Association and dissociation of aggregated IgG from rat peritoneal macrophages. Stable aggregated IgG (A-IgG) of various sizes, having high biological activity, were incubated at 4 degree C with adhering peritoneal macrophages from normal rats and the kinetics of A-IgG binding to the cell surface were studied. Equilibrium constants were high (2.8-11.7 X 10(8) M-1) and varied as a function of aggregate size. The maximum number of A-IgG bound per cell varied from 230,000 for A-IgG9 to 90,000 for A-IgG74. Binding was 50% inhibited by near physiological concentrations of monomeric IgC. These data suggest that A-IgG are bound at multiple sites by attachment of Fc frgments to Fc receptors present on the macrophage surface with larger A-IgG being more avidly bound. Dissociation was slower for larger A-IgG while no clear trend was seen relating associating rates and aggregate size. Thus, differences in the avidity of binding of A-IgG are due primarily to slower dissociation of larger A-IgG. Dissociationissociation of A-IgG was slower from cells exposed initially to higher doses of A-IgG and dissociation did not follow simple first order kinetics. Thus, the avidity of binding appears to be heterogeneous in a population of similar sized A-IgG. As expected, association was dose-dependent, more rapid than dissociation, and followed pseudo first order kinetics. Based on all of the above data, it is proposed that binding of A-IgG proceeds in two steps. First, A-IgG are loosely bound to perhaps a single Fc receptor. Then, depending upon the availability and mobility of Fc receptors, additional Fc fragments are attached and the A-IgG becomes more firmly attached. Thus binding is slow, but once attached A-IgG are avidly held.


Prostaglandin production by rheumatoid synovial cells: stimulation by a factor from human mononuclear Cells. Human peripheral blood mononuclear cells (lymphocyte-monocyte) in culture release a solube factor which can stimulate, up to 200-fold, production of prostaglandin E2 by isolated, adherent, rheumatoid synovial cells. Production of the factor by the mononuclear cells is enhanced by phytohemagglutinin. This factor is similar in apparent mol vt (10,000-20,000) to that which also stimulates collagenase production by the same cells.


Generation of natural killer cells: an autonomous function of the bone marrow. Generation of natural killer (NK) cells in spleens from radiation chimeras produced between pairs of histocompatible 'high' and 'low' NK-reactive mouse strains has been investigated. Spleen cells of high-reactive recipients reconstituted with bone marrow from low-reactive mice were found to be low reactive. Conversely, spleen cells of low mice grafted with bone marrow or fetal liver cells from high donors were high reactive. Similarly, the age-related changes of NK activity were shown to be expressed at the bone marrow precursor cell level. These results indicate that the generation of natural killer cells is an inborn and autonomous function of the bone marrow and does not depend on the genotype or other influences of the host environment.


[Investigation of a new method for the determination of glucose, using the Greiner Selective Analyzer II (GSA II) (author's transl)]. The hexokinase method and a method using glucose dehydrogenase are compared. In general, the two methods show good agreement. The samples were not deproteinized and were obtained from fasting patients of the medical, surgical, rheumatological and hemodialysis clinics. The possible influence of anticoagulants, preservatives and hemoglobin on the determination of glucose with glucose dehydrogenase was checked; there was no evidence of interference. Among the carbohydrates which were tested, only 2-deoxyglucose gave a positive reaction. In addition, this is a reliable and cheap method. The multiplication factor for the photometric analysis remains stable for seven days with a linearity between 0.55 and 44.4 mmol/1 glucose.


Quantitative determination of creatine kinase isoenzyme catalytic concentrations in serum using immunological methods. For the determination of creatine kinase isoenzyme catalytic concentrations in serum two methods based on immunological reactions are presented: One method uses inhibiting antibodies, which selectively block the activity of creatine kinase M subunits ("Inhibition Test"). This test is used for routine measurements of creatine kinase MB catalytic concentration; Another method uses precipitating antibodies, which allows a quantitative differentiation of creatine kinase isoenzymes MM, MB and BB ("Precipitation Test"). This test is used as a control for the Inhibition Test for the possible presence of creatine kinase BB activities in doubtful cases. Procedures, specificity, correlation and application of these methods are discussed.


The effects of hydrocortisone and bacterial lipopolysaccharide on the anti-erythrocyte response in the spleens of adult Triturus viridescens. The effects of hydrocortisone (HC) and bacterial lipopolysaccharide (LPS) have been tested separately and in combination, on the antigen-binding response of splenocytes of the newt. Triturus viridescens immunized with horse erythrocytes (HRBC). The timing of the presentation of each was made relative to when challenge with either low (0.0025%) or high (25%) doses of the immunogen (HRBC) was effected. Our results showed inhibition of both low and high dose responses by HC and additionally suggested that the helper-cell population of the newt is HC-sensitive. LPS given four days prior to antigen challenge initiated the generation of antigen-binding cells which enhanced the low, but not the high dose response. The use of LPS in conjunction with HC provided suggestive evidence that those LPS stimulated cells which had enhanced the low immunogen dose antigen-binding cell response were HC-resistant. Thus LPS may stimulate a non-helper cell population in the newt which is HC-resistant. The use of these two immunologic probes has provided supportive evidence on the heterogeneity of the lymphoid population of the newt, Triturus viridescens.


Progesterone-induced DNA polymerase activity in full-grown oocytes of Xenopus laevis (1). DNA polymerase activity increases in full-grown oocytes of Xenopus laevis during in vitro progesterone-induced maturation. This increase is inhibited by cycloheximide. The presence of the oocyte's nucleus (germinal vesicle) seems essential for the induction of this increase: in previously enucleated oocytes, the level of DNA polymerase activity does not change during progesterone treatment. Furthermore, a new form of DNA polymerase is detectable by DEAE chromatography in in vitro matured oocytes.


Rifampicin-resistant mutant supporting bacteriophage growth on stationary phase Achromobacter cells. A rifampicin-resistant Achromobacter mutant with an altered RNA polymerase was isolated. The mutant supports phage alpha3a growth in both log and stationary phase cells. Phage growth on stationary phase cells is sensitive to aeration and growth only occurs at oxygen concentrations of less than 5-2 p.p.m. The rifampicin-resistant mutant is similar to the spontaneous mutant strain 14 reported by Woods (1976) in that both mutants support stationary-phase phage growth under micro-aerophilic conditions. The isolation of the rifampicin-resistant mutant with an altered RNA polymerase suggests that the phenomenon of stationary phase phage growth could be due to a change in the template specificity of the Achromobacter RNA polymerase. Plaque morphology mutants which grow on log and/or stationary phase cells of the Achromobacter wild type, strain 14 and rifampicin-resistant strains are also described.


Neurofilamentous changes in goldfish (Carassius auratus L.) brain in relation to environmental temperature. The presence of neurofilaments in the synaptic boutons in the brains of goldfish maintained at 5 degrees C for 177 days or more is reported. Neurofilaments are not found in boutons of control fish kept at 15degreesC. It is suggested that the neurofilaments may be equated with neurofibrillary rings seen by light microscopy. Neurofilaments have been implicated in axoplasmic transport and, therefore, irregularities in the occurrence or appearance of these filaments may reflect alterations in their functions. The unusual occurrence of neurofilaments in the boutons of cold temperature goldfish may be an expression of early degenerative changes or may represent a modification of axoplasmic transport. The suitability of goldfish as a model for the study of the functional effects of neurofibrillary/neurofilamentous accumulations is discussed.


An in vitro study of the susceptibility of cells from a meningioma of human origin for measles virus. A cell culture from a meningioma of human origin was found permissive for the Edmonston strain of measles virus. Virus was isolated from the supernatant of infected cell sheet as soon as 48 hr post-inoculation. Cytopathic effect, observed by light microscopy, exhibited syncitia plus intracytoplasmic and intranuclear inclusions. Electron microscopy enabled viral nucleocapsids to be observed first in the cytoplasm and secondly within the nucleus of infected cells.


Differential radiosensitivity of mouse embryonic neurons and glia in cell culture. The responses of neurons and glial cells to ultraviolet and gamma-radiation were studied in cell cultures of embryonic mouse brains. A decrease in the ratio of glia to neurons occurred after both forms of irradiation. [3H]thymidine labelling followed by autoradiography revealed that all glia were capable of replication wereas 70% of neurons were non-replicating under the conditions of the study. Ultraviolet radiation caused a decrease in the proportion of replicating neurons but did not affect the proportion of replicating glia, whereas gamma-radiation caused a decrease in DNA replication in both cell types. Levels of ultraviolet radiation-induced unscheduled DNA synthesis were lower in neurons than in glia. It is concluded that sensitivity to both ionizing and ultraviolet radiation of neurons and glial cells in embryonic brain cultures is determined primarily by the capacity for and state of DNA replication. Neurons which have already reached the stage of ternimal differentiation are more resistant than replicating neurons of glial cells.


Transsphenoidal decompression of the optic nerve and chiasm. Visual results in 62 patients. A review of recent experience with transsphenoidal for lesion in and about the sella turcica establishes the value of this approach for the management of patients which visual loss. The lesions encountered consisted of pituitary adenoma in 45 cases, craniopharyngioma in 10 cases, and miscellaneous tumours involving the sella in the remaining seven cases. Sixty of the 62 patients in this series had quantitative determination of preoperative and postoperative visual status; after surgery, vision was improved in 81%, unchanged in 11%, and worse in 5%. Two patients (3%) died during the immediate postoperative period before their visual status could be evaluated.


The mechanism of spinal cord cavitation following spinal cord transection. Part 3: Delayed grafting with and without spinal cord retransection. Cavitation adjacent to transection of spinal cords can be successfully eliminated by a second operation 1 week after the initial spinal cord transection. The second operation consists of removal of the necrotic spinal cord tissue, thus producing a gap. Segments of autogenous sciatic nerve are inserted into the gap between the spinal cord stumps. If the spinal cord is injured by retransection at the second operation, cavitation again occurs in the spinal cord stumps resulting in separation of the nerve grafts from the spinal cord. The results of the present experiments support the concept that lysosomal spinal cord autotomy, which causes spinal cord cavitation, is a self-limiting process and that once the spinal cord has completed the autotomy, the process will not occur again unless the spinal cord is agiain traumatized.


Traumatic aneurysm of peripheral cerebral arteries. Report of two cases. The authors describe two cases of traumatic aneurysm of peripheral cerebral arteries. Surgical treatment as soon as possible after the diagnosis has been made is advised to avoid the high risk of delayed hemorrhage.


