The effect of emboli upon intrapulmonary receptors in the cat. The effect of successive injections (on the activity from pulmonary stretch, irritant and type J receptors) of 0.1 g aliquots of either potato starch or plastic sheres was examined in artificially ventilated, anaesthetized, open chested cats. The discharge from nineteen pulmonary stretch receptors was altered after embolisation and mean maximum changes of 10% were observed in peak frequency and spike count per respiratory cycle. The activity from twelve of fourteen irritant receptors was changed after embolisation, mainly in the form of an increase of an existing, respiratory modulated discharge. O f ten type J receptors examined, six were stimulated after embolisation to produce an erratic pattern of discharge. The response of the three groups of receptors appeared to be independent of the size of the emboli. Histological examination showed scattered emboli in capillaries and columns in arterioles, according to particle size. It is likely that all three receptor types are involved in the reflex tachypnoea induced by pulmonary embolisation, since the changes in afferent vagal discharge occurred at or before the onset of the reflex respiratory events.


Increased elastic recoil as a determinant of pulmonary barotrauma in divers. The elastic and conductive behaviour of the lungs were studied in sixteen divers during an interrupted deflation from total lung capacity (TLC.) The results in six divers, who had suffered pulmonary barotrauma (PBT) during shallow water diving, were compared with the findings in a control group of divers. Conductive behaviour and mean lung volumes were similar in the two groups. Compared with the control group, the PBT group had higher maximum transpulmonary pressures and a lower static pulmonary compliance, and deflated their lungs earlier. In relatively stiff lungs, an even distribution of elastance may increase susceptibility to barotrauma, because the more compliant zones are subjected to a greater strain. Pulmonary barotrauma appears to select from the total population of healthy divers those with lungs of decreased distensibility.


Respiratory characteristics of blood from Basenji dogs with classical erythrocyte pyruvate kinase deficiency. The oxygen affinities of blood from eight Basenji dogs homozygous for classical erythrocyte pyruvate kinase deficiency and four dogs heterozygous for the defect were compared with blood from 14 Labrador retrievers and two normal Basenji dogs. The homozygous dogs showed significant anemia compared to heterozygous and normal dogs (P is less than 0.01). The average blood P50 value (at 38C and plasma pH of 7.40) for both homozygous and heterozygous dogs was significantly higher (P is less than 0.01) than for normal dogs (33.6+/-0.4 and 31.8+/-0.7 vs 30.8+/-0.6 mm Hg). The concentrations of 2,3-DPG in the blood of both heterozygous and homozygous dogs were significantly higher than normal values. Four months after splenectomy P50 values declined to normal in four homozygous Basenji dogs without any change in the degree of anemia or blood 2,3-DPG concentrations. Iron kinetic studies showed a shorter plasma clearance time in a homozygous than in a normal dog with the heterozygote falling midway between. The red cell life span in the normal and heterozygous dogs was approximately 120 days. The 59Fe studies on the homozygous dog indicate markedly different survival characteristics which can be attributed to the existence of three populations of red cells differing in their life spans.


Convection, diffusion and cardiogenic mixing of inspired gas in the lung; an experimental approach. In 8 open-chested dogs, we measured the FN2 within 26 airways, 2.5-8.6 mm in diameter, during constant flow inflations with 0.5 liter of O2. At low flows the FN2 did not fall to zero but reached a plateau, at a value that was inversely related to inspiratory flow. When inspiratory flow is constant, the measured FN2 represents one point on a stationary front separating inspired and alveolar gas. At all points on the front the convective and diffusive transport of N2 is equal and opposite in direction. We quantitated cardiogenic gas mixing by comparing in vivo and post mortem the flow which resulted in a given stable FN2 value within the same airway. In vivo, this flow and therefore the calculated effective diffusion coefficient (D') was more than 5 times greater than that post mortem. Our results confiem some of the predictions made from model analyses of gas transport in the lung. However, calculations based on molecular diffusion as the sole mixing mechanism necessarily overestimate diffusion times and the magnitude of stratification.


Effects of local and systemic hypercapnia on the discharge of stretch receptors in the airways of the dog. We have investigated the effects of local and systemic administration of 8% CO2 on the afferent discharge from slowly adapting stretch receptors located in a functionally isolated, in situ segment of trachea and extrapulmonary bronchi in dogs. Stretch receptors situated in the trachea were not affected by hypercapnia. Discharge from bronchial stretch receptors was diminished by local CO2 administration, especially at low airway transmural pressures. Systemic hypercapnia was generally ineffective. The results indicate that stretch receptors in extrapulmonary bronchi are more accessible to CO2 in the airway lumen than to perfusion with hypercapnic blood.


The enzymology of nasal secretion.

The enzymology of nasal secretion. Normal human nasal fluid contains several enzymes of the intermediary metabolism as well as a specific protease inhibitor, which inhibits trypsinm chymotrypsin and leucocytic proteases. During the course of acute and chronic nasal and paransal sinus infections the inhibitor level varies. The inhibitor level is an indicator of poor healing. It is possible too, to differentiate viral rhinitis from bacterial or allergic or atrophic rhinitis by a signigicant increase of the activities of the enzymes GOT, LDH and CPK.


Nasal cytology as a nasal test.

Nasal cytology as a nasal test. For years the presence of eosinophils has been considered a reliable diagnostic sign in the detection of nasal allergy, but little attention has been paid to the occurrence of other cellular elements. A complete study of hematogenic and epithelial cellular elements gives valuable information about the character of the rhinitis; i.e. is it caused by allergy or infection, or by both? The vitality of the mucosa, i.e. hyperfunction and atrophy, can also be assessed.


The diagnostic value of intranasal tests in allergic rhinopathy. The method of the intranasal test, used by us, is described. It consists in a direct application of the allergen, which is presumed after a pilot-skin-test. The resulting reaction is documented by rhinomanometry. The special technical aspects of the test and the sources of error are emphasized.


Electromanometric function test of the nasofrontal duct. An electromanometric methods for the quantitative measurement of the ventilation of the frontal sinus is described which also measures the resistance of the nasofrontal duct to an experimentally produced hydrodynamic current. The biophysical basis as well as typical results of the examination are demonstrated and the field of clinical application in the differential diagnosis of frontal sinus affections is outlined.


The present status of rhinomanometry.

The present status of rhinomanometry. Rhinomanometry is today a routine method that may be used in private specialist practice, if X-Y recording is used. The results become clinical statements only when directly compared with mirror findings, i.e. by functional analysis of structure or when physiological variance is taken into account by reagibility tests. In those cases this elegant technique becomes indeed indispensable.


[Chromatographic analysis of urinary amino acids in Paget's disease. I : Biochemical study. Isolation and amino acid composition of a urinary peptide specific to this bone disease]. The authors demonstrated in the urine of patients presenting Paget's bone disease a peptide rich in hydroxyproline. The level of this compound expressed as "norleucine equivalent" was determined by chromatographic analysis of the urinary amino acids. There was a very good correlation between the total hydroxyproline level and the quantity of this peptide in the urine. The authors isolated this peptide and determined that it contained 3 hydroxyprolines for every 2 glutamines. This peptide thus seems to indicate an anomaly in the chain of synthesis; a disorder of the collagen metabolism would produce in these patients large quantities of these molecules that are excreted via the kidney. At the present stage of the author's studies this urinary peptide appears to be "specific" to Pagets disease.


[Chromatographic analysis of urinary amino acids in Paget's disease. II : clinical study]. The authors demonstrated in the urine of certain patients a peptide form of hydroxyproline and of glutamic acid. This peptide was found in patients with Paget's disease who presented clinical and laboratory signs of an evolutive episode and in other patients who presented restructuration of bone of a radiologicaly type. This peptide was one of the factors determining the increase in the total hydroxyprolinuria. The demonstration of the peptide provokes discussion as to its origin, and also of the possibility of using it as a biochemical parameter.


[Periodic disease (familial paroxysmal polyseritis). 52 cases]. On the basis of well defined diagnostic criteria, the authors conclude that periodic disease affects males in particular. It commences before the age of 20 years in 80 percent of cases. In particular it occurs in Armenian and Shiite communities. Its evolution is normally benign ; amyloidosis is found in only 8 percent of cases. Joint manifestations are found in 48 percent of cases and may take on different aspects and occur in several different sites : myaglia or arthralgia, monoarthitis, oligoarthritis, polyarthritis, neck or sacroiliac pain. The authors have not noted prolonged peripheral joint episodes. No cases of amyloidosis were diagnosed before the appearance of the clinical signs of the disease. An autosomal, dominant heredity with incomplete penetration seems to be the most likely hypothesis.


[Xeroradiography : possibilities and value in osteo-articular pathology]. The authors report their first experiences with a new method of obtaining radiological information : radioxerography. Based on physical principles, replacing the older chemical basis, this new technique makes it possible to improve greatly, and with fewer exposures, the amount of information that can be obtained from radiological investigations. The advantages of the new method, based on the edge effect, the selectivity of the contours, and the spreading of the contrast, make possible much improved definition of both the bone structure and that of the neighbouring soft tissues. With reference to these first experiences, the authors summarize the possibilities and the preferred indications of the method, which although it remains a complementary and not a substitute method, appear very interesting and full of promise for the future.


[Dorsal tenosynovectomy of the wrist in rheumatoid arthritis. Results obtained in 30 cases]. With reference to a series of thirty synovectomies of the wrist in patients with rheumatoid arthritis, the authors report the results observed after an average interval of three years and six months. There was a remarkable reduction in pain in three-quarters of the cases. On the other hand, loss of mobility was noted in 15 patients. Resection of the cubital head was carried out in half of the cases. This was followed in two cases by internal translocation of the carpus, and in three cases by internal translocation combined with cubital inclination of the hand. The results of the tenddon repairs carried out in six patients have been completely satisfactory. A study of the present cases and of data from the literature confirms the local prophylactic value of tenosynovectomy which may also prevent tendon ruptures. The best result are seen in the less evolutive forms in which the risk of relapse is least, and in cases in which surgery is carried out on stable wrists with cartilage showing little alteration. In the presence of inferior radiocubital arthritis the resection must be systematic as it makes it possible to carry out a complete synovectomy of this joint. The authors compare the value of surgical synovectomy of the wrist with that of radioactive synoviorthesis.


