Kinetics of the glomerular ultrafiltration in the rat kidney. A theoretical study. The glomerular filtration process was evaluated theoretically from micropuncture data obtained from Sprague-Dawley rats. The hydrostatic pressures in the glomerular capillaries and Bowman's space minus the oncotic pressure in systemic plasma gave the net driving force at the proximal end of the glomerular capillary. From the single nephron filtration fraction the mean net driving force over the glomerular membrane was calculated to be 20 mm Hg during normotension, decreasing to 12 mm Hg during a perfusion pressure of 80 mm Hg. The hydraulic permeability for one glomerulus was 0.7-0.8 nl/min-100 g b.wt. mmHg. The pressures at the distal end of the glomerular capillaries were 13 and 6 mm Hg under the above two conditions, indicating non-equilibrium of the filtration process at the end of the glomerular capillary. It was shown that the glomerular filtration rate is mainly influenced by the driving pressures. During hypotension an increased plasma flow dependency was evident. Brenner et al. found a filtration equilibrium and a plasma flow dependent glomerular filtration rate in a mutant Wistar rat strain. The discrepancy between their results and ours is due to the low glomerular plasma flow and hydrostatic pressures in the Wistar rats. It is concluded from our results that both pre- and postglomerular resistances may influence the glomerular filtration rate and glomerular plasma flow independently.


Reduced urinary noradrenaline excretion during rest, exercise and cold stress in trained rats: a comparison between physically-trained rats, cold-acclimated rats and warm-acclimated rats. Physically trained rats were compared with cold-acclimated rats. Trained as well as cold-acclimated rats showed cardiac and adrenal hypertrophy. Cardiac noradrenaline (NA) content was increased in both groups of rats but only the trained rats had an increased cardiac NA concentration. The adrenal NA content was increased in both groups but only the trained rats had an increased adrenal content of adrenaline (A). The spleen of trained rats had an increased NA content, while that of cold-acclimated rats had a decreased NA content. The submandibular glands of cold-acclimated rats were enlarged and had an increased NA content. Trained as well as cold-acclimated rats had lower urinary NA excretions during rest, after exercise and during cold stress when compared with controls. However, only the trained rats had a reduced net increment in NA excretion after exercise, whereas there was no difference between the increments of cold-acclimated and control rats. Six months after cessation of training, ex-trained rats still had an increased heart ratio and a reduced urinary NA excretion after exercise. It is suggested that physical training induces "cross tolerance" to cold stress, while cold-acclimation does not lead to "cross tolerance" to acute exercise.


Effects of drugs and nerve stimulation on the spleen and arteries of two species of dogfish, Scyliorhinus canicula and Squalus acanthias. The effects of drugs and nerve stimulation on the spleen of 2 species of dogfish have been examined by experiments with perfused spleens and isolated spleen and artery strips. Adrenaline, noradrenaline and phenylephrine, acting via alpha adrenoceptors, constrict the perfused spleen of both species, thereby releasing erythrocytes, and contract the isolated spleen and artery strips. Phenotolamine competitively antagonizes the excitatory effects of adrenergic agonists. The responses of the spleen to acetylcholine are very irregular, and a rapid desensitization makes evaluation of the mode of action of this drug difficult. In the artery strips acetylcholine produces a dose-dependent contraction. Fluorescent histochemistry reveals well developed adrenergic innervation of the arteries, and a few adrenergic terminals in the spleen. Stimulation of splenic nerves produces normally splenoconstriction in Squalus, which can be blocked by phentolamine but not by atropine. The nervous control of the Scyliorhinus spleen seems to be poor or lacking. It is concluded that the dogfish spleen, and maybe also the arteries, are to a large extent controlled by circulating catecholamines and (in Squalus) also by sympathetic adrenergic fibres.


The postnatal development of some twitch and fatigue properties of single motor units in the ankle muscles of the kitten. Contractions of single motor units in the gastrocnemius, soleus and pretibial flexor muscles were elicited by intracellular stimulation of the innervating motoneurones. Kittens being 1, 2, 6 and 10 weeks of age were used. The aim was to establish the pattern of postnatal differentiation of the adult motor unit types (Burke et al. 1973, 1974, Hammarberg and Kellerth 1975 b). In the developing type S units of the soleus muscle the mean value for contraction time showed a transient decrease during the early postnatal period, but the twitch half-relaxation time (HRT), the duration of motoneurone post-spike afterhyperpolarization (AHP) and the susceptibility to fatigue remained virtually unchanged during the age period studied. In the units of the developing fast twitch muscles the contraction time, HRT and susceptibility to fatigue were significantly different from those of the soleus units already at 1 week of age. At 6-10 weeks of age the contractile characteristics typical of the adult type FF and FR units were attained. The AHP duration gradually decreased up to 10 weeks of age, and it was then considerably shorter than both at 1 week of age and in the adult stage.


Effect of bulbar acidification on gastric acid responses to urecholine in Pavlov pouch dogs. Dogs were provided with mucosal septal pouches of the fundic stomach and of the duodenal bulb. Gastric secretion was stimulated by intravenous infusion of submaximal doses of porcine gastrin or the stable choline ester Urecholine. Acid perfusion of bulbar pouches profoundly inhibited acid responses to gastrin. Bulbar acidification produced little or no reduction in acid secretion induced by Urecholine. Small doses of Urecholine do not release gastrin in the dog but may induce acid secretion, mainly by direct cholinergic stimulation of the HCl glands. The fact that Urecholine-induced acid secretion was not inhibited in the present experiments is consistent with the hypothesis that the bulbar mechanism does not interfere with cholinergic stimulation acting on the parietal cells.


Relative contribution of superficially bound and extracellular calcium to activation of contraction in isolated rat portal vein. The spontaneous electrical and mechanical activity of the isolated rat portal vein is abolished after only 2-3 min in nominally Ca-free medium, and after 5-6 min there is no contractile response to depolarizing (122 mM K+), Ca-free solution. In the present study we have examined the electrical and mechanical responses of the portal vein to depolarization with simultaneous readministration of Ca2+ (2.5 mM) after periods of variable length in Ca-free standard solution. After 30 to 60 min of Ca depletion a slow contracture occurred in response to the high-K+ solution with 2.5 mM Ca2+. When the period in Ca-free medium was reduced below 30 min an early, faster phase appeared in the contracture response, and this phase was more rapid the shorter the time of Ca depletion. It is suggested that the slow contracture obtained after 30 min or more uses mainly extracellular Ca for activation and that the faster phase seen after shorter periods of Ca depletion is due to release of superficially bound Ca. This latter pool of tissue bound Ca does not alone produce contraction in response to depolarization, suggesting that extracellular Ca is required to trigger the release perhaps through a regenerative process.


Depression of taste responses by local or intravascular administration of salicylates in the rat. The effects of aspirin and sodium salicylate on the taste response in the chorda tympani proper nerve have been studied during stimulation of the taste receptors in rats with salty, sweet, sour and bitter-tasting solutions. Three methods of administering the drugs were used: locally on the tongue, intravenously into one femoral vein and intraarterially close to the branching of the lingual artery. It was observed that salicylates, given in any of these three ways, depressed the response to taste stimuli. This is discussed in relation to present views on the action of salicylates.


Kinetics of the glomerular ultrafiltration in the rat kidney. An experimental study. The quantitative relation between the driving forces over the glomerular membrane and the glomerular plasma flow, on the one hand, and the single glomerular filtration rate (SNGFR), on the other, is still uncertain. Micropuncture measurements on Sprague-Dawley rats made it possible to calculate the net driving force over the glomerular membrane. The single glomerular plasma flow was determined from SNGFR and the single nephron filtration fraction (SNFF). The effective plasma flow was measured with PAH for total kidney and for superficial nephrons. The mean glomerular capillary pressure was found to be 62.6 mm Hg. The results indicate a net driving force of about 13 mm Hg at the distal end of the glomerular capillary. SNGFR was found to be 14.1 nl/min-100 g. SNFF amounted to about 0.27. The filtration fractions determined with the PAH method were in the same range. The results indicate a filtration disequilibrium, in contrast to those of Brenner et al. from measurements on a mutant Wistar rat strain. The filtration fractions seemed to be the same in all glomerular populations. It is clear that the SNGFR is pressure dependent. Our earlier findings of a nonautoregulation of the blood flow through the outer glomeruli were also confirmed.


Effects of histamine, vasopressin, and angiotensin II on hepatosplanchnic hemodynamics, liver function, and hepatic metabolism in cats. Continuous i.v. infusions of histamine (5 mug/kg - min), vasopressin (10 mU/kg -min), or angiotensin II (0.5 mug/kg - min) were given to fasting cats. Hepatic arterial flow was decreased 30% by histamine, increased 30% by vasopressin, and not significantly affected by angiotensin, whereas portal venous flow was increased 25% by histamine, decreased 40% by vasopressin, and not significantly affected by angiotensin. The hepatic arterial conductance was decreased about 25% by histamine and angiotensin, and not significantly affected by vasopressin. The gastrointestinal conductance was decreased about 40% by vasopressin and angiotensin, and increased 25% by histamine. The conductance in the intrahepatic low pressure vessels was not affected by histamine and vasopressin, but decreased 25% during the infusion of angiotensin. These hemodynamic effects, however, were not accompanied by changes in the liver function or hepatic metabolism as judged from the splanchnic elimination of ethanol, the hepatic uptake and excretion of ICG, the hepatic oxygen consumption, and lactate and ketone production. This indicates that the functional capacity of the liver and thereby the number of sinusoids perfused is not markedly influenced by these drugs. Vasopressin caused a decrease in the oxygen consumption and an increase in the lactate production in the prehepatic splanchnic area, which may be due to a redistribution of the gastrointestinal blood flow.


