A comparative trial of a new, fast-release iron capsule ("Eryfer") and a slow-release tablet ('Ferro-Gradumet') in iron-deficiency anaemia. Sixty hospitalised patients receiving treatment for tuberculosis, diabetes or chronic bronchitis and who had iron-deficiency anaemia (Hb levels less than 12.5g./100 ml.) were entered in a between-patient comparative study of a new, fast-release iron capsule ('Eryfer') and a standard slow-release iron tablet ('Ferro-Gradumet'). Patients were allocated to either drug at random and recived either 2 capsules (100 mg. elemental iron) or 1 tablet (105 mg. elemental iron) daily for 30 days. Haemoglobin levels and packed cell volume were measured before and at the end of the trial period. The results, analysed in 57 patients (28 on 'Eryfer' and 29 on the slow-release iron) indicate that treatment with 'Eryfer' produced a significantly more predictable response in haemoglobin regeneration, the response being dependent on the initial haemoglobin level. Both treatments, however, produced a highly significant increase in haemoglobin levels in the patients (mean increas: 'Eryfer' 1.09 g. and slow-release iron 0.76 g.). No side-effects were recorded with either treatment.


Clinical evaluation of a new oral contraceptive, 'Pregnon'. 'Pregnon', a new oral contraceptive containing 1 mg. lynestrenol and 0.05 mg. ethinyl oestradiol, was administered cyclically to 639 women of fertile age over a total of 9,159 cycles. There were no pregnancies. In most cases the withdrawal bleeding resembled normal menstruation. The incidence of metrorrhagia was relatively low and when it did occur it was usually confined to the early treatment cycles and was of very limited duration. The objective and subjective tolerance was excellent.


The use of povidone-iodine ('Betadine') pessaries in the treatment of candidal and trichomonal vaginitis. One hundred and thirty-five women suffering from trichomonal, candidal, or both infections simultameously, were treated with povidone-iodine pessaries, 2 pessaries being inserted nightly. Ninety-nine women were given a 7-day course of treatment, but the results obtained were disappointing, and the authors do not recommend such a regime for routine treatment. Better results were obtained with the recommended 14-day course. A further 36 women suffering from chronic trichomonal and/or canidal infections which had previously resisted orthodox treatment were given a prolonged 28-day course of pessary treatment. The results obtained were very encouraging, 92% of the trichomonal and 96% of the canidal infections being cured. Furthermore, although povidone-iodine is slightly less effective in trichomoniasis, most patients suffering from a chronic infection (candidal, as well as trichomonal) were cured by the one preparation. Side-effects did occur, but were significant in only 3 patients. Subjective symptoms, especially any offensive odour, disappeared within 3 days of the start of the treatment. The authors recommend that the 28-day course of povidone-iodine pessaries is used in those cases where trichomoniasis or candidosis has been a therapeutic problem in the past, particularly if the patient is currently on the oral contraceptive pill.


The effects of morphine and nalorphine on the plasma 11-hydroxycorticosteroid response to insulin-induced hypoglycaemia in patients with rheumatoid arthritis. Morphine in therapeutic dosage has been shown to impair the plasma 11-hydroxycorticosteroid response to the stress of insulin-induced hypoglycaemia. Nalorphoine in similar dosage produced no impairment of the response to hypoglycaemia.


A comparison of a new analgesic, floctafenine, with dextropropoxyphene and aspirin in post-operative pain.. Seventy-seven patients took part in a double-blind crossover trial to compare the effects of floctafenine, dextropropxyhene and aspirin in the relief of post-operative pain. Pain levels were recorded at hourly intervals and pain relief scores calculated. For Dose 1, the difference between the mean pain relief score for patients receiving floctafenin (12.8) and that for patients receiving dextropropoxyphen (6.2) was significant, (p smaller than 0.05) but the difference between the mean score for aspirin (9.2) and that for dextropropoxyphene was not significant. For Dose 2, there were no significant differences between the mean pain relief scores for floctafenine (12.5), for aspirin (10.9) and for dextropropoxyphene (13.2).


Meptazinol (Wy 22811), a new analgesic: preliminary pharmacokinetic data. The authors report on the pharmacokinetic profile of a new analgesic, meptazinol, from studies of plasma and urine levels after intravenous injection in 4 healthy volunteers. Conjugated product is formed very soon after injection and its concentration changes little over the period studied compared with the unchanged product where a fast, then a relatively slow phase of decline can easily be distinguished, suggesting a two compartment open system model. Meptazinol is predominantly eliminated in this conjugated form by urinary excretion of the metabolites. Excretion is very rapid in the first few hours after dosing and elimination is almost completed after 24 hours.


Serum activity of lysosomal enzymes in relationship to contraceptive steroid dose. Women using combined-type oral contraceptives show a progressive increase in serum activity of lysosomal enzymes (beta-glucuronidase and beta-acetyl-glucuronidase) during the first 6 cycles of treatment; thereafter, the enzyme activities remain relatively constant. The increase in enzyme activity appears to be approximately proportional to the total steroid intake per cycle and not to any particular steroid or combination of steroids. These findings suggest that oral contraceptives of choice should contain the minimum amount of steroids compatible with high efficacy and patient acceptability.


Short-term assessment of 0.1% hydrocortisone 17-butyrate ('Locoid') in the treatment of skin disease. An assessment was made of the local use of 0.1% hydrocortisone 17-butyrate in the treatment of 15 patients with a variety of skin conditions involving face and neck. Treatment was used on a short-term basis ranging from 3 to 22 days. There was marked clinical improvement of the lesions in 12 patients. The results of this short study are in accord with earlier published work and suggest that this new nonfluorinated steroid has promising potential.


Comparative study on the use of co-trimoxazole and tetracycline in the treatment of lower respiratory tract infections. A double-blind trial was carried out on 116 patients with lower respiratory tract infection and systemic manifestations. One group received co-trimoxazole (480 mg. trimethoprim and 2,400 mg. sulphamethoxazole daily), and the other group received 2 g. tetracycline daily. The trial, as judged by clinical improvements, the reduction of purulent sputum and the rate of eradication of infection, showed a better result with co-trimoxazole. The incidence of side-effects were higher in the group receiving tetracycline compared with those receiving co-trimoxazole.


Chromosomes and DNA of Mus: the karyotypes of M. fulvidiventris and M. dunni. The chromosomes of the Asian mice, Mus fulvidiventris (booduga?), are typical of the Mus in general, viz., 40 telocentric chromosomes. The centromeric heterochromatin does not fluoresce brightly. The G band pattern of the euchromatin is the same as that of M. musculus. The diploid number of M. dunni is also 40, but each autosome possesses a short, heterochromatic second arm. The X chromosome is a long submetacentric, whose entire short arm and the terminal segment of the long arm are heterochromatic. The Y is a long telocentric and is heterochromatic. The G band pattern of the long arms of M. dunni involved only the addition of C bands. Mus dunni and M. booduga are sympatric in many localities in India, but they can be separated by karyological and subtle morphological differences.


Cytological assessment of meiotic exchange in a human male with a pericentric inversion of chromosome No. 4. Mitotic chromosome studies carried out on newborn male infant with congenital abnormalities and on his family members showed that the father and paternal grandmother were heterozygotes for an unequal pericentric inversion. The child appeared to have inherited a recombinant duplication/deletion chromosome. The results of meiotic studies carried out on a testicular biopsy from the father were used to ascertain the risk of recurrence of chromosomal abnormalities in future pregnancies. A model is presented which permits the analysis of C-banded diakinetic chromosomes as to whether crossing-over has occurred within the inversion segment or not. In the present study, it was estimated that either one or two cross-overs had occurred in 52% of the cells within the inversion segment. This would result in approximately 26% of the spermatozoa carrying either one of two types of duplication/deficiencies of chromosome No. 4.


Is late replication of the inactive X chromosome irreversible in all cells of mammals? The X chromosomes of the female bandicoot rat (Nesokia indica) were 3H-thymidine labeled during two consecutive cell divisions to determine if all of the same segments of the "triplicate-type" X chromosome of these animals always replicated late. In 87% of metaphases examined the findings were as expected. One entire X chromosome (X1) and the long arm of the other X (X2) synthesized DNA late in the S phase in both divisions. However, in the other 13% of the metaphases, the late-replicating and presumably genetically inactive short-arm segments of the X1 chromosome had completed DNA synthesis by the time it entered the late-S phase of the second cycle. Thus, in this species, some cells appear to have an X chromosome of which the facultative heteropycnotic segment condenses in one cell cycle but becomes euchromatic in the subsequent cell cycle. Although this appears at first to be inconsistent with the generally accepted pattern of X-chromosome condensation and genetic inactivation, it may represent an instance of evolutionary specialization for an as yet unexplained reason. It is also possible that closer analysis of other mammalian species with composite sex chromosomes or methods equally suitable for this type of analysis will reveal other instances where a minority of the somatic cells of females do not follow the predictions of the Lyons hypothesis completely.


Human Q and C chromosomal variations: distribution and incidence. Chromosome preparations of 77 normal newborn babies from Grand Junction, Colorado, were stained first for G-band identification of each chromosome and subsequently stained for Q- and C-band localization. This approach permitted determination of the variation of the C region size in all chromosomes, and is the first such study reported. A total of 391 Q and C variants was described, an average of 5.08 +/- 0.23 per subject; 225 were Q varients, 166 were C variants. Q varients were distributed among seven chromosomes in the genome and among 76 of the 77 subjects. Chromosomes 3 and 4 had variable Q intensities at the centromere, and the acrocentric chromosomes, 13, 14, 15, 21, and 22, had variable Q intensities in their short arms and/or satellites. C variants, though fewer in number, were more widely distributed in the genome, with at least one variant described in each chromosome. C variants were identified in 65 of the 77 subjects. Most unique were the six pericentric inversions found in chromosome 9. Except for giant satellites, no correlations were found between Q and C variants. Q and C variants evaluated in 16 members of four families showed that in nearly every case each variant observed in a child could be demonstrated in one or both parents. It is evident from this study that the magnitude of chromosomal variation in human populations is far greater than heretofore believed. It has also been shown that the combination of Q- and C-banding procedures will yield much more information than either technique used alone and is therefore the preferred approach to many population and gene localization studies.