[Antibody-dependent cytotoxicity of blood lymphocytes during rheumatoid polyarthritis]. Lymphocyte dependent-antibody cytotoxicity (LDAC) was studied in 29 patients with rheumatoid arthritis (RA) and 22 controls. A significant increase of cytotoxic index has been noted in RA patients (p less than 0.0001) whatever the ratio effector-target cells could be. There is a correlation between cytotoxic activity and so called "rheumatoid rosettes" (RR) level. This cytotoxic activity is linked to EA rosette forming cells without T cell markers or surface immunoglobulins, as shown by fractionation experiments. EA rosette forming cell depletion is followed by the disappearance of RR and a very important decrease of cytotoxic index. Cytotoxic activity is abolished after RR forming cell depletion while EA rosette level is nearly unmodified. RR forming cells belong to Fc receptor bearing lymphoïd population. They take place in EA rosette forming cell population. Increase of cytotoxicity in RA seems to be directly linked to these so called RR forming cells.


[Use of Dodger filters in osteoarticular radiology]. Dodger filters represent considerable progress in the harmonization of the contrast in radiography by modulation of the incident Y-ray beam. The originality of these filters is related to three factors: the mobility of the filter elements, their shape, and in particular the presence of a specific optical system that makes it possible, by demonstrating the filter lines with a luminous ray, to predict and adapt the attenuation effects obtained. Osteo-articular radiology can now be viewed in a new light, as it is possible with Dodger filters to obtain on a single fim, valid images of the whole of the bony structure of a region as well as of the corresponding soft tissues.


[Radiologic study of the jaws in the course of myeloma. A propos of 111 cases]. The authors studied the radiological manifestations in bone in 111 patients suffering from multiple bone myeloma. The analysis deals mainly with the maxilla, and in particular with the lower maxilla which was the site of myelomatous lesions in 49 cases. The authors describe two different types of image observed and the radiological methods used, and they discuss the principal problems of diagnosis. They emphasize the diagnostic value of systematic study of this site, which may be solitary, without a concomitant lesion of the cranial dome in particular.


Improved electrophoretic resolution of human serum alkaline phsophatase isoenzymes in agarose gel by Triton X-100. Triton X-100 caused the liver isoenzymes of alkaline phosphatase in some serum samples to separate into two fractions on agarose gel electrophoresis. One of these fractions migrated at the rate of the original one, and one migrated more slowly. The latter fraction corresponded to a fast-moving component on electrophoresis in Cellogel and seems to be identical with a slowly moving isoenzyme in starch and polyacrylamide gel electrophoresis. The migration rates of the bone, placental, and intestinal isoenzymes were unaltered, but the fractions appeared sharper.


Endothelial and bile canalicular alkaline phosphatase in human liver and serum. The alkaline phosphatase in homogenates of human liver was separated into two components by the addition of Triton X-100 to an agarose gel electrophoretic system. One of these components migrated at a rate identical to that of the original one and similar to alpha2-macroglobulin. The other component migrated more slowly, at a rate that resembled that of beta1-transferrin. Human serum samples regularly contained an identical fast-migrating fraction, whereas an identical slowly migrating fraction only appeared in serum obtained from patients with various diseases, especially from patients with malignant tumours, even though the liver did not contain tumour metastases. Slow isoenzyme was found in a few sera that had alkaline phosphatase activity within the normal range. Histochemical examinations of liver tissue from patients whose serum contained the slowly migrating isoenzyme showed a pronounced reaction of alkaline phosphatase in the bile canaliculi, and this isoenzyme seems to arise from the canaliculi. The fast-migrating isoenzyme might arise from the endothelial cells of the liver, to which the activity is usually confined in histochemical stainings.


The early serum insulin response to intravenous glucose in patients with decreased glucose tolerance and in subjects with a familial history of diabetes mellitus. Intravenous glucose tolerance tests with estimations of K values and measurements of serum insulin concentrations at 0, 4, 6, and 8 min after the start of the glucose injection were performed in connection with a health examination survey of middle-aged men. The possible predictive value for later diabetes mellitus of early serum insulin response after intravenous glucose administration was evaluated by studying subjects with a familial history of diabetes mellitus and patients with different degrees of glucose intolerance. The following conclusions were drawn: The early appearance of glucose-stimulated serum insulin should be studied during the first 6 min after start of the glucose injection. The advantage of making calculations for early insulin secretion by including approximate considerations of the fractional removal rate of serum insulin is not apparent. Serum insulin values in patients with decreased glucose tolerance and subjects with a familial history of diabetes mellitus were best characterized by an insulin concentration index (glucose-stimulated early serum insulin concentration divided by basal serum insulin concentration). This index was significantly lower in these groups than in healthy controls.


Further methodological studies on the intravenous fat tolerance with Intralipid emulsion. Factors affecting the reproducibility of the intravenous fat tolerance test (IVFTT) with the Intralipid emulsion have been studied in man. Temperature variations of the emulsion at the time of injection did not affect the fractional removal rate k2. Plasma samples could be treated at room temperature without affecting the k2 value. Linear k2 slopes were obtained also in pronounced hypertriglyceridaemia, which suggests that the test can be applied in subjects with wide ranges of serum triglyceride (TG) concentrations. In subjects with a wide range of serum lipids but at steady state with regard to lipid metabolism, the IVFTT was found to be highly reproducible when repeated with intervals of up to 6 months. Furthermore, the turnover of serum TG, determined as the product of the fractional removal rate and the serum TG concentration, was constant. Most Intralipid batches gave identical k2 results. In some comparisons, batches were found which gave k2 curves significantly different from the standard batches. It is recommended that the IVFTT is carried out only with Intralipid emulsions that have been standardized in this respect.


The postanoxic regeneration of 5'-adenosine nucleotides in rabbit kidney tissue during in vitro perfusion. The adenylate metabolism in rabbit kidney tissue was investigated, by isolated normothermic bloodless perfusion, during anoxic cell deterioration and postanoxic recovery in vitro. The amounts of hypoxanthine washed out during continuous anaerobic perfusion were shown to represent a definite loss of intracellular purine. No salvage of the endogenic liberated oxypurine was found to occur during postanoxic reoxygenation. The ability to restore the content of 5'-adenosine nucleotides failed after 60-120 min of anaerobic perfusion. Adenosine, adenine, inosine, hypoxanthine, and D-ribose added to the perfusate during reoxygenation were investigated with regard to their ability to stimulate postanoxic adenylate regeneration. Adenosine alone added in a concentration of more than 1 mmol/l showed a significant stimulation of the adenylate synthesis, with complete regeneration of the adenylate content after 180 min of preceding anoxia. In can be concluded that anoxia kidney deterioration is associated with a progressive loss of intracellular oxypurine, and a decreasing ability to regenerate adenylates after reoxygenation, which could be prevented by exogenic addition of adenosine. It appears reasonable to assume that the results obtained reflect the adenylate metabolism of a kidney graft during the postischaemic phase immediately after implantation.


The influence of dye infusion rate and hepatic plasma flow on indocyanine green clearance. The plasma clearance and extraction ratio of indocyanine green (ICG) were followed in cats anesthesized with chloralose. In one series of experiments the ICG infusion rate was raised stepwise and in another the hepatic plasma flow was changed by replacing part of the blood volume with erythrocytes, plasma, or dextran (Macrodex). For unknown reasons blood replacement with Macrodex increased the ICG elimination. Both plasma clearance and extraction ratio were independent of ICG infusion rate but dependent on hepatic plasma flow. In contrast, a clearance calculated from the dye elimination rate and the estimated average hepatic plasma concentration of ICG was independent of changes in hepatic plasma flow. In conclusion, plasma clearance and extraction ratio of indocyanine green are not ideal for estimation of liver function. However, when clearance is calculated from the average hepatic plasma concentration of the dye, it becomes independent of hepatic plasma flow and thus a more reliable index of liver function.


Systematic difference of extrarenal background in left and right kidney regions at renography. The problem of whether the extrarenal sodium [131I]iodohippurate background activity at renography is higher in the right kidney region than in the left was studied by analyzing data from 711 consecutive renographies. The 3 conical collimators had an aperture diameter of 78 mm, an internal diameter at crystal surface of 50 mm, and a skin-to-crystal surface distance of 115 mm, thus allowing the radioactivity of almost the entire kidney to be registered with equal efficiency.


Influence of lactate infusion on glucose and FFA metabolism in man. Sodium L(+)-lactate was infused at rates of 5 to 12 mmol/min intravenously for 30 min in health volunteers, and the exchange of lactate, glucose, and free fatty acids (FFA) was measured in the leg, the forearm muscle, and the splanchnic region. Arterial lactate levels were 3 to 5 mmol/l during the infusion. Leg blood flow increased about 2.5-fold and leg oxygen uptake rose by 35%. Blood flow, oxygen uptake, and glucose production in the splanchnic area remained unaltered. The fractional uptake of lactate by the leg, the splanchnic region, and the forearm decreased during the course of the infusion.


A simple pressure calibrator.

A simple pressure calibrator. A simple reliable, easy-to-use, and inexpensive device for obtaining any predetermined static gas pressure within +/- 35 cm H2O is described. It is suitalbe as a calibrator for pressure transducers as used in respiratory physiology. It is more convenient to use than an ordinary U-tube.


Serum bile acid concentration after a test meal. Total serum bile acid concentrations were studied by an enzymatic-fluorimetric method employing a highly purified 3 alpha-hydroxysteroid dehydrogenase. In 28 control subjects mean total serum bile acid concentration was 2.5 mumoles/1 (S.D. 1.4). In 6 healthy subjects a significant postprandial increase in total serum bile acids occurred with maximal values at 90 and 120 minutes after ingestion of a liquid test meal. The maximal postprandial increase for each subject was 1.5 to 3 times the fasting value. In 7 patients with various hepatobiliary diseases the maximal postprandial elevation of serum bile acids was higher than in the normals, and the duration of serum bile acid elevation was significantly prolonged. In the patients with normal fasting concentration of bile acids the postprandial elevation was also significantly greater than in the controls. A 2-hour postprandial sample seems suitable for the study of the bile acid test meal response for clinical use.


