of 15 patients (80 per cent) with carcinoma representing all stages and grades of disease showed an LDH-V/I ratio of more than 3. This ratio was exceeded in only 6 of 57 (11.8 per cent) and 14 of 97 (14.4 per cent) patients in whom the diagnosis of benign prostatic hyperplasia without evidence of infection was established histologically or clinically, respectively. An LDH-V/I ratio exceeding 3 was seen commonly in patients with a diagnosis of benign prostatic hyperplasia with a recent history suggesting infection and more than 10 WBCs per high power field on microscopic examination of the prostatic fluid. These observations suggest that an LDH-V/I ratio exceeding 3 in the prostatic fluid in the absence of a history of infection and more than 10 WBCs per high power field on microscopic examination should be regarded as an indication of a high risk of the presence or development of a malignancy of the prostate. The results obtained also support the concept that, in the presence of malignancy, expressed prostatic fluid provides an adequate sample of cells with altered metabolism.


Urologic complications of ileal bypass operation for morbid obesity. Preoperative, operative and postoperative data from a sampling group of 435 ileal bypass patients have been tabulated and computer-analyzed. Genitourinary disorders other than stone disease have been insignificant. Patients with stones and those without stones have been compared and the significant data tabulated. The incidence of stone disease is 6 per cent. All but 1 stone consisted of calcium oxalate. Oxalate levels were normal preoperatively and elevated in 60 per cent postoperatively. The stone formers are among the heaviest members of the studied population, they have the greatest amount of ileum bypassed and the greatest amount of 1 year weight loss. Correlations between these observations and possible pathways of metabolic stone disease are made.


The usefulness of ultrasound in the evaluation of renal masses in adults. The efficacy of ultrasonography in the diagnosis of renal masses in our own series and in the recent literature has been reviewed. Ultrasonography in combination with cyst puncture approaches 100 per cent accuracy in the diagnosis of lesions more than 3 cm. in diameter that can be adequately delineated. Complications appear to be minimal.


The effect of hydron on latex urinary catheters. Hydron, a polymeric gel which permits the passage of small molecules through its interstices, was used to coat latex urethral catheters. These catheters, as well as other catheters of varied composition, were exposed to a liquid environment from which struvite crystals could be precipitated. The deposition of struvite on a hydron coated latex catheter was significantly less than upon the other catheters.


Pediatric nephrolithiasis.

Pediatric nephrolithiasis. The management of 78 children with upper urinary calculi is described. Boys outnumbered girls by a ratio of 2 to 1. Two-thirds of the patients had identifiable metabolic causes, while the remaining third had infected renal lithiasis. In this latter group, all patients had had multiple urologic procedures, urinary infection, and stasis with diversionary and indwelling drainage devices. Contrary to earlier views, idiopathic renal lithiasis with or without hypercalciuria was the most common metabolic form of nephrolithiasis in children. Sixty-seven patients (86 per cent) were followed for an average of 7 1/2 years. With appropriate therapy, stone disease became inactive in 70 per cent of the children. The remaining 30 per cent continued with active disease--5 died of renal failure and 1 has received a renal allograft. Stone formation may be regarded as a solitary complication or one of several manifestations of a large number of underlying disorders. Along with a thorough search for etiologic factors there must be an equally aggressive therapeutic effort. Because the disease is ofter sporadic, careful long-term followup of the patients with active as well as those with inactive stone disease is mandatory.


Hypertension in infancy: the case for aggressive management. We have reported on 10 infants less than 3 months old with hypertension. Renovascular hypertension was identified in 80 per cent of these patients. Spontaneous recovery with medical management occurred in 30 per cent of the patients and 57 per cent treated medically died. Of the 3 patients treated by nephrectomy normotensive survival resulted in 2.


Segmental renal hypoplasia and hypertension. The association of hypertension with congenital renal hypoplasia (Ask-Upmark kidney) has been well established. A case is presented that clearly demonstrates the distinctive clinical, roentgenographic and pathologic features. An abnormal production of renin by the affected kidney suggested that the renin-angiotensin-aldosterone axis was involved in the genesis of the hypertension. Hypertension was cured by unilateral nephrectomy.