Spontaneous disappearance of a cerebral arteriovenous malformation in infancy. Case report. The authors report a case of the disappearance of an arteriovenous malformation in infancy, demostrated by follow-up angiography performed 7 months after the original angiograms. Some possible mechansims whereby a cerebral arteriovenous anomaly is thrombosed are discussed.


Lead encephalopathy simulating a cerebral neoplasm in an adult. Case report. The clinical and pathological findiing in an adult with lead encephalopathy due to moonshine consumption are presented. The remarkable focality of of the edema led both the clinicians and radiologists to consider this a cerebral glioma.


Lumbar spinal abscess managed conservatively. Case report. The authors report the case of a patient with spinal abscess in whom operation was withheld because of severe concomitant medical problems. Conservative management resulted in apparent cure.


Iatrogenic failure of a ventriculoperitoneal shunt. Case report. A previous undescribed cause of ventriculoperitoneal shunt malfunction is presented. Limitation of abdominal excursion by a spica cast used to correct congenital hip dislocation reduced cerebrospinal fluid flow through a shunt. This easily correctable cause of "shunt failure" nearly resulted in replacement of a working shunt.


Extracranial holded for brain retractors. Technical note. A new extracranial holder for brain retractors is described. It is suitable for solid incorporation onto the sliding rails of the operating table, and has been satisfactory employed in the operating room for over a year.


Differentiation of reversible ischemia from end-stage renal failure in nephrotic children with 131I-hippurate dynamic scintigraphy. In renal failure associated with the nephrotic syndrome, therapeutic strategy is highly dependent upon the cause of the renal failure. Dynamic hippurate scintigraphy was studied in five pediatric patients. Four had nephrotic syndrome, and of these, three had acute renal failure. The fifth patient had end-stage renal failure. Specific alteration in renal hippurate kinetics offers a noninvasive assessment of renal failure in this clinical setting.


Radionuclide lymphangiography in the evaluation of pediatric patients with lower-extremity edema: concis communication. The results of 99mTc-sulfur colloid lymphangiography in seven pediatric patients with lower-extremity edema were reviewed. Three scintigraphic patterns were identified: (A) normal uptake in the ilioinguinal nodes bilaterally, found in edema as a result of extrinsic venous obstruction; (B) diffusely increased activity over the involved extremity, with decreased visualization of the ipsilateral ilioinguinal nodes, found in secondary lymphedema; and (c) markedly decreased uptake by the ilioinguinal nodes on the affected side, found in primary (idiopathic) lymphedema. These preliminary results suggest that radionuclide lymphangiography is a useful procedure in the evaluation of pediatric patients with limb swelling.


Gallium-67 scanning at 6 hr in active inflammatory bowel disease: case report. Gallium citrate scanning at 6 hr was used to evaluate a patient with active ulcerative colitis. The localization of 67Ga in the colon correlated with the extent of the inflammatory process. When either colonoscopy or radiographic contrast studies are contraindicated, 67Ga scanning at 6 hr may prove useful in the evaluation of active inflammatory bowel disease.


Radioactive labeling of protein carboxyl groups on factor VIII: use of carbodiimides for nuclear medicine. Carbodiimides have been used to study macromolecular structure and to produce immunologically active antigens. We have used this method to label a labile coagulation protein, factor VIII, with 14C-glycine-ethyl-ester. No discernible chemical change, loss of biologic function in vitro, or alteration of the plasma disappearance of factor VIII resulted. The carbodiimide labeling method has potentially broad application because many biologic molecules contain carboxyl groups that are generally not critical to their chemical or immunologic character. This method can be used to incorporate short-lived positron emitters, such as 11C and 13N, into biologic compounds, or to attach ligands to useful antibodies for subsequent chelation to radioactive metals, such as 111In. Carbodiimides are especially useful for radionuclidic labeling of labile proteins because of the mild conditions, rapid reaction, and firmly attached label.


Scintigraphic findings in ankylosing spondylitis. A prospective study of bone scintigraphic findings has been carried out in 63 patients, firmly diagnosed as having ankylosing spondylitis. In addition to abnormal uptake of the radiotracer at the sacroiliac joints, a peripheral arthropathy has been a common finding, particularly in the proximal joints, occurring in up to 50% of patients. Increased uptake of radiotracer in the spine has also been found both diffusely and focally. Focal increases have been noted at the apophyseal joints in 40% of patients and in three patients with a sterile intervertebral diskitis, an unusual complication of this disease only diagnosed in two patients after bone scintigraphy.


The role of Ga-67 citrate imaging and diagnostic ultrasound in patients with suspected abdominal abscesses. Fifty patients with suspected abdominal abscesses were examined by [67Ga[ Gallium citrate imaging and abdominal sonography. Fifteen of the patients had a proven intra-abdominal abscess; Gallium-67 images were positive in 13 (87%), while the sonogram detected the abscess in 11 (73%). Nineteen patients had true-negative radionuclide images and sonography, and one had a false-positive result by both procedures. The remaining 15 patients did not have abdominal abscesses, but did have other abnormalities (e.g., pyelonephritis, extra-abdominal sites of inflammation) which were detected by the nuclide study. Gallium-67 imaging and abdominal ultrasound have similar sensitivity for detection of abdominal abscesses. A significant advantage of Gallium imaging is its ability to detect other inflammatory foci (both within and outside the abdomen).


Location of the site of bacterial bile-salt deconjugation by combining abdominal scintigraphy with expired C-14. A combined 14CO2 bile-salt breath and scintigraphic test has proved useful in determining the site of bile-salt deconjugation by bacteria. Data suggest that the procedure can be shortened to less than 8 hr with Tc-99m sulfur colloid abdominal scintigrams added to locate the labeled meal. Moreover the cumulative 14CO2 excretion, which is an indes of the rate of bile-salt deconjugation, gives clearer separation than peak specific activity between normals and either high or low deviations from normal, The test should be helpful in a number of difficult diagnostic problems involving chronic diarrhea, and offers as well both as well both a guide to appropriate therapy and a monitor for relapse in enfected blind-loop syndromes,


Technetium-99m phytate as a bone-marrow imaging agent: biodistribution studies in animals: concise communication. Technetium-99m phytate has been suggested as a bone-marrow imaging agent. This article compares the biodistribution of Tc-99m labeled "bone marrow" phytate, sulfur colloid, and diphosphonate in young rats and rabbits. Autoclaved bone marrow phytate revealed significant long-base depositon, but 96% of this activity was associated with compact bone and only 4% with bone marrow. This distribution is similar to that of diphosphonate, but significantly different from that of sulfur colloid. Technetium-99m-phytate is not recommended as a bone-marrow imaging agent.


Increased lactate dehydrogenase activity in buccal epithelium of zinc-deficient rats. Previous studies by us and by others have shown that the body weight of rats fed a zinc-deficient diet is significantly lower than that of pair fed controls, but marked hyperplasia and parakeratosis are seen  intra-orally in the buccal epithelium. No histologic changes occur in palatal epithelium. This investigation was undertaken to assay lactate dehydrogenase (LDH) activity in the buccal and palatal epithelium in rats fed a zinc-deficient diet. Weanling male Simonsen rats were fed a diet containing 1.2 ppm zinc for a 30-day period. Pair fed controls were fed the same diet containint 40 ppm zinc. LDH levels were determined by ultramicrochemical assay. In the buccal epithelium, a more than twofold increase over that of controls was observed in zinc-deficient rats, but there was no change in the palatal epithelium. Thse results support the conclusion of others of an organ-specific sensitivity of LDH to zinc deprivation. No increases in LDH activity in zinc-deficient rats, as observed in the hyperplastic buccal epithelium in this study, have previously been reported.


NADH-FMN oxidoreductase activity and iron content of organs from riboflavin and iron-deficient rats. NADH-FMN oxidoreductase has been proposed as an enzyme involved in the release of iron from ferritin. The effects of riboflavin and/or iron deficiencies and of dietary allopurinol on the activities of this enzyme and on the iron contents of liver, kidney and duodenum were investigated. Allopurinol, a xanthine oxidase inhibitor, did not affect organ enzyme activities nor iron contents. Riboflavin-deficient rats and iron-deficient rats both had significantly lower organ enzyme activities and iron contrnts than controls. Organ enzyme activities and iron contents of rats fed a diet deficient in both iron and riboflavin were significantly lower than those of controls. After dietary iron and/or riboflavin repletion, organ enzyme activities and iron contents increased. Rats fed an irons-overload diet had enzyme activities similar to that of controls, but organ iron contents were significantly increased over those of controls. Effects  of riboflavin and/or deficiencies in rats on NADH-FMN oxidoreductase activities and iron contents of liver, kidney and duodenum appeared to be reversible by riboflavin and/or iron supplementation. The data support the view that NADH-FMN oxidoreductase may be a controlling enxyme in iron release from ferritin.


Thiamin metabolism in vitamin B6 or vitamin B12 deficient rats. To clarify the  effect of pyridoxine (vitamin B6) or vitamin B12 deficiency on thiamine metabolism, the following two experiments were carried out. In experiment 1, rats were separated into two groups. The first group was fed a complete diet and the second group was fed a vitamin B6 and B12 deficient diet for 25 days. The groups were pair fed. In experiment 2 rats were separated into four groups and fed for 25 days. Group 1 was fed a complete diet; group 2, a vitamin B6 deficient diet; group 3, a vitamin B12 deficient diet; group 4, a thiamin deficient diet. Diet intake was restricted to 10 g/day. Fecal thiamin content increased in B6-B12 (vitamin B6 and B12), B6 (vitamin B6), and B12 (vitamin B12) deficient rats as compared to controls. Thiamin levels in blood, sciatic nerve, liver, heart and kidney decreased in B6-B12, B6, and B12 deficient rats.


Accumulation and depletion of zinc in rat liver and kidney metallothionens. The accumulations of zinc in liver and kidneys of rats fed various dietary levels of this element was investigated. Zinc started to accumulate in rat liver when 1,000 ppm or higher levels of this element were fed in the diet, but not when the dietary zinc level was 500 ppm less. Almost all of the accumulated zinc in the soluble fraction was found to be present in the metallothionein (MT) fractions. When rats were fed a diet supplemented with 2,000 ppm, zinc, the metal rapidly accumulated in MT in the liver and kidneys. The accumulated zinc was, however, depleted to the pre-supplementation level after only 3 days of feeding a zinc deficient diet. While rats were fed the zinc deficient diet, in which the element was simultaneously depleted from MT, significant increased excretion of the metal occurred in the feces urine. No evidence was found to indicate that zinc was excreted in the bile in association with MT. It was therefore concluded that MT is probably, as one of its possible biological roles, more involved in accumulation of excessive zinc rather than in storage of the metal for later utilization.


