[Treatment of epilepsy with clonazepam (Antelepsin)]. Clonazepam (Antelepsin) was tested on 179 patients in 8 institutions during a period of 180 days. 169 patients had been unsuccessfully treated with the usual standard medication and were additionally given Antelepsin. Typical absences and attacks of the West and Lennox syndromes yielded best to treatment with the drug, with favorable effects also being produced in cases of partial or focal epilepsy. The most important side-effect was tiredness, other collateral effects being balance disorders, sensations of dizziness, and musuclar weakness. The frequency of side-effects decreased in the course of therapy. In the electroencephalogram there was observed a significant increase in beta waves and a significant decrease in 3 Hz spike and wave complexes.


[Experience with a list of clinical symptoms]. This is a report of the experience with a list of complaints used to examine a sample of patients (n = 71) prior and subsequent to treatment on an inpatient basis. A reduction of symptoms was observed especially in the area of vegatative and psychic symptoms of anxiety. A detailed factor analysis yielded four interpretable factors.


[Cerebromeningeal fibroxanthoma. A case report]. This is a report on an almost seven-year-old girl with a histologically evident fibroxanthoma of the leptomeninx and dura mater cerebri. To the authors' knowledge, this is the fifth case of an intracranial fibroxanthoma reported in the literature. Histologically, the tumor consists of close-lying pleomorphic cells and giant multinuclear cells with vacuolate or homogeneous eosinophilic cytoplasm and fusiform cells occasionally arranged in meningeoma-like whorls. The experience gathered thus far shows that, so far as intracranial fibroxanthomata are concerned, predictions or conclusions regarding the course of disease and the probability of recovery should be made with reservation only.


Iron induced increase in red cell size in haemodialysis patients. In a group of haemodialysis patients who were iron loaded secondary to parenteral iron administration a slight but significant increase in red cell size was noted when compared to a normal population. This macrocytosis was not related to serum B12 or folate levels, or to the reticulocyte count. On stopping iron therapy both mean corpuscular volume (MCV) and mean corpuscular haemoglobin (MCH) values declined significantly as did serum ferritin and iron levels. Bone marrow smears were of normal or increased cellularity. When iron therapy was discontinued there was a steady fall in serum ferritin levels without a drop in haemoglobin values suggesting that the excess iron was available for haemopoiesis. These findings suggest that the increase in red cell size in this group of patients may have been induced directly by iron overload.


Psychiatric manifestations of Cushing's syndrome: response to lowering of plasma cortisol. The incidence of psychiatric abnormalities has been assessed in 38 patients with Cushing's syndrome and two with alcohol-induced pseudo-Cushing's syndrome. Twenty-six patients were examined by one of us using a standardized psychiatric interview, and this group included all those with severe to moderate psychiatric disorders. Depression was the commonest symptom: five patients (13%) were markedly or severely depressed, four (10%) were moderately depressed and 13 (32%) were mildly depressed. Four patients exhibited other, non-depressive psychiatric symptoms and only 14 (35%) were judged free from psychiatric abnormality. The first line of treatment was to reduce the circulating cortisol level either by adrenalectomy or by treatment with oral metyrapone; both patients with alcohol-induced pseudo-Cushing's syndrome were treated by alcohol withdrawal. Once the plasma cortisol level was successfully controlled, depressive symptoms were relieved in all five patients with marked or severe depression and in three of the four who were moderately depressed. Mild depressive symptoms were relieved in six of the 13 affected. It is concluded that metyrapone may be of considerable value in the management of the acute psychiatric states which may occur in Cushing's syndrome and these findings are discussed in the light of their possible pathogenesis.


[The antibiogram in hospital practice. Its necessity and usefulness]. The A. examined 525 biologic samples that reached the Laboratory for normal bacteriological research. From those samples 625 bacterial species have been isolated, which have been tested with six antibiotics of commoner use, according to the method of Kirby-Bauer, employing two sorts of medium, the Mueller-Hinton Agar and the Brain Heart Infusion Agar. From these sensitivity-tests there resulted a very high rate of antibiotic resistance to of the six antibiotics examined. Several reasons have been invoked to explain the phenomenon but the most plausible explanation is that, it is due to the genetic modifications that the bacteria have undergone.


[Chromogenic and immunological determination of antithrombin III and of antiplasmin in subjects under treatment with oral hormonal contraceptives]. We have effectuated a chromogenic and immunologic determination of alpha 2-At III and antiplasmin in plasma into three groups of patients. The 1st group is constituted of 93 subjects which never take oral hormone contraceptives. The 2nd group is constituted of 56 subjects who are taking oral hormone contraceptives. The 3rd group is constituted of 55 subjects in pregnancy (VI-VIII months). The results show a light difference, in the immunologic assay, between I in equilibrium or formed of II and I in equilibrium or formed of III, but there is not a significant difference in the chromogenic determination. Data have not evidenced significant variations in the antiplasmin too, except for the group of subjects in pregnancy.


[Evaluation of 2 analytical technics for determination of fecal lipids]. The van de Kamer titrimetric method for the determination of fecal fatty acids has been compared with the colorimetric technique described by TOMASZEWSKI. Reproducibility and accuracy as well as the applicability in a clinical laboratory service are discussed. The AA. point out that van de Kamer method still remains the method of choice for diagnostic purposes.


The direct influence of electromagnetic fields on nerve- and muscle cells of man within the frequency range of 1 Hz to 30 MHz. By using several biophysical approximations and considering man as free space model limiting order-of-magnitude values for external electric and magnetic field strengths which may be hazardous for human beings were calculated. Danger may occur by excitation processes below 30 kHz for field strengths exceeding these limiting values; for frequencies larger than 60 kHz, thermal effects are predominant before excitation occurs. The external electric field strength necessary for causing action potentials in the central nervous system exceeds by far the corona forming level. But excitation is possible by strong alternating magnetic fields. Furthermore, by comparing the electrically and magnetically induced currents with the naturally flowing currents in man caused by the brain's and heart's electrical activity, a "lower boundary-line" was estimated. Regarding electric or magnetic field strengths undercutting this boundary-line, direct effects on the central nervous system may be excluded. Other mechanisms should be responsible for demonstrated biological effects.


The effect of environmental temperature and average dose rate of microwave radiation on the oxygen-consumption rate of mice. The oxygen consumption rate of CF1 male mice was determined before, during, and after sham- and microwave-irradiation at environmental temperatures of 20 degrees C, 24 degrees C, 30 degrees C, and 35 degrees C, relative humidity of 55%, and air flow rate of 78 ml/min. Five forward power levels ranging from 0.09 to 3.3 W, which resulted in corresponding average dose rates ranging from 1.2 to 45.1 mW/g were used. The values of the oxygen consumption rate were converted to those of the specific metabolic rate (SMR). The result indicates that with high levels of microwave dosing (greater than 10 mW/g) the specific metabolic rate of mice decreased in some cases, in the environmental temperatures of 20 degrees C and 24 degrees C. However, the decreased SMR values were not lower than the SMR values of the sham-irradiated group in 30 degrees C. In the case of 35 degrees C, the high level dosing with microwave radiation caused increases in the SMR value over the sham value. A possible trend towards increased SMR value during and after irradiationwith low level (1.6 mW/g) microwave radiation in the environmental temperatures of 24 degrees C and 30 degrees C suggests further experiments with low level microwave radiation to determine possible effects of low level microwave radiation in stimulating increases in specific metabolic rate.


Effect of 239Pu on mouse hemopoietic stem cells in different types of bone marrow cavities. Repopulative activity of hemopoietic stem cells of mice given i.v. 5 kBq 239Pu/mouse (166.5 kBq/kg) was followed. The activity retained was measured in the whole mouse, the skeleton and the liver. Simultaneously average cumulative skeletal dose was calculated. Quantitative parameters of the stem cell compartment and the marrow cellularity were studied in variously arranged bones (femur, pelvis, lumbar vertebra) using the exocolonizing test and cytological techniques. The effects of radiation were most marked in lumbar vertebra, less serious changes were found in pelvis and only a moderate response was present in femur. The bone marrow hemopoiesis is damaged in various bone sites to different degrees and the percentage of cells at risk appears higher in trabecular than in cortical bone.


Effect of methyl thiouracil on radioiodine thyroidal retention in rats. Some goitrogens like methyl thiouracil (MTU) because of their thynamide grouping act as antithyroid drugs inhibiting the organification of iodide, but do not alter the iodide transport. Their administration to an intact animal, therefore, might alter the thyroidal iodine kinetics. Here an attempt has been made to study the effect of MTU on thyroidal iodine kinetics in rats as well as to find out whether any difference in kinetics could be detected between different radioiodines, viz., 131I, 125I, and 123I. Cumulated thyroidal activity which is a time integral of the activity has been taken as the parameter to represent the sum effect of thyroidal iodine kinetics over a specific time period of interest. From the in vivo thyroidal activity measurements, carried out over extended periods of time, the cumulated activity was calculated for both MTU treated and normal rats that received 131I, 125I, or 123I at different times before the MTU start. Within a day of the start of the MTU there is a rapid loss of thyroidal iodine. The severity of the loss depended upon the time that elapsed between the start of the MTU schedule and the particular radioiodine administered. The absence of isotopic effect on the uptake as well as on the rate of uptake for the three different radioiodine isotopes studied has been brought out.


Distribution of radiation induced lesions in human chromosomes and dose-effect relation analysed with G-banding. Human female lymphocytes were exposed to X-rays in vitro at 7 different doses between 40-280 R. In 830 metaphases chromosome analyses were carried out with either conventional staining or G-banding, respectively. 486 breakpoints are non-randomly distributed between chromosomes and chromosome arms. An excess of lesions was present in chromosomes 1 and 5 or in 1p. 85% of the lesions were located in G-negative bands (pale G-bands). 29% of all lesions appeared in either the last terminal pale band (21%) or in the centromere region (8%). With regard to an application of G-banding for a biological dose-estimation, the dose-response relations of dic and ace were analysed. Although G-banding enables detailed analysis of the whole karyotype it cannot be recommended for cytogenetic routine analyses in medical radioprotection monitoring, without suitable automated scoring techniques. Dose estimations based on the frequency of dic and carried out with conventional staining cannot be essentially improved at present with banding. Nevertheless, by banding criteria for a correct evaluation of other aberration types, e.g. ace, can be provided. This is a prerequisite for the calculation of representative dose-effect curves.