Familial 'minor' adenomatous polyposis coli associated with gastric carcinoma - a hiterto undescribed phenotype of polyposis coli? A clinical study of a family (Sch.) with a high incidence of death from gastric cancer in the second generation is presented. Endoscopic and/or surgical evaluation of the stomach, upper small intestine, and colon in 14 mainly asymptomatic members of the third and fourth generations revealed single or multiple (solitary) papillary adenomas in the colon or jejunum in 2 members each of the two generations. In addition, single or multiple hyperplastic polyps in the stomach or colon were found in 5 members, in 4 of them in association with papillary adenomas. The findings in family Sch. are consistent with 'minor' adenomatous polyposis coli associated with gastric carcinoma. Gastric carcinoma probably represents another phenotype among the vast variety of extra-colonic and extra-alimentary neoplastic changes known to occur in association with familial polyposis coli (FPC). The relationship of hyperplastic polyps to papillary adenoma in the colon and to gastric carcinoma respectively is discussed. Finally, evidence for a genetic relationship between family Sch. and a case with probable FPC is presented.


The diagnostic value of liver scanning. A retrospective study. Among 650 consecutive radioisotope liver scans there were selected 180 representing all cases in which a pathoanatomical evaluation of the liver was available. The scanning data, the clinical information, and the pathoanatomical diagnosis were reviewed independently, and the results achieved in each group were classified as evidence of normal liver, focal hepatic disease, or diffuse hepatic disease. Using pathology for verification scanning had a sensitivity of 97% and a specificity of 90% regarding detection of unspecified liver disease, which was significantly better than clinical setting alone. In diffuse hepatic disease scanning had a sensitivity of 100% and a specificity of 81%, whereas in the focal hepatic disease the corresponding figures were 78 and 97%, respectively. Passive hepatic congestion was recognized as a diffuse hepatic disease by scanning, thus representing a source of error in screening for liver disease sensu stricto. It is concluded that scanning, apart from being a rapid and simple procedure without significant inconvenenience to the patient, is a very accurate diagnostic tool that deserves more recognition in clinical departments.


Acid-base status in liver cirrhosis. Disturbances in stable, terminal and portal-caval shunted patients. Acid-base status was determined in 86 patients with cirrhosis of the liver. Group I comprised 55 patients living more than 3 months after examination (stable). Another 18 stable patients with a surgical porta-caval shunt (p.c.a.) formed group II. Group III consisted of 12 terminal patients without p.c.a. examined within the last week of life. With respect to liver function group II was intermediate between I and III. The most common acid-base disturbance in group I was compensated respiratory alkalosis (20%) followed by compensated metabolic alkalosis (15%). 50% of group II presented compensated respiratory alkalosis. 85% of group III showed metabolic acidosis, which was compensated in only half of the patients. Respiratory alkalosis seemed more related to impairment of liver function than to portasystemic shunting. The genesis of the terminal metabolic acidosis was  complex. Renal function was reduced in 92% of group III, and lactic acidosis was found in 36%. In this group hepatic function was most severely impaired, and 60% were hypotensive. These disturbances were not related to aetiology or treatment of the liver disease.


The demographic and social characteristics of patients with Crohn's disease in the Nottingham area. All 260 patients diagnosed as having Crohn's disease between 1958 and 1973, in the Nottingham area, were sought and demographic and social characteristics obtained by personal interview. These were compared with the general population, using the 1971 census data. We  found significantly high proportions of patients who were female; married; in the age groups 20-39 and 60-54; and in managerial or skilled manual occupations.


The enteroglucagon response to intrajejunal infusion of glucose, triglycerides, and sodium chloride, and its relation to jejunal inhibition of gastric acid secretion in man. In a previous communication we demonstrated that pentagastrin-induced gastric acid secretion is strongly and equally inhibited by intrajejunal infusions of hypertonic glucose, hypertonic sodium chloride, and triglycerides. Samples of peripheral venous blood obtained during these experiments were now analysed for insulin, glucose, pancreatic glucagon, and enteroglucagon. Pancreatic glucagon was stimulated weakly only by triglycerides. Enteroglucagon secretion was strongly stimulated by glucose, moderately by triglycerides, and unaltered after sodium chloride. Insulin secretion was stimulated only during the glucose infusion. We concluded that enteroglucagon is not responsible for the jejunal inhibition of gastric acid secretion in man by jejunal administration of hyperosmolal NaCl solution but may participate in the inhbition evoked by jejunal administration of glucose of triglycerides. Furthermore, it is unlikely that enteroglucagon is in itself insulinogenic in man.


Immunological parameters, viral antibodies, and biochemical and histological findings in relatives of patients with chronic active hepatitis and primary biliary cirrhosis. The familial occurrence of immunological, virological, biochemical and histopathological abnormalities has been studied in 39 first degree relatives of patients with primary biliary cirrhosis (PBC) and in 58 first degree relatives of patients with chronic active hepatitis (CAH). Tissue antibodies were more frequent in relatives than in age- and sex-matched controls. Abnormal immunoglobulin levels were demonstrated in about half of the relatives. Very high antibody titres to measles and rubella occurred only in the relatives of the patients with CAH. Moreover the raised titres tended to be clustered in a few families in which also the propositi had very high viral antibody titres. Liver biopsy was performed only on the relatives with biochemical abnormalities. Unspecific inflammatory changes were observed in 5 relatives of the patients with CAH and in 4 relatives of the patients with PBC. An active liver disease was detected in two relatives of the PBC-group and in one of the CAH-group. A marked accumulation of various immunological and histopathological abnormalities in four families was observed.


On the mediation inflammatory reaction in the human gallbladder epithelium. Human gallbladder epithelium was homogenized with a view to maintaining the integrity of subcellular components. In such homogenates, N-acetyl-beta-glucosaminidase, beta-glucuronidase, beta-galactosidase, beta-glucosidase, beta-fucosidase, beta-xylosidase, and acid phosphatase were demonstrated together with phospholipase activity. All the enzymes exhibited structure-linked latency. After discarding cellular debris from the homogenate, remaining subcellular organelles were analytically separated by density gradient centrifugation. After 100,000 g for 1 hour, particles containing acid glycosidases were recovered at a sucrose density of 1.18-1.19, whereas the mitochondrial marker enzyme succinate-reductase accumulated at a density of 1.16. The bulk of sedimentable phospholipase activity was recovered with particles sedimenting at 1.18-1.19. The results are interpreted as indicating that phosphalipase is present in lysosomes of the human gallbladder epithelium. Release of acid hydrolases, in lysosomes of the human gallbladder epithelium. Release of acid hydrolases, in lysosomes of the human gallbladder epithelium. Release of acid hydrolases, particularly phospholipase A, from the gallbladder epithelium is discussed as mediation of an inflammatory reaction in the gallbladder, i.e. cholecystitis.


Effect of small bowel bypass on serum gastrin levels and gastric acid secretion in man. In animals massive resection of the small intestine is followed by increased gastric acid secretion and an increase in serum gastrin levels. Whether hypersecretion occurs in man after intestinal resections or intestinal bypass is unclear, but  an increase in fasting gastrin levels has been reported after intestinal resection. In this series a significant increase in basal gastric acid secretion and fasting serum gastrin levels has been demonstrated after intestinal bypass. However, none of the patients developed peptic ulcer or clinical symptoms of hypersecretion after the bypass operation. Whether the increase in basal secretion and the serum gastrin concentration are interrelated or of any clinical importance is uncertain.


Folic acid absorption in various gastrointestinal disorders. In a consecutive study of 228 patients with folate deficiency originating from various gastrointestinal and haematological disorders, the clinical value of the folic acid absorption (TRIFA) test is assessed. It is concluded that the test is a simple, rapid, and reliable index for folic acid malabsorption of importance as well as a research tool as in daily practice.


A controlled environmental culture system for the production of erythropoietin. A controlled environmental culture system in which consistent growth of fetal liver cells typical of the tissue of origin and capable of producing erythropoietin in culture is described. This system attempts to duplicate the major components of the natural habitat of the mammalian cell allowing for meaningful studies to be conducted on the regulation and control of erythropoietin biosynthesis. The direct effects of changes in pO2, pCO2, pH and various cell nutrients on cells producing erythropoietin is now possible.


Rarity of anaemia of pregnancy in Ethiopia. Hb and PCV values were studied in three groups of Addis Ababa women during their last month of pregnancy and compared with those in a control group of non-pregnant Addis Ababa women. Irrespective of socio-economic group and parity, the Hb and PCV values were almost identical in all four groups. In one of the three test groups, a group of 'non-privileged' multiparae, S-iron, S-transferrin (TIBC), S-folate and S-vitamin B12 were also examined and showed normal values. These findings indicate a rarity not only of true anaemia but also of 'physiological anaemia of pregnancy'. This latter may not, therefore, be an adaptive phenomenon of regular occurrence as has usually been assumed hitherto. The explanation for the aberrant haematological behavior in pregnant women living in highland Ethiopia is probably the lifelong exposure to a very high iron intake combined with hypoxia due to the high altitude.


Studies on lymphocytes XIII. Nuclear volume measurement as a rapid approach to estimate proliferative fraction. A rapid method for measuring volume distributions of human, calf and goat lymphocytes and their nuclei is described along with the type of quantitation these measurements can provide by computer analysis. The size distribution studies indicate the presence of two populations of lymphocytes and their nuclei irrespective of the cell source. It is suggested that proliferative fractions of various cell populations may be estimated by determining the nuclear volume distribution.


Acquired thrombophilia: a hitherto unrecognized procoagulant-antithrombin imbalance. Inherited, acquired and iatrogenic 'diseases of low antithrombin activity' share a common denominator: each is associated with an increased tendency toward, or incidence of, thrombosis. This suggested the possibility that these diseases constituted a distinct pathogenetic entity. Molecular models and clinical studies suggested 3 interrelated phenomena: increased serum procoagulants; decreased antithrombin; a tendency to thrombosis. The term 'Acquired Thrombophilia' is proposed to designate pre-thrombotic and thrombotic individuals presenting this non-inherited combination of laboratory and clinical findings. The antithrombin clotting time is shown to be inversely related to the level of circulating serine procoagulants, directly related to the level of antithrombin, and results from a procoagulant-antithrombin inter-molecular reaction. Patients with Acquired Thrombophilia have 'turned-on' or excessive procoagulants resulting in 'turned-off' or tightly bound antithrombin molecules.


