Clonal characteristics of fibrous plaques and fatty streaks from human aortas. Using isoenzymes of glucose-6-phosphate dehydrogenase (G-6-PD) as cellular markers, a study was made of atherosclerotic fibrous plaques and fatty streaks in aortas of black women heterozygous for G-6-PD. Of 29 fibrous plaques, 26 (89.7%) contained only one isoenzyme (17, A; 9, B), the other three containing both A and B. Of 28 fatty streaks, five (17.8%) contained only one isoenzyme (2, A; 3, B), the remaining 23 containing both A and B. Normal uninvolved aorta contained both A and B isoenzymes in 99 of 101 samples. These results confirm the monoclonal character of atherosclerotic fibrous plaques; this strands in contrast to the fatty streaks which most commonly contain the two isoenzymes. The studies on the fatty streaks are inconclusive at this stage in determining whether the streak is the forerunner of the fibrous plaque.


Situation/transition groups: a conceptualization and review. Small discussion-education groups moderated by a trained leader have been used in a variety of settings for the mutual assistance of individuals who share some stressful life situation. This paper reviews the literature on a broad range of such groups, and finds they have common characteristics, modes of function, and problems of leadership. The situation group is seen as being an important primary preventive approach for both mental and physical health problems.


The use of self-help groups as supportive reference communities. Self-help groups such as Recovery Inc., Parents without Partners, and Alcoholics Anonymous have a unique role in relation to the professional system of human services. From the professional's standpoint, such groups may be viewed as self-sufficient programs, concurrent treatment programs, and as sources of information and users of consultation. Patterns of influence operative in self-help groups are examined, and suggestions made for professional cooperation with such groups to the greater benefit of clients.


Children in a warring world.

Children in a warring world. This essay considers the psychological effects on children of growing up in a society that expresses violence while it professes peace and order. Even those children not directly affected by social upheaval or instability are seen at serious risk of inadequate ego development when the social reality they perceive diverges sharply from the values they are taught. Action and education by adults congruent with the values they espouse are suggested as a first step toward facilitating the integration of ego functioning in their children.


Maternal employment reconsidered: effects on infants. Studies of the effects of variations in infant care are reviewed in relation to maternal employment. The research suggests that maternal employment may be a contributory factor in hindering the development of an optimal caretaker-infant relationship. Suggestions for further research, particularly in areas related to the formulation of social policy, are presented.


Child custody consultation.

Child custody consultation. The limited influence of the needs of the child upon the decision-making process in child custody disputes is discussed, with particular attention to the consultant's role and unique aspects of this type of consultation. A case is described in which a multitude of consultants presented the court with a morass of parent-oriented conflicting testimony. It is concluded that clinicians can better serve children by seeking to consult not for one of the competing adult parties, but only for the court.


Children, privacy, and nontherapeutic experimentation. Experimentation not for the direct benefit of the child-participant raises serious legal problems. Strict adherence to the law indicates that neither the child, parent or guardian, nor the state has the power to grant legally binding consent. A possible solution to this dilemma is suggested.


Follow-up of adolescents treated in a psychiatric hospital: operational solutions to some methodological problems of clinical research. Procedural problems inhibiting follow-up research on psychiatric patients are discussed, and solutions offered, in the areas of ethical concerns, study design, selection of variables, collection of data, and researcher-clinician relationship. Early communication with patients about methods and goals, and maintenance of rapport and feedback between research and treatment staffs may overcome many difficulties of long-term research, and even aid treatment.


Preparation during pregnancy and ability to cope with labor and delivery. Within nine weeks following childbirth, 279 new mothers were interviewed to determine effects of preparation for labor and delivery on their perceptions of childbirth and their babies. The more preparation a woman had, the more aware she was at delivery, and that awareness was strongly associated with positive reactions to the birth and the baby. These findings are interpreted in terms of theory on coping with stress.


Teacher ratings of children vulnerable to psychopathology. Teacher behavior ratings were collected on children of schizophrenic, depressed, and normal mothers. Children of schizophrenic and depressed mothers were rated higher than were children of normal mothers on classroom disturbance, impatience, disrespect-defiance, and inattentiveness-withdrawal; they were rated lower on comprehension, creative initiative, and relatedness to teacher.


Family lunch session: an introduction to family therapy in anorexia nervosa. Family lunch sessions have proved a useful diagnostic and therapeutic technique in the treatment of anorexia nervosa. This paper describes the goals of these sessions and the strategies employed in the restructuring of family relationships. Data are presented illustrating changes in eating behavior of eight identified patients.


The married manic.

The married manic. In group psychotherapy and follow-up studies, the interpersonal relationships and psychodynamics of the married manic depressive patient and spouse were studied. Prominent among these subjects were massive denial of grief, rage, and dependency in the context of symbiotic relationships; and the absence of a father during early development. Clinical expressions of these factors are presented, and therapeutic implications are discussed.


Reaching emotionally disturbed children: 'judo' principles in remedial education. The importance of the interpersonal meanings of symptomatology, especially as they relate to issues of control in therapy, is explored across a wide variety of treatment approaches. It is concluded that the often destructive behavior of distrubed adolescents may be viewed not simply as pathology to be altered, but as potential strength to be channeled. Implications for therapeutic technique are discussed, and examples are offered.


Corrective social interaction therapy: role modeling. This paper describes an experimental clinical approach to the problem child and his family, in which parents are trained to provide corrective social interaction experiences for the child. Negative interaction patterns are modified by teaching specific techniques of expressing warmth. Results of a pilot study indicate the technique is effective in working with immature and antisocial children who are hospitalized.


Drinking and feeding induced by jugular and portal infusions of 2-deoxy-D-glucose. Intravenous infusions of three levels of 2-deoxy-D-glucose (2DG) were made through chronically implanted jugular and portal cannulas in rats. Food and water intakes were unaffected by 100 mg/kg 2DG, enhanced by 200 and 400 mg/kg 2DG, and unrelated to the route of administration. Drug-induced drinking occurred as readily when food was present as in its absence. Infusions of 2DG also produced stupor and ataxia whose severity was proportional, as was feeding and drinking, to the dose administered. Drinking induced by 2DG is inconsistent with the glucoprivic theory of feeding, and it was proposed that the consummatory and aberrant behaviors elicited by 2DG may result from hypoglycemia-induced seizures in limbic structures of the brain.


Rapid insulin release after ingestion of a meal in the unanesthetized rat. Blood glucose and insulin levels were measured in undisturbed and free-moving rats. The insulin level rises already in the 1st min after the start of food ingestion, whereas the glucose level begins to increase only in the 3rd min if carbohydrate-rich food is eaten. This early rise in insulin level is observed also under conditions in which either carbohydrate-free food or even "food" without any caloric value is offered. The smell of food cannot produce this early insulin response. It is concluded that in the rat other factors besides a rise in nutrient content in the blood produce insulin release in the first minutes after food ingestion.


Glutamine transport by mitochondria isolated from normal and acidotic rats. The transport of L-glutamine by isolated rat renal mitochondria was studied by means of a rapid-filtration (Millipore Filter Corp.) technique. The movement of glutamine from the incubation medium into the inner mitochondrial compartment (matrix) was inhibited by structural analogues (6-diazo-5-oxo-L-norleucine and glutamic acid), sulghydryl-binding agents (p-chloromercuri-benzoate and mersalyl), and inhibitors of mitochondrial oxidative metabolism (azide, antimycin A, and uncouplers of oxidative phosphorylation). These results suggest that glutamine is transported across the inner membrane of renal mitochondria by a carrier-mediated system that is linked to the processes of oxidative metabolism. The transport of glutamine by isolated renal mitochondria was increased two- to threefold by chronic (5-7 days) metabolic acidosis. However, short-term metabolic acidosis did not increase the glutamine transport capacity of isolated mitochondria. A hypothesis is presented for the regulation of mitochondrial glutamine transport, in vivo, during short-term and chronic acidosis.


