Faster-flow enema equipment.

Faster-flow enema equipment. The author describes a new 127-mm (1/2-inch) bore disposable plastic enema system for administration of the viscous barium used in double-contrast colon examinations. The larger internal diameter permits simple, rapid instillation and drainage of the suspension. Faster flow in and out results in less discomfort to the patient, especially the old and handicapped, and also saves time for the patient, technician, and physician.


A simple method of barium administration for double-contrast enemas. The authors describe a simple and rapid method of administering the high-density barium used in double-contrast examinations of the colon. The use of 60-ml syringes permits better placement, control of the proper amount, and removal of excess barium from the rectum.


Balloon occlusion of the renal artery using contrast material instead of air. Occlusion of the ipsilateral renal artery prior to nephrectomy is facilitated by substituting contrast material for air in the balloon of the Swan-Ganz catheter. The higher specific gravity of the contrast medium causes the balloon to settle in the bloodstream instead of floating in it, permitting it to be carried rapidly into the renal artery.


Use of the Seldinger technique in sialography. The authors describe a modified Seldinger Technique for sialography which is especially helpful in cannulization of the submandibular ducts. This procedure was successful in 2. of 30 patients tested.


Use of a 5 French catheter with multiple side holes in abdominal aortography. The authors describe a simple technique of abdominal aortography using a 5 French catheter with multiple side holes. Bursting points for catheters of varying lengths and numbers of side holes are given.


Light sources as a means of reproducing patient positioning. A simple method to insure the reproducibility of patient positioning is described. The system uses an adjustable frame fastened to the camera head and two light sources. The light sources project two circles of light on the patient. These reference points are marked on the patient's skin with a felt pen. If the patient moves or requires a follow-up study, these two reference points can be used to reposition the patient exactly. Comparison of the light-sources method with the persistence-scope method showed a significant improvement in accuracy with the former.


Tomogram degradation due to eye shielding and collimation. Phantom-image, line-pair resolution and anterior eye exposure have been measured to determine the optimum collimation and eye shielding for petrous temporal tomography. Small round collimation and 0.5-1.0-mm lead equivalent eye shields are recommended. This reduces eye exposure to 10% of the usual dose without changing line-pair resolution.


Kidney cassettes for intraoperative radiography. A miniature vacuum cassette, contoured to conform to the kidney, has been used successfully in the operating room to visualize intraparenchymal calculi fragments. A low-dose technique using a single-emulsion film and high-definition intensifying screens has been developed. A vacuum system assures good screen-film contact. The vacuum cassette can be sterilized and reused.


Body computed tomography: a clinically important and efficacious radiologic procedure. In the institutions represented by the authors, more than 7,500 body CT examinations have been performed. Body CT has been found to be particularly useful in solving specific problems, especially when other diagnostic procedures yield confusiing results. Radiologists and their collegues, and not governmental agencies and insurance companies, should define the experimental, research and clinical usefulness of computed tomography.


Loculated pneumoperitoneum simulating gas in the bowel wall. The radiographic appearance of intramural bowel gas can be simulated by extraserosal gas bubbles loculated within adhesions.


Torsion of the wandering spleen seen as a migratory abdominal mass. Torsion of the wandering spleen is an unusual cause of an acute abdomen, rarely diagnosed preoperatively. The authors describe a case which was suspected prior to surgery and confirmed by radionuclide imaging. Radiographic findings include an extrinsic mass on barium-enema examination and absence of the splenic shadow in the left upper quadrant.


Pancreatic pseudocyst of the mediastinum. The mediassinum is a relatively uncommon site for a pancreatic pseudocyst. Two such cases are presented, along with a review of 14 additional cases from the English literature. In most cases the pseudocyst is located in the posterior mediastinum, with entry to the mediastinum via the aortic or esophageal hiatus. The most common presenting symptoms are chest or abdominal pain and dyspnea. Displacement of the esophagus and stomach anteriorly and to the left on the upper gastrointestinal series and an associated mediastinal mass are the most helpful radiographic manifestations.


Paradoxical embolism in morbidly obese persons. Three cases of paradoxical embolism are reported in patients with morbid obesity. Early consideration of the possibility of paradoxical embolism allows the appropriate therapy to be instituted without delay. It appears that these patients are at increased risk for both pulmonary emboli and paradoxical emboli. The necessity of early diagnosis in the pathophysiology of paradoxical embolism is discussed.


Direct radiographic magnification for skeletal radiology. An assessment of image quality and clinical application. Recent advances in technology have made radiographic magnification of the skeleton clinically feasible. A new electron gun micro-focal tube combined with new high-resolution recording systems were used to perform magnification radiography which was then compared with conventional contact radiography. Quantitative evaluation included measurements of speed, contrast, resolution, and noise. Qualitative evaluation included an analysis of 215 clinical cases in which both techniques were used. The superior image quality of direct radiographic magnification is confirmed and the clinical areas in which it proved most helpful are defined.


Osteolysis of the clavicular tip associated with repeated minor trauma to the shoulder. Osteolysis of the acromial end of the clavicle was seen in a 30-year-old man who had played a great deal of handball and softball, apparently as the result of repeated stress to the acromioclavicular articulation. Such osteolysis appears to be self-limited and requires no specific therapy other than rest of the affected area.


The sesamoid bones of the hands and feet: participators in arthritis. The sesamoids generally appear as small ovoid bones adjacent to articulations or at sites where tendons are angled about osseous surfaces. At either location they participate in joint afflictions, the pattern of abnormality being remarkably constant and predictable. Sesamoids may demonstrate osseous erosion in rheumatoid arthritis, bony proliferation or "whiskering" in rheumatoid variants, joint space narrowing and bony ankylosis in septic arthritis, and eburnation and osteophyte formation in osteoarthritis and diffuse idiopathic skeletal hyperostosis. These changes become particularly important when they occur in the absence of significant adjacent articular disease. In these instances, recognition of sesamoid abnormalities allows accurate radiographic diagnosis.


Single view negative mode xeromammography: an approach to reduce radiation exposure in breast cancer screening. With the increasing use of xeromammography in mass screening for breast cancer, the potential risk to women from repeated exposure to low energy ionizing radiation must be weighed against the benefit of early detection of breast cancer. Although xeromammography allows detection of 80-90% of breast cancers before metastases occur, the radiation hazard from repeated xeromammographic screening must be considered and attempts made to reduce radiation exposure. The dose from xeromammography can be reduced by greater than one half with the single mediolateral view, negative mode imaging technique. Moreover, no reduction of diagnostic accuracy of xeromammography in early detection of breast cancer was found with this technique.


Computed tomography of porencephaly and other cerebrospinal fluid-containing lesions. The EMI head scanner was used to review a large number of cases of porencephaly; computed tomographic scanning was found to be the most satisfactory method of evaluating these lesions. The nuclide brain scan has not usually been of significant value for diagnosis, and although angiography and pneumoencephalography were used for correlation in some cases, the CT scan is often the only neuroradiological procedure necessary to achieve the correct diagnosis. Porencephalic areas usually have a well-defined border, have the density of cerebrospinal fluid, and do not change in density following the use of contrast medium enhancement.


Detection of subarachnoid blood clot and other thin, flat structures by computed tomography. Eight cases of subarachnoid hemorrhages are reported to illustrate the ability of CT to demonstrate thin, flat collections of subarachnoid blood clots and the importance of CT in localization of the bleeding site, especially in cases of multiple aneurysms. The major factors in the detection of these lesions are discussed on the basis of partial volume phenomenon.


Computed tomography in the evaluation of intracranial aneurysms and subarachnoid hemorrhage. Computed tomography (CT) is a reliable technique for examining patients with subarachnoid hemorrhage and intracranial aneurysms. Extravasated blood is easily recognized and the location of the ruptured aneurysm may frequently be predicted by its distribution into the subarachnoid spaces and brain parenchyma. CT alleviates the need for repeat angiography while following the patient's clinical evolution since it clearly shows rebleed, edema follwoing vasospasm, and hydrocephalus.


Aperistalsis and esophagitis.

Aperistalsis and esophagitis. Aperistalsis of the esophagus was demonstrated in six patients with esophagitis. This was observed in reflux, caustic, and infectious esophagitis, and has occurred both as a transient phenomenon with no further sequelae, and as the initial manifestation of involvement in patients who subsequently suffered stricture. Based on biopsy and autopsy specimens in two cases, a possible mechanism of aperistalsis related to the damage to neurons in Auerbach's plexus is postulated. The presence of aperistalsis has been the first significant clue to esophageal inflammation in several cases.


Computed tomography in lead encephalopathy: a case report. The computed tomographic findings in a patient with lead encephalopathy are described. The predominantly unilateral abnormalities and the clinical history were suggestive of a cerebral tumor.


Diagnosis of descending transtentorial herniation by cranial computed tomography. Descending transtentorial herniartion (DTH) secondary to a supratentorial mass effect can be detected by CT. Early signs of uncal herniation include encroachment on the suprasellar cistern, displacement of the brain stem, enlargement of the ipsilateral crural subarachnoid space, and compression of the contralateral cerebral peduncle. Increasingly severe combined uncal and hippocampal DTH results in progressive obliteration of the suprasellar and interpeduncular cisterns, elongation or compression of the brain stem, and inferior or posterior displacement of the basilar artery.


Genetics and cancer of the gastrointestinal system. Annual oration in honor of Herbert M. Stauffer, M.D., 1914-1970. Familial aggregations of tumors may occur in virtually all organ systems. The gastrointestinal tract is a frequent site for the development of cancers having an hereditary basis. Their recognition has important relevance to cancer control and prevention. In addition, detailed clinical and laboratory studies of inherited tumors may throw light upon the cause of the more common forms of gastrointestinal neoplasms. Radiologists must have a working knowledge of the genetic and diagnostic elements of each in order to fulfill their responsibilities to the patient, the patient's family and the referring physician.


Unilateral diffuse lung opacity; Differential diagnosis with emphasis on lymphangitic spread of cancer. One hundred adults with unilateral diffuse lung opacity have been studied. Seventy cases involve the right lung. Lymphangitic cancer, pneumonia, pulmonary edema, aspiration, and radiation injury account for the majority of cases (90%). Unilateral pulmonary edema is usually right sided, and, frequently, the heart is not enlarged. Unilateral lymphangitic spread of cancer is usually right sided and most often due to a primary lesion in the involved lung. Occasionally a cancer outside the lung may spread unilaterally.


The shifting granuloma: an internal marker of atelectasis. Many patients carry internal markers of pulmonary parenchymal anatomy: calcified granulomas. When such granulomas are present, their movement is a direct sign of significant parenchymal collapse.


