Hyperglycemic and hyperosmolar responses to graded hemorrhage. Changes of the arterial plasma osmolality and of the glucose concentration were followed during a 30 min period of graded hemorrhagic hypotension (80, 50, and 30 mmHg) in the cat. Bleeding evoked a significant plasma hyperosmolality at all three hypotension levles and the responses were quantitatively related to the degree of hypotension. An approximate steady state increase in the arterial plasma osmolality was reached about 20 min after the start of the bleeding and it then averaged 8. 20, and 25 mOsm/kg H2O at 80, 50, and 30 mmHg, respectively. Bleeding also evoked an increase in the plasma glucose concentration, which almost entirely accounted for the observed hyperosmolality, especially at 80 and 50 mmHg. In late stages of hypotension at 30 mmHg, elevated plasma lactate and potassium concentrations contributed to the overall hyperosmolality. --Previous hemorrhagic hypotension experiments at 50 mmHg (Järhult 1975 b) have shown that hyperosmolality serves as an important regulator of the plasma and extracellular fluid volumes during bleeding. The present results indicate that such an osmolar compensatory mechanism is operating over wide ranges of hemorrhagic hypotension.


Factors influencing the insulin space in cerebral cortex slices from adult and 7-day-old rats. The inulin spaces and swelling of brain cortex slices from adult and 7-day-old rats were measured under differing experimental conditions. At 37 degrees C inulin penetrated into larger compartments than at 0 degrees C in both age groups. At 37 degrees C the inulin space increased with decreasing concentration of inulin in the medium. At 0 degrees C the inulin space did not depend on the inulin concentration. The swelling of the slices at 37 degrees C diminished with increasing concentrations of inulin. Anaerobic conditions, 0.2, and 1.0 mmol/l sodium cyanide and 0.1 mmol/l dinitrophenol reduced the inulin space and caused increased swelling of the slices. 1.0 mmol/l sodium iodoacetate was ineffective. In anaerobic conditions the inulin space did not change significantly as a function of the inulin concentration. A serious disadvantage of the inulin space as an indicator of extracellular space is that its size depends on the inulin concentration used. The inulin itself may influence the size of the space to be measured. Inulin also in osmotically inactive concentrations considerably reduces the swelling of brain cortex slices.


The potassium concentration in cerebrospinal fluid in young and adult rats following complete brain ischemia. Effects of pretreatment with hypoxia. The potassium concentration in the cisternal cerebrospinal fluid (CSF) was measured following brain ischemia in rats of different ages which has been kept at normoxia or pretreated with hypoxia (PIO2 = 70 mmHg) for 24 h. In all age groups the potassium concentration rose following ischemia. The rate of rise was relatively slow in the 4-day rat and faster in 16- and 24-day rats; beyond this age the rate of rise became slower. Pretreatment with hypoxia significantly diminished the rate of rise in CSF potassium in 4- and 8-day rats, while no effect was observed in the older age groups. It is suggested that the rate of rise in CSF potassium is inversely correlated with the capacity of surviving a period of oxygen deprivation.


The effect of veratrine and aconitine on the excitability of sensory units in the tooth of the cat. Intradental sensory nerve impulse activity was recorded by means of electrodes inserted into dentinal cavities in the tooth of the cat. Impulses of different amplitudes was recorded. Local application of aconitine (10(-3) g/ml) and veratrine (10(-3) g/ml) induced nerve impulse activity. A rapid increase in the temperature of the tooth surface to 45-47 degrees C, which is known to induce fluid movements in the dentinal tubuli, did not induce any nerve impulse activity. However, after pretreatment of a tooth cavity with veratrine a rapid increase in the temperature of the tooth surface gave rise to nerve impulse activity. Steady state impulse activity induced by brief local application of aconitine was influenced by a rapid increase in the temperature of the tooth; during the increase in temperature impulses of low amplitude increased in frequency while impulses of high amplitude were blocked. Furthermore, reduced pressure applied to the exposed dentin, which also induces fluid movements in the dentin, gave rise to nerve impulse activity. Thus the sensory units in the tooth are stimulated by dentinal fluid movements and alkaloids known to excite mechanoreceptors increase their excitability. It is therefore suggested that the intradental sensory nerve endings are mechanosensitive structures.


Decrease of oxygen consumption in the dog liver during temporary arterial occlusion. The effects of occlusion of the hepatic artery on total and regional splanchnic oxygen consumption were studied in lightly anaesthetized dogs. Mean whole body oxygen uptake (+/- S.D.) was 4.72 +/- 0.55 ml/kg b.w. min-1, mean liver oxygen uptake (+/- S.D.) 1.18 +/- 0.42 ml/kg b.w. min-1 and mean oxygen uptake of the portally-drained tissues (+/- S.D.) was 0.80 +/- 0.54 ml/kg b.w. min-1 during the control period. The hepatic artery contributed 45 +/- 24% of the total liver oxygen uptake. The duration of occlusion was 45 min. Mean liver oxygen uptake was found to decrease to 64% of control values. The extraction of oxygen from the portal blood increased slightly. Mean whole body oxygen uptake and mean oxygen uptake of the portally-drained tissues were unchanged. 45 min after release of the hepatic artery occlusion, liver oxygen consumption had returned to control values. It is concluded that oxygen uptake in the liver is correlated to oxygen tension.


A method to correct for the influence of gas density on maximal expiratory flow rate. Maximal expiratory flow rate (Vmax) was measured at 20, 35, 50, 65, and 80% vital capacity in 4 young healthy subjects breathing air, SF6/O2, and He/O2 mixtures. The flows of SF6/O2 and He/O2 were corrected to normal alveolar gasflow by means of only the density of the gases. The values for normal alveolar gasflow and corrected SF6/O2 flow were identical at 35% VC and larger volumes while the values for normal alveolar gasflow and corrected He/O2 flow were not. The results indicate that in young healthy subjects it is possible to correct Vmax at lung volumes above 35% VC for the changes induced by an increase in density of the gas breathed, provided viscosity is not much changed. Without correction, Vmax after O2-breathing will be underestimated by about 6%, compared with Vmax for normal alveolar gas, whereas a change in alveolar CO2 concentrations between 3 and 9% only causes a 1% decrease of Vmax.


Renal renin output during continuous intracarotid infusions of iso- and hypertonic sodium chloride solutions in the rat. On male Sprague Dawley rats isotonic NaCl during control and 1 M NaCl were infused either into the carotid artery or i.v. Glomerular filtration rate, sodium output and plasma renin activity were determined. Five of 19 animals reacted with no increase in sodium output for 1 M NaCl and are treated as a different group from the animals reacting with an increased sodium output. For the animals reacting with an increased sodium output a decrease in plasma renin activity was found together with an increase in glomerular filtration rate. In both groups the plasma sodium was constant. The animals not reacting with an increased sodium output had a higher initial plasma renin activity, which did not change during 1 M NaCl infusion. The responses were equal for both intracarotid and i.v. infusions but with a somewhat longer delay before the response occurred with i.v. infusions. These results might be explained by a central nervous effect and by a direct renal effect. Also during 1 M NaCl infusion a possible extracellular volume expansion, derived from water withdrawal from the cells into the extracellular space might occur.


Intrinsic regulation of blood flow in adipose tissue. Previous studies on intact human subcutaneous tissue have shown, that blood flow remains constant during minor changes in perfusion pressure. This so-called autoregulatory response has not been demonstrable in isolated preparations of adipose tissue. In the present study on isolated, denervated subcutaneous tissue in female rabbits only 2 of 12 expts. revealed an autoregulatory response during reduction in arterial perfusion pressure. Effluent blood flow from the tissue in the control state was 15.5 ml/100 g-min (S.D. 6.4, n = 12) corresponding to slight vasodilatation of the exposed tissue. Following total ischemia all experiments showed a period with reactive hyperemia, and both duration of hyperemia and excess flow was related to the duration of the ischemia. This response therefore seems more resistant to the experimental procedure, while autoregulation of blood flow to lowered pressure is more susceptible to surgical exposure of the tissue. During elevation of arterial perfusion pressure blood flow in the isolated tissue showed a transient increase and then almost returned to the level during normotension, indicating an elevated vascular resistance. Raising of venous pressure elicited vasoconstriction with pronounced flow reduction. These two reactions may be important for local regulation of blood flow in subcutaneous tissue during orthostatic changes in arterial and venous pressure. It is concluded that the response in adipose tissue to changes in arterial pressure (autoregulation), venous pressure and total ischemia appear to be elicited by different mechanisms.


Influence of moderate vasoconstriction on the wave reflection properties of the pulmonary arterial bed. Increased transmural pressure in the pulmonary arterial bed may reduce vascular input impedance and reduce hydraulic power linked to pulsatile blood flow. Vascular impedance and pulsatile hydraulic power (Wp) levels of isolated perfused rabbit lungs were compared after similar rises of pulmonary arterial pressure (PAp), induced either by vasoconstriction or by left atrial pressure (LAp) elevation. Resulting Wp levels were significantly smaller after vasoconstriction than LAp elevation. Wp showed a minimum level at physiologic PAp (about 20 cm H2O) irrespective of the cause of PAp elevation. Pressure pulse wave reflection coefficient (see article) was calculated for control and test situations, and was found to be approximately doubled after vasoconstriction. Only minor changes in (see article) were found after LAp elevation. Accordingly, moderate vasoconstriction (resulting PAp approximately 20 cm H2O) caused a backward traveling pressure wave of high amplitude, appearing in counter-phase to the forward pressure wave at the input site. The total pressure wave amplitude was thereby markedly lowered, resulting in a reduced Wp level. We assume that this effect of moderate vasoconstriction may be one reason for the existence of vascular smooth muscles in the pulmonary arteries.