A quantitative histochemical approach to renal transport. I. Aspartate and glutamate. Renal transport was studied by direct analysis of specific segments of the nephron for the substance transported. Rats were given inulin plus loads of glutamate or aspartate. Glomeruli, six different identified segments, and patches from thin-limb and papillary areas were dissected from individual nephrons in freeze-dried sections. Large amounts of the amino acid (up to 35 mmol/kg) accumulated in segments in which transport is believed to occur. With subthreshold loads, large amino acid increments were confined to earlier proximal segments. With loads above threshold, increases occurred throughout the proximal tubule. The early convoluted tubule probably has less transport activity than the rest of the proximal tubule. Both dicarboxylic amino acids accumulate in large amount when one is given. Aspartate is probably formed within the tubule after a glutamate load. This new histochemical approach may have general applicability for more precise localization of transport cells, for assessing changes in those cells during transport, and for study of structures inaccessible to micropuncture.


Oxygen transport of colloidal fluorocarbon suspensions in asanguineous rabbits. In anesthetized, oxygen-breathing rabbits, the entire blood volume was exchanged with a 20% colloidal fluorocarbon fluid suspension of high gas solubility. In contrast to the control animals with acute isovolemic and hypervolemic hemodilution, the fluorocarbon suspension prevented the decrease in arterial oxygen content below a hematocrit of 13%. However, the more pronounced effect of the fluorocarbon suspension on oxygen delivery occurred at higher hematocrits and was due to its efficiency as a plasma expander, since it increased the cardiac output even above the level of the hypervolemic hemodilution group. The fluorocarbon suspension also raised arterial blood pressure and total peripheral resistance due to its increased viscosity. Thus, in mild hemodilution, the fluorocarbon suspension kept oxygen utilization in the normal range by increasing cardiac output, and in extreme hemodilution it improved oxygen utilization by also raising the arterial oxygen content and arterial blood pressure. The survival time of the isovolemic control animals was 31.6 min, it was extended to 57.8 min in the hypervolemic control animals, and the rabbits with the fluorocarbon suspension lived for 124.8 min.


In vivo toxic effects of halothane on canine cerebral metabolic pathways. The effects of high concentrations of halothane on cerebral metabolism were examined in dogs with the aid of an extracorporeal circuit to support the systemic circulation. At blood levels exceeding those representing equilibration with 2.3% halothane, a dose-related decrease in cerebral oxygen consumption (CMR02) occurred that was unrelated to the presence or absence of an active electroencephalogram. In this circumstance, despite adequate oxygen delivery, a dose-related alteration in oxidative phosphorylation also occurred as evidenced by progressive decreases in cerebral concentrations of ATP and phosphocreatine and concomitant increases in cerebral lactate and lactate/pyruvate ratio. These effects were totally reversible, except for persistence of increased of increased CMR02, after return to low halothane concentrations. It is concluded that the mechanisms of the cerebral metabolic effects of halothane differ from those of thiopental and, at high concentrations, are at least in part related to interference with oxidative phosphorylation. These in vivo studies confirm the potentially detrimental effects of high halothane concentrations on cerebral metabolic pathways as demonstrated by others in vitro.


Secretion of K and fluid by rat submaxillary during sympathetic nerve stimulation. Stimulation of the sympathetic innervation to rat submaxillary gland is known to evoke saliva which contains high concentrations of potassium (130-160 meq/liter). Relationships were examined between salivary [K] and several parameters of the stimulation, including pulse frequency and duration of the stimulus train and rate of flow of the evoked saliva. Secretion of sympathetically evoked saliva was found to occur in two phases. After stimulation was started, flow rate was relatively high initially, and then decreased to a lower, relatively steady value. Initial and steady flow rates were maximal when stimulus frequency was 10 Hz. Salivary [K] was lowest initially, and, at that time, was inversely related to flow rate. At steady flow, [K] was flow independent. While salivary [K] was lower during initial than during steady secretion, the rate of K secretion was initially higher. During the initial phase, K decreased in the gland, and this decrease was sufficient to account for the increased amount of K secreted in initial saliva and for the increased initial flow.


Nitrogen utilization within equine large intestine. The distribution of nitrogen in ligated segments of the stomach and intestine of two groups of ponies has been examined at sacrifice 2, 4, 8, and 12 h following the final 12-h scheduled feeding of diets designed to provide either 1) ample protein, or 2) limited protein plus supplemental urea as the major nitrogen source. Concentrations and total quantities of total N, NH3, urea plus NH3, and alpha-amino N were determined, and protein N was calculated by difference. Liquid marker (PEG) distribution rate constants and N concentrations were used to calculate rates of entry and exit by digesta flow for the large intestinal compartments. These values, together with measured accumulations of each constituent, allowed assessment of transitory net appearance and net disappearance within each compartment due to processes other than flow along the tract. The data suggested cyclic fluctuations of microbial populations within the large intestine, particularly the dorsal and ventral colon. These segments also were implicated as major sites of microbial protein synthesis and degradation. the former process appeared more evident in animals consuming the urea-supplemented diet.


Separate roles of sodium ion concentration and fluid volumes in salt-loading hypertension in sheep. The goal of these studies was to determine whether the hypertension caused by excessive salt loading results from sodium-induced expansion of the extracellular fluid volume or whether the salt increases the pressure in some other way, such as by causing vascular constriction. In one group of sheep, a combination of total nephrectomy and hemodialysis was used to produce and maintain step increases in extracellular fluid volume for 1 wk without a significant change in sodium ion concentration. In a 2nd group, unilateral nephrectomy, dialysis, and DOCA administration were used to cause step increases in sodium ion concentration while the extracellular fluid volume was held as close to normal as possible. The results showed a 41% increase in arterial pressure in the high-volume sheep and only a 4% increase in pressure in the high-sodium sheep. In both instances the total exchangeable sodium increased almost equally--a 21% increase in the high-sodium sheep. The data support the concept that sodium retention causes hypertension almost entirely because of sodium-induced expansion of the extracellular fluid volume.


Characteristics of sodium and potassium transport in the lung. Freshly prepared lung slices were incubated in an oxygenated Krebs-Ringer bicarbonate medium for 90 min at 0.5 degrees C (chilling) followed by 60 min at 38 degrees C (rewarming). Fresh tissue cation contents (mean +/- SE) in mmol/kg dry wt were: sodium, 431 +/- 7; potassium, 416 +/- 10. After chilling, tissue sodium increased to 757 +/- 11 and potassium decreased to 113 +/- 6. Upon rewarming there was a net increase in tissue potassium of about 150 (mmol/kg dry wt) and a net decrease in tissue sodium of about 130. Tissue extrusion of sodium and reaccumulation of potassium observed at 37 degrees C were abolished when 1 mM ouabain, dinitrophenol, or iodoacetamide was added to the incubation medium. Similar results were obtained when the medium contained no potassium or when medium Na was replaced by choline. The data indicate the presence of active Na+-K+ transport in lung cells somewhat similar to that found in other mammalian tissue.


Control of tissue manganese: initial absence and sudden emergence of excretion in the neonatal mouse. All adult animals and humans tested up to this time have controlled their tissue manganese concentrations by controlling primarily the rate of the metal's excretion. In sharp contrast, neonatal mice did not excrete manganese for the first 17-18 days of life, although absorption of the natural 55Mn as well as distribution, tissue accumulation, and mitochondrial accumulation of the radioactive 54Mn were vigorous. This suggested as initially avid accumulation of this essential micronutrient, supplied in scarce traces in mouse milk (54 ng/ml) by mothers consuming very much higher dietary concentrations (55,000 ng/g). The tissue accumulation was demonstrated analytically and was particularly impressive in the brain, which can be susceptible to both manganese poisoning and deficiency.