Metastatic melanoma. Another cause of a solitary pulmonary nodule with an air bronchogram. Distinct air bronchograms were seen in a solitary pulmonary nodule, a metastasis from a malignant melanoma of the scalp. Such a finding has been reported previously only in alveolar-cell carcinoma, pulmonary lymphoma, and pulmonary pseudolymphoma.


An unusual manifestation of esophageal moniliasis. Report of two cases. Most previous reports of esophageal moniliasis have described diffuse changes in the esophagus. The authors describe two cases involving a localized polypoid lesion in the esophagus in patients with Candida infection. The pathogenesis is discussed.


Complete esophageal obstruction from cricopharyngeal achalasia. A patient with complete esophageal obstruction from cricopharyngeal achalasia in whom adequate cricopharyngeal myotomy failed to alleviate the dysphagia is described. The importance of pre-operative radiological evaluation of patients with neurologically related dysphagia is discussed, specifically, the degree of obstruction, range of tongue movement, and presence of aspiration. These factors have a predictive value in assessing the benefits of planned cricopharyngeal myotomy.


The spectrum of radiographic features of aberrant pancreatic rests involving the stomach. The radiographic features of 20 cases of pathologically confirmed heterotopic pancreatic rests involving the stomach were analyzed. Aberrant pancreatic tissue in the stomach produces a broader spectrum of radiographic findings than had been thought. The mass produced by the aberrant tissue is often larger and more sessile than usually anticipated, and may simulate a mural neoplasm or adenomatous polyp. While most cases occur in the distal antrum or prepyloric area, some occur in the more proximal portion of the antrum. Less than half of the cases in this series included the finding of a small central niche. When a niche was present, it was often large in relation to the mass, and simulated a gastric ulcer or ulcerating neoplasm.


Angiographic diagnosis of intrinsic duodenal inflammatory disease. Duodenal tumors are rare but duodenal inflammatory disease occurs frequently. In most cases it can be accurately diagnosed without angiography but in the occasional case that presents a diagnostic problem, angiography is required. Seven cases of duodenal inflammatory disease are reviewed. Careful attention to the shape and direction of vascular displacement and to separate evaluation of pancreatic and duodenal arteries accurately distinguished duodenal from pancreatic disease. This distinction can significantly influence subsequent therapy.


Barium studies in small-bowel infarction. Radiological-pathological correlation. Seven patients with proved small-bowel infarction were studied to determine whether the radiographic appearance of an ischemic segment is helpful in predicting the severity of the process, in particular the potential viability or nonviability of the affected bowel. It was found that the barium examination is useful in detecting small-bowel infarction in clinically obscure cases but is unreliable in predicting the depth of necrosis or potential viability of an ischemic segment. In addition, the longitudinal extent of ischemic damage was underestimated using the radiographic findings and there was poor correlation between the transit time of barium and the severity of bowel-wall damage.


The natural history of pneumatosis coli. Four cases of primary pneumatosis coli which exhibit a changing pattern of severity and distribution including cure without therapy are described. No previous similar cases with radiographic correlation have been found by the author in the literature. The pathogenesis of pneumatosis coli is discussed and the literature is reviewed.


The paradoxical halo sign in hepatic pseudotumor. The "halo sign" in hepatic angiography is considered a reliable sign of an intrahepatic mass. A large retroperitoneal mass may present as an hepatic tumor clinically; two such cases are presented in which the halo sign was demonstrated by hepatic angiography. When this "paradoxical" halo sign is present, several factors contribute to the diagnosis of an extra-hepatic mass: (a) minimal stretching or displacement of the hepatic artery or portal vein; (b) lack of draping of the hepatic arteries around the mass; and (c) identification of abnormal vessels or a mass in an adjacent organ.


Percutaneous fine needle aspiration biopsy of pancreatic and other abdominal masses. Percutaneous fine needle aspiration biopsy of 18 patients with pancreatic masses, and 19 with other intra-abdominal tumors, showed it to be a safe, accurate procedure. A diagnostic biopsy yield was obtained in over 85% of the cases without clinical complications. Indications for fine needle biopsy are: (a) to avoid surgery by obtaining a histologic diagnosis; (b) to determine the staging of a neoplastic disease process; and (c) to facilitate treatment planning. The technique of "skinny needle" biopsy is discussed.


The importance of temperature in angiography of the hand. Angiograms of the hand of a normal volunteer taken at skin temperatures ranging from 22 to 33 degrees C revealed that visualization of the arteries was highly dependent on the temperature. Lower temperatures produced vasospasm beginning in the smaller vessels and proportionally involving medium-sized and major arteries. Moderate warming led to optimum filling and is recommended prior to angiography of the hand. Prior injection of contrast material caused no perceptible change in the filling or appearance of the arteries.


Chondrolysis following slipped capital femoral epiphysis. Chondrolysis of the hip following slipped capital femoral epiphysis (SCFE) is reviewed and 3 cases are presented. The roentgenographic findings and early symptoms may serve to warn the radiologist and clinician of the onset of chondrolysis. Chondrolysis without SCFE is rare. Unfortunately the etiology is not well understood, and often the clinical course cannot be altered.


Effect of evaporative surface cooling on thermographic assessment of burn depth. Differences in surface temperature between evaporating and nonevaporating, partial- and full-thickness burn injuries were studied in 20 male, white guinea pigs. Evaporative cooling can disguise the temperature differential of the partial-thickness injury and lead to a false full-thickness diagnosis. A full-thickness burn with blister intact may retain enough heat to result in a false partial-thickness diagnosis. By the fourth postburn day, formation of a dry eschar may allow a surface temperature measurement without the complication of differential evaporation. For earlier use of thermographic information, evaporation effects must be accounted for or eliminated.


Diatrizoate absorption from enemas in newborn puppies. Serum iodine levels increased slightly 15 min. after Gastrografin enemas were given to 20 healthy neonatal puppies. The systemic dehydration which occurs in the neonate following an hypertonic enema primarily reflects an osmotic drawing of water into the bowel, although systemic absorption of diatrizoate through the intact gut wall enhances the alteration in serum osmolarity.


Quantitative aspects of computed tomography of the blood and cerebrospinal fluid. Computed tomographic (CT) scans of fresh and coagulated blood in vitro as well as calcium and iron solutions demonstrate that the increased absorption seen in hematomas is primarily a reflection of hemoconcentration: calcium plays essentially no role in this increased absorption, while iron makes a minimal contribution. In vitro studies of cerebrospinal fluid (CSF) indicate that CT scanning is insensitive to pathological elevations of CSF protein.


Evaluation of head trauma by computed tomography. A wide spectrum of traumatic abnormalities has been demonstrated by computed tomography. CT findings in acute trauma range from cerebral edema and contusion to intracerebral or extracerebral hematoma, subarachnoid and intraventricular hemorrhage and varying combinations thereof. Late traumatic changes shown by CT include chronic subdural hygroma, post-traumatic infarct, and porencephaly and hydrocephalus. The latter findings are indistinguishable from changes resulting from degenerative or ischemic brain disease. Follow-up CT scanning elucidates the natural course of various traumatic lesions. Occasionally, it may uncover occult, delayed sequelae which can be remedied surgically before irreparable brain damage occurs.


Computed tomography of spinal cord arteriovenous malformations. Computed tomography (CT) of the spine after intravenous contrast enhancement has been used in 4 patients with arteriovenous malformation (AVM) of the spinal cord. The enlarged, contrast-filled vessels constituting the malformation are visualized on CT scans. There was good correspondence between CT and selective angiography. CT may be a useful screening and follow-up method for AVM of the spinal cord and a safe procedure for assessing the results of therapy.


Early experience with the Varian Six Second body scanner in the diagnosis of hepatobiliary tract disease. Thirty-four patients with liver disease were studied with a research model of the Varian Six Second body scanner. Useful information was gained in patients with a variety of hepatic disorders. This scanner permits resolution of normal hepatic parenchymal detail which has not been reported previously and has reduced the streak artifacts originating from high- and low-CT objects which have been a major source of image degradation with other units.


An off-line image processing system for digital display in computed tomography. Early clinical application of an off-line image processing and analysis system for digital display in conjunction with computed tomography is described. The system consists of three operational subsystems: (a) a flexible disk for digital storage of absorption values in each of eight or more tomographic planes; (b) a high-speed interactive video system which displays the tomographic plane in correct geometry with the absorption values, which serve as the pictorial elements; and (c) a paper hard copy of the absorption values in a simulated gray-tone image of the tomographic plane in which the numerical values are the pictorial elements. Both the video and paper displays provide explicit numerical values of x-ray attenuation for each location on the tomographic plane in an image which combines analog and digital qualities.


Visualization of the thyroid gland with computed tomography. Computed tomography of the neck will demonstrate the thyroid gland particularly well after contrast enhancement. Lucent nodules within the thyroid can be demonstrated, but the attenuation numbers are not reliable enough to distinguish cystic from solid lesions with current techniques because of partial volume effects and motion artifacts.


Normal ocular circulation and the effect of arterial occlusive disorders. Arterial occlusive disease, either primary or secondary, may not only affect the appearance of the ophthalmic artery, posterior ciliary arteries, and choroid crescent, but may be reflected in the prolongation of the circulation time to the choroid crescent. Choroid circulation time determined in 80 normal carotid angiograms showed that a value greater than 4.5 sec. for a population under 30 years of age, and greater than 5.6 sec. for a population 30 years of age and older, is prolonged. One should view these studies with suspicion and search for intra-orbital, intracranial, or extracranial arterial occlusive disease.


Prognosis in meningioma through evaluation of skull bone patterns. Sixty-three cases of meningioma were selected for study. Radiologically, they were divided into blastic and cystic groups. Tumors producing more blastic patterns infrequently recurred, unlike those that contained a lytic factor. The cases were also analyzed in regard to histologic type, but no relationship was found between histologic type and recurrence.


Double diastematomyelia.

Double diastematomyelia. Double diastematomyelia was diagnosed in a 23-year-old woman. The spurs occurred at T2 and L3. To the authors' knowledge, such a wide separation of double spurs has not been reported previously and the high position of the T2 spur is rare.


Comparative evaluation of 99mTc GH, 99mTcO4, and 99mTc DTPA as brain imaging agents. The brain imaging properties of 99mTc glucoheptonate, 99mTc pertechnetate, and 99mTc DPTA are compared. Results demonstrate that optimum images are obtained at 90, 180, and 180 min., for 99mTc GH, 99mTc DTPA, and 99mTc perterchnetate, respectively. The former two images are not affected by prior bone imaging with 99mTc pyrophosphate, while 99mTc pertechnetate images are adversely affected. 99mTc glucoheptonate appears to be the superior agent for brain imaging, followed by 99mTc DTPA and 99mTc pertechnetate.