Evaluation of dose equivalent using a tissue-equivalent ionization chamber and a Geiger-Müller dosimeter. When detailed neutron energy spectrum data are lacking for a mixed field of neutrons and photons, it is permissible when estimating the dose equivalent to assume that the quality factor for the neutrons is 10. With this assumption, it is shown that the responses of a tissue-equivalent ionization chamber and a Geiger-Müller dosimeter can be used to obtain an acceptable approximation of the dose equivalent in the mixed field without requiring precise knowledge of the relative neutron sensitivity of the Geiger-Müller dosimeter.


Quantitative risk in radiation protection standards. Although the overall aim of radiobiology is to understand the biological effects of radiation, it also has the implied practical purpose of developing rational measures for the control of radiation exposure in man. The emphasis in this presentation is to show that the enormous effort expended over the years to develop quantitative dose-effect relations relationships in biochemical and cellular systems, animals and human beings, now seems to be paying off. The pieces appear to be falling into place, and a framework is evolving to utilize these data. Specifically, quantitative risk assessments will be discussed in terms of the cellular, animal and human data on which they are based; their use in the development of radiation protection standards; and their present and potential impact and meaning in relation to the quantity dose equivalent and its special unit, the rem. Recent neutron carcinogenesis data in man are evaluated.


The role of microdosimetry in radiobiology. Microdosimetry is a branch of radiological physics that provides quantitative characterization of the non-uniformity of energy deposition in uniformly irradiated matter. Consideration based on microdosimetry indicate that the action of ionizing radiation on the cells of higher organisms depends on the square of the specific energy absorbed in subcellular volumes. This is the basis of the Theory of Dual Radiation Action. The basic postulate of this theory is reviewed and four factors are discussed that modify its elementary formulation.


Hereditary damage.

Hereditary damage. For the purposes of radiation protection, risk estimates should be based on effects of irradiation at low doses and low dose-rates. Although few genetic studies have been made on effects at low doses those carried out at low dose-rates suggest that the response is generally linear for induction of both gene mutations and chromosomes aberrations. For obtaining an overall genetic risk assessment under these conditions a doubling dose of 100 rem (1 Sv) has been used by the ICRP and other bodies, with respect to radiation of low LET. In addition, it is necessary to know frequencies of human hereditary conditions, the extent to which these frequencies are maintained by recurrent mutation and the average number of generations the different categories of hereditary damage persist in the population. By the use of this information, as well as some data on translocation induction obtained directly from human exposures, an estimate of the risk of serious hereditary ill health in the first two generations after low-level radiation exposure was obtained for the Commission by one of its task groups. Thus the estimate of 10-2 Sv-1 used in ICRP 26 has a factual basis, although a number of far-reaching assumptions have still to be made when any risk estimation of this nature is attempted.


Synthesis of prostaglandins by subpopulations of human peripheral blood monocytes. The ability of monocytes/macrophages to regulate various aspects of immunologic responses may in part depend on their release of soluble substances such as prostaglandins. Using quantitative gas-liquid chromatography/mass spectrometry, prostaglandin E2 was found to be the major prostaglandin synthesized in culture by human peripheral blood monocytes. Subjecting these cells to discontinuous density gradient fractionation demonstrated significant differences in the synthesis of prostaglandins E2 and E1 among the resulting monocyte subpopulations.


Effect of corticosteroids on arachidonate induced mortality in male and female mice. Sodium arachidonate (50 mg/kg) given intravenously to male and female mice induces pulmonary emboli followed by respiratory distress and cyanosis. Female mice are significantly more resistant to this treatment than male mice. Cortisone pretreatment for four days to intact mice (10 mg/kg/day/4 days) had a significant protective effect in both males and females against arachidonate toxicity, eliminating the sex difference previously observed. Adrenalectomy four days before arachidonate infusion increased the sensitivity to SA and resulted in 100% mortality in both sexes. Pretreatment of adrenalized animals with cortisone significantly reduced to some degree the mortality rate in both sexes. Castration of male and female mice three weeks before adrenalectomy did not affect the mortality rate seen following adrenalectomy alone. In conclusion, exogenous cortical steroids augment the resistance of even intact mice and are absolutely necessary for survival in adrenalectomized animals. The observed sex differences in untreated intact animals is not seen after treatment with cortisone or adrenalectomy.


Developmental response to indomethacin: a comparison of isometric tension with PGE2 formation in the lamb ductus arteriosus. We studied the effects of oxygen and indomethacin on the isometric contractile response and the production of PGE2 in isolated rings of lamb ductus arteriosus from animals of different gestational ages (100 to 144 days; term is 150 days). Rings of ductus arteriosus from animals less than 110 days released significantly less PGE2 than did rings from animals greater than 120 days. The indomethacin-induced increase in muscle tension in relation to the decrease in endogenous PGE2 production in preparations from animals less than 110 days gestation was greater than in animals older than 120 days. These findings do not support the hypothesis that immature animals have a larger indomethacin-induced contraction due to an increased production of PGE2 earlier in gestation. They are, however, consistent with a decreased sensitivity to PGE2 in the more mature animals; they also support the hypothesis that the decreased effectiveness of indomethacin on the ductus arteriosus from later gestation animals reflects primarily a decrease in the sensitivity of the vessel to PGE2 during development.


Synthesis of tritium-labeled N-acetyl PGE2 carboxamide (CP-27,987). The preparation of N-acetyl PGE2 carboxamide (CP-27,987) regioselectively labeled at C-18 and C-19 with tritium is described. The overall radiochemical yield was 8.0% at a specific activity of 0.49 Ci/mmole. The synthesis employed is applicable to the preparation of tritium labeled natural prostaglandins and a variety of analogs.


Metabolism of N-acetyl PGE2 carboxamide in the rat. After intratracheal administration to rats, the bronchodilator N-acetyl PGE2 carboxamide was converted rapidly to PGE2 and 13,14-dihydro-15-keto-PGE2, the major plasma metabolite. Oxidation of the N-acetyl carboxamide by prostaglandin dehydrogenase and hydrolysis of the imide bond were demonstrated in vitro.


Effects of some prostaglandin E1 analogues on guinea pig and human respiratory tract. The effects of (a) 4, 5, 6-trinor-3, 7-inter-m-phenylene PGE1 methyl ester, (b) 4, 5, 6 trinor-3, 7-inter-m-phenylene 3 oxa PGE1 and (c) 4, 5, 6 trinor-3, 7-inter-m-phenylene 3 oxa PGE1 methyl ester on human and guinea pig respiratory tract muscle in vitro and in vivo have been studied. All the analogues relaxed the isolated preparations of guinea-pig tracheal chain, human tracheal, bronchial and bronchiolar muscles and decreased histamine-induced lung resistance in the anaesthetised guinea pig. On some preparations the effects of the analogues were more pronounced than those of PGE1. The results suggest that some of the inter-m-phenylene analogues of PGE1 may be bronchodilators in asthmatics.


Differential production of prostaglandins within the human uterus. The ability of broken cell preparations of human endometrium, myometrium and a mixture of endometrium and myometrium to convert 14C arachidonic acid to prostaglandins (PG's) was compared. Endometrium metabolished arachidonic acid predominantly to a mixture of PGF2 alpha and PGE2. A similar weight of myometrium showed relatively little activity, the major product identified was 6 oxo PGF1 alpha. However, a combination of endometrium and myometrium showed an enhanced conversion of arachidonic acid to 6 oxo PGF1 alpha associated with a decreased production of PGF2 alpha and PGE2. This suggests that human endometrium and myometrium differ in their ability to metabolize arachidonic acid and in their ability to convert the endoperoxides formed, to PG's.


Uptake of uranium by various cell fractions of Chlorella regularis. To know what kinds of the cell components of Chlorella regularis are concerned with uranium binding, uptake of uranium by various cell fractions was examined. The uptake value (microgramU/mg starting dry cells) of the hot water-treated cells was almost the same as that of the starting dry Chlorella cells, showing that the cell components extracted with hot water were not so concerned with uranium binding. The cell components extracted with dilute alkali seemed to play an important role in uranium binding, and those extracted with chloroform-methanol seemed to be partly concerned with uranium binding. The cellulose fraction of the cells was scarcely concerned with uranium binding. In the dry cells, 34% of uranium taken up existed in the cell walls. However, in the living cells, 85% existed in the cell walls. The above results showed that the dry or the hot water-treated cells are the most convenient for uranium recovery from the aqueous systems.


[Microdosimetry of in-flight pi-beams (author's transl)]. Microdosimetry of in-flight pi-beams was performed at the T1 channel of National Laboratory for High Energy Physics (KEK), Tsukuba, Japan. Distributions of lineal energy (y) in-flight pi-beams having six momentum values from 120 MeV/c to 1000 MeV/c were measured with an LET counter which simulates 2 micron sphere of soft tissue filled with the methane base tissue equivalent gas. Frequency spectra were obtained in the range of 1.6 less than y less than 430 keV/micron. Fractional dose y . d(y), cumulative dose D(y), and mean lineal energy were calculated from these spectra; then momentum dependences were investigated. These absolute values have little physical application because of the lack of data for y less than 1.6 keV/micron. However, the general trends of y distribution in momentum dependence were found, qualitatively. As the momentum becomes smaller, the rate of high y component in the dose increased.


Fundamental study on decontamination of tritium from gaseous phases by copper oxide. Some fundamental studies on removal of tritium from gaseous streams by a small column of copper oxide were carried out. An about 10 cm length of column packed with 100 g of copper oxide was examined on the conversion ratios of hydrogen and tritium into water. The experiment with hydrogen of 0.1% in argon showed that the logarithmic plot of remaining ratio of hydrogen by passing through the column is proportional to the reciprocal of gas flow rate and to the length of oxide column. The oxide column was also used for treating tritium-bearing waste gas from an evacuating system of alpha D-T neutron generator. It was observed that at column temperatures lower than 450 degrees C the conversion ratio of tritium in the waste gas into water is considerably smaller than that of hydrogen of 0.1% in argon.