The influence of pulmonary blood flow rate on vascular input impedance and hydraulic power in the sympathetically and noradrenaline stimulated cat lung. This study was designed to evaluate the influence of sympathetic nerve stimulation (SN) and alpha-adrenergic receptor stimulation (alphaS) on the pulmonary vascular input impedance and hydraulic power output of the right heart during variations of cardiac output (CO). An open chest cat preparation was used and pulsatile pressure and flow in the pulmonary artery were measured by high frequency response transducers. Calculations showed that vascular resistance (VR) was inversely dependent on CO, but input impedance of the unstimulated lung was not influenced by CO variations. NS or alphaS increased VR and input impedance significantly, and the relation pulsatile hydraulic power/total hydraulic power (Wp/Wt) increased 40%, indicating that such stimulation has larger relative influence on impedance than on resistance. The reduction of arterial compliance during NS (maximal stimulus) was calculated to be 60%, independent of CO. Input impedance during NS or alphaS was reduced by CO elevations, probably because the concomitant distension of the arterial bed reduced arterial resistance and inertance. The ratio Wp/CO, which expresses the fraction of pulsatile hydraulic power lost per ml mean arterial flow, was found to be flow dependent both in control and stimulated conditions: Wp/CO was positively correlated to CO in control condition and weakly negatively correlated to CO during stimulation. At high CO the arterial vessels could be stimulated and stiffened without much extra load on the right heart.


Influence of vessel distension and myogenic tone on pulmonary arterial input impedance. A study using a computer model of rabbit lung. A computer model of the pulmonary arterial (PA) bed of rabbit lungs was designed in order to test experimental observations of changes in PA input impedance and pulsatile hydraulic power (cap.) during increased PA pressure. The computer model was based on a simple 3-component analog representation of single vessels (i.e. resistance, inertance and compliance). 16 generations of arterial vessels, from PA to 60 mum diameter, were combined to calculate PA input impedance. Input impedance was found to mimic closely that observed experimentally. Both venous pressure elevation and arteriolar constriction was found to reduce input impedance and Wp. By combining arteriolar constriction with increased myogenic tone of the larger arteries, Wp was found to show a minimum level at a certain PA pressure, dependent on the degree of arterial stiffening. Wp was found to follow changes in arterial volume and resistance during stimulated vasoconstriction. Wp dissipation in arterial vessels was calculated to approx. 50% of total imput Wp at physiological pressure conditions, and could be reduced by one half after PA pressure increase from 20 to 50 cm H2O, despite a concurrent halving of arterial compliance. Arterial vessels smaller than 200 mum diameter were found to have negligible direct influence on PA input impedance.


Chemical sympathectomy of interscapular brown adipose tissue. Adult non-cold adapted rats were injected with 6-hydroxydopamine (6-OHDA) or saline and their interscapular brown adipose tissue (BAT) was removed after appropriate periods of time. Fluorescence histochemistry of control BAT demonstrated the presence of an extensive network of varicose fibers among the adipocytes and at the blood vessels. This was confirmed by electron microscopy which also revealed large and small dense core vesicles sparsely distributed in axons and terminals indicating the presence of noradrenaline (NA). After 6-OHDA injection the fluorescence from varicosities was abolished both among the adipocytes and at the vessels. Thus, chemical sympathectomy was more effective than surgical- or immunosympathectomy, which spare the innervation of adipocytes. Parallelling the disappearance of fluorescence was a significant decrease of measurable NA. During recovery the extractable NA increased before the reappearance of fluorescent varicosities. This could be explained by transmitter accumulation in the nervetrunks within the tissue, which, in general, appeared unaffected by 6-OHDA. A large number of cells with a strong yellowish fluorescence distributed through the BAT was unaffected by 6-OHDA. There was no evidence for the presence of intrinsic ganglia.


Inhibition of the lipolytic response to nerve stimulation during acidosis. Acidosis inhibits catecholamine-induced lipolysis in vivo and in vitro. The lipolytic response of canine subcutaneous adipose tissue to short (5 min) nerve stimulations at 4 Hz was, however, not influenced by hypercapnic acidosis (pH 7.0). The steady state outflow of glycerol during a prolonged nerve stimulation at 4 Hz was inhibited by 40 per cent (p less than 0.05) at pH 7.0. Similarly, glycerol outflow during vasodilatation induced by a 4 Hz stimulation in alpha-blocked adipose tissue was inhibited by 37 per cent (p less than 0.05). Post-stimulatory glycerol outflow was, however, not influenced by acidosis. This poststimulatory glycerol outflow, which may represent a complex wash-out phenomenon, forms the largest part of the response to short nerve stimulations. It is suggested that steady state, rather than poststimulatory lipolysis should be studied in order to see the influence of treatments such as acidosis on responses to nerve stimulation.


Influence of prostaglandin E1 on cerebral mechanisms involved in the control of fluid balance. The effects of infusions of PGE1 (30 ng/kg min-1) into the lateral cerebral ventricle were studied in the conscious, hydrated goat. The infusions caused release of antidiuretic hormone and increased renal sodium excretion. When PGE1 was infused together with hypertonic NaCl these effects became markedly enhanced and the infusion also induced drinking and a rise in the arterial blood pressure. Much weaker effects were obtained by the infusion of the hypertonic NaCl alone. This sodium-PGE1 interaction is discussed in relation to previously observed, central sodium-angiotensin II interaction. A more pronounced drinking effect was obtained in response to the intraventricular infusion of PGE1 + angiotensin II, than to the infusion of either substance separately. The PGE1 administered into the lateral cerebral ventricle did not induce any febrile response.


Gamma-aminobutyric acid release from neurons and glia. Release of 3H-GABA into the medium from bulk-isolated glial cells, neuronal perikarya and synaptosomes has been studied, using a continuous perfusion system. The fractions were incubated with 3H-GABA and spontaneous efflux of label in the presence and absence of aminooxyacetic acid (AOAA) was recorded. Unlabelled GABA at micromolar concentrations markedly stimulated 3H-GABA efflux from glia, synaptosomes and neurons. 3H-GABA from all fractions was also markedly sensitive to stimulation by ouabain. Glutamate was effective in stimulating the spontaneous efflux in the presence of AOAA, while superfusion with a calcium-deprived medium only slightly stimulated the 3H-GABA efflux from neurons and glia.


[Early psychotherapy in posttraumatic syndromes. A case study]. The present study analyses one case of posttraumatic syndrome following an accident, which was apparently benign. The author studies neuropsychological investigations and improvement during psychotherapy, along with intellectual "revalidation". The emotional perturbation is accompanied by a dysfunction in mental efficiency, mostly memory. The improvement takes place both in the affective and intellectual areas. The possible hypothesis regarding the etiology of such perturbations are being reviewed. The author underlines the impact of the emotional trauma along with the subsequent perturbations in a patient already sensitised to previous accidents in her family.


[Premonitory psychiatric signs of cardiovascular complaints]. The present study attempts to find out whether 19 behaviors, identified in 1952 and considered as revealing of a psychoneurotic state, appear more often among subjects who complain, 16 years later (in 1968), of a cardiovascular problem than among the subjects who remain free of any cardiovascular complaint during this period. The sample analysed comes from an epidemiological survey, realized by Leighton and known by the name Stirling County Study. That study includes 654 subjects free of any cardiovascular complaint in 1952. These subjects were divided into five independent categories in terms of the presence or absence of certain cardiovascular complaints expressed in 1968. The five categories of cardiovascular complaints were compared as to the frequency and nature of the psychiatric characteristics which differentiate them. Three conclusions appear from this study. 1. The psychiatric characteristics (identified in 1952) are more numerous among the subjects who manifest, 16 years later, a cardiovascular complaint (identified in 1968), when one compares them to the psychiatric characteristics of those who do not develop any cardiovascular complaint during this period. 2. The patterns of psychiatric characteristics which differentiate the subjects who develop a cardiovascular complaint vary with sex. These patterns are much more broad, coherent, and differentiating among women. 3. The accumulation of psychiatric characteristics possesses, among women, a differentiating value greater than any characteristic taken alone.


High doses of Haldol in the treatment of 5 young schizophrenics in a therapeutic community. Even within a unique setting with high-powered and board-spectrum therapeutic tools, acute agitation can pose a serious problem. In this communication we review the cases of five schizophrenic adolescents whose agitation created a threat to themselves and the therapeutic community. The institute tried a variety of psychotherapeutic and chemotherapeutic approaches to no avail and only as last resort we used Haldol in very high doses. Since research centers which specialise in the study of schizophrenic persons and their families rarely publish about chemotherapy in high doses, it seems worthwhile relating our findings.


[Long-acting neuroleptics. IV. Preliminary study of clopimozide (R 29764)]. Clopimozide is, in our opinion, a noteworthy neuroleptic drug. Its action is mainly ataraxic but also antidelusional, long-acting and accompanied with minimal side-effects. It is therefore particularly indicated in the maintenance therapy of psychotics, at a weekly dosage of 7.5 to 25 mg. The present conclusions are preliminary because of the limited number of patients (10) but also because of the rigidity of the trial protocol suggested to us.


Differential fertility of adopted schizophrenics and their half-siblings. The paper presents data on the differential fertility of schizophrenics and controls, and the fertility of their siblings. This study used several methodological procedures in the study of schizophrenia reproduction, which strengthens the validity of the findings. Firstly, both male and female rates were examined. Secondly, the method of selection of a control avoided the biases introduced by using census data or other non-matched controls. Third, a diagnostic criterion was used which minimizes the possibility of the inclusion of other psychiatric illnesses. The results obtained support prior reports of the lowered reproductive rates of schizophrenics. Further, the siblings of schizophrenics were found not to have a reproductive advantage when contrasted to control siblings. The failure to find a reproductive advantage conflicts with a hypothesis of a balanced polymorphism as the mechanism maintaining an apparent constant rate of schizophrenia.


[Introduction to the epidemiological study of five years of extra-hospital psychosocial practice at Ixelles]. This work is aimed at encompassing five years (1969-1973) of extra-hospital psychosocial activity performed by a multidisciplinary team of the sector of the population of Ixelles (85.000 inhabitants). Apart from a population study, we have focused on all consultants (676 patients) in a statistical frame. We have defined three directions: 1. Obtaining a complete picture of the consulting population according to epidemiological and clinical variables. 2. The control in our daily practice of three classical goals which underline the work in sector (permanence -- multidisciplinary team work -- priority to psychotics). 3. The attempt to verify some common assertions in psychiatry, general and social: relationship between season and pathology, between obligation to consults (for the patient) and social class, between type of pathology and social class. Our results for the two last issues differ from those of Hollingshead and Redlich.


