Studies on the functional morphology and ecology of the atyid prawns of Dominica. Six species of atyid prawns, representing five genera, occur in streams on the West Indian island of Dominica (figures 1-6). The ecology and habits of each are described and the relation of features of gross morphology to ways of life noted. Xiphocaris elongata, the most primitive living atyid, is a lightly built prawn whose adult habits are related to life in quiet pools in streams. An agile species and an excellent swimmer, it picks up individual small food particles with specialized chelipeds (figures 18 and 19) that differ from those of all other atyids and manipulates them with mouthparts (figure 77) which, while highly complex, are more primitive than those described for any other member of the family. Atya innocous and A. scabra, representing perhaps the most specialized atyid genus, are very similar in gross morphology and are robustly built ambulatory species. A. innocous is common in a variety of situations: A. scabra is rare and has been found only in fast-flowing water. Both have chelipeds whose three distal segments are extremely specialized (figure 36) and whose propus and dactylus are armed with an exceedingly complex array of long, slender bristles. These can be used either as brushes for collecting finely particulate detritus (figures 58-60) or as filtering fans (figures 68 and 69) which, held passively in flowing water, extract suspended particles. The Atyidae is unique among the Malacostraca in having representatives that filter passively by means of the chelipeds. The bristles (figure 40) are extended (figure 49), not by muscles, of which there are none in the distal parts of the propus and none anywhere in the dactylus, but by hydraulic forces. The return of the bristles to rest is by means of a cuticular spring. Some of the bristles of A. innocous are armed distally with minute denticles (figures 41 and 42) that facilitate scraping and sweeping: no such are present in A. scabra. The difference is related to the relative importance of scraping in the two species: A. innocous scrapes frequently, A. scabra seldom. Finely particulate food is transferred and manipulated by the extremely complex oral machinery (figure 78). One of the most elaborate parts of this is a teaselling device in which components of the maxillae and first maxillipeds participate (figures 80 and 81). The feeding mechanism is described. Morphologically and functionally Micratya poeyi can be regarded as a miniature version of Atya. It can both sweep and filter. Potimirim glabra is rare in Dominica and its habits but little known. Morphologically it is similar to, but more primitive than, Micratya. Its cheliped bristles are clearly specialized for sweeping and show few signs of being used for passive filtration. Jonga serrei occupies a separate and well-defined niche in the quieter parts of streams. For this it shows many morphological specializations and lacks such attributes as stout claws and robust walking legs that are the hallmark of its relatives living in fast-flowing waters.


Effect of cane on variables of gait for patients with hip disorders. The purposes of this study were to determine the effect of a cane, used in the hand contralateral to the involved hip, on patients' floor reaction forces and on selected time and distance measurements of gait. An instrumented cane, force plate, dynograph recorder and footswitch were among the equipment items used. When the patients walked with a cane the stride length and swing times were increased, while the cadence and the vertical component of the floor reaction force were decreased. The average peak axial loading on the can was 11.6 kg and the average anterior bending moment on the cane was 67.3 kgcm.


The effect of proprioceptive facilitation patterning upon reaction, response, and movement times. The purpose of this study was to determine the effect of proprioceptive facilitation upon reaction time, movement time, and response time. Reaction time, response time-one (flexion at shoulder, extension at elbow); response time-two (flexion, adduction, external rotation at shoulder, elbow flexion), and movement time (response time-two minus reaction time), were measured before and following a training session. Fifteen women and 27 men were randomly assigned to one of the following training groups; weight training, target throwing, and proprioceptive facilitation patterning. Subjects engaged in three training sessions a week for six weeks. Analysis revealed a significant improvement for the proprioceptive facilitation patterning group in response time-two and movement time.


The influence of isometric exercise and passive stretch on hip joint motion. A method was designed to compare the effects of isometric contractions and passive stretch on modifying joint range of motion in 30 normal men. Subjects were randomly assigned into a control group, a passive stretch group, or an isometric contraction group. Each subject assumed a left sidelying position on the force table. Stabilization was applied to the pelvis and left lower extremity. The cuff, to which the force cable was attached, was applied to the right lower extremity. Force measurements produced by the isometric contractions or passive stretch procedures were stored on computer tape. The results of the mean differences in pelvifemoral angle measurements indicated that both treatment groups significantly increased their range of passive hip flexion with the knee extended when compared to the control group. Comparisons between the two treatment groups indicated that the isometric contraction and passive stretch procedures had significant and similar effects.


Results of the Wilke operation to stop drooling in cerebral palsy. Bilateral submaxillary gland excision and posterior transplantation of the elongated parotid ducts (as advocated by Wilkie) has proved to be an excellent procedure in the surgical treatment of drooling. I report a series of 20 patients who had excellent results from this, with amelioration of the drooling and minimal postoperative complications.


Use of tarsal plate resection in blepharoplasty on atonic lower lids. We did blepharoplasties with tarsal plate resections on 24 lower lids in 13 patients, two of whom had an established ectropion and 11 of whom had a tendency to a lax ectropion. No ectropion developed in these high risk patients. The tarsal plate resection may be useful for an established atonic ectropion, or in a primary blepharoplasty or in secondary blepharoplasty patients with atonic lower lids. It should not cause detectable scarring.


Blepharoplasty in patients with an anophthalmic orbit. Blepharoplasty in the patient with an anophthalmic orbit is discussed. The different principles involved in dealing with lids on the normal side and the anophthalmic side are outlined.


Correction of cleft lip nasal deformity. A refinement of an older method. A method to correct the cleft lip nasal deformity is described. It consists of complete mobilization of the alar cartilage, and keeping it in position with two lifting thread loops which are anchored to the dorsal part of the septal cartilage.


The study of hematomas in 500 consecutive face lifts. Our incidence of hematoma in 500 consecutive face lifts was 2.6 percent, of which 1.6 percent were severe enough to need evacuation. This incidence of hematoma correlated well with the blood pressures of patients on admission; when the pressure was above 150/100 mm Hg on admission, hematoma occurred 2.6 times more frequently than in normotensive patients. Our premedication regime and hypotensive therapy was effective in reducing preoperative hypertension to normotensive levels in most, but not all, patients. However, this reduction of the postoperative blood pressure to normal levels did not prevent hematoma formation entirely.


The pathogenesis of premature craniosynostosis in acrocephalosyndactyly (Apert's syndrome). A reconsideration. A detailed examination of a stillborn fetus with Apert's syndrome showed several unexpected findings, which prompted a reevaluation of the heretofore generally accepted hypotheses regarding the cause of the dysmorphic craniofacial features in this syndrome. (1) The characteristic clinical features of Apert's syndrome were present at 24 to 26 weeks of gestation, and presumably much earlier. (2) However, there was no evidence, clinical or histological, of premature fusion of any of the cranial sutures or basilar synchondroses in this fetus. From our observations, and from a critical review of the literature, we conclude that the characteristic craniofacial malformations of Apert's syndrome are not caused by premature fusion of the cranial sutures, as has been commonly postulated. Rather, a malformation of the skull base is the most likely primary morphological event, and it leads to the characteristic dysmorphic facies, then secondarily to premature craniosynostosis. We believe the nature of the malformation is related to an abnormality in the bones which comprise the cranial base base (e.g. the sphenoid, ethmoid, and occipital bones) and to abnormal spatial relationships between the cribriform plate and the crista galli, resulting in a positional disarrangement of the points of basal attachment of the dura matter. The latter, then, precludes the normal response of the neurocranium to the forces produced by the growing brain. The synostosis is viewed as a symptom, rather than as a cause, of the dysmorphic craniofacial features typical of Apert's syndrome.


The effects of steroid instillations and hematomas on the pseudosheaths around miniature breast implants in rats. In a controlled study in rats, neither the instillation of steroids nor the presence of hematoma alone had a significant effect on pseudosheath thickness or on the intra-prosthetic pressure of mammary implants. The presence of hematoma plus steroid instillation did, however, cause an increased intra-prosthetic pressure, but these did not cause a change in the thickness of the pseudosheath.


Metastatic basal cell carcinoma. Report of four cases. Four cases of metastasizing basal cell carcinoma, one occurring in the basal cell nevoid syndrome, are presented. Two patients are surviving without evidence of additional metastases. One patient died from cerebral involvement 31/2 years after a lymph node metastasis was established by aspiration biopsy. One patient died from complications of cerebral palsy one year after a metastasis to a regional lymph node was discovered in the primary resection of the neoplasm. Only 90 cases of metastases from basal cell carcinoma have been reported previously.


Cor pulmonale secondary to cleft palate repair. Case report. A case of cor pulmonale occurred as a complication of a simultaneous palatoplasty and a superiorly-based pharyngeal flap. The patient, like two others found in the literature, had micrognathia. The cor pulmonale was not recognized in the immediate postoperative period but presented two years later with "failure to thrive." Therefore, surgeons must make other members of the health care team aware of this possible complication of combined palatoplasty and pharyngeal flap operations.


Esthesioneuroblastoma. Case report.

Esthesioneuroblastoma. Case report. We present a case of esthesioneuroblastoma, and we emphasize the importance of considering this tumor in the differential diagnosis of primary intranasal carcinomas. Although the tumor is uncommon, we feel that many cases have been misdiagnosed histologically. The typical history in these patients is one of intermittent recurring epistaxis or nasal destruction and frequently, at the time of the initial examination, the tumor has reached a considerable size with evidence of local invasion.


[Morphometric differentiation of tumor and inflammation in angiography (author's transl)]. The angiographic differential diagnosis of malignant, benign and inflammatory lesions should be facilitated by mathematical analysis of the underlying vascular structure. A rotating screen with parallel lines -- especially developed for this purpose -- is used for the first time to verify statistically essential criteria in tumor diagnosis. Random samples are taken from 2 kidneys with severe inflammatory lesions and 1 hypernephroma in order to extract mathematical indices for fluctuation of caliber, vascular avulsion, change of direction and diameter. The index for the flucutation of caliber is the single most important criterion to differentiate the vascular structure of tumor and inflammation.