[Diagnostic evaluation on cerebral hemisphere scintigraphy using 99mTc-MAA (author's transl)]. Using 99mTc-labeled macroaggregated albumin (99mTc-MAA), we made an examination of the cerebral blood flow distribution with various kinds of cerebrovascular diseases in 151 cases. The particle size of MAA used in this study ranged from 10 to 100 micron. Scan was performed after injection of 3 mCi of 99mTc-MAA into common carotid artery. No side effects were observed except for one case with headache. Distribution of 99mTc-MAA was found to be homogeneous in normal cerebral hemisphere but not in the lesion. Most lesion was shown as nonradioactive area. Meningioma with hypervascularity was represented as hot area. By this method cerebral infarct could be easily represented not only in main artery but also in such a very small artery as hardly detected by CAG. This method is therefore useful for detecting cerebral infarct, sequela of cerebral apoplexy, head injury and others. The dose of 99mTc-MAA used in this method is much lower compared with those of common brain scan, its excretion is speedy, and therefore internal radiation exposure is diminished.


[Clinical evaluation of 67Ga-citrate scintigraphy with reference to tumor detectability (author's transl)]. The clinical usefulness of 67Ga-citrate whole body scanning is evaluated in 178 cases of the various diseases in a period of 1976-1978. The cases are 59 cases of thoracic lesions, 41 cases of head and neck lesions, 35 cases of abdominal, bone, and soft tissue lesions, and 43 cases of benign and malignant lymphoma. The clinical results and detectability of various known lesions are shown in tables 1, 2, 3 and 4. The detectability of unknown lesions of malignant lymphoma is shown in table 5. The study demonstrates the particular clinical values of 67Ga-citrate scan in detectability of unknown lesions to be in cases of malignant lymphoma.


[Superimpose of images by appending two simple video amplifier circuits to color television (author's transl)]. Images are very useful to obtain diagnostic informations in medical fields. Also by superimposing two or three images obtained from the same patient, various informations, for example a degree of overlapping and anatomical land mark, which can not be found in only one image, can be often found. In this paper characteristics of our trial color television system for the purpose of superimposing X-ray images and/or radionuclide images are described. This color television system, superimposing two images in each different color consists of two monochromatic vidicon cameras and 20 inches conventional color television in which only two simple video amplifier circuits are added. Signals from vidicon cameras are amplified about 40 dB and are directly applied to cathode terminals of color CRT in the television. This system is very simple and economical color displays, and enhance a degree of overlapping and displacement between images. As one of typical clinical applications, pancreas images were superimposed in color by this method. As a result, size and position of pancreas was enhanced. Also X-ray image and radionuclide image were superimposed to find exactly the position of tumors. Furthermore this system was very useful for color display of multinuclides scintigraphy.


[On Siphonaptera from rodents of Formosa county, Goiás State (author's transl)]. Polygenis bohlsi jordani (Costa Lima, 1937) (Siphonaptera) is for the first time recorded as ectoparasite on wild rodents captured in the "cerrado" area of Central Brazil. Seven out of nine rodents collected were found bearing P. b. jordani. The most common species found infested with the flea were: Zygodontomys lasiurus, Oryzomys eliurus, Calomys callosus and Nectomys squamipes.


[Study of the thoracic duct (ductus thoracicus) termination in newborns (author's transl)]. The authors studied the terminal portion in fifteen newborn thoracic ducts, using the neoprene latex injection method and posterior dissection. Variations in the manner and number of terminations of the thoracic ducts were found and described. The results are compared with data from the literature. Differences between newborns and adults are discussed.


[Observations upon some factors which influence the laboratory maintenance of Schistosoma mansoni (author's transl)]. Schistosoma mansoni has been maintained in the laboratory using a laboratory strain of B. glabrata, white mice (Mus musculus) and golden hamster (Cricetus auratus). Observations were collected during five consecutive years and the results were analysed for factors which might have influenced them. The analysis has shown that--(1) snail mortalities were independent of the relatively small variation in temperature and of the mean number of miracidia used for infection; (2) rate of infection of snails increased slowly with the increase of the mean number of miracidia; (3) the temperature was in reciprocal proportion with the logarithm of the cercarial development period; (4) the yield of viable eggs has increased steadily in white mice during the observation period; (5) significant increase of egg production was observed in golden hamsters when subcutaneous route of inoculation was used instead of inoculation through the alimentary pouch.


[Human serum hexosamine. Determination in Brazilian pemphigus foliaceus]. The serum hexosamine levels of 39 patients with Pênfigo Foliáceo Brasileiro were determined. The mean value obtained, compared with the mean value found in 30 normal individuals in our laboratory, by Santos et al. (1977), shows that in this disease, the levels of serum glycosamine are higher than in the normal group. The application of Student's test (/t/) indicates a significant difference in the mean values (/t/) = 9,02 P greater than 0,001). Although little is known about the fundamental processes concerned with the increase of serum glycosamines, the authors based on the suggestions of Seibert et al. (1947) reason on the possibility that the essential lesion, i.e., the destruction of the intercellular cement (of glycoprotein nature) is an important factor in the increase of glycoproteins rich in glicosamines.


[Coexistence of surgical acute abdomen and acute myocardial infarct]. Based on experience acquired in 10 cases the authors stress the difficulties of the clinical and the para-clinic diagnosis when such events occur simultaneously. The severity of the clinical picture (death-rate is over 90 per cent) requires great capacity of perception of therapeutic priorities, and the success cannot be achieved but through a close medico-surgical cooperation.


[Tumors of the small intestine].

[Tumors of the small intestine]. On the basis of 20 observations of tumours of the small bowel a series of diagnostic, therapeutic and prognosis of these lesions are discussed. Malignant tumours of the small bowel (10 adenocarcinomas and 2 sarcomas in the present statistics) represent 1,9 per cent of the total number of malignant tumours of the small bowel. The patients were hospitalized following an acute complication occlusion, haemorrhage, perforation). Four of the patients benefited from a curative treatment, in 5 only a derivation was possible, and in 9 only exploratory laparotomy and bioptic sampling. Eight of the tumours were benign and consisted in : 3 fibromas; 2 neurogenic tumours; 2 adenomatous polyps, and one lipoma. All were discovered in the course of emergency surgery for occluding syndrome or haemorrhage, and benefited from a radical treatment. Two deaths were recorded in the entire series (one following embolism in the 10-th day after surgery and another in the 3-rd day with occluding shock). Both patients were in a condition of severe hydroelectrolytic imbalance.


[Gastric resection with preservation of the pylorus with a variant of pyloroplasty]. The authors present the case of a female patient with gastric ulcer of the small curvature of the stomach who showed a particular neuropsychical lability, in whom emergency surgery was performed before it was possible to obtain data concerning the behaviour of the gastric acidity. In an attempt to avoid the postoperative dumping syndrome the authors performed a medio-fastric resection, removing the area with the ulcer and maintaining the antro-pylorus. For the obtention of a good drainage of the remaining stomach a variant of the pyloroplastia technique was associated.


[Pathogenesis of primary lymphedemas].

[Pathogenesis of primary lymphedemas]. The role of the involvement of regional limph-node relays is already known, in the genesis of secondary lymphatic oedemas. With regard to the primary lymphatic oedemas however the role of regional lymph-nodes is considered to be limited. Following a complex investigation of an important clinical material the authors conclude that, in cases of primary lymphatic oedemas the determinat lesion is in the regional lymph nodes, and that it consists in an alteration of the filtration capacity, as well as in a reduction of the processing capabilities by the lymph nodes of the lymph flowing from the afferent lymph vessels. Simultaneously with the functional alterations lymphography revealed a series of changes, and macro- and microscopic examination also showed morphological pathologic alterations. The clinicat evolution and the prognosis of the oedema in the limb involved will depend on the extension and the evolution of these lesions.


[Diagnostic and therapeutic considerations in solitary round shadows of the lung]. The authors present statistic of 307 patients with radiological rounds solitares pulmonary shadows that had underwent surgery and make an analysis of diagnostic and therapeutic attitude. Diagnosis preceding surgery being incertin in 64,5% cases and because, bronchopulmonary cancers represent 20,8% of the total of patients that underwent surgery, it is that for the authors choice solution is thoracothomy with double diagnostical and therapeutical pourpouse. Their clinical results was satisfactory in 95,2%.


[Paralytic scoliosis].

[Paralytic scoliosis]. The authors discuss the problems raised by paralytic scolioses. A total of 14 patients with this syndrome were operated, of which 13 with the instrumentation, and according to the procedure introduced by Harrington. The authors stress the pathophysiologic context which defines the surgical indications and the prognosis.


[The Paltrinieri operation in treatment of pseudarthroses of the leg]. The authors present 8 cases of pseudarthroses of the tibia secondary to surgical and orthopaedic treatments of fractures of the leg, in whom para-focal osteotomia was performed. The Paltrinieri method is a simple and efficient intervention based on the biochemical principle of re-establishing a normal tibial axis, and on exclusion of the pseudarthrosis focus from under the influence of negative mechanical factors, an intervention which leads to a revival of the capacities of consolidation of the pseudarthrosis. The very good results obtained justify the recommendation ofthis therapeutical method in the treatment of pseudarthroses, especially of the suppurated pseudarthroses of the leg.


[The nutritive utilization of phosphorus in dietary calcium deprivation (author's transl)]. The influence of alimentary calcium deprivation on the nutritional utilization of phosphorus and its corporal retention, after ingestion of diethylstilbesterol has been studied in quail. When female quail are given a highly calcium-deficient diet, egg-laying stops and there follows a substantial decrease in phosphorus utilization and retention, as well as a clear drop in bone mineralization, with calcium and phosphorus content losses in the femur. In males, deprivation of alimentary calcium shows tangible effects on phosphorus retention only when this situation concurs with prior ingestion of diethylstilbestrol.


Respiratory activity during germination of seeds of Cicer arietinum L. II. Effect of some metabolic inhibitors and mitochondrial activities. Changes in respiration rate during the early period of germination of Cicer arietinum L. seeds were studied. Three phases were distinguished. During phases I and II the RQ was higher than unity. Sodium fluoride showed no effect on gaseous exchange during phase I while in phases II and III a progressive increase in the inhibition of the respiratory activity was obtained. Iodoacetate inhibited oxygen uptake and carbon dioxide evolution from the beginning of germination. The activities of mitochondrial enzymes increased during the germination period, especially after the first 24 hours. The respiratory control and ADP/O ratio of the isolated mitochondria increased gradually during germination, reaching maximum values at 48 hours, lower, however than the expected theoretical ones.