Bilateral transitional cell carcinoma of the renal pelvis with unilateral non-functioning kidney. A case is presented of bilateral transitional cell carcinoma of the renal pelvis with extension of the tumor to involve the renal parenchyma bilaterally. Unilateral complete absence of function was demonstrated and pathological study correlated the absence of function with complete replacement and destruction of the renal parenchyma by transitional cell tumor. Segmental absence of function of the contralateral kidney is also correlated pathologically with complete replacement of the involved renal segment with tumor. Total replacement of renal parenchyma by transitional cell carcinoma of the renal pelvis should be considered in the evaluation of renal non-function.


Intrarenal distribution of blood flow and renin in chronic congestive heart failure. Intrarenal distribution of blood flow was measured by the 133xenon washout curve in 33 patients with heart disease. Plasma renin activity and sodium concentration were also measured on the day when the xenon study was performed. The patients were divided into three groups according to cardiac index: Group I whose cardiac index showed higher than 3.50 1/min/M2, BSA, group II whose index ranged from 2.50 to 3.50, and group III who had lower than 2.50. Total renal blood flow was significantly decreased in group II (p less than 0.001), as compared with normal controls. The percents of the total renal blood flow supplied to component I decreased significantly in group I, II (p less than 0.05) and group III (p less than 0.01). The flow rate in component I decreased significantly only in group II (p less than 0.05) and group III (p less than 0.01). There was a significant increase in the percent distribution of component II in group II (p less than 0.05) and in group III (p less than 0.01). The flow rate of component II showed a slight increase in group I and III. The study of autoradiographs done in dogs with heart failure demonstrated that component I corresponded to a cortical area having a relatively faster flow rate, whereas component II corresponded to the cortical area which was perfused more slowly. Accordingly, component III indicated outer medulla. There was no apparent relation between intrarenal distribution of blood flow and plasma renin activity although the latter tended to be elevated in patients treated with diuretics. In view of the data available it was concluded that outer cortical as well as outer medullary blood flow are decreased in chronic congestive heart failure and that there is no apparent correlation between outer cortical flow and plasma renin activity.


Left ventricular ejection time measured by finger-tip plethysmography in healthy young Japanese. Its correction for heart rate. Finger-tip plethysmograms were recorded photoelectrically on 200 young males and females each. The relation between the left ventricular ejection time (ET) and the preceding heart rate (HR) and a method for correcting ET for the heart rate were studied. The values calculated by the formula ET/S-S or ET/square root S-S varied with the HR, so these formulae cannot be used for correcting the ET for HR. Thus from the relationship between ET and HR, a formula for converting the measured ET to the ET at an HR OF 70, I.E. ETc, was deduced. ETc equals ET + HR - 70. This formula can be used for both sexes of Japanese juveniles and the values obtained by it can be directly compared, irrespective of the HR.


Blood flow of the superior and inferior venae cavae in cardiogenic shock: a study with an emphasis of the role of the stretch receptors in the low pressure system. Blood flow of the superior (SVC) and inferior venae cavae (IVC) was simultaneously and separately measured with two cannulating type electromagnetic blood flow probes inserted into the SVC and IVC of thirty two dogs during hypotensive and low cardiac output states in hemorrhagic shock and cardiogenic shock. Blood flow ratio of teh IVC to total venous return was expressed by IVCF/CO (per cent). It was 66.3 per cent in normal condition, but was decreased to 54.3 per cent in hemorrhagic shock. In four cardiogenic shock models, however, IVCF/CO changes little from the control to the initial phase of shock state. At least in part, the marked decrease of venous return from the IVC region in hemorrhagic shock was considered due to the increase of sympathetic nerve activity in that region mediated by baro-receptors in the high pressure system. The unchanged blood flow ratio of the SVC and IVC in cardiogenic shock was assumed that the high atrial or high ventricular endodiastolic pressure was an inhibitory factor of the sympathetic nerve activity by activating the stretch receptors existing the low pressure system including left ventricle. This hypothesis was proved by the experiments in which the renal vascular resistance was suppressed by stretch of the left atrium by either extraatrial mechanical traction or intraatrial balloon inflation in hemorrhagic shock or intracardiac decompression during cardiopulmonary by pass.


