[Biochemical and clinical findings in congenital abnormalities of galactose metabolism (author's transl)]. Current knowledge of the biochemical basis of abnormalities in galactose metabolism are discussed. The clinical picture, analysis of frequency and therapy are described. Although the galactokinase defect hat been described only rarely, abundant literature has been published on the Gal-1-PUT defect. Five variations of this defect are known (Duarte, Los Angeles, Rennes, Indiana and Negro variants), but these simulate only partially the clinical picture of galactosaemia. The UDP-Gal-4-epimerase defect has only once been described. Defects in galactose metabolism which show autosomal recessive inheritance are demonstrated in milk-fed infants by means of the Guthrie test. If the clinical picture arouses the suspicion of a defect in Gal-1-PUT or galactokinase, then a milk-free diet should be given until the diagnosis has been verified by enzyme analysis. Children who have been fed on a lactose-free diet show normal physical and mental development. If possible the entire family of the proband should undergo enzyme analysis in order to detect and to counsel all the heterozygotes in the family. Genetic counselling is considered to be absolutely indicated in this case. Termination of pregnancy is not indicated under any circumstances.


[The influence of acupuncture analgesia on the sensation and feeling of pain and the autonomic state of the organism (author's transl)]. This study reports the effect of acupuncture on the sensation of pain, feeling of pain and on the autonomic state of the organism. In order to elucidate the problem physiological and psychological parameters were employed. It was observed that the insertion of the needles with electrical stimulation raised the pain threshold. The rise occurred whether a classical acupuncture point or a placebo acupuncture point was used. When the pain was assessed subjectively, it was found that the needling of a classical acupuncture point favourably influenced the experience of pain. Furthermore, persons in whom acupuncture worked well were characterized by a low subjective and objective pain threshold, a slow pulse rate and a high anxiety score.


[Basis and clinical application of the "contingent negative variation" in "evoked response audiometry" (author's transl)]. After repeated stimulation with an indicative stimulus and a second imperative stimulus, a slow negative potential shife, the "Contingent Negative Variation" (CNV), can be recorded in the EEG before the second stimulus. On account of the main features of CNV two qualitative tests can be used in audiometry. "Tone-CNV" is an objective test of perception of a pure-tone. The indicative pure-tone is followed regularly by a second imperative stimulus, a flash of light or a slide. The appearance of CNV is the positive sign of perception, even if the "acoustically evoked potential" (AEP) is difficult to define. Adults and children (5 to 12 years) with normal hearing or suffering from several forms of hearing loss developed a CNV, except those patients with severe brain damage. The advantage of this method is the short testing time and accentuation of AEPs. The test can be also done under sedation. In "Objective Speech Audiometry", a proof of concept discrimination, only words of one concept are combined with a second imperative stimulus. The other group of words of the second concept remains "unreinforced". After correct discrimination all normal subjects developed a CNV before the second stimulus and after the "unreinforced" concept a "Discriminative Positive Variation" (DPV). Thus, this method can be used for clinical purposes. Loss of discrimination, perseveration phenomena and hemispheric differences were observed in aphasic patients.


[The rhinosurgical management of nasal liquorrhoea (author's transl)]. Rhinoliquorrhoea is the leading symptome of an osteodural defect of the base of the skull, the pneumatic system of the rhinobasis being affected. Surgical attention to these defects is largely the responsibility of the rhinosurgeon. Following a description of the under-lying causes of this condition in the patients treated by us, details are given of the procedures undertaken to establish diagnosis of liquorrhoea, its localization. The indications, timing and technique of rhinosurgical treatment are discussed. Finally, some characteristic clinical cases are reported.


[The treatment of the "mobile" vocal cord carcinoma: cordectomy versus irradiation (author's transl)]. In the literature, cordectomy and irradiation each give an about 80% 5-year cure rate in cases of stage I carcinoma of the vocal cords. Between 1955 and 1969 49 patients were cordectomized and 71 patients were subjected to irradiation (5-year absence of recurrence in 75%) and 68.8% of cases respectively. 6 out of 9 criteria are in favour of cordectomy and only 3 in favour of radiotherapy in a comparison of both forms of treatment. In favour of cordectomy: 1. Direct examination of the tumour. 2. Immediate histological control during the operation. 3. Duration of treatment: 7 to 10 days (irradiation: 4 to 5 weeks). 4. Short healing period. Irradiation may entail chronic after effects. 5. Perichondritis: not observed after operation but may follow irradiation. 6. Treatment of tumour recurrence: After cordectomy: non-irradiated area and, if required, full radiation dose possible or operation in ordinary tissue. After irradiation: full radiation dose not possible, operation only in irradiated tissue. In favour or irradiation: 1. Medical contra-indications to surgery. 2. Tracheotomy: required prophylactically in case of cordectomy for 1 to 3 days, usually not necessary in case of irradiation. 3. Voice quality: Clearly better after irradiation than after operation. Irradiation is preferable in patients who have to use their voice very much. The problem should be thoroughly discussed with the patient. In general, cordectomy is the treatment of choice.


[Legal foundations for the processing of iodine 125 in radioimmunological laboratory tests, exemplified by the phadebas RAST and phadebas RIST tests (author's transl)]. The processing of iodine 125 poses legal and technical problems that can be solved if the respective guidelines are taken into consideration. The test projects have to be notified to, and approved by the authorities. In addition, the reagents have to be isolated and locked away in a suitable place and the requisite laboratory bench space locked up when not in use. If no more than 2 test kits are processed at the same time, the demands on the personnel and working place are minimal and the removal of wastes is unproblematic.


[Total laryngeal extirpation in tumour recurrence following chordectomy (author's transl)]. A review of 18 cases of laryngectomy on account of tumour recurrence following chordectomy revealed a high incidence of post-operative salivary fistulae. The tumour recurrence was extensive, as seen from the extirpated larynx specimen, in spite of regular laryngological check-up examinations. Tumour recurrence rends to be localized in the anterior commissure and sometimes infiltrates into the prelaryngeal area. The poor long-term prognosis is stressed.


[Detection of sex-chromosome anomalies in newborn infants (author's transl)]. 6084 consecutive newborn infants were screened for the purpose of evaluation of the X- and Y-chromatin in the cells of the buccal mucosa to detect sex-chromosome anomalies. An anomaly was discovered in 14 newborn infants (0.23%). Among 3184 male infants 8 cases of Klinefelter's syndrome, 2 cases of XYY syndrome and 1 case of a rare structural anomaly of the Y-chromosome were detected. Among 2900 female infants there was 1 child with Turner's syndrome and 2 children with the Triplo-X syndrome. The following clinical features were frequently observed: low birth weight, small size, dystrophy, signs of dysmaturity and increased maternal age. A gonosomal anomaly should be suspected in all cases presenting these characteristic clinical features and the necessary investigations carried out. By these means X-chromosome aberrations, at least, could be partly diagnosed.


[The effect of Iscador (Viscum praeparatum M.) on the Walker carcinosarcoma of the rat (author's transl)]. This paper reports the effects of a drug obtained from mistletoe (Iscador) on tumour growth of the Walker carcinosarcoma in rats under different conditions. No inhibitory effect on the growth of this tumour was observed.


[The treatment of the pseudocroup syndrome (author's transl)]. The results of the implementation of Myoscain E/Holzinger in the treatment of the "pseudocroup syndrome" (laryngitis catarrhalis) are reported. The generally prompt action of the drug is stressed. It is pointed out that non-response to the compound suggests a more serious form of the disease necessitating close observation. A list of diseases involved in the differential diagnosis is added.


Combined hepatic vein, umbilicoportal vein, and superior mesenteric artery catheterization in portal hypertension: estimation of the portal fraction of total hepatic blood flow in cirrhotic patients. Hemodynamic data were obtained in 13 cirrhotic patients with severe portal hypertension, undergoing combined hepatic vein, umbilicoportal vein, and superior mesenteric artery catheterization. The relative clearance of indocyanine green, the portohepatic gradient (difference between the free portal venous pressure and the free hepatic venous pressure), and the estimated hepatic blood flow were measured. The portal fraction (PF) of total hepatic blood flow was calculated in all patients using indicator dilution curves obtained from the portal bifurcation, a right hepatic vein, and when possible a left hepatic vein (six cases) after injection of (51)Cr-labeled red blood cells ((51)Cr RBC) into the superior mesenteric artery. Flows were overestimated because of loss of indicator through spontaneous portosystemic shunts; however, the ratio between hepatic and portal indicator dilution curves can be used to calculate the portal fraction of total hepatic blood flow since no extrahepatic shunts existed after the bifurcation of the portal vein (as shown on portography). In 10 patients, 15 series of curves were calculable and the PF varied between 30.1 and 100% (mean ± SE: 71.1 ± 6.2%). In the three other patients, only delayed activity from recirculation was detected from portal and hepatic vein samples and PF was 0%; in these three cases, portography and arteriography revealed spontaneous portacaval shunting with reverse and/or stagnant circulation in the portal vein. In the 13 patients, no correlation existed between PF and the relative clearance of indocyanine green or the portohepatic gradient, parameters generally used as indices of severity in cirrhosis. In 10 patients, no correlation was found between PF and the estimated hepatic blood flow.These data indicate that (51)Cr RBC dilution curves can be used for the estimation of the portal fraction of total hepatic blood flow in conscious cirrhotic patients before portacaval shunts. Using this methodology, it could be assessed whether any critical level of portal fraction exists above which poor clinical results occur after portacaval shunting. This measurement could eventually be helpful in determining the appropriate surgical procedure to be applied in individual cases.


Primary hypomagnesemia. I. Absorption Studies. The clinical course of 2 patients with primary hypomagnesemia is reported. In one male patient, 5 months old, measurements of magnesium retention, intestinal absorption, fecal excretion and renal clearance were performed. The retention (2.8%) and absorption (7.8%) of 28-Mg were markedly reduced in comparsion to controls (average retention 25% and average absorption 28%). The retention values of the parents and other realtives did not differ from those of healthy adults. The examined patient was sucessfully treated with trimagnesium dicitrate containing 1.75 g magnesium per day.


