Acetohydroxamic acid. Potential use in urinary infection caused by urea-splitting bacteria. Several lines of evidence suggest that bacterial urease is the primary cause of infection-induced urinary stones. The hydroxamate group of compounds are specific urease inhibitors. Of the cogeners studied, to dat, AHA (acetohydroxamic acid) appears to have the most pharmacologic potential. AHA is rapidly and completely absorbed from the gastrointestinal tract and is concentrated and excreted in the urine. In animals it appears to be relatively nontoxic. Although its toxicity in human beings has not been studied, its similarity to hydroxyurea suggests that reversible toxicity involving the gastrointestinal tract and the hematopoietic systems may result when high doses are administered. The only known metabolite of AHA is acetamide which is nontoxic and rapidly excreted in the urine. Pharmacologic use of AHA is expected to be practical and relatively safe. Use of AHA in patients with urinary infections caused by urea-splitting bacteria may reduce pathogenicity of the infecting organism and may lead to prevention and/or dissolution of stones commonly associated with such infections.


Urologic complications of renal papillary necrosis. Fifty-six patients demonstrating roentgenographic evidence of renal papillary necrosis were reviewed. Seven patients had an acute fulminating form of the disease. Urologic complication incident to sloughed renal papillae required urgent surgical intervention. Management ranging from ureteral catheterization to nephrectomy in 3 of 7 patients is discussed, and associated disease states are scrutinized.


Sympathetic activity of internal urethral spincter. In empty and partially filled bladder. The sympathetic activity was investigated by recording the fall of internal sphincter pressure produced by a dose of phentolamine (Regitine) which completely abolished all alpha adrenergic sympathetic activity. It was found that when the bladder was empty, the mean fall of internal sphincter pressure was 7.1 cm, water; but when the bladder was partially filled, the mean fall was 17.6 cm. water. After use of reserpine, which creates a "pharmacologic sympathectomy," no sympathetic activity was demonstrated.


Spontaneous expulsion of intravesical bullet. The first reported case of spontaneous expulsion per urethra of an intravesical bullet which initially entered through the left flank is presented. Recognition of the truc location of the millile might have been facilitated had lateral and/or oblique films have been obtained under emergency conditions as advocated by the authors.


[Work capacity of patients with dumping syndrome after stomach surgery]. Of 528 patients subjected to radical operations on the stomach for cancer, polyposis and ulcerous disease the dumping-syndrome was revealed in 74 patients. Following resection of the distal gastric portion the latter was observed in 49 cases, after resection of the cardia--in 18, and after gastrectomy--in 7. In most patients with the dumping-syndrome an impairment of basic hepatic functions and motor-evacuative function of the gastric stump was observed. The study of the work capacity in patients with the dumping-syndrome has deomonstrated its reduction in most patients (in 74% of cases). 55 of 74 investigated patients proved to be invalids of the second and third group. The capacity for work was mostly impaired in patients showing the dumping-syndrome of average and severe gravity.


[Disorders of the pancreas, liver and bile ducts in patients with ulcer disease]. Data on the state of the pancreato-biliary system in 563 patients with ulcerous disease are analysed. The incidence of clinically pronounced lesions of the pancreatobiliary system in ulcerous disease was 26.7%. Some years following the Billroth-II gastrectomy diseases of the pancreato-biliary system were diagnosed in 35% of patients under investigation.


[In defense of cholecystostomy].

[In defense of cholecystostomy]. In the paper, a question concerning indications to fistulization of the gallbladder for acute cholecystitis is discussed. A total of 165 cholecystostomies have been performed. In 121 patients (77.4%) late results were followed up from 2 to 15 years. Good and satisfactory results were noted in 83.4% of patients. The postoperative mortality after cholecystostomy was 6.2%.


[Diagnostic importance of surgical diskography]. The author's experience with roentgenocontrast studies of intervertebral discs in 15 patients with osteochondrosis during an operative procedure is reported. The technic of operative discography and some possible complications are described. An importance of intraoperative discography, that is indicated in emotionally labile patients and in cases of failure of preoperative contrasting of discs, is discussed. A contrast roentgenological investigation allowed not only to reveal structural changes in a disc, but also to determine an extent and character of operative interventions.


[Treatment of pseudarthrosis of the tibia by the method of traction]. The report is based on the experience with treatment, using the method of dosaged distraction of 39 pseudarthroses and unhealing fractures of the tibia in 38 patients. Twenty three patients showed osteomyelitis, 32-shortening of crural bones and 27-their deformation. With the aim of distraction the G. A. Ilizarov apparatus was employed. Up to data, the treatment is termined in all 38 patients. Healing was gained after 36 operations in 35 patients. No union was obtained after 3 operations of distraction the osteosynthesis in avascular forms of pseudarthrosis. Some regularities in formation of the regenerate and its reoconstruction during the process of lasting fixation were studied in 25 patients.


[Simultaneous surgical correction of deformities caused by tuberculous coxitis]. A one-moment correction of associated defects of the lower extremities was performed in 45 patients. An analysis of treatment of such patients enabled us to elaborate indications to operative interventions concerned and surgical technic. The treatment was terminated in 38 patients. In 33 of them weight-bearing of the extremity was restored by means of ankylosis of the coxa with simultaneous lengthening of the extremity and correction of concomitant deformities. In 3 patients no ankylosis in the joint developed, in two-pseudarthrosis at the site of osteotomized femoral bone was formed.


[Surgical treatment of post-thrombophlebitic disease]. A compression-functional test is recommended to determine indications to the Ascar-Zelenin operation and in selecting the optimum compression of crural muscles. The suggested complex of operative procedures involves: radical operation in the oval fossa region, partial of total removal of the great saphenous vein trunk, and, if indicated, also small saphenous vein, the Kocher and Crokett operation, duplication of the crural aponeurosis in the authors' modification with production of an additional dosaged pressure in the crural aponeurotic sheath. Late results followed up to 2 years were good and satisfactory in 94.4%, and poor--in 5.6% of the operated objects.


[Preoperative sanation of the bronchi].

[Preoperative sanation of the bronchi]. Among 255 patients with suppurative pulmonary diseases, aerosol therapy was performed preoperatively in 80 patients, complex sanation of bronchi--in 140, including 30--in association with visual sounding of segmental bronchi and intrapulmonary suppurative foci. As a result of complex sanation of bronchi, as compared with patients in whom no sanation was performed, or it was limited only by aerosol therapy, there was noted a reliable decrease in the number of postoperative pleural empyemas and bronchial fistulas, as well as an increase in the number of patients discharged with a recovery from 74.3% and 78.7% to 90%.


[Results of treatment of postoperative bronchopleural complications in lung cancer]. An analysis of the results of treatment in 138 patients with bronchopleural complications after 1400 operations on the lung for cancer is given. Conservative methods of therapy (punctures and drainage of the pleural cavity, instillation and of the fisula with 30% silver nitrite and intratracheal injections of antibiotics) were utilized in 105 patients with bronchial fistulas and pleural empyemas. Thirty there patients were treated surgically (tamponade, thoracoplasty, rethoracotomy with suturing of the bronchial fistula, transsternal suturing of the bronchial fistulas). The rate of mortality from bronchopleural complications was 4.8%, i.e. one third of all causes of death. However, recently it reduced more than twice in comparison with the initial period. The direct causes of lethal issues are complications on the part of other organs: pneumonia of the remained lung (24), septicopyemia (12), hemorrhage (10), and others (19).


[Present-time problems of the treatment of burns]. The author's experience with a large number of burnt patients enabled them to conclude that treatment of extensive deep burns is of most extreme difficulty. Many specialists should participate in treatment and rehabilitation of burnt patients. It is necessary to organize special centers of rehabilitation and dispensary control over such patients, and a further program in this respect is greatly warranted.


[Closed intramedullar osteosynthesis of diaphyseal fractures of the crural bones]. An experience with 137 operations of closed intramedullary osteosynthesis of tibial bones with Kuncher pins is analysed. Indications to surgery, technic of osteosynthesis and complications are described. Average terms of patients' incapacity were 130.7 plus or minus 14.4 days. Late results were studied in 118 patients. Good and satisfactory issues were gained in 117 patients, poor--in 1. It is the authors' opinion that closed osteosynthesis of crural diaphyseal fractures with Kuncher pins would provide solid fixation permitting to carry out functional therapy during the period of fracture consolidation.


[Experimental study of coronary-splenic arterial anastomosis with the aim of myocardial revascularization]. In search of new sources for cardiac revascularization of the myocardium in ischemic heart disease the authors elaborated experimentally on dogs an operation of construction of retrograde arterial splenocoronary anastomosis. The results of the operation were estimated by means of EEG findings, vital and postmortem coronarography and histological studies of the myocardium and zone of the anastomosis. An analysis of the experimental data obtained has revealed a patency of the vascular anastomosis in most animals; electrocardiographic signs of acute myocardial infarction, developed in high ligation of the anterior intraventricular branch of the left coronary artery, would undergo a prompt reverse dynamics after constructing a splenocoronary anastomosis. Further studies of the mentioned method of revascularization of the myocardium seems to be rather perspective.


An assessment of a method of manual pregnancy diagnosis in the ewe. The recto-abdominal palpation method of ovine pregnancy diagnosis described by Hulet (1972) was carried out on 167 ewes in three flocks. The results showed a virtual 100 per cent accuracy of diagnosis between pregnancy and non-pregnancy and approximately 70 per cent overall accuracy in differentiating single from multiple pregnancies. At least 34 ewes aborted and five died. It was concluded that the method as carried out was neither safe nor accurate enough to justify any savings consequent upon more efficient food usage.


Naturally-occurring Tyzzer's disease (Bacillus piliformis infection) in horse foals. Spontaneous Tyzzer's disease is described in quarter horse foals which died suddenly with no clinical history of apparent illness. Significant gross findings included icterus, focal paletan areas in the liver and catarrhal entercolitis. Focal dark red lesions were present in the small intestine of one foal, and the mesenteric lymph nodes of another were enlarged and hyperemic. Histopathologically, the liver showed multiple discrete and confluent foci of necrosis, fatty change, sinusoid congestion and haemorrhage. Bundles of intracytoplasmic bacilli were demonstrated in hepatocytes at the margin of liver lesions using special stains. Infiltration of the portal triads with inflammatory cells and biliary duct hyperplasia and degeneration were also observed. Lesions in the intestine were characterised by mucosal necrosis with inflammatory cell infiltration, increased mucus production, submucosal lymphoid hyperplasia and, in one foal, submucosal haemorrhage. Necrosis of lymph follicles, congestion and haemorrhage were also present in the spleen and mesenteric lymph nodes.