Effects of diet on growth and survival of rats fed toxic levels of tartrazine (FD & C Yellow No. 5) and sunset yellow FCF (FD & C Yellow No. 6). Tests were conducted on the effects of diet on the response of immature male rats to massive doses of tartrazine (FD&C Yellow No.5) and Sunset Yellow FCF (FD&C Yellow No. 6). When incorporated at a 5% level in a stock diet, tartrazine and Sunset Yellow FCF had no grossly observable toxic effects. When fed with a purified diet, however, both tartrazine and Sunset Yellow FCF at 5%  level in the diet resulted in a marked retardation in growth, an unthrifty appearance of the fur and death of 50% or more of the rats within an experimental period of 14 days. The toxic effects obtained by feeding the latter diets were counteracted by the concurrent feeding of blond psyllium seed powder, carrot root powder, alfalfa leaf meal and wheat bran. Supplements of the known nutrients had little if any protective effect. Supplements of purified cellulose were without protective effect for the rats fed tartrazine but had a moderate protective effect for those fed Sunset Yellow FCF.


Role of estrogen as a cause of fatty liver hemorrhagic syndrome. Fatty liver-hemorrhagic syndrome (FLHS), a nutritional disorder previously reported only in laying chickens was induced in immature male and female chickens, 11 weeks of age, of broiler and egg-laying breeds. Force-feeding three times a day for 21 days, amounts of feed equal to 125% and 150% of ad libitum intake, produced a gradient response in hepatic steatosis (measured by percentage of fat in the liver, and the ratio of fat to the fat-free dry weight), but not FLHS. Intramuscular injection of beta-estradiol-17-dipropionate at 2 mg/kg body weight, three times weekly for 21 days, produced a gradient response in hemorrhagic score and an increase in ad libitum feed intake. There was no significant difference between sex or breed in the score values used to evaluate FLHS, but females of both breeds accumulated significantly more fat in the liver than males. Testosterone dipropionate at 25 mg/kg of body weight, injected three times per week in immature females force-fed at the 150% level, produced increases in food intake and liver fat as did estrogen, but no hepatic hemorrhaging. The data implicate estrogen as a factor in the production of FLHS along with the necessity for the chicken to be in a positive energy balance creating sufficient hepatic fat for FLHS to occur.


Bradycardia in thiamin deficiency and the role of glyoxylate. 1. Method of recording the heart rate in rats is described. 2. It was found that during the course of developing thiamin deficiency, the heart rate of rats dropped from 448 to 220 beats/min. (There was no difference between male and female rats.) 3. A number of metabolic products were injected into the normal rats and only glyoxylate was shown to cause a significant drop in heart rate. 4. Graded amounts of Na-glyoxylate were injected peritoneally into the normal rats and blood samples were taken at intervals to test the amount of glyoxylate present. It was found that peak concentration appeared 6 min after injection and thereafter declined or disappeared, depending on the amount of glyoxylate administered. 5. It was found that glyoxylate accumulates in the body of thiamin-deficient rats and in the pair-fed rats reared on restricted diet for a long period. 6. Drop in heart rate depended on the appearance of glyoxylic acid present in the blood rather than on the reduction of body weight.


Effect of vitamin B6 on L-glutamate dehydrogenase activity in mice brain. Investigations were carried out to obtain information on the effect of vitamin B6 level on L-glutamate dehydrogenase activity in mice brain. Subcutaneous and intracerebral injection of pyridoxal phosphate or pyridoxamine resulted in a significant enhancement of the L-glutamate dehydrogenase activity. In the case of pyridoxine, much larger doses and more prolonged time were necessary to exhibit the effect. The above effect of vitamin B6 was much more evidently observed in vitamin B6-deficient animals.


Long-term effect of medium-chain triglyceride on hepatic enzymes catalyzing lipogenesis and cholesterogenesis in rats. This study was conducted to investigate the long-term effect of dietary medium-chain triglyceride (MCT) as compared with that of corn oil feeding on lipid metabolism in rats. Both serum cholesterol and triglyceride levels in MCT-fed rats showed significant decrease during the experimental period of eight weeks, although liver cholesterol and triglyceride contents were not distinguishable between the two groups. Significant elevation of the activity of lipogenic enzymes, such as fatty acid synthetase (FAS) and malic enzyme (ME) of the liver, was observed in MCT-fed rats without any fat accumulation of the liver (fatty liver). The increase of lipogenic enzyme activity was accompanied by a significant reduction of essential fatty acids (EFA) such as 18:2 (omega6) and 20:4 (omega6) in total liver lipid. In contrast, hepatic beta-hydroxy-beta-methylglutaryl CoA(HMG-CoA) reductase activity was significantly decreased in MCT-fed rats, that would play an important role in achieving hypocholesterolemia. From these results obtained in a long-term experiment, it is concluded that exogenous MCT depresses the key enzyme catalyzing cholesterol synthesis with a concomitant elevation of lipogenic enzyme activity in the rat liver.


Cholesterol ester storage disease: clinical, biochemical, and pathological studies. Of three siblings affected with cholesterol ester storage disease, two died at ages 7 and 9 years, respectively, with hepatic scarring and portal hypertension. Lipid storage was documented in both patients, as were esophageal varices and aortic plaques in the older child. The third affected sibling, followed to 13 years of age, has hepatomegaly, hyperlipidemia, short stature, adrenal calcification, and acid lipase deficiency. Leukocyte extracts demonstrated deficiency of acid lipase in this patient. This autosomal recessive condition may be allelic with Wolman disease with a more malignant course in this family than in most reported cases.


Identification of heterozygote carriers of congenital adrenal hyperplasia by radioimmunoassay of serum 17-OH progesterone. The response to administered adrenocorticotropin (ACTH, Cortrosyn) of 26 heterozygotes (parents of children with adrenal 21-hydroxylase deficiency) and of 14 controls are compared. The mean plasma levels of 4-pregnene-3, 20-dione-17, 21-diol (17-OH progesterone) were significantly greater in the heterozygotes 60 minutes (p less than 0.02) and 90 minutes (p less than 0.05) after stimulation with Cortrosyn than in controls. There is, however, considerable overlap. The results would indicate a partial enzyme deficiency in the parents of diseased subjects. There was no significant difference in the response of plasma cortisol.


Thrombosis of the left coronary artery in a newborn infant. A unique occurrence of antenatal thrombosis of the left main coronary artery in a term infant is presented. The clinical features are indistinguishable from those of several other forms of congenital heart disease. The etiology of the thrombosis is unknown.


Amniotic fluid infections in an African city. Amniotic fluid infections were the most common cause of perinatal death in Addis Ababa, Ethiopia (21.8/1,000 live births). Most such infections appear to originate in the fetal membranes near the cervical os. The high rate of spread of these local infections into the amniotic fluid in Addis Ababa appears related to a lack of antimicrobial activity in amniotic fluids. Factors that adversely affected nutrition in the gravid woman, lack of prenatal medical care, and low water usage were associated with the high rate of fatal infections.


Computer interpreted fetal monitoring data. Discriminant analysis or perinatal data as a model for prediction of neurologic status at one year of age. Intrapartum fetal monitoring may be useful in discriminating short-term and long-term infant outcomes. In order to develop a model for the classification of infants for measures of outcome and to evaluate the discriminatory value of selected perinatal data, 61 data files, which included computer interpreted fetal electroencephalogram and fetal heart rate, one and five minute Apoar scores, results of neonatal neurologic examination, and results of neurologic examination at one year of age, were submitted to computerized discriminant function analysis. For the classification of infants for neurologic status at one year, using FEEG patterns alone, 64% of the 42 normal infnats and 63% of the 19 abnormal infants were correctly classified. Using intrapartum FEEG and FHR patterns simultaneously, 69% of the 42 normal infants and 63% of the 19 abnormal infants were correctly classified. Combining intrapartum data with postpartum data, including one minute and five minute Apgar scores and neonatal neurologic examinations, 81% of the 42 normal infants and 79% of  the 19 abnormal infants could be correctly classified. These results suggest that brain damage may already be present before birth, during labor, and that the risk of abnormal neurologic outcome at one year can be detected for a large percentage of infants using computer interpreted monitoring data during labor.


Comparison of the intestinal surface damage caused by Eimeria mivati, E. necatrix, E. maxima, E. brunetti, and E. acervulina by scanning electron microscopy. Eimeria brunetti, an intestinal coccidial parasite of poultry, caused the most severe mucosal damage when compared to E. mivati, E. necatrix, and E. maxima. The damage caused by E. brunetti was observed in the ileum and large intestine and consisted of complete villar destruction in these areas. Oocysts of E. brunetti were observed in tissue debris. E. necatrix (jejunum) enlarged isolated villi causing the lamina propria core to extrude through the villus tip. Damage to the mucosal surface is not as severe as lesions observed on the serosal surface would indicate. E. maxima (jejunum) caused epithelial sloughing and isolated patches of exposed connective tissue. Oocysts of E. maxima were observed under the surface epithelial layer. E. mivati damaged the villus tips of the duodenum and caused sloughing of the villar epithelia exposuncated and clubbed the duodenal villi. E. mivati oocysts were observed in the infected epithelia.


Experimental study of Eimeria robertsoni (Protozoa, Eimeriidae) in the snowshoe hare, Lepus americanus. A 6 1/2-day prepatent period and a patent period of at least 22 days followed single oocyst infection of a young coccidia-free hare with Eimeria robertsoni. Size of oocysts increased significantly during patency and was negatively correlated with oocyst output. Oryctolagus cuniculus remained negative after inoculation per os of E. robertsoni of snowshoe hare origin.


Eimeria haematodi sp. n. (Protozoa: Eimeriidae) from the rainbow lorikeet, Trichoglossus haematodus, in Papua New Guinea. Eimeria haematodi sp. n. is described from the rainbow lorikeet, Trichoglossus haematodus, in Papua New Guinea. Oocysts ovoid to slightly pyriform, and measured 24.7 to 40.0 by 20.8 to 35.0 micronm (32.3 by 27.6 micronm). Oocyst wall approximately 1.5 micronm thick and two-layered. Micropyle (5 to 7 micronm) and oocyst residuum (10 to 12 micron) present; polar granule absent. Sporocysts ellipsoidal, 12.0 to 17.0 by 7.9 to 9.8 micronm (13.3 by 8.4 micronm), with thin convex Stieda body, and granular sporocyst residuum (4.0 to 5.0 micronm). Thirteen out of 30 wild lorikeets (43.3%) were infected with E. haematodi.