Epidemiological evaluation of funduscopic findings in cerebrovascular diseases. I. Fundoscopic findings as risk factors for cerebrovascular diseases. In order to epidemiologically clarify the relationships between the funduscopic findings and occurrence of cerebrovascular diseases, an analysis of 68 cerebral hemorrhage, 47 cerebral thrombosis and 230 controls in two rural Akabane and Asahi towns in Japan was accomplished and the results were as follows: 1. Among the fundamental funduscopic findings, irregular constriction, narrowing and retinal bleeding were high risk factors of cerebral hemorrhage in due order. Arteriolar reflex lateral displacement, irregular constriction, tapering, vertical displacement, white plaque and retinal bleeding were high risk factors of cerebral thrombosis in the order listed. Sheathing of arteriole was significantly related to the occurrence of cerebrovascular diseases. 2. Risk of cerebral hemorrhage was significant and highest in grade 3 of Scheie's hypertensive and Keith-Wagener's classifications. Grade 3 of Scheie's hypertensive and Keith-Wagener's classifications of cerebral thrombosis revealed the highest O/E ratio but was insignificant. 3. As is to be expected, the higher the grade of each funduscopic finding and the classifications of the retinal findings, the higher the risk of occurrence of cerebrovascular diseases. 4. Three or more, bright red color and large plaque shape of retinal bleeding in the upper and lower temporal areas were more indicative of future cerebrovascular diseases than in other area, and one or two, dark red color or smaller bleeding. 5. Arterial blood pressure was significantly related to the occurrence of cerebral hemorrhage and thrombosis. Albuminuria was also significantly related to the occurrence of cerebral hemorrhage, but glycosuria was not found to have an important relation to the occurrence of cerebral hemorrhage. The relationship between serum cholesterol level and cerebrovascular diseases was insignificant. 6. Systolic and diastolic blood pressure and albuminuria were more important than the funduscopic findings for prospecting the occurrence of cerebral hemorrhage, and on the contrary, the funduscopic findings were more important than systolic and diastolic blood pressure and other findings for prospecting the occurrence of cerebral thrombosis.


Epidemiological evaluation of funduscopic findings in cerebrovascular diseases. II. A multivariate analysis of funduscopic findings. The interrelationship of the funduscopic, physical and laboratory findings, the additional information of each funduscopic finding when physical and laboratory findings were considered simultaneously, and the relative importance of each retinal finding in the funduscopic pictures were investigated by a series of multivariate analysis for 68 cerebral hemorrhage, 47 cerebral thrombosis and 230 controls in two rural towns, Akabane and Asahi, in Japan and the results were as follows: 1. For the occurrence of cerebral hemorrhage, narrowing of arteriole and irregular constriction were especially important indicators, and retinal bleeding and lateral displacement were also valuable but less than narrowing and irregular constriction. On the other hand, for the occurrence of cerebral thrombosis, arteriolar reflex was considered as the most valuable indicator, and irregular constriction, lateral displacement and white plaque were also important but less than arteriolar reflex. 2. Narrowing of arteriole was most highly related with irregular constriction while the correlation between retinal bleeding and white plaque, and also the correlation between arteriolar reflex, vertical and lateral displacement and tapering were significant. 3. A significiant correlation among physical and laboratory findings was found only between systolic and diastolic blood pressure as far as analysed. Funduscopic findings by Scheie's hypertensive and Keith-Wagener's classifications were highly correlated with systolic and diastolic blood pressure. 4. Narrowing and irregular constriction were significantly correlated with systolic and diastolic blood pressure, and the relation between retinal bleeding and glycosuria was significant. 5. An analysis of the additional information of each funduscopic finding, when evaluated with the physical and laboratory findings simultaneously, revealed that irregular constriction, lateral displacement and narrowing gave prominent additional information for the occurrence of cerebral hemorrhage, while arteriolar reflex, lateral and vertical displacement and white plaque gave valuable information for the occurrence of cerebral thrombosis. 6. It is noteworthy from these multivariate analyses that narrowing and irregular constriction may arise from a similar pathophysiological mechanism which brings out vasoconstriction and the resultant organic changes due to hypertension. It is also noticed that arteriolar reflex and A/V crossing phenomenon may come from the different pathophysiological mechanism related to arteriosclerosis. It was stressed that detailed analyses of observer variability and evolution of funduscopic findings would be necessary.