Cerebrovascular disease in childhood.

Cerebrovascular disease in childhood. Cerebrovascular disease was reviewed in 92 suspected or proved pediatric cases. In addition to the classical adult patterns of the disease, a separate group of patterns occurs in children and infants who suffer a severe transient episode of cerebral hypoxemia. The patterns in the newborn are periventricular increase, laminar cortical necrosis, watershed infarct, rapidly clearing infarct, and diffuse increase. Bilateral extensive patterns correlate well with an ensuing generalized neurological deficit, and localized patterns with a focal deficit. The mixed and diffuse patterns were found to be the most common.


Incidental detection of a horseshoe kidney on radionuclide bone images. An unusual configuration of radioactivity was seen within the abdomen on a routine anterior bone study. Retrograde pyelography confirmed the nuclear diagnosis of horseshoe kidney.


Brain scanning in unilateral and bilateral occlusion of the posterior cerebral arteries. Nineteen patients with unequivocal angiographic evidence of unilateral or bilateral posterior cerebral artery occulsion were scanned during the acute phase of the stroke. In 12 of them an abnormal accumulation of radioactivity was apparent on the posterior view, but only 2 also exhibited abnormal uptake on the corresponding lateral view. The size, shape, and location of the uptake were rather constant and appeared to be almost independent of the site of occlusion and also of a collateral circulation by meningeal anastomoses. Pathological uptake was found with increasing frequency as occlusion occurred farther distally.


A real clinical indication for selective spleen scrintigraphy with 99mTc-labeled red blood cells. Demonstration of the exact visceral situs in ambiguous conditions such as asplenic syndrome may be impossible with routine investigations. In our patient the correct diagnosis was made possible by selective spleen scintigraphy.


Mesodiverticular band.

Mesodiverticular band. The mesodiverticular band is an embryologic remnant of the vitelline circulation which carries the arterial supply to the Meckel's diverticulum. In the event of an error of involution, a patent or nonpatent arterial band persists and extends from the mesentery to the apex of the antimesenteric diverticulum. This creates a snare-like opening through which bowel loops may herinate and become obstruced. Clinical and radiological findings of acute, low, small-bowel obstruction are produced by this band.


Prospective analysis of bone changes in treated childhood leukemia. Serial knee radiographs were obtained from 58 children with leukemia. Leukemic bone changes were found in approximately half of those radiographed at the time of diagnosis but were consistently absent in children older than 10 years. The bone abnormalities persisted for as long as 10 months after treatment was started and did not occur or reappear at the time of relapse. Dense metaphyses simulating the appearance of lead poisoning developed in 20 of 58 patients during chemotherapy.


Congenital syphilis with syphilitic arthritis. Radiological quiz. The authors report a case of congenital syphilis with involvement of a joint space and adjacent bony surfaces in a newborn infant. Although similar findings have been reported in older children, this appears to be the first such case in a newborn.


Ultrasonography of the normal pancreas. Success rate and criteria for normality. Study of 135 ultrasonograms shows that it is possible to display the normal pancreas with 82% success. The pancreatic head ranges between 11 and 30/mm/in thickness, the isthmus 4-21 mm in thickness, and the corporeo-caudate area 24-32 mm in thickness. The pancreas may have a sausage, dumb-bell, or tadpole shape. Variance from these outlines and thicknesses should be considered pathological.


Ultrasonography in obstructive jaundice. The usefulness of ultrasonography in the preliminary evaluation of obstructive jaundice is described in 35 consecutive patients with icterus. Diagnosis was substantiated by laparotomy, autopsy, or liver biopsy. In 23 patients with dilated bile ducts at ultrasonography, obstruction by tumor, stone, or stricture was proven operatively. Obstructive jaundice was differentiated from hepatocellular jaundice in 86% of cases; the site of obstruction was noted to be correct in 85%. The accuracy in the diagnosis of obstructive jaundice was 100% in patients with moderate or severe icterus.


Echocardiography of double outlet right ventricle: new diagnostic criteria. A thick band of muscular tissue interposed between the posterior aortic wall and the anterior leaflet of the mitral valve could be indentified on M-mode sweeps of 3 patients with double outlet right ventricle. A discrete subaortic crista supraventricularis, continuous with the anterior wall of the right ventricle, could also be identified. These signs are specific for double outlet right ventricle and are not present in other anomalies of the heart.


Radiation risks with diagnostic x-rays.

Radiation risks with diagnostic x-rays. Calculations are presented which correlate the risk of carcinogenesis with various diagnostic radiological procedures. Even though "worst case" conditions are assumed, such as a linear non-threshold dose-response relationship, most of the radiographic procedures appeared to be quite conservative in terms of carcinogenic risk. This was not true, however, for mammography of younger women.


Physical, performance, and dosimetric characteristics of the delta-Scan 50 whole-body/brain scanner. The delta-Scan 50 computed tomographic (CT) scanner has the ability to determine x-ray attenuation coefficients with a precision ranging from 0.3 to 2.6% depending upon such factors as patient size and scan diameter. Resolution is 20-80% greater than the pixel width, with values ranging from 1.2 to 2.1 mm. The collimating system determines certain characteristics of the image and affects the dose to the patient: doses for typical procedures are on the order of 1 rad, and gonadal doses are in the millirad range. Potential improvements are discussed.


Hyperthermic effects on DNA repair mechanisms. Studies have been carried out using neutral and alkaline sucrose density gradients to investigate the effect of 41 degree-43 degree C on the ability of Chinese hamster ovary cells to repair single (SSB) and double stranded DNA breaks (DSB) caused by exposure to ionizing radiation. The authors found that when hyperthermia exists prior to irradiation significant inhibition occurs. The data support the conclusion that unrepaired DNA damage may be lethal to the cell. Though no increase in radiation-induced DSB frequency was observed subsequent to hyperthermia, a 10-20% increase in SSB frequency was observed.


Thermal tolerance and repair of thermal damage by cultured cells. Exposure of hamster cells to 42.5 degrees C for long periods leads to the development of thermal tolerance; the slope of the survival curve become shallower after about 3.5 to 4 hours. If two 4-hour exposures at 42.5 degrees C are separated by various periods of time, thermal tolerance is eliminated by 20 hours. Prolonged exposure at 42.5 degrees C offers considerable protection from subsequent treatments to acute hyperthermia at 45 degrees C indicate or in conditioned medium or balanced salt solution failed to reveal any evidence of repair of potentially lethal damage.


Aspiration biopsy of discrete pulmonary lesions using a new thin needle. Results in the first 100 cases. The authors describe their initial experience with a new thin spinal-type needle for aspiration biopsy of the lung. One hundred patients with discrete pulmonary lesions were studied. Diagnosis was possible in 87% of cases, and no significant complications were encountered.


An aid to computerization of Heyman's afterloading system. The authors describe a new type of dummy implant for use in the Heyman afterloading system. Inactive dummies with the same dimensions as the radioactive sources are loaded into the capsules before obtaining the orthogonal radiographs. The actual sources are not inserted until computer verification of satisfactory dose distribution has been obtained.


Does the "missed" radiographic diagnosis constitute malpractice? Recent studies confirm that radiologists disagree as often as 50% of the time and that as many as 30% of pathological findings are "missed." Legally, "simple" errors are not considered to constitute malpractice, but "negligent" errors are; yet there are no practical guidelines to help the courts or the medical profession distinguish between the two. A practical "standard of radiological practice" must be developed, possibly by the various radiological societies, so that the courts may more easily distinguish true negligence from "simple" errors. It is also suggested that review panels be organized to render a medical opinion as to whether or not they conform to standard radiological practice.


Electron capture gas chromatographic detection of thromboxane B2. An electron capture gas chromatographic method is described for the detection of thromboxane B2. Thromboxane B2 is esterified with diazomethane, followed by treatment with pentafluorobenzylhydroxylamine hydrochloride and silylation with BSA. In pyridine, the free aldehyde form of the acetal ring is favored allowing rapid formation of a novel thromboxane B2 pentafluorobenzyloxime. The method has been applied to detect thromboxane B2 formation during aggregation of washed platelets. It must be emphasized that by ordinary analytical standards, the derivatization reproducibility from 50-375 nanograms is poor (+/- 11% - +/- 42%); however, the improved selectivity of the method and its ability to detect nanogram levels of thromboxane B2 make it a useful complement to commonly employed bioassay techniques.


Analogs of endoperoxide precursors of prostaglandins: failure to affect body temperature when injected into primary and secondary central temperature controls. It is known that central administration of prostaglandins of the E series has marked effects on body temperature. The purpose in the present experiments was to learn whether stable analogs of the cyclic endoperoxide precursors of PGE2, PGF2alpha and PGD2, injected into the primary temperature control in the preoptic/anterior (PO/AH) hypothalamic region and into a presumed secondary control in the medulla oblongata, can produce rises in body temperature similar to those caused by PGE2. Injection of the analogs U-44069 and U-46619 (1.0 and 2.0 microng) into the PO/AH region of the rat, where both PGE2 and PGE1 caused hyperthermia, had no effect on Tre. Likewise, injections into the medulla oblongata, in the region where PGE2 and PGE1 caused hypothermia, were ineffective in altering body temperature. That neurons important to the control of body temperature are selectively sensitive to PGE2 and not to analogs of prostaglandin precursors suggests that local cyclic endoperoxides can influence body temperature only through bioconversion to prostaglandin.


Ductus arteriosus responses to prostaglandin E1 at high and low oxygen concentrations. It previously has been suggested that prostaglandin E1 (PGE1) relaxes the ductus arteriosus in a low but not in an elevated oxygen environment. However, in the experiments reported here PGE1 relaxed rings on fetal lamb ductus arteriosus in vitro at both low (14 to 20 torr) and high (680 to 720 torr) oxygen tensions. The threshold concentration for PGE1 was 10(-10) M in either PO2 and the ED50's of PGE1 relaxation in high and low oxygen were 8.5 +/- 3.4 x 10(-10) M and 5.5 +/- 0.7 x 10(-10) M respectively. The magnitude of the relaxation was greater for the oxygen contracted ductus arteriosus than for that exposed to low oxygen. It is suggested that earlier reports of the lack of response of the ductus arteriosus to PGE1 in a high oxygen environment following relaxation in a low oxygen environment may be related to loss of response of the ductus arteriosus to repeated doses of PGE1 rather than to differences in PO2. Prostaglandin E1 therefore may play a significant role in the regulation of ductus arteriosus tone in the elevated oxygen environment of the newborn as well as the low oxygen environment of the fetus.