Study of the action of the nucleus accumbens septi electrical stimulation upon the unitary activity of the amygdaloid complex of waking cats. The extracellular activity of the amygdaloid cells and the action of the NAS stimulation upon them were studied in unanesthetized, non-paralized, waking cats. The neurons were classified according to their responsiveness to olfactory, auditive, visual and behavioural stimuli, and then, the action of the NAS electrical stimulation upon the spontaneous activity of the previously classified cells was studied. The number of cells responding to visual stimuli (projected spot of light, movement) was found to be higher than in previous works. On the other hand, some of the cells activated by behavioural stimulation (presence of rat) behave in a complex manner by changing the characteristics of the response upon modification of its distance from the rat. However the majority of the recorded neurons failed to respond to any of the tested natural stimuli. The existence of rather extensive zones in the amygdaloid complex without spontaneous activity as well as the small number of cells showing modifications of the rate of firing induced by NAS electrical stimulation was remarkable.


[Effects of T3, T4 and methyltiouracile short-term treatments on plasma and liver lipid levels in rats (author's transl)]. The effects of short-term administration of thyroid hormones (T3 and T4) and methyltiouracile (MTU) on liver and plasma lipid levels in female rats have been comparatively studied T3 increases the levels of all the studied liver lipids and decreases the plasma lipids. T4 produces smaller and even, in some cases (liver triglycerides and cholesterol esters), opposite effects. The administration of MTU produces, in general, opposite effects to T3 and T4.


[Effect of the thyroid hormone, triiodothyronine on fatty acid chain elongation of mitochondrial phospholipids (author's transl)]. The effect of the Thyroid Hormone Triiodothyronine (T3) on composition of Fatty Acid of Mitochondrial Phospholipids is studied. In animals (Gallus domesticus var. Cornis and White Roc.) treated with an injection of T3 containing 0.04 microgram/g body weight, increase length and insaturation increases of the hydrocarbon chains of fatty acids in mitochondrial phospholipids are observed in relation to the corresponding controls. This elongation is maximum at 14 hours after treatment with the hormone. Animals treated with T3 showed a higher proportion of stearic and eicosatrienoic acids than controls. This increase is accompanied by an equivalent decrease of the palmitic and oleic acids, their respective biosynthetic precursors. The highest proportion of long chain and unsatured fatty acids can be observed in phosphatidylethanolamines and phosphatidylcholines.


[Molecular forms of chicken liver cytoplasmic malate dehydrogenase (author's transl)]. Cytoplasmic malate dehydrogenase has been purified 20 -- fold from the supernatant fraction of chicken liver homogenates in 0.25 M sucrose (differential centrifugation at 100,000 x g) through calcium phosphate gel absorption, ammonium sulphate fractionation (45-80% saturation) and Sephadex G-100 chromatography. Two molecular forms, A and B, of the enzyme are unmodified during the purification process, observed by electrophoresis. Two additional bands that appear in the electrophoretic patterns are not attributable to molecular forms of the enzyme, but to the lack of non-dehydrogenase activity of the preparation used. Both forms differ in their thermal stability (form A is more thermolabile) and net charge; and they both have the same molecular weight (67,000 +/- 5,000 daltons), determined by Sephadex G-200 chromatography. The enzyme in the purified preparations exhibits two KM values in the double reciprocal plot v vs [L-malate], due to the presence of two forms with different affinity for the hydroxyacid.


Effect of the septal lesion on the non-learned responses of the rat. Effect of septal lesions has been studied in rats to find if they alter aspects of its SSDR. Results may be summarized as follows: 1. Animals with the septal syndrome tried to attack only when about to be caught, while they showed exaggerate freezing and submissive responses once caught. 2. A shock associated situation caused an increase in the freezing behavior and a decrease in the number of boluses excreted. 3. The septal animals never left walls of the open field, and did not explored its internal areas, showed in increase in thigmotaxis. 4. They showed an increase in the emergence time. The results are interpreted as due to an enhancement of the species-specific defence reactions.


Effect of fasting on urinary excretion of water and nitrogen in the rat. Rats housed in metabolic cages undergoing 48 h fasting showed reduced daily intake of drinking water and increased urinary volume. Both the daily amount of urinary creatinine and urea excreted were diminished with fasting, while that of ammonia was augmented. Besides demonstrating metabolic water loss under fasting, results suggest that ammonia derived from glutamine in the kidney, rather than urea formed in the liver, is the main nitrogenous catabolic product of amino acids in fasting.


[Effect of progesterone on rat plasma and liver lipid levels (author's transl)]. The effect of progesterone upon several lipidic parameters on rat liver and plasma was studied. Progesterone administration led to a significant increase in the hepatic triacylglyceride and cholesterol esterified levels and to a decrease in the phospholipid content. After progesterone treatment decreases in plasma total lipids, phospholipids, cholesterol and cholesterol esterified were observed, whereas plasma triacylglyceride and free fatty acid levels increased. The hormonal treatment altered the lipoprotein pattern, which significantly reduced the beta-lipoprotein fraction.


The effect of 2-oxoglutarate and biotin in the release of amino acids by Citrobacter intermedius C3. Excretion of amino acids by Citrobacter intermedius C3 was assayed in a mineral medium with glucose as carbon source. Glutamic acid is the main amino acid excreted in liquid medium and it is also detected at the colonial level in solid medium. Mutants with different behaviour with respect to the excretion of amino acids are studied. The presence of 2-oxoglutarate in the medium induced excretion in all strains. On the other hand when biotin was added to the culture media amino acid excretion was partially reduced.


Colostrum production by ewes and the amounts ingested by lambs. Studies involving 49 ewes which were well nourished during the last eight weeks of pregnancy indicated that ewe weight loss during pregnancy and lamb birth weights followed the recognised pattern and were within acceptable "normal" limits. Colostrum production ranged from 1238 to 4593 g per ewe during the 48 h following the first suckling and there was evidence that production levels were related to demand by the lambs. Colostrum consumption by individual lambs was related to litter size. The smaller the litter size the greater was the amount ingested during the first 48 h of life. No clear relationship was established between the amount of colostrum consumed and the level of immunoglobulin in a lamb's circulation. Possible reasons for this are discussed.


An investigation of the toxicity of 1alpha-hydroxycholecalciferol to calves. Two calves were treated with 15 micrograms/kg body weight of 1alpha-hydroxycholecalciferol by intramuscular injection on four occasions at seven-day intervals. Anorexia and reduced water consumption persisted for 48 h after each treatment. No clinical signs of iridocyclitis or any other lesions of the eyes were present at any time either macroscopically or microscopically. After the first treatment serum GOT and GD activities increased, serum AP activity fell, serum concentrations of calcium and inorganic phosphate increased, and magnesium concentrations decreased. The reduced serum magnesium concentrations and increased calcium and inorganic phosphate concentrations were maintained for the duration of the experiment, but there was no evidence of a cumulative effect of successive treatments. Blood urea concentrations increased after the third treatment. The gross pathology at post mortem examination was similar to that reported after vitamin D3 supplementation.


Immunoglobulin levels in ewe colostrum and in lamb serum. The immunoglobulin content of ewe colostrum falls rapidly after the first suckling and reaches a low level 36 h after the first feed. The whey content of colostrum will rise by more than 50 per cent during the same period. The production of colostral immunoglobulin during the 24 h following the first feed was related, in this work, to the amount of colostrum produced; the greater the colostrum production, the greater the immunoglobulin production. Colostrum production ranged from 1216 to 4493 g and immunoglobulin production from 22-21 to 86-34 g during the eight feeds studied. Colostrum production was related to demand by the lambs. There was a clear positive correlation between the total amount of immunoglobulin the lambs' circulation 30 h after the first feed and the immunoglobulin consumed. Approximately 20 to 25 per cent of the immunoglobulin ingested was present in the lambs' circulation at this time.


Increase in plasma cortisol concentrations in ewes fed oestrogenic subterranean clover. Pen-feeding oestrogenic clover to ewes increased their plasma cortisol concentration by the third day. This was not due to any change in the variation of cortisol concentration with time of day. Ovulation rate was not affected during the experiment as judged by the levels of plasma progesterone and laparoscopy. The plasma cortisol concentration of ewes also rose within three days of their being placed on oestrogenic clover pasture. During the next 21 days, their mean plasma cortisol was increased by 58 per cent. A previous history of clover disease did not affect this response.


Cure of Dermatophilus congolensis infection in cattle by long-acting oxytetracycline. Under conditions simulating traditional husbandry, a single intramuscular dose (20 mg/kg) of long-acting oxytetracycline was efficacious in treating different grades of bovine dermatophilosis. There was complete healing in 26 out of 28 animals (93 per cent) within four weeks. By contrast, only four out of 11 animals treated with penicillin (70,000 iu/kg) plus streptomycin (70mg/kg) were apparently cured and three relapsed within one month. No spontaneous recoveries were observed among 18 untreated animals. In the group treated with oxytetracycline, two, in the penicillin plus streptomycin, seven, and in the untreated control group, 11 animals died of the disease.


Identification of clumping-factor-negative staphylococci isolated from cows' udders. Identification to species level was attempted on a collection of 954 cultures of catalase-positive, clumping-factor- and beta-haemolysin-negative Gram-positive cocci isolated from teats and milk of cows. Eighty-seven per cent of the strains were identified as Staphylococcus xylosus, S epidermidis, S sciuri, S haemolyticus, S hyicus subsp hyicus and chromogenes, S simulans and S cohnii. Nine per cent of the collection belonged to another group which could not be identified with any of the known Staphylococcus species. Many of the strains of this group and also part of the S epidermidis and S hyicus subsp chromogenes strains examined showed various degrees of growth enhancement on certain media when fatty substances were added. Only nine strains were classified as Micrococcus. A scheme for the identification of coagulase-negative staphylococci from cows' milk is proposed.


Protection of goats against peste-des-petits-ruminants with attenuated rinderpest virus. Goats vaccinated with attenuated rinderpest were protected from peste-des-petits-ruminants virus for at least 12 months; vaccinated animals were unable to transmit the challenge virus. Before challenge neutralising antibodies were directed primarily against rinderpest but following exposure to peste-des-petits-ruminants, a high antibody level to both viruses was found.