Sleep deprivation as treatment for endogenous depression. Twenty-six depressed patients, 19 of whom suffered from an endogenous depression, were sleep-deprived for one night, and eight of these were additionally sleep-deprived for three to nine nights with two sleep deprivations per week. While the sleep deprivation was being carried through, none of the patients were treated with tricyclic antidepressants. The patients were rated before and after the sleep deprivation(s). Sleep deprivation appeared to be effective for both unipolar and bipolar depressions. According to the rating scale an improvement was registered especially when the clinical picture was characterized by depressed mood, psycho-motor retardation and anxiety. As sleep deprivation cured 25% of the patients and further incidentally improved another 20% of the patients, it can be concluded that sleep deprivation seems to be a valuable treatment, especially in retarded endogenous depressions.


Pipamperone (Dipiperon) in the treatment of behaviour disorders. A large-scale multicentre evaluation. Pipamperone solution or tablets were prescribed for four weeks to 188 patients (3-100 years) with behavior disorders. Fifty of these (group A) were mental retardates, the remaining 138 (group B) had a normal I.Q. Their doses were gradually increased until optimal effect was reached. Nearly all 17 items of a behaviour rating scale had improved very significantly by the end of the fourth week, while in 82% of the patients of group A and 76% of group B results were rated good to very good. Also, pipamperone proved to be far superior to previous psychotropic drugs in patients who had been treated before.


[Socioecohomic data on 447 hospitalized former prisoners of war]. The authors have analyzed the social files of all former POWs hospitalized at the Ste-Ode Hospital (Belgium) during one year. They found numerous significant results, that might be the subject of further analyses: i.a., frequent professionally inactive people, despite their age; 5 more times divorces than in the general belgian population; neglect of mental disorders in the attribution of a war invalidity.


Urbanization and psychiatric disorders--the Hong Kong scene. Indices were used to portray the rapidity and intensity of urbanization Hong Kong had undergone in the past 2-3 decades. Next the preliminary result of a psychiatric survey was quoted as an estimate of mental ill-health in Hong Kong. Data were obtained from the Mental Health Service to show the increasing demand for psychiatric care for the past 25 years. Attempts were made to analyze the basic composition of the new patients attending a psychiatric centre during this period. High density living associated with urbanization in Hong Kong was found to generate a high level of emotional strain, and psychiatric ill-health was as prevalent as that in New York. Neuroses were on the increase and psychiatrists were being consulted on a wider variety of problems. Provision of mental health care in future should take the changes in the composition of psychiatric populations into consideration.


[Psychotic masked depression or black mask for depression]. We have used as depression criteria those of Pichot and Hassan, described during the Sint-Moritz Symposium in 1973 on masked depression. According to their clinical experience in Zaïre and Senegal, the authors consider the possibility that the "bouffée délirante" (acute psychotic reaction), frequent in black Africa, is in fact a manifestation of depression. They remind the five criterias of Pichot and Hassan, i.e.: 1 degree evidence of depression symptoms; 2 degrees a background and a particular underlying personality; 3 degrees evolutional characteristics; 4 degrees familial antecedents and hereditary  factors; 5 degrees the response to antidepressive treatment. They present ten cases of acute psychosis: five from Zaïre and five from Senegal. These ten patients have been successfully treated with antidepressive drugs imipramine type, without any neuroleptic drugs; the outcome has always been a rapid remission. Some socio-cultural references are described; it permits to better comprehend the psychological frame of African people. An attempt to psychodynamically interpret the results ends the article.


Sleep deprivation therapy in depression. A study of sleep deprivation therapy was made in 62 females and 15 males, aged 20-72, with monopolar (60 patients) and bipolar (17 patients) types of manic-depressive psychosis. Of these patients, 30 had suffered only the current depression, 29 a maximum of five depressions, and 18 more than five depressions before the sleep deprivation therapy. Twenty-five patients had been treated with antidepressant drugs for less than 10 days, 12 patients for 10-24 days, and 36 patients for more than 24 days. Twenty-four patients were treated with one sleep deprivation, 29 patients with one sleep deprivations per week (average 1.59), and 24 patients with two sleep deprivations per week (average 2.5). The effect of the sleep deprivation therapy was evaluated clinically and by means of Cronholm-Ottosson's rating scale. The effect was found good and lasting in 29%, good but temporary in 38%, and poor in 32% of the cases. The best results were achieved with twice-weekly treatments, the poorest results with once-weekly treatment. The results were equal in monopolar and bipolar cases and were independent of the number of previous depressions as well as antidepressant drug treatment. No side effects have been observed, in particular no conversion to mania. The results of the present investigation indicate that depression and sleep disturbances are symptoms produced by a common factor which, however, it as yet unknown. Sleep deprivation therapy is seen to have at least some effect on all cases of endogenous depression. Sleep deprivation therapy has no side effects and is more quick-acting than any other treatment procedure hitherto known. It should therefore be considered the first treatment offer to all endogenously depressed patients in whom immediate ECT is not necessitated.


[Environmental and demographic variables associated with psychiatric morbidity in former prisoners of war]. In this study, present psychiatric morbidity of 100 former prisoners of war is related to 28 environmental and demographic variables grouped in 3 periods: before, during and after WW2. With the exception of the invalidity percentage, all statistically significant relations concern variables of the first two periods. The present results are discussed at the light of former publications by the authors. It appears among others that the age variable has to be taken in consideration in the explanation of psychiatric sequels of captivity, and that the condition "invalid of war" poorly reflects the degree of psychiatric morbidity.


[Severe neuropsychic disturbances in a young adolescent treated with an endocrine therapy]. After a treatment based on the administration of gonadotropic drugs, aimed at reduced school difficulties and caracterial difficulties by a premature onset of puberty, a young male aged 13 1/2 presents: 1 degree somatic anomalies; 2 degrees increase of intellectual, affective and behavioral troubles; 3 degrees perturbations of EEG prophiles; 4 degrees organicity tests significantly disturbed. The interruption of treatment (4 years of observation) was followed by a progressive remission, however heterogenous, of all initial troubles. The observation underlines the dangers of utilising these treatments in a pre-puberty boy.


What happened later to the lithium babies? A follow-up study of children born without malformations. The Lithium Baby Register was founded in 1968 to determine the frequency of abnormalities among children born to mothers who were given lithium during the first trimester of pregnancy. Previous studies have revealed an increased frequency of congenital malformations, possibly due to teratogenic action of lithium. The present report is a questionnaire follow-up of the physical and mental development of lithium children who were not malformed at birth. Sixty lithium children were examined; their siblings, who had not been exposed to lithium during fetal life, served as a control group. The data obtained do not reveal any increased frequency of physical or mental anomalies among the lithium children.


Self-image and emotional stability of Oedipal and non-Oedipal male homosexuals. The past several years have brought about some changes in the legal status of the homosexual in USA. In some states, the homosexual is labelled as a criminal; in others, homosexuality is not a legal affair. Psychological theories tend to consider the homosexual from two general positions: the Oedipal and the non-Oedipal. The present study was conducted to try to determine how Oedipal and non-Oedipal male homosexuals perceived their self-image and emotional stability. Significant differences were found between the two groups. Considering self-image, Oedipal subjects were found to be more negative. They had less self-worth, self-confidence and self-acceptance than non-Oedipal. They had more negative self-concepts, self-attitudes, and self-motivation. Oedipal homosexuals had less emotional stability. They had more emotional problems, shame, guilt, withdrawal, and depression than non-Oedipal subjects, as well as less success in sexual activity and commitment to the homosexual partner.


Spinal cord vascularity. IV. The spinal cord arteries in the rat. The present investigation has shown that the anatomy of the spinal cord arteries in the rat and in man is closely related but not identical. The main differences are: (1) The poor supply of radicular arteries to the lower cervical and upper thoracic segments of the cord is more marked in the rat, (2) the great ventral radicular artery of Adamkiewicz is less subjected to variations in position in the rat, (3) penetrating branches from the pial arterial plexus are absent in the rat, (4) surface anastomoses between the ventral and the dorsal spinal arteries do not occur in the rat except occasionally at the lower end of the cord. Intramedullary arterial anastomoses in the lumbosacral cord of the rat seems to be species specific.


Computer tomography of the neurocranium. The experience with computer tomography of the neurocranium in 300 patients submitted for computer tomography of the brain is reported. The more appropriate projections which may be obtained with the second generation of scanners in combination with an elaborated reconstruction technique seem to constitute a replacement of conventional skull films.


Computer tomography in the evaluation of pulmonary asbestosis. Preliminary experiences with the EMI general purpose scanner. Thirteen individuals with varying lengths of exposure to asbestosis were examined by computer tomography with the EMI Scanner. Various pleuroparenchymal abnormalities were found, many not being seen on standard chest films. In some cases, with normal chest radiography, definite pleural involvement could be demonstrated, particularly that in the posterior sulci on the diaphragm and at the mediastinum. Tissue attenuation measurements in regions of parenchymal involvement reached 90 EMI units above normal lung tissue. The normal gravity effect is abolished in cases of parenchymal disease caused by asbestosis. Parenchymal disease was much more obvious on the CT scans than on conventional chest films.


Pulmonary congestion in chronic heart disease. Radiologic, clinical and hemodynamic relationships. Pulmonary congestion in chronic heart disease was evaluated by lung auscultation and roentgen examination of the chest and compared with pressure recording of the pulmonary circulation in 49 cases. Whereas auscultation appeared not to be correlated to the pressures, the radiologic findings proved to be a reliable measure of increased pressures. The radiologic assessment was based on isolated flow shift to the upper lobes of the lungs, indicating slight pulmonary venous hypertension, and flow shift in association with blurring of the lower lobe vessels, indicating pulmonary interstitial oedema. In distinction to the results from acute cardiac failure interlobular septa were often demonstrated in association with pulmonary interstitial oedema, and pulmonary alveolar oedema rarely demonstrated in spite of marked pulmonary venous hypertension.


Visibility of the intrapericardiac segment of the ascending aorta on conventional lateral chest films. In a retrospective survey of the lateral chest films of 284 adult patients the intrapericardiac part of the ascending aorta was at least partly discernible in more than half of the cases; those with visible calcifications in the aortic wall were excluded. None of the patients had known heart disease. When the intrapericardiac part of the ascending aorta is visible it can be clinically useful for the localisation of intracardiac calcifications in relation to the aortic orifice (inside or outside), for estimating the sagittal diameter of the left atrium and for evaluating the width and shape of the aortic root.