Spontaneous closure of paravalvular leak after mitral valve replacement. Complications after prosthetic valve replacement may be multiple. In biologic valves, valve detachment and cusp perforation may occur. If this is of significant magnitude, reoperation may be required. This report describes recurrent mitral regurgitation after mitral valve replacement with a Hancock porcine xenograft. The regurgitation subsided spontaneously three months later. We felt that a paravalvular leak closed, with progressive fibrosis and tightening of the annulus. Functional results in this patient were excellent.


Massive empyema due to Citrobacter diversus. Citrobacter diversus is a gram-negative rod member of the Enterobacteriacease family. A patient is described from whom this organism was isolated twice in pure culture from empyema fluid. Our isolates of Citrobacter diversus were resistant to ampicillin and carbenicillin and sensitive to cephalothin. Citrobacter diversus should be distinguished from Citrobacter freundii, Enterobacter cloacae and Klebsiella pneumoniae. This organism joins Streptococcus pyogenes, bacteroids species, anaerobic streptococci and Escherichia coli as a cause of slight pneumonia with extensive empyema.


An electrocardiographic pattern of acute myocardial infarction associated with excessive use of aerosolized isoproterenol. A 39-year-old women inhaled approximately 675 mg of aerosolized isoproterenol in less than three days during an asthmatic attack. Serial enzyme and ECGs were consistent with acute myocardial necrosis. During a three-year-followup period, no clinical evidence or predisposing factors for coronary artery disease were revealed. The close temporal relation of isoproterenol overdosage with mycardial necrosis provides presumptive evidence that the well-documented association of myocardial necrosis with high dosage catecholamines in animals may also occur in man. While in no way detracting from the value of isoproterenol in standard doses, this report alerts physicians to the possibility of another hazard in those who may use this drug to excess.


Intermittent functional closure of patent ductus arteriosus in a ten-month-old infant; hemodynamic documentation. We describe a ten-month-old patient in whom intermittent patency and closure of the dectus arteriosus was observed clinically, and in whom this observation was uniquely demonstrated at the time of cardiac catheterization. The hemodynamics of this patient and the physiology of ductal closure are discussed.


A radiographic sign of left sided mediastinal lymph node enlargement. This report draws attention to an apparent clear space, which is normally present on routine chest posterior-anterior roentgenograms, composed of the descending aorta, pulmonary outflow tract and left upper lobe vessels which form its medial, inferior and lateral boundaries respectively. The medial margin of this space has a concave outer border. Lymph nodes of the ligamentum group lie in close proximity to this space. In the absence of other processes involving structures of the middle mediastinum, encroachment of this space from the medial direction, with formation of a convex outer border is a reliable and frequently the first radiographic sign of left-sided mediastinal lymph node enlargement.


Chronic eosinophilic pneumonia in a one-year-old child. Although the literature well describes chronic eosinophilic pneumonia in the adult, there are no reports of this entity in the pediatric age group. We describe a child with chronic eosinophilic pneumonia, emphasizing the specific radiologic features, common conditions in the differential diagnosis, and dramatic response in corticosteroid administration, which is a unique feature of this entity.


Control of hemorrhage in emergency pulmonary resection for massive hemoptysis. Emergency pulmonary resection for hemoptysis during an episode of massive intrabronchial bleeding requires protection of the contraleteral lung from aspiration of blood. We describe a method of selective unilateral ventilation applied to 15 patients, without mortality attributable to this factor.


Atrial diastolic friction.

Atrial diastolic friction. A typical triphasic pericardial rub was heard in a patient with acute myocardial infarction. Phonocardiograms during atrioventricular block demonstrated a fourth rub component in atrial diastole following every sufficiently isolated P wave.


Direct extension of bronchogenic carcinoma through the pulmonary veins. We present two surgically treated cases of lung cancer that showed progression of the tumor through the pulmonary veins toward the left atrium. The surgical technique and the influence of improper handling on the production of systemic emboli are discussed.


Maximal treadmill exercise testing in the management of the post-myocardial infarction patient. Treadmill exercise tests were performed on 32 active duty military personnel 9 to 11 months after acute myocardial infarction to enable more objective selection of candidates for return to military service. Treadmill exercise tests were terminated at heart rates averaging 92 percent maximal predicted rate for age, or when chest discomfort with ischemic ECG changes occurred. The incidence of lipid abnormalities, hypertension, and other coronary risk factors did not differ among the groups. However, treadmill exercise tests appeared to identify a high risk group. Treadmill exercise testing in young postmyocardial infarction patients suggests that those with ischemic responses are at high risk of subsequent cardiac complications. Early surgery in this group may be warranted. The more frequently encountered negative response appears to be associated with a benign clinical course and better immediate prognosis.


A radiologic index of pulmonary arterial hypertension. A new radiologic index indicative of pulmonary artery hypertension is presented. It was obtained by measuring the horizontal distances from the midline to the first divisions of the right and left pulmonary arteris, and dividing the sum of these distances by the maximum transverse diameter of the thorax. The index was significantly different in groups with and without pulmonary hypertension and was abnormal (above 38 percent in 111 of 150 patients with cardiovascular disease and pulmonary arterial hypertension (PAH). None of the cases with increased pulmonary flow from cardiac shunts but normal PAP had an anbormal index. Thus, an abnormal index suggested PAH but correlated poorly with the extent of hypertension.


Benign superior vena cava syndrome.

Benign superior vena cava syndrome. Benign superior vena cava (SVC) obstruction is an uncommon entity. However, it is important to recognize that a small percentage of SVC syndromes are due to benign diseases such as mediastinal granulomas. The insidious onset and slow progression of symptoms allow for development of an efficient collateral venous circulation compatible with long-term survival. Surgical intervention to bypass the obstruction is often unsuccessful and should be avoided in most cases. We review the English literature on the subject, classify the various causes of benign SVC syndrome, and report our experience with 16 documented cases.


Reactivation of tuberculosis in Oklahoma: 1970-1973. The medical records of 53 patients who had reactivation of tuberculosis between 1970 and 1973 in Oklahoma were reviewed. Reactivation accounted for 4 percent of all cases reported in this period. No correlation was found between race or sex and risk of reactivation. The interval between original diagnosis and reactivation (median 14.0 years) was longer than has been reported in other series but was felt to be an encouraging finding. The most important factor influencing reactivation appeared to be inadequate chemotherapy. Minimal disease appeared to be particulary prone to undertreatment in the past. Patients with reactivation of tuberculosis responded to treatment almost as well as those with a recent diagnosis, as measured by sputum conversion rates. The paucity of patients presenting with reactivated cases after having been adequately treated supports recent recommendations to discharge patients from further followup when treatment is adequate and complete.


Diagnosis of emphysema.

Diagnosis of emphysema. Thirty-seven patients with chronic obstructive lung disease (COLD) were divided into three groups on the basis of radiologic evidence of emphysema. The category of radiologic emphysema correlated with severity of abnormality of routine lung function, gas exchange and lung mechanics. Within the group of patients with no radiologic abnormally, a subgroup with severe functional abnormalities, quite similar to those found in patients with widespread radiologic emphysema, could be selected on the basis of maximum elastic recoil less than 10 cm H2O.


Systolic time intervals in chronic hypertension: Alterations and response to treatment. Systolic time interval studies were performed to evaluate left ventricular performance in 28 patients with untreated systemic hypertension but without clinical heart failure. The pre-ejection period (PEP) was significantly prolonged (p smaller than 0.001) and left ventricular ejectime time (LVET) was shortened (p smaller than 0.02) when compared to rate-corrected predicted values. The PEP/LVET ratio was abnormally high in 18 of the patients and the average ratio was 0.45 ( smaller than 0.001). Eleven patients with abnormal time intervals were restudied during treatment with antilypertensive drugs. The PEP/LVET raio decreased in ten and became normal in nine. The average ratio decreased from 0.49 to 0.41 (p smaller than 0.001), due to both shortening of PEP (p smaller than 0.02) and lengthening of LVET (p smaller than 0.001). These findings indicate that alterations in left ventricular function may occur commonly in chronic hypertension in the absence of clinical heart failure, and can be reversed with appropriate therapy. This technique may be useful in evaluating hypertensive patients and in determining the efficacy of treatment.


Diastolic time intervals in ischemic and hypertensive heart disease: A comparison of isovolumic relaxation time and rapid filling time with systolic time intervals. Isovolumic relaxation time (IVRT) and rapid filling time (RFT) were used to evaluate elasticity and compliance in 11 control subjects (Group 1), in nine patients with angina (Group 2), in 11 with hypertensive heasrt disease (Group 3), and in ten patients with healed myocardial infarction (Group 4). Pre-ejection period (PEP), pre-ejection period index (PEPI), left ventricular ejection time (LVET), left ventricular ejection time index(LVETI) and PEP/LVET ratio were all derived from simultaneous recordings of phonocardiograms, ECGs, apexcardiograms, and external carotid arterial pulses. No patients were in congestive heart failure and none were receiving medication. LVET and LVETI were the same in control patient groups; PEP was slightly increased in patients with healed myocardial infarctions (p smaller than 0.05); and PEPI was prolonged in the patients with angina (p = 0.001). THE PEP/LVET ratio too was different from the control group in patients with angina and hypertension (Groups 2 and 3-p smaller than 0.02 and smaller than 0.05 respectively). The diastolic time intervals were significantly altered in that the IVRT was prolonged in angina patients (113.4 equals or minus 28.3 msec), compared to control patients (85.7) equal or minus 18.4 msec). It was found that in 6 out of 9 patients with angina, this interval exceeded the highest normal value (108 msec), but that in only one out 11 patients with HCVD and in three out of ten with healed infarctions, was the interval prolonged. RFT was increased in HCVD (113.8 equals or minus 18.8 msec) and in healed myocardial infarction (123.8 equals or minus 30.0 msec) patients, compared to the control group (94.5 equals or minus 12.8 msec). Diastolic time intervals reflecting disorders in elasticity and compliance may occur in conjunction with alterations in systolic time intervals.