The effect of skeletal muscle needle biopsy on blood constituents, muscle glycogen and heart rate of cattle. Muscle samples from Friesian bulls were obtained using the Bergström percutaneous biopsy needle. The samples (100 to 200 mg) were suitable for metabolite and enzymic analyses and histological examination in relation to meat quality. The physiological response to biopsy was assessed by measuring serum free fatty acid and blood glucose concentrations, plasma creatine kinase activity and heart rate. Muscle glycogen concentration was also measured. These parameters were unchanged by the experimental procedure, with the exception of blood glucose and heart rate which showed significant increases. The experimental animals showed no adverse effects after repeated biopsy and it is concluded that the technique is suitable for investigating beef muscle metabolism in vivo, and does not cause an unacceptable degree of stress.


Laboratory and field trials on a formalin inactivated vaccine for the control of Pasteurella anatipestifer septicaemia in ducks. A series of laboratory trials on a number of different types of inactivated Pasteurella anatipestifer vaccines suggested that a formolised vaccine would be the most suitable for protection. A satisfactory dose of vaccine was found to be approximately 3 x 109 cells administered intramuscularly. The efficacy of this vaccine was confirmed by a field trial on a farm where anatipestifer septicaemia was endemic, ducks being vaccinated at three weeks of age before their transfer to pasture from indoor rearing units.


A whole blood method for measuring mitogen-induced transformation of sheep lymphocytes. A simple and reproducible micromethod for determination of in vitro mitogenic responses of sheep peripheral blood lymphocytes is described. The test uses (i) whole blood diluted in RPMI 1640 medium to give a cell count of 0.5 x 106-1 x 106 lymphocytes/ml, (ii) mitogens in the range of 5-20 micrograms of phytohaemagglutinin/ml, 20-80 micrograms of lipopolysaccharide/ml or 20-80 microliters of poke weed mitogen/ml, and (iii) a stimulation time of 42 to 90 h. A considerable variation in mitogenic response was observed both between animals and on different occasions in the same animal. Because of the large periodic variation it was suggested that the test should be repeated using blood drawn at different times in order to determine the mitogenic response of an animal.


Rapid assay for repair of damage induced by ultraviolet light in bovine lymphocytes. Bovine peripheral blood lymphocytes exhibit a peak of deoxyribonucleic acid (DNA) repair, measured after exposure of cells to ultraviolet light, three to four days after phytohaemagglutinin addition to diluted blood cultures. This peak of DNA repair is induced coincidentally with that of DNA replication. DNA repair is determined in the presence of hydroxyurea which inhibits DNA replication. This assay provides a rapid screening method for deficits in DNA repair synthesis in cattle.


Isolation of Leptospira of the serotype hardjo from bovine kidneys. Thirteen strains of Leptospira serotype hardjo were cultured from 200 bovine kidneys collected from an abattoir. All strains grew on primary isolation in EMJH medium 0.1 per cent Noble agar but most failed to grow in a variety of media containing neomycin or 5-fluorouracil as selective agents. Two of the cattle from which hardjo were isolated were seronegative by the microscopic agglutination test against hardjo, two had titres of 1/100, five of 1/400, three of 1/1600 and one of 1/6400.


Copper, zinc and iron levels in the cerebrospinal fluid of copper poisoned sheep. Copper, zinc and iron levels were measured in cerebrospinal fluid (CSF) of normal and copper poisoned sheep. Copper values were within the range recorded for humans but zinc levels were six to 20 times and iron levels were 20 to 30 times higher than values reported for humans. The amount of copper, zinc and iron in the CSF did not increase in sheep dosed with copper and hence it is unlikely that the level of copper in the CSF is related to the changes in the nervous system that have been reported in copper poisoned sheep.


Interaction of certain bovine immunoglobulins with complement in a single radial haemolysis system. Bovine IgG1, IgG2, and IgM initiated haemolysis by bovine complement. With guinea pig complement bovine IgG1 and IgM appeared effective, but bovine IgG2 was much less effective. Single radial haemolysis systems using guinea pig complement to measure bovine antibody are likely to detect predominantly IgG1 and IgM. However, in vivo IgG2 should activate bovine complement.


Metabolic events in acutely damaged brain and the effect of dexamethasone in guinea pigs. The effect on 210 guinea pigs of a special clinically used compound on substantial brain damage was evaluated. Cerebral metabolism was well preserved in small laboratory animals after blunt head injury by the administration of dexamethasone intraperitoneally. The high doses used were similar to those employed for cerebral contusion of the brain in patients. The concentrations of glucose, lactate, pyruvate and ATP were maintained better in cerebral tissue by pre- and post-traumatic use of dexamethasone than by treatment with a placebo. Analysis of the blood showed no such correlation indicating that the effect of dexamethasone was due to a local effect on the central nervous system, rather than a systemic effect. With rapid freezing, brain tissue from guinea pigs exposed to high doses of systemic dexamethasone was found to contain less lactate and pyruvate compared with untreated controls. ATP was preserved at the original non-traumatic level. This was not accompanied by an increased rate of glycolysis since the glucose level in the damaged brain was not affected by the glucocorticoid.


Electroencephalographic protective action of pyridoxylate during acute hypoxia and subsequent recovery in the rat. Pyridoxylase at a concentration of 0.6 mmol/kg body weight injected intraperitoneally in rats, increased the resistance of animals to severe hypoxia (O2:3.2%; N2; 96.,%). The electrocorticogram (ECoG) was used to indicate the effectiveness of the drug in lowering the delay of electrographic silence, in 19 control rats and 12 pretreated rats. The ECoG was also recorded period under pure oxygen. In pretreated rats, the ECoG records became flat in a mean time of 551 s, compared with 269 s in the control group. The latent periods of successive steps during cerebral anoxia were significantly delayed in pyridoxylate-pretreated rats subjected to hypoxia. During the recovery period, pyridoxylate improved the recovery of the normal ECoG, particularly when values were expressed as a function of the duration of the hypoxic period. These findings are in good agreement with the significant protection afforded by pyridoxylate on the cerebral rate of energy-rich phosphate bond utilization during hypoxia studied in a separate work.


Effect of pyridoxine, glyoxylic acid and pyridoxylate on oxidative metabolism in vitro and phosphorylated energy-rich compounds studied in rat brains during acute hypoxia and ischaemia. Pyridoxine (1-8 mmol/l) did not change significantly the cerebral oxygen nor the hypoxic or ischaemic degradation of phosphocreatine and ATP. Glyoxylic acid (1-8 mmol/l), an inhibitor of the citric acid cycle, depressed the electrically stimulated oxygen uptake of brain slices to a lesser extent than did pyridoxylate. Moreover, at concentrations of 0.66 mmol/l, pyridoxylate predominantly delayed the hypoxic or the ischaemic breakdown of creatine phosphate and of ATP compared with glyoxylic acid (0.66 mmol/l). These findings paralleled clearly the prominent hypoxic and post-hypoxic protection afforded by pyridoxylate upon rat brain electrogenesis, reported in the preceding paper.


Effect of infused hypothalamic phospholipids on the maturation of foetal rabbit lungs. The effect of hypothalamic phospholipids on the maturation of foetal lung was investigated in a series of experiments in rabbits. Sixteen pregnant does were injected with hypothalamic phospholipids (2 mg day-1 kg-1) from day 21 of gestation. A second group of 16 does was injected with saline, and served as controls. The foetuses were delivered at gestational ages between 27 and 28 days by means of caesarean section under intravenous pentothal anaesthesia. Foetuses born from treated mothers were more active, breathed better, and their lungs expanded to a greater extent compared with the foetuses born to control mothers. In the animals of treated mothers there was, on electron microscopy, evidence of accelerated maturation of alveolar epithelial cells.


Aetiology, diagnosis, treatment and prognosis of acute renal failure in an intensive care unit. Over a period of 2 years, 82 patients out of 2,390 (3.43%) admitted to an intensive care unit developed acute renal failure (ARF). The diagnosis of ARF was based on the usual criteria of oliguria, a rising blood urea nitrogen and creatinine, urine sodium concentration greater than 20 mmol/l and a U/P osmolality ratio less than 1.1. In 9.2% of patients the latter two criteria were misleading. Sepsis was the commonest cause of vasomotor nephropathy but in 20.7% potentially nephrotoxic agents had been administered before development of ARF. Overall mortality was 73.2%, with patients older than 50 years of age having the highest mortality. ARF is associated with prolonged bed occupancy--an average of 59.8 days for the dialysed patients with ARF versus an average length of stay of 8.4 days for the hospital overall.


Granulomatous synovitis: the role of atypical mycobacteria. Clinical data on 25 patients with granulomatous synovitis and bursitis observed from 1970 through 1977 are reviewed. The lesions occurred about the extremities, the wrists and hands being involved most often. With three exceptions, the patients had no significant underlying disease. The lesions were chronic and often followed minor trauma. Many patients had had prior surgery, steriod injections, or both. At the time of surgery for the synovitis, the gross appearance proved to be relatively characteristic, and microscopic examination revealed granulomatous inflammation. Mycobacteria were found in 20 patients. In 15 of these cases, mycobacteria were isolated in cultures; in an additional five cases, acid-fast bacilli were seen in the excised tissue but cultures were negative. The species isolated were Mycobacterium tuberculosis (four cases), Mycobacterium kansaii (six), Mycobacterium marinum (one), Mycobacterium gordonae (one), Mycobacterium avium-intracellulare (two), and Mycobacterium chelonei (one). The clinical results after therapy that combined surgery and antimicrobial agents were generally favorable. It is stressed that surgical specimens should be sent for appropriate cultures as well as for histologic study.


Variability of immune response induced by bacteria treated with subminimal inhibitory concentrations of fosfomycin. Experiments were conducted to explore the possibility that bacterial strains treated with subminimal inhibitory concentrations (sub-MICs) of fosfomycin might induce immune responses different from those induced by intact, untreated bacteria. A preliminary study was done with a strain of Salmonella wien. The immune response in rabbits immunized with bacteria that had been exposed to either the sub-MIC or the minimal inhibitory concentration (MIC) of fosfomycin was compared with that in rabbits immunized with S. wien not exposed to the drug. The titers of antibody to S. wien in rabbits immunized with abnormal, sub-MIC-treated bacteria were higher than those in rabbits immunized with either MIC-treated or untreated S. wien. This difference was seen not only with the total antigen of Salmonella but also with somatic (O) and flagellar (H) antigens.