Toxoplasmosis in nude mice.

Toxoplasmosis in nude mice. Immunity to the intracellular protozoan, Toxoplasma gondii, in mice is of the premunition type. Chemoprophylaxis with sulfadiazine normally permits mice to develop immunity to virulent organisms. However, nude (nu/nu) mice, which lack the thymus, failed to develop immunity to toxoplasma during 3 weeks of drug therapy while their hirsute littermates developed immunity during this period. When nude mice were injected intraperitoneally with thymus cells from hirsute littermates, they became able to develop immunity to toxoplasma during drug prophylaxis. The injection of bone marrow cells or high-titered specific antibody did not prolong survival after sulfadiazine was discontinued. Therefore, it appears that immunity to toxoplasma in mice is dependent upon active cellular immunity while the role of antibody is uncertain.


Dactylogyrus atripinnei sp. n. from the blackfin sucker in Tennessee. A new species of Dactylogyrus, D. atripinnei, is described from the blackfin sucker, Moxostoma atripinne Bailey, collected from the Barren River drainage in Tennessee.


In vitro development of Schistosoma mansoni cercariae. Early cercarial embryos of Schistosoma mansoni developed to swimming cercariae within seven days in vitro, via the same sequence of stages as reported in vivo. The presence of living Biomphalaria glabrata cells (Bge line) was indispensable for proper development. Cultured cercariae were water-sensitive, gave no cercarienhüllen reaction, and appeared to lack the surface glycocalyx. Further development was not detected in mice or hamsters.


Relationship between nuclear morphology and the phases of the cell cycle during cercarial development of the digenetic trematode Trichobilharzia ocellata. During the proliferative phase of cercarial development in the digenetic trematode Trichobilharzia ocellata, nuclei varied in size, appearance of the chromatin, and intensity of Feulgen staining. On the basis of interphase nuclear morphology six nuclear classes were identified. Data from microspectrophotometric determinations and 3H-TdR labeling experiments were used to correlate each kind of interphase nucleus with a phase of the cell cycle. Marked variability in nuclear area developed between cells by time they reached late G1. Increases in nuclear area could not be correlated with the onset of DNA synthesis. Throughout all stages of development of T. ocellata cercariae, proliferating cells divide mitotically; meiotic divisions were never seen. Thus, the mode of reproduction appears to be asexual. No evidence was found to support previous suggestions of diploid parthenogenesis.


Cell cycle analysis in developing cercariae of Trichobilharzia ocellata (Trematoda: Schistosomatidae). Cellular proliferation has been analyzed during cercarial development of the digenetic trematode Trichobilharzia ocellata. Prior to the tail-bud stage (about 1,000 cells), cells were actively involved in cellular proliferation. The mean cell cycle was 15.2 hr. The time for mitosis was 1.6 hr; for G1, 5.6 hr; for G2, 3.2 hr, and for the S phase, 4.8 hr. Beginning with the tail-bud stage, an increasing proportion of cells accumulate in the G1 phase. Cytological evidence of changes in the amount of cytoplasm per cell revealed that these noncycling cells were differentiating. During organ development and differentiation, the proportion of proliferating cells decreases and by the 2,000-celled stage proliferation ceases. Our results do not support a germinal lineage theory of cercarial development since none of the observed nuclear types could be unequivocally identified as belonging to the germ line.


Occurrence of a sporocyst generation of Fasciola gigantica in the mollusc Lymnaea rubiginosa. Thirty laboratory-reared, juvenile Lymnae rubiginosa were exposed to 20 miracidia each of Fasciola gigantica. Eight days postinfection snails were dissected, and clearly recognizable sporocysts were recovered from the mantle collar and renal vein. Behavior of sporocysts and mother rediae differed markedly. These observations contradict those of direct metamorphosis of miracidium into redia as reported by Ogambo-Ongoma and Goodman (1976).


A new family of pseudophyllidean cestodes from the deep-sea teleost Acanthochaenus lutkenii Gill 1884. An unusual pseudophylidean cestode, Philogythos atlanticus gen. et sp. n., from the intestine of the deep-sea teleost Acanthochaenus lutkenii (Stephanoberycidae) is described. A new family, Philobythiidae, is erected to accomodate the genus. Distinguishing characteristics of the species are: bothriate scolex with apical disk, lateral genital pores, small cirrus pouch and unarmed cirrus, postovarian vitellarium, uterus with preformed diverticula, and oncospheres contained within capsules.


Permeability studies on taeniid metacestodes: II. Antibody-mediated effects on membrane permeability in larvae of Taenia taeniaeformis and Taenia crassiceps. Incubation in immune rat serum (IRS) was shown to increase the rate of absorption of 125I RNase-A but not 125I BSA by larvae of Taenia taeniaeformis and T. crassiceps. This effect required a heat labile factor in serum, and partial activity could be restored in heat-treated IRS by adding normal rat serum (NRS) as a source of complement. In addition, the effectiveness of IRS in altering permeability was shown to be dependent on the concentration of functional complement. Both live and dead larvae incubated in NRS rapidly depleted hemolytic complement levels in the surrounding medium. Immunoglobulin fractions from IRS separated by anion exchange chromatography and and gel filtration were tested in the presence of excess complement for their ability to affect uptake of 125I RNase-A. Enhanced permeability was observed in larvae incubated in each fraction. The results show that antibodies in conjunction with complement are capable of disrupting larval permeability control in vitro. The observation that larvae were able to restore normal control as complement levels declined suggests that the parasites may overcome this immunologic effector mechanism by interfering with complement function.


Status of the genus Cyrnea (Nematoda: Spiruroidea) in wild turkeys from the southeastern United States. Two species of Cyrnea are reported from 706 wild turkeys (Meleagris gallopavo) from 25 localities in 9 southeastern states. Cyrnea (Cyrnea) neeli sp. n. in birds from Alabama and Florida is differentiated primarily by distal processes of the left spicule and spicule lengths. Specimens from wild turkeys previously reported as C. eurycerca are identified as C. coloni. The configuration of caudal papillae of C. colini is redescribed. Neither species occurred in birds from montainous regions, and C. neeli sp. n. was restricted to Florida and southern Alabama. Poults less than 1-month old were not infected. Infections peaked in early fall and then declined rapidly.


Spironoura tikasinghi sp. n. (Nematoda: Kathlaniidae) from a turtle in Trinidad, W. I. Spironoura tikasinghi sp. n. from the cecum and small intestine of a turtle, Geoemyda punctularia, from Trinidad, is characterized by having spicules 530 to 570 micronm, and a gubernaculum 310 to 340 micronm long. It is compared with other species from South and Central America, and with those reported from turtles.


Some ecological aspects of Ergasilus centrarchidarum Wright (Crustacea: Copepoda) on largemouth and spotted bass in Lake Fort Smith, Arkansas. Certain ecological aspects of Ergasilus centrarchidarum on largemouth and spotted bass from Lake Fort Smith, Arkansas, were studied during July 1970 through June 1971. There were no significant differences in E. centrarchidarum intensities between host sexes. E. centrarchidarum tended to increase in abundance with the age of the hosts through the first 3 years, then declined in older hosts. Maximum abundance and egg production occurred during the summer months. Optimum temperatures for abundance and egg production ranged from 24 to 29 C. There was no evidence of antagonism among E. centrarchidarum and other concomitant species of gill parasites.


Membrane potential-dependent and-independent tension in the canine tracheal muscle. We used the double sucrose gap apparatus to describe properties of electromechanical coupling in canine trachealis muscle, during infusion of elevated K+ and 5-hydroxytryptamine (5-HT). With 59 mM K+ and 5-HT, quasi-steady-state relationships of membrane depolarization and tension indicate electromechanical coupling, but for a given increase in tension much smaller membrane depolarizations were seen with 5-HT than with 59 mM K+. Evoked displacements of the membrane potential with anodal or cathodal current caused relaxations or contractions, respectively, and graded displacements resulted in graded tension changes. Reversal of 59 mM K+ membrane depolarization with long anodal current pulses resulted in nearly complete reversal of K+ tension, but reversal of 5-HT membrane depolarization caused tension reversal of only 20 to 40%. Data partially define electromechanical coupling in canine trachealis muscle provide evidence for membrane potential-independent tension with 5-HT at concentrations giving near threshold to maximal 5-HT tension.


The release of acetylcholine elicited by extracts of black widow spider glands: studies using rat superior cervical ganglia and inhibitors of electrically stimulated release. An extract of the venom glands of black widow spiders (BWGE) induces the release of acetylcholine (ACh) from the superior cervical ganglia of rats. The release of ACh follows first-order kinetics, which suggests that the venom either lowers the ganglionic store of ACh, or continually reduces the rate of release. Since ganglionic ACh did not decrease in the presence of BWGE, it is likely that the venom continually reduces the rate of release. The rate constant for BWGE-induced release of ACh is depressed about 45% by treatment of the ganglion with either botulinum toxin or a low Ca++/high Mg++Ringer's solution. The rate constant is depressed about 30% by treatment of the ganglion with 8.3 microng/ml of cytochalasin-B. Since these agents inhibit the release of ACh which is elicited by electrical stimulation of the ganglion, it is suggested that one action of BWGE is the stimulation of some step in the physiological mechanism involved in the release of neurotransmitters. Treatment of the ganglion with tetrodotoxin had no effect on the rate constant for release induced by BWGE. The action of BWGE on the ganglion was not reversible after 10 minutes. When treated with BWGE, ganglia whose stores of transmitter had been labeled by electrical stimulation in the presence of [3H]choline released ACh having uniform specific activity. The data suggest the presence of more than one activity in the extracts.