Prenatal diagnosis of sex in cattle by amniocentesis. A method for the aspiration of amniotic fluid from pregnant cows at 70 to 1000 day gestation and the subsequent cultivation of amniotic cells in vitro is described. The unit for aspirating amniotic fluid includes a sterile Plexitron tubing fitted with a 60 ml syringe on one end and a 12 in needle ("18 gauge) partially encased in a 6 inch AI pipette on the other. Aspiration of fluid is accomplished through the vaginal route by piercing the dorsal fornix and chromosome analysis is performed on amniotic cells after cultivation in vitro for four to seven days. This method, which is simple and accurate, provides a safe diagnostic procedure for the prenatal detection of sex and cytogenetic defects in cattle.


Vaccination against Vibrio (Campylobacter) fetus infection in sheep in late pregnancy. A single injection of vaccine containing disrupted formol-killed Vibrio (campylobacter) fetus var intestinalis serotype V was shown to give good protection against abortion from an oral challenge of the same serotype administered simultaneously. Protection was also afforded by vaccination at the time of the first abortion in sheep infected orally one month previously. These results suggest that vaccination subsequent to an abortion might be of value in preventing a proportion of further abortions.


Pectineus muscle resection as a treatment for hip dysplasia in dogs. Pectineus muscle resection was performed on 100 dogs with hip dysplasia. The degree of dysplasia was estimated by radiography and by joint manipulation. The effects of the procedure on 81 dogs were determined by personal reinspection (34), or by means of owner-reports (47). Improvement was noted in 80 per cent but only 35 per cent reached a high level of recovery. The operation has a role in the treatment of hip dysplasia but it does not cure the condition and it will be several years before the long-term results are known.


An outbreak of arsenic and toxaphene poisoning in Kenyan cattle. In a case of poisoning involving 70 cattle analysis of specimens obtained during post mortem examination showed that the toxic substances were arsenic and toxaphene. This was consistent with both the clinical and post mortem findings. Arsenic was detected in water from an abandoned cattle dip in the farm. Soil samples collected in the vicinity of the dip contained both arsenic and toxaphene.


A case of polytetrafluoroethylene poisoning in cockatiels accompanied by polymer fume fever in the owner. Five cocatiels (Nymphicus hollandicus) died within 30 minutes following exposure to fumes from a frying pan coated with the "non-stick" plastic polytetrafluoroethylene (PTFE) that had accidentally overheated. Within an hour the owner developed symptoms of "polymer fume fever" but recovered in the next 24 hours. Clinical signs and post mortem lesions of the cockatiels are described and reference is made to the unusual susceptibility of parakeets to the pyrolysis products of frying pans coated with PTFE.


A modified refractometer method as a practical aid to the epidemiological investigation of disease in the neonatal ruminant. A refractometer method for use on the farm, by the practising veterinary surgeon, to allow estimation of immunoglobulin levels of neonatal calf and lamb plasma is described. The results show that a good correlation exists between values obtained by this method and those obtained by the standard zinc sulphate turbidity method.


[Use of x-ray spectral microanalysis for studying mineralized tissues]. In microanalysis of mineralized tissues an x-ray spectral method possessed an absolute limit of sensitivity about 5-10 minus 15 g. A relative limit of the method sensitivity constituted hundredth parts of a per cent and locality of the analysis--several cubic microns. The x-ray spectral microanalysis permitted to carry out qualitative and quantitative estimations of content of elements in different structures of biological tissues. The data were obtained on content of calcium and phosphorus in compact part of human tubular bone.


[Lactate dehydrogenase and malate dehydrogenase isoenzymes in the myocardium and liver of rabbits with thyrotoxicosis]. Isoenzyme spectra of lactate and malate dehydrogenases were studied by means of polyacrylamide gel disc electrophoresis in heart muscle and liver tissue of rabbits with thyreoidin toxicosis. Under conditions of thyreotoxicosis in liver tissue content of isoenzymes LDH4 and LDH5, which slowly moved to anode, was decreased; in heart muscle content of LDH2-LDH5 was also decreased. In liver tissue the relative predominance of LDH1-LDH2 was observed, in heart muscle of LDH1. Activity and isoenzyme pattern of MDH were shown to be unaltered in homogenates of the tissues in thyreotoxicosis. An aerobisation of the LDH isoenzyme spectrum together with normal content of MDH suggested that intensive aerobic oxidation of substrates of glycolytic pathway occurred in heart muscle and liver tissue of rabbits with thyreoidin toxicosis.


[Purification and some properties of the thymidine kinase from the rat thymus]. Preparation of thymidine kinase, purified 500-fold, was isolated from rat thymus by means of fractionation with ammonium sulphate, gel filtration on Sephadex G-200, treatment with calcium phosphate gel and chromatography on DEAE-cellulose. The enzyme was shown to be stabilized by 0.12 mM of thymidine, activated by Mg2 (optimum concentration 12 mM) and inhibited by Mn2+ATP served as donor of phosphate groups in reactions, catalyzed by thymidine kinase. In respect to the phosphate acceptor the enzyme showed sharp specificity: it used as a substrate only thymidine, deoxyuridine and its derivatives, substituted at the 5-th position by haloid group. In study of affinity of the enzyme for the substrate Km equals 2.5-10 minus 5 M (Vmax equals 0.09) was determined.


[Oxidation of succinic acid in the liver mitochondria in chronic enterocolitis and after resection of the small intestine]. In liver tissue of dogs with experimental chronic enterocolitis rate of phosphorylation and P/O coefficient were decreased, when succinic acid was used as a substrate of oxidation. Within 10-40 days after resection of 1/2 part of small intestine in rats oxidation of succinate was increased with simultaneous decrease in P/O coefficient in liver tissue. In mitochondria of liver tissue on 20th and 30th day after the operation the succinate dehydrogenase activity was increased. In remote period after resection of small intestine (90 days) rates of succinate oxidation and P/3 coefficient approached the normal values, found in liver tissue.


[Citrate content in the myocardium and liver of rabbits in starvation and thyrotoxicosis]. Under starvation in rabbit blood plasma an increase in content of free fatty acids was accompanied by accumulation of citrate in myocardium and by maintenance of glycogen content in the organ. Contents of glycogen and citrate were decreased in liver tissue. In blood plasma under thyreotoxicosis an increase in concentration of free fatty acids was followed by decrease in contents of glycogen and citrate both in myocardium and in liver tissue. Under thyreotoxicosis the absence of the glycogenolysis block was associated with non-accumulation of citrate in myocardium. Difference in metabolic patterns of fatty acids in heart and liver tissues under starvation and thyreotoxycosis are discussed.


[Formation of a secondary adrenaline-heparin-fibrinogen complex and its properties]. An effect of increase in fibrinolytic activity of adrenaline-heparin (ADH) complex was studied under its incubation in a mixture with pure fibrinogen on unstablized plates of fibrin in presence of xi-aminocapronic acid, By means of spectrophotometry in UV-light an increase in lytic activity of the incubated mixture of adrenaline-heparin complex with fibrinogen was shown to be due to formation of a secondary complex, which included adrenaline, heparin and fibrinogen. After intravenous administration of a mixture of ADH complex with fibrinogen, containing products of interaction of adrenaline, heparin and fibrinogen, not only an increase in non-enzymic fibrinolytic activity of plasma occurred, but also an increase in duration of an effect of adrenaline--heparin--fibrinogen complex was observed in vivo as compared with the equivalent dose of the ADH complex


[Synthesis and study of the properties of water-insoluble products of the interaction of urease and cellulose derivatives]. As a result of reaction of urease with graft copolymer of cellulose and polyglycidyle methacrylate or with carboxymethyl cellulose, products were synthesized, containing about 2% of chemically bound urease. Binding with the cellulose derivatives was accompanied by about two-fold decrease in urease activity. Carboxymethyl cellulose-urease and polyglycidile methacrylate-cellulose-urease might be repeatedly (for 30 cycles) used for hydrolysis of urea; the enzymatic activity of the first compound did not change, but of the second one--was decreased by 30%. Activity of the compounds was not changed after storage within 2 months in 0.1 M phosphate buffer, pH 7.0 at 4 degrees C.


[Insulin activity of the blood, the action on it of various loads and the effect of blood serum on the effect of insulin relative to fatty tissue in chronic pancreatitis]. In patients with chronic pancreatitis a decrease in insulin activity of blood was observed. The activity was tested using preparations of diaphragm and epididymal fat of rats. Reaction of the insulin activity of blood, after loading with glucose, secretine and pancreosimine, was also decreased. The phenomenon was probably important for development of decreased tolerance to carbohydrates, which was observed in patients with chronic pancreatitis. In blood serum of the patients no effect of inhibition of the insulin activity could be observed by means of influence of insulin on lipolysis in epididymal rat adipose tissue. The data obtained suggest that in chronic pancreatitis the leading role in development of carbohydrate metabolism impairements belonged to the quantitative insufficiency of insulin, but not to the qualitative alterations in blood serum, where the ability to inhibite the insulin activity appeared.


[Activity of the kallikrein-kinin system in experimental myocardial infarct in dogs and the effect of catecholamines]. In experimental myocardial infarction in dogs even within first minutes after occlusion of coronary artery content of bradikinine was distinctly decreassed in blood plasma, content of kallikrein was increased and the activity of kininase was decreased in blood. These phenomena reflected the activation of kallikrein-kinin system. An increase in content of glutamate-oxaloacetate transaminase was observed only within 6 hrs after ligation of the coronary artery. Content of adrenaline and noradrenaline was increased in the zone of myocardial infarction within 2 days after the onset of the disease; content of the catecholamines was significantly increased (3-17-fold) in adrenal glands. In acute period of myocardial infarction intravenous administration of adrenaline into animals caused a promt, distinct kininogenolytic effect and increased the content of kallikrein in blood. These findings demonstrate a significant effect of adrenaline on kallikrein-kinin system.