Biosynthesis of prostaglandin D2. 1. Formation of prostaglandin D2 by human platelets. Formation of prostaglandin D2 (PGD2) during the aggregation of platelets was determined, employing a specific bioassay. PGD2 was synthesized in human platelet rich plasma (PRP) in response to thrombin, collagen and epinephrine. Indomethacin pretreatment abolished the biosynthesis of PGD2. When thrombin treated PRP was incubated for different periods of time and denatured in the presence of SnCl2 to prevent the formation of PGD2 from endoperoxides during the extraction procedure, PGD2 formation was noted within the first minute of incubation and reached a peak level after 4 minutes. PGD2 from thrombin stimulated PRP was conclusively identified by gas chromatography-mass spectrometry. The formation of PGD2 during platelet aggregation could represent a mechanism of feedback inhibition of aggregation.


Effect of indomethacin on atropine-resistant transmission in rabbit and monkey urinary bladder: evidence for involvement of prostaglandins in transmission. The effects of 2.9 x 10(-5)M atropine and 2.8 x 10(-6)M indomethacin on responses of rabbit and monkey detrusor muscle to transmural stimulation were investigated. Response to transmural stimulation were partially inhibited by atropine. Indomethacin caused further inhibition in the presence of atropine, but did not alter responses to acetylcholine. Prostaglandins E2 and F2alpha contracted rabbit and monkey detrusor. It is suggested that prostaglandins are liberated during stimulation of excitatory nerves to the rabbit and monkey detrusor, and contribute to the resultant contractile response.


Bronchopulmonary and cardiovascular effects of prostaglandin D2 in the dog. The effects of intravenously administered prostaglandin D2 (PGD2) on bronchopulmonary and cardiovascular functions were examined in the dog. PGD2 (0.03-1.0 microng/kg) was shown to be more active than PGF2alpha, a known bronchoconstrictor, in decreasing dynamic lung compliance, tidal volume, and expiratory airflow rate, as well as in elevating lung resistance. PGD2 demonstrated a potency approximately 4-6 times that of PGF2alpha on pulmonary mechanics. Atropine sulfate infusions reduced significantly the resistance and compliance responses to PGF2alpha, but only the resistance responses to PGD2, thereby suggesting that part of the bronchoconstrictor activities of these agents involved a cholinergic component. In another series of anesthetized dogs, PGD2 (0.1-10.0 microng/kg) increased pulmonary arterial pressure (comparable to PGF2alpha) and heart rate (greater than PGF2alpha, but less than PGE2), while concomitantly decreasing systemic arterial pressure in a dose-related manner (1/10 that of PGE2). Qualitatively similar alterations in cardiovascular parameters were obtained for PGD2 in conscious dogs. Therefore, potent biologic activity of PGD2 has been shown in the dog. No physiologic or pathologic role for PGD2 has yet been demonstrated, but nonetheless, since it is a naturally occurring PG derived from arachidonic acid, further studies are warranted.


Examination of the filterability of oxygenated erythrocytes (containing normal, trait or sickle cell disease type hemoglobins) in the presence of L-epinephrine, D,L-isoproterenol or prostaglandins (PG) A1, A2, E1, E2, F1alpha or F2alpha. These studies were directed toward determining effects of selected vasoactive compounds on oxygenated erythrocytes. Considering the major circulatory effects that small changes in blood flow might initiate in sickle cell anemia patients, erythrocytes from individuals with this disease and from one person with the trait condition were included. PGA1, PGE1, and PGE2 significantly increase filtration times in normal erythrocytes (AA-type hemoglobin) at 10(-11) M by this method. From studies of the effects of L-epinephrine, D,L-isoproterenol, PGA1, PGA2, PGE1, PGE2, PGF1alpha and PGF2alpha on red blood cell filterabilities, the following observations and conclusions appear to hold: (1) Erythrocytes from different individuals (or from the same individual at different times) vary greatly in responses to these compounds. Effects of vasoactive compounds upon red cell filterability may be positive, negligible or negative. Decreased filterability (positive effect) was seen more frequently than increased. (2) Effects are observed with all compounds on some erythrocyte preparation at every concentration tested (10(-5), 10(-7), 10(-9), 10(-11) M). (3) Where epinephrine showed significant positive effect, PGA2 and PGE2 did also when tested. The reverse was not always true. (4) For PGA and PGE analogs, the subscript 2 analogs affected filterability more frequently. (5) When significant average effects for a group of donors were produced by a given compound at a particular concentration, these effects were positive for the donors studied.


Prostaglandins E and F in uterine venous plasma in relation to peripheral plasma levels of progesterone and 20alpha-hydroxyprogesterone in the rat throughout pregnancy and parturition. Prostaglandins E and F in uterine venous plasma and progesterone (P) and 20alpha-hydroxyprogesterone (20alpha-OH-P) in peripheral plasma were measured by radioimmunoassays throughout pregnancy and parturition in the rat. E Prostaglandins are low (approx. 2 ng/ml) and maintain a more or less constant level throughout most of the pregnancy except just before parturition when they rise to  3.8 ng/ml on day 20. F Prostaglandin levels are always higher than E prostaglandins and show distinct peaks around day 5 (5 ng/ml), day 11 (7 ng/ml), and before parturition (8.4 ng/ml). Progesterone levels are higher than 20alpha-OH-P levels throughout most of the pregnancy (day 6-20); however, during early pregnancy (day 1-5) and before parturition more 20alpha-OH-P than P is present in peripheral blood. The possible role of uterine venous prostaglandin levels in altering the 20alpha-OH-P/P ratio during pregnancy and parturition is discussed.


The effect of loperamide on prostaglandin induced diarrhoea in rat and man. Loperamide, a new antidiarrhoeal compound, effectively antagonised prostaglandin induced diarrhoea in adult healthy male volunteers and in patients undergoing pregnancy termination with prostaglandins. This compound is effective in inhibiting prostaglandin induced fluid accumulation in the small intestine in rats. Loperamide also blocked smooth muscle stimulating action of prostaglandins, acetylcholine and histamine on gastrointestinal smooth muscle preparations from several laboratory animals.


Cervical dilatation with 16,16 dimethyl PGE2 p-benzaldehyde semicarbazone ester prior to vacuum aspiration in first trimester nulliparae. The efficacy of 16,16 dimethyl PGE2 p-benzaldehyde semicarbazone ester for cervical dilatation prior to evacuation of the uterus in 180 first trimester nulliparae has been studied. The drug was injected into the muscle of the cervix 3 hours before vacuum aspiration. In 143 patients (80%) the cervix had dilated adequately to enable evacuation of the uterus without mechanical dilatation. In the remaining 37 patients (20%) the cervix had dilated to 6 or 7 mm and additional mechanical dilatation could be performed easily in most of these patients. Side effects consisted of vomiting (11%), diarrhoea (7%), transient pyrexia and shivering (7%). There were no complications in any of the patients and no perforation of the uterus or damage to the cervix resulted during evacuation.


F prostaglandin levels in amniotic fluid in premature labour. The concentration of prostaglandin F (PGF) in amniotic fluid was measured by radioimmunoassay in 27 patients admitted in premature labour. There was a strong correlation between PGF levels in amniotic fluid and both cervical dilatation (r = 0.81; P less than 0.001) and duration of labour (r = 0.79; P less than 0.001). Cervical dilatation greater than 7 cm was associated with levels exceeding 2000 pg/ml. When contractions were present for less than one hour, levels of PGF were below 50 pg/ml. Low levels of PGF were found in amniotic fluid from a separate group of three patients, of whom two had cervical incompetence. It is concluded that the onset of premature labour is not associated with elevated levels of PGF in amniotic fluid. During premature labour, concentrations rise to an extent comparable to that observed in labour at term.


Cervico-vaginal injuries in cases of second trimester termination of pregnancy. Midtrimester abortions were induced in 796 women by Hypertonic Saline and Prostaglandins. Intra-amniotic and Extra-amniotic routes were used for saline and Intra-amniotic, Extra-amniotic andaline and Intra-amniotic, Extra-amniotic and Intra-muscular routes were used for Prostaglandins. Seven patients had cervico-vaginal injuries. All were young nulliparous patients. None of them developed any signs and symptoms of shock. Five out of the seven injuries were posteriorly situated. The etio-pathology and preventive measures of such injuries are discussed here.


The anatomical basis for a possible counter current exchange mechanism in the human adnexa. A counter current mechanism for exchange of prostaglandins between veins and arteries in the ovarian pedicle has earlier been demonstrated in the sheep. The existance of a corresponding vascular arrangement in the human ovarian pedicle has been doubted predominantly on basis of functional data which do not support a role of prostaglandins for human luteolysis. However, the present study demonstrates norphological evidence for a similar vascular anatomy in the human as in the sheep. In 43 human adnexa studied, tortuous arteries in close contact with veins were consistently found. Microscopical sections revealed thinning of the vein walls at contact areas. The possible functional significance of this finding is discussed.


Effect of 15(s)15-methyl-PGF2alpha-methyl ester vaginal suppositories on circulating hormone levels in early pregnancy. Intravaginal administration of 15-methyl-PGF2alpha-methyl ester in the form of suppositories terminated pregnancy in 70 percent of the cases whose last menstrual periods ranged from 35 to 56 days. The use of these suppositories in 49 patients, between 57 to 80 days of gestation, dilated the cervix by 10 mm or more, in one hundred percent of the cases. A decrease in circulating levels of estradiol-17beta and progesterone was observed following 15-methyl-PGF2alpha administration. The mean estradiol-17beta levels declined by about 55.9 percent at 9 hours whereas, the corresponding fall in progesterone was 32.7 percent. This was indicative of a direct action of 15-methyl-PGF2alpha on the corpus luteum. The vaginal use of 15-methyl-PGF2-alpha-methyl ester suppositories thus appears to be a promising method for the termination of early pregnancy and for pre-operative cervical dilatation. The termination of early pregnancy appears to be partly due to the luteolytic effect of 15-methyl-PGF2alpha besides stimulating uterine contractions.


Radioimmunoassay of 15-keto-prostaglandin E2 in peripheral plasma after oral administration of prostaglandin E2 tablets used for induction of labour. A radioimmunoassay of the 15-keto- metabolite of prostaglandin E2 has been developed. The details of the assay are described. Using unextracted plasma, serial measurements of 15-keto-PGE2 have been carried out every 15 minutes for 3 hours in 9 women ingesting 0.5 mg PGE2 oral tablets used for the induction of labour.


Prostaglandins and congeners XIII (1). The synthesis of dl-erythro-16-methoxyprostaglandins. dl-Erythro-16-methoxy-PGE2, PGA2, PGF2alpha, 11-deoxy PGE1, and 11-deoxy PGF1alpha have been prepared via the cuprate conjugate addition procedure. These congeners are less potent than the parent prostaglandins as stimulators of isolated gerbil colon contractions and as bronchodilators in the guinea pig Konzett assay.