Effects on venous vasomotion from the ionic content of contrast agent solutions. An investigation on microcirculation in the bat wing. The effects on spontaneous venous vasomotion from topical application of different contrast media were investigated in the bat wing. Spontaneous venous vasomotion could be stopped either by a high osmolality of the contrast medium or by absence of cations (Na+, K+, Ca++, Mg++) in the solution. The highest contrast medium concentration (mg I/ml), which did not stop venous vasomotion, was obtained when a non-ionic contrast medium solution with low osmolality was mixed with a solution containing Na, K, Ca, Mg-salts of an ionic medium.


Implantation metastasis after percutaneous transthoracic needle aspiration biopsy. The risk of tumour spread at aspiration biopsy of pulmonary tumours through the needle track has been analyzed by reviewing the case histories of 1 264 patients with a malignant tumour demonstrated by needle biopsy. Only in one case did metastatic tumour growth develop at the site of the biopsy. The history of this case is presented and the available literature on the subject discussed.


Catheterization and angiography of the abdominal arteries in the guinea-pig. The abdominal arterial anatomy of the guinea-pig was investigated by angiography and dissection. Normally, a coeliacomesenteric trunk was found, although various forms transitional to the hepatolienogastric trunk were found. Multiple renal arteries were common in comparison to other laboratory animals and to man. A technique for selective catheterization of the abdominal arteries is described.


Hydro-and hemodynamic effects of catheterization of vessels. I. An experimental model. A mechanical model for experiments on the influence on pressure and volumetric flow rate arising from catheterization is described. It is possible under controlled conditions to determine the static and dynamic pressure together with the volumetric flow rate as a function of flow type, repetition frequency, shape and amplitude of pressure surges in pulsatile flow, peripheral resistance, geometry and dimensions of a stenosis or a catheter, and physical properties of the vessel wall materials and of the fluid employed.


Kinematic analysis of posterolateral fusion in the lumbosacral spine. Three cases operated upon with posterolateral fusion in the lumbosacral spine have been subjected to a kinematic postoperative analysis with the aid of a roentgen stereophotogrammetric method. The primarily diseased intervals became comparatively rigid in spite of significant residual mobility, in two of the patients, not until 174 days postoperatively. Three levels of operation displayed unrestricted residual mobility.


Chronic multifocal cleido-metaphyseal osteomyelitis of childhood. Report of a case. A case of chronic, multifocal hematogenous osteomyelitis in a child is descirbed. It represents a special, well-defined clinical variant of this disease, which obviously reflects a more or less balanced relationship between the bacterial aggressor and the defense mechanisms. Exacerbations of old processes, and spread to new sites, can be ascribed to a temporary imbalance.


Radiologic differentiation between cysts and malignant tumours of the maxilla. Analysis of 41 cases with large maxillary lesions (23 malignant tumours, 13 cysts and 5 other lesions) with the aid of special criteria based on the radiologic appearances of various lesions to distinguish cysts from malignant tumours and inflammatory processes.


Multiple expanding renal lesions.

Multiple expanding renal lesions. Unilateral or bilateral multiplicity of expanding lesions in the kidneys is not too unusual and different types of lesions may be combined. This stresses the need for detailed angiography of both kidneys in order to establish an exact diagnosis.


Clinical course after mantle treatment of non-laparotomized patients with Hodgkin's disease. Forty-two patients with Hodgkin's disease were staged without laparotomy and considered to have only supradiaphragmatic disease. They were treated with the mantle technique and followed up for at least 3 years. Abdominal extension was later found in 31 per cent. It is concluded that occult abdominal disease usually in course of time will give symptoms.


Hypopharyngeal carcinoma. Long-term survivors following radical radiation therapy. In a material of 167 cases with squamous cell carcinoma of the hypopharynx, treated between 1961 and 1971, radical irradiation was administered to 55 patients. Of these latter patients the 3- and 5-year survival rates were 36 and 25 per cent, respectively. The lesions of the upper part of the hypopharynx were found to be more curable than those of the lower part. Three cases are presented in detail.


Effects of ionizing radiation on the activity of the ciliated epithelium of the trachea. The immediate effect of ionizing radiation on the activity of the ciliated epithelium of the trachea has been investigated using a light reflection method. This method enables continuous registration of the mucociliary activity both during and after irradiation. A notable increase of the mucociliary activity occurred within 5 seconds after beginning of irradiation and this activity reached its maximum 10 seconds after initial exposure with a dose rate of 0.34 Gy/s (34 rad/s). The mechanism causing the phenomena observed is not clear but theoretically it might be due to ATP, the source of energy of the cilia being freed by the irradiation, possibly through disturbances of the permeability in the mitochondrion membranes.


Fall in blood pressure during radiation therapy. Blood pressure and heart rate at rest in the supine and standing positions were followed before, during and after irradiation for malignant tumours in 114 patients. A statistically significant gradual reduction in blood pressure during the treatment period was established. This was more marked in older patients and in patients with higher initial blood pressure but was not related to the region irradiated or the type of tumour treated. Particularly if the patient experiences vertigo and nausea on change of position, it seems advisable to check the blood pressure during treatment.


Absorbed dose in mammary radiography.

Absorbed dose in mammary radiography. By exposure measurements in an alcohol-water mixture simulating breast tissue, the absorbed dose, and dose distribution in the breast at the radiation qualities commonly used in mammary radiography have been calculated. The absorbed doses for different recording media have been compared at those radiation qualities which result in similar image qualities in the different recording media.


Attenuation equalizing filter in diagnostic radiography. Advantages calculated by a Monte Carlo technique. The value of an attenuation equalizing filter (equalizer) has been examined by calculation using a Monte Carlo technique. The contrast enhancement caused by the equalizer is the net result of three factors: (1) The first factor arises from the contrast change caused by the difference in detector characteristics at the different energies absorbed in the detector with and without equalizer. (2) The second factor is due to the contrast change caused by the different ratios of primary to total radiation reaching the detector. (3) Finally, the third factor describes how the transparency of the object is changed by the different primary filtration with equalizer. An example is given of the reduction in radiation energy absorbed by the patient and the question of how far the attenuation equalization can be driven is discussed.


Diabetes mellitus and acute myocardial infarction. A series of 597 consecutive patients with acute myocardial infarction (AMI) have been screened for diabetes mellitus (DM). Six per cent of the series had DM, which is exactly the frequency of DM in an age-matched population. This finding corresponds with results of other investigators, indicating that treated diabetics do not have an increased risk of AMI. Diabetics suffering from AMI do not have an increased mortality, nor do patients treated with oral antidiabetics have a higher mortality than those treated with insulin.


Skeletal lesions of the feet in diabetics and their relationship to cutaneous erythema with or without necrosis on the feet. Seventy patients with cutaneous erythema of the feet with or without necrosis were the subjects of this investigation. Sixty-five of them had open diabetes. The glucose tolerance of the remaining five patients was altered in a diabetic direction. Twenty-seven of the 70 patients had roentgenologically demonstrable destruction in the bones of the feet. These 70 patients were compared with 61 diabetic control patients of corresponding age and duration of diabetes but without these skin lesions of the feet. Only four of the 61 control patients had destruction in the bones of the feet and all these destructions were small. Precipitating factors were identified in general for the skin lesions, the most common being cardiac decompensation. A higher frequency of precipitating factors was seen in patients with skeletal destructions than in those without. The skeletal destructions and cutaneous necrosis are supposed to be equivalent lesions, localized to different tissues in the feet. When patients presenting skin lesions of the feet in the form of distal gangrene were compared with those who had cutaneous erythema and necrosis of the feet, but no distal gangrene, no differences were found with respect to age, duration of diabetes, occurrence of precipitating factors and the occurrence of skeletal destruction. Cutaneous erythema without necrosis is understood to be incipient diabetic gangrene.


Body composition and glucose metabolism in hypertensive middle-aged males. Body fat, body cell mass, fasting blood sugar, glucose tolerance and fasting insulin have been determined in 106 hypertensive males aged 47-54years and in 41 normotensive 50-year-old males. Both groups were derived from screening examinations in random population samples. The hypertensive subjects were more often obese and had more often an impaired glucose tolerance and a higher fasting insulin compared with the normotensive subjects. The metabolic differences were not explained simply by the higher degree of obesity in the hypertensive subjects, as the differences remained when the hypertensive subjects were matched for body fat with normotensive controls. The impaired glucose metabolism demonstrated quantitatively in an unselected group of hypertensive subjects, might be one of the factors explaining the variable prognosis in hypertensive subjects.


Hereditary hepatic porphyrias in Finland. The occurrence of hepatic porphyrias--acute intermittent porphyria (AIP) and variegate porphyria (VP)--in Finland has been studied. During a period of 9 years 107 patients with AIP and 45 patients with VP were found. The prevalence of hereditary hepatic porphyrias was calculated to be 3.4 per 100 000 inhabitants. The patients belonged to 42 different families. Eighty-nine patients (59%) had had acute attacks, whereas 63 were symptomless latent cases. Precipitating factors, symptoms and excretion of porphyrins and their precursors did not significantly differ from what has been reported earlier from other parts of the world. A slight fragility of the skin on the back of the hands was noted in some 50% of VP patients. Abnormal sensitivity to sunlight could not be seen in a single case. However, about 50% of patients with VP showed an abnormal reaction when irradiated with artificial ultraviolet light. The difference in the skin symptoms in South African and Finnish VP patients is discussed.


Pure mitral regurgitation. Etiology, pathology and clinical patterns. The varied etiology of pure mitral regurgitation is demonstrated in this clinicopathological study, comprising 59 surgically treated cases with this condition. One third of the cases was of rheumatic origin, one fifth had ischemic heart disease, another fifth floppy valves and one eighth an isolated rupture of the chordae with necrosis of the chord matrix. To our knowledge the histopathological findings in the last group have not been described before. Congenital mitral regurgitation, bacterial endocarditis and cardiomyopathy were rare causes of mitral regurgitation. Differences between the groups were observed in the sex ratio, duration of history, auscultatory findings ECG signs, compliance of the left ventricle and in the morphological findings.