[Effect of sodium ribonucleate on amino acid acceptance by transport RNA in the rabbit liver and muscles]. Both single or repeated (during 14 days) administration of sodium ribonucleate (10 mg/kg) into rabbits, caused an increased formation of lysine-RNA, leucine-t-RNA and alanine-t-RNA; At the same time, the acceptive capacity of t-RNA and aminoacylating activity of amino acyl-t-RNA-synthetases were increased. In sceletal muscles these processes were unaltered after single administration of sodium ribonucleate, but were stimulated after the repeated injections.


[ Change in the protein spectrum of the erythrocytic membranes in certain anemias]. Proteins of human erythrocyte membranes were studied in normal state and in different anaemias. After solubilization of cell "shadows" in phenol-urea-acetic acid-water system in membranes there were found, by means of polyacrylamide gel disc electrophoresis, 20 protein fractions with molecular weight from 48000 to 225000; seven of them glycoproteins. In 9 cases out of 36 a complete or partial disappearance of a glycoprotein component with molecular weight of 170000 was observed in erythrocyte membranes from patients with inherited spherocytosis and Markiafava--Mikely disease.


[ Serotonin and monoamine oxidase activity in the dynamics of experimental neuroallergy]. A phasic type of alterations was observed in concentration of serotonin and in the monoamine oxidase activity (MAO, EC 1.4.3.4) in blood, spinal fluid and other tissues of dog in experimental allergic encephalomyelitis. In the preparalytic period a decrease in content of the amine was observed in the brain part studied and in blood; in spinal fluid content of the amine was increased. During the period of clinical manifestations of encephalomylitis reduction in content of serotonin was found in hypothalamus and brain cortex; in white substance, spinal fluid and blood content of the amine was decreased. Content of serotonin was decreased in blood and other tissues of animals without clinical manifestations of experimental allergic encephalomyelitis. In dynamics of the process the MAO activity was increased only in cortex of big hemispheres; distinct alterations were not shown in hypothalamus and white substance. The MAO activity was increased only in white substance of animals without clinical manifestations of experimental allergic encephalomyelitis. A possible mechanism and function of alterations in content of monoamines in brain under experimental allergic encephalomyelitis are discussed.


[Electron microscope study of the innervation of the large arteries of the base of the brain subsequent to subarachnoid hemorrhage, following aneurysmal rupture (a pathomorphologic and experimental study)]. The ultrastructure of the intraadventitial and paravasal nerve trunks of the superficial adventitial plexus in major vessels of the basis cerebri in man and in dogs under normal conditions and with a subarachnoidal hemorrhagic effusion was studied at the submucroscopic level. Unlike the ultrastructure of the intra-adventitial nerve trunks the paravasal ones, lying in the cerebrospinal fluid (CSF), have an endothelial sheath that substitutes the epineurium and also has a perineurium endowed with an abundantly developed system of basal membranes containing aplanated cells and bands of collagen fibrils. With a subarachnoidal hemorrhagic effusion was in evidence the disruption of the "CSF-neural barrier". The endothelial cells break" away and fall into the CSF, the basal membrane undergoes lysis, which, apparently, contributes to the penetration of various components of the subarachuoidally effused blood deep into the nerve trunks. This results in changes occurring in the ultrastructure of axones of the pulpous and, to a lesser extent,pulpousless nerve fibers.


Morphology of stored, rejuvenated human erythrocytes. Whole blood was stored at 4 degrees C for 42 days. At 7-day intervals, starting with day 21, aliquots were rejuvenated with a phosphate, inosine, glucose pyruvate, and adenine solution. Samples were taken for ATP assays and red cell morphology (by SEM) both before and after rejuvenation. Rejuvenation elevated all ATP levels in excess of 100% of the starting values and significantly increased the percent of cells in the discoid shape as measured by their morphological index, showing that rejuvenation not only raises the cell's metabolic level but causes partial reversion to fresh cell morphology.


Dissociation of MNSs antigens using sodium deoxycholate fraction of erythrocyte membranes. A dissociation of the MNSs blood group system has been demonstrated by sodium deoxycholate fractionation of erythrocyte membrane preparations. The MN antigens were localized in a fraction that sedimented at 30,000 g while the Ss antigens remained soluble after 100,000 g centrifugation for donors who were heterozygous at the MN locus. In contrast, fractions derived from erythrocytes of 'homozygous' M or N donors showed M or N activity in both the 30,000 g pellet and 100,000 g supernatant and Ss remained in the 100,000 g supernatant.


Plasmapheresis: the in vitro distribution of heparin in plasma and red cell fractions following centrifugation. A modified activated partial thromboplastin time (activated PTT) technique was employed in determining heparin concentration in plasma following centrifugation of whole blood. In reference to previous studies reporting heparin to be found essentially in the plasma, it was shown in the present study that following centrifugation of each bag of whole blood in a double-pheresis procedure, the approximate heparin distribution was 39.9 and 45.7% recovery in plasma for bags 1 and 2, respectively. It is suggested that heparin binding to cellular components may account for the low recovery in plasma. Activated PTTs conducted following reinfusion of red cell concentrates into donors were within normal values, and were consistent with the suggestion that heparin is bound to cellular components in vivo. The safety of the weekly injection of approximately 3,120 USP units of heparin into donors on a long-term basis is considered in the light of extensive data avilable from widespread systemic use.


Glucose-6-phosphate dehydrogenase deficiency and blood transfusion. Seven White American male blood donors with Italian surnames were found to have red cell glucose-6-phosphate dehydrogenase (G-6-PD) deficiency among 1,285 with Greek or Italian surnames screened. Five different genetic variants were found; G-6-PDs Mediterranean (2), "Athens-like" (2), San Juan, Columbus and "Canton-like". Clinical evaluation of 23 patients who received 24 units of G-6-PD-deficient blood (G-6-PD A-) failed to reveal any deleterious effects. Screening of Black donors for G-6-PD deficiency is believed unnecessary; further data are needed before a recommendation can be made concerning screening for non-Black donors.


[The strength and elasticity of the dura mater]. The strength and extensibility of human dura mater cold-preserved at--30 degrees--50 degrees and stored for up to 2 years were investigated. A total of 38 preserved and 5 fresh specimens were tested. The test-trials were made by using standard tensile-testing machines; The strength of preserved dura mater specimens was found to vary from 0.4 to 2 kg/mm2 and of the fresh ones--from 0.4 to 1.1 kg/mm2. The extensibility of the speciments equalled 10--30 per cent without any marked difference between the fresh and preserved ones. The duration of storage of the preserved dura mater does not affect adversely its strength.


Titration of antibodies to tetanus toxoid by agglutination of purified tetanus toxoid sensitized latex particles. The method of sensitized latex particle agglutination which we have devised allows the selection of samples of plasma for the preparation of immunoglobulins. The population of thus selected samples is the same as is selected by the in vivo test, having a titer greater than or equeal to 6 IU/ml. The test gives a clear-cut difference between the positive and negative results and does not give any prozone phenomenon. It can be used extensively, as the batches of sensitized latex particles may be stored for quite a long time.


The effect of a single or double dose of dexamethasone on granulocyte collection with the continuous flow centrifuge. A total of 33 leukaphereses were performed with the IBM continuous flow centrifuge on 28 normal healthy donors for the purpose of obtaining increased yields of granulocytes for infusion into leukopenic recipients. The pretreatment of donors within a 10- to 12-hour period prior to pheresis with a double dose of dexamethasone and the addition of hydroxyethyl starch to the input line of the continuous flow centrifuge, significantly increased the total quantity and efficiency of granulocyte collected as compared to a donor group receiving a single dose of dexamethasone in addition to hydroxyethyl starch. A mean of 25.5 times 10-9 total granulocytes were collected in addition to an efficiency of 2.11 times 10-9 granulocytes harvested per liter of blood processed in the double-dose-treated donors, in contrast to 19.6 times 10-9 total granulocytes collected and an efficiency of 1.82 times 10-9 granulocytes harvested per liter of blood processed in the single dose donor group. The results of the present study demonstrate that elevated quantities of granulocytes can be collected from normal donors by scheduling a double dose of dexamethasone prior to the pheresis procedure.


Studies on glycoproteins and glycopeptides from Tn-polyagglutinable erythrocytes. Direct evidence for the theory that Tn-polyagglutinable erythrocytes have a deficiency of alkali-labile sialic acid and galactose is gained by analysing the carbohydrate moiety of the tryptic glycopeptides with spectrophotometric methods and gas-liquid chromatography. Alkaline borohydride treatment of these glycopeptides specifically releases N-acetylgalactosaminitol. In addition it is shown that mainly the third and the first membrane glycoprotein are affected by the defect.


Anti-Kell (K1) in ascitic fluid.

Anti-Kell (K1) in ascitic fluid. The presence of anti-Kell (K1) in the ascitic fluid of a patient with adenocarcinoma is described. The antibody has persisted for over 3 years. The anit-K1 together with the anti-A and anti-B also present in the fluid, is compared with antibodies present in the patient's serum.


[Mollusca contagiosa--review and critical evaluation of a new form of therapy (author's transl)]. The present state of knowledge of the clinical features and therapy of molluscum contagiosum is reviewed. Treatment with retinoic acid, applied topically, is evaluated on the basis of 15 cases. In the majority of patients the lesions cleared up within an average of 8.9 days. This therapy is contraindicated only in patients with a disposition to develop eczema. This form of therapy appears to be superior to all those in common use up to the present date, especially in children with multiple or recurrent lesions.


[Lipoatrophia semicircularis (author's transl)]. 11 young women were seen in the span of 2 years at the Department of Dermatology, University of Innsbruck, with dents of a very similar appearance on the extensor aspect of their thighs. These dents are characterized by their band-like circular localization and isolated atrophy of the subcutaneous fatty tissue. These changes are considered to be a distinct disease, termed lipoatrophia semicircularis. A differentiation from other diseases with atrophy of the subcutaneous fat, especially lipoatrophia annularis may be obtained on the basis of the clinical symptoms, histology and the course of disease. Possible causes and the pathogenesis of this disease are discussed.


[Giant melanosomes in moles and in normal human epidermis (author's transl)]. This is the first report on the occurrence of giant melanosomes in normal human epidermis and in moles. Due to their characteristic ultrastructural features these large pigment organelles are of special interest for the research in melanin pigmentation. The diferentiation of giant malanosomes from other types of large melanin granules is discussed.