Late postoperative anatomic observations after insertion of Hufnagel caged-ball prostheses in descending thoracic aorta. Clinical and necropsy observations are described in two patients who died 11 and 13 years, respectively, after implantation of Hufnagel prostheses (the first ever used successfully in humans to treat cardiac valve disease) in descending thoracic aorta. Despite the long implantation periods, there was no evidence of prosthetic degeneration or thrombosis or intravascular hemolysis. Although approximately 4000 Hufnagel descending aortic prostheses were distributed by the manufacturer for human use, data in only 55 patients in whom these prostheses were inserted were found in previous publications, and 26 of them had died. Of the 13 late deaths previously reported, no evidence of prosthetic degeneration or thrombosis was described in the three patients surviving greater than 3 years (8, 10, 12.5 years, respectively). Since neither our patients nor any of the other three reported long-term survivors had prosthetic-related complications and since the dangers  of excising the descending aortic prosthesis are considerable, it appears most reasonable, as a rule, not to remove the descending aortic prosthesis at any time in these patients if aortic valve replacement is subsequently performed.


Pulmonary mucormycosis with massive fatal hemoptysis. Abrupt, massive, and fatal hemoptysis occurred in two patients with pulmonary mucormycosis. One patient had uucontrolled diabetes mellitus and the other acute leukemia in remission. Pulmonary artery erosion by mucormycotic hyphae caused the hemorrhage cases. Mucormycosis is an unusual cause of massive hemoptysis.


The need for leadership in hospital respiratory services. The duration of a position as physician-director of respiratory services proved to be less than five years in 68 per cent of cases followed.Based on available information, in the 50 such cases, the act of separation was not elective in these instances, except as a final response to an otherwise intolerable situation. Further study revealed the prime cause to be ignorance of the basic essentials of management. Technical incompetence was never an issue in cases of separation. The general application of principles of management to the control of respiratory services is illustrated by a series of case reports and subsequent discussion. Presently, candidates aspiring to such positions appear to rely almost entirely on their elaborate technical skills. Choice of such a career option, however, should carry with it an obligation to "learn the rules of the game." Logically, graduate training programs should provide this training.


A new catheter for percutaneous transfemoral right heart catheterization. A new catheter for percutaneous transfemoral right heart catheterization is described. The catheter can also be used for pulmonary angiography and pulmonary wedgepressure recording. Because of the speed and efficiency with which this catheter may be used, we suggested a trial by physicians involved in right heart catheterization pulmonary angiography.


Oral introduction of the flexible bronchoscope. The versatility of the flexible bronchoscope (FB) has resulted in the use of several methods for its introduction. A method is described for the oral introduction of the FB after oral intubation using the FB as a guide for insertion of a flexible oral endotracheal tube, a procedure that has been performed in more than 2,500 patients without known complications.


Successful treatment of pleural aspergillosis and bronchopleural fistula. We report the successful treatment of a patient with a bronchopleural fistual and pleural aspergilloma. Treatment consisted of intrapleural instillation of amphotericin B and nystatin followed by creation of an Eloesser flap.


Infarcted extralobar pulmonary sequestration. A 32-year-old man who presented with symptoms suggesting empyema was found at thoracotomy to have infarction of an extralobar pulmonary sequestration. He was completely relieved by excision of the sequestration after securing the systemic vascular pedicle which had undergone torsion. Recognition of the anomalous bloody supply and other congenital anomalies in such cases is emphasized.


Demonstration of Ebstein's anomaly by simultaneous catheter-tip localization of the tricuspid valve visualization: A new method. The diagnosis of Ebstein's anomaly has traditionally been made by angiocardiography and confirmed by simultaneous intracardiac electrocardiographic and pressure recordings. These techniques may result in false positive or negative tests. A new method is proposed, whereby the right coronary artery is used an an angiographic marker for the tricuspid annulus and a pressure catheter simultaneously marks the position of the tricuspid valve. In the right anterior oblique position the tip of the pressure catheter should be just under the right coronary artery as the tricuspid leaflets close in systole, indicating the normal relationship of the tricuspid leaflets and annulus. In Ebstein's anomaly the tip of the catheter extends well past the coronary artery in systole, demonstrating the characteristic displacement of the attachments of the tricuspid valve downward toward the right ventricular apex.


Evaluation of left ventricular performance in acutely ill patients with chronic obstructive lung disease. Among 28 patients with chronic obstructive pulmonary disease (COPD) with increasing dyspnea, the resting mean pulmonary arterial wedge pressure was elevated (greater than 12mm Hg) in 4 and became abnormal with exercise in 3 other subjects. Stroke volume index was reduced (less than 36 ml/beat/M2) in 16 of 26 patients (62 percent). The resting pre-ejection period index was prolonged (greater than 144 msec) in 17 patients (65 percent), while the left ventricular (LV) ejection time index was reduced (less than 408 msec) in 23 patients (88 percent). The ratio of the pre-ejection period to the LV ejection time was within the normal range (0.309 to 0.381) in only 3 of 26 patients (12 percent). Echocardiographic measurements of LV function were normal in nine patients, seven of whom had one or more abnormal values for systolic time intervals (STIs). These data suggest that reduced LV filing results in abnormal values for STIs in patients with COPD, and therefore that in such patients STIs are not accurate indices of LV function.


Echocardiography in endocardial cushion defects: a preoperative and postoperative study. Echocardiographic studies were performed on 14 patients with endocardial cushion defects of different anatomic varieties. Four patients were studied again after operation. Patients with partial atrioventricular canal (PAVC) showed multiple systolic echoes on mitral valve echogram, with significant mitral-septal apposition in diastole. The left ventricular outflow (LVO) appeared significantly narrowed. The septal motions were paradoxic. After corrective operation, an increase in the width of the LVO was noted and mitral-septal apposition appeared to be less pronounced. Multiple systolic echoes, however, reappeared and persisted. The echocardiograms in patients with complete atrioventricular canal (CAVC) were characterized by wide excursion of an apparent single atrioventricular valve. The echoes of the mitral component of the common anterior leaflet moved anteriorly into the right ventricular cavity and overshadowed the tricuspid component in diastole. In addition, patients with CAVC and divided and medially attached common anterior leaflets had solitary mitral and tricuspid echograms. This feature differentiates this group of patients from those patients with CAVC with undivided freefloating common anterior leaflet.


Monitoring preventive therapy patients for liver disease as well as compliance. An apparently increasing incidence of isoniazid-associated hepatitis concurrent with interest in the problem has led to the universal teaching that patients on isoniazid preventive therapy must be carefully monitored for liver disease. This teaching has been reinforced and endorsed in a recent report of the tuberculosis advisory committee and special consultants to the director of the Center for Disease Control; this report, in turn, led to an American Thoracic Society statement concluding that the use of isoniazid with appropriate safeguards must be based on a comparison of the benefit of preventive therapy with the risk of hepatic injury and, therefore, should be used when necessary, under careful control and follow-up. In New York City, with increasing use of the tuberculin skin test leading to increased numbers of patients receiving this treatment in nurse-operated clinics, a new control form and protocol were designed. These insure that all individuals on preventive therapy are carefully monitored for liver disease as well as compliance in taking the drug. This system also insures the safeguards alluded to, as well as increasing concern and awareness among the health professionals in prescribing the treatment.


Hyperventilation syndrome: a frequent cause of chest pain. Chest pain is frequently a prominent symptom of the hyperventilation syndrome (HVS) and must be distinguished from angina pectoris due to coronary atherosclerotic heart disease (CAHD). The association between hyperventilation and chest pain may be apparent if psychoneurotic traits or anxiety are present. Many patients with HVS are not overtly anxious or neurotic, but in the great majority, a careful history and physical examination will indicate whether chest pain is due to HVS or CAHD. The failure to make this clinical differential diagnosis, which often leads to unnecessary coronary angiography, should not be as frequent as generally experienced. Fifteen of 95 consecutive patients had chest pain and additional typical HVS symptoms. Reassurance and detailed explanation about the cause of the chest pain gave significant relief, so that all patients were less symptomatic 24 to 44 months later, and none had developed new signs or symptoms to suggest that symptomatic CAHD had been overlooked. The risk and expense of coronary angiography was avoided.


Electrophysiologic studies in a patient with atrial flutter and 1:1 atrioventricular conduction. Intracardiac electrophysiologic studies were performed in a patient having paroxysms of atrial flutter with 1:1 atrioventricular (A-V) conduction. Although duration of conduction intervals was normal during sinus rhythm, the atrio-His (A-H) interval did not show the expected increase when the atria were stimulated at progressively higher rates. The results of pacing with the extrastimulus technique also indicated that the refractory periods of the A-H tissues were shorter than normal. Yet, intravenously administered ouabain produced a significant increase in these refractory periods. The findings in the case are compatible with a partial A-V nodal bypass with a shorter refractory period than the A-V node or with an A-V node with unusual capacity for rapid conduction. The response to ouabain therapy was that of A-V nodal tissues.


In vitro pleural fluid clottability and fibrinogen content. Twenty-three specimens of pleural fluid from 23 patients were examined for quantitative fibrinogen, total protein levels, and for clottability in vitro using the recalcification time. Of the 19 specimens of pleural fluid from patients without loculation, 11 (seven exudates) had no detectable fibrinogen; another 8 (six exudates) had a mean fibrinogen level of 55.0 +/- 10.2 mg percent, and a mean recalcification time of 19.4 +/- 2.6 minutes. The pleural fluids from the four patients with loculation had no detectable fibrinogen. The only fluids containing fibrinolytic activity were from the nonloculated non-fibrinogen-containing group. No correlation existed between pleural fluid/plasma total protein ratios and pleural fluid/plasma fibrinogen ratios. In vitro clottability in this study did not reflect the in vivo tendency for coagulation and loculation.


Some epidemiologic aspects of acute myocardial infarction in Israel. A nationwide study of acute myocardial infarction in Israel was carried out during a one-year period. There were 2,504 new and 968 repeated attacks. Annual incidence rate of first attacks was 0.9 per 1,000 (1.3 in men and 0.5 in women). Incidence was highest among the European born in both sexes. But, while the pattern of the native born men was similar to that of those born in Europe, it approached the incidence of the Asian-African born in women. The sex ratio was relatively higher in those ethnic groups where male incidence was relatively higher and vice versa. Length of residence in the country had little effect on the incidence rates.