The epidemiological study on the correlation between serum lipids and cerebro-cardiovascular disease. 1. There were significant correlation between hyperlipidemia and obesity, hypertension, abnormal ECG and abnormal eyeground. 2. The incidence of cerebral hemorrhage was closely associated with hypertension but not with hyperlipidemia. 3. It was proved that hypertension with both hyper-Ch and hyper-TG was highly related to the development of cerebral infarction. 4. It seemed that the incidence of myocardial infarction and angina pectoris was related to hypertension with hyper-Ch. 5. Therefore, the present study suggested that the control of hypercholesterolemia and hypertriglyceridemia was useful for the prevention of cerebro-cardiovascular disease.


Prevalence of plasma lipoprotein abnormalities in the farming village of Tanushimaru and the fishing village of Ushibuka. From the epidemiological aspects. A prospective survey was made on the population of two village in order to compare the frequency of plasma lipoprotein abnormalities in the two cohorts. The inhabitants of the farming village and those of the fishing village had different mode of life, especially eating habits, and different incidence rates of heart attack and brain stroke, but invariably had low serum cholesterol levels. The results of the study indicated that the nature and frequency of plasma lipoprotein abnormalities made vary with difference eating habits. However, the way in which this variance is related to the development into heart attack and brain stroke in the two populations remains to be settled by further follow-up study.


Genetic control of fatty acid metabolism, especially study of genetic control of cholesterol. The serum cholesterol of 1431 inhabitants over 10 years old in the general population was estimated by the method of Autoanalyzer. The correlation coefficients of the serum total cholesterol between parent and child and between siblings were obtained from other samples which completely excluded consanguinity. The genetic study of 41 pedigrees of familial hypercholesterolemia with xanthoma which described the cholesterol value of parent and child in Japan and other countries was done, and the following results were obtained. 1) Cholesterol is a quantitative character, therefore it will be controlled genetically by polygene. 2) It was presumed that the mode of inheritance of type II hypercholesterolemia (with or without xanthoma) was also controlled by polygene. 3) The correlation coefficients of cholesterol between parent and child and between siblings were found to be 0.26004, 0.27998, respectively. 4) The heritability of cholesterol was found to be 0.5995.


Studies on pathophysiological effects of postalimentary lipemia in patients with ischemic heart disease. The present studies were undertaken to elucidate the pathophysiological effects of postalimentary lipemia(PAL) induced by the intake of much animal fat in patients with ischemic heart disease(IHD) and the preventive measures against them. Results obtained were as follows: 1) Occurrence of augmentation of ischemic changes in ECG was demonstrated after fat intake. 2) After fat intake, lowering of arterial oxygen tension and heparin-induced increase in arterio-venous difference of oxygen tension in the forearm were observed. 3) PAL resulted in an acceleration of platelet adhesiveness as well as a shortening of plasms recalcification time and that of plasma prothrombin time. 4) It was revealed that red blood cells adsorbed fat on their membrane and then readily agglutinate together. 5) Removal of chylomicrons from the blood stream was accelerated by the intravenous injection of glucose. These results lead to the following conclusions: 1)PAL exerts a deleterious effect on the oxygen supply to the myocardium in patients with IHD and it is probably due to the disturbance of pulmonary function and that of oxygen diffusion and blood flow in the myocardium. 2) As one of preventive measures against the concurrent intake of carbohydrate in an appropriate quantity appears to be of use.


Dietary treatment of the cardiovascular patient with the hyperlipidemia and the long term dietary control of the hyperlipidemia. The prudent reducing diets relatively low in fat and rich in polyunsaturated fatty acids prepared with the intension of lowering lipid and applied to the cardiovascular patient with hyperlipemia and obesity. The diet is effective to the depress of serum lipid and the reducing body weight and I.R.I. in serum revert to normal levels and normal type.