[Trophic phenomena in dermatology (author's transl)]. After a description of trophic disorders in 2 patients the great variety of trophic disorders and their diagnostic problems are discussed. Neurovascular dysfunction may be the main cause of trophic phenomena. The general opinion ist that so-called "trophic" nerve fibres do not exist, but there is evidence of the production of "trophic" substances by the nerve endings. So long as these problems remain unresolved, the term "trophic" should be avoided in favour of "neurovascular disorder".


[Reticular formation nuclei and bioelectric activity in patients with ischemic brain stem strokes]. The study pertains to new approaches in the study of corrlations between the EEG data and the degree of lesions in the nuclei of the reticular formation in ischemic strokes due to occlusive processes in the vertebrobasillar system. In all cases, because of disorders of vital functions, the authors convened artificial lung ventilation which permitted to prolong the life of the patient and to study the dynamics of the EEG. In 10 lethal cases the brain stem was studied on a series of continuous preparations to determine the degree of lesions in the nuclei of the reticular formation in the pons Varoli and medulla oblongata in ischemic foci. It was not possible to establish significant differences in the indices of bioelectric brain activity in lesions of reticular nuclei of pons Varoli and medulla oblongata. The authors stress the necessitity of reconsidering the existing concepts of a dependence of EEG changed parameters upon the localization of the focus in the brain stem.


[Autoimmune factors in cerebral circulatory disorders associated with hypertension and atherosclerosis of the cerebral vessels]. In 160 patients with disorders of brain circulation in cerebral atherosclerosis, 68 normals and 38 patients with different neurological diseases (a control group), a special study was undertaken to study the antibrain antibodies with the aid of a complement fixation test (CFT), and a test of complement utilization (CUT). Positive results in the CFT and CUT were seen in patients with ischemic strokes and transient disorders of brain circulation. The formation of antibodies to brain tissues depends upon their type, duration of the disease and is more characteristic of the rehabilitation period. In studying autoimmune processes in patients with disordered brain circulation previous diseases should be taken into consideration (brain trauma, epilepsy, strokes). The existence of antibrain antibodies correlates with the intensity of the process.


[The condition of the retinal vessels and intraocular and retinal pressure in patients with incipient forms of cerebrovascular atherosclerosis]. The authors examined 350 patients with initial forms of cerebrovascular atherosclerosis. Among the studied group 98 had discirculatory disorders. All patients were studied for the eye ground, intraocular and retinal pressure. The following clinical symptoms characterized this group of patients: antigiospasms, organic changes in the arterial vessels of the retina, changes in the peripapillar zones, in a normal eye retraction, a drop in the diastolic retinal pressure. Glaucoma was depicted in 27%. In patients with a tendency to cerebral paroxysms and transient disorders of cerebral circulation there were more distinct and more frequent symptoms of angiospasms, as well as signs of organic changes in the retinal arteries. The authors mark an increase in the systolic and retinal pressure and an asymmetry of it. Glaucoma was depicted in 3% of the cases.


[A comparative clinico-genetic study of attack-like schizophrenia with late and early manifestation with regard to age]. The author studied the genetical traits in 2 groups of probands with attack-like schizophrenia with corresponding sex and age. The 1st group (62 probands) consisted of cases where the average age of the manifest psychoses was 59.5. The second group consisted of cases with an average of the manifest psychoses of 30.9. It appeared that the morbidity risk for schizophrenia for all the relatives of the first degree of relationship in the families of patients with late attack-like schizophrenia is significantly lower than the morbidity risk in familiies with an onset in young age. At the same time the frequency of schizophrenia among the relatives of patients with late attack-like schizophrenia significantly exceeds the frequency of schizophrenia in the general population. An accumulation of psychoses of a different nozology was not observed. The frequency of schizophrenia among the parents and sibs in a late manifestation of the disease in the probands is lower than in early schizophrenia. These differences were not seen in the children. Among the relatives of patients with late and early attack-like schizophrenia there is a large amount of schizoid personality anomalies.


Clinico-pathological studies of the liver in asymptomatic carriers of Australia antigen. In an attempt to clinico-pathologically examine asymptomatic HBs AG carriers, follow-up studies were made on 57 HBAg-positive blood donors with the S-GPT within normal range and the following conclusions were arrived at: 1) The results of liver function tests made in the present studies revealed the following rates of abnormalities: the S-GPT was abnormal in 14.5% of the subjects, the S-GOT was abnormal in 9%, the serum total bilirubins were abnormal in 12.2%, the serum alkaline phosphatase level was abnormal in 24.5%, the TTT was abnormal in 4.4%, the ZTT was abnormal in 2.2%, the gamma-globulin was abnormal in 21.2%, and the ICG retention was abnormal in 25.6%. It was thus necessary to make a follow-up study of the results of liver function test. 2) Anti-HBs was negative in all subjects, the rate of lymphocytic blastogenesis in the peripheral blood (tested by the addition of PHA) was low in 7 (36.8%) of 19 patients, and the MIF test by the addition of the purified HBs Ag revealed that 17 subjects, excluding one subject with a histologic picture of acute hepatitis, were not susceptible to HBs Ag. It was, therefore, surmised that immunological insufficiency would be involved in the development of asymptomatic carriers. 3) Histologic examinations, made on 20 subjects, revealed A.V.H. in one subject, N.S.R.H. in seven, N.S.R. in ten and fatty liver in two, and further revealed mild, diffuse inflammations in 8 subjects in the first two group (40% in total). Further, pleomorphism was noted in the hepatocytes of 8 (40%) of these 20 subjects, and a study is under way of the significance of the pleomorphism.


Bioptical liver changes in florid hyperthyreosis. In 42 non-selected patients with a clinically, biochemically and radio-iodine proved hyperthyreosis, previously untreated, a Menghini liver needle biopsy was carried out for evaluation of histomorphologic changes of the liver. As a result, "reactive hepatitis" was found in 8 patients. Moreover, in about 40% of the cases vacuolated nuclei of hepatocytes were observed in such a great number, as has been found so far only in diabetes mellitus. The microscopic findings, however, are in general unspecific and without particular pathologic value, showing no positive correlation to the biochemical findings.


The effect of phenobarbital on the serum bilirubin level in normal and CCI-4 liver-damaged rats. Biochemical and histologic study. The present study was designed to determine the effect of phenobarbital on bilirubin metabolism in rats, following intraperitoneal injection of blood incubated at 37 degrees C for 24 hr to produce hyperbilirubinaemia. Blood was taken from the rats to determine the total serum bilirubin before and 6, 12, 24, 36 and 48 hours after the intraperitoneal transfusion. Comparison of the bilirubin curves shows that the serum bilirubin levels were always significantly lower in the phenobarbital pretreated animals. It is proposed that several mechanisms may be responsible for the favorable effect of the phenobarbital on the bilirubin metabolism.


Galactosamine- "hepatitis" in rats with different phagocytic activity of liver RES. Morphological investigations by lightmicroscopy were performed to evaluate the influence of an altered liver RES-function state on the course of Gal-N-hepatitis. There was a good correlation between the biochemical data and the morphological alterations. The simultaneous infusion of Gal-N 1 g/kg b.w. and carbon particles (2.6 mg/100 g b.w) into the portal vein was followed by subtotal necrosis of the liver and Sanarelli-Shwartzmann-phenomenon. Signs of RES-activity were nearly absent. 8 days after pretreatment with carbon, Gal-N application did not produce Gal-N hepatitis; 21 days after carbon infusion the morphological changes normally found after Gal-N application were present. The morphological studies confirm the concept that an altered RES-function state is a very important factor for the development of liver cell necrosis.


Subcutaneous secretin in dogs: influence of solvent and volume of solvent. Pancreatic secretion in response to subcutaneously injected secretin was studied in three dogs with chronic pancreatic and gastric fistulas. Three solvents: saline, gelatin, carboxymethylcellulose (CMC); two volumes of solvent: 2 and 6 ml; and two doses of secretin: 75 and 150 clinical units were tested. Gelatin was more effective than CMC in prolonging the action of secretin; the duration of the plateau of secretion was about twice as long with gelatin as with saline. Increasing the volume of solvent from 2 to 6 ml also increased the total duration of secretion and total HCO-3 output. It is concluded that gelatin is a suitable vehicle for prolonging the action of secretin.


Cell renewal of gastric mucosa in Zollinger-Ellison syndrome. In Zollinger-Ellison patients the gastric mucosa is characterized histologically by hyperplasia both of the glands and the gastric pits. The fundic gastric mucosa is thickened with a marked increase of the specific glandular cells. In-vitro autoradiographic examination shows a significant increase in proliferation of the stomach epithelial cells in three patients with hypergastrinaemia. The mean generation time was diminished from 72 plus or minus 2 in controls to 45 plus or minus 4 hours in the Zollinger-Ellison patients owing to a reduction of the G-1 phase from 62-63 to 36-37 hours. The labelling index (3-H-index) was increased from 10.0 plus or minus 0.2 to 15.7 plus or minus 1.8%. The DNA synthesis phase, the G-2 phase, and the mitotic time were not altered compared to the controls.


ABO blood groups and serum gastrin.

ABO blood groups and serum gastrin. Serum gastrin concentrations were measured in 75 subjects of blood group O and in 75 subjects of other blood groups. Gastrinaemia both basally and following stimulation by glycine drink or by insulin hypoglycaemia did not show any statistically significant differenc in blood group O people as compared to subjects of other blood groups. It is concluded that the claimed relationship between blood group O and parietal cell hyperplasia cannot be considered as secondary to a relationship between blood group O and increased gastrin-producting G cell mass.


Bulk flow in the cerebrospinal fluid system of the dog. Ventriculo-cisternal, intracranial subarachnoid-to-subarachnoid space and spinal subarachnoid space perfusions were carried out on dogs. The perfusate contained inulin as a tracer and the design of these experiments was based upon the concept that inulin leaves cerebrospinal fluid (CSF) compartments only by means of bulk absorption, and that actual diffusion and active transport of inulin is negligibly small. Inulin was removed from different CSF spaces by bulk absorption at rates which varied linearly with hydrostatic pressure. The rate of formation of CSF is equal to inulin clearance plus the difference between outflow and inflow rates. The total CSF formation in dogs weighing 12 to 17 kg was measured as 0.065 ml/min, and 58.5 per cent of this amount was found to come from extraventricular CSF space. The rates are independent of hydrostatic pressure in the range studied.