[Experimental studies on tumor vascularization (author's transl)]. The development of tumor vascularization of subcutaneously and intramuscularly implanted myelosarcoma I 58 of the rat was investigated. Various stages of tumor development were studied by arteriography, venography and microangiography. The roentgenographic signs known intravital angiography are related to the temporal sequence of the tumor development. The most significant signs during the period of observation are increase of number, dilatation and winding of arteries and veins in the tumor area. These alterations are observed earlier and more pronounced at the veins. Following subcutaneous tumor implantation, in all developmental stages there is a concentric arrangement of the tumor vessels with a dense peripheral tumor vascularization around an avascular tumor center. Contrary to this, following intramuscular tumor implantation, diffuse penetration of the tumor with vessels is observed. A peripheral vascularization type occurs with necrosis which is combined by an avascular tumor center. Already in the medium stage of tumor development signs of arterio-venous shunts occur regularly. Central tumor necrosis leads to extravasation of contrast medium which is known as a late tumor sign. The vascular pattern of the myelosarcoma T 58 is not only determined by the temporal sequence but also by the location of the tumor.


Angiography in giant cell tumors.

Angiography in giant cell tumors. Angiography in 9 cases of giant cell tumors of bone is described. All cases had a greatly increased vascularity of the lesion, with concomitant increase in the diameter of the supplying arteries and draining veins. The arterial branching on the surface as well as within the tumor seemed specific of giant cell tumors. Arteriovenous shunting was marked. There was a marked, long-lasting, non-homogeneous tumor stain. Examination with angiotensin enhanced the pathologic findings. The angiographic appearance, often simulating malignancy, combined with the appearance of the skeletal films, make the diagnosis of giant cell tumor almost certain. Difficulties will be expereinced in differentiating giant cell tumors from metastatic deposits, especially in the spine.


[Pelvic phlebography by injection of contrast medium into the profundal dorsal penis vein for evaluation of tumor spread in cancer of the urinary bladder and prostate (author's transl)]. 1. Tumors with infiltration of the mucosa and submucosa (T1) as muscularis (T2) do not cause anatomical alterations of visceral and parietal pelvic veins, as numerous phlebographies have confirmed. Internal pudendal veins and vessels of the bladder and prostate are involved in all patients with infiltration of bladder tumors into the paravesical tissue or prostate. -- 2. Phlebographic signs for metastatic lymph node involvement in carcinoma of the urinary bladder were observed in 24.5% (T2 in 11.7%, T3 in 33.8%, T4 in 25% of cases). These lesions were absent in tumors which involved the mucosal and submucosal layers (T1) only. -- 3. Alterations of the venous plexus depend on the extent of malignant infiltration in carcinoma of the urinary bladder. These can be recognized in stage II. -- 4. Pelvic phlebography may be helpful in differentiation of carcinomas and adenomas of the prostate.


Radiologic manifestations of pelvic lipomatosis. Ten male patients with pelvic lipomatosis are herein reported and the clinical and radiological features of the disease are reviewed. The main criteria for the preoperative diagnosis of pelvic lipomatosis include: a) radiolucency of the pelvic soft tissues with a normal to slightly increased vascularity on pelvic arteriography; b) deformity and anterior deviation of the urinary bladder together with various degrees of obstructive uropathy; and c) tubular narrowing of the rectum and upward displacement of the sigmoid colon and small intestine. The associated symptoms are usually variable degrees of dysuria, constipation, and frequently hypertension. Surgical excision of the pelvic lipomatous tissue is of limited value in the management of this disease.


[The merits of transaxillary aortography with a special catheter (author's transl)]. 230 percutaneous transaxillary aortographies are described using a new type of catheter which simplifies the catherterization and diminishes complications. There is no difference between the complication rate of the transaxillary and the transfemoral techniques. The translumbal approach shows significantly more serious complications. Transaxillary rather than translumbal aortography seems to be the examination of choice in patients with bilateral femoral artery occlusive disease.


Tumor vessels. Angiographic-histopathologic correlation. The operative or autopsy specimens of 20 cases of renal carcinoma, 10 cases of pancreatic carcinoma and 10 cases of malignant glioma were studied histopathologically and compared with the in vivo angiographic findings. The study was focused on the presence or not of newly formed tumor vessels trying to eludicate if the abnormal vessels seen on angiography are newly formed tumor vessels or altered preexisting vessels.


Recurrent effusion in the synovectomized knee joint. This report concerns a number of patients affected by recurrent effusion of the knee joint. Synovectomy was performed on 62 knees representing various diagnostic groups, e.g. indefinite synovitis, chronic effusion induced by osteoarthritis, effusion caused by traumatic lesion, synovitis of rheumatoid origin, pigmented villonodular synovitis and tuberculous synovitis. 47 knees were inspected at a follow-up study after 5 years (on average). Good results were noted for 36% of the patients, fair results for 45% and poor results for 19%. The best results were achieved in the following diagnostic groups: indefinite synovitis, synovitis caused by traumatic leasion, and synobitis of rheumatoid origin. On the whole, the results were somewhat better after subtotal than after partial synovectomy.


Dissociation of acetylsalicylic acid in blood and joint fluid. Assay method in blood of 30 patients, who had ingested 0.6 g buffered aspirin, showed earlier appearance of acetylsalicylate (ASA) than of de-acetylated salicylate (SA); the values for ASA averaged 7.7 min, and for SA, 10.9 min. Similarly in joint fluid, ASA appeared earlier than SA; the values of ASA averaged 19.4 min, and those for SA, 21.9 min. Transport times did not differ significantly between ASA and SA in most types of synovitis. Close to maximum concentrations in blood averaged 18.9 mg/l for total salicylates (TSA), 3.3 mg/l for ASA, and 23.3 mg/l for SA, whereas maximum concentrations in joint fluid averaged 15.7 mg/l for TSA, 2.5 mg/l for ASA, and 14.5 mg/l for SA. ASA in blood initially consituted 65% of TSA and decreased to less than measurable amounts 75 min after intake. Joint fluid initially contained a somewhat smaller maximal proportion of ASA, but de-acetylation progressed more slowly than in blood; ASA decreased to undetectable levels within 140-145 min after intake.


Chemical synovectomy with Varicocid in rheumatoid arthritis--further results. Varicoid was administered to 170 patients with rheumatoid arthritis, to 11 patients with a diagnostically uncertain monarthritis, to 12 patients with exudative gonarthrosis and also to 4 patients with lupus erythematodes visceralis. A total of 262 joints were treated. The short-term results, which were evaluated 4 weeks after the administration of Varicocid, revealed improvement is 95% of the patients. After 12 months, 46% of the patients were found to be free from symptoms within the area of the treated joint, and 33% of the patients showed a considerable improvement. An objectively evident improvement was found in 35 out of 40 patients with rheumatoid arthritis followed up over a period of 3 years. Comparable results after treatment with Varicocid were also obtained in patients suffering from any one of the above-mentioned rheumatic diseases. A new inflammation activity/function index for the evaluation of the local joint therapy has been used. The first investigations both of function and of morphology of the synovial membrane treated with Varicocid are reported. In our opinion, chemical synovectomy with Varicocid fills a gap in the therapy of the rheumatoid arthritis. The essential value of this type of therapy is the absence of toxicity, a temporary increase in local reactions only, and also a continuous improvement, especially in early cases.


Glycosaminoglycans in human articular cartilage of the lower femoral epiphysis in osteoarthrosis. Biopsy specimens of human articular cartilage were taken from the caudal summits and from the posterior part of both epicondyles of the right lower femoral epiphysis of 20 individuals within 12 hours post mortem. 12 articular surfaces were normal and 8 included changes attributable to osteoarthrosis. In one individual with osteoarthrotic changes the articular cartilage surface was subjected to a more detailed study. CPC- and ECTEOLA-cellulose column chromatography of glycosaminoglycans was performed and the content and collagen contents were determined. A reduced ratio of chondroitin to keratan sulphates in articular cartilage was found to be related to age. In osteoarthrosis this change was more pronounced and both chondroitin sulphate and keratan sulphate were of lower molecular weight and/or sulphate content. On approaching eburnized cartilage surfaces, decreasing concentrations of glycosaminoglycans were found, concomitant with a corresponding increase in non-collagenous proteins. No change in hyaluronic acid concentration was found with advancing age or in osteoarthrosis.


Association of bacteriuria and rheumatoid factors in a population sample. To obtain further information on the possible association of bacteriuria and RFs on the population level, an epidemiological study was carried out among middle-aged women in a rural area. Fifty-five of ther 1223 women aged 40-64 years had bacteriuria and 31 were under treatment for urinary tract infection. The latex test was twice as often positive among the bacteriuria women as among the persons under treatment and the age-matched controls. The association was noted in the same way in persons with symptoms and signs suggestive of RA and in those with no evidence of this disease.


Neutrophil function in rheumatoid arthritis. In order to determine the endocytic ability and metabolic capacity of polymorphonuclear neutrophils, 45 patients with rheumatoid arthritis were compared with a series of control subjects. Two in vitro tests were performed in each patient: the phagocytic index (Brandt's technique) and the nitro-blue tetrazolium reduction test (Braehner & Nathan's technique). These two tests show a significant decrease in comparison with controls, the NBT reduction being modified only in stimulated leukocytes. This finding, in contrast to previously reported studies based on different techniques, underlines the existence of a functional modification of blood polymorphonuclear neutrophils in rheumatoid arthritis.


The status of the gene map of the human chromosomes. In man, the specific chromosome that carries each of about 210 gene loci is known. These loci include at least one assigned to each chromosome (including the Y), about 110 assigned to specific autosomes, and about 100 to the X chromosome. For many loci, information on regional chromosomal localization is also available. The information comes mainly from studies in families and somatic cell hybrids, as well as an intgratsight of results from the two methods. Knowledge of the chromosome map gives insight into evolution, chromosomal organization in relation to genetic control mechanisms, and the pathogenesis of neoplasms and malformations. Furthermore, it is useful in prenatal or premorbid diagnosis of hereditary diseases.


Laser interferometer measurement of changes in crayfish axon diameter concurrent with action potential. Small rapid changes in the diameter of an axon takes place when an action potential progresses along the axon. In the giant axon of the crayfish these occur within a period of about 1 millisecond and are typically about 18 angstroms in total amplitude.