Thrombocytopenia in childhood: an evaluation of 433 patients. An evaluation of 433 children with thrombocytopenia is presented. The material comprises all cases diagnosed in Denmark during the period 1959-1969. The incidence was found to be 31.9 cases per 1,000,000 inhabitants less than or equal to 15 years of age per annum with a peak at the age of 3 to 4 years; the majority of the cases was diagnosed in the spring. Preceding infection, usually associated with fever and localized in the upper respiratory tract, was the most common cause. The majority of the congenital cases was hereditary and associated with other malformations involving in particular the immune system. In about half of the cases the course was spontaneous and no treatment was necessary; the remaining patients were treated with glucocorticoids, including 46 patients, who had undergone splenectomy. 22 patients died, including 16 cases due to serious underlying disorders; in 6 cases the cause of death was haemorrhage (mortality rat=1.4%). At the follow up the platelet count was below 50 mia/1 in 14 patients (4%). No difference was found concerning the platelet count at the follow up between the patients with spontaneous recovery, the patients treated with glucocorticoids and the patients, in whom splenectomy had been performed. During the course the disease autoimmune haemolytic anaemia occurred in 2 patients, whereas no patient developed systemic lupus erythematosus.


Immunoelectrophoretic 'tailing' of albumin line due to albumin-IgG antibody complexes: a side effect of nitrofurantoin treatment? The immunochemical analysis of sera of 10 patients in which immunoelectrophoresis showed a cathodic, elongated, 'tailing' albumin (TA) line is described. Eight of the 10 patients had been treated with nitrofurantoin, and withdrawal of the drug was followed by disappearance of the phenomenon in 5 cases. Most of the patients had polyclonally elevated IgG and IgA levels and a decreased albumin level; IgM; C3, C4, and C1-INH were normal. Antinuclear activity of IgG type was demonstrated in the sera of 9 patients. The TA phenomenon was due to noncovalently bound complexes between IgG and albumin. The combining sites of the IgG molecules were in the Fab fragment. The antibody-like activity of the IgG was directed towards autologous albumin. The anti-albumin activity remained unchanged after absorption of the antinuclear activity. The nitrofurantoin-induced albumin-anti-albumin system may prove useful as a human model of autoimmune response of known aetiology.


Synthesis of secretory component by human colon cancer cells. Colon carcinoma, established in long-term tissue culture, has been shown to synthesize secretory component (SC). These molecules can be demonstrated both on the cell surface and in the cytoplasm by immunofluorescence. Regeneration of SC was demonstrable after trypsinization of the cells. In culture, two lines of carcinoma epithelium were shown to incorporate (14C) leucine into newly synthesized SC. These cell lines should provide useful preparations for studying the details of immunoglobulin-SC interactions.


The role of adherent cells in the immune response. Fibroblasts and products released by fibroblasts and peritoneal cells can substitute for adherent cells. The primary immune response to sheep erythrocytes in adherent cell-depleted cultures was restored by adding a critical number of peritoneal cells. Complete substitution was achieved also with supernatants from allogeneic and syngeneic peritoneal cells. Both living fibroblasts and supernatants from fibroblast cultures were found to be highly efficient substitutes for adherent cells in both syngeneic and allogeneic systems. Supernatants from non-antigen-reated peritoneal cells and fibroblasts caused increased DNA synthesis and induction of polyclonal antibody synthesis in normal spleen cells. Thus, adherent cells need not function in the immune response by presenting antigen to the B cells via 'IgT' or by releasing signal-2 activity, which acts on lymphocytes that have already received signal 1.


A Clq immunosorbent assay compared with thin-layer gel filtration for measuring IgG aggregates. A new sensitive technique measures C1q-binding of human IgG aggregates. The method is based on the principle of the enzyme-linked immunosorbent assay with C1q-coated tubes. The IgG aggregates attaching to this C1q are shown by enzyme-linked anti-human IgG. Less than 0.01 mug of aggregates per milliliter of sample can be detected. The results with this new method showed significant correlation (P less than 0.01; Spearman rank correlation test) with the estimates of IgG aggregates of 13S or more and 10S in size obtained by thin-layer gel filtration. Both of these methods showed significant correlation with the classic hemolysis inhibition method for measuring complement fixation.


A comparison of four methods for measuring cutaneous delayed- type hypersensitivity reactions to protein antigens in the mouse. Delayed-type hypersensitivity was induced in mice by injecting keyhole limpet haemocyanin or human serum albumin in Freund's complete adjuvant. Four techniques for assessing specific skin reactions in these immunized animals were compared: increase in thickness of the footpad; increase in thickness of the ear; arrival of 51Cr-labelled syngeneic lymph node cells at the challenge site in the ear; and accumulation of (125I)IUdR at the challenge site in the ear. The most sensitive and reliable test for detecting strong and weak reactions proved to be measurement of antigen-induced thickening in the ear.


Bacteroides bacteraemia. A clinical and bacteriological analysis of 51 patients. During a 7-year period Bacteroides bacteraemia was found in 51 patients, corresponding to 1.9% of all patients with positive blood cultures. Many patients had serious underlying diseases, most frequently in the gastrointestinal tract, and 80% were subjected to surgery. Frequent clinical findings were shock (27%), phlebitis (24%) and jaundice (22%). The overall mortality was 55%. Increased mortality was associated with shock, advanced age and phlebitis. Bacteroides fragilis, showing a very homogeneous biochemical pattern, was the species most frequently isolated. The strains were sensitive to chloramphenicol and tetracycline, and as a rule also to erythromycin. It was confirmed that Bacteroides isolated from the blood usually indicates true bacteraemia.


Treatment of oral candidiasis in debilitated patients with miconazole--a new potent antifungal drug. In 24 patients with advanced malignant diseases, mainly leukaemias and lymphomas, 35 episodes of oral candidiasis were treated with topical application of miconazole. Clinical cures were obtained in 100% of the episodes and mycological cures in 91% of the episodes after a mean treatment time of only 4.9 days, although most of the patients were severely granulocytopenic and were undergoing simultaneous treatment with cytostatics, prednisolone and antibiotics. Miconazole appears to be a remarkably fast-acting, reliable and non-toxic drug in the treatment of oral candidiasis.


Tuberculin anergy in patients with Mycoplasma pneumoniae infection. Skin testing for delayed hypersensitivity to tuberculin was performed in 36 patients with pneumonia associated with Mycoplasma pneumoniae infection. 22 of these patients had a negative tuberculin reaction when first tested. The tuberculin reaction was negative in 13 out of 16 cases tested during the first 2 weeks after onset of illness, in 6 out of 11 cases tested 15-28 days after onset of illness and in 3 out of 9 cases tested 29-45 days after clinical onset. In 19 patients with a negative tuberculin test in the early phase after onset of illness the test was repeated several weeks or months later. 16 of these cases had a positive tuberculin reaction at the later time period. Two of these cases showed prolonged tuberculin anergy for more than 5 months.


Bacterial endocarditis at Blegdamshospitalet in Copenhagen 1944-1973. The clinical pattern of 34 cases ob subacute bacterial endocarditis (SBE) and 46 cases of acute bacterial endocarditis (ABE) is outlined. In the SBE group the mortality was 9% and the incidence of major complications during the treatment period was 15% for cerebrovascular accidents, 9% for other systemic or pulmonary emboli and 9% for congestive heart failure indicating valvular damage. In 31 bacteriologically proven cases growth was obtained in 68% of all blood cultures, and in 94% of the cases at least one positive culture was among the first 5 ones drawn. In the ABE group the overall mortality was 72% and mortality for cases occurring after 1960 was 58%. Major factors contributing to death were valvular incompetence, uncontrolled infection and embolisation. In order to reduce major complications and resulting disability in SBE it is suggested that treatment be started on clinical suspicion as soon as 5 blood cultures have been drawn over a period of 48 hours. Attempts to reduce mortality in ABE may include cardiac surgery in the acute phase.


Induratio penis plastica Peyronie's disease. Clinical features and etiology. The clinical and laboratory findings in 106 patients with Peyronie's disease as well as histopathological examinations of biopsies from the plaques were studied. The clinical symptoms and signs were in general similar to those found in previous studies, but bone marrow smears showed an increased number of plasma cells and lymphocytes in 18 of 24 examined. Biopsy of the plaque in cases of long-term symptomatology disclosed a fibrosis poor in cellular components. In patients with a short history of the disease and a tender induration, an inflammatory component of the specimens with perivascular accumulation of lymphocytes and balooning of endothelial cells in the small vessels was seen. Characteristic cells with "cross-banded" nuclei, described earlier only in Dupuytren's contracture and experimental fibrosis, was observed for the first time in Peyronie's disease. Based on these findings a combined traumatic-immunological etiology is suggested.


Induration penis plastica. Experience of treatment with procarbazine Natulan. Eighteen patients with plastic induration of the penis were treated with procarbazine, a cytotoxic agent. Ten patients experienced a good to excellent result; 7 patients no improvement and in one patient treatment had to be prematurely withdrawn because of gastro-intestinal side-effects. No other serious side-effects occurred in the present investigation. Patients with impaired erection, previous gastric surgery and alcoholics are deemed less suitable for this form of therapy. It can be recommended to other patients in otherwise good condition and is especially suitable when diffuse fibrosis is present or when cavernosography indicates deep infiltration of the disease into the intercavernous septum. Selection can be made from those patients who show no tendency to spontaneous remission or those unsuitable for or unresponsive to other therapeutic measures.


A controlled investigation of the value of anticoagulant therapy in cases of prostatectomy. Prior to prostatectomy, 182 patients were classified into two groups of 90 and 92 patients. The classification was performed so as to make the groups mutually comparable with respect to factors considered significant in connection with the risk of thrombo-embolism. The group with 90 patients was anticoagulated with marcoumar. The other group served as a control. There was no significant difference in mortality or thrombosis incidence between the two groups. There was a significantly larger loss of blood in the anticoagulated group. Five of the patients in the anticoagulated group died, while in the control group, 3 patients died. Epsilon-aminocaproic acid was not used on a routine basis.