Echocardiogram and phonocardiogram related to the movement of the pulmonary valve. Pulmonary valve movement and the related acoustic phenomena were investigated using high speed strip-chart echo- and phonocardiographic recording. The opening of the pulmonary valve had no definite relationship to the acoustic phenomena, whereas the pulmonary ejection sound was closely related in time to the early systolic maximal opening of the valve. The concomitant pulmonary ejection systolic murmur faded away by the time of the mid-systolic semi-closure of the valve, where the tiny extrasound occurred in a half of cases. The pulmonary component of the second heart sound occurred after the valve closure, and the time lag maximally reached up to 50 msec. Pulmonary hypertension tended to minimize this delay, giving the so-called single loud second heart sound. Graham Steell murmur started with the pulmonary component of the second heart sound and reached up to the isometric contaction phase beyond the first heart sound.


Comparison of a semi-automated sphygmomanometer with the clinical sphygmomanometer. A semi-automated sphygmomanometer Stanley B-200 has been compared with the clinical sphygmomanometer in 500 college boys by using a blind simultaneous method. Stanley B-200 has shown significantly higher systolic blood pressure (14.8 mmHg, P smaller than 0.05) and diastolic blood pressure (3.8 mmHg, P smaller than 0;05). This device also recorded 15 false positive systolic and 12 false negative diastolic results (P smaller than 0.05).


Hemodynamic and clinical significances of atrial fibrillation, pulmonary vascular resistance and left ventricular function in rheumatic mitral stenosis. Seventy-four patients with rheumatic mitral stenosis were catheterized and hemodynamic and clinical significances of atrial fibrillation, pulmonary  vascular resistance and left ventricular function were studied. These data were also compared to those in the 6 control cases. In addition to the correlation of mitral valve area to the functional classification of patients, significance of atrial fibrillation was also demonstrated. Patients with this arrhythmia had lower cardiac index than those with regular sinus rhythm by approximately 20%, throughout the range of mitral valve area observed. The lower average cardiac index was associated with a higher average left ventricular end-diastolic pressure in cases with atrial fibrillation than in cases without the arrhythmia, in the face of similar average heart rate and average mitral valve area; Average pulmonary vascular resistance correlated to the functional classification, but its systematic influence on the relation between mitral valve area and cardiac index was not observed. Abnormalities of left ventricular function were suggested frequently by various combinations of abnormal values in end-diastolic pressure, end-diastolic volume, ejection fraction, angiographically-measured circumferential fiber shortening velocity (Vcf), and pressure-derived maximal contractile element velocity (Vmax). Patients with enlarged left ventricle had significantly lower average cardiac index than those with normal ventricular size.


Effect of apomorphine on the canine SA node. A constant pressure perfusion of the sinus node artery was performed in 10 in situ and in 3 isolated SA node preparations. The selective administration of apomorphine caused a negative chronotropic effect which was not blocked by treatment with atropine. The sinus deceleration was usually produced by apomorphine, 10-300 mug, while sinus irregularity and finally atrioventricular nodal rhythm in the in situ preparation or sinus arrest in the isolated one resulted from doses above 1 mg. In the in situ preparation at a higher dose from 300 mug to 1 mg, a slight sinus acceleration was occasionally induced following sinus deceleration; In this time, a fall in blood pressure was usually observed; This acceleration response to apomorphine was inhibited by propranolol. From these results, it is concluded that apomorphine induces direct depressive action on the SA node and, in extremely high doses, a slight sinus acceleration may be induced by reflex mechanism.


Pseudo-Wolff-Parkinson-White syndrome observed in a patient with Lutembacher's syndrome. Pre- and post-operative vectorcardiograms (Frank system) and angiocardiograms in a patient with Lutembacher's syndrome, were correlated. Preoperative vectorcariogram showed the initial conduction delay, complete RBBB, increased QRS voltage, and open QRS loop, while left ventriculography and left atriography demonstrated the markedly posteriorly dislocated left ventricular major axis surrounded by the huge right ventricle and right atrium. Two months after operation, when the left ventricular major axis shifted from abnormally posteriorly directed to left and inferiorly, with the decreased right-sided heart chambers, the initial conduction delay disappeared with decreased QRS voltage. As these vectorcardiographic and angiocardiographic changes at the postoperative stage were parallel, we concluded that the initial conduction delay was a representation of "the pseudo-W-P-W syndrome" and due to the abnormally posteriorly dislocated left ventricular apex and the delayed excitation of the right ventricular free wall caused by the huge dilatation.