Elemental sulfur: accumulation in different species of fungi. Sulfur, in elemental form, is present in several fungi especially in self-inhibited and resting structures such as dormant spores and sclerotia. The possible importance of sulfur in fungal spore dormancy is discussed.


A luminous bacterium that emits yellow light. A strain of Photobacterium fischeri that emits yellow light has been isolated from seawater. The bimodal spectrum, which is unique among the luminous bacteria, consists of a major band with a maximum at 545 nanometers and a minor band with a maximum at 500 nanometers. The former represents a heretofore unreported range of emission for luminous bacteria, while the latter coincides with the emission spectrum of typical blue-greeen-emitting strains of P. fischeri. The relative contributions of these two bands to the total in vivo luminescence changes as a function of ambient temperature. When luciferase is extracted and luminescence observed in vitro, the emission is entirely blue-green, identical with that of luciferase isolated from other strains of P. fischeri.


Major innervation of newborn rat cortex by monoaminergic neurons. A major monoaminergic innervation in infant rat neocortex, predominantly in layer IV, has been demonstrated by ultrastructural and biochemical studies after the administration of exogenous catecholamine precursors and congeners. One-third of all cortical synapses have an uptake-storage mechanism for catecholamines. In newborn cortex, the storage capacity for catecholamines is tenfold greater than the endogenous levels, and the uptake-storage mechanism matures earlier than the ability to synthesize neurotransmitter.


Trigeminal substrates of intracranial self-stimulation in the brainstem. Intracranial self-stimulation was elicited by electrodes located in the trigeminal motor nucleus of the rat. Rebound jaw movements were also elicited at postiive self-stimulation placements, but control experiments revealed that the lever pressing was not a motor artifact. It is suggested the modulation of trigeminal motoneurons may serve as an important reinforcement mechanism in the brainstem.


Assortative mating by unwed biological parents of adopted children. Analyses of data obtained from 662 unwed couples whose children were relinquished for adoption reveal that biological parents of adopted children mate assortatively. For physical characters, assortative mating of unwed parents was similar to that of wed parents; for behavior characters, however, there was less assortative mating by the unwed parents. Because assortative mating inflates estimates of genetic parameters in adoption studies, future studies should collect information on both biological parents.


Vibrotactile pattern perception: extraordinary observers. Two sighted peopled showed a remarkable ability to perceive vibrotactile patterns generated by the Optacon, a reading aid for the blind. These individuals were able to read at very high rates, 70 to 100 words per minute, through their fingertips. Additional testing showed them to be much better than other people at discriminating and recognizing vibrotactile patterns.


The elusive rise in the American birthrate. In summary, (i) neither an immediate nor a dramatic increase in fertility will be required during the next few years for young married women to realize their family-size expectations; (ii) annual fertility trends in California do not provide a useful indicator of annual fertility trends at the national level; (iii) recent economic trends appear to merit considerable attention in an assessment of furture fertility prospects. An examination of recent economic conditions suggests that a substantial increase in annual fertility is unlikely to occur immediately. It would be more likely to occur when the current unfavorable economic conditions have been eliminated.


Myasthenic immunoglobulin accelerates acetylcholine receptor degradation. Degradation of acetylcholine receptors by cultured rat skeletal muscle cells was determined from the release of 125I from bound 125I-labeled alpha-bungarotoxin. Addition of immunoglobulin from patients with myasthenia gravis to the culture medium accelerated the degradation rate to a mean of 8.51 +/- 0.44 percent per hour, compared with the mean control rate of 3.97 +/- 0.14 percent per hour (P less than .001). A similar mechanism may possibly be involved in the autoimmune pathogenesis of myasthenia gravis in man.


Venereal transmission of La Crosse (California encephalitis) arbovirus in Aedes triseriatus mosquitoes. Veneral transmission of La Crosse virus by males of Aedes triseriatus was demonstrated. La Crosse virus was detected in the bursa of females after induced copulation, and disseminated infection was shown to occur occasionally. Since males of Aedes triseriatus have transovarial filial infection rates similar to those of females and can repeatedly mate, veneral transmission may be an important supplement to other natural endemic maintenance mechanisms.


Internal calcium changes in a bursting pacemaker neuron measured with arsenazo III. Arsenazo III was used to measure changes in the free intracellular calcium concentration during spontaneous bursting pacemaker activity in the Aplysia R1K neuron. Intracellular calcium increased during the burst, and this increase was sufficient to cause the hyperpolarization that followed. The results suggest that the interval between bursts is determined by the rate of subsequent decline of free intracellular calcium.


Denervated skeletal muscle fibers develop discrete patches of high acetylcholine receptor density. Denervated skeletal muscle fibers of mice develop discrete patches of high acetylcholine receptor density. The patches vary in size from less than 1 micrometer up to 30 micrometers, depending on the muscle and the period of denervation. Within the patches the acetylcholine receptor density is some 20 times greater than elsewhere along the muscle fiber and probably approaches that in the subsynaptic membrane.


Partial denervation affects both denervated and innervated fibers in the mammalian skeletal muscle. Partial denervation of the rat extensor digitorum longus muscle was performed by sectioning only one of the sciatic nerve roots. Measurements of spike resistance to tetrodotoxin in individual muscle fibers revealed denervation changes not only in the denervated fibers but also in the adjacent innervated ones. The results support the concept that products of nerve degeneration play a role in the origin of muscle changes induced by denervation.


Schedule control of behavior reinforced by electrical stimulation of the brain. Electrical stimulation of the brain was used to train rats to respond on random interval schedules. Stimulation was either delayed for 0.5 second and preceded by a brief signal, delayed and unsignaled, or presented contiguously with the response. In every case, responding was maintained on schedules and showed resistance to extinction typical of food-reinforced responding. Priming was never necessary. These data cast doubt on the generality of beliefs about the behavioral effects of brain stimulation reinforcement.


Levodopa, fertility, and longevity.

Levodopa, fertility, and longevity. High concentrations of the dopaminergic drug levodopa (L-dopa, L-3,4-dihydroxphenylalanine) administered to mice in their diet affected fertility to a moderate degree and prolonged the mean life-span by a maximum of 50 percent.


Classical conditioning with auditory discrimination of the eye blink in decerebrate cats. Cats were subjected to complete lower brainstem transection, and were then tested for learning ability according to a classical conditioning paradigm. An auditory stimulus was systematically paired with a brief shock to the eyelid. Within a few weeks after the operation, the decerebrate cats could learn the conditioned response with a tone frequency discrimination and then a discrimination reversal. Our results support the notion that the brainstem reticular formation can support a conditioned response which isbehaviorally similar to that obtained in the intact animal.


Vacuum aspiration: an efficient outpatient screening technic for endometrial disease. In an effort to find a safe, efficient, and inexpensive means of ruling out the existence of a neoplastic process causing abnormal vaginal bleeding form the uterine cavity, 103 patients over 34 years of age had preoperative aspiration (Vabra aspirator) of the endometrial cavity. The tissue obtained at the time of D&C and hysterectomy was correlated with that obtained by the outpatient diagnostic procedure. In this pilot study, the aspirator was 98% accurate in evaluating high-risk women with abnormal uterine bleeding for malignant disease. In the two neoplasms missed, both women had had a recent D&C.


Acute hypertension after abrupt withdrawal of antipsychotic medication. An 18-year-old patient with catatonic schizophrenia developed hypertension when administration of antipsychotic medication was discontinued. Elevated blood pressure was sustained for three days until it was discovered that intramuscular administration of benztropine mesylate immediately reduced it to normal. The fact that the hypertension was not noted earlier while the patient was receiving the antipsychotic drugs suggests that it was a withdrawal phenomenon.


Otolaryngology in the medical school curriculum. Whether the family practitioner will emerge as the primary physician in the area of otolaryngology, with the specialist relegated to either a secondary or tertiary role, remains as yet unsettled. Given the uncertainty of the future place of otolaryngology in general health care, more attention should be placed on teaching otolaryngology to medical students.


Detecting ventricular arrhythmia after myocardial infarction: comparison of Hoiter monitoring and treadmill exercise. The effectiveness of Holter monitoring is compared to modified treadmill exercise for detecting ventricular arrhythmia in 54 patients during the third week after a documented myocardial infarction. Treatment with digoxin and antiarrhythmic agents had been discontinued for 48 hours. Whereas 76% of the patients had no PVCs during treadmill exercise, only 7% were free of PVCs during Holter monitoring. Complex PVCs occurred in 37% of the subjects during Holter monitoring and in 4% of the subjects during treadmill stress. Although Holter monitoring was significantly more reliable in detecting ventricular arrhythmia, assessment of exercise tolerance and angina status during modified treadmill stress makes both technics desirable in carefully selected patients awaiting discharge from the hospital after myocardial infarction.


Irradiation failures in cancer of the larynx. A series of 116 laryngeal carcinomas treated definitively with irradiation over a 9 1/2-year period is presented. By preliminary follow-up, there have been 20 recurrences, for an initial treatment failure rate of 17%. Of the 20 patients with recurrence, 16 had salvage surgical procedures. Four of the 16 surgical wounds (25%) presented complications. Eleven of the 16 patients having salvage attempts are thus far free of disease. The initial treatment failure rate of 17% has thus been lowered to 7.8% at preliminary follow-up.


Hypopituitarism: a complication of diabetes. Hypopituitarism is a rarely reported accompaniment of diabetes mellitus. Autopsy studies suggest, however, that pituitary lesions are ten times more common in diabetics than in nondiabetics. Three cases of diabetes with hypopituitarism are reported. We believe that clinically important hypopituitarism may occur more commonly than is suspected in diabetes and that the diagnosis should be sought more aggressively.


Acute postinfectious crural myalgia in children. An outbreak of acute crural myalgia in children is reported. The severe calf pain followed an influenza-like episode, with subsequent complete recovery. Laboratory studies in most cases showed elevated creatine phosphokinase and SGOT values, with a low peripheral white blood cell count. Electromyographic studies were normal. Results of one muscle biopsy were normal. This postviral myalgia is a distinctive syndrome only recently being recognized in the United States.