Vascular resistance in hypothermically perfused kidneys damaged by warm ischemia. Vascular resistance was determined during hypothermic perfusion of rabbit kidneys after various periods of warm ischemia. Ischemia was induced by clamping of the renal artery, or of the renal artery and vein, in situ. Studies were made after periods of clamping ranging from 0 to 180 min. The perfusing fluid was 5% Dextran of low molecular weight in balanced saline solution (Tis-U-Sol), with addition of 5 mg % Papaverin. When the renal artery was clamped for more than 15 min, vascular resistance increased. Maximal resistance was reached after 60 min of clamping, and was 3 times as high as that value in the control group of kidneys which were not clamped. The vascular resistance attained after 60 min of clamping did not further increase when clamping was maintained for 180 min. When both the renal artery and the renal vein were clamped vascular resistance first increased after 30 min. Maximal resistance was reached after 60 min of clamping, but was only 1/2 of that level seen when the renal artery alone was clamped.


The influence of an agonal phase on the vascular resistance of the kidney measured during hypothermic perfusion studies. The influence of the agonal phase on the rabbit renal vascular resistance during warm ischemia was studied in 24 hypothermic perfusion experiments. The agonal phase was induced by tracheal clamping in anesthetized animals. The interval from strangulation to cardiac arrest was, on average, 8.1 min. Kidneys were removed between 0 and 60 min after cardiac arrest. Comparison with an earlier study where warm ischemia was induced by clamping of the renal artery shows that the agonal phase is not a significant factor in that renal vascular resistance is not increased.


The effect of temporary clamping of the renal vessels on the vascular resistance in rabbit kidneys. In studies of 45 rabbits, either the renal artery (35 animals), or the renal artery and vein (10 animals) were clamped in situ. The effect of the clamping--of the warm ischemia--on the vascular resistance of the kidney after reestablishment of the circulation was examined in perfusion studies made after removal of the kidneys from groups of 5 animals between 1 and 5 days after revascularization. Resistance patterns were measured during hypothermic perfusion. The results confirm earlier findings that vascular resistance increases in proportion to the duration of warm ischemia up to 60 min, but not thereafter. The renal vascular resistance falls over the days following revascularization, more slowly after longer periods of ischemia. Thus after 60 min of warm ischemia the vascular resistance became normal within 24 hours, but after 180 min of warm ischemia, the normal resistance range was not reached until 96 hours after reestablishment of the circulation. When both the renal artery and the renal vein were clamped, the pattern was the same but much less emphatic. The vascular resistance never attained such high values as seen after clamping of the renal artery alone, and became normal after 24 hours of revascularization, even when the period of warm ischemia was as long as 180 min.


Effect of splenectomy on anemia in patients on regular dialysis treatment. Splenectomy was performed in 7 patients on regular hemodialysis treatment who had disabling anemia. All patients had a short 51Cr red cell survival time and an increased splenic uptake of red cells verified by external counting and computer-aided scintigraphy. The need for blood-transfusions was eliminated in all except one. In all patients the hemoglobin concentration rose after splenectomy. This was probably an effect of a reduced plasma volume and the removal of a large pool of non-circulating red cells. No consistent changes in the red blood cell survival time or the red cell volume were observed. The white cell and the platelet counts in the blood rose to twice the preoperative value. No adverse effect of the splenectomy was observed.


Skeletal status in patients with chronic renal disease. The bone mineral content (BMC) was measured in 17 patients with chronic renal failure. The patients as a group had a mean BMC of 89% compared with 127 normal subjects. The investigation failed to disclose any significant correlation between BMC and the stage of renal diseases.


Subcutaneous arteriovenous fistulas for dialysis with special emphasis on vascular insufficiency. Ninety-four subcutaneous arterio-venous fistulas were created for haemodialysis in 83 patients. Seventy-one patients eventually received well-functioning fistulas. The most common complication was thrombosis at the suture line. Thus, 8 primary fistulas clotted within 24 hours of surgery and 5 clotted later. Eleven patients were reoperated with a successful result in six. One patient developed arterial insufficiency in the hand with finger ulcerations, probably due to a radial steal syndrome. Four patients got extremely swollen hands and threatening gangraena because of thrombosis of the vein proximally to the anastomosis. Vital capillary microscopy in the patients with vascular insufficiency demonstrated profound changes of the nutritional capillaries which were not seen in control patients with well-functioning fistulas. After closure of the fistulas the edema disappeared and the ulcerations healed rapidly.


Experience with arteriovenous fistulas CIMINO in chronic hemodialysis. A report on forty-five patients. Experiences with 45 uremic patients with arteriovenous fistulas for dialysis are described. The operation is easy and successful if the vessels of the patient are intact. Varicose syndromes of the hand may occur but can be managed. Complications from cannulations, such as large hematomas, are rare but may obstruct otherwise good fistulas. The fistula should be constructed in good time before a definite need for dialysis arises.


Duplication of the male urethra treated by septotomy. A case report. In a case of incomplete duplication of the male urethra the interurethral septum was divided by scissors. After this simple operative procedure, the patient was relieved of his obstructive symptoms. Postoperative urethrography revealed considerable improvement of the calibre of the urethral lumen, and uroflowmetry showed almost normalized flow values. This technique is recommended as treatment in similar cases.


Giant vesical calculas and anuria.

Giant vesical calculas and anuria. A 50-year-old fisherman developed uremia and anuria, due to a giant vesical calculus. He was treated with suprapubic lithotomy, and a calculus weighing 1 640 g was removed. This may be the largest calculus ever removed with recovery of the patient. No other reports of giant stones leading to anuria has been found in the available literature. More than 4 years later an inoperable carcinoma of the bladder was discovered. The long delay in diagnosis of the giant stone, as later of the carcinoma, was due to the patient's lack of confidence in doctors and hospitals.


Partial hydronephrosis in a patient with horseshoe kidney and bilateral duplication of the pelvis and ureter. A case of the rare combination of horseshoe kidney, bilateral duplication of the pelvis and ureter, with stricture of one uretero-pelvic junction causing symptomatic hydronephrosis is reported. The patient was treated with resection as modum Anderson-Hynes. The embryology, symptomatology and treatment of such anomalies is discussed.


Influence of posture on pulmonary gas exchange and heart rate in chronic obstructive lung disease. Sixteen subjects with chronic obstructive lung disease were studied in supine and sitting position. VT, VE, VD and VD/VT were definitely higher in the sitting position (p less than 0.001). PaCO2 was slightly lower in the sitting position, whereas Pa¿O2 was the same in both positions. P(A-a)O2 was essentially the same in both positions, but the estimated QS/QT was definitely lower in the sitting position. In patients with low FEV1.0 the heart rate showed a tendency towards higher values in the sitting position.


Comparison of infused and inhaled terbutaline in patients with asthma. Skeletal muscle tremor is the most common side effect when giving the relatively selective beta2-adrenergic-stimulators. Tachycardia is a side effect which limits dosage in a few patients only. Dose-reponse relation was tested on ventilatory capacity, heart rate, blood pressure and skeletal muscle tremor after terbutaline was given intravenously and as an aerosol. Terbutaline infusions in doses exceeding the recommended therapeutic level did not produce maximal relaxation of the bronchial muscle in patients with endogenous asthma, but increased the heart rate by 25 beats per minute and more than doubled the tremor. The tachycardia is mainly due to peripheral vasodilation and reflexogenic heart stimulation. Terbutaline given by inhalation produced the same bronchial relaxation without any effect on heart rate, blood pressure of tremor, indicating a local effect. The acute margin of safety was notable; the increase of pulse after 63 inhalations of this long-acting substance being only 16 beats per minutes.


Scanning of viscosity in sputum.

Scanning of viscosity in sputum. A viscometer for measurement of sputum viscosity is described. The apparatus makes possible continuous measurement of sputum samples from 5 to 50 ml in volume. It has been calibrated against capillary and rotation viscometers with excellent correlation. The recordings obtained from sputum impressively display the heterogeneity of this material. They render the possibility of calculating a mean viscosity and of plotting the viscometer are given and the relationship between this instrument and other types of viscometers is discussed.


Exercise-related changes in plasma levels of 15-keto-13,14-dihydro-prostaglandin F2alpha and noradrenaline in asthmatic and normal subjects. In an attempt to elucidate the roles of prostaglandin F2alpha and noradrenaline in exercise-induced asthma, plasma levels of these substances were measured at rest, during and after exercise in normal and asthmatic subjects. Changes in airways resistance were assessed by measuring the peak expiratory flow rate. Plasma levels of 15-keto-13,14-dihydro-prostaglandin F2alpha (a relatively stable metabolite of prostaglandin F2alpha) and noradrenaline, at rest, and the changes that occurred during and after exercise, were similar in both the normal and asthmatic subjects. Exercise-induced broncho-constriction occurred in all asthmatic subjects following exercise while no significant change occurred in the peak expiratory flow rates of the normal subjects. At this time, in both groups of subjects, the levels of 15-keto-13,14-dihydro-prostaglandin F2alpha were lower than at rest. The level of noradrenaline observed following exercise were lower than during exercise in all but one subject. It would appear that neither noradrenaline nor prostaglandin F2alpha (or its metabolites) play a significant role in the aetiology of exercise-induced asthma.


On the pharmacokinetics of rifampicin during treatment with intermittent administration. II. Influence of age and sex and of the patients. Pharmacokinetic investigations in 75 patients receiving their first treatment for infectious lung tuberculosis gave the following results: RMP and its products of biotransformation are excreted via the urine in smaller amounts in patients above 55 years than in younger patients. In the older age group the induction phase - as measured by the urinary excretion of RMP - is also more marked than in younger patients. Both the serum RMP-concentration and the urinary excretion of RMP are significantly higher in women than in men. The sex specific differences in pharacokinetics seem to be of clinical importance. Because of the higher serum RMP-concentration it is possible to reduce the RMP-dosage 10% in female patients, even with intermittent administration, and to diminish the risk of dose-dependent side effects.