Effects of testosterone and prolactin on rat prostatic weight, 5alpha-reductase, and arginase. Prostatic weights, 5alpha-reductase, and arginase activities were utilized as indexes for the effects of prolactin in short-term experiments in intact, hypophysectomized or castrated rats. Experiments were performed in which a dose-related response in the above parameters was obtained with testosterone administration in castrated mature and immature rats in order to evaluate the effects of simultaneously administered prolactin. This approach was necessitated by the failure of prolactin alone to affect the parameters listed in intact, castrated or hypophysectomized rats. It was shown that ovine prolactin may have an enhancing effect on the prostatic weight, 5alpha-reductase, and arginase activities, but that this effect is neither consistent nor striking when compared to that of testosterone.. Nevertheless, it is still possible that the long-term effects of prolactin, even if they are only of an enhancing quality, may play an important role in normal prostatic physiology and in abnormal states.


Analysis of brain uptake and loss or radiotracers after intracarotid injection. The amount of radioactivity in brain was estimated at different times after intracarotid injection in the pentobarbital-anesthetized rat. Fifteen seconds after injection, six radiolabeled solutes minimally metabolized by brain, 3H2O , isopropanol, nicotine, antipyrine, 3-O-methyglucose, and codeine, left the brain according to first-order kinetics. Two solutes metabolized by brain, lactic acid, and heroin, behaved in a more complex fashion. The behavior of the six nonmetabolized solutes was interpreted satisfactorily by a simple model in which the brain is treated as a single compartment. From the model, uptake at 15 s as a percentage of the dose is linearly related to the permeability when the uptake is low, i.e., 30% or less. In higher uptakes blood flow becomes increasingly important. The efflux rate is similarly related to permeability and blood flow, but additionally it depends inversely on brain space. The exchanges of 3H2O, isopropanol, and nicotine were determined almost solely by blood flow and brain space. Movements of codeine and 3-O-methylglucose depended primarily on permeability and those of antipyrine on both factors.


Intra-SA-nodal pacemaker shifts induced by autonomic nerve stimulation in the dog. Pacemaker shifts in the canine heart were inferred during stimulation of thoracic cardiac nerves and following norepinephrine from changes in the initial site of activation of bipolar electrodes sutured over the rostral, middle, and caudal regions of the sinus node, over the internodal pathways, and His bundle. During control periods, pacemaker activity was localized within the sinoatrial (SA) node 87% of the time, with the middle electrode most frequently showing initial activation. Stimulation of the right-sympathetic nerves enhanced sinus node pacemaker dominance, shifting it rostrally within the node. Right-vagal stimulation shifted the pacemaker caudally within the SA node, to nonnodal sites, and to the lower atrioventricular node and His bundle. Left-sympathetic stimulation shifted the pacemaker caudally within the sinus node and enhanced pacemaker activity in the vicinity of the internodal pathway electrodes and His bundle. Dispersion of pacemaker activity was particularly apparent during stimulation of the ventrolateral cervical cardiac nerve. Stimulation of the left-vagal nerves produced effects similar to those of the left-sympathetic nerves. Norepinephrine enhanced pacemaker activity particularly in the rostral region of the sinus node. Slight shifts in pacemaker activity within the sinus node produced changes in pattern of atrial excitation.


Hypothalamic map of stimulation current thresholds for inhibition of feeding in rats. The rat hypothalamus was mapped for the purpose of identifying regions at which electrical  stimulation caused the feeding behavior of a hungry animal to be inhibited. At each inhibitory site a determination was also made of the minimal stimulation current necessary for the inhibition of feeding. The results indicated that the inhibitory sites with the lowest current thresholds tended to form a discrete cluster in the lateral part of the ventromedial nucleus and the adjacent neuropil bordering it ventrolaterally. A few low thresholds were also found in the anterior hypothalamic area. The higher thresholds formed an orderly ascending gradient radiating away from the ventromedial nucleus and its ventrolaterally situated anatomical projections. In areas related to ascending monoamine  pathways, including the lateral hypothalamus, preoptic region, and arcuate nucleus, as well as in the mammillary bodies, stimulation usually failed to suppress feeding behavior. Implications bearing on neuroregulatory models of feeding behavior are discussed.


An analysis of the time course of gustatory neural adaptation in the rat. Neural responses were recorded from the rat chorda tympani nerve following stimulation of the tongue with several concentrations of NaCl. These responses were integrated using a fast time constant (47 ms), and the time course of the decline in neural discharge from the peak of the transient response was computer analyzed. The time course of the adaptation process was described by a constant term and two exponentially decaying components, which most likely reflect the existence of two separate mechanisms contributing to the adaptation process in taste. The constant term and the amplitude of the second gradual exponential decay were correlated with NaCl concentration, whereas the amplitude of the initial rapidly declining exponential component was independent of stimulus intensity. The initial transient response of the chorda tympani nerve may be a function of the rate of stimulus adsorption, whereas the gradual second decline in the neural response may reflect an adaptive mechanism of the taste receptor cell.


Vascular volume-distensibility characteristics of the isolated dogfish gut. The vascular capacitance and volume distensibility of the isolated dogfish gut and segments of dogfish arteries and veins were investigated. The volume-distensibility curves for dogfish arteries and veins are very similar to comparable curves derived from arteries and veins of dogs or man. The vascular volume-distensibility curve of the gut, however, shows a greater distensibility at higher systemic pressure than at lower pressure. Evidence is presented that significant amounts of fluid leave the vascular compartment at a lower systemic pressure than in an isolated dog hindlimb preparation. However, this alone does not explain the atypical vascular volume-distensibility curve obtained from the dogfish gut. It is suggested that in the dogfish capillary filtration pore enlargement takes place at a very low capillary pressure or volume (compared to mammals) and this complicates the construction of a volume-distensibility curve because initial vascular volume is not constant.


Factors affecting O2 transfer in sheep and rabbit placenta perfused in situ. In these experiments we have studied three factors that affect placental O2 transfer. The fetal artery of an isolated cotyledon of the sheep placenta (or one of the umbical arteries in flow studies in rabbits) was perfused in situ with blood of varying PO2 and at different flow rates while the ewe was administered varying inspired O2 concentrations. Measurements were made of the PO2 of inflowing and outflowing umbilical blood, and the O2 transfer rate was calculated by the Fick principle. Changes in individual factors could be studied, since most compensations tending to maintain normal O2 delivery were not operative in the isolated preparation. Results indicate that a 20% change in umbilical arterial PO2, a 14% change in umbilical blood flow, and a 20% change in maternal arterial PO2 would be equivalent in causing a 10% change in placental O2 transfer. Small changes in umbilical arterial PO2 are sufficient to maintain the rate of placental O2 transfer equal to the rate of fetal consumption. Maternal arterial PO2 becomes progressively more critical to fetal oxygenation as its level falls. The experimental results are compared to those predicted by a mathematical model of placental exchange.


Measurements of dog blood-brain transfer constants by ventriculocisternal perfusion. Ventriculocisternal perfusions of mongrel dogs were performed for 1-6 h with solutions containing isotopically labeled compounds. At the conclusion of the perfusion period, serial brain samples were taken from the caudate nucleus and analyzed for radioactivity. Tissue concentration profiles were constructed from the data, and apparent tissue diffusion and capillary exchange coefficients were determined. The tissue diffusion constant of sucrose was 3 X 10(-6) cm2/s, which is approximately 45% of its free-water value. The permeability of the brain capillary complex to creatinine, sodium, and mannitol was so low that it could not be accurately measured by this technique. Capillary transfer coefficients, expressed as half-times, were determined for water, urea, and ethylene glycol; the t1/2 values were 1.5, 15, and 17 min, respectively. These numbers were converted to PS products and compared to other published values. This work suggests that the exchange of these compounds between blood and brain is partially (water) or nearly completely (urea and ethylene glycol) limited to membrane permeability.