Medicolegal implications of the incompetent, errant, and "sick" physician: changing times. A great deal of publicity has been given recently to the problems and consequences of incompetent and errant physicians. There has been great clamor on this subject from many sources-the medical profession, the legal community, the legislatures, the judiciary, and the public. All of these interested parties have undertaken studies to evaluate the nature and sources of the problem. Based on the knowledge thus acquired and on past experience, reforms have been suggested and implemented by each of the groups. The results of the studies and experiences are examined, and the remedies are outlined and analyzed in this paper. There is sufficient evidence to suggest that reforms are proving productive. Finally, the prognosis for the problem is explored.


Hematuria and sickle cell disorders.

Hematuria and sickle cell disorders. To examine the relationship between gross hematuria and sickle cell disorders, all patients admitted to Grady Memorial Hospital with the diagnosis of a sickle cell disorder during a 14-month period were reviewed. Of 115 such patients, 65% had sickle cell disease and 35% had sickle cell trait. None of the former but seven of the latter group had gross hematuria. Mean age of the seven was 30 years. Comprehensive examinations and laboratory studies showed that all were free of concomitant disease. Physical findings, diagnostic modalities, and treatment were reviewed. Findings suggest that conservative therapy (bed rest, hydration, and diuresis) is usually effective.


Primary carcinoma of the trachea: report of two cases. Primary carcinoma of the trachea is not common. Of 23 cases diagnosed as "carcinoma of the trachea" at our institution since 1949, 21 actually represented secondary involvement from carcinoma of the larynx, lung, or esophagus. The two cases of primary carcinoma of the trachea are presented. Discussed are the relation of histologic type to anatomic site, frequency of the more common histologic patterns, the poor prognosis associated with this cancer, and pertinent clinical and radiologic diagnostic tests and findings. More consideration should be given to this diagnosis, especially in a patient developing stridor, as so often this lesion is amenable to treatment.


Minoxidil-induced hypertrichosis: treatment with calcium thioglycolate depilatory. Minoxidil is a new, effective, investigational antihypertensive drug. A serious, cosmetic side effect in women is hypertrichosis. Five female patients with this complication had successful removal of the excessive hair with a calcium thioglycolate depilatory agent.


The effect of serum oncotic pressure on serum cholesterol levels: a study in "normal" and nephrotic subjects. Clinical data in neprtotic and nonnephrotic subjects were examined to help delineate the mechanism of hypercholesterolemia in nephrotic syndrome. Analyses of the relationship between total serum cholesterol and serum albumin levels and between total serum cholesterol and calculated serum oncotic pressure in 500 nonnephrotic individuals revealed strong positive correlations (r = 0.9714, p less than 0.001 and r = 0.9720, p less than 0.001, respectively). Serum beta-lipoprotein concentration was found to bear an inverse relationship to measured serum oncotic pressure in 13 nephrotic patients (r = -0.8192, p less than 0.01). Our results lend support to the thesis that serum oncotic pressure is the major governing factor in hypercholesterolemia in nephrotic syndrome.


Arthroscopy: its role in treating nontraumatic and traumatic lesions of the knee. Arthroscopy of the knee is a useful adjunct in the diagnosis and treatment of intra-articular disease. We reviewed 178 patients who had arthroscopy at Duke from November 1972 to May 1975. Anesthesia was either general or local with a block of the infrapatellar fat pad and the infrapatellar branch of the saphenous nerve. This experience demonstrated that arthroscopy was relatively rapid, increased the accuracy of diagnosis from 70% by clinical assessment alone to 96%, and influenced the management of the knee in 55% of the cases. In many instances, arthroscopy demonstrated major pathologic conditions not readily noted by prior arthrography, multiple roentgenograms, or physical examination. Arthroscopy does not eliminate the need for arthrography, although frequency of arthrography diminished as arthroscopic technics were mastered and equipment improved. Arthroscopy is valuable in the management of most knee problems. The surgeon undertaking the procedure must have adequate instruction and a wide and continued usage in order to become and remain adept.


Avoiding a pitfall in resuscitation: the painless cervical fracture. For the physician treating an injured patient, it is important to recognize fracture of the cervical spine without neck pain. Films of the cervical spine in patients with head or facial trauma, or patients who are unconscious, inebriated, or have multiple injuries, should be routine and are best obtained by portable technic in the emergency room before procedures requiring or resulting in cervical manipulation. The cost of cervical spine injury may be great for the patient, society, and the physician who fails to recognize it.


Pathogenesis of Kerley's B lines on the chest roentgenogram. A 36-year-old white man with gastric cancer manifested his disease clinically by respiratory distress and roentgenographically by Kerley's B lines. The pathogenesis of these lines and the importance of their recognition are emphasized.


Clinical and echocardiographic manifestations of a thrombosed Bjork-Shiley aortic valve. A 36-year-old woman with a Bjork-Shiley prosthetic aortic valve developed acute congestive heart failure and pulmonary edema. She was found to have a new diastolic murmur, absence of valve clicks, and an immobile prosthetic disk as shown by echocardiography. At surgery the valve, which was covered with fibrin and thrombus, was replaced, and she did well following operation.


Agenesis of the gallbladder--an inherited defect? Agenesis of the gallbladder is a rare anomaly believed to be an organogenetic failure. This is the third instance of familial agenesis of the gallbladder reported in the literature. The diagnosis of agenesis of the gallbladder can only be made during exploratory celiotomy and must be confirmed by an intraoperative needle cholecystogram. This congenital anomaly should be suspected when oral cholecystography shows a nonvisualizing gallbladder in relatives of any patient with proven agenesis of the gallbladder.


Perforating granuloma annualare.

Perforating granuloma annualare. Described is a 37-year-old male patient with signs and symptoms of localized perforating granuloma annulare (PGA) on the dorsa of his hands, fingers, elbows, and extensor forearms. PGA usually occurs primarily on the extremities, but the condition may be generalized. Review of the literature indicates that the cause and pathogenesis of this entity remain obscure. Sunlight may exacerbate PGA. Therapeutic success has been obtained with topical steroids with occlusion and with systemic prednisone. Our patient showed no response to liquid nitrogen but responded satisfactorily to topical steroids with occlusion.


The columnar-cell-lined (Barrett's) esophagus: a premalignant condition? A 65-year-old man developed adenocarcinoma arising in Barrett's epithelium of the esophagus. He died three months after unsuccessful surgery to remove the tumor. The columnar-cell-lined esophagus may represent a premalignant condition, and it is suggested that patients with this condition undergo regular follow-up examination.


Platypnea and hypoxemia in Laennec's cirrhosis of the liver. A patient with Laennec's cirrhosis of the liver presented with platypnea (dyspnea in the upright position relieved by a recumbent one), severe hypoxemia, and a hyperdynamic cardiovascular state. Diagnostic studies suggest that generalized vasodilatation and shunting account for these findings.


Hodgkin's disease presenting in epitrochlear lymph nodes. A patient who had clinical stage IA Hodgkin's disease involving a single group of epitrochlear nodes is presented. A few patients with this disease have been reported to have involvement of epitrochlear lymph nodes, but none have had disease limited to this nodal site. At staging laparotomy a single focus of Hodgkin's disease was found in the spleen. Theoretical aspects of the mode of spread of Hodgkin's disease are discussed with respect to this case.


Pulmonary dirofilariasis: another coin lesion. A 67-year-old woman with a long history of debilitating rheumatoid arthritis developed a peripheral coin lesion in the lower lobe of the left lung. A wedge resection was done and pathologic study revealed noncaseating granuloma secondary to rheumatoid infection with Dirofilaria immitis, a nematode. Although rare, canine dirofilariasis should be considered in the differential diagnosis of coin lesions.


Diseases in urban and rural Black populations. Diseases of urban and rural Blacks in South Africa are reviewed. In rural Blacks the major problems are infection and malnutrition. Other important disorders include cancer of the oesophagus, liver and cervix, and rheumatic heart disease and cardiomyopathy. The diseases in urban Blacks are those of a population in transition. Characterised by all gradations of socioeconomic development, from the relatively primitive to the completely westernised, these people exhibit a correspondingly wide and varied range of disease embracing the afflictions of rural dwellers and the new diseases of the city. Whereas the prevalence of some of the former, such as infection and malnutrition, is declining, they still constitute a considerable problem in urban Blacks. More important is the increasingly serious impact of the new disorders, which may be divided into two groups: (a) a large range and variety of alcohol-related disorders with serious effects at the social, economic, psychological and physical levels; and (b) most, if not all, of the diseases encountered in western populations. Some of these, such as obesity and hypertension, have not only attained epidemic proportions among urban Blacks, but their prevalence may actually have exceeded that among Whites. Other conditions, such as coronary heart disease, gout, gallstones and colonic cancer, which emerged later, are relatively uncommon or rare. A plea is made for much greater epidemiological research. This is necessary in order to obtain reliable knowledge of the prevalence of disease, to determine the best ways of applying present knowledge with existing and future resources, and to obtain knowledge regarding both old and new diseases of which the pathogenesis is still obscure.


A comparison of ornipressin and adrenaline for local vasoconstriction. The effectiveness of ornipressin and adrenaline as local vasoconstrictors is compared, with special reference to cleft-lip-and-palate surgery. A latent period of 3 - 5 minutes with the use of ornipressin is advised. A brief review comparing the local and general effects of ornipressin and adrenaline is included.


Paget's disease of bone (osteitis deformans) treated with human synthetic calcitonin. Thirteen patients with symptoms of active Paget's disease of bone, confirmed biochemically and radiologically, were studied. Each patient received a 6 months' course of therapy with human synthetic calcitonin (HCT), starting with 1 mg daily subcutaneously or intramuscularly for the first month and thereafter 3 times per week for 5 months. Twelve patients completed the course of therapy. Ten of the 12 patients derived moderate to great symptomatic improvement from their treatment. The improvement usually became evident 6 weeks after the start of treatment and this improvement persisted in 4 patients from 6 months to 1 year after treatment was stopped. The plasma alkaline phosphatase had fallen from the initial values by a mean of 26% after 6 weeks and 31% after 6 months of treatment. The urinary hydroxyproline likewise had fallen by 42% at 6 weeks and 46% at 6 months. Side-effects were generally mild and self-limiting, with flushing being the most common. It is concluded that human calcitonin is beneficial in the treatment of Paget's disease of bone and may prevent the problems of antibody resistance and allergic phenomena encountered with other preparations of calcitonin.