Peripheral nerve injury as a complication of axillary arteriography. Five patients with peripheral nerve injury after axillary arteriography are presented. The clinical and electromyographic pictures of this complication are described. In 4 patients the brachial plexus was damaged due to haematoma or pseudoaneurysm-formation at the site of the arterial puncture. The grave prognosis for this complication is illustrated on the basis of the literature and our cases. Since it is concluded that the prognosis is better if rapid surgical correction of the complication is performed, certain steps to prevent the disabling outcome are proposed.


Myopathy and neuropathy associated with osteomalacia. Thirty unselected females with proven osteomalacia were evaluated clinically, electromyographically and histopathologically for muscle dysfunction. Clinical evidence of myopathy was found in all the patients except one; the electromyograms were abnormal in 25 of them, and histopathological abnormalities, although slight and nonspecific, were seen in all the 17 patients who underwent muscle biopsy. Electromyographic findings revealed a myopathic pattern as evidenced by a significant reduction in motor unit potential duration and amplitude, and an increased percentage polyphasicity as compared to the controls. There was a complete absence of denervation potentials. The histopathological abnormalities were nonspecific and slight, and consisted of fatty infiltration, interstitial fibrosis, sarcolemmal nuclear proliferation and variation in muscle fibre thickness. A statistically significant reduction in motor nerve conduction velocities of the ulnar and peroneal nerves was found. It was considered that this reduction in the velocities was due to subclinical neuropathy. Our data suggest that myopathy, neuropathy and osteomalacia in our patients are due to nutritional deficiencies of multiple vitamins.


Intestinal absorption in myotonic dystrophy. Forty-four patients with myotonic dystrophy were subjected to various tests for intestinal absorption. A varying number of patients were subjected to the various tests. In one patient (of altogether 11 patients) a pathological vitamin A absorption test was found together with increased faecal excretion of fat and nitrogen. Two of 12 patients showed pathological D-xylose tests. The reason for this may possibly be deficient urine collection. Schilling tests were on the whole normal. Glucose tolerance tests were pathological in 26 of 35 patients. The following pathological findings were made: elevated fasting blood sugar, elevated peak level, delayed return to pretest level, biphasic response and reduced increment in blood glucose levels following loading. The biphasic response seems to be a rather characteristic finding in myotonic dystrophy. The peak concentration was in all except one case reached within 15-60 minutes. Intravenous glucose loading gave normal response curves. The pathological response on oral loading was probably often caused by intestinal motility disturbances and not by malabsorption. Malabsorption seems to be a rare feature of myotonic dystrophy.


The concepts: Disturbed state of consciousness and psychosis. A theoretical analysis is made of the two concepts: "disturbed state of consciousness" (DSC) and "psychosis", and these concepts are defined in ways which are consistent with actual clinical psychiatric work on the Continent. Concerning DSC's two points are emphasized: Whether we, as psychiatrists, are conscious of it or not--one of our premisses for classifying a state as a pathological DSC is an evaluation of the client's ability to change the state voluntarily. Furthermore, stating that a DSC was present in the time interval tl0tn implies stating that all experiences were abnormal in some way during the interval--when the word "experience" is taken in the broad sense, including William James' "fringe" and "embeddedness" in the stream of consciousness. Reality testing may remain the cardinal point in the definition of "psychosis"--if we make the distinction between theoretical, "fullblown", syndromes and concrete syndromes with fewer symptoms clear to ourselves.


Prognosis of paranoid states in relation to the clinical features. Scandinavian psychiatrists acknowledge endogenous psychoses which are neither schizophrenic nor manic-depressive, i.e., above all the "reactive psychoses" and the "schizophreniform psychoses", both of which differ from schizophrenia in their features as well as in their good prognoses. These Scandinavian diagnoses bear relationships to psychoses, which I separate from schizophrenia. In the present paper, paranoid states are discussed with regard to their clinical pictures and their good prognoses. Among these are the "cycloid psychoses". Patients suffering from these diseases recover from every phase, though most of the German psychiatrists consider them schizophrenic. Among the cycloid psychoses, the "ansiety happiness psychosis" shows ideas of reference on the one hand and ecstatic ideas on the other. In "inhibited confusion psychosis", the patients are suffering from ideas of reference and ideas of significance; in "excited confusion psychosis", from misidentifications of persons. The other symptoms which occur--anxiety, happiness, stupor, incoherent pressure of speech--confirm the cycloid psychoses and disprove schizophrenias. Besides the already mentioned psychoses, there is a monopolar psychosis, "suspicious depression", in which ideas of reference and ideas of guilt mix. It is extremely important, not only for theoretical but also practical reasons, to separate from schizophrenia paranoid states which terminate in complete recovery from every phase.


Predisposition for mental syndromes: A study comparing predisposition for depression, neurasthenia and anxiety state. A hypothesis of selective predisposition for drepression, neurasthenic syndrome and anxiety states has been tested in a prospective study. The primary material for the investigation consisted of 4,000 city inhabitants who had registered a private car. Almost all of these could be invited to a group investigation by questionnaire in the autumn of 1959. Out of those invited, 83% participated, and out of these, 3,019 were males (the secondary material). Six years later, the registers of public psychiatric out- and in-patient units in the city were examined as to the appearance in 1960 or later of the men in the secondary material. One hundred and fourteen of these men were found in the registers. For each of these men ten controls, matched for age, were chosen from the rest of the secondary material. Thirty-seven of the patients had had a depression and 17 a neurasthenic syndrome as the main diagnosis, and 17 had an anxiety state as the main or secondary diagnosis. As independent factors were chosen the Sjöbring personality factors sub-validity (psychasthenic traits), sub-stability (syntonia) and sub-solidity (hysteroid habitual attitude), as well as subclinical phenomena related to the neurasthenic, depressive and anxiety syndromes. It was not possible to show a specific predisposing power of the background factors investigated. Psychasthenic premorbid personality, however, was significantly related to depression, and also showed a strong tendency to an association with neurasthenic syndrome and anxiety states.


Depression: Predisposing factors.

Depression: Predisposing factors. Factors predisposing to a depressive state had been investigated in a prospective study on a stratified population, accounted for in the preceding article (Nyström & Lindegård (1975a) ). Of the 114 persons seeking psychiatric care during the period of observation, 37 had a depression as the main diagnosis. As compared to their 370 matched controls, these patients showed a significant overrepresentation of psychasthenic traits (subvalidity according to Sjöbring), a tendency to ruminate, shyness in company and lack of endurance, certain asthenic subclinical symptoms such as habitual fatigue and irritability, certain depressive subclinical phenomena, various expressions of anxiousness, all kinds of insomnia, and certain forms of medical care and examinations. The findings can be used for mental hygienic purposes. It can be recommended that the environmental pressure within occupational as well as within private life, should be kept as low as possible, expecially for persons with characteristics shown to indicate mental vulnerability.


Sex chromatin anomaly among Chinese psychiatric inpatients compared to schoolchildren. In a study of sex chromatin abnormality among Chinese psychiatric inpatients, buccal smears were examined from a total of 1,253 psychiatric inpatients (639 males and 614 females). One male psychiatric inpatient (1.6/1000) was chromatin positive (plus ve); two female psychiatric inpatients (3.3/1000) were found to have two sex chromatin bodies (less than e). The lower rate for male inpatients in comparison to Chinese schoolboys (i.3/1000) is thought to reflect a higher rate of mental subnormality in the primary schoolchildren. This is considered attributable to the special nature of the school system and psychiatric patient facilities in Taiwan. The higher rate for female inpatients in comparison with the schoolgirls (0.5/1000) tends to indicate a predisposition to mental disorder in favor of psychosis associated with double sex chromatin abnormality in the female.


Alterations in chromatin functions during aging in vitro. Age-associated alterations in the chromatin functions of human diploid cells have been observed. These alterations include: (1) a decline in the rate of histone acetylation; (2) a reduction in the rate of RNA synthesis as measured by (a) the rate of 3H-uridine incorporated into the RNA of young and old cells; (b) comparison of the template activity of isolated chromatin from young and old cells using E. coli RNA polymerase and (c) measurement of chromatin template activity using the endogenous RNA polymerase of young and old cells. It is suggested that the nondividing state of old cells may be the result of the inability to synthesize specific RNA molecules (and perhaps specific proteins) necessary for the cell to continue through the cell cycle.


Creatinephosphokinase in human diploid cell lines. The activity of CPK was proved in cultivated cells from amniotic fluid cells, thymus, spleen, pericardium, umbilical cord, skin and muscle. The activity in these strains did not significantly differ. The average value is 224 plus or minus 68 i.u. CPK/mg N. No differences of activity were disclosed between embryonal, foetal and children cultures. The activity of CPK in post mortem cultures was not altered. The relationship between collagen synthesis and CPK activity is suggested. The evidence of CPK activity in amniotic fluid cells corresponding to the activity in other foetal cultures and the whole sample under investigation opens the way to the prenatal investigation of pathophysiology and inborn errors of the metabolism of this enzyme.


Studies on the proliferative capacity of mouse spleen cells in serial transplantation. The ageing of mouse spleen cells in vivo was investigated by determining the size distribution of cell volumes. It was found that ageing is accompained by an increase in cell volume which is in agreement with published data on ageing for a number of cell types both in vivo and in vitro. After the first transplantation into irradiated hosts the size distribution of spleen cells proves to be more heterogeneous which may affect the proliferative capacity. After the fifth transplantation, when the cell population is three years old, the parameters of the volume distributions of spleen cells agree better with the data from middle-aged mice than with the data from old-aged mice. Further it was found that at least six serial transplantations are possible if the interval between passages is long. Therefore our data do not show an intrinsic limited proliferative capacity of these cells.


Ageing and the loss of auditory neuroepithelium in the guinea pig. By microscopic evulation of the cellular pattern of the organ of Corti in 3 age groups of guinea pigs (6 weeks, 7 months and 3 yr) the linear dependence of the loss of sensory cells on the age of animals was found. The linearity of the decrease in number of sensory cells supports the idea that the effect observed was induced by the ageing of the organism in normal conditions of living.