Effect of vasoactive agents on the distribution of renal cortical blood flow in dogs. The distribution of renal cortical blood flow was studied in 6 Nembutal anesthetized dogs during control periods and during infusions of adrenaline, noradrenaline, angiotensin and vasopressin. Local cortical blood flow was measured as H2 gas desaturation rate recorded polarographically by platinum electrodes in outer and inner cortex. The total renal blood flow (RBF) was measured by an electromagnetic flow meter. In the control period the outer cortical blood flow (OCF) and inner cortical blood flow (ICF) averaged 3.59 (+/- S.D. 0.85) ml/min - g and 3.23 (+/- S.D. 0.64) ml/min - g, respectively. Infusions of the various vasoactive agents caused essentially equal vascular responses. All agents caused increased local renal resistance and reduction of RBF whether given intravenously or intraarterially. The RBF could be lowered to 20-50% of initial control flow by increasing doses of vasoactive agents. OCF and ICF fell proportionately and almost to the same extent as RBF, or OCF fell slightly more than ICF. There was no evidence for patchy or zonal hypoperfusion in cortex caused by infusion of adrenaline, noradrenaline, angiotensin and vasopressin.


Time courses of pulmonary gas exchange and heart rate changes in supine exercise. The time courses of ventilation (VE), O2 uptake (VO2), CO2 elimination (VCO2), respiratory exchange ratio (R), end-tidal PO2 and PCO2 and heart rate (HR) were studied in seven subjects performing light dynamic leg exercise in the supine position. Individual and group mean time courses in response to step changes in work load were computed and displayed graphically. A computer-based method was also used to fit mono- or bi-exponential mathematical functions to the recorded responses. The over-all rate of HR change in response to the transition from 0-load pedalling to exercise (on-response) was faster (mean response time, MRT = 31 s) than the corresponding VO2 response (MRT = 45 s) while VE responded considerably slower (MRT = 86 s). During the reverse transition (off-response), VO2 and VE changed with the same rate as in the on-response, while the HR-change was slower than during the on-response (MRT = 50 s). During the initial 15-sec period, VO2 changed only slightly, which contrasts to previous results in the sitting position, where 50% of the final change in VO2 has been reported to occur within the first 15-sec period, and where changes in blood distribution and stroke volume are known to be more pronounced than in the supine position. Our results emphasize the importance of central circulatory changes for the time course of VO2 at the start and end of exercise.


[Attitudes towards alcohol in adolescents of 3 social classes in the City of Cordoba]. When dealing with some of primary prevention of alcoholism, the starting point is always a preliminary descriptive study of valueattitude systems of community groups, being one of the main prevention goals to modify certain guidelines and patterns of alcohol intake. This research aims at: a) Description of attitudes towards alcohol of 116 adolescents between 12 and 16 years in Córdoba City, belonging to middle class, white collar and qualified blue collar; b) Definition of relationships between adolescents' attitudes and social class; c) Determination, according to the social class, of favorable, unfavorable or neutral attitudes towards a program of prevention and control of alcoholism. A questionnaire with 49 uncomplete phrases first conceived for Chile and adapted to our milieu was used. General results show that middle class and nonqualified working class groups are the ones who most disapprove of and condemn alcohol abuse and, at the same time, avoid to a higher degree drinking alcohol. When alcohol intake in women is considered, the percentage is even higher. Groups belonging to middle classes think alcohol abuse is the result of sadness, anguish, and the like. For the qualified working classes, the causes are attending parties or meetings where others drink; there is a high percentage of answers showing compassion for alcoholics. Helping attitudes are higher in these groups, and more permissive and flexible attitudes are found. A favorable disposition towards prevention programs is registered for more than 55% of the total number of adolescents in this research.


[Indication for jointed matrimonial and familial therapy]. Before psychological treatment is prescribed, one should take into account, with utmost detail and depth, the ways and styles of integration of patients into their family-systems. In order to prove this contention we use the theoretical framework of C. A. Paz and D. Liberman, in connection with criteria of "analyzability". We include three clinical examples in which the need for a model allowing for the systemic character of family organization and marriage partnership is put into evidence. The model is built up starting from developments made in the field of Cybernetics which in turn are based upon Set theory.


[Psychodynamics of ideological democracy]. In order to understand "ideological democracy" and its consecuences for therapy it is important to study the ideology of group members from the psychodynamic standpoint. Ideology is understood as a system of rules to interpret reality, although from a theoretical point of view, we contend reality itself is free from ideology. Ideology is thus defined as a cognitive system, stemming from emotional matrices of the psychosexual development of personality. The understanding of how the members of the Therapeutic Community attain "ideological democracy" is, to our mind, essential in order to be able to attain therapeutic goals. After a brief introduction the paper deals with ideology and its relationship with different personality structures: hysteric, phobic, psychopatic, depressive, paranoid and schizoid. Several common mechanisms for building ideology are set forth. The final conclusion is that such an analysis helps to ascertain the best strategies for community therapy.


[Brief psychotherapy].

[Brief psychotherapy]. During the last few years, psychotherapy has gained a new and well deserved place among therapies in Buenos Aires. The author stresses the importance of making a clear distinction between psychotherapy and psychoanalytical treatments considering that people who would benefit from one of these therapies would not from the other and viceversa. This paper does not deal with technical differences between both therapies but will show instead a case history of a brief psychotherapy treatment which could be considered successful.


[Concept of behavior in phobic symptoms]. Phobic symptoms are discussed from behavioral viewpoint. A symptom is considered phobic when avoidance mechanism coming from anxiety is underlying it. Fear and anxiety are similar reactions, although some clinical difference is pointed out between them. A classification of the kind of situations present at the beginning of phobic symptoms is proposed: 1. Association with the neutral stimulus under a strong fear. 2. Learning of the fear response by teaching of social environment, before being in front of the neutral stimulus. 3. Previously nonphobic anxiety or anxiety crisis occurred in front of the neutral stimulus, without presence of any dangerous stimulus.


[The problem of interpretation in psychology]. It is essential to all of the so-called "Sciences of Man" the way in which the problem of method is approached but it is most specifically important in Psychology. Psychology in its several schools has been and still is the discipline which mostly uses as a method to understand its own goal. As a matter of fact, the scientific basis of Psychology lies on the possibility of being able to determine and establish the object of interpretation. Starting from the description of interpretation we propose the following stages: a) The given data understood at a perceptive or imaginative level. b) Doxic characteristics, or characteristics of belief. c) Symbolic level, and d) Significance. The four stages integrate in the search (in the ideal sense at which we aim, according to Kant) of a totality as near to apodicticity as possible, that is to say, as adequate as possible to its object. Obviously the base-line on which interpretation is built up is ambiguity, that is the "impossibility" of a perfect adequacy of interpretation to the object being interpreted. This "impossibility" is the limit of interpretation as far as the search for perfect adequacy is concerned; this limit, on the other hand, is the atmosphere of the relationship between "Siences of Man" and ideologies. That is, the clarification of the method of interpretation depends on the historic and concrete explanation of the relationship between "Sciences of Man" and ideologies, meaning on the one hand, the truly scientific discoveries and, on the other hand, the illicit extension of those discoveries (ideologic extension). Furthermore, in a general sense the possibility of constituting the so-called "Sciences of Man" relies precisely on the everchanging relationship between science and ideology, because they are historic and stem from facts.


[Profanities and the profane person].

[Profanities and the profane person]. The phychological aspects of language show an antithesis between learned and profane languages. The former implies control and abides by the rules of good interpersonal relationship. The latter means discontrol, violence and rupture of those rules. Profane of "forbidden" language is, always, a disturbed comunication. It shows agressive, sexual and exhibitionistic trends. It might stand for real crime at a symbolic level; and it has, in some way, a prophylactic role, fulfilling defensive needs by means of substitution. Its sexually aggressive content endangers sexual repression, therefore fostering anxiety.


[The physician as an agent of change and the change in the outlook of the physician]. Illness implies, to a lesser or greater extent, a "vital crisis", and it is sometimes the only visible part of the maelstrom. The medical conception of illness, based on cut out nosological entities with specific organic or mental locus, splits the patient's reality. Such an approach fosters and spreads illness, since it leads the dynamic field of doctor-patient relationship to stagnation. The example is given of a case treated by a member of a (modified) Balint group, an endocrinologist who sees the patient after many derivations, and focuses the therapy on the one symptom his speciality enables him to deal with most proficiently: excess overweight. Such an approach was unfit to grasp the whole of the patient's behaviour and protheic symptoms. The group points to the need for a change to a wider and more comprehensive approach. The practitioner understands such a need, which implies also a change in his own previous technical patterns; he now views himself as the "organizer" of the patient's situation, and succeeds in integrating a comprehensive conception of the total illness. This change involves more than just a technical switch; a slight apparent variation, implying deep changes in the doctor's personality is achieved the way Balint encourages which in turn modify the whole ideology at the basis of conceptions of illness and of being-ill. We hold that illness doesn't have either a "natural history" or a unique determinant, but that different medical conceptions and ideologies are at the basis of many different ways of evolving and developing the situation of "being ill".


Therapeutic results in brief-interval unilateral ECT. The study reported comprised 104 patients with endogenous depression who were given unilateral electroconvulsive therapy (ECT). The patients were divided into two equally large groups, one receiving two and the other four treatments per week. The latter group was selected openly, while the former had been collected by a double-blind technique on a previous occasion. The severity of depression was assessed before the first treatment and on the days after the sixth and the last treatment, and at these times memory testing by WMS Forms I and II and EEG were also performed. An analysis is presented of the therapeutic effect obtained, assessed by: (1) the number of treatments applied in the two groups; (2) the reduction in the depression score; and (3) the effect achieved per treatment. In the group with frequent electrostimulation one to two addititional treatments were required, the difference being statistically significant. On the other hand, frequent stimulation tended to be more effective in terms of the reduction in the depression score. The effect per treatment was identical in the two groups. Four treatments per week did not result in a higher frequency of complications. A comparison of the five severest depressions in each of the two groups did not reveal any difference in the therapeutic effect of the two methods of treatment. It is concluded that the technique with four treatments per week instead of two offers the advantage that the duration of the treatment period is reduced by 11-12 days. As the study also revealed that the discomforts, including memory impairment, are not increased by frequent stimulation, it is recommended that unilateral ECT is administered with a frequency of four treatments per week.