Lipid and glycogen metabolism in the hypoxic heart: effects of epinephrine. The metabolism of cardiac lipids and glycogen in hypoxic and well-oxygenated perfused rat hearts was studied in the presence or absence of epinephrine. Heart lipids were pre-labeled in vivo with [1-14C]palmitate. Triglyceride disappearance (measured chemically and radiochemically) was observed in well-oxygenated hearts and was stimulated by epinephrine (4.1 X 10(-7)M). Utilization of tissue triglycerides was inhibited in hypoxic hearts in the presence or absence of added epinephrine. Hypoxia resulted in a small increase in tissue 14C-free fatty acids and inhibition of 14C-labeled triglyceride fatty acid oxidation. Epinephrine had no stimulatory effect on fatty acid oxidation in hypoxic hearts. Utilization of 14C-labeled phospholipids (and total phospholipids) was similar in well-oxygenated and hypoxic hearts with or without added epinephrine. These results suggested that the antilipolytic effects of hypoxia were predominant over the lipolytic effects of epinephrine. Glycogenolysis was stimulated threefold by epinephrine in well-oxygenated hearts. Hypoxia alone was a potent stimulus to glycogenolysis. Addition of epinephrine to perfusates of hypoxic hearts resulted in a slight enhancement of glycogenolysis.


Mathematical and mechanical modeling of stress-strain relationship of pericardium. Several mathematical expressions (models) were compared for use in describing the stress-strain (sigma - epsilon) relationship of pericardium. The expression sigma = alpha[ebeta epsilon - 1] was preferred because of its simpler form, theoretical consistency, and "good fit" of experimental data. A method was developed for estimating the precisions of the estimates of the parameters alpha and beta. This approach can have general usefulness in assessing the significance of a change in stress-strain relationship of various soft tissues following different interventions. A mechanical model was formulated for the pericardium which consisted of springs representing the collagen and elastin fibers connected in parallel. It could be simulated by the above equation and could describe the behavior of the pericardium.


Sympathetic afferent nerve activity of right heart origin. Six mongrel dogs anesthetized with sodium pentobarbital and paralyzed with gallamine triethiodide were studied on total cardiopulmonary bypass. This study verified the existence of right heart mechanoreceptors whose afferent nerves traverse the upper thoracic white rami communicantes. these mechanoreceptors were studied by observing changes in average maximum, and total nerve spike frequency when right atrial and right ventricular systolic and diastolic pressures were altered by means of intracardiac balloons. Receptors that responded to volume and pressure changes were found in both the right atrium and right ventricle. Nerve activity in these afferents increased with increasing right atrial and right ventricular pressures. These mechanoreceptors were more responsive in the upper physiological ranges of right heart pressures. In most nerve fibers studied, maximum activity occurred during both right atrial and right ventricular diastole.


Distributions of spike bursts in cat duodenum. The histograms of spike bursts over short distances were examined in the isolated cat duodenum with multiple electrodes arranged circumferentially and longitudinally. At a single cross section of the duodenum, spike bursts occurred simultaneously in any single slow-wave cycle, but all eight monitored sites in the circumference participated simulatenously only in a bout 25% of the spike-burst cycles. There also were wide variations in the incidence of spike bursts at different locations in a planar cross section. In a longitudinal section, net level of activity over short distances varied widely. Also, spike bursts were out of phase in the longitudinal axis, appearing to spread caudad; 80% of spike burst groups involved less than an average of 5.5 consecutive electrode sites (spaced at 5-mm intervals). Since spike bursts seem to be correlated with ring contractions of the circular muscle, the fact that they appear sequentially in time along the duodenum indicates that such contractions must always be peristaltic. An estimated 80% of such contractions sweep less than about 3 cm. Records of spike bursts from a single electrode do not accurately reflect activity beyond that one point site.


Brainstem loci for activation of electrodermal response in the cat. Brainstem loci from which electrodermal responses could be elicited were systematically explored by direct-stimulation techniques in chloralose-anesthetized and decerebrate cats. Reactive sites of the greatest amplitude were found to extend from the rostral border of the posterior hypothalamus, through the ventrolateral reticular formation of the pons and the medulla, to the cervical cord. Stimulation of these sites elicited stable, reproducible electrodermal responses of 10-30 mV in amplitude. In addition, it was found that stimulation of the ventrolateral extent of the lower brainstem evoked similar responses in the decerebrate preparation. Electrodermal responses could not be elicited from the dorsal medulla, the posterior commissure, or the midline region. The electrodermal response could be elicited from an apparently hypothalamus through the ventrolateral brainstem.


Cellular basis for reversal of hyperkalemic electrocardiographic changes by sodium. We examined the hypothesis that reversal of hyponatremic hyperkalemic electrocardiographic changes through the infusion of saline solutions was due to the action of sodium ion in increasing the action potential rising velocity which is depressed when the cell is exposed to increasing concentrations of potassium. Using standard microelectrode techniques, the rising velocity of canine ventricular cells was shown to increase by 21%, whereas conduction time between two microelectrodes decreased 17% when the sodium concentration of the perfusate was increased from 120 to 163 mM in 2.7 mM potassium solution. When these cells were exposed to identical increases in sodium concentration in a 7.7-mM potassium solution, rising velocity increased 55% (P less than 0.005), whereas interelectrode conduction time decreased 33% (P less than 0.05). Similar changes were noted in experiments on human ventricular cells. These experimental findings are consistent with the hypothesis stated above.


Influence of inhibitors of prostaglandin synthesis on the canine pulmonary vascular bed. The effects of two chemically dissimilar inhibitors of prostaglandin (PG) synthesis on vascular resistance and responses to pressor and depressor hormones were evaluated in the canine pulmonary vascular bed. Indomethacin or meclofenamate, 2.5-5 mg/kg iv, increased lobar arterial pressure. Since lobar blood flow was held constant and left atrial pressure did not change, the rise in pressure reflects an increase in vascular resistance. The rise in lobar pressure after indomethacin occurred in the absence of a change in lobar venous or translobar airway pressure. This agent enhanced the response to angiotensin but not to norepinephrine. Meclofenamate decreased responses to both agents. Indomethacin enhanced the dilator response to PGE1 and both indomethacin and meclofenamate increased the response to PGF2alpha. These data indicate that the rise in resistance after indomethacin or meclofenamate was the result of vasoconstriction in vessels upstream to the small veins, presumed to be small arteries. These data are consistent with the hypothesis that under resting conditions synthesis of a dilator prostaglandin may be important for the maintenance of the pulmonary vascular bed in a dilated state. However, results of the present study are not consistent with the postulate that prostaglandins modulate responses to norepinephrine but suggest that indomethacin and meclofenamate interfere with the inactivation of PGF2alpha and PGE1 in the lung.


Differential labeling with orotic acid and uridine in compensatroy renal hypertrophy. Using [5-3H]orotic acid and [5-3H]uridine as precursors, we compared the efficiency of labeling and the localization of labeled RNA during compensatory hypertrophy of the mouse kidney. [5-3H]orotic acid in tubules labeled RNA 15 times more intensely that [5-3H]uridine, presumably because of greater incorporation of orotic acid into tubular cells. Of the orotic acid label, 97% was in tubular cells, mostly in the proximal tubules. Only about 80% of the uridine label was in the tubules; the ratio in proximal tubules compared with that in distal tubules was 2:1. No changes in distribution within the nephron were produced during compensatory hypertrophy. [5-3H]uridine should be used as the precursor of generalized labeling is desired, but [5-3H5orotic acid is the better precursor of RNA for many studies of compensatory hypertrophy since it is more efficient and concentrates in the segments of greatest biologic activity.


Metabolic background for glucose tolerance: mechanism for epinephrine-induced impairment. Turnover rates of blood glucose in rats were calculated from the decay of [14C]glucose. A glucose load suppressed glucose appearance and this was reversed by epinephrine or glucagon. Incorporation of [14C]bicarbonate into liver glycogen and blood glucose demonstrated that these hormones did not alter gluconeogetic rate but, rather the proportion of glucose recovered in the two products. The glucose enhanced by glucagon, probably through increased insulin secretion. In contrast, epinephrine decreased peripheral glucose uptake.