[Vaccination of children against influenza]. In 19 children of 1-7 years of age hemagglutination inhibiting antibodies were measured before and after vaccination against influenza. Before vaccination the serum titers have been markedly lower than in adults. A single vaccination with Alorbat, a vaccine of representative strains of influenza virus inactivated and adsorbed to aluminumoxide, was followed by the same rise of titer as in adults. Therefore with this vaccine a single vaccination is effective in children, and a booster 4 weeks later, as recommended otherwise, is not necessary.


Permanent neonatal diabetes mellitus: a case report with plasma insulin studies. The 11th case of permanent neonatal diabetes mellitus appearing during the first month of life is reported. A critical review of the literature is also presented. The permanence of diabetes is demonstrated by the duration of insulin therapy still necessary after 30 months. Insulin-stimulation tests have been performed some for the first time in such a young diabetic. They have shown a nearly total failure in beta-cell response, only very high doses of glucagon provoking a moderate insulin secretion. The absence of acetonuria is discussed. It can perhaps be explained by the hyperglycemia which, by a mass effect, brings about cellular glucose penetration and this stops liberation of Nefa's from adipose tissue.


Intestinal iron absorption under the influence of available storage iron and erythroblastic hyperplasia. Comparative studies in children with hereditary spherocytosis, nonspherocytic enzymopenic hemolytic anemia, acquired hemolytic anemia, vitamin B12 deficiency induced megaloblastic anemia, erythroblastic hypoplasia and aplastic anemia. A high negative correlation (coefficient similar to 0.9) between increased 59Fe absorption from a diagnostic 0.56 mg 59Fe2+ dose and the depletion of available storage iron was observed in menstruating and pregnant women, fullterm and premature infants, blood donors, patients with infections, inflammations, tumors, hepatic cirrhosis, gastric surgery, increased urogenital or gastrointestinal blood loss. The increased diagnostic 59Fe2+ absorption is a reliable and sensitive indicator of at least depleted iron stores or prelatent iron deficiency as caused by iron malnutrition or maldigestion, increased iron requirement in pregnancy, infancy, urogenital or gastrointestinal blood loss. Although the messenger system which signalyzes the depletion of iron stores to the iron absorbing enterocytes of the duodenal and jejunal mucosa is not yet known available storage iron seems to control intestinal iron absorption under normal and the great majority o pathological condition in humans. Anemia per se or high erythropoietin levels in blood do not influence iron absorption since patients with even severe erythroblastic hypoplasia, aplastic anemia and megaloblastic anemia due to vitamin B12 deficiency absorb iron according to their iron stores. An only mild hyperplasia of the erythropoietic system in the bone marrow does also not effect iron absorption which was still under the control of available storage iron in patients with hereditary spherocytosis, nonspherocytic congenital hemolytic anemia due to glucose-6-phosphate dehydrogenase deficiency, acquired hemolytic anemia and vitamin B12 deficiency induced megaloblastic anemia..


[Coagulation tests from capillary blood. Determination of thromboplastin time, thrombin time, fibrinogen, factor II (prothrombin), factor V (accelerin) and factor X (Stuart-Prower factor) from capillary blood]. Methods are described for the determination of the thromboplastin time, the thrombin time, for fibrinogen and factor II, V and X from capillary blood. These methods are easy to perform and comparison of the results from venous and capillary blood showed a very good correlation. The described methods seem suitable for routine coagulation tests in pediatrics.


A case of leprechaunism and an analysis of some clinical manifestations of this syndrome. A case of Leprechaunismm is reported. The parents were not consanguineous. The patient had two female and one male sibling. The patient was female and one sister was normal but the brother was also affected by Leprechaunismm. Another sister was possibly affected by Leprechaunis. The laboratory and autopsy examination showed various abnormal results, but few correlation was noted between the findings of the investigations and the clinical manifestations. The abnormality of the carbohydrate metabolism in Leprechauism may be due to the delay of insulin-release from pancreatic islets, from the abnormality of insulin receptors, or an abnormality of the biological activity of insulin.


[Influence of spontaneous collaterals on the fibrillation threshold of the heart following acute coronary occlusion]. Fibrillation threshold (FS) were determined in 27 mongrel dogs by direct electrical stimulation of the myocardium by 50 Hz AC impulses of 0.20-0.28 sec during the vulnerable period. The FS is the current which just suffices to produce ventricular fibrillation. Sinus rhythm was restored 10 sec after onset of ventricular fibrillation by defibrillation. Determinations of FS were carried out for each animal repeatedly before and 3 min after acute ligation of the circumflex ramus respectively the descendens ramus of the left coronary artery. Post mortem selective coronary angiography was performed in all cases and the extent of spontaneous collateral vessels was estimated by the rate of retrograde contrast radiography of the ligated coronary artery. The FS fell appreciably following acute ligation of both the circumflex ramus and the sescendens ramus. Beside the size of the ligated area (the circumflex ramus supplies a larger area of the myocardium in the dog than the ramus descendens) the extent of collateral supply was the determining factor for the reductions of the FS: Following coronary ligation of the circumflex ramus the FS fell on the average from 24.0 mA to 4.1 mA if no collateral vessels were detectable; in the animals with well developed collaterals the FS was reduced from 24.8 to only 14.1 mA. After acute occlusion of the descendens ramus the FS fell from 27.9 mA to 11.5 mA in the group with not sufficient collateral supply and from 31.2 mA to only 21.5 mA in the group with well developed collaterals. The comparison of the different decreases of the FS after coronary occlusion clearly shows that the influence of the in size differing ischemic areas on the decrease of the FS is particularly evident if no collateral vessels are existent. If collateral vessels are well developed this difference is not significant. These results demonstrate that the influence of well developed collaterals on the decrease of the FS after coronary occlusion exceeds the dependence on the size of the ischemic area.


[Influence of acute preload changes on the mean velocity of circumferential fiber shortening of the left ventricle]. The cineangiographically determined mean velocity of circumferential fiber shortening (-vcf) has been used as a measure of basal cardiac contractility in man. In order to test the effect of acute changes in preload on -vcf, dextran was administered i.v. in steps of plus 2 percent, plus 4 percent and plus 6 percent of body weight to 8 closed-chest anesthetized dogs after minimizing cardiac reflex adjustments by 0.5 mg/kg propranolol i.v. and by cutting the vagi. -vcf, end-diastolic and end-systolic volume were estimated from left ventricular (LV) monoplane cinefilms in the right anterior oblique projection. At plus 2 percent and plus 4 percent of dextran -vcf remained unchanged as compared to control, i.e. after autonomic blockade. At plus 6 percent -vcf decreased significantly. LV max dP/dt increased significantly up to the step of plus 4 percent and decreased then slightly despite a further significant increase of LV end-diastolic pressure. In additional 6 dogs the largest volume load (plus 6 percent) was applied as the first step after control. Under these conditions there was no significant change in -vcf. In conclusion, -vcf appears to be essentially independent of changes in preload. Its usefulness as a measure of contractility is however limited by the negative inotropic effect of repeated injections of contrast dye.


[Cineangiographic left ventricular dimensional analysis in normal subjects and patients with coronary disease]. The cineangiographically determined left ventricular function was studied in normals and in CAD-patients with one- and three-vessel disease. From single plane RAO-LV-cineangiograms following parameters were calculated; LV-volumes (EDV, ESV) according to the area-length method, ejection fraction (EF), percentage shortening of the medial perpendicular short axis delta (M,deltaMpl), mean velocity of circumferential fiber shortening (V(CF), V(CFPL)). It can be concluded that there is 1. no correlation between the severity of coronary heart disease and the morphological left ventricular wall lesions, 2. a depressed left ventricular function in coronary heart disease and normal ventriculograms, 3. a more impaired left ventricular function when cineangiograms show hypokinesis or aneurysms, 4. hypokinesis or aneurysms in the anterior wall leads to a more depressed left ventricular function than the same lesions in the posterior wall.


[Hemodynamic differences between maximal treadmill and bicycle ergometer test in coronary disease]. 9 patients with diagnosis of coronary heart disease (CHD) and typical angina pectoris (AP) were studied by means of a multistage, symptom-limited treadmill test and a similar bicycle ergometer (bike)-test. The sequence of tests was determined by chance. Between the tests, the patients rested one hour. Oxygen uptake (vo2) was determined by the Douglas-bag-method, blood pressures were measured via catheters placed in a pulmonary and a brachial or radial artery, respectively. Cardiac output (Q) was calculated by the direct Fick principle. In all tests, with the exception of one bike-test, all patients were limited by AP. They attained high VO2 (mean 1316 ml/min) on the treadmill (TM) while on the TM their mean arterial blood pressure (BP) was significantly (P greater than 0.05), namely 10 mm Hg as an average, lower. Comparing the final minute -3 of the TM-test with the final minute -1 of the bike-test in 5 patients, we found heart rate (HR), BP and pressure rate product (HR times BP) lower on the TM (P greater than 0.05), whereas VO2 was the same. Patients, whose exercise performance is limited by angina pectoris on bike and TM, achieve higher VO2 on the treadmill, together with lower BP. This may be of clinical importance in exercise-testing and -training of patients with CHD.


[Course of coronary disease. Evaluation of prognosis and progression of coronary insufficiency with atrial pacing and ergometry]. Significant reduction of angina threshold (145 Imp./min to 134 Imp./min) and increase of ST-segment depression (0.13 to 0.17 mV) indicating progression of coronary artery disease was seen in 34 subjects studied by atrial pacing at intervals betion (0.22 mV to 0.12 mV) during exercise, which correlated significantly with decrease of heart rate (121 to 110 beats/min), is interpreted as consequence of diminished sympathetic activity and myocardial O(2)-demand. The change of hemodynamic parameters during controlled exercise does not allow evaluation concerning the progress of coronary artery disease, whereas cardiac stress test with atrial pacing is reproducible. There was no difference in relation to reduction of angina threshold between the group after combined longterm medication with nitrate and ss-blocking agent and the control group. Plasma lipid abnormalities were predictive of subsequent reduction of angina threshold. Severe 2 and 3 vessel obstruction was seen more frequently in patients exhibiting reduction of angina threshold. Level of uric acid, obesity, hypertension, age, combination of risk factors, the initially studied myocardial lactate production and angina threshold during exercise and atrial pacing had no predictive value concerning reduction of angina threshold.