Effects of dopaminergic agonists and antagonists of feeding in intact and 6-hydroxydopamine-treated rats. The effects on food intake of treatments which alter central dopaminergic function were examined in rats. Doses of d-amphetamine that increased the conversion of 3H-tyrosine to 3H-dopamine in the brain were found to decrease food intake, an effect that was reduced by the systemic administration of the dopaminergic antagonists alpha-methyltyrosine, haloperidol or spiroperidol. The dopaminergic agonists, apomorphine, dopa, cocaine and methylphenidated, also reduced feeding and these effects were attenuated by low doses of spiroperidol. In larger doses, spiroperidol itself decreased feeding, and this effect was potentiated by alpha-methyltyrosine. The ability of dopaminergic agonists and antagonists to inhibit food intake was also observed in rats treated with 6-hhyroxydopamine so as to produce a selective 83% depletion of dopamine. In these animals, d-amphetamine was found to be less effective as an anorexic agent, whereas dopa, apomorphine, alpha-methyltyrosine and spiroperidol each was more effective in reducing food intake. These alterations in sensitivity may reflect neurochemical changes which occur at residual dopaminergic synapses after subtotal lesions of dopaminergic neurons. We conclude that both increases and decreases in central dopaminergic activity can reduce feeding and propose that some intermediate rate of dopamine release provides an optimal level of neuronal activity for feeding by the hungry animal.


Vascular responses to the monoenoic prostaglandin precursor dihomo-gamma-linolenic acid in the perfused canine lung. Dihomo-gamma-linolenic acid (DGLA; 2 mg/kg i.v.), the monoenoic prostaglandin (PG) precursor was reported earlier to produce systemic hypotension in the intact dog. It is shown here to produce pulmonary vasoconstriction when given (50-500 microng/kg) in the pulmonary artery of the isolated perfused canine lung lobe. This effect is similar to that of arachidonic acid (AA), the bisenoic PG precursor. PGF1alpha was vasopressor in both preparations. The DGLA response at 100 microng/kg in the lung was nearly identical with that of AA25 microng/kg; DGLA 200 microng/kg=AA50 microng/kg;DGLA 300microng/kg=AA 100 microng/kg. The DGLA 100 microng/kg response was nearly equal to that with PGF1alpha 1 microng/kg. The equipressor dose ratio, DGLA/AA, varied 2.5 to f1 and DGLA/PGF1alpha was 100:1. DGLA and AA vascular responses were blocked by indomethacin. Linoleic acid, used as a control fatty acid, had no pulmonary pressor action. When a dextran-based artificial perfusate was used, the vasopressor response to DGLA was essentially unchanged from that in the blood-perfused lobe. The effects of DGLA appear to be due to conversion to vasoactive products in the PG biosynthetic pathway. These products are less potent than those formed in the metabolism of AA.


Meperidine effects on schedule-controlled responding. The effect of meperidine were studied on responding by pigeons under a multiple fixed-ratio, fixed-interval schedule of food presentation. Low doses of meperidine (0.3-3 mg/kg) generally increased and higher doses decreased responding under the fixed-interval component of the multiple schedule. The responding under the fixed-ratio component was usually unaffected by low doses and decreased by doses greater than 3 mg/kg of meperidine. Naloxone (1 mg/kg) antagonized the rate increases in the fixed-interval component; however, no dose of naloxone (1-56 mg/kg) or cyclazocine (0.1-3 mg/kg) antagonized the rate decreases produced by meperidine under either schedule component. The effects of morphine and meperidine were compared in two birds treated daily with methadone. In a bird maintained on a daily dose of 120 mg/kg (p.o.) of methadone, there was a 10-fold shift of the dose-effect curve for morphine but no shift of the meperidine dose-effect curve. In a bird maintained on a daily dose of 30 mg/kg (p.o.) of methadone, there was a 3- to 5-fold shift of the morphine dose-effect curve, but again no shift of the meperidine dose-effect curve. Thus, the rate-decreasing effects of meperidine were not antagonized by narcotic antagonists, nor did they show cross-tolerance to methadone.


Application of A. C.-polarography in a study of p-nitroanisole metabolism and its kinetic properties. Phase sensitive alternating current polarography was introduced for the simultaneous determination of p-nitroanisole and its metabolites p-nitrophenol and p-nitrocatechol in kinetic studies with rat liver microsomes. The substrate p-nitroanisole disappears rather rapidly while p-nitrophenol is formed. First traces of a second oxidation product, p-nitrocatechol, can be detected only after a few minutes after the initiation of the reaction. This suggest that O-demethylation of p-nitroanisole is the primary reaction which is followed by aromatic ortho hydroxylation of p-nitrophenol. After incubation times longer than 15 minutes, appreciable amounts of p-nitrocatechol are found which shows optical absorption characteristics similar to those of p-nitrophenol (absorption maximum at 440 nm). It is concluded from these kinetic experiments that optical determination of the primary metabolite during the initial reaction phase constitutes a reliable measure of microsomal O-demethylation activity. Phenobarbital induction differentially increases O-demethylation and ring-ortho-hydroxylation activities. From this and respective inhibition studies it is concluded that possibly multiple forms of cytochrome P-450 are involved in the metabolism of either p-nitroanisole or p-nitrophenol.


A study of the binding of sulfur to rat liver microsomes which occurs concurrently with the metabolism of O, O-diethyl O-p-nitrophenyl phosphorothioate (parathion) to O, O-diethyl O-p-nitrophenyl phosphate (paraoxon). In order to investigate the nature of the sulfur that is bound to liver microsomes concurrently with the metabolism of parathion to paraoxon, an isolated rat liver microsomal preparation was labeled with [35S] parathion and the purified product was examined by chemical degradation. Characterization of the degradation products by thin-layer chromatography indicated that the sulfur is bound as a polysulfide or hydrodisulfide formed by the combination of a reactive form of sulfur, released from parathion, with cysteine residues of the microsomal protein. Preliminary investigations revealed similar binding occurs when the microsomal preparation is replaced with purified rabbit cytochrome P-450 plus NADPH-cytochrome P-450 reductase and NADPH.


Images on serving marijuana, alcoholic beverages, and soft drinks. The images on serving marijuana, beer, bourbon, and soft drinks at a small informal party were compared with use of a posttest only with a control group experimental design. A total of 249 Ss were randomly assigned and received one of four shopping lists of a person planning the party. The four shopping lists were identical except for the fifth product; i.e., Ss received a shopping list including either marijuana, beer, bourbon, or soft drinks. Significant differences in images between the four products were found.


Relationship of MMPI scores of drug-abusers to personal variables and type of treatment program. The MMPI scores for drug-abusers admitted to a multimodality treatment program (N=324) were analyzed to determine the extent of MMPI scale differences due to basic personal variables (age, sex, race), as well as type of program entered (drug-free vs. methadone-based) and program environment (residential vs. ambulatory). The results support the view that the MMPI group profile for drug-abusers, characterized by a substantially elevated Pd scale and somewhat less elevated scores on most other diagnostic scales, is relatively invariant and not substantially affected by personal background or program differences.


[Painful and transient spasm of the cardioesophageal sphincter (author's transl)]. The writers describe a painful and transient spasm of the lower esophageal sphincter. Clinically, it is a matter of total aphagia, which is painful and prolonged, and occurs during eating; it always responds to medical treatment (rehydratation and antispasmodics), and it does not exceed 48 hours. An X-ray examination is both essential and characteristic: it visualizes the spasm of the lower esophageal sphincter in its full extent, the food gap, the sideration of the thoracic esophagus, and the disappearance of the air pocket. A perfect understanding of these clinical and and radiological signs enables a recognition of the functional nature of this medically curable condition, and thus aids patients of all ages to avoid an unecessary surgical operation.


[A study of the lower urinary apparatus using 105 mm ampliphotography (author's transl)]. The exploration of the lower urinary apparatus was carried out using a 105 mm ampliphotography system. 230 examinations were performed according to several techniques: descending and micturition cystography; urethrocystography or retrograde and voiding cystography; cystography with suprapublic puncture; and cystometrography. An analysis of the results enabled an evaluation of the method. The morphological study may appear inadequate if electronic enlargement is not employed. The dynamic study is excellent in the diagnosis of diseases of the neck and uretheral stenosis. The limits of the amplifier field should not lead to a failure to recognize a possible vesicoureteral reflux. A decrease in the exposure dose makes it a technique of choice in children on the condition that the rate of exposures is not excessive and electronic enlargement is not performed too frequently.


The contribution of an adult educationalist to a trainers' group. I have summarized my findings as a non-medically qualified educationalist attending regularly at meetings of a group of general-practitioner trainers. I believe that it is essential for trainers to learn to draw general principles from specific examples in order to help trainees to learn. Two other contributions an educationalist can make are promoting counselling relationships and helping trainers understand more deeply their own relationships with their patients.


Continuing education for general practice--a learning system. A learning system for continuing education for general practitioners is described and illustrated by examples from educational programmes held in Doncaster. The work that needs to be done by organizers in planning, organizing, implementing, and evaluating educational programmes is outlined. I hope that this will help other organizers of continuing education.


The opinions of postgraduate tutors on continuing education for general practitioners. The recent big increase in learning opportunities for general practitioners, particularly in postgraduate medical centres, has been accompanied by increasing suspicion that educational activities may not be fulfilling the aims of continuing education, and that there is dissatisfaction with existing courses.This study took place in the north-western region, and 18 clinical tutors were interviewed using a structured interview schedule.Very few of the clinical tutors were aware of the existence of the book The Future General Practitioner-Learning and Teaching, and most activities consisted of lectures, lecturers usually being local and regional consultants, with occasional national authorities. Small group teaching rarely occurred, and all the centres had been supplied with videotape equipment.Most of the tutors had attended a course on audiovisual aids, or a meeting organized by the National Association of Clinical Tutors, but the tutors appeared ill at ease when answering questions about educational aims and objectives, and most tutors were unable to identify an educational objective from a group of statements.


Users and non-users of doctors--implications for self-care. Sixty patients who visited their general practitioner were matched with 60 patients registered with the same doctor, who were of the same sex and in the same ten-year age group, and who had not visited the doctor for at least one year, but had recently experienced symptoms similar to those presented by the attending patients.Comparison of the 60 pairs revealed the following differences, all substantial although not all statistically significant. The patients who visited the doctor perceived themselves as less healthy, fewer had attempted self-treatment, more reported serious personal problems, and fewer reported obstacles to visiting the doctor.Differences between the pairs were negligible for total number of current ailments, effectiveness of self-treatment, if used, optimism about the healing powers of doctors, and fear of troubling their doctor with trivia.