Adrenergic receptor and epinephrine-induced hyperglycemia and glucose tolerance. Intravenous glucose tolerance in fasting rats was improved by phentolamine, an alpha-adrenergic blocking agent, and diminished by propranolol, a beta-adrenergic blocking agent. These effects of adrenergic blockers were dependent on the action of insulin, secretion of which is controlled by an adrenergic mechanism. Epinephrine caused by hyperglycemia and impaired glucose tolerance. Both actions of epinephrine were partly inhibited by either an alpha or beta blocker and completely abolished by combination of both blockers in normal rats. However, in rats treated with anti-insulin serum or 5-methoxyindole-2-carboxylic acid, a potent inhibitor of gluconeogenesis, both actions of epinephrine were blocked by propranolol alone, but not by phentolamine. It is concluded that beta-receptor-mediated inhibiton of peripheral glucose utilization is primarily responsible for epinephrine-induced hyperglycemia and impairment of glucose tolerance. Furthermore, the reduction of glycemic action of epinephrine observed after alpha blockade is due to the hypoglycemic action of insulin secreted by the stimulation of beta receptors in pancreatic beta cells.


Uptake and supply of purine compounds by the liver. We have analyzed for purine compounds entering and leaving the liver in lightly anesthetized rabbits and rats and for the export of utilizable purine from liver perfused with oxypurine. The in vivo results indicate that roughly 80% of hypoxanthine, xanthine, and urate is removed in a single passage of blood through liver. Conversely, the adenosine concentration of hepatic venous blood is increased 10-fold over portal or arterial levels. When the liver is isolated and perfused with hypoxanthine there is significant release of adenosine, whether measured quantitatively by microbiological assay or qualitatively by analysis of the radioactive purines released from liver that has been prelabeled with [14C]hypoxanthine. These results provide direct evidence for the clearance of hydroxylated purines and the release of utilizable adenine derivatives by liver.


Effect of lactate infusion on myocardial FFA metabolism in diabetic dogs. The effect of elevated arterial lactate concentration on myocardial free fatty acid (FAA), acetoacetate (AcAc), and beta-hydroxybutyrate (beta-OHB) uptake was studied in alloxan-diabetic dogs under control conditions and following the constant infusion of Na-L-(+)-lactate. Only minor changes in hemodynamic parameters were observed. During lactate infusion, arterial lactate increased and FFA, AcAc, and beta-OHB decreased. The extraction ratio and myocardial uptake of both AcAc and beta-OHB diminished. No significant change of myocardial FFA oxidation was noted. While myocardial lactate uptake was very small under control conditions, it increased considerably during the infusion of lactate. The fraction of myocardial CO2 production derived from FFA oxidation was unchanged during lactate infusion, while the fraction derived from ketone bodies decreased and that derived from lactate increased. Thus, during hyperlactacidemia a larger fraction of myocardial substrate was derived from lactate and a smaller fraction from ketone bodies than were derived under control conditions.


Autoregulation of renal blood flow in the puppy. The ability of the immature kidney to autoregulate blood flow was investigated. Renal blood flow was measured by electromagnetic flowmeter. In six puppies, selective blockade of the intrarenal effects of angiotensin II (AII) by [1-sarcosine, 8-alanine]angiotensin II (anti-AII) administered into the renal artery did not change renal blood flow. During selective renal AII blockade, intravenous AII raised perfusion pressure from 76 +/- 2 to 100 +/- 6 mmHg. Renal blood flow increased from 1.59 +/- 0.29 to 1.98 +/- 0.59 ml/g kidney per min, but returned to control levels within 40 s in spite of persistent arterial pressure elevation. In another group of seven puppies, renal blood flow remained constant despite reduction of renal perfusion pressure by aortic constriction to 60 mmHg. In two of these seven puppies intrarenal anti-AII did not abolish autoregulation. Autoregulation of renal blood flow occurs in the puppy and is not influenced by inhibition of angiotensin. The renin-angiotensin system does not appear to be involved in the normal regulation of renal blood flow in the puppy.


Transalveolar transport of large polar solutes (sucrose, inulin, and dextran). The in vivo transalveolar transport of three large polar solutes, sucrose, inulin, and dextran (mol wt 60,000-90,00), was compared with the transport of urea in saline-filled dog lung. Apparent permeability coefficents (p', in cm X sec-1 X 10(6)) were as follows; urea: 2.4 +/- 0.28 (SD) greater than sucrose: 0.64 +/- 0.31 (P less than 0.001) greater than inulin: 0.12 +/- .05 (P less than 0.001)--not different from dextran (mol wt 60,000-90,000): 0.08 +/- .02 (P greater then .01). Calculation of the resistance of the alveolar epithelium compared to total barrier resistance for the various solutes indicates that approximately 90% of the total resistance resides in the alveolar epithelium. Comparison of the ratio of permeability coefficients to the ratio of free-diffusion coefficients in water shows similar values for the three large polar solutes, suggesting that permeation through the alveolar epithelium occurs by means of water-filled channels. The values for permeability coefficients of alveolar epithelium fit into the spectrum of values reported for other epithelial structures (including gall bladder, frog skin, and toad bladder); it seems to have a system of channels with a small number of  wide "pores" (greater than 80 A) that permit permeation of large polar solutes and is not a relatively homogeneous structure.


The need for intervention: a further delineation. Clinical material from experimental tape sessions is used further to delineate a crucial variable in psychotherapy research: the degree to which the therapist meets the patient's need for intervention. Several discrete needs for intervention are identified, how they were (later) met by a therapist is observed, and the outcome of each is assessed.


Child-rearing patterns of poverty.

Child-rearing patterns of poverty. The author feels that the perpetuation of poverty is not adequately explained by the popular theories of recent years, that is, social oppression and cultural deprivation, including maternal deprivation. Impaired verbal development and a lack of inner controls are products of specific child-rearing patterns which create fear and rage, and stifle verbal self-expression.


Gestalt encounter in the treatment of hospitalized alcoholic patients. The Gestalt approach with alcoholics is different from other, traditional approaches. Its emphasis on growth, awareness, and self-support is aided through some simple guides. Several guides are suggested which have been used with this population and specific examples from therapy are provided to show how they were used and what the effects may be.


Resistance interruption in programmed psychotherapy. Research Interruption in Programmed Psychotherapy introduces a directive intervention into personally maladaptive patterns of behavior while supporting constructive alternatives. Observations, results, and follow-up on 50 patients are given. Benefit related to this handling of resistance in psychotherapy is suggested.


Brief or crisis-oriented therapy in a city hospital setting. The philosophy of brief therapy in a city hospital setting is outlined. Therapists frequently resist a brief and active approach and offer rationalizations against it. Most patients, however, seek only symptom alleviation or problem solving, and not insight psychotherapy. Specific treatment goals and foci must be established early when the treatment contract is formulated. Transference and countertransference play a significant role.


Psychotherapy of love loss.

Psychotherapy of love loss. Abandonment in love brings with it considerable psychiatric casualty. Although time usually heals, it may also reinforce psychopathologic attitudes. The main task of psychotherapy is to offer an explanation, stretched over time, which is emotionally acceptable, protects self-esteem, and diminishes the fear of new alliances.


A psychiatrist moves his office.

A psychiatrist moves his office. This paper describes a therapist's experience in moving his analytically oriented psychotherapy practice from an exclusive private setting to the psychiatric floor of a busy general hospital. The ways in which different patients react to this similar experience are described and the dynamic implications discussed. A feature common to most patients is highlighted and its implications for psychotherapy generally are examined.


Facilitating ego mastery in brief psychotherapy with medical students. Four related techniques for doing brief psychotherapy with medical students are described, which capitalize on styles of ego adaptation and defense characteristic of this population. These styles involve use of intellectual mastery and intellectualization. The therapeutic use of a frequently occurring form of positive ego-ideal transference is also discussed.


Therapist and patient after hours.

Therapist and patient after hours. A patient in brief psychotherapy told of a sexual advance made to her now by a former psychotherapist. Computer testing predicted her motivation and behavior accurately. A number of related issues in professional ethics and in dynamic psychology are discussed. Legal cases are cited.