[Polar vectors in the posterior-inferior parietal myocardial infarct and left anterior hemiblock]. The Frank's ECG leads and the polar vectors have been quantified in 165 normal and abnormal cases. The abnormal cases were: postero-diaphragmatical infarctions, left anterior hemiblocks, postero-diaphragmatical infarctions and left anterior hemiblocks together. Our examinations were made with triaxicardiometer (TCM) analogue computer. We formed the numerical averages of the patients' groups into graphical algorithms. According to our examinated abnormal groups the X and the Y ECG derivations and the elevation angles (V degrees) of the polar vectors (triaxicardiograms) have the greatest diagnostical values.


Comparison between Wilson's thoracic leads and the telemetrically transmitted lead CM6 in patients with heart diseases during exertion. In 76 patients suffering from heart diseases and 19 healthy men simultaneously the chest leads V(2), V(4) and V(5) were recorded and the bipolar lead CM(6) (Manubrium sterni-Apex cordis, 6th intercostal space) transmitted telemetrically during increasing exercise load on the bicycle ergometer. The lead CM(6) was most similar to chest lead V(5) with regard to R/S-ratio, ST-depression, form and amplitude of the T-wave, QX-QT-ratio and ST-elevation. ST-depressions of V(5) were found nearly without exception in CM(6), mostly more pronounced. Ascending ST-depressions are more frequent in CM(6) than in V(5), in single patients also ST-depressions with horizontal or downward slope. ST-elevations registrated in V(2) and V(4) are not reliably reproduced in CM(6). It is concluded that the wireless transmission of the bipolar chest lead CM(6) is sufficient for the diagnosis of coronary insufficiency during exercise,


[Coronary fistula into the sinus coronarius. Hemodynamics, clinical aspects, therapy]. Coronary artery fistulas are rare, inborn anomalies which will be diagnosed more often as the diagnostic method of coronary arteriography is increasing. This report concerns a preoperatively diagnosed coronary arteriovenous fistula of the right coronary artery to the sinus coronarius; Frequency, pathological physiology, clinical symptoms, differential diagnosis, prognosis and treatment are discussed. The importance of using selective coronary arteriography to outline the anatomy of these malformations is stressed. Surgical treatment is the only effective way of therapy and should be performed after diagnosis, even if in an early stage of the disease the ECG does not show any changes in spite of a large fistula.


Trypanosoma rhodesiense: folate levels in sera and tissues of normal and folic acid-deficient rats. An experimental model composed of the folic acid deficient Sprague-Dawley rat and Trypanosoma rhodesiense was used to study folate levels in sera and tissues. Serum folate levels in well fed rats inoculated on day 21 averaged 21 plus or minus ng/ml; well fed normal rats averaged 18 plus or minus 4 ng/ml. In rats given the pair-fed control diet, serum folate levels averaged 17.2 plus or minus 4 ng/ml for trypanosome-free animals and 20.2 plus or minus 3 ng/ml for infected ones. In rats given the folic acid-deficient diet, serum folate levels averaged 8.6 plus or minus 2 ng/ml for noninfected control animals and 9.3 plus or minus 2 ng/ml for trypanosome-infected ones. Regardless of diet, the infected animals inoculated on day 56 had higher serum folate levels over the controls on the last day of observation (day 5 of infection). Livers from rats fed complete and pair-fed diets and inoculated on day 21 showed no significant differences in folate content when compared to control animals. However, livers of rats on a deficient diet showed significantly more folate when compared with uninfected controls, reaching a maximum of 362% of day 25. Liver folate levels of rats (regardless of the dietary regimen) inoculated on day 56 showed significantly higher values than the controls on day 60. Irrespective of the time of inoculation or diet, brain and spinal cord of T. rhodesiense-infected rats had significantly higher folate values than their controls on day 5 of infection. The folate level of the brain and spinal cord, at this time, ranged up to 58 and 107% respectively.


Routine angiographic follow-up examinations after vascular surgery. In 28 (i.e. 11.8 percent) of 237 primary vascular reconstructions stenoses of the reconstructed vascular segment caused by technical errors could be verified by post-operative follow-up angiography. These errors very often cannot be recognized intra-operatively, but since they disturb the haemodynamics, they can be regarded as the cause of re-occlusions. Immediate reoperation is indicated. Though the routine performance of follow-up angiography requires additional efforts, they seem to be justified by the results obtained. The pictures show typical post-operative angiographies, which shall illustrate our study.


Anomalous coronary artery origin and bicuspid aortic valve. A patient presenting with signs and symptoms suggesting myocardial ischemia was found to have anomalous origin of his right coronary artery from the left aortic sinus of valsalva associated with a bicuspid aortic valve. Abnormal left ventricular function with anaerobic myocardial metabolism was documented in the absence of significant coronary artery disease or aortic obstruction. The possible relationship of these findings to the coronary artery anomaly and bicuspid aortic valve is considered. The necessity of identification of the origin of the coronary arteries is re-emphasized in the evaluation of patients with bicuspid aortic valves coming to cardiac catheterization. Anomalous origin of a coronary artery is a rare occurrence. The association of this anomaly with a bicuspid aortic valve has not been emphasized and the possible clinical consequences of this combination of malformations have not been described. We recently evaluated a patient with anomalous origin of right coronary artery from the left coronary ostium and a bicuspid aortic valve. A description of these findings follows.


Results of treatment of experimental pulmonary embolism, as determined by radioactive microspheres. In this experimental study seventeen dogs subjected to pulmonary embolism were treated with either saline, heparine or streptokinase. Regional blood distribution was calculated in both, the healthy and infarcted lung tissue by means at the sequental injection of radioactive microspheres. Results of fibrinolytic treatment compare favourable over heparine or saline administration.


On the mechanism of maleate action on rat kidney mitochondria. Effect on substrate-level phosphorylation. 1. Maleate inhibits the substrate-level phosphorylation linked to anaerobic dismutation of 2-oxoglutarate in rat kidney mitochondria. 2. Phosphate and magnesium diminish the inhibitory effect of maleate. Arsenate also relieves the inhibition of 2-oxoglutarate consumption but only at low (1 mM) phosphate concentration; at higher concentrations, the action of phosphate and arsenate is competitive. 3. Acetoacetate, malonate and succinate, the substrates of CoA-transferase, relieve the inhibition of 2-oxoglutarate metabolism by maleate both in the respiring mitochondria and in the "anaerobic" system containing antimycin and rotenone. 4. The interference in succinyl-CoA metabolism by maleate is discussed as a possible mechanism of the inhibitory action of this compound.


Intracellular localization and some properties of UDPG: sterol glucosyltransferase from Calendula officinalis. UDPG: sterol glucosyltransferase is localized in the 2-week-old C. officinalis seedling in the membrane structures, separated from chloroplasts and mitochondria, and consisting probably of fragments of the Golgi apparatus. A minor part of the enzyme activity is associated with the microsomal fraction. A number of synthetic detergents stimulate the activity of the membrane-bound enzyme causing its solubilization. The enzyme preparation purified about 70-fold is strongly inhibited by HgCl2 and p-chloromercuribenzoate; it is markedly stimulated by mercaptoethanol and dithiothreitol, and to a lesser extent by Mg2+ and Ca2+ as well as by some chelating and reducing agents. UMP stimulates and UDP and UTP markedly inhibit the enzyme activity. The enzyme does not act on 4-methylsterols although it utilizes a number of 4-demethylsterols. It seems that the presence of a double bond in ring B enhances the affinity of the substrate for the enzyme. Delta-5-Sterols are utilized at a higher rate than delta-7-sterols. Saturated sterols and delta-25-sterols are poor substrates.


Molecular properties of the inducible lupanine hydroxylase from growing cultures of Pseudomonas lupanini. An improved method for isolation of lupanine hydroxylase, giving a 450-fold purification, is presented. The molecular weight of the enzyme is about 72 000, and the sedimentation coefficient S20, W 5.05. The enzyme contains a component similar to Pseudomonas cytochromes c. Its oxidation-reduction potential was found to be below + 45 mV.


Thrombocytopenia complicating infectious hepatitis. A patient of 50 years is admitted to hospital. He is found to be suffering from infectious hepatitis complicated by thrombocytopenia, the initial platelet count being 10 000 per mul soon falling to 2000 per mul. A prompt increase in the number of platelets is seen during treatment with prednisone, but a sudden fall is observed after a gradual reduction of prednisone to zero, the reaction for hepatitis associated antigen at that point still being positive. After a renewed therapy with adrenocortical steroid, the platelet count is within normal limits, and the patient is discharged with a small dose of prednisone. At the time of discharging, the HAA reaction had been negative for 3 weeks. After treatment with a small dose of prednisone for 2 months, the patient was taken into hospital. In the course of one week the dose of prednisone was gradually reduced without any fall in the platelet count. The possibility of lysis of a platelet-virus antigen as an explanation of thrombocytopenia complicating infectious hepatitis is discussed.


Dermatitis herpetiformis and small intestinal lesion--no strict association in german patients. Dermatitis herpetiformis (DH) has been reported to be associated with various degrees of intestinal villous atrophy in 19 to 68 percent of the cases studied.  This was true particularly in British and American populations.  The present investigation deals with morphological and functional characteristics of small intestinal mucosa in a group of German DH patients (n=16): No case of villous atrophy could be detected, whereas interepithelial lymphocytes were shown to be slightly but significantly elevated.  Intestinal disaccharidase activities were not statistically different from those of healthy control subjects, and oral lactose tolerance tests were normal in each of 8 patients tested.  Genetical and immunological differences between our DH patients and those studied by British and American authors may be responsible for the basically different results as to "dermatogenic enteropathy".


Xylose absorption test before and after surgical repair of coarctation of the aorta. The aim of the study was to ascertain whether the acceleration of physical development in children after operation for coarctation of the aorta is due to the improved intestinal absorption.  Lowered values of the oral xylose absorption test were found in all 9 patients before surgery.  In all the patients who had been operated on, sphigmo-oscillometry revealed an increased pulsatile character of the blood flow, pulsatile volume in the lower extremities, and a rise of mean arterial blood pressure in this area.  On the other hand, surgical repair had no influence on the renal blood flow as evidenced by PAH clearance and isotope renography.  There was no correlation of diuresis and the xylose excretion test.  Increased values of the xylose test after operation for coarctation of the aorta are due to the increased intestinal absorption rather than to improved renal function.  Improved intestinal absorption may be a factor responsible for the accelerated physical development of children operated on for coarctation of the aorta.