Disopyramide in ventricular tachycardia. Administration of disopyramide phosphate (DE) i.v. in two doses, 30 min apart, to a patient with ventricular tachycardia was accompanied by no, or only slight, changes in systemic arterial pressure (SAP), cardiac output (Q), stroke work (SW), and pulmonary artery diastolic pressure (PADP). Heart rate fell from 123 to 103/min. Following reversion to sinus rhythm, which occurred 60 min after the second dose of DE at a serum concentration greater than 4.3 mug/ml, Q ans SW showed significant increases above their control values. PADP fell from 20 to 6 mmHg whereas the mean SAP remained largely unchanged. There seemed to be no adverse effects of drug administration. In this patient, recurrent attacks of ventricular tachycardia not responding to conventional antiarrhythmic treatment could be prevented by oral DE in a dose of 800 mg/day.


Clinical and hemodynamic findings following prosthetic valve replacement for mitral valve disease. A study of patients with the new Björk-Shiley tilting disc valve. Clinical and hemodynamic results have been evaluated 12--24 months after mitral valve replacement with the new Björk-Shiley tilting disc valve prosthesis. After operation, most patients were improved symptomatically and were classified as I-II (N.Y.H.A.). No patient became worse. Hemodynamic status at rest showed significant reduction in pulmonary capillary venous pressure, pulmonary artial pressure and significant increase in cardiac output when compared with the preoperative values, but postoperative hemodynamic abnormalities remained. Exercise produced a rise in pressures in the pulmonary circuit and in cardiac output. The increase in cardiac output was less than expected from the increase in oxygen consumption, with a few exceptions. Apparently, there was no close relationship between the symptomatic improvement and the hemodynamic results. Thus, the present study points to the importance of hemodynamic data in the objective assessment of the results of cardiac surgery.


A validation of cause-of-death certification in 1,156 deaths. Swedish twins have been followed for mortality since 1961, when the Swedish Twin Registry was formed. During the years 1961-73 there were 1290 deaths among twins born in 1901-25. In 1156 cases the cause of death could be established from collected records and classified according to the 1965 revision of ICD. Using the review of records as the standard, rates of detection and confirmation relating to the death certificate diagnoses were calculated. It is concluded that Swedish death certificate data are fairly valid for use in epidemiological studies and mortality statistics with regard to most cancer forms, cerebrovascular disease, ischemic heart disease, bronchitis, asthma and emphysema, accidents and suicides, but not for diabetes mellitus, alcoholism, mental diseases, rheumatic heart diseases and other heart diseases. However, in selected clinical-epidemiological studies it is often necessary to collect all available documents prior to judging the cause of death.


Five-year mortality in the city of Bergen, Norway, according to age, sex and blood pressure. The City of Bergen was covered by a Mass Miniature Radiology Survey in 1963-64. On the initiative of the University of Bergen, examinations of BP were included. The initial survey has been reported previously (1). This analysis concerns the relationship between the 5 1/4-year cause-specific mortality and BP. Non-attenders have excess mortality in relation to attenders and this is mostly explained by a generally high mortality among bedridden people. The age-specific total mortality shows a clear pattern of a general increase with increasing BP. At high systolic BP levels, the 5-year mortality is independent of whether the age is 45 or 75. The systolic age-adjusted curve for males increases quite linearly, while the diastolic curve is more U-shaped. Thus, when comparing the predictive power of BP, allowance must be made for this fact. Using a second order polynomial prediction function, this conclusion is reversed. The mortality from cerebral stroke shows a dramatic increase with increasing BP. The diastolic curve shows a bend-off for high values, above 110 mmHg. This may be due to the offer of treatment which such patients received after the screening. Also the CHD mortality curve flattens for high BP values, especially for diastolic BP.


A five-year survey of human Yersinia enterocolitica infections in Hungary. Human infections associated with Yersinia enterocolitica in Hungary in the years 1969-1974 have been surveyed. During this period the public health laboratory network isolated 1355 strains from 1096 persons. The number of isolates according to sero-groups was: 1343 O3, 6 O9, 2 O1, 2a, 3 and 1 strain for O5, O6, O1O and O15 each. (ii) A total of 2192 serum specimens from patients gave positive agglutination reaction with antigen O3 in 26.8%, with antigen O9 in 3.2%. (iii) Fifty-six per cent of bacteriologically positive persons had enteritis. Other clinical forms (pseudoappendicitis and other abdominal complaints, erythema nodosum, rheumatoid arthritis) were encountered in O 1-2.7%. Symptomless excreters of Y. enterocolitica amounted to 23.1% of all positive persons. (iv) Patients with enteritis and symptomless excreters were rather evenly distributed between 10 and 60 years of age; 1--9-year-old children were affected more frequently (47.7% of all positive persons). Six distribution was, males: females = 1.5 : 1. In seasonal incidence yersiniosis differed from other enteric diseases: it showed a peak in the autumn-winter months. Sporadic cases and family outbreaks were the most frequent; epidemic infections in nurseries were also recorded. (v) Out of 59 animal strains 39 group O3 cultures were isolated from pigs, which may be assumed as the most important reservoir of yersinosis in Hungary.


[Incidence of staphylococcal serotypes in different hospitals (author's transl)]. A total of 409 Staphylococcus aureus strains were classified with 17 typing sera into 16 groups and 14 types. Strains with the formula a b+ c e and h+ i k l were most frequently met with. The majority of strains isolated from typical staphylococcal diseases contained antigens e', h+ and/or h++ whereas those associated with atypical infections showed antigens b++ and o most frequently. Classification by Oeding and Williams' scheme yielded a less wide variety of serological units: most strains fell into group 4; spontaneously agglutinating and group 1, 2 and 3 strains were next in order.


Suppression and disinhibition of instrumental alimentary reactions after successive lesions of the dorsomedial and lateral amygdala in dogs. Damage of the dorsomedial amygdala produced impairment of instrumental performance to CS(+) with no changes to CS(-). Subsequent lesion of the lateral amygdala resulted in restoration of instrumental performance to CS(+) and transient disinhibition to CS(-). These results support the hypothesis that the dorsomedial amygdala is involved in facilitation, while the lateral amygdala in inhibition of alimmentary reactions.


Hyperthermia and inhibition of feeding produced by self-stimulation in the septum and preoptic area in dogs. Dogs bearing electrodes implanted in the anterior part of the basal forebrain were tested for their response to food upon electric stimulation of rewarding sites, and for self-stimulation-produced hyperthermia. Self-stimulation and forced (experimenter-induced) stimulation of 12 out of 16 loci evoked a negative reaction to food the strength of which was determined according to occurrence and persistence of three effects: ignoring food (the dog performing self-stimulation in the presence of readily available meat), food rejection (the dog's failure to take meat offered together with passive stimulation of the rewarding site), and food ejection (throwing meat out of the mouth upon passive stimulation). The rise in body temperature during self-stimulation was positively correlated with the rate of responding. Hyperthermia was significantly higher during self-stimulation in sites where stimulation produced a strong negative reaction to food, as compared with those where stimulation failed to stop the animal from eating. The stimulus-contingent negative reaction to food may reflect a short-term satiety which is supposed to play an essential role in the mechanism of reinforcement. Hyperthermia, and particularly stabilization of hypothalamic temperature on an elevated but fairly constant level, argues for a shift of the set-point for temperature regulation. Occurrence of the two effects supports the claim that self-stimulation produces some complex activation of neural processes controlling energy homeostasis.


Learning, stress, and psychosomatic symptoms. Professor Jerzy Konorski was an internationally renowned scientist with a remarkable range of intellectual power and enthusiasm; he also was a warm friend. It is a great honor to be invited to contribute a paper to publications commemorating his life and work. As infectious diseases are being conquered, other pathological conditions are assuming increasing medical importance. A number of these are strongly influenced by the brain in its central role of regulating a wide variety of vital functions. It has long been believed that the mind affects the body; recent research in supplying objective evidence for an increasing number of such psychosomatic effects. This paper summarizes some experiments from the author's Laboratory on such effects and also on some of the ways in which amines and hormones in the brain affect behavior. In view of the wide range of Professor Konorski's interests, it is fitting that the work to be summarized here has been multidisciplinary. Clinical studies, especially under conditions of combat in war, show that fear and the conflict it can induce can produce a wide range of psychosomatic, neurotic, and even psychotic symptoms. Such work also indicates that purely psychological factors, such as learning when it is dangerous and when it is safe and learning coping responses, can make a great difference in the amount of fear experienced and in its psychosomatic effects. However, while clinical observations of human behavior are particularly relevant, it is difficult to untangle confounding factors and thus determine unequivocal causal relationships. The immediately following experiments attempt to fill part of this gap.


Visual cortex role in object discrimination in cats deprived of pattern vision from birth. A simultaneous object discrimination task for food reward was elaborated in normal cats and in cats deprived of pattern vision from birth. In the latter the learning was more difficult and retraining was necessary after a preoperative retention period. In both groups the cortical projection of central vision was removed in areas 17, 18 and 19. In deprived cats the deficit following the cortical lesion was less than in normal animals. It is concluded that deprived cats used visual cortex less in learning and thus they learned more slowly but were less deficient postoperatively.


EEG correlates of acquisition and extinction of expectancy. The work to be described was begun in 1958 at the Montreal Neurological Institute in order to verify some of the prevailing neurophysiological notions concerning the mechanisms of habituation and attention. The results dealing with the EEG correlates of habituation and acquisition of expectancy were presented at the annual meetings of the American Psychological Association (Mahut 1959). Beginning in 1960 other authors started questioning the validity of the claims regarding mechanisms of attention that had been previously reported in the physiological literature. I hesitated, therefore, to publish my data. Professor Konorski, however, kindly urged me to do so, particularly the results concerned with the EEG of extinction and the effects of arousal on cortical electrophysiology. It is to his memory that this report is dedicated.


The effect of conditioned stimuli signalling food upon the autochthonous instrumental responses in dogs. Food CSs, presented (i) concomitantly with SD controlling bar pressing for food, or (ii) on the background of non-discriminated bar pressing (FR 1/15), suppress instrumental performance but elicit undiminished conditioned salivation. This result supports Soltysik-Konorski's model of CNS mechanism controlling food-oriented behavior which postulates drive inhibition by taste-consummatory neurons.