Recombination as a mechanism in the evolution of influenza viruses: a two-year study of ducks in Hong Kong. An analysis was made of 149 influenza A viruses isolated from ducks in Hong Kong during the period of November 1975 through October 1977. The viruses were isolated five times more frequently from ducks raised in the People's Republic of China than from those raised in Hong Kong. The isolation rate fo viruses was higher from the cloaca than it was from the trachea, but this pattern varied over the two years of investifation. The large number of different combinations (30) of hemagglutinin and neuraminidase genes suggests that recombination of viruses was taking place. Analysis of these combinations showed that their distribution was not random and that certain combinations occured more frequently, and others less frequently, than was expected. The recombination of influenza viruses and the excess or restriction of certain combinations may have implications for the evolution of pandemic strains of influenza virus in humans.


Nosocomial infection due to Pseudomonas pseudomallei: two cases and an epidemiologic study. Pseudomonas pseudomallei was recovered from urine specimens of two patients who acquired the organism after they were admitted to a hospital in a region in which it is endemic. Both patients were diabetic and both had urethral catheters passed while they were hospitalized. samples of soil taken from the hospital grounds yielded an isolate of P. pseudomallei that was identical biochemically and by antibiogram to the two isolates recovered from the urine specimens of the two patients. The two patients stayed in wards located in separate hospital blocks, which were geographically distinct but connected by a walkway. The relevant clinical histories of the two patients and the epidemiologic and microbiologic characteristics of the P. pseudomallei isolates were studied. Sera from both patients showed a significant rise in titers of antibody specific for P. pseudomallei. These two patients are considered to represent the first reported cases of hospital-acquired infection due to P. pseudomallei.


Prolonged effect of Corynebacterium parvum stimulation on granulopoiesis. An intravenous injection of 548 microgram of killed Corynebacterium parvum (C. parvum) into C57BL mice led to a significant increase in the number of both committed stem cells (GM-CFC) and proliferating cells of bone marrow granulocytic series. This increase appeared 24 h after the injection of the bacterium, persisted in varying levels until the 4th week and was accompanied by a marked and prolonged granulocytosis. The proportion of GM-CFC in DNA synthesis was found to be increased 1, 2, and 5 d after injection of C. parvum. Increased serum lysozyme levels were observed on the 9th and 15th d. These findings suggest that C. parvum can stimulate granulopoiesis in the animal system. This property of the bacterium should be considered when a combined chemo-immunotherapy schedule has to be applied.


Studies on the presence and possible oscillations of granulocytic progenitor cells (CFU-C) in human blood. The presence of CFU-C in the peripheral blood of 3 healthy volunteers was monitored over a period of 70 d. Blood samples were taken 3 times a week. Mononuclear cells (MNC) were separated from blood leucocytes by dextran sedimentation and the iron ingestion method. After cryopreservation the cells were cultured in soft agar. One sample of mononuclear cells was cultured using a leucocyte feeder layer as a source of colony stimulating activity (CSA) and another sample using human placental conditioned medium as CSA. In cultures using a leucocyte feeder layer, the average number of CFU-C was 29, 43, 118 per ml blood. No systematic oscillations were observed. When human placental conditioned medium was used the average number of CFU-C was 255, 125, 222 per ml blood, respectively. Significant oscillations with periods of 23, 19 and 25 d were observed.


Human erythropoiesis in diffusion chambers. The diffusion chamber technique has been modified in order to stimulate human erythropoiesis in addition to granulo- and monocytopoiesis. The chamber recipient mice were subjected to a combination of 750 rad irradiation and long-term non-interrupted hypoxia (0.5 atm) without chamber retransplantation. 7 d after implantation erythroid cells started to increase, reaching a maximum of up to 70% of the nucleated cells on day 12.


Sézary syndrome associated with sideroblastic anaemia. A 66-year-old man with acquired sideroblastic anaemia and Sézary syndrome is described. This is believed to be the first such case reported in the literature. We speculate on the possibility that a common stem cell defect could account for the simultaneous development of the two abnormalities. Other features of this case of Sézary syndrome are discussed in relation to previous reports on patients with this disease.


Pel-Ebstein fever coinciding with cyclical haemolytic anaemia and splenomegaly in a patient with Hodgkin's disease. A 46-year-old man with an aortic valve replacement was investigated for recurrent episodes of fever associated with splenomegaly and haemolytic anaemia. Initially bacterial endocarditis was suspected. At laparotomy he proved to have mixed cellularity Hodgkin's disease confined to the spleen. The undefined mechanism underlying Pel-Ebstein fever in this patient may also have been the cause of simultaneous haemolysis and splenomegaly.


Characterization of peripheral blood, spleen and bone marrow cells from a patient with hairy cell leukaemia. The peripheral blood cells, spleen cells and bone marrow cells from a patient with hairy cell leukaemia were studied by means of several immunological methods and by phase contrast and electron microscopy. Both by light and electron microscopy the cells had the morphology of hairy cells. 60 % of all the peripheral blood cells, and 80 % of the spleen cells had membrane-bound IgGk immunoglobulin. 60 % of the peripheral blood lymphocytes and 90 % of the spleen cells were positive for Ia-antigens, and 80 % of the peripheral blood, and 70 % of the spleen cells had receptors for complement factor C3. The percentages of cells with receptor for the Fc part of IgC and receptors for sheep red blood cells (SRBC) were low both in peripheral blood and in spleen. Reduced numbers of peroxidase positive cells and cytotoxic plaque-forming cells were also observed as well as reduced lymphocyte responses after stimulation of peripheral blood lymphocytes with PHA, PWM, ConA, PPD and allogeneic cells. A normal antibody-dependent cell cytotoxicity (ADCC) and PHA-induced cytotoxicity was observed for the peripheral blood lymphocytes of the patients. Our results suggest that the hairy cells in our patient are derived from B lymphocytes and have a monoclonal origin.


Glucose-6-phosphate dehydrogenase deficiency in a native Danish family. A new variant. Deficiency of red cell glucose-6-phosphate dehydrogenase was found in a native Danish family, in which 2 boys suffered from severe haemolytic anaemia. The mother and 3 sisters of the boys were heterozygotes for G-6-PD deficiency. The biochemical investigations indicate that this deficient G-6-PD is very similar to the Mediterranean variant; however, this variant gene may represent another example of G-6-PD 'Helsinki' or an unique variant with properties similar to G-6-PD B(--).


'Lennert's lymphoma' terminating as malignant histiocytosis. A case of the so-called 'Lennert's lymphoma' terminating as malignant histiocytosis is reported. Such a sequence of diagnoses is discussed as a possible progression of the initial 'Lennert's lymphoma' eventually under the influence of cytostatic treatment. A review of other known malignancies ending up in malignant histiocytosis is given.


Transient acquired resistance to the coumarin anticoagulants phenprocoumon and acenocoumarol. A 62-year-old man developed resistance to coumarin congeners during treatment with phenprocoumon (Marcoumar) and acenocoumarol (Sintrom), requiring at least triple the usual therapeutic dose and plasma concentration of phenprocoumon for satisfactory anticoagulation. After 8 months on this high dosage, the patient suddenly developed haemorrhagic diathesis. The medication was therefore discontinued. The resistance could not be ascribed to impaired absorption or enhanced metabolism.


Antibody dependent cellular cytotoxicity and mitogen responsiveness of human peripheral blood lymphocytes differing in avidity for sheep erythrocytes. To characterize the effector cells (K-cells) in antibody-dependent cellular cytotoxicity (ADCC) against a nucleated target cell (El 4), human peripheral blood lymphocytes (PBL) were fractionated by rosette sedimentation into subpopulations differing in avidity for sheep erythrocytes (E). The fractions obtained were assayed for surface markers, and as a functional T cell marker, for responsiveness to the mitogen leucoagglutinin (La). By depleting PBL of E-receptor-bearing cells (Et+), approximately half of the cytotoxic potential was found in the Et-depleted fraction. While the Et+ fraction had low activity on a per cell basis, it nevertheless contained a significant proportion of the original cytotoxicity. By sequential E-rosetting, fractions binding E with high avidity (Et+), low avidity (Et+) or not at all (E-) were obtained. Both E-binding fractions consisted primarily of T-cells, as judged from their surface marker profiles. Both fractions responded well to La, but with different dose optima. The E- fraction contained primarily B-and null cells and did not respond  to La. Significant K-cell activity was found in all these fractions. The results show that a significant fraction of the K-cells have receptors for E and these can be of either high or low avidity. Since both EH+ and EL+ fractions respond well to La and contain K-cells, a T-cell origin of the latter is suggested. However, whether or not cytotoxicity and La-responsiveness are functions of the same cells remains to be established.


Primary structure of pooled, papain-solubilized HLA-A, -B, and -C antigens. The tentative amino acid sequence of pooled, papain-solubilized HLA antigen heavy chains has been determined. The amino acid sequence comprises 273 residues. As the structural analyses were performed on HLA antigen heavy chains comprising a mixture of several allelic forms derived from the A, B, and possibly C loci, multiple residues were encountered in several positions. However, a quantitatively dominating residue could always be easily identified. The present data suggest that the amino acid variability of the HLA-A, -B, and -C antigens is found in restricted regions of the molecule. The COOH-terminal third of the HLA antigen heavy chain appears to be less variable than other regions of the molecule. Previous work has shown that the HLA antigen heavy chain contains two immunoglobulin-like disulphide loops. The COOH-terminal third of the heavy chain was shown to be similar in primary structure to beta 2-microglobulin and the immunoglobulin G constant domains.


Reconstruction of patellar articular cartilage with free autologous perichondrial grafts. An experimental study in dogs. The cartilaginous potential of the perichondrium has earlier been utilized to reconstruct articular cartilage in unloaded joints in adult rabbits. The present work in adult dogs has been performed to find out if the perichondrium can be used for the same purpose in joints subjected to pressure. In 13 knee joints the articular cartilage of the patella was excised completely and the resected surface was covered with an autologous perichondrial graft taken from the rib cartilage. After 3 weeks of immobilization the dogs were allowed to run freely until sacrifice 2 to 17 months later. In all 13 cases regeneration of cartilage took place. Within 8 months the regenerated cartilage showed no or only very slight degenerative signs but from 12 months and later such changes were common. In control cases where the resected surface was left without any graft no cartilage at all was found. Conclusively cartilage formation from grafted rib perichondrium is achieved in the knee joints of adult dogs, but it does not resist considerable pressure forces.