The effects of aminoacetonitrile and its derivative on components of hepatic connective tissue in rats with chronic hepatic injury. Aminoacetonitrile (AAN) and its derivative, p-carboxyphenylglycyl-aminoacetonitrile (p-CPGAAN) were given to rats with chronic liver injury induced by carbon tetrachloride and their effects of the components of the hepatic connective tissue were studied.  1. Both AAN and p-CPGAAN markedly inhibited an increase in the amount of collagen in injured liver and in addition these agents interferred with an increase in the amount of hepatic glycosaminoglycans, particularly of the sulfated fraction.  2. In the AAN-treated group, such side effects attributable to AAN as loss of the body weight, depilation and exostosis were observed and an increase in the hepatic collagen solubility was also noted.  However, no apparent side effect was found in the p-CPGAAN-treated group, and there was no difference in the solubility profile of hepatic collagen between the p-CPGAAN-treated and control groups.  3. It is assumed that p-CPGAAN has an action to prevent the hepatic fibrosis via a mechanism different from that of the lathyrogenic action.


The carbon-tetrachloride-hepatotoxicity as a model of liver damage.  First report: Long-time biochemical changes. 176 Growing female Wistar rats get injections of 1 ml CCl4 per kg twice a week.  Seven days after the beginning of the experiment over a period of eight weeks blood samples were collected after the decapitation of the animals for liver function tests.  The CCl4-hepatotoxicity seems to have a three or four phased course.  The first phase of two or three weeks is characterised by a necrosis, demonstrated by the rising enzymes values, and a beginning damage of the liver as shown by the decreasing value of the pseudocholinesterasis.  The second phase of two or three weeks is charcterised by as massive fatty infiltration and an increasing necrosis, demonstrated by the high plateau of the triglycerides, the increase of SGOT and the BSP-retention and the decrease of the pseudocholinesterases.  These values may correspond to a liver fibrosis at the end, too.  The third phase is marked by more increasing values of the SGOT, hydroxyproline, triglycerides and BSP-retention.  The final decrease of the pseudocholinesterasis and liver weight demonstrate a reduced synthetical ability and an atrophy of the liver.  The rats were in this last phase in a nearly pre-final state. --These biochemical changes of the CCl4-hepatotoxicity which correspond to histological damages reported elsewhere seem to be a good measure to characterise liver damage quantitatively and qualitatively.  The therefore may be used as a model for systematical studies in the repair of a disturbed liver function.


Statistical correlations of diffuse cerebral atrophy, with special reference to diagnostic and aetiological clues. To evaluate diagnostic and aetiological clues for diffuse cerebral atrophy, the statistical correlations between 35 pneumoencephalographic and 97 clinical variables in 268 patients were analysed. Each case of diffuce cerebral atrophy was originally of unknown cause, and all had pneumoencephalography. Ventricular diffuse atrophy correlated positively with psychic and co-ordinative impairment and dysarthria, and cortical diffuse cerebral atrophy with psychic impairment (P smaller than 0.01 to 0.001). There was a close correlation (P smaller than 0.001) of cortical diffuse cerebral atrophy with use of vibrating tools at work. Psychic impairment combined with co-ordinative dysfunction and dysarthria is an unspecific syndrome, but should make one think of diffuse cerebral atrophy, Arteriosclerosis, abuse of alcohol, and vibrating tools at work appear to have aetiological significance for some types of diffuse cerebral atrophy. Thus the number of patients with idiopathic diffuse cerebral atrophy may rapidly decline.


The degree of alpha asymmetry and its relation to handedness in neuropsychiatric referrals. While alpha rhythm asymmetry among normals is thoroughly documented, the significance of this finding in patients is not well known. The occurrences of alpha amplitude asymmetry in 82 clinical referrals of neuropsychiatric patients was studied in this research. Two separate means of quantifying the alpha asymmetry were used: The first by visual inspection; and the second by measurement in a standard manner. A handedness questionaire was administered and indicated that 77 of the sample were right- and five were left-handed patients. By measurement, the mean overall differences in the alpha amplitude between the hemisphere was small (4 per cent) and non-significant. Seventeen patients showed a difference of 15 per cent or greater, and in two the difference reached 33 per cent. It was concluded that alpha asymmetry must be interpreted with care because it was found that there was an association between left-temporal abnormalities and ipsilateral alpha enhancement, and the greater degrees of asymmetry were found in normal EEGs.


The effect of dantrium on spasticity of hemiplegic patients. The effect of a new peripherally acting muscle relaxant drug Dantrium, on spasticity tested on 11 hemiplegic patients. The effect was evaluated both with regular clinical examination and with electromyographic technique. The latter concerned a quantitative analysis of the patients' voluntary control of fine neuromuscular activity both with and without the drug. The results indicated that spasticity was initially markedly reduced in the majority of the patients without, however, meaningfully increasing the daily-living functions of the patients. After a few months, the medication could be discontinued without any immediate increase in the spasticity. No severe side-effects were noted. In some cases, the medication had to be discontinued due to marked tiredness. Electromyographically, it was found that the ability of the patients to control fine neuromuscular activity with the paretic muscles was increased significantly with Dantrium, indicating that the reduction of the spasticity increased the ability for fine control of the muscles.


Hereditary ataxia, photomyoclonus, skeletal deformities and lipoma. An account is given of a form of hereditary, cerebellar ataxia and photomyoclonus. Eight cases from 5 generations were affected. The disease seemed to be transmitted as an autosomal dominant trait. The age at onset usually varied between 35 to 40 years. The symptoms and signs consisted of a cerebellar ataxia, dysarthria and intention tremor. There was no nystagmus. All patients exhibited photomyoclonus and were extremely sensitive to photic stimuli. Other signs were dementia, kyphosis, pes cavus and lipoma localized in the nape of the neck, shoulders and back. Two patients had a partial syndrome with photonyoclonus and skeletal deformities. None of the patients suffered from epilepsy, In one case, histopathological examination revealed atrophy within the cerebellar cortex, dentate nucleus and the posterior columns of the spinal cord. It is concluded that this syndrome belongs to a groups of hereditary ataxias and myoclonus, and differs from myoclonic cerebellar dyssynergia (Ramsay Hunt) and alos from a variety of familial myoclonus and ataxia (Gilbert et al. 1963);


Cerebrotendinous xanthomatosis (cholestanolosis). Investigations on two sisters and their family. Two sisters, aged 38 and 32, suffering from cerebrotendinous xanthomatosis are described. The most important clinical findings were xanthomas, central nervous affection with motor and mental dysfunction, EEG changes and juvenile cataract. The diagnosis was established by the demonstration of increased amounts of cholestanol in serum. Both sisters had amenorrhea, and their excretion of dehydroepiandrosterone in the urine was increased. In the elder sister, the levels of urinary 17-keto steroids, androsterone and estradiol were also increased. Other unusual features of the disease in the elder sister were hyper-prebeta-lipoproteinemia and serum cholesterol in the higher normal range.


Use of nitroblue tetrazolium (NBT) test in the differentiation between pyelonephritis and cystitis. NBT tests were performed on blood from 37 patients with urinary tract infections caused by coliform bacteria. The level of infections was evaluated by the clinical signs, ESR, renal concentrating capacity and titre of antibodies against the strains of E. coli isolated in their urine. Elevated proportions of NBT-positive neutrophils were found in 11 of 14 patients with pyelonephritis and in 3 of 23 patients with cystitis or asymptomatic bacteriuria (ABU). The total number of NBT-positive neutrophils was 1000 or more per mm3 blood in 11 of 13 patients considered to have pyelonephritis, while it was 800 or less in all the patients investigated, evaluated as having cystitis or asymptomatic bacteriuria. The NBT test is recommended as an adjunct in the level diagnosis or urinary tract infections in children. The utility of the test in smouldering pyelonephritis is presently being investigated.


The changing panorama of cerebral palsy in Sweden 1954-1970. I. Analysis of the general changes. From an unselected series of 560 cases of cerebral palsy in Sweden, born 1954-70, the changes in incidence through the four periods 1954-58, 1959-62, 1963-66 and 1967-70 were analyzed. The total incidence successively and significantly decreased from 2.2% in the first period to 1.3% in the last. This decrease was mainly related to (1) the syndromes of spastic and ataxic diplegia, (2) the low birth weight babies, and (3) the group with perinatal causes. The decrease was not related to any special intelligence quotient or geographical region.


The changing panorama of cerebral palsy in Sweden 1954-1970. II. Analysis of the various syndromes. From an unselected series of 560 Swedish cases of cerebral palsy, born 1954-1970, various data of etiologic and pathogenetic interest were analyzed in detail. Untraceable and prenatal factors were found to dominate within the group of spastic hemiplegia. Placental dysfunction in small-for-date babies and severe asphyxia were thought to be the two main pathogenetic factors among the patients with spastic tetraplegia. In spite of a significant decrease in the number of low birth weight children within the group of spastic diplegia, this syndrome was still very characteristic for the child born immature. Ataxic diplegic forms were found to have greater pathogenic similarities to spastic diplegia than to simple ataxia. In two-thirds of the children the latter syndrome was characterized by normal pregnancy, delivery and birth weight and an untraceable (genetic?) factor. Dyskinetic syndromes were mostly encountered after perinatal asphyxia.


A new form of prolonged transient tyrosinemia presenting with severe metabolic acidosis. Yet another form of tyrosinemia is described, in a young baby who developed metabolic acidosis and ceased to grow when weaned from breast milk onto a higher protein formula. Severe tyrosyluria and mild tyrosinemia cleared on a low-protein diet which also corrected the acidosis. However, restoration of growth required a normal protein intake with very greatly reduced amounts of phenylalanine and tyrosine. The metabolic fault later resolved spontaneously at about 12 months of age. Mental development appears normal and liver disease was never apparent. The patient and her mother both excrete quite large quantities of an unidentified peptide.


Cystine deficiency during dietotherapy of homocystinemia. Cystine deficiency was inadvertently produced in a boy receiving specific dietary therapy for homocystinuria. This was manifested as a loss in weight, the reappearance of significant amounts of homocystine in the plasma and urine, and the elevation of the plasma methionine level. In addition, there was a significant reduction in the level of cystine in the plasma. This reduction in plasma cystine level differentiates cystine deficiency from loss of biochemical control due to failure to keep the prescribed diet. The addition of cystine to the regime of this child, without any other dietary modification, resulted in a complete remission.