The relationship between psychoneurotic status and psychoactive drug prescription in general practice. Psychoneurotic scores in a sample of all patients between the ages of 17 and 70 in a group practice have been studied, and the relationship with psychoactive drug prescribing examined. In addition some social factors have been studied, namely, the use of alcohol and tobacco, and self-medication.The psychoneurotic scores of those prescribed psychoactive drugs are significantly higher than those for the general population, but do not fall after treatment.


Evidence to the Royal Commission on the NHS. From the Royal College of General Practitioners. 1. It is the right of everyone in the UK to have access to personal and continuing primary health care of a high standard (para. 4.1).2. The primary health care service should be built on general practice (paras 2.3 to 2.10, 4.1 to 4.3).3. The nature of the most important health problems today means inevitably that the main burden of care will fall on the primary health service (paras 3.2 to 3.7).4. It follows that the NHS must be reorientated around primary health care; the functions and size of the hospital service will then depend on the responsibilities of the primary health care sector (para. 4.2).5. It also follows that primary health care must attract a higher priority in the allocation of resources (paras 4.4, 5.2 to 5.8).6. Setting standards of performance is a high priority for all the health professions and the NHS itself (paras 3.6, 3.7).7. In medicine, professional standards will not improve unless medical education is radically reshaped by the implementation of the recommendations of the Committee of Enquiry into the Regulation of the Medical Profession (para. 5.4).8. Inadequate care by some general practitioners today is acknowledged (paras 2.12, 2.13); the main causes are examined (para. 2.15) and remedies are suggested (paras 4.4, 5.4 to 5.6).9. The special problems of primary care in parts of conurbations are described (paras 2.14 to 2.17); a proposal to deal with this exceptional situation is made (para. 5.7).10. Primary health care should be provided normally by functionally integrated teams of general practitioners, nurses, health visitors and, where appropriate, social workers, supported by receptionists and secretarial staff (paras 2.4, 2.10).11. Within the primary health care team ultimate responsibility must rest with general practitioners (para. 4.1).12. To provide good primary health care we need:i) Appropriate manpower (para. 5.2).ii) Adequate premises (para. 5.3).iii) Effective education (paras 5.4, 5.5).iv) A modern record/information system (para. 5.6).13. General practitioners should remain independent contractors so that patients have an independent medical adviser in a State dominated health service (para. 4.7).14. The administration of the NHS should work on the principle that bureaucratic interventions between patients and the health professions should be kept to an absolute minimum (para. 4.4).


The workload of a commercial deputizing service. The analysis of 1,098 calls to a commercial deputizing service during a period of four weeks is described. Approximately 20 per cent of the calls were for illnesses considered potentially life-threatening while in 22 per cent telephone advice was given and the patient was not visited by the deputy on call.


Recurrent pregnancies during oral contraception. The records of the Royal College of General Practitioners' Oral Contraception Study were examined for those women who had become pregnant while using combined oral contraceptive pills. Analysis reveals that these women are much more likely than average to have further failures if they resume taking the Pill (seven failures in 35 women-years, compared with one in 500 women-years for the whole study). This finding could occur through some factor in the patient's personality (patient failure) or through some factor in the patient's metabolism.


One trainee's clinical experience.

One trainee's clinical experience. I report my clinical experience as a trainee. I am doubtful about the usefulness of hospital medical and accident and emergency posts, but obstetric and paediatric posts are highly relevant. There was little experience and teaching in the general practice year about psychiatry and gynaecology. It seems possible that trainees are not seeing enough chronic illness or associated problems, such as obtaining social services, therapy in chronic cases, and correct delegation to practice nurses. These points all suggest that the work of doctors undergoing vocational training should be monitored, at least at present.


Classifying disease in general practice. I have developed a system of classifying diseases in general practice based on headings relevant to general practice which are built up in a hierarchy. I believe this is better than abbreviating the International Classification of Disease with the addition of individual symptoms.Ideally, a classification ought to include occupational diseases and psychosocial problems, and it must be accompanied by a terminology defining as precisely as possible the different categories based on criteria relevant to ordinary general practice. It should still follow the main divisions of the International Classification of Disease as far as possible.I believe that general practice will not progress any further unless it is prepared to loosen its traditional allegiance to hospitalorientated disease classifications, which are, for our purpose, inappropriately rigid.


A comparison of three systems of classifying presenting problems in general practice. Three internationally recognized systems have been devised for classifying presenting problems in general practice. They are: the Royal College of General Practitioners' (1963) classification, the US Ambulatory Medical Care Classification of Symptoms (NAMCS), and the World Organization of Colleges and Academies of General Practice/Family Medicine (WONCA, 1976) classification which is known as An International Classification of Health Problems of Primary Care (ICHPPC).These three systems were compared in over 8,000 consultations conducted by 81 randomly selected British general practitioners in Nottinghamshire.For all ages of patient, the NAMCS, which has only 197 categories, was the most specific, and the least specific was the classification of the Royal College of General Practitioners.


Induction of ovulation with clomiphene citrate. There are specific indications for the use of clomiphene. When used with the simple precautions that have been outlined, it is a safe, relatively inexpensive and convenient method of ovulation induction. Clomiphene certainly deserves its prominent place in the treatment of the infertile woman.


Attitudes towards euthanasia.

Attitudes towards euthanasia. There are an infinite variety of attitudes to euthanasia, each individual response to the concept being influenced by many factors. Consequently there is a literature on the subject ranging from the popular article to papers in specialized journals. This study, however, has taken a well defined sample of people, inviting them to answer a questionnaire which was designed to elicit their attitudes to euthanasia in a way which could be analysed statistically. Nor surprisingly attitudes appeared to 'harden' as those answering the questionnaire grew more experienced in dealing with patients and also more professionally established. Thus it was found that of the seven groups questioned practising physicians showed more positive attitudes to euthanasia and their responses did not differ significantly from those of senior medical students. It is these groups which actually or potentially have to resolve the clinical dilemma posed by the dying patient.


Studies on antagonism between human skin bacteria. Antagonism by an antibiotic-producing Staphylococcus epidermidis strain (S6+) against other bacteria was studied semi-quantitatively on solid media and quantitatively in liquid batch culture. Parallel experiments were performed with a similar but non-antibiotic producing strain (S6-). On solid media strain S6+ in the logarithmic growth phase unilaterally inhibited members of all gram-positive species tested, whereas S6- had no effect. In liquid media, more complex interactions were observed, including mutual and reversed antagonisms. The relevance of these findings to the ecology of human skin is discussed.


Osmotic relations of nerve fiber.

Osmotic relations of nerve fiber. The volumetric elastic modulus of the sheath and the osmotic swelling pressure of the axoplasmic polymer network of the giant axon of Loligo vulgaris were measured. Evidence was obtained that (1) the elastic modulus of the sheath, (2) the swelling pressure of axoplasm, and (3) the effective osmotic pressure difference due to mobile solutes  determine axonal volume. The contributions of the sheath and the axoplasm were significant because the effective osmotic pressure due to mobile solutes was a small fraction of the theoretical bulk osmotic pressure due to these solutes. The giant axon was converted from an imperfect to a near perfect osmometer by minimizing the contribution of the sheath and the axoplasmic gel.


Fractures and dislocations of the extremities in children. A prospective study of 410 fractures seen in 398 children during 1 year was carried out. Fractures were more common on the left, and the upper extremities were more frequently injured than the lower extremities. The two commonest sites were the hand and the distal forearm. The radius was the bone most commonly fractured. Fifty-seven (13.9%) of the fractures involved epiphyses and 67 (16.3%) were torus fractures. Of the 398 patients 236 were males. There was a slightly increased incidence of fractures in the summer months and in older patients.


Fracture healing in the sciatically denervated rat. Fractures of the fibula were produced in rats with sciatic denervation. The denervated rats exhibited more rapid fracture healing than controls. Fifteen days following injury, enhanced union was measured by histologic assessment (p less than 0.001), and biomechanical testing including fracture stress (p less than 0.005), elastic modulus (p less than 0.005), strain at failure (p = 0.01) and energy to failure (p = 0.05).


Objective assessment of the trauma patient in a surgical intensive care unit. A 6-month study using the Therapeutic Intervention Scoring System (TISS) to evaluate trauma patients admitted to a surgical intensive care unit showed a correlation between severity of illness and TISS score at the same time. The TISS is useful in the ICU, where numerous complex interventions are made in caring for acutely ill and injured patients.


Accelerated tumor growth following experimental burns. When mice are given a 30% scald burn, the growth of subsequently inoculated Ehrlich ascites tumor is markedly accelerated. This effect, which parallels the well documented suppression of cell-mediated immunity occurring postburn, disappears 10 days postinjury. Possible clinical implications are discussed and an illustrative case report is presented.


Persistent hemothorax secondary to malposition of a subclavian venous catheter. In a group of seven patients with percutaneous subclavian catheters in the pleural space, three were found to have continued blood loss from the catheter tip, and in four patients thoracotomy was prevented by discontinuing blood administration through the subclavian catheter during a re-evaluation phase.


Irreducible fracture dislocation of the ankle due to posterior dislocation of the fibula. In order to prevent permanent disability, a proper diagnosis of the fixed posterior fracture dislocation of the fibula with fracture dislocation of the ankle joint must be made. Full-length (knee to ankle) radiographs are necessary to make this diagnosis. Although a closed reduction has been described as successful, we feel that an open reduction is usually necessary. Freeing of the trapped fibula from behind the tibia results in a satisfactory reduction of this fracture dislocation. The reduction and fixation of the malleolar fragment is then simple, and an excellent result can be expected.


Atrial septal defect due to blunt thoracic trauma. The case report of an atrial septal defect with right-to-left shunting in an adult following blunt chest trauma is presented. To our knowledge a successfully repaired traumatic atrial septal defect has not been previously reported in the English-language literature.


Intraoperative localization of renal calculi during nephrolithotomy by ultrasound scanning. An ultrasound B-scan probe has proved to be useful in the intraoperative localization of renal calculi. The probe is small, readily available and produces an anatomical cross-sectional image of the kidney. The use of a 10 MHz. frequency probe enables 2 to 3 mm. stones to be detected readily. Calibration of the screen and the use of a fine needle inserted into the kidney under ultrasound control provide for precise 3-dimensional localization of the stone to facilitate its removal. The method has been successful in accomplishing the complete removal of small stones or residual fragments in 7 of 11 patients in whom it has been used. The method requires some experience in the use of the probe and in the interpretation of the ultrasound image.