Prostaglandins lack a direct inhibitory action on electrolyte and water transport in the kidney and the erythrocyte. The possibility of a direct effect of prostaglandins of the E, A, and F series upon renal electrolyte and water transport was assessed using in vitro preparations of rabbit cortical and medullary tubular suspensions as well as cortical renal slices from rat and guinea pig and medullary renal slices from rabbit. Net fluxes of Na, K, C1 and H2O between the intracellular compartment and the extracellular fluid were measured in the presence of PGE1, PGE2, PGA1, PGA2 and PGF2alpha in concentrations ranging from 1 X 10(-5) to 1 X 10(-10)M. No inhibitory action was observed with any of these prostaglandins and in fact a slight stimulation of Na transport was seen under some circumstances. We conclude that the natriuresis which follows in vivo administration of some prostaglandins is not the result of a direct inhibition of Na reabsorption at the contraluminal pump site and is most likely secondary to renal vasodilation. We also studied net and isotopic Na fluxes in human erythrocytes. Na transport was not affected by prostaglandins of the E, A or F series using both normal and high sodium erythrocytes. Our results emphasize the need for caution in extrapolating the effects of prostaglandins upon Na transport from one tissue to another since their actions appear to be tissue-specific.


Radioimmunoassay of PGE and an approach to the specific measurement of PGE1. A specific radioimmunoassay for prostaglandins of the E series is presented. Several refinements of the conventional procedures used for unknown sample preparation prior to assay are described. Validation of the method through recovery of labeled and unlabeled prostaglandin E from plasma indicates: 74% extraction efficiency, 80% chromatographic separation efficiency, and a 67% overall recovery figure for the complete assay. The development of an "absorbed system" approach for measuring one E prostaglandin (PGE1) without interference from the other E prostaglandin (PGE2) is also described. A preliminary study of rat tissue and male plasma samples measured by these assay systems is included. Alternate approaches to the development of a specific PGE1 assay, although less feasible in these authors' hands, are discussed.


A radioimmunoassay for 13, 14-dihydro-15-keto prostaglandin F2alpha with chromatography and internal recovery standard. Antibodies to the 13, 14-dihydro-15-keto metabolite of prostaglandin F2alpha(PGF2alphaM) were raised in sheep using a bovine thyroglobulin conjugate of PGF2alphaM. Labeled 13, 14-dihydro-15-keto prostaglandin A2(PGA2M), 13, 14-dihydro-15-keto prostaglandin E2 (PGE2M) and PGF2alphaM were prepared from their corresponding high specific activity parent prostaglandins with swine kidney homogenate and purified using reverse phase liquid-liquid partition chromatography. A rapid method of column chromatography for use prior to radioimmunnoassay was developed. Mathematical corrections for the effect of recovery tracer on the logit/log transformation are presented with a new approach to expression of radioimmunoassay cross reactions allowing continuous expression of the variation of these cross reactions with displacement. These mathematical approaches are widely applicable to other radioimmunoassay systems and transformations. The assay was used for measurement in groups of human volunteers: males, females, women at delivery and paired venous umbilical cord bloods. A correlation between venous cord and maternal peripheral PGF2alphaM levels is demonstrated with a gradient from the cord plasma to maternal plasma.


Differential separation of thromboxanes from prostaglandins by one and two-dimensional thin layer chromatography. [14C]-labelled thromboxane B2 and hydroxy fatty acids were isolated using thin layer and gas chromatographic procedures from human platelets incubated with [1-14C]-arachidonic acid. A number of TLC solvent systems were evaluated for differential separation of thromboxanes and hydroxy fatty acids from prostaglandins E2, A2, D2 and F2alpha. Chromatographic properities in nine different solvent systems are tabulated. Two dimensional TLC procedures suitable for complete resolution of mixtures of these compounds on a single plate were developed. The systems were used to demonstrate conversion of [1-14C]-arachidonic acid to thromboxane B2 and prostaglandin E2 by human lung fibroblasts in tissue culture.


Symmetry in prostaglandins.

Symmetry in prostaglandins. Observations of the agonist activity of prostaglandins on the guinea-pig ileum are analysed. The structure-activity relationships are interpreted in relation to the approximate diad axis of symmetry in the molecules. It is suggested that some receptors for prostaglandins may have a perfect diad axis of symmetry between identical protein subunits.


Suppression of the release of prostaglandin-like substances by hydrocortisone in vivo. Muscular exercise of the dog's hind leg evokes the release of prostaglandin-like substances/PG-like substances/into femoral venous blood. The release of PG-like substances detected by the bioassay method was significantly greater in adrenalectomized as compared to normal dogs. To test the possibility that this difference may be related to the deficiency of adrenocortical secretion in adrenalectomized dogs, the effect of hydrocortisone/HC/and aldosterone/AS/upon the release of PG-like substances induced by muscular work of the dog's hind leg was investigated. The doses of HC and AS infused intravenously or intraarterially were close to the range of physiological secretion rate of these hormones. HC suppressed the release of PG-like material by 30 to 60%, whereas AS had no effect upon the rate and duration of the release. The rate of removal of exogenous PGE2 in the hind limb circulation was not influenced by HC, suggesting that the diminution of PG release by HC results from the suppression of PG generation rather than from the enhancement of degradation. It is suggested that PG-like substances may be related to the membrane-stabilizing properties of this hormone. The difference in the intensity of the release of PG-like substances between normal and adrenalectomized dogs suggests that, at least in some conditions, the release of endogenous PGs from tissues may be influenced by the state of adrenocortical activity.


Prostaglandin F2alpha induced luteolysis, hypothermia, and abortions in beagle bitches. Luteal phase plasma progesterone was radioimmunoassayed in samples collected before, during, and after a 72 hr treatment period during which Beagle bitches received repeated i.m. injections of prostaglandin F2alpha (n=17) or saline (n=3). PGF2alpha (20 ug/kg every 8 hr or 30 ug/kg every 12 hr) was administered to 7 pregnant and 8 nonpregnant bitches during the mid or late luteal phase of the cycle (Day 25-58) and to 2 nonpregnant bitches during the early luteal phase (Days 5 and 20). Progesterone was depressed from pretreatment levels (3-40 ng/ml) in each of the 15 bitches given PGF2alpha after Day 25 of the cycle. Mean progesterone (ng/ml plasma) at -24, 0, 12, 24, 36, 48, 60, 72 and 96 hr from the initial PGF2alpha injection were 16.6, 15.6, 9.3, 5.1, 2.1, 1.5, 1.4, 1.1 and 1.1 (+/- 0.9, n=15). Thereafter, progesterone was nondetectable in the 8 nonpregnant bitches and in 4 pregnant bitches that aborted. Abortions occurred when progesterone was depressed to 0.6-1.4 ng/ml, 56-80 hr after starting PGF2alpha treatment on Days 33-53 of the cycle. Three pregnant bitches did not abort when progesterone was depressed to a mean low value of 2.1 ng/ml during PGF2alpha treatments begun on Day 31-40 of pregnancy. Progesterone in these bitches recovered to 5-10 ng/ml and was maintained until the normal prepartum decline. Since PGF2alpha can induce complete luteolysis it may be of use as an abortifacient in the bitch. A transient fall in rectal temperature occurred in each of 12 luteal phase bitches injected with PGF2alpha (20 ug/kg, i.m.). The hypothermia was detectable within 15 min, maximal at 45-60 min, and averaged 1.39 degrees similarly treated.  In six luteal phase bitches, plasma progesterone fell 20-45% within the 15 min required to observe a consistent decline in rectal temperature following PGF2alpha administratic effect and dependent on a fall in progesterone.


The effect of ritodrine on PgE levels in pregnant rabbit vena cava blood. A chronic model was utilized in the rabbit to determine the effect of ritodrine hydrochloride infusions on pregnancy. Infusions were carried out for 6 hours in the unanesthetized, conscious animal between the 25 to 27 day of pregnancy. Pre and post infusion blood samples were drawn from a catheter lying at the lower inferior vena cava and analyzed for prostaglandin E and F, and progesterone. As compared to a control animal, there was a significant fall in prostaglandin E after 6 hour infusion of drug, but no change in prostaglandin F or progesterone was observed.


Effect of 5-hydroxytryptamine on the peripheral chemoreceptors in the rat. 5-Hydroxytryptamine (5-HT), in the doses of 2-5 mug/kg injected into the carotid body area, produced a significant increase in the respiratory rate and carotid sinus nerve activity. Selective ablation of the ipsilateral carotid sinus nerve abolished the respiratory stimulation produced by the drug. On the other hand, the same doses of 5-HT injected into the ascending aorta did not produce stimulation of respiration when the carotid sinus nerves were sectioned. The activity of the aortic nerves did not increase after injecting the drug into the ascending aorta or at the root of the right subclavian artery. These results indicate that 5-HT stimulates the chemoreceptors in the carotid body of the rat. The lack of responses to the injections of the drug in the aortic or subclavian region was due to the absence of chemoreceptors in these regions of the rat.


In vitro and in vivo studies of extrapineal N-acetyltransferase of rat brain. In a series of experiments, extrapineal rat brain N-acetyltransferase was further characterized and was demonstrated to have a similar pH optimum and similar activity to that of the low activity daytime pineal N-acetyltransferase. Experiments in vivo indicate that N-acetylation may be a possible alternative metabolic pathway for biogenic amines and that brain N-acetyltransferase activity may be regulated by a beta-adrenergic mechanism.


Metabolism and probable active metabolite of alpha-l-acetylmethadol in rat. alpha-l-Acetylmethadol is being currently evaluated as a substitute for methadone in the treatment of heroin addicts. The metabolites, isolated from urine, liver, and serum, were identified by gas-liquid chromatography. Methadone and its metabolites were found to be present in urine, liver and serum of rats treated with alpha-l-acetylmethadol. The presence of methadone was confirmed by gas-chromatography-mass spectometry. The purpose of this study was to determine whether alpha-l-acetylmethadol is metabolized to methadone, which might explain in part the longer duration of action of alpha-l-acetylmethadol.