Iatrogenic osteomalacia in epileptic children. A controlled therapeutic trial. Bone mineral content (BMC) ub tge forearms (related to total body calcium) was measured for a controlled therapeutic trial in 25 epileptic children on long-term treatment with phenytoin and in 22 normal children before and during treatment with vitamin D or placebo. In the epileptic children, hypocalcaemia and elevated serum alkaline phosphatase was found in 20% and 16%, respectively. The group of epileptic children treated with vitamin D2 (2000 IU daily) for 3 months showed a significant increase in bone mineral content, 5% on average. The epileptic children treated with placebo showed a significant decrease, 2% on average, while the normal children treated with vitamin D or placebo showed no change in bone mineral content. The results indicate a possible benefit of prophylactic vitamin D treatment in epileptic children.


Health and behaviour in four-year-old children. A health control of an unselected population of 2447 4-year-old-children included a thorough somatic examination as well as an analysis of child upbringing practice and problems. The relation between the children's physical health, as defined by presence or absence or "functionally important health problems" and the children's behaviour, as reported by their mothers, was elucidated. On the whole, children with health problems were not perceived as more troublesome, although children with some special kinds of disturbances, e.g. neurological and dental, constituted problems in certain areas, e.g. toilet training and hyperactivity. The use of blame as a method of upbringing was very frequent and especially frequent in children with dental defects and visual disturbances. The perception of behaviour problems and the use of methods in upbringing were the same in children with newly detected health problems as in children with previously known health problems. The implications for the Child Health Service are to identify these risk-groups, to advise and support them in order to reduce parent-child conflicts.


An epidemiological study of child health and nutrition in a northern Swedish county. VII. A comparative study of general and dental health, food habits and socio-economic conditions in 4-year-old children. A study of the general and dental health and the food habits of randomly selected 4-year-old Swedish urban children was performed. The results were compared with the findings of an investigation carried out four years earlier in the same area. In comparison with the earlier study no significant differences were found in haemoglobin values, packed red cell volume, microsedimentation rate and anthropometric measurements. The food habits had altered. A reduction in the frequency of between-meal consumption, particularly of sweets and soft drinks, as well as a reduction of the frequency of meat, fish and egg consumption was found. The children had an increased sandwich and milk consumption. The caries frequency was markedly reduced, which might be explained by the decreased between-meal consumption and an increased consumption of fluoride tablets. The food habits and the caries situation were generally influenced by the parents' socio-economic conditions, especially their educational level.


Absence of insulin resistance in 4 cases of mild juvenile diabetes. A preliminary report. Four children with a mild non-insulin-requiring diabetes were studied. They had no insulin response at intravenous glucose tolerance test. When insulin was infused at a rate which simulated a normal early insulin response to intravenous glucose, blood glucose decreased to the same extent as it did in healthy subjects. When a normal early insulin response was simulated during the intravenous glucose tolerance test, the glucose assimilation rate was normalized. These results suggests that a peripheral resistance to insulin is unlikely in mild juvenile diabetes, and that the primary defect is a deficient release of insulin.


Submaximal blood flow and blood viscosity in newborn infants. In newborn infants with varying hematocrit values the submaximal blood flow has been studied by the use of strain gauge plethysmography under standardized conditions. Submaximal flow was defined as the flow obtained after 4 minutes of suprasystolic occlusion. With increasing hematocrit there was a decreasing maximal flow. Capillary filtration coefficient seemed to decrease with increasing hematocrit. The relation between circulatory failure in newborns due to abnormally high hematocrit and low capacity to increase blood flow upon demand has been discussed.


Temperature regulation in children during exercise. Rectal and skin temperature and sweat rate were measured in eight 11-year-old boys exercising one hour on a bicycle ergometer at each of three different work loads. Rectal temperature rose according to the relative work load and reached a steady state level after a shorter time than had been previously observed in adult subjects. A good relationship was observed between the levelling off value of rectal temperature during work and the relative work load, but the value of rectal temperature at rest just before the start of work affects this steady state value. The average skin temperature was kept fairly constant during exercise except on the heaviest work load (70%), during which it rose about 1 degree C mainly as a result of the rise in skin temperature on the arm, hand and thigh. Temperature increases on skin locations in general were minimal except on the back where the temperature decreased slightly. Sweat rate showed a close relationship to the absolute work load, and in this report the conclusion is supported that the 11-year-old boys regulate their body temperature during exercise at constant work load in the same way as do adult subjects.


Growing pains and restless legs.

Growing pains and restless legs. Growing pains is a common and distressing symptom in children, but has aroused little interest. There is a similarity between growing pains and the painful form of restless legs, but it is not known if these two conditions are identical. I have recently observed a family in which the mother has growing pains since her childhood. The pain persists in adult age, which is unusual. She also has typical restless legs. Her three sons have severe growing pains. The study of this family has convinced me that growing pains and restless legs are different conditions.


Chemically defined diet in the treatment of kwashiorkor. Kwashkorkor is associated with malabsorption of energy and nutrients. Standard diets often initiate diarrhea and a high mortality is still prevalent. A synthetic monomolecular formula has been evaluated and compared with a standard diet in the early rehabilitation phase of 21 children with kwashiorkor. The formula group had significantly less vomiting and reached minimum weight faster than the group on standard diet. Weight gain and diarrhea were similar. The rise of albumin and BUN was faster on standard diet. A significant increase in haemoglobin was seen only in the formula group. A rise in body temperature after a meal was evident in most patients and significantly more pronounced in the formula group. The lower total nitrogen content of the formula may explain the observed slower rise in albumin and BUN but the ready utilization was indicated by the favourable weight changes as well as the rise in rectal temperature. As high energy per volume was desirable the formula was not diluted to isoosmolality. However, the high glucose concentration in the experimental diet probably caused some negative effects.


Endocrinological aspects at follow-up studies in neonatal hypoglycaemia. Thirty-seven cases of neonatal hypoglycaemia were studied at follow-up at the age of 2 6/12-r 9/12 years. Two of them had had hypoglycaemia were stuafter the newborn period, and another patient died in a hypoglycaemic state following surgery at 10 weeks of age. Twenty-three children had oral glucose tolerance tests and intravenous insulin tolerance tests performed. Diabetic glucose tolerance was noted in 3 children. None of them showed symptoms of diabetes mellitus, neither was there any family history of diabetes. One of these patients had experienced hypoglycaemia after the newborn period and responded with hyperinsulinism during the glucose tolerance test. The other hypoglycaemic patient showed an exaggerated insulin release in response to tolbutamide. Deficient serum cortisol response to insulin-induced hypoglycaemia was demonstrated in 7 patients and 6 of these had concomitant minimal growth hormone response. One of these patients also had a diabetic glucose tolerance. None were of short stature. It is probable that a disturbance in the hypothalamic-pituitary-adrenal axis may contribute to an impaired carbohydrate metabolism in some patients with neonatal hypoglycaemia.


The effect of various therapeutic trials on the prophyrin excretion in a case of congenital erythropoietic prophyria. A patient with a biochemically "new" type of congenital erythropoietic porphyria has been studied under various therapeutic trials. Splenectomy had no demonstrable effect on porphyrin excretion or clinical picture. Vitamin E caused a moderate fall in porphyrin excretion, however, there was no significant improvement in light tolerance and tendency to hemolysis. Beta-carotene reduced skin photosensitivity appreciably, while total porphyrin excretion remained unchanged and the tendency to develop hemolytic anemia showed only slight improvement. Red cell transfusion caused a rapid, dramatic fall in prophyrin excretion (in 4-5 days) and a transient increase in light tolerance, while the distribution of the different porphyrins excreted remained unchanged. These observations indicate that all or nearly the abnormal porphyrins excreted are of erythropoietic origin, and that the overwhelming part of the porphyrins originate from an abnormal population of shortlived red cells. Findings on fluorescence microscopy of blood and bone marrow support this view. Meticulous protection against light of the shorter wavelengths caused a similar rise in hemoglobin level as produced by red cell transfusion, however, in this instance the total excretion of porphyrins did not fall. It is suggested that the inhibitory effect of transfusion on erythropoiesis (and thereby porphyrin excretion) might be due partly to a depression of erythropoietin formation, partly to the presence of an erythropoiesis inhibiting factor (chalone) in the transfused red cells.


Studies on photopherapy in newborn infants. Influence on protein binding of bilirubin and salicylate and on activity of acetylsalicylic acid esterase. Phototherapy of newborn infants with hyperbilirubinemia was shown to result in an increase in hematocrit values and in the activity of the erythrocyte enzyme acetylsalicylic acid esterase. The elevation of the enzyme activity also could be produced in light-treated rabbits and in vitro after illumination of blood from adult volunteers. The binding of bilirubin to serum albumin and of salicylate to plasma proteins did not alter, nor did the concentrations of albumin or total proteins in plasma. It is concluded that light does not increase the unbound fraction of bilirubin in blood.


Hypertension associated with unilateral renal disease in childhood. Report of two cases and review of the literature. Two girls are described, aged 7 and 10 years respectively, who presented with arterial hypertension associated with unilateral kidney disease. Both were cured by nephrectomy, according to criteria for cure which are described in the paper. Only 45 similar cases could be found in the literature; these results are summarized and compared with those obtained in adult patients. The cure rate in children was 76%; similar large series including patients of all ages, but consisting predominantly of adults, show cure rates of only about 25%. It is inferred that the age of the patient is an important factor in determining prognosis, and should be considered in the selection of patients for nephrectomy. Methods of investigation of these patients, and possible mechanisms concerned in the pathogenesis of the hypertension, are briefly discussed.


Exchange transfusions with concentrated ACD-blood. II. Effects on bilirubin, total protein, chloride, phosphate, calcium, magnesium and potassium. During ten exchange transfusions with ACD-blood (NIH, sol. B), newborn infants' bilirubin, plasma protein and electrolyte gain or loss were studied quantitatively. The loss of bilirubin was closely correlated to the pre-exchange bilirubin concentration. On the average, there was a significant loss of plasma chloride of 3.21 mmol per kg bodyweight. There were no significant gains or losses of plasma protein or sodium, potassium, magnesium and calcium of whole blood during the ET. There was a calculated significant inflow of whole blood calcium from the extravascular space of 0.02 mmol per kg bodyweight together with a calculated significant increase of plasma phosphate of 0.06 mmol per kg bodyweight.