Increase in years of life after eliminating causes of death: significance for health priorities. The theory of competing risks of death has been applied in this study for the construction of two indices: (1) increase in the expectation of life as a function of age, and (2) increase in the average number of years to be lived by a newborn up to various ages, when selected causes of death are eliminated. The indices have been applied to the 1970 mortality in Finland. Vascular diseases comprise the most important cause of death in both sexes, when the first index is applied. According to the second index, considering ages up to 65 years, violent deaths emerge as the most important cause of death among men and neoplasms appear equally important as vascular diseases among women. The magnitude of a health problem was found to be dependent on the index selected, which should be considered in health planning.


Hospital treatment of addicts arrested for intoxication in Finland. In the present study the treatment of addicts as performed by the Finnish police was investigated. The intention was to evaluate how the treatment procedure functioned in meeting the need for medical care and safety of the addict. The series was collected from the police district of Helsinki, the Finnish capital, and comprised all addicts arrested and transported to hospital during 1969. The series totalled 859 cases, which is about 2% of all addicts arrested in Helsinki during 1969. The reasons for transportation to hospital were: external injuries (60%) and the addict's complaints of an injury or illness (17%). Of all subjects, 44 were admitted to a hospital ward and of these, 2 died later on the ward. Furthermore, 7 addicts had died at the police station, on the way to hospital, or at the out-patients' department. Thus the number of deaths totalled 9. On investigating the cases of death in detail it was found that omission of or delay in the transport to hospital may have been of decisive influence on the addict's death in 4 cases. It was estimated that, had the police not transported any of the addicts to hospital, the number of deaths would have been about 20. When the cost of hospital treatment and transport to hospital is used as an evaluation factor the effort of the activity covered by the present study is 98 500 Fmk (U.S. $ 23 200). The output is the number of lives saved, i.e. 11. The efficiency of the activity is thus the saving of one life at the cost of about 9000 Fmk (about 2 100 U.S. $). The social characteristics of the addict were not found to have had a decisive bearing on the question of transportation to hospital. Differences between the various points of activity were observed in the relative numbers of the addicts arrested and transported to hospital.


Smoking and the subjective health condition among Finnish military conscripts. Information on smoking habits and a subjective self-estimate of general state of health was collected by means of a questionnaire from 400 conscripts in Northern Finland. The data were treated by factor analysis. Long-term fatigue, frequent headache, insomnia and occasional depression were less frequent among non-smokers than among smokers.


Results of a quit-smoking research project in a randomly selected population. In the spring of 1973, 58 strictly randomized heavy smokers from a defined population of men born in 1914 were asked to quit smoking, at least for 8-9 weeks, as a part of a research project focused upon the relationship between smoking and peripheral blood flow, fibrinolysis, and lung function. Eighty-eight per cent of the smokers were willing to try to quit smoking. Seven (12%) refused at the outset, as they regarded quitting as impossible. Of the remaining 51 it was possible to keep 31 (60%) free from smoking for 8-9 weeks with the aid of an intense anti-smoking program lasting 6 weeks. Checks of continued smoking abstention were made by questionnaire and COHb-determination. After six weeks, no further information was given to the subjects. A follow-up after 8-9 months revealed that 33% of the 51 participants (i.e. 29% of the original 58) were still non-smokers. The long-lasting effect of our quit-smoking method was equal to the best reported by others and 30% is probably the highest rate of long-term success to be achieved in smoking cessation.


The layman's medical vocabulary. A study of illness definitions and perceived need for medical care. A knowledge of the layman's illness concepts is of value both for diagnosis and therapy in the practical application of the medical services. It is also valuable for the estimation of morbidity and of the need for medical assistance. The present article describes an investigation intended to throw light on the import of ten different illness concepts and on the implications these may have for the utilization of the medical services. The study is based on interviews with 100 middle-aged women. Most of the respondents considered that an illness may have many causes--a multifactorial aetiology. Great differences between the illnesses were noted with respect to the opinions as to whether examination by a doctor was necessary for diagnosis. The interpretations as to whether an illness needed treatment--medical attention, medicine, hospital care--seemed however to be more closely related to its duration than to its nature. A long duration was regarded by a surprisingly large number as a sign that hospitalization was required--even in the case of a common cold! Only 8% considered obesity 'serious'. As regards the choice of illness alternatives, earlier experience of illness influenced this only in the case of 'shortness of breath' and 'nervous symptoms'. Social class was not found to affect the type of answer.


Sexual problems in patients suffering from multiple sclerosis. A questionnaire which allowed anonymous answering and which also included many other questions besides those dealing with sexual life was sent to 302 patients suffering from multiple sclerosis (MS). Sexual life had changed for 91% of males and 72% of females. About half of the patients replied that their sexual life was unsatisfactory or had ceased altogether. These patients were as a rule in a relative poor physical condition. In males, disturbances in erection (62%) were the most common problem, erection was normal in only 20%. In females the essential figures were: loss of orgasm in 33%, loss of libido in 27% and spasticity in 12%. There was no correlation between the incidence of sexual disturbances and the duration of the MS. It seems that the neurological disturbances in sexual life depend simply on the location of the plaques in the central nervous system.


Mental health and housing.

Mental health and housing. With the present trend away from the designing of individual buildings and towards the systematic planning of whole residential communities, it should be possible to take mental health requirements into account at the planning stage. At present, sociologists are all too seldom consulted on matters of residential planning. When discussing the relationship between housing and mental health one cannot restrict oneself only to the external aspects of the house, but rather one must also consider the opportunities available for the members of the family to satisfy their own needs, both within the home and in its immediate surroundings. Factors which may affect residential requirements include geographical location, type and standard of dwelling and time and continuity of occupation. A move between two districts or groups representing different housing norms and values may lead to withdrawal symptoms in the individual. This may arise equally well from the remoteness of the country districts as from the conflicting pressures brought on by the abundance of contacts available in the large towns. Town life tends to heighten susceptibility to neuroses and personality conflicts. The character of a residential area may affect the mental health of its occupants. Faris & Dunham (4), in studying the incidence of various types of mental illness with an urban population, observed that schizophrenia was most common among people who were in some way isolated from social involvement. The striving for spaciousness in residential areas and the creation of a "summer city" or "garden city" image or a "family-centred way of life" may lead to unexpected problems and have a variety of social consequences. Mental health difficulties have been noted, for example, among housewives in "dormitory" towns or suburbs (11). The institutions required by a community may be grouped into four categories, representing the basic needs of its members. These are (1) economic institutions, (2) social and political organizations, (3) leisure-time clubs and (4) societies and institutions for promoting social integration, including educational, advisory and assistance bodies. The study of satiation processes offers an interesting approach to the relationship between housing and mental health. Man requires new stimuli to motivate him. Boredom and satiation serve to induce passivity and may provoke destructive behaviour and escapism. Finland has the highest percentage of dwellings constructed in the immediate post-war period of any country in Europe, and in respect of the functions of housing many aspects are still apparent which are detrimental to mental health.


Do you die from rheumatism? The five-year mortality in a middle-aged population sample with respect to reported joint symptoms. With special reference to reported joint symptoms, the five-year mortality was studied of a population sample of 3394 persons, 56-60 years old in 1965. An age- and sex-matched comparison was made between the mortality of the total population of the same age-group, and the sample investigated. A significant excess mortality was found for males reporting previous hospital admission for "rheumatoid arthritis". In this group, however, only 28% really had rheumatoid arthritis according to generally used criteria. The other diseases were mainly previous rheumatic fever and degenerative joint disease. It is concluded that males are harder hit by degenerative joint disease than females. The sample investigated had a lower mortality than the population from which it was sampled. The comparability of a fixed sample and a mean population found in official statistics is discussed. The non-response group was estimated to have a considerable excess mortality.


Coronary ostial stenosis: a complication of aortic valve replacement of coronary perfusion. Coronary ostial stenosis developing after aortic valve replacement is a clinically well-recognized entity. This non-atheromatous intimal proliferation may be limited to the proximal part of the coronary artery, probably as a complication of intra-operative coronary perfusion. It may also occur in association with widespread intimal thickening in the aortic root, presumedly as a reaction to turbulence around aortic ball valve prostheses. We have encountered this process in 2/508 patients (0.4%), who underwent aortic valve replacement with the Björk-Shiley tilting disc valve prosthesis. The coronary perfusion technique was identical in all the operations.


Recurrent cardiac tamponade after replacement of three heart valves. A case report. Delayed pericardial effusion and cardiac tamponade are rare late complications of open-heart surgery. A case after replacement of all three heart valves with the Björk-Shiley tilting disc valves with an unusual clinical course is presented in the following. Unsuccessful subsequent medical treatment, subsequent surgical intervention and its results are described and discussed. The need of further reports on similar observations is emphasized.


Mitral valve replacement with ball and tilting disc valve prosthesis. A clinical and haemodynamic study. A survey is presented on the results of 100 consecutive patients who underwent mitral valve (78 patients) or mitral and aortic and/or tricuspid valve replacement (22 patients) with ball or disc valve prosthesis. The patients were followed-up from 6 to 54 months postoperatively. The mortality for mitral valve replacement was 13 (17%) early deaths (up to one month from operation) and 5 (6%) late deaths. The corresponding figures for multiple valve replacements were 9 (41%) and 3 (14%). A direct correlation was found between early mortality and preoperative functional class IV of the New York Heart Association (30% dead). Pulmonary hypertension combined with multiple valve disease resulted in an early mortality of 42%. No significant differences in early mortality figures after MVR were found between ball and disc valve prostheses. Predominant complications were respiratory infection and atelectasis (13%), acute myocardial infarction (11%) and haemorrhage (9%). Haemolysis was found in 9 patients and three other patients had haemolytic anaemia attributable to paravalvular leak which in two indicated the reapplication of the prosthesis. The main causes of death were heart failure, 8 early and 4 late deaths, and myocardial infarction, 5 and 4 respectively.


Surgery in acute and chronic pericarditis. Pathophysiology and management. Forty-two cases of surgically treated pericarditis are presented, with comments on the management and pathophysiology of the acute, recurrent, and chronic stages of the disease. The spectrum of aetiological factors has changed within the last few decades in that tuberculosis is now rare, whereas uraemic pericarditis is referred to surgery with increasing frequency. With the advent of haemodialysis and renal transplantation, these cases should be treated vigorously, since they are amenable to surgical cure. Rapid surgical intervention is advocated in impending tamponade, and in all other acute cases which do not respond promptly to conservative management. In recurrent and chronic pericarditis, surgery is also preferable to long-term medical treatment with steroids and diuretics. Chronic pericarditis should not be allowed to progress to an advanced stage of disease with myocardial involvement and impairment of liver function. Early operation carries little hazard and gives lasting relief in the majority of cases. Microscopical examinations and laboratory analyses point towards an abnormal permeability of capillaries and visceral pericardium as an early and major event in the development of pericardial effusions. Destruction or preservation of the mesothelial cell lining is probably an important factor in determining the progression of acute disease towards adhesions and constriction.