Factors affecting immediate mortality of patients with acute myocardial infarction: a nationwide study. The hospital mortality was evaluated for 21 days in all patients with a first attack of acute myocardial infarction (AMI) in Israel. Total mortality was 21.1 percent. The following factors were associated with relatively better prognoses: age, young; sex, male; marital status, married; ethnic origin, European; site, subendocardial; history of smoking, and, to a certain degree, hypertension; low levels of white blood cells, blood sugar, serum transaminase and cholesterol; and anticoagulant therapy.


Aneurysm of a pulmonary artery branch: an uncommon cause of a coin lesion. We report the case of a 26-year-old woman with ventricular septal defect associated with a typical coin lesion as shown on the chest roentgenogram. Selective angiography revealed the coin lesion to be caused by an aneurysm of a tertiary pulmonary arterial branch. In addition, two smaller aneurysms were noted. It is postulated on clinical and histologic grounds that the aneurysms were caused by congenital weakness of the pulmonary arterial wall in conjunction with increased pulmonary flow and slightly elevated pulmonary arterial pressure.


Melioidosis: recrudescence associated with bronchogenic carcinoma twenty-six years following initial geographic exposure. Melioidosis was diagnosed in association with lung cancer in a World War 2 veteran 26 years after geographic exposure. The case history illustrates the prolonged latency, difficult diagnosis, and resistance to therapy of chronic melioidosis. Implications are that chronic forms of the disease will continue to surface in veterans of Southeast Asian conflicts for decades.


Tricuspid and pulmonary valve atresia with aortopulmonary fistula: survival of a patient to 21 years of age. We report the case of a patient with tricuspid and pulmonic valve atresia, with survival to the age of 21 years. Postmortem examination revealed an anomalous vessel connecting the ascending aorta with the main pulmonary artery. This fistula measured 20 mm by 4 mm, arose independently of the coronary arteries and had the histologic features of an elastic artery. The remarkable longevity was ascribed in part to the maintenance of pulmonary arterial flow by the left-to-right shunt through the anomalous arterial connection.


Differentiation between hydropneumothorax and destroyed lung by thoracoscopy with a fiberoptic bronchoscope. In a 39-year-old man radiologic examination could not distinguish definitely between a hydropneumothorax and total destruction of one lung. Introduction of a fiberoptic bronchoscope through the opening for the chest drainage tube permitted direct inspection of the air space. A definite diagnosis of a destroyed lung was made, permitting appropriate modification of the treatment.


Effects of methotrexate and phenobarbital on the hepatic microsomal drug-metabolizing enzymes in normal rat. The effect of methotrexate on the NADPH-dependent hepatic microsomal drug-metabolizing enzymes of the normal rat has been investigated. Pre-treatment of the animals with methotrexate for 3 successive days resulted in significant increases in the activities of biphenyl hydroxylase and ethylmorphine N-demethylase. The activity of these enzymes obtained from liver microsome preparations was also increased by methotrexate in vitro. The body weight, liver weight and the amount of both protein and DNA in each liver were significantly depressed by methotrexate treatment. All values, except the body weight, were increased to the control levels by additional treatment of the animals with phenobarbital. A likely explanation for the increase of enzyme activity by methotrexate has been discussed.


Effect of long-term treatment of urinary tract infection with a single dose in the evening. 59 hospital patients with an average age of 78 years were long-term treated for urinary tract infection with either cephalexin 125 mg/day, cephalexin 250 mg/day or with nitrofurantoin 100 mg/day given as a single dose in the evening. The patients were observed for a maximum of 12 months. One single dose of cephalexin 125 mg was as effective as one single dose of 250 mg given in the evening in the long-term treatment of urinary tract infection. The urine remained free of bacteriuria in 63% of the patients treated with nitrofurantoin and in 50% of those treated with cephalexin. The duration of the bacteriuria-free interval preceding reinfection was 108 days in those patients treated with nitrofurantoin and 92 days in those treated with cephalexin.


Model of the antimicrobial silver uracil. A model is proposed for the antimicrobial agent, silver uracil, whereby silver interacts with uracil forming a silver uracil combination with the silver in the +1 state intercalating between stacked uracils in a manner similar to a 'sandwich' model. The uracils maintain stability by hydrogen bonding with the water solvent, and 'flip-flop' through an antiparallism mode at 220 degrees. The silver bonds to the uracil by a charge transfer mechanism, increasing the nuclear shielding field of the pyrimidine. The presence of the water (solvent) is necessary for the structure.


Effect of lincomycin on lipase formation by Staphylococcus aureus. The production of Staphylococcus aureus lipase could be inhibited by addition of 0.1 mug/ml lincomycin to the media without affecting growth. Addition of the same amount of drug at various stages of growth inhibited further enzyme production. The enzymatic activity of the lipase could not be inhibited at a concentration of 2.5 mug/ml lincomycin.


[Localization diagnosis of epithelial-body tumors through selective determination of parathyroid hormone. Surgical sequelae of a new method]. A new method for the localisation of abnormal parathyroid tissue is reported. This is carried out by selective venous blood sampling from the thyroid veins and the large veins of the neck. Parathyroid hormone levels are measured by radioimmunoassay. The peak hormone level indicates the site of the tumor suspected. Parathyroid venous blood was taken in 15 patients with primary hyperparathyroidism. In 12 patients localisation of the parathyroid tumor was achieved pre-operatively. The procedure is especially valuable in patients with previous unsuccessful parathyroid surgery. There are no complications or contraindications to the method.


[St. George's model of total elbow-joint prosthesis]. The elbow-prosthesis, design St. George, a hinge prosthesis is developed according to the principle of the Low Friction Arthroplasty. Only small resection of the joint is necessary so that in the "second line of defence" a resection-arthroplasty of elbow is possible. The experiences on 44 implanted prosthesis and the results of 37 cases are described. Restriction of motion, pain, instability and ankylosis in case of rheumatiod arthritis and posttraumatic arthrosis were the main indications.


[Influence of the bone-cement mixing time on hypotonic blood circulation reactions in hip-joint replacement surgery]. The amount of methylmethacrylatemonomer that is released into the blood-stream, during the alloplastic replacement of the hip-joint, depends on the time taken to prepare the bone cement(so-called extracorporeal polymerization-time). In vitro experiments reveal that the release of monomers depends on the preparation time. Gas-chromatographic monomer determinations show, that by prolongation of the preparation time from 2 to 5 minutes, the amount of monomer released into the blood-stream is decreased by a factor of 7. With the increase in preparation time the number of hypotonic circulatory reactions caused by the monomers will decrease. Extension of the extracorporeal polymerization-time from 2 to 5 minutes decreases the incidence of intra-operative circulatory depressions from 95% to 26%. These results were obtained by intra-arterial measurements of the blood pressure in the radial artery.


[Indication for appendectomy after evaluation of 4258 pathologico-histological examinations]. Between Feb. 1962 and Jun. 1974 we performed 4419 appendectomies. All preparations were examined histologically, 4258 of which were ana


RNA synthesis: a requirement for hormone-induced DNA amplification in Rhynchosciara americana. Injection of beta-ecdysone into mid fourth instar larvae of Rhynchosciara americana induced within 23-28 hours after injection a rise in the percentage of 3H-thymidine (3H-TdR) incorporating nuclei in salivary gland region S1 from about 10-20% in the controls to 80-90% in the injected larvae. The 3H-TdR incorporating nuclei displayed a weak continuous labeling pattern or a band-labeling pattern with grains over the vast majority of the bands. The majority of nuclei with a band labeling pattern displayed DNA amplification at the DNA-puff regions.--Injection of actinomycin D at different times after ecdysone injection abolished the higher incorporation rate at the amplifying regions within 15 hours after the injection. However, the percentage of nuclei incorporating 3H-TdR and the frequency of the two labeling patterns remained essentially the same when RNA synthesis was inhibited. Only the over-all rate of 3H-TdR incorporation seemed to be reduced.--These data suggest that in the DNA puff regions the rate of DNA chain elongation is higher when amplification occurs than during a normal replication cycle. It, further, seems that the higher rate during amplification is dependent upon de novo RNA synthesis.


DNA reassociation kinetics and chromosome structure in the crabs Cancer borealis and Libinia emarginata. DNA reassociation kinetics have been partly elucidated for the higher crabs C. borealis and L. emarginata, using calf thymus DNA as a standard. These crabs contain no detectable repeated DNA in the approximate multiplicity frequency range 2-100 copies, which is unusual for invertebrate DNAs. Each species contains a component renaturing at an intermediate rate, and also a very rapidly renaturing fraction. The very rapidly renaturing fraction is considerably larger than the cesium chloride-resolvable satellites of each species. The fraction reassociating at an intermediate rate includes sequences with a reiteration frequency of up to 9.0 X 10(4) copies. This is unusually high for invertebrate DNAs. The nearly exact correlation between kinetic complexity and independently determined haploid genome size leads to the conclusion that the most slowly renaturing sequences of both crab species are present only once per haploid genome. Therefore the chromatids of these species are uninemic structures, and there has been no detectable occurrence of polyploid speciation in the recent evolutionary history of either species.


Mouse satellite DMA in noncentromeric heterochromatin of cultured cells. Specific chromosomes in several mouse lines have interstitial C-bands. In situ hybridization studies indicate that these interstitial bands contain typical mouse satellite DNA.


Variation of C-bands in the chromosomes of several subspecies of Rattus rattus. All subspecies of black rats (Rattus rattus) used in the present study are characterized by having large and clear C-bands at the centromeric region. The appearance of the bands, however, is different in the subspecies. Chromosome pair No. 1 in Asian type black rats (2n=42), which are characterized by an acrocentric and subtelocentric polymorphism, showed C-band polymorphism. In Phillipine rats (R. rattus mindanensis) the pair was subtelocentric with C-bands, but in Malayan black rats (R. rattus diardii) it was usually acrocentric with C-bands. In Hong-Kong (R. rattus flavipectus) and Japanese black rats (R. rattus tanezumi) it was polymorphic with respect to the presence of acrocentrics with C-bands or subtelocentrics without C-bands. The other chromosomes pairs showed clear C-bands, but in Hong-Kong black rats the pairs No. 2 and 5 were polymorphic with and without C-bands. In Japanese black rats, 6 chromosome pairs (No. 3, 4, 7, 9, 11 and 13) were polymorphic in regard to presence and absence of C-bands, but the other 5 chromosome pairs (No. 2, 5, 6, 8 and 10) showed always absence of C-bands. Only pair No. 12 usually showed C-bands. C-bands in small metacentric pairs (No. 14 to 20) in Asian type black rats generally large in size, but those in the Oceanian (2n=38) and Ceylon type black rats (2n=40) were small. In the hybrids between Asian and Oceanian type rats, heteromorphic C-bands, one large and the other small, were observed. Based on the consideration of karyotype evolution in the black rats, the C-band is suggested to have a tendency toward the diminution as far as the related species are concerned.