Formation of cartilage from rib perichondrium grafted to an articular defect in the femur condyle of the rabbit. In immature and adult rabbits perichondrium from the rib was autologously grafted to a surgically created defect of the articular surface of the femur condyles exposing the subchondral bone. After one week of immobilization the animals were allowed to move freely until sacrifice after 7 and 13 weeks. In all grafted cases newly formed cartilage of a hyalin appearance filled the defect. Using the technique of intraarticular administration of tritiated thymidine, mitotic activity was found in the superficial zone of the regenerated cartilage indicating that the proliferation of cells is initiated from the perichondrium. In control cases where no graft covered the defect no cartilage was found.


Single layered periosteoplasty in experimental mid-palatal clefts. A histological study in the cat. At the age of 2 months, the mid-palatal suture, with adjacent bone and nasal mucoperiosteum, was resected in 20 domestic cats leaving postoperatively only the oral side of the more than 5 mm wide osseous defect covered with mucoperiosteum. After cessation of general growth this single layered "palatal cleft periosteoplasty" had, an all animals, resulted in the formation of new bone extending from the resection edges, i.e. nearly butting in the midline in about 85% of the cases. Bone bridges interlocking the palatal halves were, as in normal untreated individuals, never observed. In 3 out of 20 other cats where merely an oral mucoperiosteal flap had been elevated and replaced, i.e. a shamoperation without resection of bone or mucoperiosteum, a beginning synostosis of the mid-palatal suture was found. In the remaining 17 cats of this last group and in further 20 unoperated controls, the suture was open even at 2 1/2 years of age. The results seem to indicate that soft tissue trauma inevitable in palatal surgery may interfere with periosteal and sutural integrity. In addition, the findings may render new informations in palatal/maxillary growth following cleft palate periosteoplasty.


Transversal maxillary growth in experimental submucous mid-palatal clefts. A roentgen-cephalometric study in the cat. At the average age of 2 1/2 months the mid-palatal suture and adjacent bone was extirpated in 24 domestic cats resulting in a 5 mm wide submucous cleft in the hard palate. In 16 other animals the corresponding mucoperiosteal flap was elevated and replaced without resection of the suture, i.e. testing the effect of the soft resection of the suture, i.e. testing the effect of the soft tissue trauma implied. Twenty-eight unoperated cats of corresponding age served as controls. The transversal maxillary growth was then studied radiographically by measuring the increase in distance, on cephalograms, between metallic implants inserted into both sides of the hard palate. Up to 50% reduction of transversal growth appeared where the mid-palatal suture had been extirpated. The palatal dimensions of the sham operated- and the unoperated groups did not diverge. The results obtained seem to indicate that growth in the mid-palatal suture is a combination of active growth due to proliferation of the sutural tissue, and passive growth induced by external forces exerting a traction in lateral direction.


A technical and biomechanical comparison between two types of microvascular anastomoses. An experimental study in rats. The microvascular sleeve anastomosis, where one vessel is inserted into the other, was compared with the conventional end to end anastomosis. In an experimental study in rat femoral arteries 42 anastomoses of each kind were examined. Operating time, patency rates, flow rates and strength of the anastomoses were recorded at various postoperative time intervals. It is concluded that the sleeve anastomosis is quicker to perform and that the two types of anastomoses in biomechanical respects are similar. Flow rates are slightly decreased immediately postoperatively in the sleeve anastomosis but this is of a temporary nature.


Columella lengthening in bilateral cleft lip patients. Experience with the forked flap procedure. All patients with bilateral complete clefts of the lip and some patients with incomplete clefts have a short or almost non-existing columella. This is a characteristic deformity which can only be corrected by surgical lengthening of the columella. Among the numerous methods which have been used for this purpose, the forked falp method as described by Millard (1958) has certain advantages: 1. Sufficient donor tissue is available in the lateral parts of the prolabium to produce full lengthening of the columella and adequate projection of the tip of the nose. 2. Most patients with bilateral clefts need secondary correction of the lip scars and a narrowing of the nostrils after the primary operation. Both of these objectives are achieved as a part of the forked flap procedure. 3. Access is gained both to the lip muscles and to the alar cartilages at the tip of the nose. 4. Narrowing of the lip in the upper part results in a natural eversion of the lower part, and a short lip can be lengthened by letting the remaining central part of the prolabium go down during suturing. 5. The scars left in the upper lip are in an unobtrusive position corresponding to the philtral ridges. During the period 1965-77, 87 patients with bilateral cleft lip have had a columella lengthening performed according to the forked flap method. Our experience with this method has been very favourable. No serious complications have ensued, and the cosmetic results have been most satisfactory in the majority of cases.


Sagittal splitting of the mandibular ramus. Electromyography and radiologic follow-up study of temporomandibular joint function in 44 patients. A follow-up study was performed on 44 patients operated with sagittal splitting of the mandibular ramus for correction of a mandibular protrusion. The study included clinical examination, electromyography and masticatory efficiency test as well as radiography of the temporomandibular joint. The maximum opening capacity and protrusion of the mandible decreased one to three years after the operation. The activity of the temporal muscle decreased in rest position after the operation. Masticatory efficiency was unchanged. The position of the condyle in the fossa was unchanged postoperatively, while a posterior and superior condylar movement occurred during the fixation period. Normalization of the condylar position tended to occur one year after the operation. In 37 of 86 condyles, a double contour was seen on the postesuperior margin of the condyle one year after the operation. Possible mechanism behind the development of the new condylar bone layer is discussed.


Sagittal split osteotomy in our experience. A follow-up study of 100 operated patients. Sagittal split osteotomy is a tricky and time-consuming operation but gives excellent mobilization of the mandibular body for the purpose of positional changes. A follow-up study of 100 operated patients up to 3 years and more has demonstrated good and stable occlusion and subjective appraisal of improvement in appearance and bite. Negative effects of the operation are injuries to the inferior avleolar and lingual nerves. We are now of the opinion that sagittal split osteotomy is the method of choice only for correction of mandibular retrusion with or without open bite.


Surgical correction of mandibular prognathism by the oblique sliding osteotomy. A clinical and radiological follow-up study of 112 consecutive cases. The oblique sliding osteotomy has been used for surgical correction of mandibular prognathism, sometimes in combination with open bite, in 112 patients treated from 1969 to 1978. The method has proved to be connected with few surgical complications and minimal relapse tendency. No correlation was found between the degree of posterior positioning or closure of open bite at the operation and relapse tendency. Consequently no limitations in the field of application concerning the degree of mandibular protrusion or open bite have been found in this study.


Implant arthroplasty of the scapho-trapezial joint. Degenerative changes in the scapho-trapezial-trapezoidal (ST) joint may occur as an isolated process or more frequently as a dominant part of pantrapezial degenerative joint affections. In the present study results of surgery on 24 hands with isolated degenerative changes in the ST joint have been assessed. Arthrodesis was previously the sole procedure and has resulted in normal hand function in those cases where bony union was achieved without complications. The ST joint is difficult to fuse, however, and prolonged immobilization implies obvious risks of rigidity and impaired hand function. During the last 5 years a new technique for implant arthroplasty of the ST joint has been tried. The distal articular surface of the scaphoid has been resected and replaced with a heat-molded silicone rubber implant. In the present paper the method is presented and anatomical and technical points and pitfalls are discussed. It is concluded that implant arthroplasty may become a useful method for treatment of isolated ST arthrosis provided that the implant material will tolerate the compressive stress created during pinch.


Hyperaemia induced by topical application of anaesthetic formulations containing ketocaine. The hyperaemia produced by topical application of ketocaine-containing formulations was studied in human skin. The temperature in the hyperaemic area was unchanged or decreased which indicates that the hyperaemia was of a passive type, caused by a reduced flow in the venous side of the capillary bed.


The sleeve anastomosis in clinical microsurgery. Case report. Clinical use of the microvascular sleeve anastomosis in 6 elective free tissue transfers is reported. Arterial and venous anastomoses were performed. It was found that with the exception of the distal anastomosis of a vein graft to artery the sleeve anastomosis was simple and efficient. It was concluded that when the vessels to be anastomosed have suitable length and diameter the sleeve anastomosis may well be used. By its use time and effort can be saved, especially in cases requiring multiple anastomoses.


Labiobuccal mucosal island flap for closure of anterior palatal fistulae. Case report. A method for closure of wide anterior palatal fistulae with a labiobuccal mucosal island flap introduced to the defect along the nasal floor is described. Five operated cases, of which one was a partial failure, are presented. The operations preferable for various types of fistulae are discussed.


Comparison between the in vitro flow dynamics of the standard and the convexo-concave Björk-Shiley tilting disc valve prostheses. In the new convexo-concave model of the Björk-Shiley prosthesis the disc pivots 2.5 mm downstream, creating a space between the disc and the ring when the disc tilts open. Its flow dynamics were compared with those of the standard model under steady flow rates 0--32 1/min of a water-glycerin mixture employed as blood-analogous test fluid. The following results are valid for corresponding sizes of the conventionally used 21, 23, 25, 27, 29 and 31 mm prosthetic valves of the two models. The transprosthetic pressure fall varied directly, but in a parabolic fashion with the steady flow rate for all the partial and full flow orifices. The resistance to flow 0--32 1/min for the full flow orifice of the convexo-concave prosthesis was in average 16% lower than that of the standard model, with highly significant differences for the 21 and 23 mm prostheses (p less than 0.001). There was a redistribution of flow towards the smaller prosthetic opening from 23% (S.D. +/- 1.4) for the standard model to 30% (S.D. +/- 2.4) for the convexo-concave model (p less than 0.001). The minimum steady flow rate required to maintain the convexo-concave disc in completely open position (60 ml/sec) was only half that (37--50%) required for the standard disc (125 ml/sec) (p less than 0.001). Regurgitation through the closed prosthesis varied directly and linearly with the driving pressure and was slightly but definitely lower with the convexo-concave model than with standard model. The main features of the new design are decreased resistance to flow, redistribution of the flow within the prosthesis in order to prevent stasis along its smaller orifice, diminished opening resistance and reduced regurgitation. It is concluded that the flow dynamics of the convexo-concave model Björk-Shiley prosthesis constitute a significant improvement over those of the standard model.