Histological and biochemical changes in neonatal thyroid tissues. The thyroid tissues of 17 infants who died between 3 hours and 46 days after birth were studied by histological and biochemical techniques. The morphological aspect and the iodine content of these tissues are not related to the gestational age of the neonates, but they are related to the survival time. There are dramatic events early after birth: desquamation of the epithelium and absence of colloid, low iodine content of tissue extract (less than 1 mu g 127I per mg of protein) and low percentage of thryoglobulin (less than 10%). 24 hours after birth, the vesicles fill with colloid and the epithelium is cuboidal; the iodine content of the protein increases (between 1 and 2 mu g 127I per mg protein) as well as the thyroglobulin percentate (around 20%). One week after birth, there is a maximum of colloid and flat epithelium; the iodine content of the protein extract is much higher (more than 2 mu g 127I per mg protein) as is thyroglobulin percentage (up to 40%). Our studies of thyroid tissues of neonates suggest that a leakage of colloid, iodine and thyroglobulin takes place in the perinatal period, this phenomenon being followed by their rapid repletion.


Abnormal proteolysis in sick newborns.

Abnormal proteolysis in sick newborns. 87 newborn infants were studied on their first day of life for defects in the coagulation and fibrinolytic systems. The infants were divided into two diagnostic groups, one with IRDS, the other with mixed neonatal disorders. Factor V, fibrinogen and fibrin/fibrinogen degradation products (FDP) were abnormal more often than any of the other factors examined. The presence or absence of "multiple defects" appeared to depend on the severity of the illness and its ultimate course. Thus 28% of the surviving infants or 85% of those who died had "multiple defects". The pattern of abnormalities did not differ between the infants with IRDS and those with mixed disorders. The "multiple defects" are ascribed to the following mechanisms: (1) impaired synthesis due to vitamin K deficiency and/or liver damage, (2) abnormal proteolytic activity stimulated by tissue damage and causing (a) an activation of the coagulation process (b) activation of the fibrinolytic system, or (c) of both the coagulation and the fibrinolytic systems. Differentiation between these pathways to defective haemostasis are important when deciding upon therapeutic measures in addition to the basic treatment.


Renal biopsy studies in 150 children with non-specific glomerulopathy. The experience with light microscopic examination of kidney biopsies in 150 children with nonspecific glomerulopathy is reported. Most major types of glomerular lesions, as they are at present known, were observed but in a very uneven distribution. Four groups of clinical symptoms were observed in the primary as well as in the associated non-specific glomerulopathies: hematuria, proteinuria, acute nephritic syndrome and nephrotic syndrome. Although in a number of instances, the histologic lesion was suggested by the clinical picture, a correlation was lacking in most instances. More information was obtained from the histology when the evolution was considered, particularly in the primary nephrotic syndrome and the Schönlein-Henoch nephropathy.


Oxygen affinity of haemoglobin and red cell 2,3-diphosphoglycerate in childhood diabetes. Red cell 2,3-diphosphoglycerate (2,3-DPG) and the oxygen haemoglobin dissociation curve (ODC) were determined in 32 ambulatory, non-acidotic diabetic children and in 49 healthy children. Despite the fact that the diabetic children had, on average, an increased haemoglobin concentration, their erythrocytes contained significantly more 2,3-DPG than normal. Both in diabetic and in healthy children a negative relationship was found between the content of 2,3-DPG and the haemoglobin concentrations. No relationship was present between the plasma glucose and the 2,3-DPG concentration. The concentration of plasma inorganic phosphate (Pi) in the diabetic children was significantly higher than in the control children, and for all children there was a significant relationship between the 2,3-DPG and the Pi. In the diabetics 2,3-DPG was positively correlated to the P50 (7.40) and to the P50 (in vivo ph) of the ODC. However, despite the significant increase in 2,3-DPG among the diabetic children the average P50 (7.40) and P50 (in vivo pH) was not increased as compared with the control children. The inhibitory factor preventing the oxygen affinity from decreasing among the diabetics was strongly correlated to an increase in the mean corpuscular haemoglobin concentration. The result of this study suggests the presence of an increased amount of haemoglobin fraction with high oxygen affinity (haemoglobin Alc) in the red cells of juvenile diabetics.


Infantile genetic agranulocytosis. A review with presentation of ten new cases. A review of the literature on the subject since 1956 is made in connection with a presentation of ten new cases from northern Sweden. Nine of these are related to the main pedigree published in 1956. Consanguinity between the parents has been established in two of the new families. The clinical course was identical to that described in 1956. A few additional details are presented. The granulocytopenia is present on the first day of life and the granulocyte count subsequently rapidly decreases during the first week. The existence of a diaplacental factor is regarded highly probable. It is assumed that the maturation defect in the granulocyte precursors may be due to deficiency of a serum factor. The fact that many cases of infantile genetic agranulocytosis occur sporadically is finally explained.


Renal vein thrombosis in neonates. Report of three cases treated with nephrectomy. Three neonates with unilateral renal vein thrombosis successfully treated with nephrectomy are reported. One of them also received Heparin therapy before and after surgery because of evidence of consumptive coagulopathy. All were well at follow-up.


The occurrence of mycoplasmas in the urinary tract of patients with chronic pyelonephritis. Two groups of patients, each consisting of 40, were investigated for the occurrence of mycoplasmas in the urethra, bladder and upper urinary tract. Mycoplasmas were isolated significantly more frequently from the bladder urine of patients with chronic pyelonephritis than from patients with non-infectious urinary tract diseases. Furthermore, mycoplasmas were isolated from the upper urinary tract of 5 patients with chronic pyelonephritis, while mycoplasmas could not be cultivated from the upper urinary tract of patients with non-infectious urinary tract diseases.


Application of electrophoresis for separation of trimethoprim and sulphamethoxazole in combined therapy. Determination of the concentration of each drug in the combination trimethoprim: sulphamethoxazole was performed in patient sera by separation of the drugs by electrophoresis in agarose-gel followed by microbiological assay. The electrophoretic method was equivalent to the methods used in the routine and showed good reproducibility,


Studies on the pathogenicity for rat of a mycoplasma isolated from rheumatoid arthritis. The pathogenicity for rat of M. arthritidis strain Jasmin and strain 20-P from rheumatoid synovial tissue were studied. Only strain Jasmin produced signs of illness in four of the 12 rats infected. A mycoplasma was isolated from three tissue specimens. Ten of the 48 rats investigated showed mycoplasma antibodies. Five rats showed minor inflammatory changes in the distal joints of the limbs. The failure to induce arthritic symptoms in rats inoculated with strain 20-P from rheumatoid arthritis may be due to its 10-year long storage outside the animal host.


Glycogen content in the brain stem neurons during hyperthermia in cats. Using the histochemical method of McManus the authors investigated the glycogen content in neurons in the reticular formation of brain stem in animals subjected to hyperthermia. For comparison certain nuclei outside the reticular formation were tested in the same region. A significant fall in glycogen content of reticular formation neurons was observed in hyperthermic animals. Changes in the neurons outside the reticular formation were negligible.


Differences in the composition of leucoyctes in the splenic artery and vein in rabbits, and dogs. Differences in the composition of leucocytes in the splenic artery and vein in rabbits, and dogs. Acta Physiol. Pol. 1975, 26 (1): 33-39. Blood samples were taken from the splenic artery and splenic vein of 14 rabbits and 9 dogs under general anaesthesia (with hexobarbital sodium in rabbits and Eunarcon in dogs) to compare the quantitative and qualitative composition of white blood cells. It was found that the rabbit spleen releases into the circulation mononuclear cells which do not differ in their size from cells of the blood flowing into the spleen, and that it can retain or release granulocytes, probably due to their intravascular margination. The dog spleen can retain or release granulocytes and mononuclears simultaneously or separately, probably due to the mechanism which includes spontaneous contraction of the spleen.


Influence of sodium palmitate on the cellular action of potentials of the left ventricle of isolated, perfused guinea-pig heart. Influence of sodium palmitate on the cellular action potentials of the left ventricle of isolated, perfused guinea-pig heart. Acta Physiol. Pol. 1975, 26 (1): 1-11. Transmembrane action potentials (APs) were recorded from the left ventricle and glucose uptake was estimated in the isolated guinea-pig hearts perfused with Langendorff method. After the control period the perfusion fluid was changed for the solution of altered composition containing: 1) 0.5 mM of palmitate complexed with 4% albumin and no glucose; 2) 0.1 mM or 0.5 mM of palmitate added to solution containing 11 mM of glucose; 3) substrate-free solution; 4) solution equilibrated with 5% CO-2 + 95% N-2. In all experimental groups marked shortening of AP duration was observed accompanied by the shortening of the functional refractory period and by the desynchronization of repolarization. The effect of perfusion with the substrate-free solution was similar to that evoked by substituting palmitate for glucose. In all the groups except for anoxia, fibrillation either occurred spontaneously or it was evoked by early extra stimuli. Fibrillation was reversible in all groups except for substitution 0.5 mM palmitate for glucose. Under anoxic conditions loss of excitability was observed, and shortening of AP was smaller than under palmitate. Glucose uptake was inhibited by 30% in the presence of 0.5 mM of palmitate, but not by 0.1 mM of palmitate. Thus changes in the shape of AP are not related to the glucose uptake. The possible effect of palmitate on inhibition of cellular respiration and glycolysis is discussed.


Acetylcholine content in the brain and heart of developing rats. Acetylcholine content in the brain and heart of developing rats. Acta Physiol. Pol. 1975, 26 (1): 41-44. The content of acetylcholine was determined in four parts of the brain and in the heart of developing rats. It was found that changes in acetylcholine level were not parallel in the examined brain stuctures and in the heart in the time period from birth to 18 months of age of the rats.