The seroepidemiology of malaria in Middle America. I. Longitudinal studies on populations in a low incidence area of El Salvador. Serologic profiles were established using the indirect fluorescent antibody test in a longitudinal study of six villages in an interior area of El Salvador. Positive serologic responses as well as active cases found through the voluntary collaborator posts occurred primarily in adult males, suggesting that much of the malaria experience in the study area resulted from exposure of this segment of the population in more malarious areas where they traveled to engage in temporary agricultural labor. Malaria incidence was generally low but transmission potential apparently varied markedly even over relatively small distances. Serologic profiles reflected the malaria experience in the population sampled, but many localities were widely dispersed and samples taken from village centers were found in some cases not to be representative of the entire locality population in terms of malaria exposure. The indirect fluorescent antibody technique was found to reflect the malaria experience in the population segments examined. When these data were correlated with the surveillance data from the voluntary collaborator posts, the epidemiology of malaria in the study area was more thoroughly understood.


The seroepidemiology of malaria in Middle America. II. Studies on the Pacific coast of Costa Rica. Serologic studies for malaria using the indirect fluorescent antibody technique suggest that active transmission is either absent or very low in 6 villages on the Pacific side of Costa Rica. Positive titers (1:20 or higher) were seen in the under-15-year age group in three of the study localities, but only 5 such responses were encountered among 249 people examined in this age range. In the adults (15 years and over) from the same 3 villages there were 68 positive titers among 161 examined. There were 43 positive responses in 189 adults from the remaining 3 villages where none of 307 persons under 15 years of age showed a titer of 1:20 or higher to any of the 3 malaria antigens tested (Plasmodium falciparum, P. vivax and P. malariae). These data suggest that the positive responses in the latter villages are more likely to be associated with old or imported cases than with current local transmission. Serologic responses of 1:80 or higher to the P. falciparum antigen suggested the continued presence of this parasite in the population in spite of the paucity of positive blood smears with this species in recent years. Positive titers with the P. malariae antigen suggest that this parasite is probably still present in the area. Such serologic studies help to indicate areas where malaria transmission is active and provide information on parasite reservoirs in particular populations.


Clinical trials with metronidazole in human balantidiasis. Therapeutic activity of metronidazole against Balantidium coli was evaluated by using two drug regimens in 20 human cases of balantidiasis. All patients also harbored Trichuris trichiura. Children received a total amount of drug that varied from 2.5 g during 5 days to 7.5 g in a period of 10 days. Adults were given 5 g in 5 days or 12.5 g during a period of 10 days. In all patients B. coli disappeared after the 4th day of treatment. Frequent posttreatment stool examination remained negative. All patients tolerated the drug well and there were no side effects.


Incidence of intestinal obstruction in children infected with Ascaris lumbricoides. The most serious consequences of infection with the large roundworm, Ascaris lumbricoides, are complications requiring surgical intervention, particularly intestinal obstruction caused by a bolus of worms. A study was conducted to estimate the incidence of this complication among infected children in an area of the southeastern United States where ascariasis is endemic. A chart review at three rural Louisiana public hospitals revealed that 21 patients had been hospitalized with intestinal obstruction secondary to ascariasis over a 3-year period. The prevalence of ascariasis in three parishes (counties) served by these hospitals was calculated from the results of 2,360 stool examinations performed by the State Health Department and one hospital laboratory. The prevalence of ascariasis in 1- to 5-year-old children was similar to that in 6- to 12-year-olds and ranged from 8% to 28% in the three parishes. Prevalence rates were three times higher for blacks than for whites. It was found that most cases of intestinal obstruction occur in children in the 1- to 5-year age group and that this incidence approximates two such complications per 1,000 infected children per year.


A quantitative post mortem analysis of urinary schistosomiasis in Egypt. II. Evolution and epidemiology. Further analysis of the data obtained from 190 unselected autopsies at the University of Cairo (Faculty of Medicine) hospitals reinforces our conclusion that a high prevalence of urinary schistosomiasis leads to infection intensity causing severe uropathy and mortality, both directly and by way of complications and sequelae. Based on histological study, two stages of urinary schistosomiasis must be considered in epidemiological work: "active disease", characterized by significant egg excretion; and "inactive disease", in which eggs are excreted rarely. The proportion between active and inactive cases is progressively reversed with advancing age, while mean tissue egg burdens rise, plateau, and ultimately decrease, most sharply beyond 50 years of age. A model of the progression of active disease has been derived from the relations of individual organ egg burdens to overall infection intensity, showing that both the onset and the termination of oviposition probably begin in the urinary bladder and spread centrifugally. Therefore, extravesical activity may persist longer than bladder activity. Severe uropathy and mortality occur at all stages of the disease and depend principally, but not exclusively, on egg burden, i.e., on infection intensity. Correlations of infection intensity with degree of uropathy show that severe disease is quantitatively separable from incidental disease by its tissue egg burdens and lesions. However, the factors determining death from urinary schistosomiasis are only partly understood. They include bilateral upper obstructive uropathy and, probably, focal egg concentrations leading to rapid obstruction, such as aberrantly high egg burdens in the left ureter relative to those in the bladder. Analysis of epidemiologically homogeneous population groups reveals close mutual relationships between the total frequency of infection (active plus inactive), the intensity of infection, and the frequency of severe uropathy. A statistical model predicts that any rise in frequency beyond a 30% threshold will result in a linear increase in the frequency of severe disease, whereas below that threshold the bulk of infections will be incidental. These insights, applicable only to pathological material, must be complemented by efforts to establish clinical and laboratory criteria defining the severity and stages of urinary schistosomiasis in living patients, and to examine their population dynamics, so that effects of therapeutic and preventive measures may be evalulated more precisely.


Anticholinergic properties of the antischistosomal drug hycanthone. The effect of the antischistosomal drug hycanthone on the motor activity of Schistosoma mansoni was studied in vitro. Hycanthone stimulates motor activity at concentrations of 10(-6) to 10(-5) M, and partially blocks the paralytic effects of carbachol and physostigmine. Lucanthone, a closely related although less active congener of hycanthone, does not produce these same effects in vitro. Some blocking of acetylcholine can also be produced by atropine, although this drug is less active in this regard than is hycanthone. These findings suggest that the therapeutic efficacy of hycanthone may be related to interference with acetylcholine receptors in schistosomes. Hycanthone is an inhibitor of acetylcholinesterase (ACHE) from S. mansoni, but is less effective against ACHE of mammalian origin. In contrast, physostigmine inhibits the mammalian enzyme more effectively than it does the helminth enzyme. These observations suggest that schistosome ACHE differs from the mammalian enzyme with respect to the configuration of the active center, and that hycanthone may have a selective affinity for schistosomal cholinergic systems.


Treatment of schistosomiasis mansoni and japonica in baboons with tubercidin given by direct intravenous injection. Baboons (Papio cyanocephalus and P. anubis), infected with Schistosoma mansoni or S. japonicum, were treated with single doses of tubercidin (7-deazaadenosine; Tu), 1, 3, and 5 mg per kg of body weight, administered by intravenous drip. Crystalline Tu was dissolved in sterile 0.9% NaCl solution (1 mg per ml), and the solution was delivered at a rate of 4 ml per minute. Detectable short-term host toxicity was limited to the 5 mg per kg dose, mainly in the form of reversible mild to moderate kidney damage. Only this 5 mg per kg dose administered to baboons with relatively heavy S. mansoni infections was capable of completely suppressing fecal egg excretion for 6 to 8 weeks, eliminating the female worms, and terminating active disease, as indicated by histopathological findings. Comparable effects were achieved following the administration of the 3 mg per kg dose to baboons with moderate to heavy S. japonicum infections.


Comparative sensitivity and specificity of the Casoni intradermal and the immunoelectrophoresis tests for the diagnosis of hydatid disease. The Casoni intradermal (ID) test, using two antigens, was compared with the immunoelectrophoresis (IEP) test for diagnosis in 47 surgically confirmed cases of hydatid disease and 73 non-hydatid persons. An antigen prepared from boiled hydatid cyst fluid (HF) was markedly more sensitive in the ID test than another prepared from whole HF but both produced false-positive reactions in three persons with other disease conditions. The IEP test yielded no false positives and its sensitivity was similar to the ID test using the more sensitive boiled HF antigen. Some patients were ID-positive and IEP-negative and vice-versa. Diagnostic sensitivity of both tests varied according to the localization and condition of the cyst. A detectable immune response was more frequent in patients with liver cysts than in those with lung cysts. Regardless of cyst localization, lowest diagnostic sensitivity was observed in patients whose cysts were intact and of the hyaline type, whereas recently broken cysts were associated with the most consistently detectable immune response. The limitations of the ID test are discussed and it is suggested that, until more specific antigens are available, there appears to be little value in utilizing this test where the more specific serological techniques are available.