The role of retinol in, and the action of anti-inflammatory drugs on, hereditary retinal degeneration. Light deprivation retarded retinal degeneration in albino dystrophic rats. In pigmented dystrophic rats the presence of pigment in the eye retarded the degenerative process. Retinol labilized rat retinal lysosomes in vitro. Acetylsalicylic acid stabilized retinal lysosomes even in the presence of the concentration of retinol which produced the maximum labilization. The effect of acetylsalicyclic acid was concentration dependent, maximum stabilization being produced by 0.25-0.50 mM. The results provide further evidence for the hypothesis that hereditary retinal degeneration in rats is mediated by an increased amount of retinol (produced by the action of light on an unusually labile type of visual pigment) causing a premature release of lysosomal enzymes.


Effect of age on kidney hyperplasia in the rat after unilateral nephrectomy. The absolute weight of the rat's kidney increases from 3 weeks to 3 months and from 3 months to 12 months. The relative weight decreases. The number of cells freed from the kidney by trypsinization increases. (2) After nephrectomy, the kidney weight increases in all age groups. The increase is mery high in the youngest rats, lower but still significant in the 3 month old rats and still lower in the 12 month old rats. The number of cells freed from the kidney after nephrectomy is again very high in the young and 3 month old rats, but very low in the 12 month old rats. In these animals, the cell number is lower after nephrectomy than before, and a greater vulnerability of the cells is suggested as the cause of this phenomenon.


Effect of age on kidney hyperplasia in the rat during cold acclimation. In adult rats acclimated to 5 degrees C, the kidney weight increases with the length of the exposure. Kidney cells of younger rats survive explantation better than the cells of control rats of the same age. Kidney cells of older rats after cold acclimation and after unilateral nephrectomy have a lower vitality in vitro than corresponding control cells. Unilateral nephrectomy performed in rats aged 3 and 6 months, exposed previously to low temperature, leads to a better survival of explanted kidney cells than nephrectomy or cold only. Old rats do not survive exposure to 5 degrees C for more than 18 hr.


Biosynthesis of collagen during the life cycle of human diploid cell lines. In the course of the active phase of growth collagen synthesis appears relatively stable and decreases when the culture passes into the degenerative phase III. The increase of cell nitrogen indicates the increasing accumulation of cell proteins with their aging in vitro. The ratio of soluble to insoluble collagen is relatively constant in fibroblast cultures from different tissues, periods of development during the active phase of growth. The increase of insoluble collagen in long term cultivated Marfan syndrome fibroblasts indicates the possible relationship between increasing stability of collagen and ageing of fibroblasts in vitro. Further studies confirmed the significant differences between control fibroblast and fibroblast derived from tissues of patients affected by Marfan syndrome. No differences were found in collagen synthesis and in the ratio of soluble to insoluble collagen in fibroblast strains from embryos, foetuses, children and young adults. The collagen synthesis and the ratio of soluble to insoluble collagen does not differ in fibroblast cultures derived from or post-natal period of life. The collagen synthesis in amniotic fluid cells was confirmed by analysis of cell proteins and proteins produced into the cultivation medium. The ultrastructural analysis of these cells reveals formation of intracellular fibrills and their growth in the extracellular space. The possibility of prenatal investigation of inborn errors of collagen metabolism is pointed out.


Ageing processes in collagens from different tissues of rats. It has been demonstrated by solubility data, that the differences in cross-linking and degree of polymerisation in connective tissue from different organs of a single animal are much more pronounced than the increase which occurs with advancing age. Judged from the cross-linking analysis one can therefore conclude that in a single animal there are connective tissues which differ in their degree of maturity. It is therefore conceivable to suggest that the level of cross-linking should not be taken as the measure of the biological age of the animal.


The effect of nutritional regimes upon collagen concentration and survival of rats. It has been demonstrated that food restriction put upon animals at any stage of the individual's life, if chronic, produces a distinct increase in the lifespan. This can be effected in youth and still have a distinct effect in old age even if the food restriction is cut down and for the rest of the life the animal is allowed food ad libitum. Since the effect upon the aging of the animal is delayed on the time scale, it is obviously an effect which is stored somewhere and it is suggested that this storage occurred somewhere along the DNA-RNA pathway. Also the effect of under nutrition is not identical with that of oxidizing free radical blocking agents and therefore it is concluded that the food deprivation does not minimize the attack of the free radicals on the long chain macromolecules and as a matter of fact it seems that the proportion by which free radicals contribute to the changes in the average lifespan in undernourished and fully nourished animals is small. It has been also demonstrated that the addition of reducing agents to normal diet and to the diet of food restricted animals increases the average and maximum lifespan in both cases practically to the same extent, which supports the idea expressed before. This feeding effect has been observed in three different species of rodents and no extrapolation has been done to other types of mammals. Due to the data published on this topic and dealing with rotifers and some insects (2) it is conceivable to conclude that the effect of undernutrition is general and is not limited to the food restriction in the early stages of development only. Collagen starts to accumulate in the kidneys and liver of experimental animals roughly ten months before 90 percent of the population dies out. Tus an increase in collagen concentration can be indicative of involutional changes in the organ (and perhaps organism). These data are i- good agreement with previously published results on the relation between collagen accumulation and chronic food deprivation in rats (6). It can be also concluded that food deprivation induced in the adult, though not so effective in life prolongation as the food restriction during early development, still can increase survival in experimental animals to a high degree.


Relations between development of the capillary wall and myoarchitecture of the rat heart. The type of the blood supply to the myocardium appears to be closely related to its structural arrangement. The heart of adult poikilotherm animals is either entirely spongious, supplied from the ventricular cavity or its spongious musculature is covered by an outer compact layer with vascular supply. The size of the compact layer increases with increasing heart weight. The changes in the heart size during the ontogenetic development of honoiotherms are accompanied by the gradual transformation of the vascularless spongious musculature into a compact myocardium supplied thrugh coronary vessels. Up to the development of coronary arteries (in the rat up to the 17th day of embryonic life - ed) the myocardium is entirely spongious and supplied from mentricular cavity. Two types of primitive vascular bed are characteristic for this period: a) intertrabecular spaces, which penetrate deep into the ventricular wall as direct continuation of the endocardium, and b) intramyocardial clefts without endothelial lining. During further development of the terminal mascular bed, the outgrowth of endothelial cells into the myocardial clefts is important. The first capillaries with closed endothelial wall can be observed on the 18th ed. At this time various developmental stages o the terminal blood bed can be observed simultaneously. Within the following period (20-21 ed) the thick capillary walls become narrow and pericytes occur. The process of differentiation spreads in both ventricles and in septum from the base to the cardiac apex and is practically finished by the 14th day of postnatal life. The longitudinal orientations of myofibres starts between the 20th and 22nd ed. The final arrangement of muscle cells and capillaries into three layers (outer and inner longitudinal, central circular) is terminated during the second postnatal week.


The use of arrested populations of human diploid fibroblasts for the study of senescence in vitro. It has been shown that human diploid cells from various donor ages can be arrested in an essentially nonmitotic state by reducing the serum concentration of the incubation medium from 10 to 0.5 percent. Cells incubated at this serum level maintained the population distribution that was present when the cells reached confluency. The population, which has 90 percent of the cells in the G1 phase of the division cycle, was not static and exhibited a low level of mitotic activity with prolonged interdivision times. These cells also exhibited a greatly reduced (30 percent) protein content which occurred within the first 7 days of cultivation with 0.5 percent serum. Cells arrested by incubation with low serum medium and subsequently recovered to a proliferative state underwent an equivalent or greater number of population doublings with a concomitant extension of in vitro calendar time when compared to growth controls. This indicated that the number of mitotic events and not the length of time in culture was the primary determinant of in vitro lifespan. The ultimate passage level achieved by experimental cells as compared to controls was different in the three cell strains studied. A gradient of attained passage number according to donor age was established with cells from younger donors reaching a significantly greater number than those from older donors. The use of arrested cell populations for the study of cellular senescence offers a unique opportunity to have an in vitro system which may more closely approximate those in vivo tissues which normally do not exhibit a rapid rate of proliferation. By the use of this system numerous biochemical parameters can be investigated at various cell ages without the interference of proliferative processes.


Morphometrical and mathematical analysis of the ageing changes of the muscle-connective-tissue-relation in smooth muscles. The rate of the process of ageing studied in this work as well as of other ageing processes observed by us constantly decreases with increasing age. By an adaptation of exponential functions to series of measurements it is possible to estimate the theoretically possible end stage of histological ageing processes for extremely long lifetimes. The histological biomorphosis is much slower in female persons during their generative phase than in males. Results of planimetric measurements made on sections suggest that, so far as the shift in muscle-connective tissue relation in favour of the connective tissue is concerned, primary significance should be attached to muscular atrophy, while the connective-tissue proliferation may be considered to the secondary in this respect.


Time-lapse cinemicrophotographic studies of cell division patterns of human diploid fibroblasts (WI-38) during their in vitro lifespan. Genealogies of human diploid embryonic lung fibroblasts, WI-38 were prepare from analysis of filmed sequences of clones at passages 20, 28 and 53. The results indicate heterogeneity in cell division patterns, interdivision time and migration activity. The relationship of the cell division patterns to age of culture is difficult to assess at this time because of the heterogeneity of the clones, however, the late passage culture appeared to be more variable in terms of sister-sister, and mother-daughter relationships. The passage 28 culture was representative of a highly proliferating clone, exhibiting short interdivision times and a synchronous division pattern. The passage 20 and 53 clones exhibited longer interdivision times and less synchronous division pattern than the passage 28 clone. A gradual lengthening of average interdivision time with successive generations has been observed in all genealogies regardless of passage level of the donor culture. A portion of daughter cells in the fifth and sixth generation exhibited lower interdivision time than the mother cell. The effects of nutrients, space, and mitotic inhibitors or stimulators on interdivision time of the cells within the clones is discussed.