Discrimination of time intervals in cats. Fourteen cats were trained to discriminate between 5 and 20 s periods of confinement as evidenced by differential responding to two feeders. In a subsequent titration procedure the cats discriminated 5 from 10 or even 8 s. Positional mediation of correct responses was observed only in some animals. The present task may complement the classical and operant conditioning situations in which the temporal distribution of responses reflects the animals' abilities for both time discrimination and response inhibition.


Efferent connections of the basolateral amygdaloid part to the archi-, paleo-, and neocortex in dogs. Small electrolytic lesions were placed in the basal and lateral amygdaloid nuclei of the dog and the distribution of degenerating fibers was studied with Nauta and Fink-Heimer modifications of the impregnation methods. Degenerating axons were followed into the hippocampal region and entorhinal cortex as well as insular and temporal cortices. The present results suggest that: (i) The hippocampal region receives projections from the basal parvocellular and basal magnocellular nuclei; (ii) the entorhinal cortex from the lateral and basal parvocellular nuclei; (iii) the insular cortex, cortex of the anterior ectosylvian and sylvian gyri, and to a smaller degree the claustrum, from the lateral and basal magnocellular nuclei; (iv) the temporal cortex of the posterior suprasylvian gyrus from all nuclei of the basolateral part of the amygdala. It is concluded that the basolateral part of the amygdala in the dog has a complex and highly developed connections with the archi-, paleo- and neocortex.


Localization of acetylcholinesterase activity in the amygdaloid body of man. The localization of acetylcholinesterase (AChE) activity in the nuclei of the amygdaloid body of man was studied by Gerebtzoff's modification of Koelle's acetylthiocholine method on 10 human brains. To compare the histochemical results with the cytoarchitectionics, additionally sections from 10 human brains were stained with cresyl violet. The intensity of AChE activity in the different amygdaloid nuclei varied widely. The high AChE activity occurred in the basal lateral nucleus and in the lateral part of the central nucleus. Very little activity was found in the medial nucleus and in the intermediate part of the central nucleus. All remaining nuclei showed AChE activity of moderate intensity. In almost each amygdaloid nucleus, differences of AChE activity among various areas were observed. In the amygdala of man all nuclei described in animals were found except nucleus of the lateral olfactory tract. Most of the human amygdaloid nuclei show more differentiated structure than in lower mammals in terms of not only cytoarchitectonic subdivision, but also in the intensity of AChE activity.


The effects of cerebral sensory cortical ablation on instrumental conditioned reflex in cats with cerebellar lesions. Cats were trained to reach with their fore limbs for food placed in horizontally mounted cylinders of various diameters. The chain instrumental reflex (entering cylinder, reaching for, grasping and bringing food toward the mouth) survived cerebellar paravermal cortical ablation or interposite-dentate nuclear lesion, with some exaggerated flexor or extensor responses respectively. Movements improved with time. Cats were then subjected to ablation of cerebral sensory cortex, SI and SII. SI or compined SI and SII lesion resulted in an initial period of decompensation of cerebellar symptoms. Sensory loss was also noted for 30-40 days after SI lesion and throughout the observation period up to 53 days after combined SI and SII lesion. The conditioned responses were soon accomplished at preoperative level. Furthermore, visual occlusion did not change the performance in conditioning situation. The result indicates that the compensation of cerebellar symptoms does not depend on an intact cerebral sensory cortex. It also suggests that functional accomplishment can be obtained through training despite neurological deficits following certain brain damage.


The orienting reflex in cats with experimental temporal lobe epilepsy. Aluminum-induced temporal lobe epilepsy in 24 cats showed marked interictal intensification of somatic and EEG components of the orienting reaction and increase in their resistance to habituation. The greatest disturbances of the orienting response were noted in cases of bitemporal foci, of foci situated in the allocortex (hippocampus and amygdala) and of foci inducing generalized or generalized and partial seizures.


The effect of leukocyte-induced degradation products of albumin on the analgesic action of morphine. The effect of leukocyte-induced human albumin degradation products (LPAD) on the analgesic potency of morphine was investigated. The degradation products given alone to the rats did not affect pain threshold; while combined with morphine, they potentiated its analgesic action. Moreover, the degradation products increased the concentration of morphine in the brain tissue.


Activity of some enzymes in the cortex of the cat with pretrigeminal brainstem transection. The visual and somatic sensory cortex were investigated. The activity of acetylcholinesterase and lactate dehydrogenase was similar in the pretrigeminal and non-operated cats. The activity of these two enzymes, as well as that of choline acetyltransferase, butyrylcholinesterase and acid phosphatase was similar 3 and 8 h after the pretrigeminal transection. Results support the possibility of utilizing the pretrigeminal cat for investigations of biochemical correlates of learning.


[Diagnosis and differential diagnosis of solitary pulmonary coin lesions]. In the present analysis, the diagnosis as well as the differential diagnosis of solitary pulmonary coin lesions are discussed. The coin lesions of 361 patients who were at our diagnostic ward from 1968 to 1970 were defined according to Rube [1967]. The investigations are in accordance with the routine examinations and were consciously demonstrated in nonselected patients in order to express the several diagnostic procedures, their field of indication and their efficiency in a balanced ratio. Therefore, the efficacy of the X-ray diagnosis could be proved in a broader range than in a collective of circular foci which would have been chosen exclusively under the aspect of the diagnosis by means of needle biopsy and which would reveal a higher percentage of morphological clarification of the focus.


BCG vaccination and epidemiological situation: a decision making approach to the use of BCG. The clinical efficacy of a well-controlled and correctly applied BCG vaccine can hardly be questioned, nor its usefulness under individual circumstances. But a problem more and more often raised now is that of the opportuneness, at the present time, to still use BCG on a mass- systematic - scale, particularly in the TB control programmes of low-prevalence countries. The article proposes an approach which, alongside with other methods already presented for assessing the epidemiological value of BCG and its public health indications, can help appreciate the advantages and disadvantages brought by vaccination in high- as well as in low-prevalence countries. The article focuses on the future, i.e. on what can, from now on, be expected from BCG in terms of epidemiological, economical and psychological benefits. Test runs were made considering three cohorts of 100,000 individuals (newborn, school enterers, school leavers), vaccinated or not vaccinated, submitted to various risks of infection (corresponding to conditions of high-, intermediate- and low-prevalence of tuberculosis) and experiencing various breakdown rates from infection to disease. Cost for BCG on the one hand, and cost for diagnosis, treatment of tuberculosis and loss of wages on the other, were also entered in the calculations; an attempt was also made to quantify in absolute terms and in relative ones the in conveniences linked to the application of BCG itself. Beyond figures and results presented as examples, what is more important is that the article furnished a method of reasoning and the possibility to feed one's own data in the model; it may help to encompass the scope and implications of a decision, and it furnishes elements of dialogue with other members of the planning team. It should be well realized that the elements provided and those which can be worked out are elements of reflexion to found a decision; the decision itself - to start, to pursue or to stop BCG on a mass scale - is of political nature (public health policy): it always implies a value judgement - from the part of the providers of the services and/or, preferably, from the part of the users, i.e. a preference which is the result of a 'weighing' between advantages and inevitable disadvantages, both involving time, place, existing system, existing beliefs and other fields of health and welfare.


Rapid purification of human high molecular weight kininogen. Human high molecular weight kininogen was isolated by a rapid procedure, using anion exchange chromatography on QAE-Sephadex, ammonium sulfate precipitation and cation exchange chromatography on CM-Sephadex. The poor recovery and relatively low specific activity observed in earlier experiments was found to be due to a contaminant, presumably enzymatic, capable of releasing kinin from the kininogen. The "spontaneous" kinin release was blocked by soy bean trypsin inhibitor and by C1-inactivator. The isolated kininogen was stable at different temperatures, did not contain free kinin and was a good substrate for plasma kallikrein and plasmin.


Diamines and polyamines in DMBA-induced breast carcinoma containing mast cells resistant to compound 48/80. In female rats, mammary carcinoma were induced by DMBA (7,12-dimethylbenz(alpha)anthracene) administration. The activities of histidine and ornithine decarboxylases and the concentrations of histamine, putrescine and polyamines were determined in tumour extracts and urine. In the tumour tissue, formation of histamine and putrescine took place at much higher rates than in normal mammary tissue. Administration of compound 48/80 in doses that mobilized about 70% of histamine contained in the ear failed to release histamine contained in the tumour; 48/80 also failed to produce histological signs of degranulation of the tumour mast cells. It thus appears that these cells are different from mast cells in most normal tissues, a distinction that calls for further study.


Comparison of the immunosuppressive efficacy of 6-mercaptopurine, azathioprine, cyclophosphamide and 036.5122 (Asta) on the primary and secondary immune response of mice to sheep erythrocytes. Two alkylating (cyclophosphamide and 036.5122 Asta) and two antiproliferative agents (6-mercaptopurine and azathioprine) have been compared for their immuno-suppressive potency on the primary and secondary humoral immune response of mice. If equitoxic dosages of the respective drugs are compared, the alkylating agents proved to be of much higher immunosuppressive potency than the antiproliferative agents. In non toxic dosages alkylating agents were able to completely inhibit a primary or secondary immune response, whilst a similar effect with antiproliferative drugs could not be obtained even within toxic dose ranges. Induction of immunological tolerance was possible only by use of the alkylating agents. The significance of these comparative studies is discussed in view of the frequent use of the tested drugs in clinical immunosuppression.


Thrombus formation, hemostasis, adhesiveness of leukocytes and morphological abnormalities in the microcirculation of adjuvant arthritic rats. Microcirculatory alterations which may be responsible for the chronicity of adjuvant-induced arthritis in the rat were investigated. Thrombus formation in the mesenteric microcirculation was investigated by laser-technique. In arthritic rats thrombus formation for a given stimulus was increased significantly and a correlation was found between the intensity of the arthritic changes and this thrombotic reaction. Adherence of leukocytes to the venous endothelium was studied by an in vivo technique. The number of "rolling" and "sticking" leukocytes was greatly increased in the mesenteric venules of arthritic rats. Acute treatment of severely arthritic rats with aspirin greatly reduced the increased adhesiveness of granulocytes. By the use of an atraumatic technique for vital microscopy of the microcirculation of skin of arthritic rats, striking morphologic changes with stasis of erythrocytes were observed. Morphological aberrations were also found in the mesenteric microvessels of diseased animals.