Immunotherapy of disseminated renal cell carcinoma with transfer factor. Ten patients with disseminated renal cell carcinoma have been treated with transfer factor as an immunostimulant. In 5 patients with metastatic disease evident at the time of initial diagnosis treatment involved removal of the primary tumor followed by transfer factor therapy. Of these patients 3 had a temporary stabilization of metastatic disease. Three patients with recurrent metastatic disease after previous nephrectomy were treated, 2 of whom showed a temporary stabilization of metastatic disease. There were 2 additional patients without clinically evident metastases but at a high risk for recurrent disease who were treated and remain free of disease. We used 5 immunologic parameters to evaluate the clinical effects of transfer factor. No objective clinical regression was noted in any patient treated with measurable disease.


Cystometrics during endoscopy of a ureterocele: determination of potential for reflux. We describe a simple preoperative clinical test to determine whether a ureterocele that is unroofed will cause reflux postoperatively. The method is outlined and explained, and clinical examples are presented.


The continent vesicostomy: clinical experiences in the adult. During a 2-year period continent vesicostomy has been attempted in 17 adults and a continent stoma has been achieved in all but 4 patients. Operative morbidity is low and there has been no operative mortality. Definition of precise indications and contraindications must await further experience but this operative procedure seems to be a useful alternative in the management of neurogenic bladder and incontinence.


Altered bladder function in staghorn calculus disease. Disorders of the lower urinary tract that predispose to urinary infection were identified in 69 per cent of 62 patients with branched renal calculi. Within an average followup of 6.3 years control of these disorders was observed to reduce the rate of reinfection and the frequency of complications after operative stone removal.


Urinary fistulas: vaginal repair using a labial fat pad. A technique is recommended to repair urinary fistulas vaginally using a pedicle of labial fat to separate the urothelial and vaginal layers. The technique was used in 6 patients with vesicovaginal and 4 patients with urethrovaginal fistulas. Anatomic results were successful in all cases and stress incontinence was cured in all patients who had this coexistent condition.


Benign lesions of the tunica albuginea.

Benign lesions of the tunica albuginea. Although most testicular masses are malignant we present 7 cases to demonstrate that benign lesions of the tunica albuginea do occur and that these may be a source of diagnostic confusion. Consideration should be given to the possibility of a benign lesion of the tunica albuginea when the lesion is small, discrete, painless and projecting above the surface of the tunica albuginea. All of our patients were referred to us with a tentative diagnosis of testicular malignancy. We do not wish to decrease the importance of vigilance concerning testicular masses but the cases presented herein demonstrate that all masses of the testis are not malignant.


Loop nephrostomy with the Cummings catheter. Experience with the Cummings U-nephrostomy tube for more than 3 years in more than 30 cases has been favorable. Replacement in patients requiring long-term diversion has been necessary every 3 to 4 months because of ingrowth of tissue into the mushroom, causing an obstruction. Insertion of the new Cummings catheter by the technique outlined has been easy and free of complications.


Radioisotope bone scanning characteristics of metastatic skeletal deposits of prostatic adenocarcinoma. Radioisotopic bone scans and metastatic bone surveys were conducted on patients with endocrine-unresponsive prostatic adenocarcinoma undergoing multiple drug chemotherapy. Three types of bone scans were observed--type I scans were characterized by asymmetric radioisotope activity and normal renal imaging, type II was characterized by symmetrical skeletal uptake and faint or absent renal imaging and type III showed symmetrical skeletal uptake with normal renal imaging and was interpreted as normal, although the bone surveys showed diffuse osteoblastic disease. The appearance of a type II scan was a grave prognostic indicator.


The functional approach to the management of the pediatric neuropathic bladder: a clinical study. A functional approach has been used in the management of the pediatric neuropathic bladder. Herein we report on our experience with incontinent children using pharmacologic manipulation with anticholinergic and sympathomimetic agents. Neuropharmacology and neuroanatomy as they apply to this approach are reviewed.


Blow out of a colocystoplasty loop owing to bladder neck obstruction. A case of blowout of the colonic segment of a colocystoplasty at its free end owing to late development of bladder neck obstruction is described. Prostatitis and secondary bladder neck contracture provided further hindrance to the already inefficient voiding mechanism and predisposed to the rupture of the decompensated bowel loop. This is an extreme example of proof that the colonic loop, except as an improved substitute for an ileal segment, cannot withstand high intraluminal pressures generated in the presence of bladder outlet obstruction.


Management of penile zipper injury.

Management of penile zipper injury. A penile problem that physicians are confronted with in the emergency room is entrapment of the foreskin by a zipper fastener. A case presentation and a simple technique for its management are described.


Megalophallus in sickle cell disease.

Megalophallus in sickle cell disease. A case of megalophallus in sickle cell disease with repeated episodes of priapism is reported. A possible cause of penile hypertrophy with preservation of potency is discussed. Corpus cavernography was helpful in the diagnostic evaluation.


Chylous ascites: an unusual complication following retroperitoneal lymphadenectomy for testis tumor. A 32-year-old man who had chylous ascites 6 weeks after retroperitoneal lymphadenectomy for embryonal cell carcinoma of the testis is reported. To our knowledge there have been only 4 previous reports of this interesting and unusual complication. Diagnosis, pathophysiology and management are discussed.


A study of hypertension: participation of central adrenaergic mechanism on the angiotensin II-induced hypertension. I. Interactions of angiotensin II and norepinephrine in the rat hypothalamus and other brainstem were studied by intraventricular perfusion or/and intravenous administration. (1) Intravenous administration of angiotensin reduced the hypothalamus norepinephrine content. (2) Intraventricularly perfused angiotensin reduced the hypothalamus norepinephrine but did not alter that in other parts of brainstem. Hypothalamus norepinephrine was reduced more by intravenous administration of angiotensin than by intraventricularly perfused angiotensin. II. The involvements of adrenergic mechanism in the central pressor effect of angiotensin II were studied through observation of blood pressure changes following injection of angiotensin II, phentolamine and propranolol into the rabbit lateral ventricle of rabbit brain.(1) Intraventricular administration of phentolamine suppressed the central mediated pressor respons of angiotensin. (2) Simultaneous intraventricular administration of propranolol enhanced the angiotensin pressor effect in anesthetized rabbits.


Elevated coronary venous oxygen content during oxygen breathing in the ischemic myocardium under pacing-induced stress in dogs. The purpose of the present study was to investigate the effect of oxygen inhalation on the stressed (pacing-induced) ischemic myocardium. In 13 open-chest dogs, the left anterior descending coronary artery was partially occluded, the coronary vein accompanying the artery was cannulated for coronary venous blood sampling and a myocardial strain gauge arch was sutured on the myocardium perfused with the partially occluded coronary artery in order to measure the myocardial contractile force. The heart rate was increased by left atrial pacing to increase myocardial oxygen consumption. Respiration was instituted either with oxygen or with room air. Increase of the heart rate caused an increase of blood flow through the partially occluded coronary artery, an increase of the local myocardial oxygen consumption and no consistent change of the local myocardial contractile force both during air breathing and oxygen breathing, provided that the heart rate was less than 200. These values decreased if the heart rate was increased more than 200 both during air and oxygen breathings. Coronary venous oxygen content from the local coronary vein accompanying the partially occluded coronary artery was 2.7 ml per 100 ml on the average during air breathing, while it was elevated to 3.8 ml per 100 ml during oxygen breathing. Although, pacing caused a similar change on coronary blood flow or myocardial contractile force both during air and oxygen breathings, elevated coronary venous oxygen content during oxygen breathing might indicate that ischemic myocardium becomes more aerobic during oxygen breathing. This may be one of the reasons why patient with coronary artery disease can perform more work without complaining chest pain during oxygen breathing.


Prolongation of Q-I interval in atrial septal defect. The present paper is concerned with Q-I interval and factors affecting this interval in 55 patients with atrial septal defect of ostium secundum type (ASD) in comparison with the interval in 60 healthy individuals and 37 patients with mitral stenosis. The results obtained are as follows: 1) Q-I interval was significantly greater in patients with ASD than in healthy individuals, and less than in patients with mitral stenosis. 2) The Q-I interval in ASD showed significant correlations with size of septal defect and age, but no correlation with other variables such as heart rate, blood pressure, and right heart catheterization data. 3) The interval was significantly shortened following the surgical closure of ASD. These findings suggest that left-to-right shunt at atrial level leads to prolongation of Q-I interval. Mechanisms for these results were discussed.


Electrophysiologic effects of diltiazem, a new slow channel inhibitor, on canine cardiac fibers. The effect of diltiazem hydrochloride (CRD-401), a coronary vasodilator, was investigated in isolated perfused canine ventricular muscles and Purkinje fibers using microelectrodes. The drug at a concentration of 1 microng/ml lowered the level of action potential plateau and shortened the duration in both ventricular and Purkinje fibers without change in maximum rate of rise (Vmax) or resting potential. Contractile tension of ventricular muscle was markedly decreased with shortening of plateau. With higher drug concentrations (5 microng/ml), Vmax in both ventricular muscle and Purkinje fiber decreased about 20% without change in resting potential, and the effect on repolarization became more marked. The drug blocked spontaneous firing which appeared in depolarized Purkinje fibers and abolished the automaticity elicited in electrically depolarized ventricular muscles. Input resistance of ventricular muscle, measured by small, hyperpolarizing short pulses, was not changed appreciably by the drug; suggesting no change in potassium conductance. These results suggest that the drug is a slow channel inhibitor, and its clinical implication is discussed in terms of antiarrhythmic activity.


Echocardiographic demonstration of anomalous septum in cor triatriatum. A 20-year-old male was admitted because of palpitation and dyspnea. A routine echocardiography revealed an abnormal echo in the left atrial outflow tract and was thought to have originated from the anomalo septum, and subsequently it was confirmed by operation.


Left atrial infarction with saddle embolism. Left atrial and left ventricular infarction with various atrial arrhythmias, multiple systemic arterial thromboembolism, and a large mural thrombus over the left atrial infarction is reported. In ischemic heart disease, systemic arterial thromboembolism may develop due to atrial infarction which is often overlooked in antemortem as well as in postmortem examinations. When a clinical diagnosis of atrial infarction is made, the possibility of a Stokes-Adams syndrome, thromboembolism, and rupture of the atrium should also be investigated.


Emergency care of the reimplantation patient. Emergency care of the reimplantation candidate involves care of the patient as well as the severed part. The part should be cooled rapidly to 0-4 C (32-39.2 F) after gentle cleansing with normal saline solution or Ringer's lactate. The stump should be gently irrigated with normal saline and pressure dressing applied. The suitability of the reimplantation candidate, chances for survival of the amputated part, and likelihood of eventual rehabilitation should be evaluated.