Experience with the EMIT method of determining anticonvulsant levels in serum. Clinical and laboratory experience with the EMIT immunoassay method for the determination of serum phenobarbitone levels is reported. A modification of the published laboratory method permitting manual operation in a general clinical chemistry laboratory was used. In 42 of the 75 children monitored, the serum levels of phenobarbitone indicated a change of the prescribed dosage.


Mucolipidosis III: two patients displaying genetic pleiotropism. Two Cape Coloured siblings with typical features of Hurler's syndrome, but without mucopolysacchariduria or mucopolysaccharide accumulation in tissues, are presented. The clinical features, in conjunction with raised beta-D-galactosidase and alpha-L-fucosidase levels in fibroblast cultures from one of the patients, suggest the diagnosis of a mucolipidosis. Theories relating to the intracellular deficiency and extracellular excess of lysosomal enzymes in these conditions are reviewed. Phenotypical and cell culture differences between 2 siblings who display the same overall clinical syndrome, illustrate the genetic pleiotropism inherent in this group of diseases.


Topical chemotherapy for burns using cerium salts and silver sulfadiazine. These experimental data indicate that cerium compounds exert a measurable antimicrobial action in vitro. In vivo the simultaneous use of cerium sulfadiazine and silver sulfadiazine was more effective than silver sulfadiazine alone or the combination of cerous nitrate and silver sulfadiazine. When cerous nitrate was used clically, gram-positive bacteria predominated. In contrast, wounds exposed to silver salts alone harbor a predominately gram-negative flora. The combination of cerous nitrate and silver sulfadiazine appears to provide a broad spectrum inhibitory to both types of organisms. It is apparent that a sampling problem exists in any attempt to monitor wounds that may exceed a square meter in extent. These bacteriologic data pertain only to the surface flora. The need to culture tissue samples of burn wounds has been emphasized. Our experience, however, is that invasion of deep tissue without dense surface colonization, greater than 10(5), is infrequent. Furthermore, fragments of eschar were submitted regularly for culture; those results confirmed the surface culture findins. The characteristic yellow-green color of cerium nitrate treated eschars may results from oxidation of trivalent cerium to yellow ceric ions. Free silver and sulfadiazine ions are available also in small amounts because of limited ionization of the highly insoluble silver sulfadiazine. This might promote the in vivo formation of cerous sulfadiazine and would provide a continuous source of ionic cerium for microbial inhibition. The modification of silver sulfadiazine cream by incorporating cerous nitrate into it strikingly enhances its topical antiseptic effect in burn wounds without increasing toxicity.


Delayed hypersensitivity reactions in patients with carcinoma of the colon and rectum. Two hundred and thirty-seven patients with carcinoma of the colon and 16 patients with benign lesions of the colon and rectum underwent skin tests with 2-4, dinitrochlorobenzene and a battery of intradermal antigens. The incidence of 2-4, dinitrochlorobenzene reactors decreased with the increasing stage of the disease. Seventy-six per cent of the patients with Dukes' A cancer were 2-4, dinitrochlorobenzene positive compared with 56 per cent of those with Dukes' B cancer and 61 per cent of those with Dukes' C lesions. Of the patients with advanced primary operable cancer, those who have metastases beyond the intestine and its mesentery, only 46 per cent were 2-4, dinitrochlorobenzene positive. Only 42 per cent of the patients with inoperable advanced or recurrent disease reacted to 2-4, dinitrochlorobenzene. Neither age nor sex was a determinate factor in the capacity of the patient to respond to 2-4, dinitrochlorobenzene. Tumor burden appeared to correlate best with the ability of the patient to respond to 2-4, dinitrochlorobenzene. In patients with Dukes' A or B lesions, the clinical follow-up period was too short to gauge prognostic significance of skin tests. In patients with Dukes' C lesions who were observed at 12 months, six of 11 in the 2-4, dinitrochlorobenzene negative group had a recurrence or died of disease compared with only four of 17 in the 2-4, dinitrochlorobenzene positive group, p less than 0.10. In 38 patients with advanced primary operable cancer who were observed for nine months, 40 per cared iwth 28 per cent of 2-4, dinitrochlorobenzene positive group. A similar relationship was observed in a group of patients with advanced or recurrent disease who were observed for nine months in which 58 per cent of the patients in the 2-4, dinitrochlorobenzene negative group were dead of disease compared with 40 per cent of those in the 2-4, dinitrochlorobenzene positive group. Skin testing with 2-4, dinitrochlorobenzene and selected intradermal antigens adds prognostic information to that predicted from the clinicopathologic stage of the disease in instances of carcinoma of the colon and rectum. In general, patients with reactive skin tests have more favorable recurrence and survival rates with each stage of the disease.


A ten year study of medullary carcinoma of the breast. In this large series of patients treated for medullary carcinoma of the breast by radical mastectomy, the over-all five year survival rate was 63.7 per cent and the ten year survival rate, 49.5 per cent. Although survival was adversely affected by axillary lymph node involvement, there was an equal incidence of such involvement, there was an equal incidence of such involvement in tumors less than 4 centimeters compared with those greater than 4 centimeters in size; however, patients with tumors greater than 4 centimeters in size fared poorer categorically than did those with smaller lesions. Women in the premenopausal period had one-third of the cancers and had a significantly better survival rate than did those in the postmenopausal period, despite a similar incidence of axillary lymph node involvement. Medullary carcinoma is among the small group of malignant tumors of the breast that have distinctly better five and ten year survival rates than other more common varieties.


The significance of intracapsular cultures in total hip operations. In a consecutive retrospective study of 1,500 total hip replacements, analysis of cultures taken at the time of operation revealed that positive cultures obtained in primary arthroplasties are not significant. In our series, no statistical difference could be demonstrated between primary and revision arthroplasty cultures as related to joint infection, but on the basis of other clinical studies and the higher incidence of positive cultures in revision arthroplasty cultures as related to joint infection, but on the basis of other clinical studies and the higher incidence of positive cultures in revision arthroplasties, it is believed that these cultures should be treated vigorously. Further studies are being carried out to help clarify the role of prophylactic antibiotics in hip replacement operations in the prevention of postoperative hip joint infection. Antibiotic therapy for the treatment of potentially contaminated hips is also being reviewed. Such studies must be performed over a long term period.


A study of polybutilate lubricated polyester sutures. In the 49 patients in whom polybutilate coated polyester sutures were used, no adverse side-effects, such as increased redness, tenderness, pain or edema of the wounds, were noted. Primary healing was achieved in each patient. There were no suture related complications encountered during the early or late follow-up examinations. Polybutilate coated polyester sutures were found to be easy to work with. They were strong, pliable and handled and tied with ease. They had no tendency to twist, tangle or adhere to gloves or instruments. Tissue passage through skin, fascia, arteries, veins and Dacron vascular grafts was better than it was with uncoated polyester sutures and as good as with Teflon coated sutures. No unusual drag, pull or catching of the sutures was encountered. Over-all, the polybutilate coated polyester suture is thought to be a safe, reliable and an easy to use material for a wide variety of surgical procedures for which a strong nonabsorbable suture is indicated.


Surgical significance of capsule invasion of adenoma of the thyroid. Capsule invasion observed in instances of adenomas of the thyroid was studied in correlation with the clinical course of the patients. The invasion, as defined in the cut-off and turn-out of the collagen fibers in the capsule, occurred in eight of 611 adenomas. The clinical course of the eight patients revealed no recurrence of an adenoma, even though there was no antitumor drug therapy. On the other hand, recurrences of adenomas were found in five of the 603 patients with noninvasive adenoma, of the 603 patients with noninvasive adenoma. Capsule invasion, therefore, is not a cause for the recurrence of an adenoma. The recurrence may result from the leaving of microadenoma in the thyroid when the first operation took place. Capsule invasion cannot be considered as a histologic sign of malignant tumor of the thyroid.


The operative treatment of Crohn's disease in childhood. Fifteen pediatric patients have been presented who required operative treatment for Crohn's disease. This disease is associated with severe side-effects in children, especially maturation and growth arrest. There are clear indications for surgical treatment: fistula, chronic obstruction, hemorrhage and perforation. Failure to grow, when associated with obstruction of the small intestine, is an urgent indication for operation. From our observations, we conclude that growth arrest in these patients occurs because of malnutrition. In a majority of patients, chronic obstruction of the small intestine contributes significantly to this malnutrition. Operative treatment is one of conservative resection, and the operative mortality is nil. The majority of patients with growth arrest will grow postoperatively. Operative treatment of Crohn's disease is carried out for its complications, and treatment is quite effective in relieving these complications, although the disease itself may persist.


The natural history of benign ulcer of the rectum. The cause of benign ulcer of the rectum is obscure, and there are varying views as to its pathogenesis. It is usually found to have a clinical onset in young adults of either sex. On sigmoidoscopy, the lesion has a characteristic appearance. The ulcers are, most often, solitary but more than one ulcer can be present. Diagnosis at biopsy is not essential, but distinctive changes can be seen in tissue from both the ulcer itself or the mucosa adjacent to the ulcer. Clinically and histologically recognizable preulcerative and nonulcerative phases are seen. Despite the benign nature of the ulcer, it may persist unchanged for many years, often associated with rectal prolapse. In general, medical and surgical methods of treatment have proved unsatisfactory.


Early prostaglandin release from the ischemic myocardium in the dog. Cellular consequences of myocardial ischemia were studied in anesthetized dogs. Confirmation of myocardial ischemia was provided by electrocardiographic and biochemical indexes. Prostaglandin F2alpha release into coronary venous blood was significantly elevated during myocardial ischemia, whereas indomethacin treatment prevented this increase in coronary venous prostaglandin F2alpha concentrations. No significant increase in prostaglandin E2 release was observed in response to myocardial ischemia, but indomethacin treatment significantly reduced coronary venous prostaglandin E2 concentrations below those of control values. Within one hour after occlusion of the coronary artery, the S-T segment was significantly altered, and coronary venous prostaglandin F2alpha had increased significantly above the control concentration. These changes persisted during four hours of myocardial ischemia. Plasma creatine phosphokinase activity increased significantly after two hours of myocardial ischemia and remained elevated for the subsequent two hours of ischemia. After four hours of myocardial ischemia, myocardial creatine phosphokinase activity of ischemic myocardium was significantly reduced, and labilization of myocardial treatment prevented increases in prostaglandin release but did not influence other biochemical changes or the electrocardiographic response to ischemia. Thus, prostaglandin release by ischemic myocardial tissue is an early response to the ischemic stimulus.