Pertussis vaccine oedema: an experimental model for the action of penicillamine-like drugs. A delayed hypersensitivity response was induced in the rat paw using pertussis vaccine. Oedema was measured after the challenging injection. D-penicillamine and levamisole enhanced the response, while indomethacin suppressed it. This model is useful to distinguish the effects of anti-inflammatory drugs from those like D-Penicillamine which have a specific activity in rheumatoid arthritis.


Pertussis vaccine pleurisy: a model of delayed hypersensitivity. Male Wistar rats have been sensitized to Bordetella pertussis using a mixture of Freund's incomplete adjuvant and pertussis organisms. Intrapleural challenge 12 days later with pertussis produced a marked delayed inflammatory response, maximal at 48 hours and dominated by influx of mononuclear cells. Dosing with D-penicillamine (25 mg/kg) and levamisole (5 mg/kg) at the time of challenge produced a significant enhancement of the reaction. A long period of dosing with either drug, or treatment with indomethacin (3 mg/kg), suppressed the response. The relevance of this to the testing and mode of action of antirheumatic drugs is discussed.


Inflammation and the vascular changes due to thermal injury in rat hind paws. The vascular changes due to thermal injury have been determined in rat hind paws. In anaesthetized rats one hind paw has been injured by immersion in water for 30 seconds; temperature range 49-65 degrees C. Changes in blood flow, blood content and albumin content have been determined and compared with values from uninjured rats. The swelling caused by thermal injury was temperature-dependent, the higher temperatures caused the larger swellings. There were also temperature-dependent increases in blood flow to the injured paw and albumin content of the injured paw. Changes in blood content only occurred at the highest temperatures. Swelling, increased blood flow and albumin content could be detected within 1 minute of injury. The swelling and albumin content of the tissue then continued to increase gradually. The increase in blood flow was greatest 1 minute after injury and then stabilized at a flow some 4-5 times higher than normal paw flow. The method described can be used to measure vascular changes due to other inflammatory stimuli and could be applied to measure changes in other discreet areas.


Modification of adjuvant inflammation in rats deficient in essential fatty acids. Rats deficient in essential fatty acids (EFA) did not develop as much foot swelling on receiving injections of complete Freund's adjuvant as did normal controls. Both the acute inflammation and the chronic inflammation were affected. This reduction in the chronic phase of adjuvant inflammation was restored to normal levels by feeding a small supplement of corn oil as a dietary source of EFA. Since the EFA are biologic precursors of prostaglandins (PG), the lack of EFA is thought to influence adjuvant-induced inflammation by reducing available PG mediators of inflammation.


Release of prostaglandins from the isolated perfused rabbit ear by bradykinin and acetylcholine. (1) The isolated rabbit ear was perfused via its artery and the venous outflow superfused a PGE-sensitive rat stomach strip or a PGF-sensitive rat colon. (2) Injection of bradykinin intra-arterially into the ear produced a larger contraction of the rat stomach strip than the application of the same dose of bradykinin directly to the superfused muscle. (3) This difference is explained as a release of PGE-like material by bradykinin since indomethacin (infused i.a. into the ear) reduced the effect of the i.a. applied bradykinin. (4) PGF-like material could not be detected in the venous effluent. (5) ACh released only minimal amounts of PGE-like substance. (6) CONCLUSION: The amount of PGE-like material released by bradykinin is large enough to sensitize the paravascular pain receptors in the rabbit ear for the attack of bradykinin. Therefore, inhibition of PG-synthesis (i.e. by indomethacin) or inhibition of the sensitizing action of E-type PGs (i.e. by polyphloretin phosphate) reduces the pain producing effect of bradykinin. Since ACh releases only minimal amounts of E-type PGs, its effect is reduced only to a minimal extent by indomethacin or polyphloretin phosphate.


Influence of adjuvant arthritis on connective-tissue metabolism. In rats with adjuvant arthritis, an analysis was made of the metabolism of sulfated proteoglycans, with particular attention to the dorsal skin and the extremities. Alterations were demonstrated in all the tissues examined. In the uninflamed dorsal skin, the uptake of exogenous sulfate was diminished. By contrast, in both hind limbs, at the injected and the non-injected site, the turnover of sulfated mucopolysaccharides was increased, above all in ligament and cartilage; the calcium content of the bone tissue of both hind legs was, however, not affected by the disease.


Polyphloretin phosphate reduces the algesic action of bradykinin by interfering with E-type prostaglandins. (1) The method of the isolated perfused rabbit ear connected to the body by its nerve only was used to investigate the influence of the prostaglandin-antagonist polyphloretin phosphate (PPP) on the algesic effect of bradykinin (B) and acetylcholine (ACh). (2) Intra-arterial injections of B and ACh into the ear elicit a reflex fall in systemic blood pressure of the anaesthetized animal. PPP reduces this effects of B in proportion to the dose. The effect of ACh is reduced only to a small extent and only under higher concentrations of PPP than those necessary for inhibiting the effect of B. (3) Prostaglandin E1 (PGE1), when infused i.a. into the ear, enhances the effect of B and ACh by a sensitizing action on the perivascular pain receptors. PPP reduces or totally abolishes the PGE1-induced enhancement of the effect of B and ACh. (4) It is concluded that PPP reduces the effect of B mainly by inhibiting directly the pain enhancing action of the endogenously released PGs of the E-type. The effect of ACh is reduced only in the high concentration of PPP to a small extent probably by inhibiting the ACh-action rather than the sensitizing action of the only minimal released amounts of PGs. The PG-antagonizing action of PPP is further proven by the fact that during an additional infusion of PGE1 the enhanced effects of both B as well as ACh are reduced or abolished by PPP.


Anti-inflammatory and related properties of 2-(2,4-dichlorophenoxy)phenylacetic acid (fenclofenac). Fenclofenac was shown to possess anti-inflammatory, antinociceptive and antipyretic properties as measured by tests in rats that detect clinically active compounds. In a chronic test for assessing anti-inflammatory activity (established adjuvant arthritis), it was approximately equipotent to alclofenac, fenoprofen calcium and phenylbutazone, more potent than acetylsalicylic acid and ibuprofen, but was less potent than diclofenac sodium, indomethacin, ketoprofen and naproxen. In contrast, the potency of fenclofenac in acute tests for anti-inflammatory, antinociceptive and anti-pyretic activity was generally lower, the drug being approximately equipotent to acetylsalicylic acid in such tests. The anti-inflammatory activity of fenclofenac was not mediated via the pituitary-adrenal axis or a counter-irritant action. Fenclofenac was shown to have remarkably low gastric ulcerogenic potential, both acutely and chronically.


Computer-based approach to chelation therapy: a theoretical study of some chelating agents for the selective removal of toxic metal ions from plasma. COMICS is a computer programme for calculating equilibrium concentrations of metal complexes and reactive species in multi-metal-multi-ligand systems. Its usefulness for analysing metal ion equilibria in blood plasma has been improved by including albumin as a ligand. Using this model system the distribution and removal of copper(II) and zinc ions in histidinaemia, lead poisoning and Wilson's disease have been examined. The efficacy of TRIEN in removing excess copper(II) is shown. The use of specific tripeptides such as Gly-Gly-His methyl ester for the selective removal of copper(II) is suggested. A possible chemoprophylaxis of influenza based on complexation of zinc is discussed. Calculations confirm that thiosemicarbazones such as methisazone and 2-acetylpyridine thiosemicarbazone are effective competitors for heavy metal ions under physiological conditions.


A radioactive mercury vapor generating and exposing system for small scale animal experiments. An apparatus is described for exposing small animals to high specific activity elemental mercury vapor. The vapor is generated by reduction of mercury chloride labelled with the 203HG isotope. The vapor is carried by a constant stream of air into the exposure chamber. The method has been used to expose rats or mice to constant air concentrations of mercury vapor in the range from 0.008 to 0.32 mg/m3. The specific activity of the mercuric chloride used in the study was approximately 1.8 mCi/mgHg. This is sufficiently high to allow measurement of tissue deposition of mercury after an exposure period of only 30 minutes.


Measurement of protection factors of chemical cartridge, half-mask respirators under working conditions in a copper smelter. The performance of three commonly used chemical cartridge respirators for SO2 was measured under working conditions in a copper smelter. An effective SO2 protection factor for each man-respirator trial was calculated as the ratio between average SO2 concentrations sampled outside the respirator mask and that simultaneously sampled from inside the mask. The in-use SO2 protection afforded by the three respirators proved to be highly variable with mean protection factors of 22, 18, and 13. The distributions of the protection factors and the effects of mask type, facial size, and mask comfort are discussed.


Quantitating the efficiency of the coal mine personal respirable dust sampler for sampling oxide fumes. Coal mine environments containing fume contaminants are assessed using the standard personal respirable dust sampler. The effect of the first-stage collector and filter on the total concentration measured was evaluated. The results showed that the personal respirable dust sampler could be used to sample fumes with TLV's greater than 1.0 mg/m3.


Air-purifying powered respirator pack utilizing a miniature two-stage air mover. Design and construction of a moderate-weight, battery-powered, positive-pressure respirator pack is described. Design detail of a two-stage air mover is given, along with its adaptation for use as a portable air sampler.


Decision and estimation procedures for air contaminants. This paper deals with the problem of enforcing average exposure standards for atmospheric contaminants in an industrial environment based upon short-period samples. Due to inherent uncertainties, a decision is to be made only if the probability of incorrect decision is below a prescribed level. It is shown how such a decision can be obtained in a very simple manner with the help of a decision chart with families of curves corresponding to the number of observations.


A statistical technique for determining compliance with dual hygienic standards. A mathematical technique was developed to calculate log-normal distribution for sample results. This is then compared with a Limiting distribution defined by the sampling time, the Time-Weighted Average and the Ceiling Limit standard for the material tested. The technique provides a more effective means to decide if either or both the T.W.A. or Ceiling Limit has been exceeded. Sample times from 10 minutes to 4 hours are considered. A similar technique has previously been reported for evaluating benzene exposures. Examples are provided to illustrate the procedure.