A case of the omphalocele. The discussion about the frequent combination of the cardiac malformation, and the observation at the early non-cyanotic period of Fallot's tetralogy. Even in the severe tetralogy of Fallot the performance of right ventricle is maintained normally without loaded pattern in ECG compensated by the blood flow derived through the ductus arteriosus at early neonatal period. Thereafter, stenotic murmur and reversed shunt appear, because the degree of right ventricular stenosis presumably increases gradually and right ventricular resistance11) become higher than systemic one.


Peutz-Jeghers syndrome: its natural course and management. Two hundred and twenty-two patients with Peutz-Jeghers syndrome were ascertained in Japan between 1961 and 1974 through two nationwide surveys, medical literature, and personal examinations. Genetic analysis was made of this group as well as 102 follow-up cases. The average age at diagnosis was 23 in males and 26 in females, with male to female ratio of 1:1.13. Presenting complaints of 170 patients included obstruction (42.8 per cent of patients), abdominal pain (23.4 per cent), rectal bleeding (13.5 per cent), extrusion of polyp (7.2 percent). Diagnosis of 52 patients was based on melanin pigmentation. Intussusception occurred in 46.9 per cent of the patients, most often in the small intestine. Polyps occurred in the stomach in 108 patients (48.6 per cent), small intestine, 142 patients (64 per cent), colon, 118 patients (53.2 per cent) and rectum, 71 patients (32 per cent). Among the 222 patients, cancer was histologically verified in 28. Fifteen early cancers occurred (3 gastric, 8 small intestine, 4 colon), and 11 advanced cancers (3 gastric, 1 small intestine, 6 colon, and 1 both colon and small intestine). Mortality was lower than in patients with familial polyposis coli but higher than in the general population. Conservative surgical management, planned medical follow-up, and the need for a national registration system are stressed.


Carcinoma in the Gardner syndrome: a case report. Carcinoma of the colon is commonly seen in the Gardner syndrome and familial polyposis of the colon. Therefore early detection of these symdromes in families and careful follow-up are important. During a study of families at high risk of developing colorectal cancer, an asymptomatic 19-year-old female was found to have the Gardner syndrome. Although barium enema examination was negative, colonoscopy revealed the presence of polyps; biopsy of one polyp revealed carcinoma-in-situ.


Polycythemia produced by hemoglobin Osler (beta-145 (HC2) Tyr yields Asp). Polycythemia in a black woman was associated with hemoglobin Osler. In this hemoglobin the tyrosine at the penultimate position of the beta chain is replaced by aspartic acid. As a result oxygen affinity of the hemoglobin is very high, heme-heme interaction is absent, and the influence of hydrogen ion and 2,3 diphosphoglycerate on oxygen affinity is attenuated.


Clinical and pathological studies in a growth hormone-deficient dwarf. Postmortem studies were performed in one of three closely related dwarfs. Repeated arginine infusions and insulin tolerance tests never resulted in plasma levels of human growth hormone (HGH) greater than 2.0 ng/ml in any of these three dwarfs. However, pituitary somatotropes in the autopsied subject were well granulated and were reduced in number to 20% of normal. In the absence of a second defect, there should have been substantially higher HGH levels in plasma after provocative stimulation. The clinical and pathological data appear most compatible with (a) deficiency of growth hormone releasing factor, or (b) insensitivity of somatotropes to this material. It seems reasonable to postulate that a major group of dwarfs clinically simulating HGH deficiency can be explained by one of these mechanisms rather than by an absolute deficiency of HGH.