Aortic valve replacement. A randomized study comparing Björk-Shiley and Lillehei-Kaster disc valves. Haematological evaluation. In this study, 79 randomized patients with either Björk-Shiley (B-S) or Lillehei-Kaster (L-K) aortic disc valves were re-admitted two years after operation for clinical, haemodynamic and haematological evaluation. This paper deals in particular with the haematological results. Cine-aortography was carried out in 76 patients and left ventricular catheterization via the transseptal approach was performed in 43 patients. Haemoglobin concentration, erythrocyte count, platlet count, reticulocyte count, plasma haemoglobin concentration, serum bilirubin, serum iron, serum haptoglobin and serum lactate dehydrogenase were studied in the patients. Postoperatively all patients had normal haemoglobin and erythrocyte count. Haptoglobin was absent or reduced in 43% of patients with B-S valves and in 65% of those with L-K valves. Serum lactate dehydrogenase activity (LDH) was abnormally elevated in 26% of patients in the B-S group and in 65% of those in the L-K group. Mean LDH was significantly higher in the L-K group compared with the B-S group (p less than 0.01). A highly significant linear correlation could be demonstrated between mean systolic pressure difference across the valve (delta pm) and LDH (p less than 0.001). This finding helps to explain why the L-K valves provoke more erythrocyte destruction than the B-S valves, since delta pm proved to be significantly higher in the L-K group. LDH was not significantly increased in 6 patients in whom a paravalvular leakage was demonstrated.


Myocardial protection during aortic valve replacement. Selective infusion of cold cardioplegic solution into the left coronary artery. A simple method for hypothermic cardioplegia during aortic valve surgery is described. Cold cardioplegic solution (Ringer's acetate with 16 mEq potassium added) was selectively infused into the left coronary artery after the aorta had been opened. This resulted in an even cooling of the left ventricle with a relatively small amount of cardioplegic solution. Local cooling with "soft ice" was then initiated and the heart isolated from its warmer surroundings with the aid of a specially designed pad of compressed plastic foam. Thus, the left ventricular temperature could be kept below 20 degrees C for more than one hour. One hundred and three (103) patients were operated on with this method during a one-year-period. Only one patient died (1%). There were few early and/or late complications. Postoperative heart function was excellent in 23 patients subjected to a special study. Peak aortic pressure during the first 16 postoperative hours was 130 (+/- 22) mmHg, mean left atrial pressure 12 (+/- 2) mmHg, mean right atrial pressure 10 (+/- 2) mmHg and all patients were in sinus rhythm. There was a brief and limited release of myocardial enzymes postoperatively, indicating slight intra-operative myocardial damage. Apart from the cardioplegic technique, there are certain factors of importance for the efficacy of myocardial protection during aortic valve replacement. Among them may be mentioned avoidance of ventricular fibrillation, gentle reperfusion after release of the aortic cross-clamping, avoidance of left ventricular distension and administration of calcium intravenously before termination of bypass.


Elevated mid-myocardial oxygen tension in the fibrillating heart during cardiopulmonary bypass. Mid-myocardial tissue oxygen tension was measured in the left ventricular wall of the hearts of ten dogs by means of a Silastic tonometer implanted earlier. During cardiopulmonary bypass, myocardial PO2 was significantly higher in a spontaneously fibrillating heart (5.4 +/- 0.9 kPa) than during the initial beating period (3.7 +/- 0.5 kPa) or after defibrillation (4.0 +/- 0.7 kPa). In general, there was a tendency towards increased myocardial blood flow, elevated oxygen uptake and reduced coronary sinus oxygen content during ventricular fibrillation, compared with the situation in the beating heart. Myocardial lactate extraction remained unchanged during the different phases of cardiopulmonary bypass. The increase in mid-myocardial oxygen tension during ventricular fibrillation was probably due to increased total myocardial blood flow and redistribution of regional myocardial circulation. In two additional dogs, ventricular fibrillation resulted in left ventricular distension and a simultaneous fall of myocardial oxygen tension, which indicates the necessity of left ventricular decompression suction in a fibrillating heart during cardiopulmonary bypass.


Effect of aortic valve replacement on the left ventricle. A ciné-angiographic evaluation. Heart catheterization and quantitative left ventricular ciné-angiography data on thirty patients with aortic vlave disease were analyzed pre-operatively and 12 months after insertion of a Björk-Shiley tilting disc valve. The pre-operative and postoperative data were compared and also with a control group of 22 patients with no organic heart disease. According to the functional NYHA classification, 14 patients had improved, 14 were unchanged and 2 had deteriorated. Regurgitation had been totally corrected in 27 patients, and the high or moderate pressure gradient between the left ventricle and aorta had been reduced, but the valve itself caused a gradient of 5 to 35 mmHg. The pre-operatively abnormal pump function, hypertrophy, dilatation and impaired myocardial function had all become markedly more normal. The most obvious changes were an improvement in stroke work relative to end-diastolic volume and myocardial mass (p less than 0.001) and reductions in end-diastolic volume (p less than 0.001), pump power (p less than 0.001) and myocardial mass (p less than 0.001). Aortic valve replacement seems to be an appropriate procedure in cases where the left ventricular performance and haemodynamics are sufficiently disturbed.


Thrombotic obstruction of the Björk-Shiley aortic valve prosthesis. Report of four cases. We present four cases of late thrombotic obstruction of the Björk-Shiley aortic valve prosthesis. The incidence of this complication reported in the literature to vary from 0.7% to 5%. In our experience of a total of 623 Björk-Shiley aortic valve replacements, we observed this complication in only 4 patients (0.6%). Two of them had poorly controlled anticoagulation therapy. The clinical presentation was subacute in all four patients. Surgical treatment, thrombectomy and debridement, was performed in all of them. The diagnosis was made upon abrupt and progressive onset of dyspnoea, physical examination data and echocardiographic and radioscopic findings. Angiocardiographic studies were needed in two patients.


Rupture of the inferior vena cava during open-heart surgery. Aetiology and surgical management. Bleeding during open-heart surgery is a not unusual complication. Rupture of the inferior vena cava during dissection of the heart from adhesions from a previous operation for mitral disease or congenital palliative surgery is a serious and sometimes fatal complication. Its treatment is a challenge even to the most experienced heart surgeon. In two of our three patients, vena cava rupture occurred during open-heart surgery for correction of mitral and aortic valvular disease. In one patient, congenital infundibular stricture of the right ventricle, associated with tricuspid valve insufficiency, was present. In this report, some relevant data were presented from each case and the aetiology of the rupture is discussed.


Retrograde (atrial) dislodgement of a Cross-Jones mitral valve occluder. Fatal atrial dislodgement of a lenticular disc occurred seven years after surgery in a 54-year-old patient, who had had a mitral valve replacement with a Cross-Jones prosthesis, for ruptured chordae tendinae. A marked distortion of the titanium ring reinforced silicone rubber lens disc due to material wear was the cause of this complication. From the literature available to us, atrial dislodgement of a prosthetic mitral occluder has not been previously recorded. We therefore intend to recommend elective replacement of the Cross-Jones prosthesis in all patients who have had their artificial valve functioning for more than five years.


DC-conversion of atrial fibrillation after mitral valve operation. An analysis of the long-term results. In a prospective study comprising 43 patients with atrial fibrillation after mitral valve surgery, an evaluation was made of the prognostic significance of clinical, radiological, haemodynamic and operative factors for the maintenance of sinus rhythm after DC-conversion. Atrial fibrillation with a duration of less than 12 months proved to be the only single factor of significance for sustained sinus rhythm after 12 months and it is suggested as a simple clinical criterion for selection of patients for DC-conversion after mitral valve operation.


Liver drug metabolism in patients undergoing open-heart surgery. The effect of open-heart surgery on the drug metabolism of the liver was investigated in 17 patients by using the rate of antipyrine elimination as an index. A correlation was found between the pre-operative heart size and the antipyrine elimination rate. In patients with a markedly dilated heart, the plasma antipyrine half-life was prolonged and apparent clearance significantly impaired. Immediately postoperatively, antipyrine elimination was impaired in all patients. Later, the drug metabolism improved in patients with atrial septal defect, changed temporarily in patients with aortic valve replacement, and remained unchanged in patients with mitral valve replacement. The results indicate that adaptive changes in drug metabolizing capacity occur in patients undergoing cardiac surgery. The changes are related to the type of lesion corrected, the pre-operative functional capacity of the liver, and the time lapse after surgery.


Postpericardiotomy syndrome diagnosed by echocardiography. In order to evaluate the present incidence of post-pericardiotomy syndrome (PPS) and the reliability of conventional diagnostic methods in its detection, 194 consecutive patients were studied by echocardiography one month after cardiac surgery and thereafter every third month up to one year, and also during hospitalization if symptoms or signs of PPS appeared. PPS was diagnosed on the basis of pericardial effusion demonstrated by echocardiography and was found in 15 patients (8%) 7-142 days (mean 44 days) after operation. Four of these patients (27%) were without symptoms. In 7 patients (47%) there were no diagnostic signs on the electrocardiogram and the chest X-ray and in 6 of those patients the pericardial friction rub was missing. Hence in 40% of the patients echocardiography was the only way to make correct diagnosis. In the investigation of a patient with chest pain and/or fever after cardiac surgery, echocardiography seems very useful since the conventional electrocardiogram and the chest X-ray are often unreliable because of the changes caused by the cardiac surgery per se.


Surgical correction of subclavian steal syndrome. Eleven patients with subclavian steal syndrome underwent surgical correction without mortality. Ten patients were relieved from their symptoms. Two vessels reoccluded, two months and three years postoperatively, with reappearance of symptoms. One patient was hemiplegic after the operation. Associated lesions of other precerebral vessels were found in 7 patients, and surgical correction of two or three stenosed or occluded arteries was performed in 5 of them. Satisfactory and complete preoperative angiographic study of all precerebral vessels is therefore important. In 4 patients studied, the vertebral artery flow changed from a mean retrograde flow of 91 ml/min to a mean forward flow of 64 ml/min.


Surgical experience with simultaneous bilateral carotid endarterectomies. Eighty patients who had undergone bilateral carotid endarterectomy at the same operation were reviewed. All operative procedures were performed under general anaesthesia and during systemic heparinization and in all but six cases by using internal shunt. There were three deaths related to the operation representing 3.8% hospital mortality. Transient neurological deficits were noted in four patients (5% incidence) and permanent neurological deficits in four patients (also 5% incidence). A 100% late follow-up after an average period of 48 months revealed that 85.7% of the long-term survivors were functionally normal or improved. There were ten late deaths with heart disease accounting for 50% and stroke 30%.