A study of attempted suicides in urban versus rural areas, with a follow-up. The group of subjects consisted of 44 patients (attempters) who were admitted to hospital for treatment because of attempted suicide during a 3-month period in Norther Savo (in Eastern Finland), another 44 patients (non-attempters) admitted to hospital in the same period for other reasons serving as controls. The number of women was the same in both groups, and so was, in consequence, the number of men. The study compared the attempters with the non-attempters and, in addition, the patients coming from urban areas with those coming from rural areas, the ratio of the urban to the rural patients being the same in both groups. The study was based on personal psychiatric interviews with the patients, which took place in each case both immediately following the patient's admission and precisely 3 months afterwards. The results showed that schizophrenia was significantly more frequent in the rural than in the urban attempter group. By contrast, alcoholism and alcohol abuse were more frequent in the urban than in the rural attempter group. Compared with the urban patients, the rural patients tended to be physically more seriously desordered. Poisoning by drugs was a significantly more frequent means of attempted suicide in the urban than in th rural group. The patients in the latter group, again, had resorted oftener to the so-called "active" methods of attempted suicide. Of the attempters, 25% attempted suicide anew during the 3-month follow-up period, the corresponding figure for the non-attempter group being only 6%. During the follow-up period, a greater number of suicidal attempts was made by the patients in the rural group than by those in the urban group, and, as regards the intent to succeed, the attempts of the former were more serious than those of the latter. The so-called "active" methods were used more often by rural than by urban patients also during the follow-up period. All in all, the self-destructive behaviour exhibited during the follow-up period was graver in the rural than in the urban group.


Fibrous septa in the straight dural sinus. Postmortem exploration of the straight sinus supplemented in some cases by radiography revealed the presence of single or multiple septa or synechiae in the sinus in 44 of 145 cases. A septum should not be mistaken for a thrombus. The septa are of roentgenologic significance because of their ability to alter the appearance of the sinus from one cerebral angiography to another in one and the same patient.


Bone scintigraphy of facial skeleton with 99Tcm-diphosphonate. Bone scintigraphy of the facial skeleton with 99Tcm-diphosphonate using gamma-camera was performed in 10 cases without, and in 4 cases with pathologic processes. A. p. and lateral projections were used and a converging collimator. The normal distribution of the isotope in the bones of the face seemed to be uniform with minor variations. Increased uptake varying in intensity was evident in the region of the lesion.


Comparison between the area and the volume of the air-filled ear space. The area of the air-filled ear space, assessed planimetrically, was compared with the volume in cases with chronic otitis media with central perforation or recent traumatic perforation of the tympanic membrane. A significant correlation between the area and volume existed. In chronic otitis media the area was larger than in cases with traumatic perforation with equal volume. In these cases the area does not correlate completely with the volume of the functioning air space. The results favour the hypothesis that the pneumatisation of the temporal bone is affected by infection.


Lymphography in carcinoma of the uterine cervix. Lymphography was carried out in a series of 158 patients with carcinoma of the uterine cervix. The diagnostic accuracy rate of 85 per cent compares favourably with the results of a similar investigation made ten years ago. Positive lymphography does not alter the survival rate in clinical stages I and II, probably due to the more accurate and selective therapeutic approach induced by lymphography. In stage III the 2-year survival rate of patients with negative findings is 58 per cent compared to only 17 per cent in case of positive lymphographic findings.


Radiography of laryngeal carcinoma. Assessment of value. The value of various radiographic methods (except laryngography) in laryngeal carcinoma was assessed in a material of 71 patients. Radiography proved of no value in T1 and T2 tumours if a satisfactory clinical examination could be performed but gave valuable information in recurrences as well as in T3 and T4 cases.


Effects of intraarterial injection of contrast medium on regional circulation in soft tissue trauma. The effects of repeated intraarterial injections of methylglucamine metrizoate on regional circulation were registered in soft tissue trauma to the dog hind leg. The circulatory disturbances were determined by hemodynamic measurements and by angiography. The changes of flow following injection of the contrast medium were related to the films. The informative arterial phase appeared in the time lag between injection and the flow increasing effect of the contrast medium both before and after trauma. No evidence of a cumulative effect was recorded.


Bone mineral content in hereditary polycystic osteodysplasia associated with progressive dementia. Measurements of the bone mineral content were made in five patients with a disease characterized by progressive dementia and lipomembranous polycystic osteodysplasia. Decreased bone mineral density (g/cm3) was observed not only in the region of cysts in the distal radius but also in the diaphyses of radius and ulna. The 85Sr vertebral uptake was low in the youngest patient, normal in two and raised in another two. The observations were compatible with the hypothesis of a general metabolic disorder of the bone.


Soft tissue radiography in painful shoulder. Specialized soft tissue radiography was applied to the shoulder region to differentiate between shoulder peritendinitis and radiating cervical pain. The technique is presented, together with the results of a clinical trial. Local inflammation was demonstrable even in the absence of calcific deposits.


Arterial collaterals in intrahepatic arterial occlusion. Two cases are reported, where intrahepatic peripheral arterial collaterals were angiographically observed. In one case the collateral artery connected the subsegmental arteries of the dorso-caudal and ventro-cranial segments; in the other collateral circulation existed between the ventro-cranial segmental artery and the middle hepatic artery. Thus, the segmental arteries of the liver are not always end arteries. A schematic drawing of the hitherto angiographically confirmed collaterals is given.


Speed of response of a 50 Hz and a 250 Hz TV system. The speed of response of a newly developed 250 Hz high image rate Plumbicon television system was compared with the ordinary 50 Hz Vidicon and Plumbicon television systems. The high time resolution of the 250 Hz system, almost five times that of the 50 Hz Vidicon and three times that of the 50 Hz Plumbicon system, makes it well adapted for videodensitometry particularly if the velocity of the contrast bolus or the pulse profile within the circulation are to be evaluated.


Carcinoma of the larynx. V. Relationship between biologic effect and failure of irradiation. Among 147 patients with laryngeal carcinoma, treated with 60Co irradiation and followed for 5 to 10 years, there were 5 cases of recurrence due to incorrectly placed fields. The glottic cases consisted of one group below and one above a Partial Tolerance of 1 650 ret. In the latter group the recurrence rate was significantly lower than in the former. Higher ret levels did not lower the residual tumour or recurrence rate in the glottic group but seemed to lower the rate in the supraglottic group.


Computer dosimetry based on pelvic simulation. A technique is described which shows a good correlation between computer dose rates based on a simulated pelvic irradiation system and dose rates measured in patients using a probe monitor. With radiation sources in position, the system described permits a rapid check of computer dosimetry output in a clinical situation. As a dual dose monitor system greater confidence in the accuracy of implant dose distribution is possible.


Stathmokinetic failure to enhance radiation response in human tumours. The literature concerning the use of metaphase inducing agents as clinical sensitisers to radiation is briefly reviewed, and five cases are reported, which suggest that under ordinary clinical conditions, these agents are not likely to be of value. These results accord with animal experiments and a possible reason is suggested.


Effect of therapeutic radiation on peripheral blood lymphocytes in patients with carcinoma of the breast. Effects of radiation therapy for carcinoma of the breast on responsiveness to mitogens of blood lymphocytes of patients at different clinical stages were analysed. Patients at different clinical stages had comparable numbers and responses of lymphocytes. During therapy the mean lymphocyte numbers decreased to 31 per cent of the pre-treatment value and mean responses to mitogens in whole-blood cultures decreased to 15 to 39 per cent of pre-treatment values. Similar decreases occurred whether or not mastectomy was performed.


Effects of 131I therapy on blood borne leucocytes in hyperthyroid patients. The different types of circulating leucocytes were examined in 54 patients before and 2 to 4 months after 131I therapy for hyperthyroidism. An absolute and differential percentage increase in the number of juvenile segmented neutrophils, eosinophilic and basophilic granulocytes was demonstrated in the patients free from signs of hyperthyroidism after therapy. This increase was statistically significant. No changes occurred in the 11 patients remaining hyperthyroid.


The risk of atherosclerotic vascular disease in subjects with xanthomatosis. The morbidity and mortality in 172 males and 164 females with xanthomatosis have been investigated. Symptoms of coronary heart disease (CHD) were the most frequent initial manifestation of atherosclerotic vascular disease. Angina pectoris was the first symptom in about 3/4 of males as well as females; myocardial infarction was the first event in 26% of the males and 9% of the females. Other manifestations of atherosclerosis were comparatively rare and occurred late in life. Half of the subjects were affected with symptoms of atherosclerotic vascular disease by the age of 52 in men and 62 in women, the mean age for first symptoms being 49 and 56 years, respectively. No significant influence of other CHD risk factors than xanthomatosis and hyperlipidaemia was found in these patients. An increase in the number of cardiovascular deaths was seen in xanthomatosis patients, compared with the general population, in particular in the number of "sudden deaths". Half of the males died before the age of 66 and half of the females before the age of 74.5, which is about 10 and 7 years earlier than predicted at 30 years of age for the normal population. The cumulative relative mortality in both men and women was about twice that expected for the general Norwegian population until 70 years of age.


Predictable reduction in anticoagulant activity of warfarin by small amounts of vitamin K. After withdrawal of warfarin (Marevan), 48-72 hours are required to raise the Thombotest values from a therapeutic level (range 5-10%) to 12% or higher. By i.v. administration of 1 mg vitamin K1 (Konakion) and without changing the dose of the anticoagulant, this effect could be obtained within 24 hours. Furthermore, the effect of vitamin K vanished within 2-5 days. The use of small amounts of vitamin K may therefore be a simple and reliable way of obtaining a rapid, temporary reduction in anticoagulant effect.


Studies on the haematologic and cytogenetic effect of lithium. The corpuscular elements of the peripheral blod and the morphology and chromosome constitution of bone marrow cells have been studied in patients before and during lithium therapy as well as in patients who had received lithium for a substantial period. Lithium therapy produced elevated total white cell, granulocyte, eosinophil and thrombocyte counts and a lymphocytopenia, whereas no effect was seen on the erythrocyte and reticulocyte counts. There were no morphological or cytogenetic changes in the bone marrow aspirates. Neither were toxic doses of lithium able to produce chromosome abnormalities in rats.