The effect of reserpine on acetylcholine synthesis, choline acetylase and cholinesterase activity. The effect of reserpine on acetylcholine synthesis, choline acetylase and cholinesterase activity. Acta Physiol. Pol. 1975, 26 (1): 55-61. Reserpine-induced changes in ACh content in various tissues of white rats (cerebral cortex and brain stem, stomach, lungs, heart, spleen) and the effects of reserpine on the synthesis, enzymatic breakdown of ACh, and ChAc activity were studied. Reserpine administered subcutaneously caused a singificant rise in ACh content of the cerebral cortex and insignificant rise in the heart and spleen. Reserpine (in a concentration of 0.25 mug/ml) had no effect on ACh synthesis in vitro. Reserpine in vivo increased significantly ACh synthesis in the brain. No effect of reserpine on ChAc and AChE activity was demonstrated.


The effects of neurohormones and biogenic amines on contractile reactivity of the rabbit spleen in vitro. The effects of adrenaline, noradrenaline, isoproterenol, Alupent, histamine, acetylcholine and serotonin on the isolated rabbit spleen were studied in vitro. The myographic method of recording was used. It was found that all these substances with the exception of Alupent evoked contraction of the rabbit spleen. The contractile response of the spleen was greatest after adrenaline, insignificantly smaller after noradrenaline, very small after isoproterenol and absent after Alupent. A still smaller response was observed after histamine, acetylcholine and serotonin.


The effect of peptone shock on oliguric-hypertensive bladder reflex. The effects of peptone shock on changes in the arterial blood pressure, respiration and urine excretion induced by bladder distension were investigated in 8 anaesthetized female dogs. It was found that during shock when the arterial blood pressure reaches its lowest value no effect can be induced. Later on, when the arterial blood pressure rose to intermediate values the intensity of the reflex effects were proportional to the value of arterial blood pressure. After shock when the arterial pressure was normal again the reflex effects were slightly less intenisve than the control ones obtained before shock, and they were dependent on biochemical changes affecting the nervous centres participating in the reflex.


Investigations on the effects of vibration on the neurosecretory cerebral system using 3-H-methionine. The effects of vibration on the neurosecretory system of the brain were studied using the method of autoradiography. Both control and exposed to vibration (for 6 or 12 days) guinea pigs were injected with tritiated methionine and the uptake of the isotope was determined after 1, 6, 12, 24 h. Some differences were found in the number of silver grains in the brain neurosecretory system between the controls and both experimental groups. These differences, were however, not statistically significant.


The effect of X-irradiation on the alanine--and aspartate aminotransferase activity in the liver, kidney and spleen of mouse. The effect of X-irradiation on the alanine- and aspartate aminotransferase activity in the liver, kidney and spleen of mouse. Acta Physiol. Pol. 1975, 26 (1): 95-101. The alanine- and aspartate aminotransferase (GOT and GPT) activities and the protein content were measured in the liver, kidney and spleen homogenates of mice exposed to a single whole body X-irradiation with a 900 r dose. The assays were performed in 6 h intervals during the first day and 24 h intervals from the 2nd until the 6th day after the exposure. Significant differences in the enzymatic activity were found in the course of 24 h in control animals and a marked increase of this activity was found after irradiation. This may be explained by changes in the permeability of the mitochondrial membrane for enzyme molecules.


Investigations on the effect of vibration on the neurosecretory cerebral system using 35-S-cysteine. The investigations were carried out on guniea pigs subjected to vibration of varying parameters and varying duration. Isotope method with 35-S-cysteine administered suboccipitally was used, and the investigated material included supraoptic nuclei and the pars nervosa of the hypophysis. Exposure to vibration was followed by more rapid release of labelled cysteine as demonstrated by reduction in the number of silver grains in autoradiograms.


The catecholamine-responsive adenylate cyclase system and its modification by 5'guanylylimidodiphosphate. The frog erythrocyte adenylate cyclase system was inhibited by addition of acidic phospholipids. The ratio of activity produced by isoproterenol to that produced by norepinephrine was not significantly changed by addition of various phospholipids and lipid extracts. Addition of isoproterenol plus Gpp(NH)p to the frog erythrocyte membranes produced an adenylate cyclase activity much higher than the sum of activities produced by these reagents when tested separately. The same high rate was still obtained after preincubation of the enzyme with isoproterenol plus Gpp(NH)p followed by exhaustive washing of the preparation. ATP and Mg++ were not required for the preincubation. When isoproterenol alone was preincubated with the enzyme, a persistent active state was not produced; dilution or washing readily reduced the activity to the low basal level. Formation of the persistent active state by preincubation with Gpp(NH)p plus isoproterenol was prevented by the beta-receptor blocking agent propranolol which reduced the activity to that obtained by Gpp(NH)p alone. However, propranolol completely failed to inhibit the activity if added after the enzyme had been preincubated with the catecholamine plus the nucleotide. Propranolol readily blocked the activity when added to enzyme which had been preincubated with isoproterenol alone. The findings lead to the tentative conclusion that the hormone acts by facilitating the action of Gpp(NH)p and that, having done so, the hormone perhaps plays no further role. It is further suggested that in the case of the natural nucleotide GTP, the hormone is required continuously for activation in order to maintain GTP at a regulatory site.


Prostaglandins and the eye.

Prostaglandins and the eye. Prostaglandins are present in the iris and cilliary body and are synthesized in these tissues. Prostaglandins are released into the aqueous following a variety of insults to the eye, and the results of such trauma can be reproduced by the application of prostaglandins to the eye. Prostaglandins have been detected in the aqueous of patients suffering from endogenous uveitis and it is probable that the anti-inflammatory effects of drugs such as aspirin and indomethacin are due to their prostaglandin antagonistic actions. little is known yet concerning the physiological role of prostaglandins in the eye, but their association with adrenergic mechanisms, which is now being studied, may produce some clarification. The relationship between prostaglandins and antidromic stimulation of sensory nerves and the so-called axon reflex is still obscure and it would be ironic if the miosis following stimulation of the Vth nerve, which was the starting-point for the discovery of irin and its subsequent identification with prostaglandins, is not in fact due to prostaglandin but to some other chemical mediator.


Electronic tonometry in the newborn.

Electronic tonometry in the newborn. Mackay-Marg electronic tonometry was performed without any kind of drugs in 604 eyes of newborn babies (up to 4 days of age). The first 100 cases were eliminated from the sample due to the significantly higher intraocular pressures obtained, attributed to small number of tonometries in each eye. The decision is fully discussed. The remaining cases (504 eyes) gave a mean of 12.41 mm Hg and a standard deviation of 2.58. The most important finding was the extreme and continuous variations found in newborn intraocular pressure; some hypotheses are discussed in this regard. The concept of 'basal intraocular pressure' is introduced to use the lowest intraocular pressure as a more homogenous comparative level than the ones previously used. Standardized anesthetic procedure is recommended for baby tonometry. While the possibilities of the Mackay-Marg electronic tonometer are recognized, the Goldmann tonometer (manual model) is found to be more reliable for clinical decisons in babies.


Temporary transvenous pacemakers in the community hospital. The use of temporary transvenous pacemakers has become firmly established. While the technique of temporary pacing is by no means the answer to all problems associated with myocardial infarction, it has clearly been lifesaving for certain patients treated in the community hospital. Temporary pacing is a simple and safe procedure with relatively few complications. It can be done in the community hospital by the faimly physician who has an interest in cardiology.


Organophosphates--a pediatric hazard.

Organophosphates--a pediatric hazard. These agents act as anticholinesterases. Signs of toxicity are: overactivity of the parasympathetic nervous system, nausea, vomiting, diarrhea, sweating, abdominal cramps and copious secretions. Large doses may cause sustained depolarization of the motor end plate, leading to muscular paralysis. Death may ensue from respiratory failure. The extensive and often careless use of insecticides, fungicides and pesticides makes organophosphates a particular pediatric hazard. Atropine and pralidoxime chloride are effective for therapy.


Diazoxide for hypertensive crisis.

Diazoxide for hypertensive crisis. Diazoxide is a potent and safe antipressor agent for parenteral administration in hypertensive emergencies. Its rapidity of effect provides distinct advantages. Drug resistance does not develop in responsive patients and adverse effects are mild and infrequent. The minor changes in blood urea concentration, despite a marked reduction in blood pressure, enhance the usefulness of diazoxide in azotemic hypertensive patients.


Axillary nerve blocks.

Axillary nerve blocks. Axillary nerve block is a safe and reliable method of providing anesthesia for the upper extremity. It is particularly useful because it can be applied in cases of traumatic injury where general anesthesia might present particular hazards. The use of a large volume of anesthetic solution is important, particularly when it is essential to block the musculocutaneous or axillary nerve.


Psychologic aspects of depression.

Psychologic aspects of depression. In managing depressed patients, the physician deals with impairment of moods, capacity to think and ability to function. Along with psychopharmacologic approaches, there is an initial necessity to provide a hopeful and consistent relationship. The patient uses physical symptoms and as long as these symptoms attract attention, an effective psychotherapeutic relationship is avoided. An important therapeutic approach is to challenge distorted thought processes such as exaggerated self-deprecation and delusional convictions or guilt. Too often, as symptoms recede, treatment ends.


Coffee treat or trick?

Coffee treat or trick? The popularity of coffee is due not only to its pleasant taste and aroma but also to its physiologic and psychologic effects. These effects are caused mainly by the caffeine provided in the beverage. However, caffeine may have adverse effects as well, including stimulation of gastric acid secretion. A relationship between heavy coffee ingestion and myocardial infarction has not yet been established but it is a bothersome possibility.


Routine telescopic laryngoscopy.

Routine telescopic laryngoscopy. Routine laryngoscopy can be performed easily and quickly utilizing a right-angle telescope with a specially designed holder. In 1,000 consecutive laryngoscopies done on patients without laryngeal symptoms, abnormalities were found in 173 patients (17.3 percent). Among the abnormalities was an asymptomatic carcinoma which, thanks to early detection, was successfully treated by radiation.


Lomotil ingestions in children.

Lomotil ingestions in children. Although the incidence of adverse reactions is relatively low in adults, Lomotil may result in serious toxicity in children. Early effects are often due to the atropine present in the compound, while the narcotic-like actions of diphenoxylate HCI tend to occur later. Respiratory depression is the most threatening reaction and should be treated with naloxone.