Effect of purification on the accumulation of radioactive gallium labeled leukocytes in abscesses. In rabbits, autologous peripheral blood leukocytes labeled in vitro with 67Ga citrate have been purified in vitro by the processes of dialysis and cell washing to determine the effect of purification on the accumulation of the labeled cells in abscesses of the abdominal wall. Dialysis was found to be ineffective, but cell washing produced a population of labeled leukocytes that was essentially free of noncell bound radioactivity. The purification process minimally altered the recirculating capacity of the leukocytes but significantly enhanced the relative accumulation of radioactivity in the septic area. Thus, the use of an essentially pure population of labeled leukocytes should offer a significant potential in the definitive scintiscan demonstration of hidden abscesses.


The value of liver scan in the follow-up study of patients with adenocarcinoma of the colon and rectum. Seventy consecutive patients with adenocarcinoma of the colon and rectum had a liver scan followed by surgical exploration of the liver. Preoperatively, blood chemistry studies were done in addition to palpation of the abdomen. Surgical findings were correlated to results of the liver scans, function tests and palpation of the liver. The overall concordance of liver scans with surgical findings was 78 per cent. Thirty per cent had false-positive results and 15 per cent, false-negative results. The correlation of the liver scan with surgical findings was improved with increasing extent of metastases. When less than 25 per cent of the liver was replaced by tumor, there was a random correlation of scan to surgical findings. By combining liver scans and liver function tests, metastases could be predicted with increased reliability only in patients who had severe metastatic disease of the liver. It is strongly recommended that patients with liver scans suggestive of metastatic disease and with most liver function tests within normal limits undergo exploration to establish the diagnosis. Exploratory laparotomy seems to be the only way to avoid chemotherapeutic treatment of patients with false-positive scans and still allow detection and treatment of metastases to the liver to occur at earlier stages.


Postoperative wound infection rates.

Postoperative wound infection rates. Postoperative wound infections following 5,260 selected procedures at a University Hospital were studied. These data were collected during a three year period using a single surveillance system. These data were compared with those of earlier reports. Accurate postoperative wound infection rates can be obtained as part of a total hospital surveillance program. Operative procedures should be subdivided, so that postoperative wound infection rates among different institutions can be reasonably compared. The major importance of prospective surveillance lies in the actual control of infections.


The relationship of coagulation factors to clinical complications of acute pancreatitis. Alterations in coagulation factors have been reported during acute pancreatitis. Therefore the relationship of coagulation measurements to complications of pancreatitis was evaluated prospectively in 35 patients in whom 130 serial coagulation profiles were performed, consisting of fibrinogen, platelet count (PC), fibrinogen-fibrin-related-antigen (FR-antigen), prothrombin time (PT), partial thromboplastin time, thrombin time, euglobulin clot lysis, and Factors II, V and VII-X levels. During attacks of acute pancreatitis, over-all mean initial fibrinogen and PC of 268 mg. per 100 ml. and 214,000 per cubic millimiter rose significantly (p less than 0.005) to peaks of 362 mg. per 100 ml. and 477,800 per cubic millimeter by day 6 to 10. Mean initial FR-antigen of 4.8 microgram per milliliter rose to peak 7.4 microgram per milliliter on day 5. In 21 patients with mild pancreatitis, mean highest fibrinogen, PC, FR-antigen, and PT were 329 mg. per 100 ml., 361,500 per cubic millimeter, 5.3 microng per milliliter and 14.1 seconds. These values were significantly higher (p less than 0.05 to 0.01) in patients with severe pancreatitis, being 422 mg. per 100 ml. 528,000 per cubic millimeter, 13.7 microng per milliliter, and 15.5 seconds, respectively. Evaluation of the relationship of coagulation measurements to early clinical features showd that mean initial fibrinogen levels were significantly higher (p less than 0.05 to 0.01) in patients with initial amylase greater than 1,000 Somogyi units percent, serum glutamic oxaloacetic transaminase (SGOT) greater than 250 S.F.U. percent, and initial 72 hour PAO2 less than 75 mm. Hg. Early hypoxemia also correlated (p less than 0.05) with elevated initial FR-antigen levels. Impaired early renal function correlated (p less than 0.01) with elevated initial PC only. Early hypocalcemia did not correlate with coagulation measurements. These findings demonstrate that marked changes in coagulation parameters occur during acute pancreatitis and are related to over-all morbidity. Correlation of early coagulation measurements with amylase levels and with respiratory, renal, and hepatic dysfunction suggests that enzyme-related intravascular coagulation may be implicated in the pathogenesis of these complications of pancreatitis.


Postlaminectomy arteriovenous fistula.

Postlaminectomy arteriovenous fistula. Forty-nine cases of postlaminectomy arteriovenous fistula have been reported. Perforation of the anterior spinal ligament by the pituitary rongeur during discectomy with resultant simultaneous damage to artery and vein is causative. Whether aorta, cava, and/or iliac vessels are involved depends upon the level of laminectomy, the angle of the instrument, and anatomic variations in aortocaval bifurcation. Nine patients presented early after operation and were diagnosed promptly. The 40 patients who presented from months to years following laminectomy to physicians unfamiliar with this entity often had a distressing delay in diagnosis. High output congestive heart failure, particularly in a young person, and the characteristic abdominal and back bruit, should arouse suspicion. Arteriography confirms the diagnosis and allows planning for the operative repair. Though potentially disastrous, the operative correction of a major arteriovenous fistula may be done safely if standard principles of vascular surgery are followed. When combined with technical hints regarding clamp placement, transvascular repair, balloon catheter use, vein preservation, and the multiple inventive uses of the Dacron vascular prosthesis, a successful outcome should be expected.


Serial changes in arterial endothelium following ischemia and perfusion. The acute and chronic changes produced in canine femoral arteries by ischemia and by perfusion with D10W were examined by light and by scanning electron microscopy. Mild changes of injury characterized by medial and adventitial inflammation and an increase in intimal lining cells occur following 30 minutes of perfusion with return to a normal microscopic appearance within one week. Perfusion for 6 hours produces significant injury to the entire arterial wall, as evidenced by depletion of cells and elastin from the media, replacement with collagen, and eventual fibrosis. The intimal surface is replaced by a layer of spindle cells which appear to originate in the media. The internal elastic membrane is flattened and thrombosis is prominent, particularly in areas where medial fibrosis is severe. Many of the vascular changes produced by perfusion injury may persist for 3 months and some may even by permanent. A period of 6 hours of ischemia also produces similar but less prominent alterations in vascular morphology which return to near-normal appearance within 8 weeks.


Life expectancy following aortofemoral arterial grafting. The existence of symptomatic aortoiliofemoral occlusive vascular disease would appear to result in approximately a 10 year decrease in life expectancy compared to that of the "normal" population. However, a significant proportion of the cumulative mortality rate appears to be due to both coronary artery disease and diabetes mellitus, as patients with peripheral vascular disease had a near "normal" life expectancy in the absence of either coronary artery disease or diabetes mellitus. Neither the presence nor the anatomical location of occlusive disease distal to the comon femoral bifurication by itself decreased life expectancy compared to those patients with aortoliofemoral disease but without similar distal occusive disease. Low operative mortality rate, excellent long-term patency, and potentially "normal" life expectancy all encourage an aggressive operative approach in patients with symptoms of peripheral vascular disease but without either diabetes mellitus or coronary artery disease. Revascularization in those patients with diabetes mellitus should be directed at limb salvage rather than at relief of minor symptoms of ischemia.


Carotid bruit as a risk factor in aortoiliac reconstruction. Records of 248 patients undergoing aortoiliac reconstruction for occlusive disease between 1957 and 1975 were reviewed. Carotid bruits were ausculted in 35 patients (14%). Five of the patients with bruits also were thought to have symptoms of transient ischemia. Strokes occurred after operation in four of the 248 patients (1.6%). No patient with a previously noted bruit developed postoperative stroke. Two patients with transient cerebral ischemia and no confirmed bruit before operation did develop postoperative strokes. Cerebral angiography was performed in 18 of the patients with carotid bruits. Two of these patients underwent carotid endarterectomy prior to aortoiliac reconstruction. None of these 18 patients developed strokes following their carotid surgery of aortoiliac reconstruction. A third patient with no bruit but with retinal cholesterol emboli also underwent arteriography and endarterectomy without complication. The results suggest that the asymptomatic carotid bruit alone does not indicate an increased risk of stroke during aortoiliac reconstruction. The authors conclude that their experience does not support prophylactic carotid endarterectomy in the asymptomatic patient prior to aortoiliac reconstruction.


Abnormalities of liver function following extensive jejunoileal bypass and resection in rats. A greater than 90% jejunoileal bypass similar to the type performed in man for morbid exogenous obesity was performed in 70 adult female Wister rats; in an additional 70 rats a greater than 90% jejunoileal resection was performed. The control group consisted of 46 rats, which were not subjected to any experimental measures. Following operation the bypass group demonstrated a significantly greater weight loss than did the resection group. Total plasma protein, albumin, and glutamic oxalacetic transaminase all decreased from the control in both the resection and bypass groups; the decrease, however, was more significant in the bypass than in the resected group. These results suggest the possible production of a hepatotoxic factor in the excluded small bowel segment.


Melanoma of skin of the breast: therapeutic considerations based on six cases. Melanomas of the skin of the breast are uncommon lesions which are amenable to cure with standard mastectomy techniques, even when lymphatic spread has occurred. Of six patients treated at the University of Iowa, two have died of metastatic melanoma, one treated by wide excision and subsequent axillary dissection and the other by radical mastectomy initially. Of the remaining patients, one with positive axillary nodes at the time of mastectomy died 28 years following operation of unrelated causes, one with axillary nodes involved is 5 years without evidence of recurrence, and two who have been followed for less than 2 years, are without evidence of recurrent disease in spite of having had positive nodes at the time of initial treatment. All six patients had had pigmented lesions of the skin of the breast for many years, suggesting that such lesions in this location should be considered premalignant.