Long-term observations of cardiac arrhythmias during and after cardiac surgery. I. Acquired heart disease. Twelve arrhythmias that occurred during and following surgery for acquired heart disease were studied in a group of 52 randomly selected patients. In cases of aortic and mitral valve replacement, Björk-Shiley prosthetic valves were used, and procain-magnesium-aspartate solution was applied for cardiac arrest. Registration and analysis of rhythm disturbances were carried out at 10 different time intervals, spaced narrowly in the intra-and early postoperative phases, then more widely up to the 96th hour of observation. Arrhythmic incidence and occurrence per case and phase are given, thereby allowing an account of transient arrhythmias as well. The peak occurrence of serious rhythm disturbance was found, intraoperatively, at about the time of aortic cross-clamping and release (ischaemic effect) with the exception of the mitral-commissurotomy group. The 1st-6th postbypass hours showed an arrhythmia trough, followed by a 2nd peak (9th-96th postoperative hour) made up of less serious arrhythmias (electrolyte- and acid-base disturbances; digitalis effects). All 12 arrhythmia types, as well as the five separately considered ventricular arrhythmias of the "first arrhythmia peak", did not reveal any significant relation to: patients' age, N.Y.H.A. criteria, pre-operative PAm or the duration of anaesthesia, surgery and bypass time.


Pulmonary vein flow pattern in mitral incompetence, combined mitral stenosis/incompetence and after prosthetic valve replacement. Pulmonary vein flow (PVF) pattern was studied with an electromagnetic flowmeter in 11 patients with combined mitral stenosis/incompetence (MS/MI), in 6 patients with pure mitral incompetence (MI) and in 24 patients after mitral valve replacement (MVR). ECG, left atrial and left ventricular pressures were recorded simultaneously. The anomalous flow patterns, which were recorded, reflected the left atrial events and mitral valve function. Before MVR, the major forward flow occurred in ventricular diastole. In patients with predominating MS and small/moderate MI, a small retrograde PVF (RF) occurred in early ventricular systole, while pure or combined severe MI produced a holosystolic reversal of PVF.


Pulmonary vein flow pattern in mitral stenosis before and after commissurotomy. Pulmonary vein flow (PVF) pattern was studied with an electromagnetic flowmeter in 15 patients with mitral stenosis. ECG, left atrial and left ventricular pressure were recorded simultaneously. Commissurotomy was performed in 8 patients and prosthetic valve replacement in the others. Measurements were performed before and after the intracardiac procedure. The predominating forward flow occurred in ventricular diastole, in contrast to ventricular systole in normal hearts. A small retrograde PVF was observed in 11/15 patients in early ventricular systole, coinciding with the c-wave in left atrial pressure (LAP). The reversed flow did not exceed 13% and showed no correlation to a slight regurgitation demonstrated at left ventricular angiography. The maximum delay in forward systolic PVF after onset of ventricular systole was 0.10 sec. The PVF pattern remained unchanged after commissurotomy in the majority of patients, even after reduction of the mitral valve gradient to less than 5 mmHg. However, holosystolic reversed PVF occurred in one patient, indicating a severe mitral regurgitation. The method of PVF recording is simple and proved useful for haemodynamic analysis and as a control after mitral valve surgery for evaluating the degree of mitral regurgitation.


Intra-operative haemodynamic findings and their prognostic significance in femoropopliteal reversed saphenous vein graft bypass operations. Post-reconstructive graft blood flow (basal flow') was measured by means of an electromagnetic flowmeter in 72 consecutive femoropopliteal reversed saphenous vein grafts performed for occlusive atherosclerosis causing leg ischaemia. In the last 48 operations, post-reconstructive pre- and post-graft intra-arterial pressures were recorded, and graft blood flow after papavarine-induced vasodilation ('maximal flow') was measured. Mean 'basal flow' was 132 ml/min, mean 'maximal flow' 285 ml/min and mean flow increment after papavarin 136%. Mean 'basal flow', mean 'maximal flow' and mean flow increment after papavarine were higher in the claudication group than in the gangrene group, and higher in cases having good angiographic run-off than in those having poor. Mean common femoral and popliteal pressures were 85 and 80 mmHg, with no differences between different groups. Mean post-reconstructive graft pressure gradient was 5.1 mm. Mean peripheral resistance was 769 milliprus, being higher in the gangrene group and in cases having poor run-off. The prognostic significance of these findings was evaluated by analysing patency in all patients living 3 months ('early') and 1 year ('late') after operation. Cases having a 'basal flow' less than 60 ml/min, a 'maximal flow' less than 200 ml/min or a flow increment after papavarine less than 100% had significantly poorer 'early' patency (p less than 0.01) and 'late' patency (p less than 0.05). Femoral and popliteal pressures, graft pressure gradients and peripheral resistance did not influence patency significantly.


Regional cerebral blood flow and vertebral angiography at rest and in connection with arm work in patients with the "subclavian steal phenomenon". Vascular anatomy and haemodynamics of the vertebro-basilar system were investigated by means of vertebral angiography as well as rCBF measurements using the 133Xenon clearance method in 12 patients with occlusive disease of the subclavian artery. Prior to the investigation, the occlusive lesions had been demonstrated by aortocervical angiography, which in 9 out of 12 patients showed reversed vertebral blood flow at rest. All selective vertebral angiographies and rCBF measurements were performed at rest and in connection with graded arm exercise. Patients with the subclavian steal phenomenon were found to have a slightly reduced rCBF. After arm exercise, the intracranial flow velocity of contrast medium in the cerebral vessels remained unchanged, while the velocity of the reversed flow of contrast medium in the vertebral artery was increased. Regional cerebral blood flow in the vertebro-basilar system increased during arm exercise, the average increase being about 16%. The augmentation of flow is probably due to activation of neuronal processes within the brain. The magnitude of these flow alterations in healthy individuals is unknown.


A case-referent study on neuropsychiatric disorders among workers exposed to solvents. Published reports give justification for the belief that long-term exposure to solvents might induce chronic but nonspecific neuropsychiatric conditions. This case-referent study of data from a regional Swedish pension fund register indicated a risk ration of 1.8 in regard to nonspecific neuropsychiatric disorders among workers such as painters, varnishers and carpetlayers who are exposed to solvents as compared to workers not so exposed. Moreover a dose-response relationship seems to exist between exposure in terms of occupational years and neuropsychiatric conditions, the result being that persons affected are considered eligible for disability pensions.


Urinary mandelic acid concentration after occupational exposure to styrene and its use as a biological exposure test. Excretion of mandelic acid from workers in the reinforced polyester plastic industry was studied with the determination of urinary mandelic acid concentrations. The styrene exposure level at the workplaces was evaluated with measurements of the styrene concentration in the ambient air. Three different groups (I, II and III) were studied. In group I [n=9, median of the time-weighted average (TWA) of exposure = 23 ppmof styrene, postexposure observation period = 64 h] two excretion slopes were observed, the first with a median half-time of 9.4 h (postexposure period 0--18 h) and a second with a median half-time of 16.6 h (postexposure period 19--64 h). For group II (n=9, median TWA exposure = 248 ppm, postexposure observation period = 15 h) a half-time of 6.4 h was found. These results suggest that the excretion rate of mandelic acid is dependent on the styrene exposure level. In addition the mandelic acid concentrations of 29 workers (group III) before and after the work shift were analyzed. The urinary mandelic acid concentrations of groups I, II and III, sampled immediately after the 8-h work shift, correlated with the 8-h TWA of styrene exposure (n=47, r=0.93). Accordingly about 2,300 mg of mandelic acid per gram of creatinine corresponded to 100 ppm of styrene.


Eight-year follow-up of viscose rayon workers exposed to carbon disulfide. An 8-year follow-up of workers exposed for at least 5 years to carbon disulfide showed an excess of deaths due to coronary heart disease in reference to a comparison cohort. However, after effective preventive measures, e.g., leaving only 19% of the original group exposed and reducing the level of exposure to less than 10 ppm, had been undertaken after the 5th year of follow-up, coronary mortality decreased and no excess mortality during the last 3 years of follow-up occurred. These results, although only suggestive -- due to the small number of deaths and the short time of follow-up after the intervention -- seem promising from the point of view of improving the prognosis of workers who have already accumulated an excess risk for coronary death.


Occupational lead exposure in Finland. V. Shipyards and shipbreaking. Three Finnish shipyards and two shipbreaking enterprises were studied for lead exposure. Blood lead (Pb-B) concentration was measured for 568 workers in the shipyards and 13 workers in the shipbreaking enterprises. Erythrocyte delta-aminolevulinic acid dehydratase (ALAD) activity was determined for 139 workers in one shipyard and 7 workers in one shipbreaking enterprise. Hemoglobin level was determined for 545 workers in the three shipyards and 7 workers in one shipbreaking enterprise. Lead exposure in the shipyards was relatively low. No Pb-B value exceeded 70mug/100 ml. The most exposed occupations were welders, plumbers, painters, repairmen, and sheet metal workers. The mean Pb-B did not exceed 40 mug/100 ml in any of these groups. In both shipbreaking enterprises one Pb-B value exceeded 70 mug/100 ml, the mean Pb-B values of all the workers in the two enterprises being 51 and 46 mug/100 ml. respectively. ALAD values corresponded well with the respective Pb-B values. All the hemoglobin mean values were normal, and there were no statistically significant differences between the hemoglobin values of different groups.


Gnathotrichus sulcatus: synergistic response to enantiomers of the aggregation pheromone sulcatol. In laboratory and field bioassays, Gnathotrichus sulcatus responded to sulcatol (6-methyl-5-hepten-2-ol) only when both enantiomers were present. Response was greater to racemic sulcatol than to a mixture (65 : 35) of S-(+) and R-(-) enantiomers, the naturally occurring isomeric ratio. Enantiomer-specific active sites on receptor proteins in the same or different cells are implicated.