The angiotensin infusion test as a method of evaluating left ventricular function. Fifteen patients had left ventricular function measured by the angiotensin infusion method. Seven patients had no evidence of heart disease, and eight patients had angina pectoris and coronary arteriographic evidence of coronary disease without congestive heart failure. During angiotensin infusion, those patients without heart disease had a decrease in cardiac index (average, 0.63 L. per minute per square meter) and a decrease in heart rate (average, 12 beats per minute.) The ventricular function curve had a poor SWI response in four of the seven subjects. The patients with coronary artery disease also had a reduction in cardiac index during angiotensin (average, 0.44 L. per minute per square meter) and the heart rate was unchanged in four subjects, increased in two subjects, and decreased in two subjects. Six of the subjects had flat or descending slopes on the function curve, and in one subject there was only a very gradual ascending slope. Many of the curves of both groups looked similar so that the function curves did not differentiate between those patients with or without heart disease. The mechanism for production of bradycardia, reduction of cardiac output, and depressed function curves with angiotensin is multifactorial, but is probably due to the baroreceptor reflex response, the increase in coronary artery resistance, and possible to the direct effect of increased left ventricular afterload itself. The ventricular response to angiotensin is so variable that the angiotensin infusion method of evaluating ventricular function is not reliable.


Permanent pacing in disorders of sinus node function. Thirty-three patients with disorders of sinus node function treated with permanent endocardial pacemakers were evaluated.  Study of the underlying heart rate and rhythm was accomplished by external inhibition of pacemakers.  The development of stable atrial fibrillation was documented in 7 out of 29 patients studied and effectively terminated the syndrome of sinus node dysfunction.  Embolic complications appeared to be an important factor in the morbidity and mortality in patients with changing supraventricular rhythms.  Pacemaker therapy effectively controlled syncopal episodes due to bradycardia, but recurrent episodes of tachycardia and problems associated with this remained unaffected.


Effect of ventricular aberrancy on fibrillation threshold. VFT's were determined in 12 open-chest dogs at epicardial sites in the right and left ventricles (RV and LV) following normally or aberrantly conducted beats.  The normal beats were produced by right atrial pacing, and the aberrant beats by surgical RBBB or ventricular pacing at an RV or LV site.  The mean VFT following normal beats was 21.2 plus or minus 1.8 ma. in RV and 23.0 plus or minus 2.7 ma. in LV. The mean VFT following aberrant beats of RBBB was 21.3 plus or minus 2.6 ma. in RV and 25.0 plus or minus 2.8 ma. in LV.  The difference between the mean VFT of normal beats and that of aberrant beats was not statistically significant.  The mean values of VFT's determined in RV or LV following aberrant beats produced by pacing of the contralateral ventricle were not significantly different from those of the normal beats.  The mean VFT was 22.9 plus or minus 3.1 ma. in RV and 20.1 plus or minus 2.1 ma. in LV.  These results indicate that  the aberrancy of ventricular beats per se is not associated with decreased VFT or increased ventricular vulnerability to fibrillation.  The most predictable observation was that the mean VFT's were significantly lower in both ventricles when they were determined at the site of application of pacing stimuli.  The mean values were 12.4 plus or minus 1.2 ma. in RV and 13.6 plus or minus 1.6 ma. in LV.  This decrease in VFT may be due to slow conduction and increased asynchrony of recovery of excitability at or near the site of application of pacing stimuli.


Effects of dipyridamole and acetylsalicylic acid on platelet functions in patients with aortic ball-valve prostheses. The effects of dipyridamole and ASA on platelet functions were studied in patients with aortic ball-valve prostheses.  Before ingestion, platelet adhesiveness was markedly reduced and platelet survival time slightly, but insignificantly shortened.  ASA prolonged the bleeding time, reduced collagen-induced platelet aggregation, and inhibited secondary aggregation initiated by adrenalin.  Similar effects were obtained with 2 Gm. of ASA alone as with 1 Gm. daily in combination with 225 mg. of dipyridamole.  Platelet adhesiveness remained low.  Depyridamole alone, 375 mg. daily, did not influence any of these parameters.  The mean platelet half-life was prolonged from 3.52 to 3.72 days by each drug and to 4 days by the combined treatment.  None of the differences was, however, statistically significant.  A clinical study with ASA has been started in a larger series of patients to evaluate the effect on arterial thromboembolism.


Frequency response of fluid-filled catheter-micromanometer systems used for measurement of left ventricular pressure. The resonant frequencies of five commonly used fluid-filled catheters connected to a solidstate microdisplacement pressure gauge were 18 to 33 per cent higher than those obtained with a conventional manometer.  Four catheters had a flat amplitude response to 26 Hz. or more at the 20 per cent amplitude distortion level.  The dynamic response characteristic of certain fluid-filled catheters used with microdisplacement pressure gauges allows one to record high fidelity left ventricular pressure curves.


A new method for determination of postmortem left ventricular volumes: clinico-pathologic correlations. A description is presented of a new and simple procedure for ventricular volume determination by means of pressure fixation of the heart and preparation of plastic molds of the ventricles which can be used to displace water in a graduated cylinder to determine the volume of the mold.  Correlations between postmortem ventricular volume as measured by this method and antemortem stroke volume or clinical cardiac status indicate that a large left ventricular volume is often correlated with a low cardiac output and cardiogenic shock.


Bacteroides pericardial effusion and cardiac tamponade in a patient with chronic renal failure. A 31-year-old woman with chronic renal insufficiency and recurrent pericarditis developed an enlarging cardiac silhouette and physical signs of cardiac tamponade.  Cardiac catheterization demonstrated pericardial effusion with hemodynamic evidence of cardiac compression.  At pericardial exploration, 1.5 L. of foul-smelling purulent material was removed from a distended pericardial sac.  Cultures of both the exudate and pericardium revealed pure growth of Bacteroides fragiles.  The patient was subsequently treated with intravenous chloramphenicol and has had an uncomplicated clinical course since that time.  This represents the first reported case of cardiac tamponade secondary to culturally proved Bacteroides pericarditis in the setting of chronic renal insufficiency.


Atrioventricular and intraventricular conduction in hyperkalemia. Twelve patients exhibited electrocardiographic evidence of fascicular block during hyperkalemia. Isolated left posterior hemiblock occurred in four, isolated left anterior hemiblock in two, right bundle branch block with left anterior hemiblock in two, right bundle branch block with left posterior hemiblock in one, left bundle branch block with abnormal left axis deviation in two and advanced atrioventricular block in one. In all seven patients with sinus rhythm the P-R interval shortened after correction of hyperkalemia. Electrophysiologic studies using His bundle recording and atrial pacing in one patient revealed intraatrial conduction delay and marked prolongation of conduction time in the His-Purkinje system. It is concluded that conduction defects in the specialized intraventricular conduction system are common in hyperkalemia and result in electrocardiographic patterns of fascicular block.


Blood platelet response to plasma from patients with ischemic heart disease. Blood platelets change shape (from small round spheres to larger spread forms) as they participate in thrombosis. Using an electron microscopic technique, we surveyed 14 patients with both acute and chronic ischemic heart disease; each had increased spread platelet forms (69 plus and minus 22.2 [standard deviation] percent) when compared with 14 asymptomatic control subjects (P less than 0.001). When platelets from these 14 control subjects were exposed to plasma from the patients with ischemic heart disease, spread forms increased from 13.4 plus and minus 9.1 to 44.5 plus and minus 15.5 percent (P less than 0.001). There was no significant increase in spread platelets in these control subjects when their blood was mixed with plasma from another control group. Similar studies were performed in seriously ill noncardiac patients: 9 of 13 had increased spread platelet forms when compared with control subjects, but plasma from only 5 of these 9 subjects caused increased spread forms when mixed with platelets from normal subjects (P less than 0.05). Thus a factor existed in the plasma of these patients with ischemic heart disease that caused normal platelets to become spread. Similarly the plasma of some patients with serious noncardiac disease had a comparable effect on normal platelets. Although the identity of this factor is unknown, it is probably unrelated to hormonal or therapeutic influences occurring either during acute infarction or during the stress of serious illness because (1) the effect of the plasma from patients with acute ischemic heart disease was identical to that of patients with chronic ischemic heart disease, and (2) the effect was not present in all patients with serious noncardiac disease.


Radiation-related pericarditis.

Radiation-related pericarditis. To determine the incidence of pericardial effusion in patients undergoing upper mantle radiation therapy, 81 patients with Hodgkin's disease, stages I to IIIB, were selected from a protocol series of 98 patients. Twenty-four patients (29.6 percent) met X-ray criteria for the presence of pericardial effusion. Eleven of the 24 also underwent right heart catheterization to confirm the presence of pericardial effusion and to define any hemodynamic abnormality. Fourteen patients were found to have transient effusion. Five of the 11 patients have had partial pericardiectomy for symptoms and signs of cardiac tamponade. There has been no evidence of recurrent Hodgkin's disease in these surgically treated patients. Ninety-two percent of the pericardial effusions occurred in the first 12 months after the end of radiation therapy. Therapeutic implications depend on elucidation of the natural history of this process. At present close follow-up is necessary with surgical intervention for signs or symptoms of cardiac tamponade.


Natural history of aortic and mitral valve disease. An appreciation of the natural history of acquired valvular heart disease is a prerequisite to an understanding of how surgical intervention has altered the natural outlook. The prognosis for a patient with valvular heart disease treated medically is dependent on the stage of the disease at which he is first seen. Therefore, assessment for surgery requires evaluation of the pathophysiologic consequences that have resulted from the hemodynamic alterations. Survival statistics for patients seen at the University of California Medical Center at San Francisco are presented and compared with the data of others. Stenotic lesions appear to have a poorer prognosis than chronic regurgitant lesions and generally warrant surgical intervention at an earlier functional stage of the disease. However, valvular insufficiency produced acutely is poorly tolerated and many constitute a surgical emergency.


Long-term follow-up of isolated replacement of the aortic or mitral valve with the Starr-Edwards prosthesis. Review of 1,684 cases of isolated aortic or mitral valve replacement with a Starr-Edwards prosthesis demonstrated that the procedure provides improved life expectancy over that found in the natural history of valvular heart disease. Further improvement in results depends on continued reduction in operative and late mortality and in the incidence of thromboembolism. Advanced preoperative functional class, atrial or ventricular enlargement, a history of prior heart surgery, advanced age at operation and untreated valvular disease were among the factors related to increased early or late mortality. The data suggest that adequate anticoagulation, earlier performance of valve replacement and more complete repair of valvular dysfunction may increase survival rates.