Identification of glucuronides as in vivo liver conjugates of seven cannabinoids and some of their hydroxy and acid metabolites. Glucuronide conjugates of cannabidiol (CBD), 7-hydroxy-CBD, propyl-CBD, cannabinol (CBN), 7-hydroxy-CBN, CBN-7-oic acid, propyl CBN and cannabichromene have been identified as major metabolites of CBD, CBN and their propyl homologues and of cannabichromene in mouse liver. Trace amounts of the glucuronide conjugates of delta1- and delta1(6)-tetrahydrocannabinol (THC) were also detected. Identification was made by combined gas-liquid chromatographic and mass spectrometric studies of the trimethylsilyl (TMS), d9-TMS and methyl ester-TMS derivatives of the glucuronides and the TMS derivatives of the product of the reduction of the metabolites with lithium aluminium deuteride.


Effects of fructose and other substances on ethanol and acetaldehyde metabolism in man. The comparative effectiveness of oral administration of fructose, glucose sucrose and alanine has been investigated on the rates of blood alcohol clearance, and acetaldehyde removal in man. Oral administration of fructose was found to exert the most pronounced effect. It increased the rate of blood alcohol clearance by about 100%. Orally administered alanine was found to be least effective in increasing the rate of blood alcohol clearance after blood alcohol had reached peak levels, perhaps due that poor absorption of alanine. Fructose administration partially prevented the ethanol-mediated increase inlactate/pyruvate and beta-hydroxybutyrate/acetoacetate in the blood. Fructose exerted the most pronounced antiketogenic effect and the levels of circulating free fatty acids decreased in the 24-hour fasted patients upon administration of fructose with ethanol compared to ethanol alone. Oral administrations of fructose, glucose, sucrose or alanine did not significantly change the levels of acetaldehyde in the blood. Combined administration of fructose with ethanol resulted in an increase in the levels of blood sorbitol. The mechanism through which fructose exerts its stimulatory effect on the metabolism of ethanol in the liver has been discussed.


Pathogenesis of duodenal ulcer. Gastric hyperacidity caused by propionitrile and cysteamine in rats. Cysteamine and propionitrile, experimental duodenal ulcerogens, stimulated gastric acid secretion in the rat. Gastric acid secretion was measured by two separate methods, the conventional pylorus ligation technique and a non-invasive technique based on the pH dependent liberation of azure A from azuresin in the stomach with subsequent excretion of the liberated dye in the urine. Volume, acid concentration and acid content of gastric fluids aspirated immediately before the pylrous ligation were markedly increased 1,4 and 7 hours after a single dose of either cysteamine or propionitrile. Both acid concentration and acid output of gastric contents collected 30 minutes after pylorus ligation were also significantly elevated 1.5 hours after propionitrile and 4.5 hours after cysteamine. Significant increases in gastric acid secretion after these chemicals were also measured by the non-invasive technique which demonstrated a 4 to 6 fold increase in 24 hour urinary azure A output in rats injected with either propionitrile or cysteamine. Enhanced gastric acid output may play an important role in the pathogenesis of duodenal ulcer produced by propionitrile and cysteamine.


The effects of anti-inflammatory agents on skin tumor initiation and aryl hydrocarbon hydroxylase. The effects of various clinically used anti-inflammatory agents on mouse skin tumorigenesis and aryl hydrocarbon hydroxylase (AHH) were investigated. Oxyphenbutazone, a nonsteroidal anti-inflammatory agent, inhibited 3-methylcholanthrene (MC) tumor initiation but was less effective than the steroidal anti-inflammatory agent, dexamethasone. Oxyphenbutazone was not found to induce AHH activity in mouse epidermis, whereas indomethacin and Seclazone had a slight inducing effect. When these agents were added directly to the in vitro AHH assay, they did not inhibit AHH activity. However, additional experiments have shown a decreased epidermally mediated covalent binding of MC to DNA in vitro when the epidermal homogenates were isolated from mice pretreated with either dexamethasone or oxyphenbutazone and MC at 3 or 12 hr before killing.


Effects of alternating magnetic field (12 gauss) on transplanted neuroblastoma. Exposure of A/J animals bearing transplanted neuroblastoma (C1300) to a 12 Gauss, 60Hz magnetic field for 16 days, starting 3 days post transplant resulted in - (a) early slowing of tumor growth, (b) more free red blood cells in the tumor areas and (c) a tendency to focal tumor cell destruction suggesting that a small alternating magnetic field may affect transplanted tumor growth.


Renal clearance of digoxin in young infants. The renal clearance of digoxin and creatinine were measured in eleven infants, aged one to five months, with congenital heart disease and heart failure. The renal clearances of digoxin were low at one month of age (50 ml/min/1.73 m2) but increased progressively until the adult range was attained at about five months of age (130-150 ml/min/1.73 m2). At any given age, however, the renal clearance of digoxin was almost twice as great as the simultaneously determined creatinine clearance (mean ratio 1.73). This stands in marked contract to older subjects where creatinine and digoxin clearances are usually similar. These data explain (in part) the larger digoxin dosage requirement of infants.


Pharmacokinetics of peniobarbital in the cat and comparisons with the rabbit and man. In eight experiments involving four cats, doses of 12.5 to 50 mg of sodium pentobarbital per kg of body weight were administered intravenously and pentobarbital plasma concentrations (from arterial blood) were measured as a function of time. Pharmacokinetic linearity was evidenced by a mean plasma clearance (C1p) of 1.81 ml/(kg x min), with a coefficient of variation of 16.6%, and a range of 1.51 to 2.36 for all experiments, and, a linear relationship between total area under the curve (AUC) and mg/kg dose in cat "4 given doses of 12.5, 25 and 50 mg/kg. However, the apparent elimination half-life, (t1/2)beta' averaged 4.87 hr, with a coefficient of variation of 40.7%, and range of 1.80 to 7.52 in all experiments, and, in cat "4 the half-life was the same, namely 7.5 hr following the two higher doses, but lower, namely 4.7 hr, after the lowest dose. There was also evidence of kinetic nonlinearity in the intial fall-off portions of some of the curves. Results are compared with literature data for both rabbits anamen. The order of plasma clearances in units of ml/(kg x min) were: rabbit greater than cat greater than man. For neither the rabbit nor the cat were there any significant correlations between calculated pharmacokinetic parameters and mg/kg doses using data from all animals studied; this also suggests kinetic linearity.


Defluorination of methoxyflurane by a glutathione-dependent enzyme. Partial purification from rat liver of an enzyme which catalyzes defluorination of methoxyflurane is described. Fractionation of liver homogenates by protamine sulfate and ammonium sulfate precipitation and by Sephadex G-100 chromatography results in a 10-fold purification with 53% recovery. The enzyme requires glutathione for activity, and other sulfhydrhyl compounds cannot be substituted. The enzyme appears to be a glutathione S-transferase, possibly one of several which have recently been characterized.


In vitro studies of some chlorpromazine metabolites as potential N-methyltransferase inhibitors. A series of chlorpromazine metabolites were tested as inhibitors of rabbit lung N-methyltransferase activity in vitro. The hydroxylated metabolites were found to be more effective with the 7,8 dioxy derivatives the most potent. Various chelating agents had no effect, suggesting that the inhibitory effects of the hydroxy metabolites were not due to divalent cation chelation.


Effects of spin labeled acetylcholine analogs on cholinergic receptors of the leech. The spin labeled acetylcholine analog, SL-2, which is a potent, non-stimulating muscarinic antagonist on the isolated frog heart, is a potent agonist a low concentrations (3x10-5 M) and an antagonist at slightly higher concentrations (4.5x10-5 M) on the mixed cholinergic receptors of the leech. Ion the other hand, the spin labeled acetylcholine analog, SL-1, possesses no agonist activity while it retains the antagonist activity of SL-2. Furthermore, the spin labeled analog, SL-3, which causes hyperpolarization and a decrease in action potential frequency, exhibits neither agonist nor antagonist activity.


Atropine-induced bradycardia in the guinea pig: dose-response. The effect of atropine sulfate on the heart rate of the unanesthetized guinea pig was studied using a wide range of doses injected via a chronic jugular cannula; dose-response data are presented for the range of 5 mg/kg to 50 mg/kg. A long-lasting dose-dependent bradycardia was produced. This finding is in contrast to the clasically reported effect of atropine in man and dog: tachycardia sometimes preceded by a transient bradycardia. Thus, the guinea pig may be an excellent model for the study of parasympathomimetic, bradycardia-producing effects of atropine.


Reversal of two manifestations of dopamine receptor supersensitivity by administration of L-dopa. Rats treated chronically with dopamine receptor blockers were found to have an increase in striatal 3H-dopamine binding and adenylate cyclase activity as manifestations of receptor supersensitivity. Both the increase in binding and in adenylate cyclase activity were reversed by chronic 1-dopa treatment, presumably by increasing the supply of specific ligand (dopamine). The use of deliberate receptor sensitivity manipulation may be useful as a treatment for conditions involving disturbances in receptor sensitivity such as tardive dyskinesia and insulin resistant diabetes.


The effects of some tobacco smoke constituents on foreign compound metabolism in the cat and the rat. The effects of chronic nicotine administration on its own metabolism have been studied in the cat and the rat. Nicotine administration caused an increase in the in vitro metabolism in the liver of both species and in cat kidney. Cotinine production from nicotine was enhanced in both species by pretreatment with nicotine. The magnitude of the increase in enzyme activity was relatively small but of the same order as that produced, in the rat, by phenobarbital treatment. 3-methylcholanthrene pretreatment stimulated rat liver nicotine metabolism but was without effect on cotinine production. Chronic exposure of rats to relatively low levels of carbon monoxide inhibited the in vitro aryl hydrocarbon hydroxylase activity but did not affect nicotine metabolism. The data are discussed in relation to the observed enzyme inductive effects of tobacco smoke.


Interaction of o, p'DDT with the estrogen-binding protein (EBP) in human mammary and uterine tumors. The in vitro effect of o, p'DDT on the binding of 3H-estradiol-17beta (3H-E2) to the high affinity estrogen-binding protein(EBP) in cytosol derived from human mammary and uterine tumors was examined. o,p'DDT inhibited the binding of 3H-E2 to EBP in both breast and uterine tumors. Using Scatchard and Linweaver-Burk plot analyses, the inhibition by o,p'DDT of 3H-E2 binding to mammary tumors EBP appears to result from competition for the 8S moiety binding sites and not from deactivation of the binding sites. The KI for the inhibition by o,p.'DDT with EI binding was determined, yielding a value of 0.5 +/- 0.1 muM. The possible relevance of these findings to human population exposed to DDT derivatives is discussed.


High-pressure liquid chromatographic (HPLC) determination of tolmetin and its major metabolite in plasma. A high-pressure liquid chromatographic assay was developed for the quantitative determination of tolmetin and its major metabolite in plasma. Determination of tolmetin was compared to a previously reported spectro-photometric assay method. The standard curves were evaluated statistically and daily standard curves were preferred over a pooled standard curve. The method was applied to samples of one subject's plasma containing both tolmetin and its major metabolite.