Laboratory studies of transovarial transmission of La Crosse and other arboviruses by Aedes albopictus and Culex fatigans. Transovarial transmission of La Crosse virus by experimentally infected Aedes albopictus females to 2.7% of their F1 generation offspring was demonstrated. Progeny of both sexes were infected. Mean virus titers in parent mosquitoes and infected F1 generation adults were 10(4.6) and 10(3.4) plaque forming units/insect, respectively. The La Crosse-infected offspring were randomly distributed among the female parents. After two serial passages in A. albopictus, a marked change occurred in the plaque morphology of the virus but this had no apparent effect on the subsequent vertical transmission rate. In contrast, transovarial transmission did not occur in La Crosse-infected Culex fatigans or in A. albopictus and C. fatigans infected with vesicular stomatitis-Indiana, Cache Valley, Batai, Arumowot, and Itaporanga viruses. Results of this experiment suggest that the La Crosse model might be useful in studying the mechanism of transovarial transmission in additional mosquito species.


Host preferences of Aedes trivittatus (Diptera: Culicidae) in central Iowa. The vertebrate host preferences of Aedes trivittatus mosquitoes were studied to gain an insight into the possible hosts of trivittatus (TVT) virus (California encephalitis group) in Iowa. Engorged mosquitoes were collected with a Malaise trap and Dry Ice-baited CDC miniature light traps. The origin of mosquito blood meals was determined by the capillary tube precipitin test. Of 600 A. trivittatus blood meals tested, 409 (68.2%) reacted positively with anti-rabbit serum. The incidences of mosquitoes feeding on other vertebrate species ranged from 0.2% to 2.5%. The vertebrate host preferences of A. trivittatus suggest a close association between this mosquito species and the eastern cottontail rabbit (Sylvilagus floridanus) in central Iowa. Furthermore, the results indicate that the eastern cottontail rabbit may be an important host for TVT virus in Iowa.


A technique of anaesthesia in haemorrhagic shock. Illustrative case histories and a discussion. The anaesthetic management of patients in haemorrhagic shock is described. The principles are those of initial resuscitation with electrolyte solutions and alleviation of metabolic acidosis, combined with early induction of anaesthesia to permit control of bleeding as soon as possible. The anaesthetic technique depends on pre-oxygenation, intravenous anaesthesia, muscular relaxation and ventilation with pure oxygen. Earlier cases were induced with thiopentone and maintained with intermittent suxamethonium, but intravenous ketamine was later employed for induction and intramuscular ketamine for maintenance; this use of ketamine is now the author's method of choice. The use of a central venous pressure line connected to a cannula in the internal jugular vein is recommended.


Immediate care after aspiration of vomit. The diagnosis of aspiration can be made from the characteristic clinical features. Management is then based on the measurement of the pH of the gastric contents, blood gases and acid-base values, the serial measurement of pulse blood pressure and central venous pressure, and the haemoglobin and haematocrit. If available measurement of the plasma or blood volume, pulmonary artery and wedge pressure and cardiac output may also be of value in diagnosis and guiding treatment. The following treatment should be carried out: Head down in right lateral position to drain vomit from airway. Suction. Laryngoscopy to clear the airway. Bronchoscophy if asphyxiated by solid material. Endotracheal intubation if liquid. High inspired oxygen. Artificial ventilation if the PO2 is low. Steroids Hydrocortisone 200 mg intravenously and 100 mg intramuscularly every 6 hours; or Dexamethasone 10 mg intravenously and 5 mg intramuscularly every 6 hours. Aminophylline if bronchospasm is severe. Plasma or plasma substitute for hypotension and hypovolaemia. Correct acidosis.


The role of hospital medical teams at a major accident. Despite an apparently adequate major accident plan which has been used successfully on two previous occasions, considerable difficulties were experienced by the mobile medical teams at the scene of the Moorgate tube train accident. The authors have attempted to describe the role and organisation of mobile medical teams placing particular emphasis on a simple and flexible plan.


A local complication of intravenous induction of anaesthesia. A triple response resulting from true intraluminal injection into constricted wrist veins is described and its nature discussed.


[Cardiovascular effects of the new inhalation anaesthetic isoflurane in man (author's transl)]. Cardiovascular responses to isoflurane (forane)-nitrous oxide-oxygen anaesthesia were studied in seven older premedicated patients. Anaesthesia was induced with the new non-barbiturate induction agen etomidate. All patients were intubated and mechanically ventilated to maintain normal PaCO2. Clinical concentrations of isoflurane (0.75 and 1.5 vol.-% inspiratory) decreased mean arterial pressure 22%-42%. Only small reductions in cardiac output and stroke volume were seen. Heart rate, central venous and pulmonary artery pressure remained nearly unaffected. The major cause of the arterial hypotension was a fall in total peripheral resistance by 36% as anaesthesia deepened. Left ventricular maximum dp/dt and load data indicated that isoflurane also possesses negative inotropic properties. Tension-time-index and total body oxygen consumption decreased by 47% and 20% respectively. AVDO2 values remained within the normal range. We take this to mean that the oxygen supply was adequate to meet the metabolic demands of the body as a whole. This was corroborated by the finding that base excess did not change significantly. Conclusions considering the use of isoflurane in patients with diminished cardiovascular reserve are drawn.


[Epinephrine injection with enflurane anaesthesia: incidence of cardiac arrhythmias (author's transl)]. Two hundred patients, primarily A.S.A. status I and II, were prospectively divided into two groups of 100 each. One group received nitrous oxideoxygen-enflurane anaesthesia and subcutaneous infiltration of adrenaline in lignocaine for haemostasis, while the other received enflurane but not adrenalin. Patients were continuously monitored with a cardioscope. Epinephrine dosages were limited to those recommended for safe use with halothane anaesthesia. No patient in the control group experienced an arrhythmia, and only one patient in the study group developed a burst of premature ventricular contractions following adrenaline injection. The authors conclude that adrenaline may be given subcutaneously for hemostasis in patients under enflurane anaesthesia provided the safeguards established for halothane are observed.


[Haemodilution and cerebral blood flow (author's transl)]. Cerebral blood flow has been estimated in 10 patients during acute haemodilution and during the consecutive operation. Cerebral blood flow showed a lasting increase during the time of haemodilution, but this increase did not parallel the decrease of haematocrit value. The increase of cerebral blood flow became pronounced only, when the haematocrit become lower than 30%. Assumably the elevation of cerebral flow is mainly due to autoregulative mechanisms of cerebral blood flow to sustain oxygenation. It is concluded, that haemodilution below values of 30% hc might be dangerous in patients suffering from cerebral sclerosis.


[Sodium and water balance in the dog under halothane and methoxyflurane anesthesia (author's transl)]. In our model of volume expanded dogs with an equilibrium between input and renal output of sodium and water halothane anesthesia (1,5 Vol.-% insp.) was performed. In deepening halothane anesthesia we found a progressive decrease of mean aortic pressure, GFR and renal sodium and water excretion. There was a strong correlation between GFR and sodium excretion. With a high GFR significantly more sodium was excreted under halothane, whilst reduction of GFR led to an overproportional decrease of sodium excretion. Urine osmolality, too, depended on GFR under halothane. The results of methoxyflurane anesthesia were quite similansion. Concentrations of inorganic fluoride in serum and urine, which we measured in these experiments, did not result in visible changes of sodium or water balance, compared with the conscious state.