Myocardial perfusion imaging with 99m-Tc or 113m-In macroaggregated albumin: correlation of the perfusion image with clinical, angiographic, surgical, and histologic findings. Scintillation camera myocardial perfusion images were performed in 77 patients with proved or suspected ischemic heart disease following the intracoronary injection of 1.5 mCi 99m-Tc or 113m-In macroaggregated albumin. Perfusion images were classified as normal (36) or abnormal (41), and the location of abnormality was noted. Thirty-seven out of 41 patients with abnormal images had prior myocardial infarction based on history (30), ECG Q-waves (27), local contraction pattern abnormality (23), or direct surgical (9) or histologic (4) inspection, either singly or in combination. Three out of five patients with pre-infarction angina had image defects-none had evidence of infarction by ECG, ventriculogram, or surgical inspection. Coronary artery stenosis correlated with image defects to the extent that myocardial infarction was associated; 28 out of 29 patients with total occlusions and other evidence of infarction had image defects, four patients with complete occlusions but without other evidence of infarction had normal images. We conclude that, excepting patients with pre-infarction angina, this technique is more sensitive and direct in the identification of myocardial scar than standard ECG, clinical evaluation, or biplane left ventriculography.


Cardia venous blood flow in atrial pacing versus exercise-induced angina pectoris. Thirteen patients with angina pectoris underwent measurements of great cardiac vein blood flow at rest, with the onset of angina pectoris induced by atrial pacing, and again during angina pectoris induced by exercise in order to compare the regional coronary blood flow response to differing myocardial stresses. All patients had significant obstructions of the left anterior descending artery. Exercise-induced angina, compared to pacing-induced angina, was associated with a higher systolic pressure, higher left ventricular end-diastolic pressure, and a lower heart rate. Indices of myocardial oxygen demand, that is, the systolic pressure-heart rate product and the tension-time index, increased to a similar degree during both types of myocardial stress and great cardiac vein blood flow paralleled these changes. We conclude that in a given patient the level of regional coronary blood flow is similar at the onset of either pacing- or exercise-induced angina, despite significant differences in the hemodynamic response to these myocardial stresses.


Circulating renin in essential hypertension: an evaluation of its significance in the Japanese population. Plasma renin activity (PRA) was measured in 139 healthy subjects and 200 patients with essential hypertension. There was an obvious relationship between the PRA levels and aging. Elevated PRA values were obtained only in younger subjects under 20 years of age, while the PRA levels were very low only in advanced ages over 60 years. In essential hypertensive subjects, subnormal resting PRA was found in 23.5 per cent, normal PRA in 64.5 per cent, and high PRA in 12 per cent. A marked impairment of renal function and severe retinal changes were observed in the patient with high resting PRA values. On the contrary, hypertensive complications of the kidney and ocular fundi were mild in the patients with low resting PRA values. A reaction of renin secretion was studied in 161 patients with essential hypertension. There were no apparent relationships between the responsiveness of the renin system to intravenous furosemide following upright posture and hypertensive vascular injury.


Packed cells, platelet-rich plasma, and adenosine diphosphate in the production of occlusive vascular changes in lungs of rabbits. An experimental study to simulate the lesions of primary pulmonary hypertension was under-taken in rabbits. Five groups were made, each having six animals and these were given separately packed cells (3 per cent suspension of homologous erythrocytes in physiologic saline), plasma rich in platelets, plasma without platelets, ADP solution, and normal saline injections biweekly for a period of three months. Clinical, electrocardiographic, and histologic examination of the lungs were made. It was noted that animals given packed cells, plasma rich in platelets, and ADP solution developed electrocardiographic changes and histologic lesions in the lungs suggestive of pulmonary hypertension.


Effect of autonomic neural influences on the cardiovascular changes induced by coronary occlusion. The influence of vagal stimulation and/or beta-adrenergic receptor blockade on the heart rate, blood pressure, contractile force, and cardiac rhythm was evaluated in chloralose-anesthetized cats subjected to occlusion of the anterior descending coronary artery. Occlusion performed in 25 control animals produced significant decreases in heart rate (minus 22.9 plus or minus 4.4 beats per minute), blood pressure (minus 19.2 plus or minus 2.4 mm. Hg), and contractile force (minus 21.6 plus or minus 6.3 per cent). Death due to ventricular fibrillation occurred in five out of 25 animals. Coronary occlusion performed in the presence of vagal nerve stimulation resulted in similar decreases in blood pressure, whereas the decreases in contractile force were significantly greater than in control animals. In addition, the time to onset of the arrhythmias occurring in the vagus-stimulated group was increased. Death due to ventricular fibrillation was similar to control animals (i.e., two of seven, or 28 per cent). Blockade of beta-adrenergic receptors with propranol (0.75 mg. per kilogram) resulted in the usual decreases in rate, pressure, and force with occlusion but the duration of arrhythmias was shortened. The incidence of ventricular fibrillation was not different from that of the control animals. The combination of propranolol and vagal stimulation also failed to confer protection against ventricular fibrillation. Propranolol was observed to prevent the large decrease in contractile force seen with vagal stimulation. These results suggest that: (1) increasing vagal tone above the level existing after acute myocardial infarction does not decrease mortality, (2) propranolol pretreatment does not affect the incidence of ventricular fibrillation induced by coronary occlusion, (3) the duration of the arrhythmia after coronary occlusion is effectively shortened with propranolol, and (4) cardiac beta-adrenergic receptors do not appear to be involved in the decreases in heart rate, blood pressure, and contractile force seen with coronary occlusion.


A demonstration of differential refractoriness within a single fascicle of the human ventricular specialized conduction system. In 15 patients with left bundle branch block (LBBB), atrial (A), His bundle (H), and ventricular (V) electrograms were recorded. Successively more premature atrial depolarizations were introduced via a catheter in the right antrium. In eight patients, the ventricular specialized conducting system (VSCS) was the most refractory portion of the entire atrioventricular conducting system (AVCS) and A-V conduction, which had been occurring via the right bundle branch (RBB), failed below the His bundle as the effective refractory period (ERP) of the VSCS was reached. In two of these eight patients, after the ERP of the VSCS was exceeded, further shortening of the H1-H2 interval (by 40 to 50 msec.) resulted in an unexpected resumption of A-V conduction, but with markedly prolonged H-V intervals (160 to 230 msec.). This demonstrates that differential refractoriness exists within the RBB of these patients. A zone of maximal refractoriness was initially encountered within the RBB when the premature impulse first blocked below the His bundle. In relative terms, this zone was distal to a more proximal area of the RBB where, with further shortening of the H1-H2 interval, sufficient conduction delay occurred to permit recovery of excitability distally and the resumption of A-V conduction.


Heat stress limits for the sedentary worker. Performance on four sedentary tasks was monitored during temperatures of 85 degrees f,  95 degrees F, and 105 degrees F WBGT for work periods up to 2 hours. Results were compared with limits recommedned for occupational safety and health regulations. It is suggested that this limit is not a single line, but rather a range of temperture-time combinations. Further, man's compensating nature during short exposures supports a higher temperature limit for brief work bouts.


The use of activiated carbon for sampling industrial environs. This paper describes techniques employed at a large semiconductor manufacturing plant to analyze for organic contaminants in production areas. Activated carbon was employed in the sampling procedure as the collection medium. Vapors of a number of common industrial solvents were absorbed and collected on the activated carbon surface at concentrations in the ppm and sub-ppm range. Analyses of the collected samples, stripped from the carbon surfaces with carbon disulfide, were performed by gas chromatography using a number of different colum packings. Also discussed is work carried out using a gas chromatograph-mass spectometer system to separate and then identify individual constituents. Other related applications of activated carbon sampling are also reported.


Certain non-auditory physiological responses to noises. The non-auditory physiological effects of extended exposure of pilots to high intensity noise were investigated. The health records of 22 professional pilots (FAA) were examined for recorded measurements of heart rate, systolic and diastolic blood pressure, serum cholesterol, and glucsoe. These data were compared to records of the same measurements from 29 non-flying FAA personnel of the same age, social and economic status as the pilots. The yearly means for each parameter were analyzed for changes with time, within the same population, and for differences between the two study groups. Audiometric histories were tabulated and compared, and noise levels inside aircraft were determined. Although it was demonstrated that FAA pilots were exposed to high occupational noise levels there was no indication that their exposure produced any significant non-auditory physiological response.


The adsorption of water and benzene on amosite and chrysotile asbestos. In previous work the authors showed that chrysoltile is more porous than amostie and consequentd benzene with a high molecular cross-section are used as adsorbates. Benzene adsorption is extremely slow on both adsorbents with each point taking from 4 to 24 hours for equilibration. Evidently, the larger benzene molecule has a more difficult ime working its way thrugh the small pores. The water adsorption is predominait. In both cases hysteresis was found. Benzene adsorption on amosite resembled Type IV which relfects capillary condensation phenomena. With chrysotile some chemisorption may have occurred. BET surface areas and heats of adsorption are calculated.


Industrial survey of lost time injuries. An attempt to discover factors affecting lost time injuries under varying government programs involved visits to a sampling of industries in six provinces and six states. The resulting observations are used to illustrate some variables, many of which have previously been ignored, but which must be considered in any objective study of man at work.


Ragweed pollen generation and sampling methods for filtration studies. The means of generating and measuring the concentration of ragweed pollen particles for air filtration studies is discussed. The development of an inexpensive in-line impaction type sampler which collects the sample on filter paper is described. The advantages of the total particle count method when using this sampler are also defined. The effect of sampling an air steam without using an isokinetic probe was investigated; a non isokinetic sampling train was found to give results with accuracy comparable to isokinetic data. Another part of the study was to examine the "shadowing" effect of one sampling probe. Means are given for adjusting data for this effect.


Aerobic capacity of dock workers in Bombay. The aerobic capacity (VO2max) of 61 healthy loaders from Bombay Docks actively engaged in heavy manual work of lifting and carrying of food grains bags was estimated by an extrapolation technique based on linear relationship between heart rate and oxygen uptake at different levels of physical work. The average VO2max was found to be 2572 plus or minus 54 ml (S.E.)/min.(STPD) or 46.6 plus or minus 0.96 (S.E.) ml.min.-1 kg-1 (STPD) which is high in many cases when compared to the values reported by other Indian workers among different occupational groups. The possible reasons are discussed. The results further reveal that the VO2max is negatively correlated with age and that this relationship is more pronounced with subjects, aged 31-49 years. The gradual fall in aerobic capacity was observed beyond 33 years of age.