The effect of glycerol infusion in acute cerebral infarction. Intravenous administration of glycerol has been used in an effort to improve the prognosis for patients with acute cerebral infarction. Fifty patients were treated actively and 56 served as a control group. The neurological status before, during and after treatment for six days was assessed by a score system. The patients were grouped according to the initial score. Those with the highest and lowest scores did not improve from glycerol infusion. However, the treated patients with intermediate scores, where the prognosis is known to be dubious, showed a significant improvement compared to the controls. The mortality was not influenced. No undesirable side-effects from glycerol were registered.


Factors related to blood pressure in a general population sample of Swedish men. Blood pressure (BP), heart rate (HR), height, weight, hereditary factors, smoking habits and physical activity have been determined in a random population sample of men aged 47-54 years attending a screening examination, which was part of a multifactor primary preventive trial. Of the 9,967 men who were invited to the study, 83% answered a postal questionnaire and 75% took part in the screening examination. Of all persons not on antihypertensive treatment, 10% had systolic blood pressure (SBP) greater than 175 mmHg and 6% had diastolic blood pressure (DBP) greater than 115 mmHg. Of those on hypotensive treatment 43% had SBP greater than 175 mmHg and 30% had DBP greater than 115 mmHg, indicating that the hypertension was not well controlled. A weak positive correlation was found between HR and BP and between relative body weight (RBW) (defined as [weight/height] - 100) and BP. Both HR and RBW were higher in the treated hypertensives than in the remainder of the population studied. Subjects with a positive heredity for myocardial infarction or stroke had a significantly higher BP than persons with a negative heredity, but the absolute differences were small. A weak relationship was demonstrated between smoking habits and DBP, with the lowest BP in persons smoking greater than 25 cigarettes a day. There was no relationship between the degree of physical activity and BP.


Ectopic pituitary function.

Ectopic pituitary function. Two patients with acromegaly have been treated with hypophysectomy. Because the disease was still active, the patients were reoperated. No pituitary tissue could be found at the second operations. Besides the acromegaly, one of the patients had diabetes mellitus (appeared after the first operation), Cushing's syndrome, probably ACTH-dependent, and evidence of thyrotoxicosis. In both patients extopic pituitary tissue was suspected. One of the patients reacted with a normal fall in plasma growth hormone to growth hormone releasing-inhibiting hormone. Ectopic pituitary function should be suspected, if the pituitary function is retained after a hypophysectomy.


Selected psychosocial variables in the delay of reaching the coronoary care unit. Sixty-one first admissions to a coronary care unit have been analysed regarding "delay period" from onset of chest pain to admission to the CCU in relation to psychosocial information, collected from the closest relative. On the whole, psychosocial variables seemed to play a modest role in the determination of the delay period. However, one "type A behavior" variable, inability to relax during leisure time, was related to a shorter delay period. Young subjects tended to have a relatively short delay.


Cutaneous reactions of the extremities of diabetics to local thermal trauma. An earlier report described cutaneous lesions, consisting of erythema with or without necrosis, on the legs and/or feet of elderly diabetics and the cause was suggested to be an altered reaction to precipitating factors such as cardiac decompensation. The present investigation concerns the cutaneous reactions to traumatization with local heat or cold to the skin of legs and forearms of 35 diabetics and 25 controls. Petechiae within the area of traumatization with either heat or cold were observed more often in diabetics than in controls. They occurred more frequently on the legs than on the forearms. Among the controls, petechiae were observed only in those over 50 years of age and only on the legs. In the diabetics under 50, petechiae were almost always observed when the duration of diabetes was 10 years or more but seldom in young patients with diabetes of short duration. The duration of diabetes was not significantly related to the occurrence of petechiae in diabetics over 50. In these diabetics, moreover, petechiae developed after traumatization with heat of a lower temperature than that which caused petechiae to appear in corresponding controls. The initial skin lesions in dermopathia diabetica (Melin) have a reddened border. The skin of the legs of some of the diabetics developed an intensely reddened border round the area of experimental heat or cold traumatization. These patients were either elderly diabetics or younger patients with diabetes of long duration. Each of them had dermopathia diabetica and each developed atrophic circumscribed skin lesions on the site of traumatization. Nineteen diabetics had dermopathia diabetica and 16 of them developed atrophic circumscribed skin lesions on the site of traumatization, lesions which were never seen in the controls. Thus, diabetics differ from controls in their reaction to a certain thermal trauma. The possible reasons for this altered reaction are discussed.


Thyroid carcinoma after 131I treatment for hyperthyroidism. Report of a case. A case of anaplastic thyroid carcinoma is described, occurring in a 71-year-old woman, 8-1/2 years after treatment with 8 mCi 131I for hyperthyroidism.


Frequency of infection and efficiency of transfection of Rhizobium meliloti cells and spheroplasts. Competent cultures of Rhizobium meliloti cells and spheroplasts obtained by various methods were infected with DNA of phage 1A. The Frequency of infection among the cells and spheroplasts was 2 X 10(-8)-5 X 10(-10). The efficiency of transfection calculated from the ratio of plaque forming units to infective DNA molecule of phage 1A was 5 X 10(-8) to 10(-10). Frequency of infection and efficiency of transfection among the competent cells were by one order of magnitude higher in the case of the spheroplasts. The use of various media did not noticeably alter the efficiency of transfection.


Isolation and some properties of colicin V preparations. E. coli strain CLI(V) produces colicin V which can exist in two chemically different forms. A heat-stable, liposaccharide-protein complex is present as a main component of the cell wash. An intracellular colicin is a heat-labile and seems to be a simple protein. Preliminary experiments have shown that colicin V inhibits simultaneously synthesis of protein, RNA and DNA. Its mode of action is similar to colicins: E1, B, K and A.


Influence of salts on the microbial activities in arid and semi-humid soils. The influence of salt mixtures consisting of Ca(H2PO4)2, trace elements, CaSO4, CaCO3, Na2CO3, NaCl and K2SO4 in different combinations on the nitrifying power, evolution of carbon dioxide and the total number of bacteria was studied in arid soils (sandy and alluvial) and semi-humid ones (chernozem and rendzina). Salt mixtures comprising of either mono-calcium phosphate or sodium chloride showed highly inhibiting action on the studied microbial activities in sandy, alluvial and chernozem soils, whilst mono-calcium phosphate stimulated the heterotrophs of rendzina. Trace elements stimulated the autotrophs of the clay soils. The other different salts mixtures acted according to the salt combination and nature of the microbial activity.


Studies on metabolic activity of planktonic bacteria isolated from three lakes. Studies were carried out on metabolic activity of 480 bacterial isolates on 9 substrates. All bacterial isolates studied except one utilized the casamino acids. Also with casamino acids the highest oxygen uptake values were obtained. Among the carbohydrates, glucose was most frequently utilized by the planktonic bacteria. Bacteria isolated from water of the various lakes differed in their metabolic activity as well as in the capability of utilizing the individual substrates. The capability of attacking by the bacteria the substrates applied depended largely upon the time of their isolation.


Kinetic studies on citric acid production by Aspergillus niger. I. Phases of mycelium growth and product formation. The physiology and growth kinetics of Aspergillus niger B-64-5 in shaken culture were studied, five successive phases of citric acid fermentation being distinguished. Growth was found to be diauxic, spore germination being followed by an exponential growth phase, then a period of growth disturbance, and last of all a phase of secondary growth, characterized by a constant coefficient of growth decline appeared. The citric acid production started in the phase of growth disturbance. The chief increase in citric acid concentration took place in the production phase, i.e. in the last fermentation phase.


Effects of prefrontal lesions on left leg-right leg differentiation to nondirectional acoustic cues in dogs. Twenty five dogs were trained preoperatively in left leg- right leg differentiation to nondirectional acoustic cues. Removal of the medial precruciate cortex as well as the proreal or orbital cortex together with underlying fibers did not affect performance of the task, whereas lesions which involved the fibers underlying the medial precruciate cortex produced more or less pronounced, yet moderate impairment. Comparison between impairment described in this paper and that obtained following similar lesions in earlier experiment with directional cues indicates that fibers underlying the medial precruciate cortex are of greater importance when directional cues are involved in task.


Delayed responses of the kinesthetic type following frontomedial lesions in rats. Returning behavior was tested before and after frontomedial surgery. In this test rats had to go for food and return to the starting place by the same route in an elevated T maze. The correct return response required the immediate retention of the turn performed on the way to food. Subtotal, although considerably large lesions of the frontomedial cortex, had no effect on performance. Lesions covering almost the entire area between the tip of the pole and genu of the carpus callosum decreased performance almost to the chance level, and no improvement was observed during 30 sessions.


The effect of postural reflexes on the acquisition of the left foreleg-right foreleg differentiation in dogs. One group of dogs was trained to perform a placing movement of the right or left foreleg in response to tactile stimuli administered to the ipsilateral hindlimbs. The animals learned this task with difficulty. In another group of dogs the method of crossed reflexes was applied. As a correct response to the right tactile stimulus, the movement of the left foreleg was required, and vice versa. This task was solved rapidly. It is suggested that this was due to the facilitory effect of the Sherringtonian postural reflexes.


Limb coordinations during locomotion in cats and dogs. The relations among swing, stance and step durations for the fore and hind limbs were investigated. Registration of the swing and stance phases was performed by the opening and closing of an electrical circuit as the cat moved along the conductive pathway. In the walking animal, longer swing and shorter stance durations for hind limbs, in comparison with the fore limbs, were observed. However, during trotting phases, these differences were insignificant. The correlations between swing and stance durations were found for both fore and hind limbs. As the walking animal moved faster, swing and stance durations became shorter.


Limb coordinations during locomotion in amygdalar, rubral and funicular cats. The registration of the step phases and the relations between them for all of the four limbs were described in the amygdalar, rubral and funicular cats. The evident changes in motor behavior observed after damage of the amygdala and red nucleus did not result from coordination disorders. Conversely, the damage of the medial part of the lateral funiculus in the dorsally hemisected spinal cord disturbed the coordination between fore and hind limbs.