Differential fluorescence of sister chromatids in chicken embryos exposed to 5-bromodeoxyuridine. Differential fluorescence of sister chromatids (SCD) and sister chromatid exchanges (SCE) were visualized in chromosomes obtained directly from growing chicken embryos. SCD was obtained by exposing 3-day embryos to BrdU (12.5-50 mug) in ovo for 26 hours and staining air dried chromosome preparations with 33258 Hoechst. Bright, stable fluorescence and continued SCD were achieved if slides were mounted in McIlvaine's pH 4.4 buffer. Embryo growth, mitotic activity and gross chromosome morphology were not adversely altered by the BrdU treatments. The SCE rate was estimated to be 0.07 SCEs per macrochromosome and 0.75 SCEs per metaphase for two cell cycles.


Intussusception of the rectum-internal procidentia: treatment and results in 90 patients. A series of 90 patients with intussusception of the rectum (internal procidentia) has been studied. In 11 per cent of the patients there was also an enterocele and in 3 per cent, a large proctocele. Forty patients were operated upon by the Ripstein procedure. Indications for operation were, in most cases, incontinence for gas and/or feces. Seventy-five per cent of the preoperatively incontinent patients were, at follow-up 2 to 10 years after operation, continent. When indications for surgery were pain and or a sensation of obstruction, the results were poor; most of these patients had unchanged symptoms postoperatively, and some even had increased symptoms. There was one postoperative death. Of 50 patients treated conservatively during a period of 2 to 10 years, only two had to be operated upon: one due to the development of a rectal prolapse and the other due to severe pain and an increased sensation of obstruction.


Abstract: single session -- psychotherapy. The paper takes a look at the special opportunities which present themselves to patient and psychotherapist in the initial interview. Citing two case examples, the paper suggests that it is possible to have a therapeutic impact and to reach sufficient closure during a single interview with certain types of clinical problems.


Basal-cell carcinoma originating at the colostomy site: report of a case. An unusual case of basal-cell carcinoma originating at the site of a long-standing colostomy is presentedmirritation and frequent ulceration around the colostomy site as a result of bad hygiene and reluctance to use colostomy appliance by the patient may have caused this tumor. A long-term cure for more than 37 years was obtained following radiation therapy for carcinoma of the rectum. Radiation therapy should be attempted for palliation or possible cure, despite adverse indications, whenever surgical excision of the carcinoma of the rectum is not possible.


Diverticular fecalith in scleroderma simulating colonic neoplasm: report of a case. This is a report of a patient with the CRST syndrome, a mild variant of scleroderma consisting of calcinosismraynaud's phenomenon, sclerodactyly, and telangiectasia. Typical changes of scleroderma were present in the extremities, esophagus, duodenum and colon. In addition, there was a polypoid filling defect in a colonic diverticulum due to a fecalith. The radiologic appearance at first resembled a colonic neoplasm, although its location within a diverticulum and its speckled appearance suggested the possibility of a fecalith. This was confirmed at colonoscopy, which disclosed numerous wide-mouthed diverticula, with inspissated fecal material projecting from several diverticula. In patients with scleroderma and polypoid filling defects in the colon, the possibility of a fecalith within a diverticulum should be considered. Where the radiologic study is inconclusive, colonoscopy may provide a definitive diagnosis.


Clinical recognition of early schizophrenic decompensation. The early signs and symptoms of schizophrenic decompensation are subtle and variegated. Today's community patient often presents with vague complaints of brief duration making it imperative that today's diagnostician be able to recognize and appropriately treat early psychopathology. This paper collates a number of observations of developing psychotic phenomena -- self reports, clinical studies and controlled experiments -- and provides a useful format for organizing these complex and changing behaviors.  Data are presented and discussed using our clinical schema for detailing the natural progression of developing psychotic phenomena into four distinct stages. Efficacy of early recognition and treatment in aborting or diminishing a major psychotic episode is discussed. The advantages of recognizing the early signs of psychotic decompensation are apparent. First, with adequate intervention and treatment, the overt psychotic state may be attenuated. Although the feasibility of reducing the incidence of schizophrenia through intervention in "high risk" groups, or those experiencing insidious symptoms remain speculative (further investigation in this area is urgently needed), nonetheless, early diagnosis and comprehensive rehabilitative care significantly improves social and occupational adjustment. A second advantage accrues from early diagnosis. It enables patient and family to better cope with the illness. We have previously outlined a schema detailing the natural progression of developing psychotic phenomena into four distinct stages. The phenomena, when identified, can be seen as a continuum. However, many clinicians fail to recognize the earlier phases and typically the diagnosis of psychosis is made relatively late at what we call stage three of the four stages we described.


Colonoscopy in the differential diagnosis of colonic strictures: report of four cases. Colonoscopy was performed on ten patients who had colonic strictures demonstrated by barium-enema examination. In all cases the diagnosis of carcinoma had been considered, but it was confirmed by colonoscopic examination, cytology, and biopsies in only two patients. Five patients were shown to have benign inflammatory strictures due to ischemic colitis, ulcerative colitis, Crohn's disease, irradiation colitis, or postoperative strictures. The remaining three patients were shown to have no intrinsic lesion. These eight patients were thereby spared further diagnostic procedures, and even unnecessary laparotomy.


Current medico-legal issues -- a psychiatrist's view. The present challenges in medicine indicate clearly that a fuller partnership between patient and doctor is being evolved, without secret or unshared clauses. When a satisfactory relationship develops, it not only satisfies medico-legal requirements, but also fulfills the basic needs of excellent practice. The education of the patient and his family is an important part of the treatment process. The physician must consider and evaluate symptom, disease, and the patient as a person. It is the failure to establish a balanced equilibrium of these elements in any program of patient care, which give  rise to crisis in patient-physician relationships, from which legal actions originate.


Leiomyoma of the cecum presenting as an acute surgical abdomen: report of a case. This is a case of a benign leiomyoma of the cecum that perforated the bowel wall and manifested as an acute surgical abdomen. The literature was reviewed and the lesion was found to be uncommon. Clinical pictures may vary, but a colonic mass of this nature should be treated as a cancer, as it is not usually possible to distinguish benign from malignant lesions preoperatively.


Methaqualone abusers: a preliminary survey of college students. A questionnaire was used to survey the methaqualone experiences of college student users, and psychological test data from these users and a control group of non-users were compared. On differential pattern found was that methaqualone users have experimented with a wider variety of psychoactive drugs than have non-users. However, the two groups were essentially indistinguishable on the psychological test variables assessed. A preliminary modal profile of the college student methaqualone abuser and abuse experience was generated.


Ethnic and age differences in mental health measurements. Data gathered in a survey of 1441 respondents were analyzed to study the influence of chronologmost equal representation of six age groups (20-29, 30-39, 40-54, 55-64, 65-74, 75-94), and three ethnic groups (Blacks, Anglos, Mexican-Americans). The sample includes equal representation of both sexes and two socioeconomic levels. The Twenty-two Item Screening Scale and the Affect Balance Scale are used as measures of mental health. The analyses show age-related and ethnic-related patterns; each pattern, however, is independent of the other. The age-related pattern is the same within the three ethnic groups, and the ethnic pattern is independent of age. Anglos report significantly more psychiatric symptoms, especially those of one factor grouping named "anxiety," and they report more recent experiences with both positive and negative affect than do Mexican-Americans and Blacks. The elderly persons "well enough" to participate in a long interview express no significant increase in symptomatology compared with younger groups. If the symptom expression is broken into several categories based on factor analysis, we find a small, significant increase in symptom expression by older groups on the factor grouping named "depression." Additionally, the older groups compared with middle-aged and younger groups, report less positive and negative affect expression.


Pentazocine psychosis: a case of persistent delusions. A case of psychosis secondary to pentazocine is presented. The patient demonstrated hallucinations, preceptual aberrations, a distorted body image and delusional thinking. The delusional ideation persisted for a period of three weeks. Such a case of persistent delusional thinking secondary to pentazocine administration has not been reported previously.


[Raised trypsin concentration in duodenal secretion after a test meal (Lundh test) (author's transl)]. The Lundh test for exocrine pancreatic function was performed on 376 patients. An increased trypsin concentration in duodenal secretion (greater than 28.9 IU/ml) was measured in eight. Seven of them had symptoms of pancreatic disease, six of them with acute episodes. Eight further cases have been reported in the literature, at least two of them definitely having pancreatic disease. Both in the reported cases and in the authors' study the proportion of patients with abnormally raised enzyme concentrations among the group of patients with acute or subacute pancreatitis was significantly greater than in a control group. It is possible that abnormally raised enzyme concentration is due to subacute pancreatic disease and may at times be the only finding. An abnormally raised enzyme concentration in the Lundh test should therefore simply be classified as such and not be taken as the expression of normal or even "excellent" pancreatic function.


[Spontaneous regression of endemic goitre in South Baden: preliminary report (author's transl)]. A representative cross-section of 3933 persons living in South Baden indicates that the incidence of goitre, both in the native and the immigrant population of this area has markedly decreased between 1963 and 1973, even without iodine prophylaxis. In 1973, euthyroid goitre among native inhabitants was 24.7% (47.0% in 1963). With this reduction was a tendency towards goitre formation amongst females. Despite the lowered incidence of endemic goitre, particularly nodular goitre among the small-holdings farmers, a marked correlation with socio-economic factors and age has remained. However, a levelling out of goitre incidence in farmers and urban population with increasing social and economic betterment has become evident.