Clinical aspects of persistent sciatic artery: report of two cases and review of the literature. The sciatic artery is the principal blood supply to the lower extremity in the human embryo prior to the development of the femoral artery. Persistence of the sciatic artery in the adult is a rare albeit well documented anomaly with at least 29 cases reported in the world's literature and two additional cases presented here. The persistent sciatic artery is a branch of the internal iliac artery. It leaves the pelvis in close proximity with the sciatic nerve and is continuous with the popliteal artery. The superficial femoral artery usually is present and hypoplastic and only sends collaterals to the popliteal artery. Diagnosis of a patent sciatic artery is suggested by auscultation with a Doppler ultrasound and confirmed by autography. Obstruction and/or aneurysms of the sciatic artery should be treated with a femoral to popliteal or other distal artery bypass and ligation of the aneurysm if one is present.


Training in microvascular surgery.

Training in microvascular surgery. This is the first report that analyzes the time required for a general surgeon to master the technique of anastomosis of arteries with diameters of 1.25 and 1.5 mm. Probes of 0.25 mm gradation were used to calibrate the lumens of the arteries and the anastomoses. The Zeiss microscope was used at 25 magnifications to repair a transverse division of the abdominal aorta of a 120 gram rat. Fifteen hours were required for the surgeon (S.H.) to become accustomed to the use of the equipment. Then a series of 40 rats were operated upon and kept alive from 1 to 6 weeks. Patency rate was 100% (40 of 40). No anastomosis was less than 1.25 mm in diameter. After the initial practice period of 15 hours, quality of anastomosis was unchanged, but time required to perform it diminished from 45 minutes to 15 minutes during the course of 40 procedures that occupied 35 laboratory hours.


Selective intra-arterial tolazoline infusion in peripheral arterial trauma. Intra-arterial tolazoline has been used as an adjunct for angiographers and has been investigated for application in certain peripheral vascular disorders secondary to its potent activity as a vasodilator. We have had experience with three cases in which severe peripheral arterial trauma had resulted in nonviable extremities in spite of both orthopedic manipulation and vascular reconstruction. Continuous infusions of intra-arterial tolazoline were begun with marked improvement in blood flow in all extremities and resultant viability in all three within 48 hours. All three of these extremities, although severely traumatized, had one patent vessel distal to the popliteal trifurcation which was patent and which insured at least some flow to the distal extremity. Canine experiments were performed which demonstrated that intra-arterial tolazoline increased distal limb blood flow but did not moderate muscle surface hydrogen ion increase. These experiments confirm that the most important effect of the drug is in opening of precapillary arteriovenous shunts in the skin which increase total blood flow in medium and large size blood vessels in the injured limb. Major systemic effects of the drug were not observed when used in these specified concentrations and when monitored carefully by nursing personnel. We therefore feel that infusion of tolazoline can be used in specified cases of peripheral arterial trauma when both orthopedic and vascular reconstruction have not restored adequate blood flow to the traumatized extremity.


The axillopectoral muscle (Langer's axillary arch): a cause of axillary vein obstruction. The second patient recognized to have high grade intermittent obstruction of the axillary vein due to an anomalous axillopectoral muscle is reported. This relatively common anomalous muscle extends from the latissimus dorsi to the insertion of the pectoralis major and overlies the neurovascular bundle in the axilla. Preoperative recognition of this anomaly appears possible by phlebography, a history of intermittent axillary vein obstruction, loss of the normal axillary concavity, and a market disparity between obvious visual fullness in the axilla and the great difficulty encountered in palpating an axillary mass. Although a correct preoperative diagnosis of the presence of this anomaly has not been made yet, awareness of this entity is important because simple excision of this muscle is curative.


Lymphoblastoid cell lines of homozygous typing cells used for sensitization in PLT. Lymphoblastoid cell lines of homozygous typing cells were used as the sensitizing cells in MLC to prepare PLT cells. Results obtained using such cells against a panel of restimulating cells were compared to those obtained using regular PLT cells in which priming had been accomplished with normal peripheral blood lymphocytes. It appears that lymphoblastoid cell lines can be used for this purpose; the advantages of such an approach are given.


Sibling Method for Detecting HLA-linked genes in disease. Where it is possible to ascertain a number of families each having two or more siblings with a particular disease, data from such families can be used to test for the presence or otherwise of important genes in the HLA chromosomal region causing susceptibility to the disease. The method for analysing such data is detailed.


HLA--Cw4 in paranoid schizophrenia.

HLA--Cw4 in paranoid schizophrenia. On a group of 40 paranoid schizophrenic patients HLA serotypes for HLA--A, B, C antigens a significant increase of Cw4 was observed. It is argued that this finding represents the common denominator for previous data reporting increased A9 and A28 antigen in SCH because these antigens are frequently present on haplotypes bearing Cw4. The possible role of the HLA "central" parts, i.e. the chromosomal segment between HLA--A and HLA--B locus in the pathogenesis of schizophrenia was stressed.


The association of HLA antigens A3, B7, and DW2 with 330 multiple sclerosis patients in the United States. Reported associations of HLA antigens with MS have varied considerably. In this study we have examined 330 clinically definite MS patients from the United States. The frequency of DW2 (52%) was highly statistically significant in MS patients as compared to controls (p less than 0.00001). Neither A3 nor B7 was significantly increased in MS; however, the joint occurrences of A3-DW2 (20% vs 7%, p less than 0.001) and B7-DW2 (30% vs 13%, p less than 0.0002) are highly associated with MS.


A note of relative risks.

A note of relative risks. In the study of disease correlations with specific antigens, the current expression for "relative risks" is computationally convenient. However, a more exact expression has been devised which is also more easily interpretable as the relative probability of contracting a disease for individuals carrying a specific antigen as compared to the probability for those not carrying that antigen.


Acquisition of typing serum from post partum blood clots. The proposed technique provides an inexpensive, totally harmless and rapid procedure for the collection of pregnancy serum having either HLA or anti B-cell cytotoxic activity, Its disadvantages are the necessity for large storage space and the relatively small volume of the obtainable serum.


Mortality risk associated with the use of oral contraceptives. Recent studies in Great Britain and the United States have raised serious concern about the safety of oral contraceptives for women aged 40 and over. This article reanalyzes the data published in these studies and shows that a clear understanding of the synergistic effects of smoking and pill use is essential for proper assessment of the safety of oral contraceptives. The present analysis indicates that (1) the use of oral contraceptives, in the absence of smoking, is considerably safer than no fertility control for all ages, including the group aged 40-44; (2) the use of oral contraceptives among smokers aged 40 and over is substantially more hazardous than no fertility control, although there is little difference for light smokers; (3) the use of oral contraceptives among heavy smokers in the group aged 30-39 may be more hazardous than no fertility control; and (4) the use of oral contraceptives among heavy smokers in the group aged 15-29 may be more hazardous than any other method of fertility regulation.


Response reliability in a longitudinal survey in Thailand. The two rounds of the National Longitudinal Study in Thailand provide a useful opportunity to explore response reliability in a large-scale social and demographic survey in a developing country. The results indicate that nonrandom reliability at the individual level ranged from quite high (for several straightforward, facual questions) to quite low (for most attitudinal questions). There was considerable distributional stability, however, even for many of the variables with low individual-level reliability. In terms of its response reliability, the Thai study compares reasonably well with several leading US fertility surveys. However, in both countries response reliability at the individual level for attitudinal questions is distressingly low. This clearly should be a matter of major concern for social scientists using survey results.


Governmental population incentives: ethical issues at stake. Governmental incentives to influence population-related decisions are examined in terms of the ethical issues at stake. A typology of incentive schemes is presented, and ethical implications of various incentives are discussed. It is argued that, in a just scheme, a progressive, negative incentive or fee, calculated as a surtax on a modified income tax or an equivalent standard, would distribute burdens equally. A set of guidelines for ethical evaluation of incentive schemes is proposed.


Trends in fertility and family planning in Jordan. A national fertility sample survey conducted in 1972 on the East Bank of the Hashemite Kingdom of Jordan collected information on fertility levels, desire for additional children, and knowledge and practice of family planning. The data suggest that in Jordan, as in many other developing countries, the fertility rate is extremely high, and that, while rural/urban residence and socio-economic status have no significant influence on fertility, educational attainment of wives does have a marked effect on fertility. The survey results also indicate that, while knowledge of contraception is not lacking, its practice is limited, and that the average ideal family size is lower than the actual size among almost all socioeconomic groups.


A review of blood donor motivation and recruitment. Sixty English-language articles on the motivation and recruitment of blood donors and nondonors are reviewed and evaluated. Apparently researchers have been finding essentially the same results for approximately twenty years. Motivations to donate are: altruism/humanitarian, personal or family credit, social pressure, replacement and reward. Motivations not to donate are: fear (of needle, sight of blood, weakness, finger or ear pricking), medical excuses, reactions, apathy, and inconvenience. Deeper analysis of motivation suggests that donors may unconsciously desire a "pat-on-the-back" for their efforts. Retention and management of prior donors may be more significant to meeting blood needs than motivation of new donors. Suggestions for donor recruitment effectiveness are presented.


In vitro function of granulocytes isolated from blood of normal volunteers using continuous-flow centrifugation in the IBM-aminco celltrifuge and adhesion-filtration leukapheresis using nylon fiber. Granulocytes were harvested from each of five healthy male volunteers once by continuous flow centrifugation with the IBM-Aminco Celltrifuge, and once by adhesion filtration leukapheresis with nylon fiber. Granulocyte recovery and purity were significantly better with the filtration leukapheresis system than with continuous flow centrifugation. Measurements of trypan blue dye exclusion and muramidase activity were similar to those in control granulocytes regardless of the method of isolation. Granulocyte-stimulated oxygen consumption was diminished in granulocytes prepared by the adhesion filtration method, but normal in those prepared by continuous flow centrifugation with the IBM-Aminco Celltrifuge.