Visual discrimination learning in cats with different early visual experiences. Simultaneous object discrimination learning in an alimentary situation was strongly impaired in cats deprived from birth of patterned visual experience. The same impairment was observed in cats with experience limited to those objects that were used later in the discrimination task. Some impairment was also present in cats which were reared with opened eyes in the laboratory as compared with normal cats, that spent the early period of life outside of the laboratory. It is concluded that the deprived cats were impaired mainly because of the lack of opportunity during early development to use visual cues in alimentary tasks.


Prognosis of right bundle branch block and left anterior hemiblock after intracardiac repair of tetralogy of Fallot. One hundred and forty-one survivors of intracardiac repair of tetralogy of Fallot (TOF), operated on between 1958 and 1972, were studied in order to document the incidence of right bundle branch block and left anterior hemiblock (RBBB and LAH) and to definite the late prognosis. RBBB and LAH occurred in 31 patients (22 per cent), all of whom have had complete follow-up. Transient complete heart block (CHB) occurred postoperatively in 2 patients; there were no other significant arrhythmias. Two late deaths have occurred, neither from arrhythmia (one from progressive congestive heart failure, and the other from attempted reclosure of a ventricular septal defect). The remainder of the patients are well an average of 76 months postoperatively (range, 144 to 12 months). The absence of late-onset CHB or sudden death in this series contrasts with the relatively high incidence of these events in some studies of RBBB and LAH after intracardiac repair of TOF. However, in those reports a history of transient postoperative CHB (indicative of trifascicular disease in this setting) can be found in 75 per cent of those who developed late-onset CHB or died suddenly. We conclude that the occurrence of RBBB and LAH after intracardiac repair of TOF does not of itself carry a bad late prognosis. The critical factor in a bad late prognosis in patients with ECG evidence of RBBB and LAH may be with ECG evidence of RBBB and LAH may be the history of transient postoperative CHB.


Angina pectoris with normal coronary arteriograms: hemodynamic and metabolic response to atrial pacing. Seventeen subjects ranging from 36 to 58 years of age presented with chest pain suggestive of myocardial ischemia. Each patient had a positive double Master's two-step test with ST segment depression of 0.5 mm. or more in the postexercise ECG. In each case coronary angiography and left ventriculography were normal. Hemodynamic and metabolic investigations were carried out during sinus rhythm and atrial pacing. Thirteen patients experienced pain during pacing but only one showed an abnormal hemodynamic response. Two patients showed abnormal myocardial lactate metabolism during the control period and four during pacing-induced tachycardia. The increase in ejection fractions in this group suggests hyperdynamic ventricular contraction which could result in increased oxygen requirements and thus induce ischemic pain in the absence of arteriographically demonstrable coronary artery disease.


Myocardial lesions in sudden, unexpected coronary death. In order to test whether sudden coronary death patients had a more "vulnerable" myocardium compared with other patients, morphological lesions of the myocardium and conduction system were examined in a selected autopsy series. Chronic inflammatory microlesions, frequently affecting single muscle fibers, predominated among 47 sudden coronary death cases compared with 34 cases with chronic coronary or noncoronary diseases (P less than 0.001). Nonfibrous lesions of the atrioventricular node and the bundle of His also predominated among the sudden death cases (P less than 0.05). Myocardial infarcts of any age as well as relative heart weight (the ratio: total heart weight/body weight) did not differ in the sudden coronary death and the chronic coronary patients. The chronic inflammatory microlesions and the nonfibrous lesions of the conduction system predominating among the sudden death cases may signify a vulnerable condition of the myocardium in sudden coronary death.


Age-related changes in size of the aortic valve annulus in man. Data previously published in the literature, regarding the size of the aortic valve in man, have been reanalyzed. Aortic valve size increases at a slower rate than the surface area of the human body until maturity is reached at approximately 18 to 21 years of age. After that age, aortic valve size increases nearly linearly with age. There appears to be a slightly faster rate of aortic dilatation in males than in females, but this may be due to errors in estimating body surface area from only height and weight for obviously different body contours. Body surface area, thus, does not seem to be a good normalizing factor for the aortic valve size and the practice of referencing aortic valve sizes to the body surface area size should be discontinued. Alternate forms of using linear regression equations are reported and would appear to be preferable.


Effects of age on responses to isometric exercise. Isometric handgrip in noninvasive screening for cardiovascular disease. Isometric handgrip (IHG) imposes an acutely increased afterload on the left ventricle. Utilizing systolic time intervals, we studied various responses to IHG, measured as changes from resting values with near-maximum IHG, in old normal (ON) subjects, young normal (YN) subjects, and old patients with hypertensive heart disease (HHD) and patients with coronary artery disease (CAD). There were no differences in responses to IHG between ON and patients with HHD or patients with CAD. However, there were clear differences between the responses of ON and YN subjects. Increase in heart rate (HR) was much more prominent in YN (ON vs. YN = +11.6 +/- 2.6 vs. +15.6 +/- 5.7 beats per minute p less than 0.001). Pre-ejection period (PEP) end isovolumic contraction time (IVCT) increased in ON but decreased in YN (PEP + 6.2 +/- 1.7 vs. -11.0 +/- 3.7 msec., p less than 0.001; IVCT +8.1 +/- 2.2 vs. -13.8 +/- 3.4 msec., p less than 0.001. Shortening of LVET was much more marked in YN (-6.5 +/- 4.1 VS. -63.3 +/- 9.9 msec. p less than 0.001), but this was entirely due to the HR differences since there was no difference in ejection time index (+ 5.1 +/- 3.4 vs. -0.4 +/- 7.3 msec. p greater than 0.5). IHG produced no significant differences between ON and YN in the timing of the "mitral" component of the first heart sound (q-Im), in the ratio PEP/LVET, or in pulse transmission time (PTT). By contrast, resting control PTT was markedly short in ON, especially those with CAD. Resting PTT in ON was 27.1 +/- 2.6 msec.; in YN 43.7 +/- 1.4 msec.; in CAD patients 20.7 +/- 1.3 msec. We conclude that even near-maximal IHG does not seem to be an adequate noninvasive screening test for cardiovascular disease in that age alone seems to have the most significant influence on the responses.


Coronary hemodynamics during reperfusion following acute coronary ligation in dogs. The coronary hemodynamic effects of re-establishing blood flow to ischemic myocardium and the regional distribution of myocardial flow during reperfusion were studied in anesthetized open-chest dogs. A large portion of the left ventricular wall was rendered ischemic by occlusion of the left anterior descending coronary artery for 2 hours. During reperfusion of the LAD, coronary resistance in the reperfused vasculature increased progressively for the first 3 hours, while resistance in the intact LC vasculature was unchanged. Minimal resistances in the reperfused vascular bed, calculated from mean aortic pressure and peak coronary reactive hyperemic blood flow following a 90 sec. LAD occlusion, were elevated significantly during reperfusion. The increased minimal resistance values, which reflect the passive physical component of resistance, indicate structural changes in the reperfused vascular bed which were evident shortly after the initiation of reperfusion and persisted throughout the experimental period. Coronary resistances (RH) in the reperfused (LAD) and intact (LC) vasculatures during the reactive hyperemia following 10 sec. coronary occlusions were evaluated. During reperfusion, RH in the reperfused vasculature increased progressively while RH in the intact bed was unchanged. The marked increase in RH in the LAD indicates that the reactive hyperemic flow response to a consistent period of coronary occlusion progressively diminished, and reflects a gradual reduction in the vasodilatory potential of the reperfused coronary circulation. The regional distribution of myocardial blood flow following 5 minutes, 2 hours, and 4 hours of reperfusion was measured with multiple injections of radioactive microspheres. These measurements demonstrated a progressive reduction of blood flow to the reperfused myocardium with no significant change in flow to the control myocardium. In contrast to the uniform transmural distribution of flow in the normal myocardium, the reperfused region showed a distinctly nonuniform distribution of flow after 2 hours and 4 hours of reperfusion, with more severe reduction of flow to the endocardial layer. These studies would suggest that rechannelling blood flow distal to an acute coronary occlusion in human subjects might not in itself be capable of reversing the myocardial injury. It is hoped that additional therapeutic measures might be applied to salvage the injured myocardium.


Sound envelope averaging and the differential diagnosis of systolic murmurs. Phonocardiography previously has been limited in scope because the attained suboptimal signal-to-noise ratio has interfered with the sensitivity and clarity of recordings. A new system is described that reduces this problem by utilizing demodulation and synchronous averaging of the "envelop" of cardiac sounds. A limited survey of the differential diagnostic capabilities of this technique is presented for 80 patients having one of six common forms of pathological systolic murmurs and an 89 per cent diagnostic accuracy is demonstrated. This system promises to be a valuable noninvasive adjunct in cardiologic diagnosis research and education.


An inexpensive portable ECG transmitter. A small, easy-to-construct, pocket-sized ECG telephone transmitter utilizing few components and costing less than $20.00 is described. The tone produced varies with the ECG signal and may be transmitted over the telephone system to a demodulator and ECG recorder for permanent records and interpretation, as well as serving as an indicator of the ECG signal at the bedside. This simple device provides useful information on patients with various clinical problems.


Probable postcardiotomy syndrome following implantation of a transvenous pacemaker: report of the first case. The syndrome of fever and pericarditis is reported following implantation of a transvenous pacemaker in a 72-year-old man. The pacemaker was placed for prophylactic reasons (i.e., presence of bifascicular block). The syndrome resolved spontaneously after over four weeks of fever and a pericardial friction rub. Perforation of the right ventricle, although not recognized in this patient, is a complication which occurs with passage of a transvenous pacemaker. There was no other antecedent events to explain the syndrome such as myocardial infarction or trauma to the chest.