The energetics of mask wear.

The energetics of mask wear. Experimental data further defining the region of predominant respiratory stress is presented. Within this region, energy requirements of respiration increase disproportionately to the overall energy expenditure of the body as excercise intensity increases. Addition of a mask accentuates this tendency, especially since no physiological compensation is possible in mask parameters. Mask technology has improved masks to the point where they no longer dominate the man-mask system, but instead contribute resistances and dead volumes approximately equal to those naturally occurring in man. Modeling base on minimization of respiratory energy rate of expenditure in the human is applied to this man-mask system and predictions are made which to this point have been nearly impossible to obtain from experimental data.


Serial measurements of left ventricular ejection fraction by radionuclide angiography early and late after myocardial infarction. The left ventricular ejection fraction was determined serially with radioisotope angiography in 63 patients with acute myocardial infarction. After the peripheral injection of a bolus of technetium-99m, precordial radioactivity was recorded with a gamma scintillation camera and the ejection fraction calculated from the high frequency left ventricular time-activity curve. Since this technique requires no assumptions with respect to left ventricular geometry, it is particularly useful in patients with segmental left ventricular dysfunction. Serial measurements during the first 5 days after hospital admission were made in 50 patients, 30 of whom were studied during the subsequent 2 to 39 months (mean 19.9 months). Late follow-up serial studies were also performed in an additional 13 patients who had only one measurement of the left ventricular ejection fraction during the early postinfarction period. Early after infarction, the left ventricular ejection fraction was normal (more than 0.52) in only 15 of the 63 patients, and averaged 0.52 +/- 0.05 (standard deviation) in the 27 patients with an uncomplicated infarct. The ejection fraction was reduced in 24 patients with mild to moderate left ventricular failure (0.40 +/- 0.05, P less than 0.0001) and in the 12 patients with overt pulmonary edema (0.33 +/- 0.07, P less than 0.0001). In 35 patients the ejection fraction correlated with the mean pulmonary arterial wedge pressure (r = 0.72). In 15 patients with normal left ventricular wall motion by heart motion videotracking, the ejection fraction was significantly higher (0.53 +/- 0.08) than in the 26 patients with regional left ventricular dysfunction (0.41 +/- 0.10, P less than 0.0001). During the early postinfarction period, the left ventricular ejection fraction improved in 55 percent of patients and remained unchanged or decreased in 45 percent. A further increase in the ejection fraction was noted in 61 percent of patients during the late follow-up period. Patients with an initially low or decreasing ejection fraction had a significantly greater incidence of early mortality and left ventricular dysfunction (P less than 0.02) than those whose ejection fraction was normal or improved to normal early after infarction. These data indicate that the ejection fraction is a sensitive indicator of left ventricular function after acute myocardial infarction and that serial measurements are helpful in predicting early mortality and morbidity.


Regional myocardial blood flow during hyperemia induced by contrast agent in patients with coronary artery disease. Regional myocardial specific blood flow (regional specific flow) was measured at rest and during contrast hyperemia after the intracoronary injection of xenon-133. The changes in regional specific flow were transient, resulting in some compromise in one of the underlying restraints of the inert gas washout method, namely, the presence of a steady state. Therefore, to determine the clinical utility of this technique, regional specific flow values obtained with this method were correlated with the presence and severity of coronary artery disease as assessed from the coronary arteriogram and left ventriculogram. Regional specific flow during contrast hyperemia was 186+/- 11 (mean +/- 1 standard error of the mean) ml/min per 100 g in control patients and 115+/-5 in patients with coronary artery disease. There was an inverse relation between regional specific flow during contrast hyperemia and the percent coronary stenosis when the stenosis was 40 percent or greater (r = 0.70, P less than 0.001). Regional specific flow was significantly less in patients with asynergy (77 +/- 10 ml/min per 100 g) than in patients with normal ventricular function (105 +/- 5) distal to coronary stenoses of greater than 75 percent. Thus regional specific flow measured during contrast hyperemia using the xenon washout technique and the Anger camera differentiated patients with normal coronary arteriograms from those with coronary artery disease. With this technique, good correlation was shown between regional specific flow and the percent coronary stenosis and presence of ventricular wall abnormalities. The information obtained with this method may provide prognostic information concerning suitability for surgical intervention.


Noninvasive myocardial imaging with potassium-43 and rubidium-81 in patients with left bundle branch block. Noninvasive myocardial imaging with potassium-43 and rubidium-81 has been used successfully to identify areas of infarction and exercise-induced ischemia as regions of decreased radioactivity. The image defects observed are believed to be due to a decreased radionuclide uptake in regions of myocardial scar or to heterogeneous myocardial accumulation of tracer as a result of regional ischemia. Of 27 patients with left bundle branch block studied with noninvasive imaging at rest and during exercise, 25 manifested at rest reduced radioactivity in the region of the interventricular septum. This pattern is similar to that seen in patients with anteroseptal myocardial infarction. Sixteen of the 27 patients underwent diagnostic coronary arteriography and left ventriculography. Only five of these patients had evidence of either previous infarction or significant obstructive coronary artery disease as assessed with clinical or angiographic criteria, or both. Although the image defect was routinely demonstrated at rest in patients with left bundle branch block, this defect was generally normalized or less distinct with exercise in patients with no anatomic heart disease. In contrast, a larger, more distinct or new image defect with exercise correctly identified the presence of significant obstructive coronary artery disease in patients with left bundle branch block. In the clinical application of noninvasive myocardial imaging, these image defects observed at rest can lead to the false pasitive radionuclide interpretation of anteroseptal myocardial infarction.


Reduction of S-T segment elevation with infusion of nitroprusside in patients with acute myocardial infarction. The effect of infusion of sodium nitroprusside on S-T segment elevation was evaluated in 12 patients with acute anterior myocardial infarction. Precordial 35 lead S-T segment maps were obtained in each patient immediately before and 10 minutes after infusion of 53 mug/min (range 20 to 100 mug/min) of nitroprusside. The following measurements were made from each S-T map: sigmaST (total S-T elevation in all leads), NST (number of leads with S-T elevation greater than 1 mm) and ST (average (S-T elevation in leads with more than 1 mm elevation). After administration of mitroprusside, evidence of myocardial ischemic injury as assessed by S-T mapping decreased in association with reduction of the myocardial oxygen consumption index of pressure-time per minute. Group mean values diminished significantly for sigmaST (41.7 to 28.6 mm, P less than 0.001), NST (20.3 to 14.6, P less than 0.001) and ST (1.6 to 1.2 mm, P less than 0.005). Pressure-time per minute decreased from 2,690 to 2,372 mm Hg-sec/min (P less than 0.001). Because there was no significant relation (P less than 0.05) between reductions in S-T elevation and lower indexes of myocardial oxygen consumption, it is suggested that nitroprusside may possess a separate action of augmenting regional blood flow to ischemic myocardium. Evaluation with the precordial S-T mapping technique suggested that intravenous administration of nitroprusside was associated with evidence of reduced ventricular ischemic injury in patients with acute myocardial infarction. This effect appears to be related to reduction of myocardial oxygen demand by the peripheral cardiac unloading mechanisms of nitroprusside as well as to a possible direct action of the drug in improving regional blood flow to ischemic heart muscle.


Variation in the size and distensibility of the pulmonary arteries in d-transposition of the great arteries. The relative size of the main pulmonary artery was determined from cineangiograms of 117 patients with d-transposition of the great arteries by calculating the ration between the diameters of the main pulmonary artery and aorta. The pulmonary artery was largest in patients with ventricular septal defect or patent ductus arteriosus, or both, because of increased pulmonary arterial pressure and flow. In patients with an intact ventricular septum or with left ventricular outflow tract obstruction, or both, the main pulmonary artery was approximately the size of the aorta. Two cases of d-transposition and gross dilatation of the main pulmonary artery and hypoplastic first branch pulmonary arteries are presented. In these cases the ratio between the diameters of the main pulmonary artery and aorta was greater than in any of the other 117 cases studied...


Surgical treatment of degenerative mitral regurgitation. Between October 1965 and April 1975, mitral valve replacement was preformed in 66 patients with myxomatous degeneration of the mitral valve ("floppy valve syndrome"). Operative mortality was 6 percent (four patients). Current evaluation was obtained for all patients; the average postoperative follow-up interval for surviving patients was 3.5 years (range 1 month to 9.9 years); the total duration of postoperative follow-up for all patients was 180 patient-years. Overall survival rates, calculated by the actuarial method, were 81, 68 and 50 percent, respectively, 1, 2 and 5 years after mitral valve replacement. Preoperative variables with a significantly adverse effect on patient survival included patient age greater than 50 years, New York Heart Association functional class IV, left ventricular end-diastolic pressure greater than 12 mm Hg and mean pulmonary arterial wedge pressure greater than 16 mm Hg. Support is advanced for the concept that mitral valve dysfunction associated with myxomatous degeneration constitutes a broad spectrum of clinicopathologic involvement. Acute clinical and hemodynamic deterioration may often occur in the setting of chronic mitral valve dysfunction. Postoperative mortality is directly related to preoperative functional disability and hemodynamic evidence of impaired left ventricular function. Consideration should be given to earlier operative intervention in patients with myoxmatous mitral degeneration and mitral insufficiency before severe and probably irreversible impairment of ventricular function occurs.


Echocardiographic evaluation of tricuspid valve endocarditis: an M mode and two dimensional study. Standard M mode echocardiography and a new real time two dimensional echocardiographic imaging system were utilized to follow the progressive anatomic destruction of the tricuspid valve in a patient with bacterial endocarditis. The initial two dimensional echocardiographic study revealed large vegetative masses attached to severely prolapsing tricuspid leaflets. Serial studies demonstrated eventual disruption of the chordal attachments of the anterior tricuspid leaflet resulting in frank leaflet flail. This technique was seen to complement both M mode echocardiography and cardiac angiography by providing spatial information concerning serial changes in the disordered tricuspid valve. Such findings call attention to the relative roles of various diagnostic measures, including M mode and two dimensional echocardiography, in assessing the specific anatomic and functional performance of a diseased tricuspid valve.