The quantitative relations between diffusion-controlled reaction rate and characteristic parameters in enzyme-substrate reaction systems. I. Neutral substrates. With the development of techniques for studying fast reactions, we are confronted with some experimental observations which, according to the classical diffusion-controlled reaction theory based on the assumption of pherical symmetry, will lead to paradoxical consequences. Recently, some investigators have attempted to present a theory of non-spherically symmetric diffusion-controlled reaction. Owing to the difficulty in mathematics, only the formal discussion has been given, and the numerical results have not yet been reported. The combination between enzyme and substrate is not only non-spherically symmetric, but also related to the force field existing between the reacting molecules. In the previous article we introduced the spatial factor and the force field factor and derived a general equation for these reaction systems. We present in this article a general method for finding the numerical solution of the above equation. With the numerical results obtained by this method we may interpret the experimental facts which can not be explained from the viewpoint of the classical diffusion-controlled reaction theory. In order to examine more closely the kinetic behaviour of enzyme-substrate reaction systems, we defined several characteristic parameters. The quantitative relation between these parameters and the rate of diffusion-controlled reaction has been discussed.


Western pine beetle: specificity among enantiomers of male and female components of an attractant pheromone. The flight response of both sexes of Dendroctonus brevicomis to the mixture of myrcene, racemic frontalin, and (1R,5S,7R)-(+)-exo-brevicomin and to the mixture of myrcene, (1S,5R)-(-)-frontalin and racemic exo-brevicomin was significantly greater than the response to the same mixtures in which the antipodes were substituted. The flight response to these two mixtures was also greater than the response to the ternary mixture of myrcene, racemic frontalin, and racemic exo-brevicomin (MFE). The walking response of both sexes to the mixture of myrcene, racemic frontalin, and (+)-exo-brevicomin was not different from the response to MFE. Substitution of the antipode lowered the response when compared to that of MFE. When evaporated with ponderosa pine turpentine, (-)-frontalin was active in the field while its antipode was not.


Localization of central structures involved in descending inhibitory effect of acupuncture on viscero-somatic reflex discharges. The pain reaction provoked by visceral traction has been one of the main problems to be solved in acupuncture anesthesia. By means of recording the viscero-somatic reflex activity in the animals, we have found that this reflex activity can be inhibited by acupuncture, and that the inhibitory effect originates from the supraspinal structures. The central structures involved in the inhibitory effect of acupuncture have been identified in a series of transection and lesion experiments. In decerebrated animals the inhibitory effect during acupuncture was preserved, but the after-inhibition of acupuncture disappeared; transection at the lower medulla as well as the cervical cord abolished near completely the whole inhibitory effect of acupuncture; a median lesion in the medulla including the nucleus raphe maguns resulted in a significant decrease of the inhibitory effect during acupuncture and a complete disappearance of the after-inhibition of acupuncture. The available evidence indicates that the median region of the medulla is involved in the elaboration of the inhibitory effect of acupuncture on the viscero-somatic reflex. A suggestion is thus offered that these supraspinal structures may be the essential link of the centre which is activated by acupuncture and involved in the descending inhibitory influence on the pain reaction of visceral stimulation.


Nuclear magnetic resonance patterns of intracellular water as a function of HeLa cell cycle. Nuclear magnetic resonance relaxation time (T1) of the intracellular water protons and water content were measured in synchronized HeLa cells. The T1 was maximum (1020 milliseconds) in mitotic and minimum (534 milliseconds) in S phase cells. The cyclic pattern of T1 values correlated well with the chromosome condensation cycle. By treating cells with spermine, it was possible to alter T1 without a significant change in the water content. The results of this study suggest that an additional variable, namely, the conformational state of macromolecules, should be incluced in any expression explaining the shortened relaxation times of water protons in biological systems.


Vasoactive intestinal polypeptide: abundant immunoreactivity in neural cell lines and normal nervous tissue. Vasoactive intestinal polypeptide immunoreactivity is present in high concentrations in clonal lines of neuronal and glial origin. The central nervous system and sympathetic ganglia are also rich in the peptide. The findings suggest that this peptide, hitherto thought limited to the gastrointestinal tract, is widely distributed in neural tissue and may have broad physiological significance.


Human handedness: a partial cross-fostering study. The hand preference of college students correlated significantly with the writing hand of their biological parents but not that of their stepparents. The results are consistent with a genetic theory of the origin of human handedness.


Tunneling in ligand binding to heme proteins. Rebinding of carbon monoxide to the beta chain of hemoglobin after photodissociation by a laser flash is intramolecular below about 200 K. Above 25 K, rebinding occurs via classical over-the-barrier motion; below, quantum-mechanical tunneling dominates. Both are described by an energy spectrum peaked at Epeak=4.0 kilojoules per mole. The barrier width d(E), determined from the energy dependence of the tunneling rate, depends on barrier height, d(E) approximately 0.05 nanometer X (E/Epeak) 1.5.


Wastewater renovation and reuse: virus removal by soil filtration. Secondary sewage effluent and renovated water from four wells at the Flushing Meadows Wastewater Renovation Project near Phoenix, Arizona, in operation since 1967, were assayed approximately every 2 months in 1974 for viruses during flooding periods. Viruses, regularly found in the secondary effluent, were not detected in any renovated water samples. Our results indicated that human viral pathogens do not move through soil into the groundwater, but are apparently absorbed and degraded by the soil and reduced in numbers by a factor of at least 10(4) (99.99 percent removal).


Neuroendocrine (bag) cells of Aplysia: spike blockade and a mechanism for potentiation. Bag cell activity in Aplysia can be recorded intracellularly and extracellularly. Electrical stimulation anywhere along the connective nerves can produce prepotentials which are not synaptic potentials but represent the passive invasion of action potentials blocked in the neurites. Potentiation of these prepotentials results from progressive movement of the site of spike blockade toward the somata. This type of propagation plasticity may occur in many networks of low conduction safety.


Sodium arachidonate can induce platelet shape change and aggregation which are independent of the release reaction. Sodium arachidonate causes shape change and aggregation of rabbit or human platelets that have been washed and then degranulated by treatment with thrombin. Since these platelets do not contain releasable adenosine diphosphate (ADP) and the aggregation is not inhibited by the creatine phosphate-creatine phosphokinase system, sodium arachidonate must be able to cause aggregation that is independent of the release of ADP. Since aggregation of these platelets induced by sodium arachidonate is inhibited by acetylsalicylic acid or indomethacin, it seems likely that products (such as prostaglandin G2) formed from sodium arachidonate are responsible for aggregation. Thus, sodium arachidonate-induced shape change and aggregation of platelets may be caused (i) by the release of ADP by products of sodium arachidonate metabolism and (ii) directly by the products of sodium arachidonate metabolism, independently of released ADP.


Human bloodstains: individualization by crossed electroimmunodiffusion. Crossed electroimmunodiffusion was evaluated as a means for establishing the individuality ("fingerprinting") of human bloodstains. In ten separate examinations on stains from each of ten persons there was at least one peak with a unique range in height so that individualization was possible. The heights of certain peaks showed statistically significant female-male differences.


Monoamine oxidase activity decreased in cells lacking hypoxanthine phosphoribosyltransferase activity. The Lesch-Nyhan syndrome in humans is characterized by lack of hypoxanthine phosphoribosyltransferase activity and neurologic abnormalities that suggest changes in catecholamine metabolism. Monoamine oxidase, which degrades biogenic amines, has decreased activity in noradrenergic murine neuroblastoma cell lines lacking hypoxanthine phosphoribosyltransferase activity and in skin fibroblasts from patients with the Lesch-Nyhan syndrome.


Ultrastructure of the auditory regions in the inner ear of the lake whitefish. Hair cell polarization patterns were investigated on the sensory macule of the sacculus and lagena of the lake whitefish. The saccular hair cells are divided into four groups, with all of the cells within a group having the same orientation. Saccular orientations are anterior, posterior, dorsal, and ventral with respect to the axis of the animal. Two groups, one dorsal and one ventral, are found on the lagena. The saccular orientations are significantly different from those in tetrapods. Since this organ appears to have different functions in fish and tetrapods it is likely that the orientation patterns in fish are adapted to some aspect of audition--perhaps directional localization of sound.


Vibrational spectroscopy of chemisorbed fatty acids with inelastic electron tunneling. We have measured and assigned the inelastic tunneling spectra of hexanoic acid chemisorbed onto an oxidized aluminum file. We present evidence for gauche-trans as well as-trans conformers in the monolayer and evidence in support of a recent theory of tunneling intensities.


Thrombosis in association with atherosclerosis induced by dietary perturbations in dogs. The distribution, severity, and complications of diet-induced atherosclerosis in dogs can be altered by changing the source of fat in the diet. Thrombosis and thromboembolic disease associated with atherosclerosis occurred with diets containing beef tallow and lard of coconut oil but were absent in dogs fed cottonseed oil as a source of fat. Experiemtnal animals with and without thrombosis are of value as models in elucidating the role of platelets and thrombostatic mechanisms in atherosclerosis.


Ingestion of Streptococcus mutans induces secretory immunoglobulin A and caries immunity. Ingestion of killed cells of a highly cariogenic strain of Streptococcus mutans induced specific antibodies in both saliva and milk but not in serum of gnotobiotic rats. These antibodies were associated with the immunoglobulin A class. When infected with Streptococcus mutans, orally immunized animals developed significantly fewer carious lesions than nonimmunized infected controls.


Imprinting to chemical cues: the basis for home stream selection in salmon. Juvenile coho salmon were exposed to morpholine or phenethyl alcohol (p-alcohol) for 1 1/2 months and then released in Lake Michigan. During the spawning migration 18 months later, morpholine and p-alcohol were metered into separate streams, and the number of morpholine- and p-alcohol-exposed fish returning to each stream was determined. Seventeen other locations were also monitored. The majority of the fish exposed to morpholine were captured in the stream scented with morpholine and most fish exposed to p-alcohol were captured at the p-alcohol-treated stream. This field study demonstrates that coho salmon imprint to and utilize chemical cues for homing.