Effect of initial storage at room temperature on human red blood cell ATP, 2,3-DPG, and viability. The concentrations of ATP and 2,3-DPG and post-transfusion viability were measured in human red blood cells exposed for one, four and seven hours to room temperature before refrigerated storage for 21 days. No effect of room temperature storage was observed on ATP or viability. Decrease in 2,3-DPG was accelerated by room temperature exposure but the differences in 2.3-DPG were small and unlikely to have a significant adverse effect on red blood cell oxygen delivery. Delays of up to seven hours in refrigeration of blood do not appear to have serious adverse effects on red blood cell viability or function.


Citrate anticoagulants for plateletpheresis. In 112 plateletphereses done by the Haemonetics blood processor, the comparative effectiveness of ACD formula A, ACD formula B, and 2 per cent citrate in saline was evaluated. With respect to yields of platelets and white blood cells (e.g., lymphocytes), ACD-B was significantly better than the other two. Both ACD-B and 2 per cent citrate gave a much lower incidence of citrate reactions in the donors than were encountered with ACD-A.


Abdominal pain in donors during filtration leukapheresis. An unusual donor reaction characterized primarily by lower abdominal and/or perineal pain occurs in 1.2 per cent of donors during filtration leukapheresis (FL). The reaction occurs almost exclusively in female donors. Corticosteroid pretreatment appears to be highly effective in preventing the reaction. The pathogenesis of this donor problem is speculative.


Red blood cell survival studies in patients with anti-Cha, anti-Yka, anti-Ge, and anti-Vel. The survival of red blood cells, which were strongly incompatible in vitro, was measured in five patients whose serum contained an antibody to a high-frequency antigen. In the two patients with anti-Cha, and in the patient with anti-Yka, the cells survived normally. In the patient with anti-Ge, a small proportion of the cells was destroyed at an increased rate during the first 24 hours, but the remaining cells survived normally. In the patient with anti-Vel, the injected cells were rapidly destroyed.


An example of anti-Jra.

An example of anti-Jra. Anti-Jra is an antibody that has been detected in at least 15 individuals that are known to lack the corresponding high frequency antigen. An example of this antibody with anti-Jra specificity was found in a woman upon routine prenatal antibody screening and was evaluated for involvement in a hemolytic process which occurred in the newborn.


Acute hemolytic transfusion reactions--a fresh look at pathogenesis and considerations regarding therapy. A review of our knowledge of acute hemolytic transfusion reactions indicates that we have learned much in recent years about the pathogenetic mechanisms involved. An approach to effective therapy for patients suffering such reactions should be based on our latest understanding of the pathophysiology of this syndrome. However, changes in our therapeutic approach have not kept abreast of our increased awareness of the etiologic factors, and the patient, therefore, is not getting the benefit of our increased knowledge in this area. The primary pathogenetic mechanisms involved in these reactions appear to be disseminated intravascular coagulation and a series of hemodynamic alterations leading to ischemic necrosis of tissues. Therapy would best be aimed at interfering with these primary pathophysiologic pathways.


Oxygen consumption, platelet aggregation and release reactions in platelets freeze-preserved with dimethylsulfoxide. Platelets were frozen with 4% or 5% DMSO at an overall rate of 2 to 3 C per minute and were stored at -80 C for as long as 10 months. They were washed with DMSO-plasma and acid-citrate-dextrose (ACD) solutions and were stored in 30 ml of autologous plasma at room temperature for about three hours before transfusion. Measurements were made of oxygen consumption, platelet aggregation and release reaction, platelet factor-3 and-4 activities, and platelet response to hypotonic stress. Platelet basal and latex stimulated oxygen consumption were found to be significantly impaired; platelet aggregation response to ADP, epinephrine, and collagen were decreased; platelet ATP and ADP content and release reactions were decreased; platelet antiheparin activity (platelet factor-4 level) was decreased; and the platelet response to hypotonic stress was impaired. What the results of these in vitro tests mean in relation to in vivo survival and hemostatic function of preserved platelets was not established.


Spontaneous glomerulonephritis in dogs. I. Classification and immunopathology. A morphological study of kidneys of 101 dogs with and without clinical signs of renal disease was done. In 90% of the dogs there was morphologic evidence of glomerulopathy. Types of glomerulonephritis were: membranous, 26 cases (with spikes, six cases; without spikes, 20 cases); membranoproliferative, 30 cases (with mesagial proliferation, nine cases; with mesangial sclerosis, 21 cases); mesagial-proliferative, 16 cases; and mesangial-sclerosing, 19 cases. There was no linear immunofluorescence indicative of autoantibodies to the glomerular basement membrane. Membranous glomerulonephritis with spikes was associated with coarse subepithelial deposits of IgG and C3. Membranous glomerulonephritis without spikes often had a linear fluorescence pattern of C3. In membranoproliferative glomerulonephritis, there were subendothelial deposits of IgG and C3, and frequently C3 deposits were within the mesangium. Mesagial deposits of C3 were frequently found in kidneys with mesangial-proliferative and mesagial-sclerosing glomerulonephritis and glomeruli that histologically appeared normal.


Eight cases of pericardial defects in the dog. Pericardial defects were found in eight dogs. In four dogs the defects were on the left side, in two on the right side, and in two on both sides. Six dogs had only one defect on the left or right side,one dog had three defects on the left side. One dog had four defects on the right side. All these defects were incidental findings at necropsy. There were no significant findings concerning breed, age, sex or localisation. It is not known if the defects were congenital or traumatic.


Giant hypertrophic gastritis of Basenji dogs. Giant hypertrophic gastritis is a newly recognized disease of adult Baseji dogs similar to Menetrier's disease of man. It is characterized by weight loss, diarrhea, dry coat, pale membranes, anorexia, raised convoluted rugae in the body of the stomach, palpable fluid- and gas-filled intestines, colonic inflammation, and radiographically demonstrable dilated intestinal loops. Laboratory findings include leukocytosis, neutrophilia, low hemoglobin, hypoalbuminemia, hypobetaglobulinemia, hypergammaglobulinemia, decreased serum fatty acids, hypocholesterolemia, indicanuria, low fecal pH, and increased fecal fat and nitrogen. Four dogs studied had gastritis with hypertrophy and diffuse lymphocytosis and plasmacytosis of the small intestine.


Two renal tumors in cottontail rabbits (Sylvilagus floridanus). Renal tumors were found in two cottontail rabbits (Sylvilagus floridanus) about 1 year old. One tumor was intimately associated with the kidney and consisted of isolated ductular and tubular structures within an abundant connective tissue stroma and was diagnosed as a hamartoma of urogenital origin. The second was composed of epithelial cells arrange as alveolar structures with papillary projections, epithelium that was less differentiated into tubules and ducts, and neoplastic epithelial cells in solid sheets. The diagnosis of renal adenocarcinoma was based on the histologic features as metastasis had not occurred.


The pathogenesis of porcine rectal stricture. I. The naturally occurring disease and its association with salmonellosis. Rectal stricture occurred in each of 23 pigs submitted for necropsy from eight Indiana farms. Each stricture was an annular cicatrization of the rectal wall, 2.0-5.0 cm anterior to the anorectal junction. Emaciation, colonic dilatation and compression atrophy of abdominal and thoracic viscera were a result of chronic obstipation and inanition. Most pigs with strictures had severe enteric disease 4-8 weeks before the strictures occurred. Salmonella typhimurium was isolated from seven of the eight groups of pigs examined. Ulcerative proctitis, a possible precursor of rectal stricture, was frequently in pigs with enterocolitis caused by S. typhimurium.


The pathogenesis rectal stricture. II. Experimental salmonellosis and ischemic proctitis. Experimentally induced oral Salmonella typhimurium infection in pigs resulted in a severe, prolonged enterocolitis with ulcerative proctitis a constant feature. Healed lesions were annular cicatricial ulcers in the part of the rectum affected with rectal strictures. Strictures indistinguishable from the naturally occurring lesion were produced by injecting chlorpromazine into the cranial hemorrhoidal artery of three pigs. Dye injected into the cranial hemorrhoidal artery perfused the entire rectum in normal pigs, but in pigs with either rectal stricture or salmonella proctitis the dye halted at the cranial margin of the transverse mucosal defect. The predilection of rectal stricture and its proposed precursor, salmonella ulcerative proctitis, for the middle third of the rectum was attributed to a normally precarious arterial supply which renders the rectum unusually susceptible to ischemic injury and decreases its reparative capacity.


Pathological changes in calves injected intradermally with Mycobacterium intracellulare serotype Davis and M. avium serotype 2. Three strains of the M. intracellulare-M. avium complex were injected intradermally into 12 calves. M. intracellulare serotype Davis (M. avium complex serotype 8) was injected into five calves. One calf died with disseminated caseous granulomas at 79 days; three calves killed between 56 and 82 days after inoculation had widely disseminated caseous or caseous or caseocalcareous granulomas. One calf killed at 173 days had only encapsulated granulomas at the injection site and its regional lymph node. Two strains of M. avium serotype 2 (M. avium complex serotype 2) were injected intradermally into seven calves. Six had disseminated granulomas when killed 54-170 days after inoculation. One calf killed at 55 days had granulomas confined to the inoculation sites and their regional lymph nodes. Lesions induced by both M. avium serotype 2 and M. intracellulare serotype Davis were initially caseocalcareous granulomas which became encapsulated and nonprogressive after about 112 days. Two calves inoculated with similar doses of M. bovis and killed in extremis at 37 and 65 days after inoculation had disseminated progressive lesions without encapsulation.


Demyelination in mice after two or three infections with avirulent Semliki Forest virus. Adult mice given two or three intraperitoneal inoculations with avirulent Semliki Forest Virus showed typical lesions of a viral encephalitis similar to those caused by a virulent strain of the virus. Demyelination also was seen in the medulla and in the folia of the cerebellar white matter. Neuronophagia was seen only in mice that had had three successive infections. The repeated inoculations of avirulent virus exacerbates the encephalitis of a single inoculation and causes demyelination. The mice did not have neurological clinical signs except for a short-lived weakness of the hind legs. No central nervous system lesions were seen by the 7th and 8th week after the initial infection and all mice recovered.