[Severe side-effects during peritoneal dialysis caused by sorbitol-containing dialysate (author's transl)]. In seven patients with chronic renal failure in an advanced stage 17 episodes of upper abdominal pain, hypertension, vomiting and (in some of them) coma occurred during peritoneal dialysis with sorbitol-containing dialysate. The signs recurred in some of the patients but did not when glucose-containing dialysate of otherwise identical composition was used. Very high levels of sorbitol in CSF and serum were measured in the comatose patients. The precipitating factor is probably a reduced metabolic breakdown of sorbitol in renal failure with preferential intracellular deposition of sorbitol and subsequent cellular oedema. To avoid this dangerous reaction it is necessary to use glucose instead of sorbitol in peritoneal dialysates, despite the technical problems of sterilisation. Where this is not possible, glucose should be added in order to reduce the sorbitol concentration in the dialysate to less than 15g/l.


[Sterno-costo-clavicular hyperostosis: a hitherto undescribed entity (author's transl)]. Persistent pulling pain in the sternum, clavicles and both first ribs, especially during cold and wet weather, necessitated medical investigations and treatment in 3 patients. Externally a cylindrical or spindle-shaped swelling of the clavicles was noticeable and two patients had signs of superior caval obstruction in addition. X-rays showed hyperostosis of the sternal and middle part of the clavicle, synostosis of the sternoclavicular joints with involvement of the two first ribs as well as a thickening and increase in breadth of the sternum. In one patient there were additional swellings of the first to fourth ribs bilaterally. During the period of observation there was no radiological progression of the bone disease. Apart from a consistently raised erythrocyte sedimentation rate blood chemistry was normal. The sterno-costo-clavicular hyperostosis led to bilateral occlusion of the subclavian veins with resulting upper venous congestion in two patients. Histology of the biopsy samples showed a characteristic hyperostotic spongiosclerosis in all three cases. The cause of this sterno-costo-clavicular hyperostosis is unknown. Clinical, radiological and histological findings indicate that it is a uniform disease which has not previously been described.


[Joint bleeding in haemophiliacs receiving substitution treatment as out-patients (author's transl)]. 15 patients with severe haemophilia A recorded the rate and course of acute joint bleedings during one year. The episodes treated by replacement were compared with those not so treated. From the results it is evident, that treatment with factor VIII concentrates (n equal 8) alone does not completely prevent haemophilic arthropathy, but may reduce it in the individual cases to a level where it only occurs with higher bleeding rates. The bleeding rate depends mainly on the stage of the arthropathy. There is significant improvement of joint movement and significant regression of joint circumference after infusion treatment. Acute joint bleedings in haemophiliacs can be successfully treated by a combination of haemostatic and anti-inflammatory substances, as well as by physiotherapy and orthopaedic means.


[Diastolic murmur caused by a phaeochromocytoma (author's transl)]. A protodiastolic murmur was noted in a 24-year-old man with phaeochromocytoma, the murmur disappearing three months after tumour resection. It was probably the result of pulmonary regurgitation, caused by reversible changes in the pulmonary vascular bed or pulmonary valve from the increased catecholamine production.


[Therapy of acromegaly using bromocriptine]. Oral administration of 1.0 or 2.5 mg bromocriptine (CB 154: 2-brom-alpha-ergocryptine) in nine of twelve patients with active acromegaly resulted in a reduction of growth hormone level by 80-90% over 8-10 hours. During treatment for 2-9 months with daily doses of 4.0 to 10.0 mg bromocriptine, there was a sustained reduction of growth hormone levels in these patients. At the same time soft-tissue swellings and tendency towards sweating decreased. In two patients with diabetes mellitus the blood sugar profile improved and in one of them the insulin dose could be markedly reduced. The rise in growth hormone levels after TRH administration also occurred during bromocriptine treatment. In those patients in whom growth hormone levels failed to react to either acute or chronic administration of bromocriptine no rise followed TRH administration. It is possible that in these patients there is a hypophyseal adenoma without hypothalamic control. On gradually increasing dosage bromocriptine was tolerated without side effects.


[Patients' attitudes towards the physician's duty to inform. Results of an inquiry]. More than 200 patients filled in questionnaires on their attitude towards doctors' duty to inform them on all possible diagnostic and therapeutic hazards. 8% wanted none of this information, 49% wanted to be informed of the important risks, and 43% wished to know all possible hazards. If fully informed about possible risks, 88% felt they would undergo medical treatment with less anxiety, while 12% believed anxiety would be enhanced. 3% wanted no information about any incurable disease, 35% wanted to know part and 62% all of the truth.


[Continuous daily blood-sugar profile in relation to serum insulin in subjects with normal metabolism and ideal or normal weight (author's transl)]. Continuous blood-sugar measurement is at present the most suitable method for testing daily blood sugar profile. It allows to relate variations in blood sugar levels in metabolically normal subjects to body weight. Mean blood-sugar level and postprandial blood-sugar variations are greater in those of normal than of ideal weight. At the same time, metabolically normal subjects of normal weight have a high insulin secretion in the fasting and postprandial states. This makes it likely that those of normal weight, although it is only slightly different from those of ideal weight, have already reached a transitional stage to an increased diabetes risk from over-weight.


[Macro-amylasaemia: report of two cases (author's transl)]. Macro-amylasaemia is a rare form of hyper-amylasaemia without evidence of pancreatic or renal disease. It is due to the presence of a macro-molecular amylase complex in serum, whose origin and clinical significance remains uncertain. The abnormality was diagnosed in a 25-year-old woman and a 44-year-old man. In both the amylase complex was demonstrated by gel filtration on Sephadex G-200.


Miconazole: a review of its antifungal activity and therapeutic efficacy. Miconazole2, a synthetic imidazole derivative, is a new topical antifungal agent for use in the local treatment of vaginal, and skin and nail infections due to yeasts and dermatophytes. It is particularly active against Candida spp., Trichophyton spp., Epidermophyton spp., Microsporum spp. and Pityrosporon orbiculare (Malassezia furfur), but also possesses some activity against Gram-positive bacteria. In vaginal candidiasis, miconazole vaginal cream has produced higher cure rates than conventional nystatin vaginal tablets or amphotericin B vaginal cream. There have been no published comparisons with nystatin vaginal cream or foaming vaginal tablets - the nystatin dosage form preferred by some clinicians. The vaginal cream has also achieved a cure where previous nystatin or natamycin therapy had failed. Miconazole has proved equally effective in both Candida and dermatophyte infections of the skin, but as yet there have been no published comparisons with other antifungal agents. However, it has been successfully used in chronic skin infections which had not responded satisfactorily to other agents such as natamycin and pecilocin. Preliminary experience with oral and intravenous miconazole therapy in systemic candidiasis is promising. Miconazole preparations are well accepted and tolerated.


[Various aspects on the teaching of veterinary physiology in Latin America]. The results are presented from a PAHO/WHO survey conducted in 1974 with a view to ascertaining the characteristics of the teaching of veterinary physiology in Latin America. A total of 35 schools of veterinary medicine (out of the 69 existing at the time of the survey) replied to the questionnaire sent. In addition, the authors of this article visited 17 schools in seven countries. They examined the following aspects of the teaching of veterinary physiology in the schools surveyed: placement of the program (inside or outside the veterinary school), number of students enrolled in the courses, teaching personnel, student-instructor ratio; academic organization; course content; use of laboratory animals, text and reference books, and laboratory facilities and equipment. The problems faced in the teaching of this subject in Latin America include: lack of suitable instructors and the imbalance in the student-instructor ratio, study programs not geared to the needs of the country, wide variation in the number of hours devoted to teaching, and lack of coordination between this course and other subjects. A number of recommendations for solving those problems are put forward.


[Experimental course in medicine at the University of São Paulo]. The structure, general objectives, characteristics, and administrative organization of the experimental course in medicine at the University of São Paulo, Brazil, are examined. The individual course subjects are then described, as are the six cycles, together with the class hours allotted to each, into which the course is divided: (1) basic instruction; (2) studies vertically integrated into the system; (3) the preclinical course; (4) the clinical course (corresponding to the fourth year); (5) the rotating internship; and (6) the elective internship. Including the internship system adopted in the last four years, the course comprises a total of 10,000 hours. Emphasized are: teacher training of instructors; position in the course of social sciences and medical psychology; factors adversely affecting the teaching of community medicine; effects on the student of the characteristics of the system adopted for practice during internship and in the teaching hospital. Establishment of a continuing process for stimulating attainment of the objectives, improving teaching methods, and securing the desired results is recommended as part of the experimental course.


[First national seminar on the teaching of preventive medicine in the medical academic programs in Peru. Summary of the seminar report]. A summary report is presented of the Seminar held in Lima, in November-December 1974, attended by 44 delegates, including university professors, Peruvian Health Ministry officials, representatives of the Peruvian Association of Academic Prpgrams in Human Medicine, students, insturctors and PAHO/WHO advisers. The main topics were: concepts of preventive medicine in medical education, cirriculum structure, teaching methods, and educational resources. A comprehensive review of the course content in preventive medicine and how it is taught was made with the aim of instiuting uniform and criteria in this area of instruction. The recommendations reflect a thoroughgoing analysis of the subjects discussed and are a valuable contribution to improvement of the teaching of preventive medicine.


Transient hypothyroidism associated with increased anti-microsomal antibodies. An unusual case of transient hypothyroidism during the course of chronic thyroiditis was reported.  A 25 years old female noticed the remarkable enlargement of thyroid gland 3 months after paturition and was developed to be hypothyroidism with decreased blood thyroid hormone and increased serum TSH.  The patient recovered to be euthyroid spontaneously in association with the decrement of goiter size.  Anti-thyroid microsomal antibody increased concomitantly with hypothyroid period and decreased parallel with the recovery of thyroid function.  The ratio of TSH potency estimated by bioassay to that by immunoassay changed during the course.  Possible etiologic factors of this transient changes were discussed.


Uptake of 3H-progesterone by brain and pituitary of castrated male rats. Gonadectomized male rats of Wistar strain were administered 3H-progesterone.  Various brain tissues and anterior pituitary were analyzed for retention of radioactivity, using a liquid scintillation technique.  Radioactivity, in all tissues, was highest at 20 min after steroid treatment, and thereafter dropped nearly in the same pattern as each other.  Among the tissues examined median eminence and anterior pituitary retained more radioactivity for a longer period of time than did other tissues.  The results suggest that there is long-term retention of progesterone in the median eminence and anterior pituitary of male rats.