Pulsus paradoxus as a parameter in treatment of the asthmatic. In 40 patients treated in the Billings Hospital emergency department for acute exacerbations of bronchial asthma, pulsus paradoxus was noted at presentation and at the time of admission to the hospital or discharge. No level of initial pulsus paradoxus predicting eventual admission was found. High initial pulsus paradoxus was more frequent in admitted patients. A correlation between the percent drop of pulsus paradoxus and success or failure of treatment was noted. Treatment failure was the most frequent criterion for admission.


Cardiac arrests in children.

Cardiac arrests in children. The management of cardiac arrests in infants and children is based upon principles common to management of arrests of all age groups. Specific pediatric disease states predispose the patient to arrest. Special adaptions and pharmacologic management are required for pediatric cardiopulmonary resuscitation.


Primary chronic sclerosing osteomyelitis. The case of a ten-year-old white male with longstanding, painful swelling and severe limitation of left elbow motion is reported. The lack of symptoms and signs characteristic of infection and the pseudosarcomatous radiological findings coupled with the pathological findings of chronic osteomyelitis outline the diagnosis of primary chronic sclerosing osteomyelitis. A detailed description is given of the clinical course to illustrate the diagnostic difficulties encountered in a case of this nature. The outcome was favorable.


Localized tumor-like lesions in ulcerative colitis and Crohn's disease of the colon. Ulcerative colitis and Crohn's disease of the colon may manifest roentgenographically as localized tumor-like lesions of the colon. Such lesions are often of inflammatory origin but are likely to be mistaken for polypoid carcinoma or infiltrating submucosal malignancy. Four patients with localized inflammatory lesions of the colon that mimicked a neoplastic process are reported. The clinical features and the radiological-pathological correlation of such lesions are presented.


[Comparative characteristics of the I. T. Akulinichev and McFee systems in evaluating the electrical field of the heart]. The authors present a comparative assessment of A. T. Akulinichev's system, widely used in this country, and McFee's orthogonal corrected system for the presentation of the main parameters of the electric field of the heart in normal individuals. The obtained results were received from the examination of 120 normal individuals, the results were processed on a "BESM-6" computer with the aid of an information-measuring system.


[Role of mitral valve dysfunction in the development of cardiac insufficiency in postinfarct cardiosclerosis]. The clinical suggestion on the dysfunction of the mitral valve in 20 patients with post-infarction cardiosclerosis was confirmed by ventriculography (8 persons) and in autopsy (12 persons). The paper presents a clinical characteristics of the both groups of patients, the indices of the central hemodynamics, the end diastolic pressure in the left ventricle of the heart, coronaroangiography, as well as morphometric data of the examination of the hearts and of the extent of the scar lesions of the myocardium in patients who died of congestive cardiac insufficiency against the background of postinfarction cardiosclerosis combined with the papillary muscle affection.


[Effect of exogenous catecholamines and pain action on the tissue respiration of the myocardium]. In vitro experiments employing the polarographic technique of in-rush currents have demonstrated that adrenalin and noradrenaline in concentrations approaching those found in blood of myocardial infarction patients during the early days of the disease inhibit the tissue respiration of the cardiac muscle by 10--50%. A 10-minute intensive pain stimulation was found to inhibit the aerobic processes in the myocardium by 20--24%. Hypercatecholaminemia observed in the acute period of myocardial infarction is suggested to play an important role in the pathogenesis of cardiac insufficiency during myocardial infarction, since it causes histotoxic hypoxia of the intact portions of the cardiac muscle. The importance of eliminating the pain syndrome in patients with myocardial infarction and angina pectoris is emphasized.


[Hemodynamic observations in acute myocardial infarct]. A haemodynamic study was conducted in 96 patients with acute myocardial infarction. The method of right heart catheterization at the bedside using the Swan-Ganz floating balloon-tipped catheter is safe and feisible. An elevation of pressure in the pulmonary circulation was revealed in patients with transmural myocardial infarction and in those without clinical signs of heart failure. The pressure elevation is detected the more often the sooner after the onset of infarction the examination is conducted. To evaluate fast pressure changes heart catheterization is essential and cannot be substituted by any other technique of examination Digoxin administration during the acute phase of myocardial infarction fails to produce any significant reduction of the pulmonary circulation pressure, but a prompt reduction of the pulmonary circulation pressure can be achieved by way of Phentolamine infusion. The pulmonary circulation pressure measurements during the acute phase of myocardial infarction are believed to be an indispensable component of examinations for the heart failure therapy.


[Clinical and morphological correlational analysis of different forms of myocardial infarct]. On the basis of a mathematical analysis carried out by a "Minsk--220" computer, the correlation between the most essential morphological changes in the coronary arteries, the peculiarities of myocardial infarction, history and its clinical manifestations were studied in 320 myocardial infarction cases (148 males and 172 females over 50 years of age) with the distinction of 276 clinical and morphological signs. The numerical assessment of the conjugation indices of the morphological changes and the clinical-laboratory data permitted to evaluate the role of each of the examined factors in the genesis of primary and secondary myocardial infarctions, their spreading in the heart muscle, and their clinical manifestations. It has been demostrated that similar changes in the coronary arteries that create a background for a relative circulatory insufficiency are realized in different forms of myocardial infarction. Relative coronary insufficiency varies widely and becomes the leading cause of myocardial ischaemia. The effect of other factors is interpreted as modifying, and some of them--as triggering. The presented correlations analysis proves the rationale of assessing each case of myocardial infarction in terms of the probability theory of patho- and morphogenesis of ischaemic heart disease.


[Rupture of the interventricular septum in acute myocardial infarct]. The authors examined ruptures of the interventricular septum in 12 patients with acute myocardial infarction. Septal ruptures comprise 8% of all cardiac ruptures that occur within the early days of infarction, they are poorly diagnosed, and most of such patients die before the end of the 1st--5th week due to acute left-ventricular insufficiency. Characteristic features suitable for making the diagnosis are lacking. A transverse systolic murmur and "cat's purr" are important, but rare signs. Systolic murmur, maximum at the apex, is seen more often than of transverse, which makes the differential diagnosis of papillary muscle rupture still more complicated.


[Comparative evaluation of different physical load tests in patients who have had a myocardial infarct]. A comparative analysis of the results of exercise tests conducted in 2 groups of patients following myocardial infarction was done on the basis of data from the A.L. Myasnikov Institute of Cardiology, USSR Acad. Med. Sci., and the research group of medical rehabilitation of the Humboldt University, Berlin. Continuous and interrupted step-wisely growing bicycle exercises in sitting position were compared. The duration of each step comprised 5 min with pedalling at 60 rpm. With continuous tests every step increase the workload by 25 W. With stepwise tests in half of the patients the work load was increasing by 25 W every step, in the other half--by 16.7 W, the pause between the steps lasting 10 min. It was found that the main parameters of both types of tests did not differ in the two centers, as shown by statistical processing; an identical threshold capacity of the workload, equal elevations of the arterial pressure and heart contractions rate at the peak of the test were obtained. No differences were revealed in the criteria of test interruption with both types of examinations in the two centers. A slight tendency towards a greater elevation of the heart contractions rate and systolic arterial pressure was noted with continuous tests, in contrast to the step-wise. This results in a greater variance of the workability parameters when comparing the results. Therefore it seems preferable to conduct one type of tests--the continuous one.


[The syndrome of inappropriate secretion of vasopressin (SIADH) (author's transl)]. The syndrome of inappropriate ADH secretion ("SIADH") was first recognized 1935 by Roth et al. and described in detail 1957 by Schwartz et al. The clinical symptoms (hyponatremia, hypertonicity of urine and inability to excrete a water load) are caused by inadequately elevated ADH secretion under a variety of situations and diseases. Some recent work was focused on the pathogenesis of this syndrome and new clinical findings (low plasma levels of uric acid and potassium) as well as special forms ("SIADH" without elevated vasopressin levels in plasma) are thought to be of relevance. New therapeutical recommendations will be discussed.


[Cardio-pulmonary parameters after myocardial infarction in the late period of recovery. Investigation at rest and during exercise (author's transl)]. From 22 patients in the late period of recovery from myocardial infarction, cardio-pulmonary data were recorded at rest and during exercise. The physical work was increased stepwise until patients reached their individual limit of exercise. According to the different work capacity four groups of patients were formed with the aim to demonstrate the adaption processes of cardio-pulmonary parameters until reaching the peak of work capacity. In one half of the patients we still found signs of cardial insufficiency at rest. After only slight physical work signs of cardiac insufficiency appeared also in the other half of patients.


[About degradation products of the inter-alpha-trypsin inhibitor in serum. II. Acid label derivatives of the inter-alpha-trypsin inhibitor (author's transl)]. Simultaneous to the liberation of the acid stable trypsin-plasmin-inhibitor from the inter-alpha-trypsininhibitor in vivo, acid labile degradation products are set free. The main product can be estimated by immunological methods. This product is not excreted by the kidney in contrast to the acid stable inhibitor. The product accumulates in serum in different diseases. An increased concentration of this product indicates also an increased turn-over of the inter-alpha-trypsin inhibitor in the case when the concentraton of the intact inter-alpha-trypsin inhibitor or of the filtrable derivative are within normal range.


[Digoxin and beta-methyldigoxin concentrations in cerebrospinal fluid and plasma (author's transl)]. 12 patients were treated for at least two days with digoxin or beta-methyldigoxin before a lumbar punction was done for diagnostic purposes. At the same time venous blood was drawn and both samples were radioimmunologically analysed for digoxin concentration. The relationship of concentrations from plasma to cerebrospinal fluid was 2 for beta-methyldigoxin and 8 for digoxin.


[Biochemical characterization of a new variant of glucose-6-phosphate dehydrogenase (G-6-PD) deficiency with favism: G-6-PD Bielefeld (author's transl)]. A new variant of G-6-PD with favism has been detected in a German family. After partial purification the enzyme was biochemically characterized. It revealed normal electrophoretic mobility, normal thermostability and a flat pH-activity curve. The Km-value for G-6-P was reduced, whereas this value was normal for NADP. The substrate analogues 2-desoxy G-6-P, Gal-6-p and deamino-NADP were utilized to increased rates. The biochemical data were compatible with the benign clinical course.