[Changes in the biosynthesis of corticosteroids from progesterone-C14 under the effect of prostaglandin E2 in rabbits with vasorenal hypertension]. The effect of prostaglandin E2 on the biosynthesis of corticosteroids was studied in intact rabbits and in the ones with vasorenal hypertension in different periods of its development (1st group) and in the animals subjected to a spurious operation (2nd group). Prostaglandin added to an incubation medium was found to produce in intact rabbits a significant depression of the 11-dehydrocorticosterone and cortisone biosynthesis from progesterone-C14. In rabbits operated upon (1st and 2nd groups) prostaglandin E2 brought changes in the production of corticosteroids no sooner than in 1 month after surgery. In rabbits with vasorenal hypertension brought about through unilateral constriction of the renal artery with an intact second kidney the content of the labeled 11-desoxycorticosterone and 11-desoxycorticosol materially decreased under the effect of prostaglandin E2, while the biosynthesis of the end fractions--11-desoxycorticosterone, aldosterone and cortisone, would gain in intensity. These changes preceded somewhat the most significant rise of the arterial pressure. In the rabbits spuriously operated upon prostaglandin E2 increased the production of corticosteroids and 11-dehydrocorticosterone, low at that time. It is presumed that prostaglandin E2 produces a regulating influence on the processes of the corticosteroids biosynthesis both in normalcy and in vasorenal hypertension.


[Electrophysiological classification of myocardial infarct]. The paper treats some questions concerning the electrophysiological diagnosis of myocardial infarction. An attempt has been made to work out an electrophysiological classification of myocardial infarction basing on 4 categories: localization, stage, volume, electrical instability. In new concept reversibility of changes at the very early stage of the disease has been developed. Great importance was given to the volume of the lesion, and to electrical instability. Three types of electrical instability were differentiated (the myocardium, automatic centers, atrioventricular system) and the "staircase phenomenon" has been described. All the categories were classified and coded and as a result a formula was proposed to express and asses in terms of codes and mathematical figures all the features of the process. The importance of this formula for the application of computers in electrocardiology was stressed.


[Physical exertion tests in patients with acute myocardial infarct at the hospital stage of rehabilitation]. The aim of the work is to clarify the part of physical exertion tests applied to patients early after myocardial infarction, i.e. on the 30--35th day of the affection and also to appraise the reserves of the coronary circulation with a definite threshold tolerance to physical efforts. Tests with a graded physical loading were set up in 50 patients with acute macrofocal (including 34 transmural) myocardial infarction at the time of completion of the intrahospital rehabilitation program that included the regimen of an early activation. A continually-rising type of loading with an initial rating of 150 kgm/min was used. At the instant of effort the ECG was being registered in 4 chest leads. The threshold load-rating was found to average 315 kgm/min and the sum-total of the work performed equaled 2190 kgm. Tests with graded physical loading are of great importance for elaboration of concrete recommendations for rehabilitation and prophylactic measures in patients with acute myocardial infarction.


[Determination of pressure in the pulmonary artery by indirect method in pregnant women with heart defects]. The purpose of the work was to ascertain the degree of reliability achievable by an indirect measurement of pressure in the pulmonary artery in pregnant women with congenital and acquired heart diseases. To determine the pressure in the pulmonary artery by the indirect method electro-phonocardiograms and a phlebogram from the jugular vein were recorded simultaneously. The pressure in the pulmonary artery was measured with reference to the duration of the isometric relaxation period of the right ventricle, estimated from the distance between the pulmonary component of the II sound and the beginning of the diastolic fall on the phlebogram. By registering the duration  of this period and the heart rate the systolic pressure in the pulmonary artery was found from the nomogram. A total of 55 patients, including 19 pregnant women, were examined. The pressure levels calculated by the indirect method were contrasted against the results obtained through catheterization of the cardiac cavities,  or during surgery--by direct puncturing. Investigations have shown a high degree of reliability of the estimated pressure levels in the pulmonary artery of patients with congenital and acquired cardiac defects. The indirect method of measuring the pulmonary artery pressure is simple, quite safe and accurate. It allows one to ascertain the extent of pulmonary hypertension in pregnant women irrespective of the type of the defect, the age and the intensity of the pulmonary hypertension.


[Certain problems of study of cardiohemodynamics by the method of ultrasonic Doppler-echolocation]. Results obtained in experiments on 10 adult mongrel dogs are offered. A synchronous registration of ultrasonic doppler-cardiograms (USDC) and of the intraventricular pressure continued throughout the experiment helped establish the relation between the pressure range in the left ventricle and the acceleration on the USDC curve. On the ground of the dependence thus obtained 2 indexes are proposed, viz. for an indirect evaluation of the intraventricular pressure (the index of "rated acceleration") and for appraising the contractability or the muyo cardium (the index of "relaxation from acceleration"). The available data might in the future provide for the possibility of devising appliances supplementing and replacing the catheterization.