The conversion of pregnenolone-7alpha-3H and progesterone-4-14C to estrogens by corpora lutea of menstrual cycles and pregnancy. The metabolism of pregnenolone-7alpha-3H and progesterone-4-14C by human corpora lutea tissue of menstrual cycles and pregnancy was studied. In the incubations, equimolar mixtures of pregnenolone-7alpha-3H and progesterone-4-14C were used as substrates. Three corpora lutea of cycles were used as minced tissue. From those corpora lutea progesterone, 17-hydroxyprogesterone and androstenedione were formed, although no estrogens were formed. One corpus luteum of cycle and one corpus luteum of pregnancy were used as homogenated tissue, and those formed estrone and estradiol as well as the same three delta4-metabolites. The corpus luteum of cycle also formed testosterone. All metabolites including estrogens showed the lower 3H to 14C ratio than the starting ratio. 17-hydroxypregnenolone in only one corpus luteum, and no delta5-metabolites in the other four corpus luteum were identified. It is therefore proposed that the major pathway for estrogen formation in human corpus luteum is pregnenolone yields progesterone yields 17-hydroxyprogesterone yields androstenedione (or testosterone) yields estrone and estradiol.


Two cases of pseudoaldosteronism (Liddle's syndrome) in siblings. Two cases of Liddle's syndrome were found in a brother and sister.  Both showed typical hypokalemic hypertension without hyperaldosteronism.  These cases showed similar responses in various pharmacological tests and their symptoms of hypokalemic and hypertension were relieved by triamterene.  And in a family survey, the father appeared to be affected.  This seems to be the first report on this syndrome in Japan.


Calcitonin activity assessed by calcium tolerance test in patients with thyroid disorders. The calcium tolerance test was performed in 34 healthy subjects and in 103 patients with simple goitre, thyrotoxicosis, hypothyroidism, subacute thyroiditis, medullary carcinoma and in patients after subtotal or total thyroidectomy and after radioiodine therapy. Calcium lowering activity which reflects mainly the activity of clacitonin, was significantly impaired in thyrotoxic and totally thyroidectomized patients. An abnormal calcium tolerance test in a patient with medullary carcinoma corresponded with large amounts of released calcitonin.


The role of age in the development of hypothyroidism after treatment with radoiodine. The authors have studied the role of age in the development of posttherapeutic hypothyroidism in 141 patients treated with radioiodine for thyrotoxicosis. The minimum time of the follow up after treatment was 10 years. The patients were divided into two groups according to age at which the treatment was administered. The critical age was 55. The incidence of posttherapeutic hypothyroidism was significantly greater in the elderly patients. There was a gradual increase of incidence of posttherapeutic hypothyroidism during the 10 year follow up. The dangers of the thyroid treatment in the elderly hypothyroid patients with persisting cardiac involvement may be reduced by a concomitant administration of beta blocking agents.


Antidiuretic hormone and lipolysis.

Antidiuretic hormone and lipolysis. Lysine vasopressin did not increase plasma FFAs level in man and in rat Pitressin and lysine vasopressin did not influence adenyl cyclase activity in rat epididymal fat pad, while ornithine vasopressin induced a statistically significant adenyl cyclase increment. These findings suggest that the adipokinetic acticity of ADH which has been correlated only with the amino acid arginine is also correlated with ornithine.


[Morphology of the rat placenta in experimental, hormone-induced, prolonged pregnancy. II. Plancenta in intrauterine macerated dead rat fetuses]. In course of overdue pregnancy in rats, produced by application of synthetic gestagens the intrauterine death rate rises, when the gestation time is more than 23 days. Placentas of 47 macereted fetus rats we have investigated. The pathologic-anatomical picture of the placenta characterized by collaps and following regression of the peripheral fetal blood system. Furthermore, there are narrowing processes in great fetal vessels. In the maternal sinus occurs fibrin. The labyrinth of the placenta inclines by production of collagen fibers to a homogenous structure. The trophoblastic epithel is less differentiated. These findings in rat placentas we have compared with those in human placentas in cases of fetal maceration. The worth of these changes for differentiation of intravital against postmortal regressive processes is evident.


Evidence for permanent enhancement of residual ADH induced by antidiuretic agents (chlorpropamide, carbamazepine, clofibrate) in patients with pituitary diabetes insipidus. Excretion of free water was studied in 7 patients with pituitary diabetes insipidus before treatment and after withdrawal of antidiuretic drugs (chlorpropamide, carbamazepine, clofibrate) used on a long-term basis. A statistically significant decrease in free water clearance was found after 2-4 weeks of withdrawal of antidiuretic agents. This was considered as a clinical evidence for the permanently enhanced release of residual ADH induced by chlorpropamide, carbamazepine and clofibrate in patients with partial defect in ADH secretion.


Hormonal disturbances and effect of pharmaca. The hormonal milieu of the organism may exert certain influences on the activity and lasting of the effect of some drugs. This was demonstrated in female rats with the example of a steroid hormone (estrone) and a short acting barbiturate derivative (hexobarbital). Estrus produced with estrone is not to be influenced by ovariectomy. Hyperthyrosis lead to the cumulation of estrogens in active form and lengthened their effect. Hypothyrosis accelerated estrogen metabolism inducing a relatively ephemer effect of estrone. Hexobarbital metabolism is faster in ovariectomised rats as well as in thyroidectomised ones than in controls. The catatoxic effect of testosterone is bringing about a short anesthesia. Hyperthyrosis reduced the effect of hexobarbital to one fourth of the control values. A special care is necessary in administering drugs when endocrine disorders are present. Individual dosages of the pharmaca may be taken into consideration to adapt the right dosages to the hormonal disturbances.


Earlier responses in the delay of Korotkoff sounds as compared to the Achilles reflex time in rapid changes of thyroid function in man. In rapidly changing thyroid state Rodbard's Q-Kd interval (reflecting heart contractility) changes more rapidly, than ART (reflecting skeletal muscle contractility). After withdrawal of substitutive therapy in athyreotic patients the Q-Kd intervals prolongs more rapidly than ART and during intensive treatment of hypothyroidism the Q-Kd interval shortens more rapidly that ART. A more rapid metabolic turnover in heart muscle in comparison with skeletal muscle is proposed as suitable explanation. Practical consequences for early diagnosis of hypothyroidism and for instant functional diagnosis of thyroidal disorders are stressed.


Surface and gas-phase resistances to the evaporation of droplets. Attempt has been made to asses quantitatively the magnitudes of both the gas-phase resistance and the surface resistance to the evaporation of droplets and to determine the transition point at which the evaporation changes from a diffusion-controlled to a surface-controlled process. This transition point is strongly dependent upon the ambient pressure and the droplet size. It is found that at atmospheric pressure the particle radius at which the transition takes place is in the range of 1 - 10mu for water, 0.1mu for n-dibutylphthalate, 0.1 - 1.0mu for mercury, and 0.001mu for liquid helium. Furthermore, we have found that the surface resistance and the gas-phase resistance vary with the size of the droplet in opposite direction, leading to the existence of a maximum rate of evaporation at a certain value of the droplet radius, this radius being dependent upon the characteristics of the liquid concerned. This conclusion may be useful in the search for an optimum and most efficient method of combustion of fuel sprays in automotive engines, gas turbines, and oil-burning power plants.


A comparison of food habits of white perch (Morone americana) in the heated effluent canal of a steam electric station and in an adjacent river system. Analysis of the stomach contents of 97 white perch, Morone americana, taken from the effluent canal of a steam electric station (S.E.S.) and 106 white perch from adjacent Patuxent River waters indicated similar food habits from September 1970 through August 1971. However, 35% of all white perch taken from the heated effluent canal contained small pieces of coal and cinders, whereas only 3% of the river specimens contained such items in their stomachs. Fly ash and coal dust are present on the bottom of the S.E.S. canal, whereas little such material, if any, can be found on the river bottom in the study area. This suggests the canal fish were actively feeding in the heated effluent and not simply moving into the canal after feeding in the river. No significant difference (Pgreater than0.05) was found between the average wet weight stomach contents of the river and canal fish within the same mouth.


The dynamics of diquat in a model eco-system. Muskelung (Esox-masquinongy chiensis) fry were used in a 96 hour toxicity study with diquat and simazine. Although the death of sufficient control fish invalidated the test as a whole, some interesting observations were made. At the end of 48 hours 4 out of 10 fish had died in the control tank and 8 had died in the simazine tank while all 10 diquat-treated fish appeared healthy. Two model eco-systems with components from Chautauqua Lake, N.Y. were constructed in 20 gallon glass aquaria to trace the movement of 14C labeled diquat. After activity had reached near background levels in the water from the test tank, fish, plants, sediments and snails were counted in a liquid scintillation counter to discover the fate of diquat within the system. The concentration of diquat was found to be highest in sediments, followed by fish tissue, snail parts, with plants having the lowest measured concentration.


Dissolved yellow organics: quantitative and qualitative aspects of extraction by four common techniques. The dissolved yellow organic matter is removed from aliquots of the same freshwater sample by four common techniques: lyophilization, ion-exchange, ultrafiltration and organic solvent. Quantitative and qualitative aspects of the recovery, including fractionation by gel filtration and total nitrogen determinations, are presented.


Measurement of SO2 in air using coated piezoelectric crystal detectors. Use of hydrophobic membrane filters is shown to effectively reduce the interfering moisture level in the detection of SO2 in air at the parts per billion range. Quadrol is used as a sensitive coating on piezoelectric crystal detectors in a flow system.


A simple drift measurement technique for industrial cooling towers. Drift loss rate was measured for three induced draft cooling towers by following the decrease in concentration of two conservative additives in the recirculating water during operation with no blowdown and normal makeup. The method described is simple and inexpensive and provides information essential in water use planning.


The determination of arsenite and arsenate ions in fish and shellfish by selective extraction and polarography. Arsenite ion, as arsenic trichloride was extracted into benzene from strongly acidified tissue homogenates. Following this, arsenite was extracted from the benzene into water, made up in 1N HCl and analyzed polarographically. Arsenate ion, left in the homogenate after arsenite extraction is isolated in exactly the same way following treatment of the homogenate with cuprous ion to reduce arsenate to arsenite ion. Treatment of the acidified homogenate with cuprous ion prior to extraction gives a homogenate which is readily analyzed for total "inorganic" arsenic. The method was efficient to a maximum level of about 20 mug inorganic arsenic since at higher levels lower recoveries were found. Analysis of a variety of marine biological specimens, with levels of total arsenic up to 40.5 ppm, indicated little of this arsenic was present in an inorganic form. Post mortem reduction of arsenate to arsenite was found to occur rapidly in fish tissue.