Coronary angiographic, echocardiographic, and electrocardiographic studies on a patient with variant angina due to coronary artery spasm. A 45-year-old Caucasian female patient with a clinical rehistory and ECG's conforming to the syndrome of variant angina as characterized by Prinzmetal is presented. ECG's recorded during spontaneous pain demonstrated ST-segment elevation and symmetrical peaking of the T-waves in the lateral precordial leads and short runs of ventricular tachycardia. Similar ECG changes were recorded during treadmill exercise- and hand-grip exercise-induced chest pain. An echocardiogram recorded during angina induced by hand-grip exercise demonstrated progressive flattening of septal motion. Multiple views of the coronary system by selective coronary cineangiography were normal with the patient at rest. Angina was then induced by hand-grip exercise and a repeat right anterior oblique view of the left coronary system revealed marked spasm of the left anterior descending artery proximal to the first septal perforator.


The problem of nonejection systolic clicks and associated mitral systolic murmurs: emphasis on the billowing mitral leaflet syndrome. Nonejection clicks and associated mitral systolic murmurs are common in routine cardiologic practice and can result from multiple etiologic factors affecting the complex mitral valve mechanism. Such factors include a specific syndrome the essential feature of which is that the mitral leaflets or part thereof, primarily the posterior one, are voluminous. The syndrome has stimulated widespread interest and study during the last decade and various descriptive terms, including the "billowing mitral leaflet syndrome" (BMLS), have been applied to it. A familial occurrence of the BMLS may be detected and symptoms include chest pain, palpitations, syncope, and anxiety. Arrhythmias, conduction defects, and ECG abnormalities which mimic occlusive coronary artery disease are important features which remain ill understood. It is suggested that there is a possible relationship between the so-called "athlete's heart" and the BMLS. We also postulate that the entity of acute myocardial infarction without demonstrable occlusive coronary artery disease is, in at least some instances, a complication of the BMLS-possibly on the basis of coronary spasm. More severe mitral regurgitation, infective endocarditis, or, rarely, sudden death may supervene in the BMLS but we conclude, from published data and our own experience, that the prognosis is generally good.


Specificity of elevated serum MB creatine phosphokinase activity in the diagnosis of acute myocardial infarction. Creatine phosphokinase (CPK) isoenzyme determinations are useful in the diagnosis of myocardial infarction. However, until suitably sensitive and precise quantitative procedures became available, the diagnostic specificity of serum CPK isoenzyme elevations could not be thoroughly examined. In this study an assay procedure capable of accurately determining activity of individual CPK isoenzymes even in serum samples with normal total CPK activity was employed to obtain two types of information. First, CPK isoenzyme profiles were examined in extracts of a spectrum of human tissues obtained at operation to determine whether the isoenzyme associated with myocardium is presented in other human tissues in quantities sufficient to produce increased activity in serum. In addition, CPK isoenzymes were analyzed quantitatively in serial serum samples from 50 hospitalized control subjects, 100 patients with acute myocardial infarction, 100 patients undergoing non-cardiac surgery and 50 patients undergoing cardiac catheterization to determine whether insult to tissues other than the heart is associated with increased "myocardial" CPK isoenzyme activity in serum. Results from analyses of tissue extracts indicated that myocardium is the only tissue surveyed containing sufficient MB CPK to account for substantial increases in serum MB activity. Results from analyses of serial serum samples indicated that MB CPK activity levels are consistently elevated after myocardial infarction, averaging 0.089 IU/ml. However, after cardiac cathetrization or noncardiac surgery peak serum MB activity remains low, averaging only 0.004 IU/ml despite marked elevations in total serum CPK activity. Thus, elevated serum MB CPK activity is a highly specific as well as sensitive criterion of myocardial injury.


The functional defect in amyloid heart disease. The "stiff heart" syndrome. Left ventricular performance was studied in three patients with heart failure due to amyloid deposits. The diagnosis of amyloidosis was proved by cardiac biopsy in two patients and by rectal biopsy in the third. One patient had myelomatosis, but the other two had no other identifiable disease. The investigative technique allowed simultaneous measurements of pressure and volume in the left ventricle. The functional defect with slow cardiac filling at high pressure and greatly reduced left ventricular contraction differed from that of constrictive pericarditis and other heart muscle disease. These features of a "stiff heart" are probably unique to amyloidosis and should make possible positive recognition of the condition on the basis of echocardiographic, angiographic and hemodynamic findings.


Sinus nodal responses to atrial extrastimuli in patients without apparent sinus node disease. In 36 patients without sinus node disease scanning with an atrial extrastimulus (A2) was performed during sinus rhythm with the sinus cycle length measured in milliseconds. Zones of nonreset due to interference, reset, interpolation and sinus echoes were defined by noting the timing of the first response after A2. Zones were defined in terms of their longest and shortest A1-A2 coupling intervals (in milliseconds). A zone of nonreset was found in 12 of 12 patients in whom A2 was delivered late. The mean cycle length in these 12 patients was 779 msec, with a mean zone of nonreset of 779 to 585 msec (25 percent of cycle length). All 36 patients (100 percent) had a zone of reset. The mean cycle length in these 36 patients was 803 msec with a zone of reset from 692 to 319 msec (46 percent of cycle length). Seven of 36 patients (19 percent) had a zone of interpolation. The mean cycle length in these seven patients was 754 msec, with a mean zone of interpolation of 344 to 279 (9 percent of cycle length). Four of 36 patients (11 percent) had a zone of sinus echoes. The mean cycle length in these four patients was 870 msec, with a mean zone of echoes from 350 to 313 msec (4 percent of cycle length). Calculated sinoatrial conduction time ranged from 40 to 153 msec (mean +/- standard deviation 92 +/- 30 msec). Shortening of the cycle length with atrial pacing increased the number of patients with zones of interpolation and echoes. In conclusion, zones of nonreset and reset are found in all patients with normal sinus nodal function, whereas zones of interpolation and echoes are much less common. Sinoatrial conduction time is surprisingly long in patients without apparent sinus node disease.


Dissociation of the inotropic effect of digitalis from its effect on atrioventricular conduction. The relation between sequential changes in left ventricular contractility and atrioventricular (A-V) nodal conduction and refractoriness was assessed in open chest dogs during intravenous administration of acetylstrophanthidin (5 mug/kg) at 5 minute intervals until toxic arrhythmias developed. At each time interval, high fidelity left ventricular pressure, its electronic derivative (dP/dt) and a His bundle electrogram were simultaneously recorded and the A-V nodal refractory period was measured by graded trains of stimuli. Animals were studied with an intact autonomic state (Group I), with pharmacologic blockade of both the beta adrenergic and parasympathetic system (Group II) and with parasympathetic blockade (Group III). Whereas contractility increased in response to small doses of digitalis, displaying a linear dose-response relation independent of autonomic tone, A-V nodal transmission indexes responded minimally to less than 50 percent of the toxic dose of digitalis, and the response was dependent upon autonomic tone. These results indicate a dissociation between the effects of digitalis on contractility and A-V transmission in that the major drug action on the ventricular contractile mechanism is a direct, linear one in contrast to the nonlinear response of A-V nodal transmission, which is predominantly mediated through the autonomic system. Clinically, these observations imply that the optimal dose and serum level of digitalis required to treat congestive heart failure may differ significantly from those required to treat supraventricular tachycardias, the therapeutic response of the latter being largely determined by the underlying autonomic tone.


Improved diagnosis in coronary cinearteriography with routine use of 110 degrees oblique views and cranial and caudal angulations. Comparison with standard transverse oblique views in 100 patients. Conventionally mounted X-ray systems for coronary cinearteriography limit angulation of the X-ray beam to the transverse plane of the patient, and use of the motorized cradle restricts rotation to 60 degrees to 70 degrees. These limitations of available projections seriously hamper adequate examination of the coronary arteries. With use of the Siemen's Cardoskop-U, which was designed to overcome this problem, the coronary arteries of 100 consecutive patients were examined with standard oblique projections, and in addition with cranial and caudal angulated oblique and 110 degrees oblique projections. These arteriograms were independently examined by two expert observers. In approximately 20 percent of patients the additional views unmasked lesions that would otherwise have been missed. In a further 34 percent the diagnosis was significantly improved because the full extent of a lesion was revealed, overlap of branches was avoided or the degree of an eccentric stenosis was upgraded. In 4 of 12 patients with apparently normal arteriograms in standard projections, lesions were unmasked by the additional views.


Comparison of observer performance with 16 mm cinefluorography and 70 mm camera fluorography in coronary arteriography. Clinical 16 mm cinefluorography and 70 mm camera fluorography were compared in 30 unselected patients undergoing coronary arteriography. Accuracy in detecting coronary arterial stenosis and collateral vessels and in assessing the degree of stenosis was similar with the two techniques. With both methods, there were significant inter- and intraobserver differences in estimating the degree of stenosis. These differences indicate that coronary arteriography is only a semiquantitative method for making decisions about treatment, prognosis and follow-up of patients. The use of more than one observer increases the likelihood that stenotic lesions will be detected. Interobserver variation in detecting collateral circulation is small.


Survival after systemic to pulmonary arterial shunts in infants less than 30 days old with obstructive lesions of the right heart chambers. Ninety-seven infants less than 30 days old with obstructive lesions of the right heart chambers underwent palliative surgery from 1950 through 1972. The diagnosis was made at cardiac catheterization and confirmed at operation or subsequent autopsy. Because of unavailability of complete preoperative studies and sufficient blood gas data, 36 patients presenting between 1950 and 1965 (Group I) were analyzed for surgical risk only. In 61 patients who underwent palliative procedures between 1966 and 1972 (Group II) a more detailed analysis was done. In this group, 31 had a Potts shunt, 29 a Waterston shunt and 1 a Blalock-Taussig shunt. The most frequently encountered malformation was severe tetralogy of Fallot (30 percent) with or without pulmonary atresia, followed by pulmonary atresia with intact ventricular septum (25 percent). The overall surgical mortality rate in patients seen after 1965 (Group II) was 34 percent compared with the 78 percent mortality rate in patients seen earlier (Group I). The surgical mortality in infants operated on during the 1st week of life was double that of those operated on in the 2nd through 4th weeks. Survivors were compared with nonsurvivors for timing of surgery, age at presentation and clinical profile. Only two significant differences were found. Preoperative continuous murmurs were more common in those who survived operation (13 of 40 patients) than in those who died (2 of 21). Arterial pH during cardiac catheterization was the best predictor of subsequent survival, nonsurvivors having significantly greater metabolic acidosis. Palliation of these severe lesions still carries a high mortality rate to which must be added the risk of subsequent repair. Our data suggest that primary repair is to be preferred if it can be undertaken with a risk approximating that of palliative procedures.