Influence of surgery on the natural history of rheumatic mitral and aortic valve disease. The rate of survival, the evolution of functional cardiac status and the incidence of major complications during a 5 year period were studied in 410 patients with rheumatic mitral or aortic valve disease, of whom 200 were treated medically and 210 by surgery. The 5 year survival rates in patients with various types of rheumatic mitral valve disease were similar (45 percent for those with mitral stenosis and 46 percent for those with mitral insufficiency or mixed mitral insufficiency and stenosis). The survival rate in patients with aortic valve disease was somewhat more favorable (64 percent). Mitral valvulotomy had the most positive influence on mortality. The 85 percent 5 year survival rate of patients who underwent this procedure was significantly higher than that of patients with medically treated mitral stenosis. In patients submitted to mitral and aortic valve replacement, the survival rate was also improved in comparison with data in the corresponding medically treated group, but to a lesser degree (70 percent for aortic valve replacement and 60 percent for mitral valve replacement). In all surgically treated groups, initial operative mortality was the primary determinant of the rate of survival at the end of 5 years. Survivors of all surgical groups had appreciable improvement in cardiac functional classification and a remarkable reduction in the incidence of heart failure and atrial fibrillation. The incidence of infectious endocarditis was significantly reduced after mitral valvulotomy, as compared with the incidence in patients with medically treated mitral stenosis. Mitral and aortic valve replacement did not reduce the incidence of infectious endocarditis. The incidence of thromboembolic phenomena was favorably influenced by mitral valvulotomy and aortic valve replacement, but not by mitral valve replacement.


Effects of alcohol on cardiovascular performance after experimental nonpenetrating chest trauma. Electrocardiographic and hemodynamic correlates were recorded before and after a standardized nonpenetrating blow to the chest in 9 anesthetized control dogs (Group I), 5 dogs, pretreated with alcohol, 0.4 g/kg intravenously (Group II), and 12 dogs undergoing chest trauma after alcohol infusions (Group III). In animals in Group I, transient major arrhythmias, including complete heart block and ventricular tachycardia, occurred immediately after impact. One animal died with ventricular fibrillation. In the eight survivors these disturbances were accompanied by acute reductions in aortic pressure and cardiac index; values for both variables gradually increased after restoration of sinus mechanism. Alcohol alone (Group II) produced no significant alterations in either hemodynamic performance or electrical activity, but when combined with nonpenetrating chest injury (Group III) it caused a mortality rate of 92 percent, the majority of animals dying with electromechanical dissociation. Mean survival time in Group III was 23.1 plus and minus 6.5 (standard error of the mean) minutes compared with 80.3 plus and minus 9.6 minutes in Group I. At autopsy, minor cardiac lesions of either the pericardium or myocardium were observed in all animals in Groups I and III, but none were considered lethal. It is concluded that administration of alcohol, even in small doses, can effect catastrophic reductions in mechanical performance in the presence of otherwise nonfatal cardiac injury secondary to nonpenetrating chest trauma. The clinical implications of this association are discussed.


Effects of myocardial hypoxia and ischemia on myocardial scintigraphy. The effect of regional myocardial ischemia and hypoxia on myocardial scintigraphy was studied in patients and dogs after intravenous administration of cesium-129. Seven men with angiographically proved ischemic heart disease underwent exercise testing and 129Cs was given immediately when ischemia was manifested in the electrocardiogram. Defects were not evident in the scintigrams of any patient. Failure to visualize a defect might be related to delayed uptake of 129Cs by the myocardium (maximal uptake in 45 minutes). The ischemic state was dissipated before the disparity in uptake between normal and ischemic myocardium could be visualized. Cesium-129 is useful for identifying acute myocardial infarcts but should not be used to visualize transient exercise-induced regional ischemia. Six dogs were given 129Cs after induction of regional myocardial hypoxia by perfusion of the anterior descending coronary artery with venous blood. In each, scintigraphy revealed a defect that resolved after reperfusion with arterial blood. Two other dogs were given 129Cs before perfusion with hypoxemic blood; neither dog manifested a defect. Since perfusion was maintained by a pump these results suggest that the major cause of the scintigraphically observed defect was inadequate cellular uptake of 129Cs rather than excessive cellular loss. Since regional myocardial hypoxia produced a reversible defect, scintigraphic studies might overestimate the size of an acute myocardial infarct in man by including the ischemic zone surrounding the infarct.


Ventricular performance in patients based upon rate of change of power during isovolumic contraction. Energy is expended by the ventricle during isovolumic contraction as the blood within the ventricle is compressed. This isovolumic energy of compression, as well as the isovolumic rate of energy transfer (power) and acceleration of energy transfer (rate of change of power), was calculated in 17 patients with angina pectoris who underwent diagnostic cardiac catheterization. The peak isovolumic rate of change of power in patients with normal left ventricular performance (based upon the ejection fraction, mean velocity of circumferential fiber shortening and end-diastolic volume index) was 31,000 plus or minus 3,000 dynes cm sec-2 (mean plus or minus standard error), whereas in those with poor ventricular performance it was 18,000 plus or minus 2,000 dynes cm sec-2 (P less than 0.01). None of the patients with poor ventricular performance had a peak isovolumic rate of change of power that exceeded 25,000 dynes cm sec-2. Overlap between patients with normal performance and those with reduced performance was less with the peak rate of change of power than with peak power, peak rate of change of intraventricular pressure (dp/dt), maximal (dp/dt)/p or Vmax. The derivation of these isovolumic energy transfer rates requires no assumptions related to ventricular geometry or characteristics of muscle fibers. Peak isovolumic rate of change of power may be a useful and sensitive indicator of ventricular performance in patients with coronary artery disease.


Isovolumic fractional rate of change of power: its applicability to assessment of ventricular performance in patients. The ratio of the instantaneous isovolumic rate of change of power, normalized to instantaneous isovolumic power, appears to be an expression of physiologic and practical significance. This ratio, termed the isovolumic fractional rate of change of power, describes the capability of the ventricle to sustain, during isovolumic contraction, an acceleration of energy production relative to instantaneous rates of energy production. The expression is independent of assumptions of ventricular geometry, fiber orientation, symmetry of contraction or elasticity of muscle fibers. It was derived upon the basis of established principles of fluid dynamics. The expression serves in an integrative fashion by demonstrating a simple relation between characteristics of performance derived on the basis of fluid dynamics and those derived on the basis of muscle mechanics. In this study, the isovolumic fractional rate of change of power permitted distinction between patients with normal and abnormal ventricular performance (as characterized by the ejection fraction, mean velocity of circumferential fiber shortening and end-diastolic volume index) (P less than 0.01). The firm theoretical basis of the isovolumic fractional rate of change of power, and its demonstrated capability to permit identification of patients with normal or abnormal left ventricular performance, recommends it as a meaningful and useful hemodynamic expression.


Solitary interruption of the arch of the aorta. Clinicopathologic review of eight cases. Patients with isolated total interruption of the arch of the aorta not accompanied by other cardiovascular anomalies may survive to advanced age. Their symptoms and course resemble those of patients with postductal coarctation of the aorta. However, there are basic differences in the pathologic findings in these two types of anomalies that may be of aid in the radiographic diagnosis.


Electrophysiologic effects of the antiarrhythmic agent disopyramide phosphate. The electrophysiologic effects of the antiarrhythmic agent disopyramide phosphate given intravenously were studied in 10 patients with cardiac disease. Studies included determinations of sinus recovery time and refractoriness of the atria, the atrioventricular (A-V) node and the His-Purkinje system. Measurements were performed at rest and 15 and 30 minutes after administration of disopyramide. Serum drug levels were measured at these times. Sinus recovery time was shortened at both 15 and 30 minutes, with an average decrease of 39.5 and 146.2 msec, respectively (P less than 0.01). Atrial refractoriness was not altered significantly, but tended to be reduced; the mean effective refractory period was 289.5 msec before administration of disopyramide and 259 and 270 msec 15 and 30 minutes, respectively, after administration. The functional refractory period of the atrioventricular (A-V) node was definitely prolonged in seven patients 15 minutes after administration of disopyramide. The relative refractory period of the His-Purkinje System was not altered. Although this study does not elucidate the mechanism by which disopyramide acheives its antiarrhythmic effects, animal work has shown that it is similar to that of quinidine. In the doses used the drug does not seem to cause first, second or third degree A-V block or fascicular or bundle branch block; it did not increase the severity of first degree A-V block in the three patients with this disturbance. The drug may be particularly useful when arrhythmias are associated with slow sinus rates.


Electrocardiographic manifestations of dual pathways of retrograde impulse conduction in the human heart. Three cases are presented in which the electrocardiogram provided evidence for the functioning of two separate pathways of retrograde impulse conduction. In the first case, distinct points of entry of the impulses into the atria are inferred. In the second case, the origin of the retrograde impulses was created by the stimuli of an artificial pacemaker. In the third case, the operation of two pathways of retrograde conduction was evidenced by the demonstrated differences of the refractory periods and the conduction velocities. Each of the three cases reflects a particular aspect of the phenomenon.


Conduction system in systemic lupus erythematosus with atrioventricular block. We describe the clinical course and the postmortem cardiac findings in a 12 year old girl with systemic lupus erythematosus, complete heart block, renal failure and hyperkalemia. The conduction system was examined by serial section. The sinoatrial and atrioventricular nodes were found to be almost completely replaced by granulation tissue; we believe that this finding is related to the systemic lupus. The hyperkalemia is not considered to be the cause of the block, since the block persisted despite the lowering of the blood potassium level and the morphologic findings in this case are not found in hyperkalemia.


Myocardial infarction due to coronary atherosclerosis in three young adults with systemic lupus erythematosus. Three patients, 24, 24 and 25 years of age, with systemic lupus erythematosus had signs of myocardial infarction. Two had serial electrocardiographic changes indicative of infarction without any cardiac symptoms. The third patient had clinical evidence of an acute massive myocardial infarction, which was proved at autopsy to be due to coronary atherosclerosis. This case is presented in detail and the association between systemic lupus erythematosus and myocardial infarction is reviewed. It is postulated that the relation between lupus erythematosus and coronary atherosclerosis is more than coincidental.