[10-year experience with heart stimulation in atrioventricular heart block]. Data covering 177 cases of the atrioventricular block where cardiostimulation was effected by using Soviet-made batch-produced electrocardiostimulators are analyzed. The largest group included patients 50 to 70 years old (71 per cent). In 47 per cent of the cases the atrioventricular block stemmed from ischemic heart disease. As indications for cardiostimulation served the Morgagni-Adams-Stocks syndrome and a well-marked circulatory insufficiency. The hospital lethality comprised 15.8 per cent. The death was caused by acute cardio-pulmonary incompetence, thromboembolism of the pulmonary artery and myocardial infarction. Among complications secondary to cardiostimulation figure suppuration of the operating wound, disturbed integrity of the myocardial electrodes and a premature exhaustion of the cardiostimulators reserves. From among 130 patients kept under observation the duration of cardiostimulation comprised: up to 1-year--in 20.7, from 1 to 3 years--in 26.1, from 3 to 5 years--in 20.7, from 5 to 10 years--in 1m.7 and over 10 years--in 14.8 per cent.


[Constant endocardiac stimulation of the heart ventricles controlled by atrial biopotential]. The technique procedures and the first clinical experience of the atrial biopotential controlled endocardiac electric stimulation of the ventricles applied to 14 patients 17 to 72 years old with complete or intermittent atrio-ventricular block and attacks of Morgagni-Adams-Stocks disease are described. An endocardial detector electrode designed by German scientists was used to take biopotentials of the atrium. The stimulation proved successful in all the patients who were kept under observations for a period from 1 to 30 months. Advantages of the method under review are set forth.


[Role of the vagus nerve in the origination and cessation of atrial tachyarrhythmias]. At the root of the mechanism of supraventricular tachyarrhythmias observed in an isolated atrium following electric stimulation of the vagus nerve lies circulation of the excitation wave or waves. The origination of this circulation is due to a normalized conduction in the regions inhibited by the vagus nerve, the existence of such regions having been shown in experiments. The trajectory of the circulating excitation wave was reproduced with the help of a mathematical model the properties of whose elements had been pre-set axiomatically. The forecasts and effects of the model were verified in tests involving the use of the microelectrode technique. The question as to the applicability of the proposed model for explaining the mechanism causing the development of disorders in the cardiac rhythm at the time of myocardial infarction is discussed. The inhibited regions develop not only on stimulation of the extracardiac vagus, but also after direct stimulation of the myocardium. Direct tests demonstrated that the activation of the intramural nerves is apt to suppress disturbances of the rhythm, occasioned by the circulating excitation and ectopic activity. It is suggested that the excitation of the intracardiac nerves during electric defibrillation may appear as an additional factor causing a positive antiarrhythmic effect of the condensator discharge.


[Distribution of the density of defibrillating current in the chest and underneath the defibrillator's electrodes]. Results of experiments carried out in animals and of measurements made on electrophysical and analogue models are presented. It has been found that with routinely employed manipulations in the electric impulse therapy of arrhythmias the denstiy of the current in the chest and directly underneath the defibrillator's electrodes is distributed in a non-uniform fashion. This results in high defibrillation thresholds, possible damages of the heart and body teguments. The causes responsible for this non-uniformity are analyzed, the non-uniformity itself is assessed and ways of its elimination are indicated.


[Classification and clinical-electrocardiographic evaluation of his bundle-branch block]. Investigation covered 114 patients with ischemic heart disease exhibiting electrocardiographic signs of deranged intraventricular conduction. Major ECG changes with blocked left anterior and left posterior brances of the bundle of His and also in combined blocks of two and three branches are described. A quantitative spatial analysis of the ECG in corrected orthogonal leads after McFee with determination of the initial, terminal and median orientation of the QRS vector in the frontal plane, as well as of the azimuth and elevation was made. A classification of the His bundle-branch block is proposed. It includes single-, double- and triple-bundle branch blocks. Clinical and electrocardiographic comparisons showed that disrupted conduction in the ramification system of the bundle of His occurs with marked diffuse or focal alterations in the myocardium of the left ventricle observed in patients afflicted with different forms of ischemic heart disease.