Results of pulmonary arterial banding in infancy. Survey of 5 years' experience in the New England Regional Infant Cardiac Program. The results of pulmonary arterial banding in 238 infants, 12 percent of the infants admitted to the New England Regional Infant Cardiac Program, is reviewed. Overall survival to age 1 year was 63 percent. Survival was least likely (37 percent) in those who required banding within the 1st month of life. Additional surgery decreased the survival rate in those operated on after 1 month of age. Infants with anomalies for which no corrective surgical procedure is available (23 of 238) have only a 30 percent chance of survival. Those with lesions correctable within the 1st year (133 of 238) have a 74 percent survival rate; 52 percent (82 of 238) of those for whom a curative operation is available after the 1st year survive. These pulmonary arterial banding data coupled with results of primary correction should provide the data base required for an intelligent decision in respect to appropriate surgical treatment of infants with critical heart disease.


Considerations in the surgical management of infantile coarctation of aorta. The results of a recent 5 year experience with resection of coarctation of the aorta in infants less than 1 year of age are compared with those of an earlier series from the same institution. The significant improvement in mortality and morbidity statistics is attributed to modifications in operative and postoperative care. Operative mortality has decreased from 38 to 17 percent and the incidence rate of significant restenosis has diminished from 60 to 33 percent. It is suggested that in patients with large associated intracardiac shunt banding of the main pulmonary artery should be performed before resection of the coarctation. Three of five patients have survived procedures performed in this sequence. Microsurgical techniques and careful approximation of the aortic lumen with interrupted sutures are the major factors responsible for the reduced incidence of recoarctation. Prolonged ventilatory support postoperatively with the occasional addition of controlled positive airway pressure and continued aggressive medical therapy for heart failure are recommended.


Multiple ventricular aneurysms.

Multiple ventricular aneurysms. Angiocardiographic study of a case of multiple ventricular aneurysms in a 17 year old Nigerian girl is reported. The patient presented with ventricular tachycardia and has remained well after conversion of the arrhythmia to sinus rhythm. The pathogenesis of multiple ventricular aneurysms is briefly reviewed.


Herniation of mitral leaflets in the Ehlers-Danlos syndrome. A 47 year old patient with the Ehlers-Danlos syndrome (hypermobility of the joints, hyperextensibility of the skin and atrophic cutaneous scars) was evaluated because of a mitral regurgitant murmur and paroxysmal atrial tachycardia. Angiocardiography and echocardiography demonstrated marked systolic herniation of the posterior leaflets of the mitral valve. An echocardiogram from the patient's daughter, who also had paroxysmal atrial tachycardia, revealed the same abnormality. Although a "floppy" valve is common in Marfan's syndrome, this report emphasizes that it may also occur in patients with other heritable disorders of connective tissue.


Systolic hypertension: nonhomogeneous diseases. Prospective studies have shown that systolic hypertension is associated with increased cardiovascular risk, but few physiologic studies have characterized the problem. Therefore, two groups of men (older and younger than 35 years) with systolic hypertension (systolic pressure 150 mm Hg or greater and diastolic pressure 95 mm Hg or less) were studied hemodynamically. The 13 younger patients demonstrated a hyperkinetic circulation manifested by a significantly increased heart rate, elevated left ventricular ejection rate and cardiac indexes and normal vascular resistance. The  13 older patients had a normal heart rate, significantly reduced cardiac and left ventricular ejection rate indexes, and increased vascular resistance with respect to the younger men with systolic hypertension and normotensive control subjects. Plasma volume was reduced only in the older patients (P less than 0.05). These data demonstrate that systolic hypertension should not be considered a homogeneous disease entity clinically or physiologically. The physiologic differences between the younger and older patients suggest that different mechanisms may be operative.


Hypertension with renal arterial stenosis: humoral, hemodynamic and histopathologic factors. In 46 hypertensive patients with unilateral renal arterial stenosis, peripheral and renal venous plasma renin activity, juxtaglomerular cell count and granularity and systolic pressure gradient across the stenosis were determined. After corrective surgery and a mean postoperative observation period of 4.3 years, 18 patients were completely relieved of hypertension (good responders), 14 had a substantial reduction in arterial pressure (fair responders) and 14 remained hypertensive (poor responders). Analysis of plasma renin activity in both renal veins indicated that a ratio (stenotic/nonstenotic side) greater than 2.0 correctly predicted a favorable surgical result in all cases. Peripheral plasma renin activity was greater than normal in 65 percent of good responders, in 50 percent of fair responders and in one nonresponder. The prognostic accuracy of a pressure gradient greater than 40 mm Hg was 78 percent; no patient with a gradient of less than 40 mm Hg benefited from surgery. An increased juxtaglomerular cell count on the affected side predicted a successful operative result in 88 percent, as did increased granularity in 85 percent of cases. Renal venous renin ratio correlated positively (r =0.738, P less than 0.001) with the pressure gradient across the stenosis. The renal venous plasma renin activity of the  affected side also correlated positively (r = 0.771, P less than 0.001) with the absolute count of granular cells in the juxtaglomerular apparatus. Plasma renin activity in both renal veins is the most reliable predictor of operative outcome. The addition of juxtaglomerular cell count or pressure gradient across the stenosis increases prognostic accuracy only slightly. The close mutual correlations between renal venous renin ratio, pressure gradient and juxtaglomerular cell count support the experimental evidence of a causal relation between the hemodynamic effects of the arterial lesion and the humoral and histologic changes observed in hypertension with renal arterial stenosis.


Relation of renin status to neurogenic vascular resistance in borderline hypertension. The relation of renin-angiotensin status to general hemodynamics and to neurogenic vascular resistance was studied in patients with border-line hypertension. Plasma renin activity during standing was referred to a standard renin-urinary sodium nomogram derived from 18 normal subjects. Among 22 patients with borderline hypertension the renin level was high in 8, low in 4 and within normal limits in the remaining 10. In patients with borderline hypertension and high or normal levels of plasma renin activity, the blood pressure elevation was due to increased total peripheral vascular resistance. In contrast, in patients with low renin borderline hypertension, total peripheral resistance was not significantly elevated; the blood pressure elevation reflected a cardiac index 12 percent higher than that in normal subjects. The neurogenic contribution to total peripheral vascular resistance was assessed by studying the effects of alpha adrenergic blockade with phentolamine, after prior autonomic blockade of the heart with atropine (0.04 mg/kg body weight) and propranolol (0.2 mg/kg). Phentolamine (15 mg) produced an immediate reduction in total peripheral resistance of 12.0 +/- 6.7 percent in patients with high renin borderline hypertension (P less than 0.01) but no change in normal subjects or those with borderline hypertension and normal or low renin levels. Normalization of the blood pressure followed "total" autonomic blockade with atropine, propranolol or phentolamine only in patients with high renin borderline hypertension. It is concluded from these preliminary data that in high renin borderline hypertension the blood pressure elevation is sustained by neurogenic mechanisms. The elevated renin level in these patients is probably an expression of increased sympathetic nervous activity. Although the elevated plasma renin level may possibly be contributing to the generation of higher sympathetic tone, or data do not support a direct role of circulating angiotensin in the maintenance of the elevated vascular resistance.


Vitamin B6 levels in rheumatoid arthritis: effect of treatment. Patients with rheumatoid arthritis were found to have low plasma pyridoxal phosphate. Treatment with 50-150 mg/day of pyridoxine hydrochloride for 3 months caused a rise in pyridoxal phosphate in most cases to more than 3 times pretreatment levels. There was, however, no improvement in the clinical aspects of rheumatoid arthritis.


Serum and erythrocyte folates in combined iron and folate deficiency. A high incidence of iron and folate deficiency was found in 80 female subjects living in a private institution. Iron therapy in individuals with low serum iron values resulted in a significant increase in hemoglobin levels. An improvement in serum and RBC folate levels was also found following iron therapy but this could not be attributed to treatment since a similar increase was observed in untreated control subjects, probably due to an increased dietary intake of folates during the study period. In subsequent studies small amounts of pteroylglutamic acid were given to all patients and their response to therapy was related to initial serum and RBC folate values. No correlation between serum folate levels and response to folate therapy could be demonstrated. Red cell folate levels on the other hand correlated well with response to therapy. A significant increase in hemoglobin was found following folate therapy in patients with low RBC folates, but not increase in subjects with normal RBC folates. Conversely, the increase in hemoglobin following iron therapy in subjects with normal RBC folates was three times as much as in patients with low RBC folates. Thus, unlike serum folate determinations, RBC folate measurements are a reliable index of tissue folate stores, and useful in the prediction of response to folate therapy in both the iron-deficient and iron-replete states.


Lowering of plasma cholesterol levels in free-living adolescent males; use of natural and synthetic polyunsaturated foods to provide balanced fat diets. Two hundred and twenty-nine adolescent male pupils, attending two boarding schools, participated in a study, under free-living dietary conditions, designed to assess the effects on plasma lipids of altering only the type and not the amount of dietary fat. The students were monitored for 6 weeks on three different diets. During the first study period, dietary changes comprised substituting a polyunsaturated dried "filled" milk and products derived therefrom for conventional dairy products (diet A). The second dietary phase involved replacing all meat and dairy products with equivalent polyunsaturated ruminant fat products (diet B). The third period consisted of a control diet of conventional dairy and meat products. During both polyunsaturated diets a 14% reduction in plasma cholesterol was achieved compared with control levels. Low-density lipoprotein cholesterol was similarly suppressed. A greater decrease in plasma cholesterol of 19-21% was recorded in those pupils with initial cholesterol levels greater than 230 mg/dl. There was no significant difference in plasma triglycerides between diet A and the control diet whereas the triglyceride levels were 16.5% lower during diet B. The fall in plasma cholesterol coincided with an increase in plasma triglyceride linoleate from 8% to 19% of total triglyceride fatty acids. Dietary analysis of the pupils' diet indicated an increase in the ratio of polyunsaturates to saturates from 0.27 during the control period to 1.08 on the dried filled milk and 0.90 on the polyunsaturated ruminant fat products. A palatability survey showed that both the dried filled milk and the polyunsaturated ruminant fat products were as well accepted by the pupils as the conventional products. The results suggest that such products could, if introduced to the general population, play an important part in plasma cholesterol suppression in the hope that this would significantly reduce the incidence of coronary artery disease.