Effect of 2-fluorohistidine upon leukocytopoiesis in mice. Administrationof L-2-fluorohistidine to mice produces a dose and time dependent leukopenia, hypocellularity with reduction in hematopoiesis in the spleen and bone marrow, and depletion of lymphocytes in the spleen, lymph nodes and cortex of the thymus. The LD50 is 250 mg/kg at five days. The effect on hematopoetic tissue is nearly as great at non-leathal "therapeutic" doses. Effects on circulating erythrocyte and reticulocyte levels and the deposition of hemosiderin in the spleen are minimal. At non-leathal doses the effects of this amino acid analog appear to be completely reversible after 6 to 10 days.A description of the toxicity, histopathology and a discussion of the possible mechanisms of action are presented.


On the mechanism of hypocholesterolemic action of amphotericin B in rat. The transient hypocholesterolemia phenomenon observed in rats, injected i.v. with amphotericin B (1.5 mg/kg/day) for three weeks, was investigated by in vitro [14C] acetate incorporation into the liver cholesterol. The incorporation of acetate in liver slices of treated animals increased more than two-fold (p less than 0.02) when compared with controls.When amphotericin B was added in vitro to liver slices of control rats, the incorporation of acetate into cholesterol decreased to about 65% of that observed with the corresponding controls (p less than 0.01). The results are consistent with the hypothesis that initially amphotericin B causes inhibition of de novo cholesterol synthesis resulting in hypocholesterolemia which disappears on continued treatment possibly due to compensatory increased rate of cholesterol biosynthesis.


Correlation of creatinine levels in saliva and plasma in normal subjects and renal patients. Whole saliva and serum creatinine levels were evaluated in three normal subjects and 12 patients with chronic renal failure receiving regular hemodialysis treatments. Ratios of the serum vs. saliva creatinine levels ranging from 4.5 to 30.0 were found. Repeated studies also revealed marked intra-subject variations in these ratios. We conclude that the monitoring of whole saliva creatinine levels is only of limited value in accurately predicting serum or plasma creatinine levels, despite its appeal of simplicity, convenience and non-invasiveness. Its value in the qualitative monitoring of renal function may, however, be useful.


Resistance of the rabbit to dietary pyrrolizidine (Senecio) alkaloid. Rabbits were fed Senecio jacobaea for 263 days. Total intake of the plant averaged 112.5% of initial body weight. No gross lesions, or changes in serum protein and albumin occurred. Microscopic changes in liver tissue were seen. Two rabbits injected with 150 mg Senecio pyrrolizidine alkaloid/kg body weight died in less than 24 hours. The resistance of the rabbit to chronic Senecio intoxication, but not to injected alkaloid, suggests that alkaloid absorption may be low in this species.


Amine releasing action of nicotine from rat hypothalamus in vitro. Nicotine released 3H-radioactivity from rat hypothalamus labeled with 3H-metaraminol (3H-MA) in a concentration-related manner. The release was not blocked by hexamethonium (1.8 x 10(-5)M - 2.3 x 10(-3)m), tetrodotoxin (3 x 10(-7)M), lidocaine (6 x 10(-5)M or Ca++-free medium. Cocaine  (3 x 10(-5)M) blocked the releasing action of nicotine. Nicotine failed to release 3H-MA in tissue exposed to tyramine. It is concluded that the nicotine-induced release of 3H-MA is intracellular.


Reduced sulfhydryl groups of rat neurons, glial cells and neurofilaments. Reactive thiol groups were measured in neurons glial cells and neurofilaments of rat central nervous system. Neurons displayed 27 nmol/mg prot. reactive SH-groups while the figures for glia and neurofilaments were 36.5 and 44 nmol, respectively. For comparison, brain and spinal cord homogenates contained 3.2 and 6.9 nmol/mg of prot. extractable free thiol residues.


A computational model of pulmonary gas transport incorporating effective diffusion. A computational model of gas transport in the lung is described which remedies many of the deficiencies of previous models, as listed by Chang and Farhi (1973), in that it allows for fluctuating lung dimensions, gas exchange, simultaneous convection and diffusion, and the enhanced effective diffusion that occurs when convective flow is also present. The results of calculations using the model are presented, showing the maximum effect of Taylor diffusion. The actual magnitude of Taylor diffusion, suitably modified to allow for the disturbed conditions within the lung, is considered in the light of recent experiments.


Intrapulmonary receptors in the Tegu lizard: I. Sensitivity to CO2. Single unit vagal recordings from intrapulmonary receptors were obtained in decerebrate, paralyzed lizards both during pump ventilation and during unidirectional ventilation on the cannulated, sack-shaped lung. Two types of receptors were identified: (1) CO2-receptors, which increased their discharge frequency as intrapulmonary CO2 concentration decreased but were not sensitive to stretch of the lung. (2) Mechanoreceptors, which rapidly increased discharge frequency when the lung was stretched. These receptors' CO2 sensitivity varied. Lungs of lizards thus appeared to possess both CO2 receptors, which have functional characteristics similar to those in birds, and mechanoreceptors with properties similar to stretch receptors in mammals.


Intrapulmonary receptors in the Tegu lizard: II. Functional characteristics and localization;. Intrapulmonary receptors identified in the Tegu lizard by single-unit vagal recording (Fedde et al., 1977) were subjected to a number of stimuli and localized within the lung. Some carbon dioxide receptors could follow periodic changes in intrapulmonary CO2 concentrations as rapidly as 1.3 Hz; No oxygen sensitivity was observed with this receptor type, and halothane markedly depressed the discharge frequency. In response to intravenously injected acetazolamide they increased their discharge frequency and became almost totally insensitive to CO2, suggesting molecular per se is not the direct controller of receptor discharge; These receptors show many of the functional characteristics described for those in the avian lung. Afferent activity from both CO2 and mechanoreceptors could be elicited by electrically stimulating the lung surface. The CO2 receptors appeared to be organized in a receptive field covering more than 1 cm2 of lung surface, multiple receptors being innervated by a single afferent fiber. Activity in afferent fibers from mechanoreceptors could be evoked from only one distinct spot on the lung surface. Conduction velocities of afferent fibers from CO2 receptors ranged from 1 to 3 m-sec-1; from mechanoreceptors, from 1.9 to 5.2 m-sec-1.


Response of avian intrapulmonary chemoreceptors to venous CO2 and ventilatory gas flow. Avian intrapulmonary chemoreceptor activity is reduced by increasing airway PCO2 from 0 to 60 torr. Using extracellular electrodes, we recorded discharge of individual intrapulmonary chemoreceptor cell bodies in the left nodose ganglion of the rooster (Gallus domesticus) during unidirectional ventilation of the lungs. All receptors recorded were in the left lung. To vary pulmonary arterial PCO2 independently of ventilation, we ventilated the two lungs separately and supplied the left pulmonary circulation with systemic arterial blood. When the PCO2 in the pulmonary arterial blood was increased, discharge frequency decreased in all 21 receptors studied. Sensitivity to pulmonary arterial PCO2 was similar to sensitivity to airway PCO2. When PCO2 of ventilatory gas was lower than that of pulmonary arterial blood, discharge frequency of the receptor increased when pulmonary blood flow was stopped. Discharge frequency also increased when PCO2 at the receptor site was lowered by increased ventilatory gas flow. We conclude that intrapulmonary chemoreceptors respond to the delivery and removal of CO2 by blood and ventilatory gas. This suggests that the receptors are located within the respiratory gas exchange region of the lung. Because these receptors have a strong inhibitory effect on ventilation, they may serve to (1) adjust minute ventilation to the rate of metabolic CO2 production and (2) to regulate individual breath size.


Ventilatory response of decorticate and decerebrate cats to hypoxia and CO2. The steady state ventilatory response of normal, fully awake cats was studied under graded hypoxia (at PAO2 = 110, 55, 45 torr) with PACO2 controlled throughout at the resting, normoxic level and at +5 torr. Subsequently, either a mid-collicular decerebration or a decortication was performed, and the ventilatory studies were repeated. Respiratory frequency, tidal volume, and ventilation in the decerebrate state responded to hypoxia and hypercapnia in a manner indistinguishable from the control. The decorticate cats, however, exhibited an exaggerated response to hypoxia, principally the result of increased frequency. The negative hypoxic, hypercapnic interaction, characteristic of awake cats, was demonstrable in both the decerebrate and decorticate animals. The findings are interpreted as revealing coupled descending influences on the medullary respiratory centers in hypoxia--one that is facilitatory and originates in the diencephalon, and the other, inhibitory, from the cerebrum. The significance of this suprapontine system in normal hypoxic ventilatory control is discussed.


Innervation of stretch receptors in the extra-thoracic trachea. We have studied the innervation of the stretch receptors in the extra-thoracic trachea by recording their unitary action potentials from the vagus nerve in the neck before and after blocking the nervous conduction in the recurrent laryngeal nerves (RLNs). On the left side all the receptors had their activity going through the ipsilateral RLN:78% of the stretch receptors had their fibres joining the RLN in the neck whilst the remaining receptors join this nerve within the thorax. These latter receptors were located mainly in the lower extra-thoracic trachea. On the right side only 45% of the receptors were found to follow the right RLN whilst the others reach the vagus nerve through a different pathway. These latter receptors were located in the lower part of the extra-thoracic trachea. Therefore sectioning both the RLNs would interrupt about 3/4 of the fibres coming from the extra-thoracic trachea if done just before their entrance into the main vagus nerves. When the section is done exclusively outside the thorax, at the level of the thoracic inlet, the de-afferentation would be about 60% of the total supply.


[Anterior angiomas of the spinal cord and their treatment]. For a long time surgical removal of intra-medullary angiomas was considered as impossible. Accurate localization of the lesion by spinal angiography, microsurgical techniques allow to overcome this surgical challenge. 15 cases of spinal arteriovenous malformations fed by the anterior spinal artery have been operated. Criterias for surgery and post-operative results are mainly dependant upon the neurological states and the anatomical type of the malformations (type I, II, III, IV), Total removal of the malformations was performed in 12 cases with post-operative control angiography in seven instances.


[NEOLOGISMS AND MOTOR APHASIA. (Afferent pathology?)]. The authors describe a case of post-traumatic aphasia in a 39-year-old man. The linguistic disturbances were marked by the unusual association of oral expression consisting mainly of neologisms, normal comprehension and almost normal written expression. A physiological interpretation based on disturbance of treatment of the sensory afferent nerves from the bucco-phonator organs is suggested to account for the neologisms in this particular form of aphasia.