Anticonvulsant level in saliva, serum, and cerebrospinal fluid. Levels of four anticonvulsant drugs were measured simultaneously in saliva, spinal fluid, and dialyzed serum, i.e., free drug in serum. The level of diphenylhydantoin and possibly of carbamazepine was the same in the three body fluids. The leves of phenobarbital was the same in spinal fluid and dialyzed serum, but was lower in saliva. The level of primidone was different in each body fluid. The technique is simple (flow of saliva stimulated when the subject chews candle was or Teflon) and will be useful to determine the level of free diphenylhydantoin and carbamazepine, which is more closely related to intoxication or drug failure than is the total level of drug.


Effects of taurine on kindled amygdaloid seizures in rats, cats, and photosensitive baboons. Acute administration of taurine produced a transient loss of susceptibility to photically induced seizures in photosensitive baboons, but failed to affect kindled amygdaloid convulsions in baboons, rats, and cats. In addition, it was totally ineffective in changing the course of spontaneous status epilepticus in kindled cats. These results suggest that a taurine-deficiency model of epilepsy applies only to certain types of seizure-generating conditions, apparently excluding kindled amygdaloid convulsions.


Free amino acids in serum of patients with epilepsy: significant increase in taurine. More than half the amino acids determined in serum were lower in patients with epilepsy than in control subjects. Taurine was the only amino acid to be increased in epilepsy. The changes could represent a compensatory metabolic reaction to limit the imbalance of amino acids in epileptic brain and to facilitate uptake of taurine, which has an anticonvulsant action.


Effects of acute and chronic paleocerebellar stimulation on experimental models of epilepsy in the cat: studies with enflurane, pentylenetetrazol, penicillin, and chloralose. Effects of acute and chronic paleocerebellar stimulation were evaluated in four experimental models of epilepsy in 24 adult cats chronically implanted with bilaterally symmetric parasagittal electrocorticographic electrodes and anterior lobe cerebellar stimulation electrodes. Pentylenetetrazol was given intraveneously in 50-mg increments or 4% enflurane was inspired until grand mal seizures occurred spontaneously or were triggered by photic or auditory stimuli. Alpha-chloralose, 50 mg/kg, was injected intraperitoneally to produce a model of stimulus-sensitive myoclonus and sodium penicillin G, 350,000 units/kg, was injected intramuscularly to produce a model of petit mal epilepsy. One- to 250-Hz electrical stimulation of paleocerebellar cortical surfaces was performed with constant-voltage or constant-current stimulators at threshold and suprathreshold intensities with average intensities of 8 V and 2.5 mA, respectively. Acute or chronic, threshold or suprathreshold paleocerebellar stimulation did not predictably alter the electrographic or clinical manifestations in any of these four models.


Excessive light sensitivity in Papio papio: its variation with age, sex, and geographic origin. Excessive sensitivity (levels 3 and 4) in a population of 1,122 Papio papio was related with age, sex, and geographical origin. (1) Age. There was no clinical response to intermittent light stimulation under the age of 5 months. These was no difference between animals 6 months to 2 years (J1) and those aged 2 to 4 years (J2). Adult females were less often light sensitive (levels 3 and 4 = 32.9%) than immature females (52.4%). Adult males could usually not be tested, but were probably less often sensitive than immature males. (2) Sex. Immature females (J1 + J2) were more often light sensitive (52.4%) than immature males (38.1%). (3) Geographical origin. No animals from East Senegal (Sansande Region) were very light sensitive. Animals from Casamance were more often light sensitive (56.2%) than those from the Niokolo-Koba National Park (N.K.N.P.) (20%). Of two samples taken at one spot between these two regions, one group resembled the population from Casamance and the second resembled that from the N.K.N.P. This observation raises several questions about the respective roles of genetic, ecological, and ethological factors.


Plasma levels of diazepam after parenteral and rectal administration in children. Plasma levels of diazepam and N-desmethyldiazepam were investigated in 19 children by a gas chromatographic method permitting the use of capillary sample. Intravenous administration was studied in 3 children and the plasma level curves showed a rapid decline during the first hour. Absorption and elimination after rectal administration of a solution in 16 children were similar to those after intramuscular administration. Diazepam given by suppository to 5 children gave much lower plasma levels and delayed time to peak levels. Recurrence of seizures in 2 children indicated that the anticonvulsants plasma level was of the order of 150 to 200 mug/liter. No significant side effects were observed. Thus rectal administration of a solution of diazepam is a practical method to arrest convulsions in children.


A tentative recommendation for the maximum daily intake of selenium. In order to make a tentative recommendation for the maximum acceptable daily intake of selenium, relevant data were compiled from the available literature. Normal daily intake of selenium from foods was estimated as about 100 mug, half of which comes from fish and shellfish (in an average adult Japanese). Intake of selenium from other sources was negligible. The amount of selenium excreted in the urine was found to be compatible with the estimated value of the daily oral intake. The range of the margin of safety was then estimated as 10 to 200 times the normal level on the basis of human and animal toxicity data. The variation of dietary selenium intake in the general population is discussed, leading to the conclusion that the consumers of large amounts of fish may ingest as much as 500 mug daily. Consequently, a value of 500 mug is proposed as the tentative maximum acceptable daily intake of selenium for the protection of human health.


Effect of dieldrin toxicity on acetate and palmitate metabolism in rat liver. The effect of a single oral dose of dieldrin (30 mg/kg body weight) on lipid metabolism in rats was studied. Liver lipids content increased and this increase was mainly in the triglyceride fraction. The incorporation of acetate-14C into fatty acids was decreased indicating an inhibition of lipogenesis. Fatty acid oxidation was increased. Palmitate-14C incorporation into the triglyceride fraction was enhanced pointing to an overall increased utilization of fatty acids.


Effects of simulated high altitude (3800 m) on reproductive function in the pregnant rat. Ovarian appearance, uterine contents (including numbers of fetuses, size and weight), and levels of gonadotropic hormones were studied in pregnant rats exposed to simulated altitude (3800 m). Comparisons were made at 11, 20 and 21 days of gestation between sea level controls rats bred at sea level and placed at reduced barometric pressure on confirmation of pregnancy (SHA). Although fewer fetuses were present in SHA rats on day 11 of gestation, litter size at days 20 and 21 was similar to controls. Body weight and length of SHA fetuses were significantly reduced by day 21 of gestation while placental weights remained similar to controls. The follicle-stimulating hormone (FSH) content in the pituitaries of SHA rats was significantly reduced at days 11 and 21 of pregnancy as compared with controls; luteinizing hormone (LH) content was lower at day 20 than at day 11 among SHA rats. Plasma gonadotropin levels were similar between SHA and control rats all all three stages of gestation. It is suggested that, despite lack of placental adaptation and altered endocrine functions, exposure of rats to hypoxic conditions only during gestation permits better maintenance of pregnancy than reported in rats with longer exposure to high altitude.


The influence of a carbachol aersol on the tracheobronchial deposition of 99mTc tagged particles. The tracheobronchial deposition of inhaled 99mTc tagged teflon particles of 6 mum (specific density 2g/cm3) was determined in rabbits by comparing the particle content in free dissected parts of the tracheobronchial tree with that in the whole lung. There was a singificantly larger deposition of particles in the proximal parts of the airways in rabbits exposed to an aerosol of the bronchoconstrictor compound carbachol than in control rabbits exposed to distilled water alone. The resistance to insufflation of a constant volume of air increased during the exposure to the carbachol aerosol, indicating bronchoconstriction. There was reproducible interindividual differences in bronchoconstrictor response to the carbachol aerosol. They were attributed to interindividual differences either in deposition of carbachol or in bronchial muscle sensitivity to carbachol. It is concluded that bronchoconstriction might serve as a defensive measure in causing a more proximal deposition of inhaled particles.


Investigations into the inhibition of DNA repair processes by detergents. The inhibition of semi-conservative DNA replication and unscheduled DNA synthesis by three different detergents was investigated in mouse spleen cells. The investigations were made by following the kinetics of the incorporation of 3H-thymidine into the DNA, as well as by autoradiographic studies. At various concentrations different inhibition patterns were found and the significance of these findings is discussed.


The effect of several crude oils and some petroleum distillation fractions on intestinal absorption in ducklings (Anas platyhynchos). Ducklings given hypertonic saline drinking water show significant increases in the rates of Na+ and water transfer across the intestinal mucosa. These increased rates of transfer are maintained as long as the birds are fed dypertonic saline. Oral administration of a single small dose of crude oil had no effect on the basal rate of mucosal transfer in freshwater-maintained ducklings but the adaptive response of the mucosa is suppressed in birds given hypertonic saline. When crude oils from eight different geographical locations were tested, the degree of inhibition varied between them; the greatest and smallest degrees of inhibition being observed following administration of Kuwait and North Slope, Alaska, crude oils respectively. The effects of distallation fractions derived from two chemically different  crude oils were also examined. The volume of each distallation fraction administered corresponded to its relative abundance in the crude oil from which it was derived. The inhibitory effect was not associated exclusively with the same distallation fractions from each oil. A highly naphthenic crude oil from the San Joaquin Valley, California, showed the greatest inhibitory activity in the least abundant (2%), low boiling point (smaller than 245 degrees C) fraction and the least inhibitory activity in the highest boiling point (greater than 482 degrees C) most abundant (47%) fraction. In contrast, a highly paraffinic crude oil from Paradox Basin, Utah, showed the greatest inhibitory effect with the highest boiling point fraction and a minimal effect with the lowest boiling point fraction; the relative abundances of these two fractions in the crude oil represented 27 and 28% respectively. Water-soluble extracts of both crude oils also had inhibitory effects on mucosal transfer rates and these roughly proportionate to the inhibitory potency of the low boiling point fraction of each oil. Weathered samples of San Joaquin Valley, California, and the Paradox Basin, Utah, oils showed greater effects than corresponding samples of unweathered oils even though most of the low molecular weight material from both oils was either evaporated or solubilized in the underlying water during the 36-h weathering period.