Lack of effect of massive dose of vitamin C on fluoride excretion in fluorosis during a short clinical trial. The effect of daily administration of 2 g of vitamin C on urinary excretion of fluoride in patients suffering from endemic fluorosis was studied. Urinary fluoride excretion was found to be constant over a period of 4 weeks in each patient. The results suggested that vitamin C does not influence the rate of resorption of fluorotic bone in man.


A fine structural demonstration that some benzopyrones act as vitamin P in the rat. In rats fed a diet lacking flavonoids (but which had supplementary vitamin C) definite fine structural alterations were found in blood capillaries and tissues. These fine structural alterations were quite different from those reported in C-avitaminosis and imply a different deficiency. They were largely prevented by feeding the benzopyrones, coumarin or coumarin plus troxerutin, thus pointing to the specificity of the lesions. This implies that, for the rat, benzopyrones are vitamins and that vitamin C and "vitamin P"-deficiency states are qute distinct. In "P-avitaminosis" the basic lesion is the opening of some blood capillary endothelial intercellular junctions. Unlike in C-avitaminosis, the endothelial cells are intact, without pale, grossly swollen cytoplasms.


Treatment of reactive hypoglycemia with buformin. The therapeutic effect of short-term buformin (l-butylbiguanide) treatment was investigated in 12 patients with reactive hypoglycemia. Eleven of them were classified as having idiopathic reactive hypoglycemia, nine obese and two nonobese. None of these patients had a degree of hyperglycemia during glucose tolerance tests which would indicate diabetes mellitus. In one patient reactive hypoglycemia was related to chemical diabetes. The diagnosis of reactive hypoglycemia was established on the basis of patient's hypoglycemic reaction and low blood glucose levels during 6-hour oral glucose tolerance tests. The patient's received 200 mg of buformin daily for 7 days and its therapeutic effectiveness was assessed by repeat testing. Buformin treatment resulted in significant increase of blood glucose values between 180 and 360 min after oral glucose challenge and in considerable improvement of hypoglycemia in nine obese patients with idiopathic reactive hypoglycemia and in the patient with chemical diabetes. Buformin also significantly reduced maximal insulin response and incremental insulin areas. In two nonobese patients hypoglycemic reaction was deteriorated after buformin therapy.


Endogenous ethanol production and hepatic disease following jejunoileal bypass for morbid obesity. In this study, we sought to determine whether or not elevated levels of ethanol were present in the systemic circulation, resulting from endogenous ethanol production, which might contribute to the hepatic damage following jejunoileal bypass for morbid obesity. Venous serum samples for assay of ethanol by gas-liquid chromatography were obtained in 8 normal subjects, 9 obese patients prior to surgery, 20 obese patients 2 weeks to 40 months after jejunoileal bypass, and in 2 dogs before and after jejunoileal bypass. Ethanol was detected after jejunoileal bypass in only 7 of the 20 patients and in the 2 dogs. Serum ethanol concentrations ranged from 0.15 to 4.12 mg/100 ml with a mean of 1.18 +/- 1.59 (SD)( mg/100 ml in the 7 patients and ranged from 0.20 to 2.23 mg/100 ml in the dogs. Incubation of the contents of the bypassed intestine of a dog with dextrose resulted in the production of significant amounts of ethanol. However, there was no correlation between the presence of ethanol in the serum and liver histology, when liver biopsy was obtained, postoperatively. Since ethanol was detected in the serum in only small concentrations and in only one-third of the patients, it is unlikely that ethanol production by bacteria in the intestine is of significance in the pathogenesis of liver disease following jejunoileal bypass.


Serotonin metabolism in children with kwashiorkor. Intestinal fat absorption, serum 5-hydroxytryptamine (5-HT) and 24-hour urinary excretion of 5-hydroxyindoleacetic acid (5-HIAA) were studied in 13 children with kwashiorkor and 10 matched healthy controls. Eight out of 13 children with kwashiorkor who had steatorrhea also showed raised plasma serotonin levels in parallel with the high urinary excretion of 5-HIAA. In five children with kwashiorkor who showed normal intestinal fat absorption, the serum 5-HT and urinary 5-HIAA levels were comparable to controls. After therapy, concurrent with clinical and biochemical recovery, the intestinal absorption of fat improved, serum 5-HT concentration and the urinary excretion of 5-HIAA returned to normal range. This suggested that the deranged serotonin metabolism in our cases was secondary to the protein-calorie deficiency. The presence of defective metabolism of serotonin (5-HT) in children with kwashiorkor has been reported and its possible role in the etiopathogenesis of steatorrhea-diarrhea, skin lesions and psychomotor changes has been suggested for further work.


Food iron absorption. I. Use of semisynthetic diet to study absorption of nonheme iron. Recent studies have established the validity of employing an extrinsic radioiron tag to measure the absorption of nonheme iron from a complex meal. In the present study, extrinsic tagging was used to measure absorption of nonheme iron from a standard meal chosen as representative of a typical American meal, and from a semisynthetic meal having the same total chemical composition. The latter was designed so that the major dietary components could be systematically altered to determine their separate effects on food iron absorption. Absorption from the standard meal in 32 healthy women averaged 10.0% as compared with a mean absorption of 1.8% from semisynthetic meal. Most but not all of this fivefold difference in absorption could be explained by the enhancing effect of meat in the standard meal. The low availability of iron from the semisynthetic meal will be of particular value in studying factors which enhance food iron absorption, whereas the standard meal is suitable for studying factors which reduce availability of food iron.


A field worker's guide to a nutritional status survey. This guide has been prepared specifically for the medical worker in a developing country who has little experience for survey methodology and few outside sources on which to draw. All, or only portions of the guide, may be used as local needs dictate. It provides an outline of necessary preparations, sampling, field organization, measuring techniques and recording form. To aid the statistical treatment and presentation of the data, a sample recording form is given together with coding instructions and output table layout.


Dietary intake in the third trimester of pregnancy and birth weight of offspring among nonprivileged and priviledged women. The dietary intake during the third trimester of pregnancy among 20 nonprivileged and 10 privileged primigravidae in Addis Ababa was studied in a 2 day weighting inventory survey. With the exception of iron and thiamin, the nonprivileged group consumed a diet that was deficient in all nutrients, with an average daily protein and energy intake below 60% of the FAO/WHO Recommendations. The privileged group was found to meet the recommendations for all nutrients except for calcium and riboflavin. Infants born to the nonprivileged women had significantly lower mean birth weight when compared with the infants born to the privileged women.


Amount and rate of disappearance of liver fat in malnourished infants in Jamaica. The fat content of the liver has been measured in 163 biopsy specimens taken from 95 malnourished children in Jamaica within a few days of admission to hospital and at various stages of recovery. The fat content was also measured in 38 samples from children who died. Severe degrees of fatty infiltration, up to 50% of the wet weight, were found. Fatty liver of this degree of severity may be a cause of death. The increase in fat was accompanied by an increase in water content. This may be the result of breakdown in the energy-dependent regulation of water content. Repeat biopsies were done within 6 weeks of admission in 26 children. The average rate of clearance of fat expressed as a fraction of the amount present at any time was 5.5% per day. An attempt was made by more frequent biopsies to determine whether the rate of decrease was influenced by the protein content of the diet, but the results were inconclusive.


A new medical trend in China.

A new medical trend in China. Chinese biomedical scientists are now developing a new approach to medicine by combining traditional Chinese medicine and Western biomedical science. This is the current medical trend in China. Some significant results have already been achieved. For instance, in treating fractures the traditional dexterity in coaxing broken ends of bones into alignment has been successfully adopted, and x-ray has been used to check whether there was accurate bone union. Heart diseases are treated with Western drugs in combination with Chinese herbal medicine, and the results are encouraging. Ancient theories such as Fu Chen Pei Ben (to strengthen the patient's vitality) are applied, for instance, in cancer therapy, i.e., to stimulate the patient's appetite and to improve his general condition with herbs while being treated with Western anti-cancer remedies. However, the Chinese admit that this process has only just begun.


Non-pharmacological approaches to the treatment of drug abuse. As a result largely of dissatisfaction with existing treatment methods for narcotic addiction, there has been considerable recent interest in various non-pharmacological approaches to treatment. Acupuncture, transcendental meditation, electrosleep, biofeedback and hypnotism all have generated considerable interest and seem to be effective in a number of cases. Although apparently quite different, all of these approaches seek to induce a state of relaxation which in turn appears to exert specific neurophysiological changes in the brain. These treatment methods not only help for some addicts, but should contribute to our overall understanding of the addiction process.


Cardiovascular effects of moxibustion at Jen Chung (Go-26) during halothane anesthesia in dogs. The cardiovascular effects of moxibustion at Jen Chung (Go-26) in 10 dogs under halothane anesthesia were compared to 5 dogs under halothane anesthesia without moxibustion and 5 dogs under halothane anesthesia in which moxibustion was effected at a neutral or non-acupuncture site. Cardiac output, stroke volume, heart rate, mean arterial pressure, central venous pressure, total peripheral resistance, pH, PaCO2, PaO2 and base deficit were measured over a two-hour period. A significant increase in cardiac output and stroke volume and a significant decrease in the total peripheral resistance were observed in the group which was stimulated by moxibustion at Jen Chung (Go-26). Heart rate, mean arterial pressure and pulse pressure were significantly increased during the early part of the two-hour period in the same group. The cardiovascular effects of moxibustion at Jen Chung (Go-26) which were observed at the end of two hours were also present in two dogs in which measurements were continued for two additional hours.