[Abnormal movements of patients with Parkinsonism treated with L-dopa and anomalies of dopamine metabolism]. The authors describe the results of biochemical analysis carried out on 28 patients with Parkinson's disease who had been treated by L-dopa. Twenty of them showed either no abnormal movements at all or very few, eight others had considerable dyskinesia. Biochemical analysis of the urinary degradation products of L-Dopa revealed the existence of a swing in the degradation of dopamine towards 4-O-methylate derivatives in dyskinetic patients (significant difference at .01). The results confirm those obtained in their initial analysis carried out in 1973. The authors express the view that abnormal movements while under L-Dopa treatment are dependent on two factors: one, the hypersensitivity of dopaminergic reception, the other, the greater or lesser preponderance of the COMT isozyme giving rise to 4-O-methylates;


Degenerative changes in the intervertebral discs of the lumbar spine and their sequelae. Careful pathological examination of lumbar spines removed at autopsy has shown that degenerative changes are present in the intervertebral discs of all subjects by middle age. The degenerative changes are more marked and occur at an earlier age when evidence of vertical or posterior disc prolapse is also present. Degenerative changes in the discs are always accompanied by osteophyte formation on the margins of the vertebral bodies and remodelling changes in the apophyseal joints. There is a direct relationship between the degree of disc degeneration, marginal osteophyte formation on vertebral bodies, and apophyseal joint changes, which suggests that disc degeneration is the primary event leading to the clinical condition of 'degenerative spondylosis'.


Biochemical aspects of development and ageing of human lumbar intervertebral discs. Nucleus pulposus and annulus fibrosus from individual normal discs of different ages have been separately examined, and the topographical distribution of constituents across the annulus fibrosus has been determined. Collagen content, including the molecular species, and proteoglycans have been estimated. Type I collagen was found in the outermost regions of the annulus and type II in the innermost, whereas the nucleus contained type II collagen. In older spines the collagen content of the annuli increased both outwards in the disc, and downwards along the spinal levels. Proteoglycan content was higher in the nucleus, and the proportion of keratan to chondroitin sulphate increased with age, as did the hyaluronate content. It is concluded that differences in mechanical function may be reflected by differences in chemical composition of the discs, and that mechanical failure could result from local variations in chemical composition.


Correlation between pseudospondylolisthesis and arthrosis of the hands. Two groups of 25 patients, one with pseudospondylolisthesis (PSL) and the other without, have been compared in order to verify the impression that arthrosis of the hands occurs more frequently in those with PSL. The observed differences were significant, being especially marked in women in whom five or more hand joints were involved and increasing in frequency with age. No relation was found between PSL and either discarthrosis or being overweight. The presence of PSL can probably be included in the pattern of generalized osteoarthrosis described by Kellgren and Lawrence (1958).


[Evaluation of radiologic criteria in rheumatoid arthritis]. The authors compared the hand Xrays of 53 patients with rheumatoid arthritis (AR) with those of 53 control subjects matched for age and s. x. Each AR patient conformed to the New York clinical criteria. Assesment was carried out on Xrays of both hands, search being made for erosions, geodes, and joint narrowing, the severity being graduated from 0 to 4, according to data from the international Atlas of Radiology. The sensitivity, sepcificity and severity of each of these abnormalities was studied joint by joint (18 for the hand). Analysis of the results shows that study of all 18 joints in the hand is not useful; account may be taken only of the first three metacarpo-phalangeal joints, the carpo-metacarpal joints and the radio-carpal joint. The proximal interphalangeal joints, contrary to the most commonly held opinion, are more a source of errors than of diagnosis. Erosion is the most specific sign, especially if one is only considering the characteristic sites. With a specificity of the order of 98 per cent, this abnormality has sufficient weight to counteract the very low incidence of the disease in a population in comparison with degenerative disorders. Geodes should be studied more by their severity than by their frequency; this is high in the controls, which diminishes their specificity (45 for the wrist, 62 for the first carpo-metacarpal, and 75 for the first metacarpo-phalangeal joint). Joint narrowing is a difficult sign to read and its value is all at the radiocarpal and carpal joints.


[Patellar imbalance and external rotary instability of the knee]. The importance of external hyperrotation and external rotary instability in patellar imbalance is examined. In view of the progressive nature of patellar imbalance and of the predominant part played by the muscular and capsulo-ligamentous elements in the stability of the extensor apparatus, the authors advocate an earlier and more radical surgical approach with a view to improving the patellar medialization forces (transplantation of the intermediate great muscle and retension of the lateral patellar retinaculum) as well as the elements of active internal rotation of the tibia (modified version of Slocum's operation and transfer of the internal third of the patellar tendon).


[Hyperostosis of the iliac crest. Anatomo-radiologic features]. Anatomical and radiological features of two cases with hyperostosis of the iliac crest are related. They help to illustrate a brief discussion of the general prcal factors as well as general medical conditions (especially diabetes mellitus, for which careful clinical investigations should be performed when hyperostosis is discovered radiologically); 2) histological structure; 3) differentiation from osteophytes of osteoarthrosis.


[Radiation lesions of the hip].

[Radiation lesions of the hip]. Irradiation lesions of the hip are much better known than they used to be, and problems diagnosis no longer arise. Study of these 49 cases of irradiation lesions of the hip shows that they occur in 1 to 36 per cent of patients irradiated for pelvic cancer. The rate of occurrence may be reduced by selection and improvement in the techniques of radiotherapy. The extent of the lesions is determined from the time that irradiation is stopped. The lesions appear after a delay of several months and develop progressively throughout their extent. This confer on them a false appearance of a progressive lesion. There are severe lesions, which seriously threaten ambulation. Trans-cervical fractures should be considered separately; these are usually isolated lesions, simple to treat and of good prognosis. Fractures of the acetabulum and necroses of the acetabular roof or of the femoral head, developing usually as paired lesions or in the context of an irradiation coxopathy, constitute another group, in which treatment by total prosthesis raises numerous technical problems. Total prosthesis has however given to these hips; in almost 2 cases out of 3, a function which is at present satisfactory but whose future is unknown. The abnormality high levels of infection and in particular loosening are related to the extent to which the lesions have progressed. Resection of these prosthesis in cases of failure is similar to resection of the head and neck, and has its place as a salvage operation since its allows mobility and pain relief to be obtained at the price of stability.


[A test for acute hypocalcemia using swine and salmon calcitonin]. The production of acute hypocalcemia was investigated using either 80 U. MRC of salmon calcitonin or 160 1. mrc of pork calcitonin in 117 subjects (58 patients with Paget's disease, 22 with osteoporosis, 22 with Sudeck-Leriche algodystrophy and 15 control subjects). The results obtained with the two types of calcitonin did not differ. Induced acute hypocalcemia was more pronounced in patients with Paget's disease than in the other subjects studied. In patients with Paget's disease there were statistically significant correlations between the hypocalcemia produced and the initial levels of alkaline phosphatase and total 24 hours urinary hydroxyproline.


[Differential diagnosis betwen Gougerot-Sjögren syndrome and sialadenosis using quantitative scintigraphy of the salivary glands]. The symptoms of both Gougerot-Sjögren's syndrome and sialadenosis consist in a reduction of salive and tear production. Sialadenosis is either essential or secondary to the intake of certain drugs. As it is sometimes difficult to differentiate between the two diseases a new quantitative scintigraphic method is proposed, where the activity over the salivary glands is compared with a neutral zone. This method has been validated with control sialography and parotid biopsies and permits an easy differentiation between the two conditions.


[Primary hyperparathyroidism. Our experience with 30 cases]. The authors analysed thirty cases of hyperparathyroidism seen between 1969 and 1975 at Centre Hospitalier Universitaire at Poitiers. They noted the similarity of their observations with those which have generally been made in this condition. The only peculiarities of this study were a low incidence of calculi and a particularly high incidence of chance discovery by routine blood calcium measurement. The diagnostic value of blood calcium levels and blood citrate levels is confirmed in the same way as the advantage of a quantitative bone biopsy even although a few false positives limit the specificty of the test.


Stimulation of anti-influenza serum antibody formation in the rat using bovine thymus polypeptide extract. The authors show that a thymus polypeptide extract, TP1, prepared by them has the effedt of stimulating the formation of anti-influenza serum antibodies and do not show antigenic properties. The extract causes increase of serum lymphocytes. Electrophoretic analysis in polyacrylamide gel reveals a number of 11 fraction, while paper chromatography for amino acids, a number of 12 spots.


L-proline loading for the assessment of pituitary GH reserve. Intravenous insulin (0.1 U/kg body weight) and oral 1-proline (100 mg/kg body weight) tolerance tests were performed in 22 healthy and 30 short-statured children and adolescents and blood glucose, serum immunoreactive growth hormone (GH), immunoreactive insulin (IRI) and 1-proline were determined. The peak level of serum GH was significantly higher following insulin than after 1-proline. The proline loading correctly identified the normality of GH axis in 12 out of 22 controls and in 3 out of 7 normopituitary short-statured patients. The serum 1-proline levels consideration did not improve much the ability of 1-proline load to detect either the normal GH responsiveness or the pituitary insufficiency. The mechanism of GH stimulatory properties of 1-proline in some healthy subjects is not known.


Seasonal and circadian modifications in the RNA concentration in rat adrenals after swimming effort. Variation of the adrenal RNA as a reaction to standard physical effort--30 min. of swimming daily for 5 successive days-was studied on adult male white Wistar rats in relation to the season and the hour at which the physical effort was made. The relationship between the seasonal variation and the adrenal adaptation response to swimming was followed up in the interval between March 1972 and December 1974; the circadian variation was examined at 0600, 1200, 1800 and 0000. 1. The circannual differentiation in the response to effort is expressed in the increase of the adrenal RNA concentration, statistically non-significant in spring, maximum in summer and statistically significant in autumn; in winter, the RNA concentration, by its significant decrease as against the controls, expresses an inversion of the adrenal response to effort. 2. Within a 24-hour period the increase in the adrenal RNA concentration under effort is maximum at 1800 and generally higher at night. The fundamental chronobiologic structure of the species seems to interfere significantly the adrenal adaptation to physical effort.


Thyropathic endemic dystrophy in an area of the Argeş Valley. The authors carried out a clinical, chemical and medico-social study of an endemic focus in the Argeş Valley. Iodine deficiency and partially water hardness constitute the main goitrogenic factors. Owing to the curative-prophylactic means, the goitre frequency substantially decreased in school children (from 98.5% in 1949 to 18.3% in 1969) and serious forms of the third degree did not occur in the last 14 years. A certain percentage of diffuse goitre still remains in school children besides the residual pathology before the iodized prophylaxis. In the period when the prophylaxis with KI (potassium iodine) troches was neglected, a slight increase of goitre frequency was found in the investigated groups.