[Serum electrolytes during neuroleptic analgesia and spinal anaesthesia (author's transl)]. Spinal anaesthesia is particularly suitable for operations on the prostate in geriatric patients. We investigated the effects of spinal anaesthesia, using Bupivacaine 0.5%, on electrolyte metabolism in 12 patients and compared these with the effects of neuroleptanalgesia in 13 patients. Neuroleptanalgesia did not affect electrolytic concentrations, whereas spinal anaesthesia was associated with a temporary slight fall in potassium concentration.


[An unusual intubation (author's transl)]. Report of an unusual intubation in a patient who had had resection of maxilla and exenteration of the orbits. Because of a lock jaw the intubation had to be performed through the orbita.


[Side effects of nitrous oxide (author's transl)]. When nitrous oxide is breathed the alvolar partial pressure will cause it to diffuse into the blood, tissues and gas-containing spaces within the body until equilibrium is reached. At the same time nitrogen will be excreted from tissues and blood to alveolar gas. There is a 35 fold difference in the blood-gas partition coefficient between nitrous oxide (0.47) and nitrogen (0.013). For every molecule of nitrogen that is removed from the aircontaining space in the body, 35 molecules of nitrous oxide are transferred from the blood to the air space. This differential solubility of nitrogen and nitrous oxide results either in an increase in the volume of the gas space if the space is compliant (gastrointestinal tract, pneumothorax, air embolus, cuff of the endotracheal tube), or in an increase in the pressure if the space is non-compliant (pneumencephalography, middle ear, sinus). The clinical significance of these side effects of nitrous oxide and experimental studies are discussed.


[The influence of volatile anaesthetics on drug metabolism in the liver (author's transl)]. In Vitro experiments with rat liver microsomes (difference spectra, p-nitroanisol-demethylation) and in vivo experiments with rats (tritium release from 3H-mestranol) suggest an inhibition of the metabolism of certain drugs (type-1-substrates) by competition for the binding site of cytochrome P-450 under anaesthesia with diethyl ether, halothane, enflurane and methoxyflurane.


[Central venous pressure and orthostasis in the postoperative period (author's transl)]. In 18 postoperative patients (1st to 10th day) of both sexes, aged 26 to 74, the relation was studied between the CVP and arterial BP measured in the horizontal and in a partly upright position (45 and 60 degrees respectively). Patients with higher CVPs in the horizontal position generally showed a lesser orthostatic drop of the BP. The fall of CVP which we observed simultaneously in all patients was, however, significantly more marked in the patients with the higher horizontal CVP values, irrespective of the angle of inclination. The cause of these findings appears to be the dependence of the venous hydrostatic indifference point upon the intravascular volume.


[Hyperbaric Bupivacaine 1% (Marcaine, Carbostesine heavy) for hemi-spinal anaesthesia in orthopedic (author's transl)]. A report is given on 170 orthopedic operations performed under hemi-spinal anaesthesia. The anaesthetic agent used was hyperbaric bupivacaine 1% (Marcaine, Carbostesine). Of these cases 92 were total hip joint replacements and 78 other operations of the lower extremities. Generally, the patients were classified as category three risks (A.S.A.) Their average age was 63 years. The anaesthetics and postoperative courses were smooth. In the total prosthetic hip joint operations hypotension during the implantation of acelabulum--or femur--cement was not observed. With doses of 1 ml of the local anaesthetic the average duration of analgesia was 3 hours and 10 minutes, and with added vasoconstrictor 4 hours.


[The in vitro influence of dehydrobenzperidol (droperidol) on lymphocyte transformation (author's transl)]. Droperidol, an agent which is used in neurolept anaesthesia was tested in vitro for its effect upon the lymphocyte transformation test. Using peripheral blood of healthy volunteers droperidol was added simultaneously with PHA (phytohaemagglutinin) respectively after the lymphocytes had been incubated with PHA already for a period of 47 hours. Lymphocyte transformation was not impeded significantly when the first method was used, when clinically comparable concentrations were administered. When droperidol was added after PHA even lower concentrations caused an inhibition. The significance of these different modes of testing is discussed. It is concluded from these results that droperidol in clinical concentrations as used in Neurolept anaesthesia does not have a distinct and lasting influence upon lymphocyte transformation and thus has no considerable immunosuppressive effects.


[The psychological effects of intensive care (author's transl)]. After some twelve years experience as a Consultant Anaesthesist in Intensive Therapy Units the author suffered a catastrophic illness which required a period of artificial ventilation in the I.T.U. in which he worked. He found that much of what he and others had written about the psychological effects on the patient of intensive therapy was mistaken. The main psychological problems were anxiety, disorientation and exhaustion and communication difficulties. The methods used by the author to achieve recall of these distressing events and suggestions as to how such problems may be alleviated are discussed.


Pulmonary fat embolism in the traumatised patient: development of a prophylactic programme in a city accident hospital. Low molecular weight plasma expanders, proteinase inhibitor and phosphatidilcholine have been used in a city accident hospital prophylactically against fat pulmonary embolism (F.P.E.) in traumatised patients. Their routine use in patients at risk has shown a decrease in the frequency of this syndrome, suggesting the validity of such treatment.


[Provocation of an epileptic seizure during induction of NLA (author's transl)]. We report about a case in which the induction of NLA produced an epileptic seizure. The seizure was checked by relaxation, intubation and controlled ventilation. During the following anaesthesia the EEG-monitoring did not show any increased disposition to cramps. The operation was finished without complications.


Scanning electron microscopy of the articular surfaces of the hip joint disorders. The specimens from 19 femoral heads with various abnormalities are observed with scanning electron microscopy, comparing with light microscopic findings. Villi and plica appearance implies the fibrillated surface of degenerated cartilage with fibrous tissue proliferation. Beside these findings, craters with their associated undulations of concentric circles or guitar-shaped figures are visualized in the areas histologically showing the exposed cartilage of the deep zone. The undulations are correspondent to the fine clefts of the shredding surface. From the observations reported here, the existence of the lamellar system around the chondrocyte lacuna is proposed in the deep matrix of the articular cartilage.


Cytochemical differentiation of muscle fibers by succinic dehydrogenase (SDH) activity in the respiratory muscles of an air-breathing fish, Channa punctatus (Bloch). 1. A cytochemical study on the succinic dehydrogenase activity of the respiratory muscles of Channa punctatus reveals that the Adductor mandibularis is made up entirely of white muscle fibers. 2. The Adductor, Dilator and Levator operculi are composite muscles and composed of white as well as red fiber bundles. However, these composite muscles are dominated by white muscle fibers. 3. The interior of the Protractor hyoideus is dominated by red and medium fibers whereas its superficial part is dominated by white muscle fibres. 4. The muscles innervated by the branches of V trigeminal nerve (Adductor mandibularis, Dilator operculi) are dominated by white fibers, whereas those innervated by the VII facialis (Adductor and Levator operculi and Protractor hyoideus) show dominance of red fibers.


The effects of changes of water balance on the renal pelvic epithelium of the rat. The effects of changes of water balance on the renal pelvic epithelium of the rat. The fine structure of the various epithelia which line the renal pelvis was investigated in five hydropenic rats and five rats undergoing a water diuresis. In the former, the thin epithelium which covers the outer medulla showed dilated intercellular spaces and an increased number of cytoplasmic vacuoles whereas the intercellular spaces were tightly closed and there were few vacuoles in the diuretic rats. It was considered that these changes indicate an exchange of water and solute between pelvic urine and the outer since medulla they are similar to those occurring in epithelia elsewhere which are engaged in transport of salt or water. Similar but less marked changes were found in the papillary epithelium. Changes in the transitional epithelium were similar to those which have previously been described elsewhere in the urinary tract.


Contribution to the study of functional architecture of ligamentum venosum in adult man. Seventeen specimens, removed at necropsy from adult individuals, were submitted to different methods: a) dissection under stereomicroscope; b) 100 mum panorganographic sections stained by Azan, Weigert's resorcin-fucsin; c) total preparations to be examined under polarized light; d) 10 mum thick histological sections stained by Verhöff-van Gieson; e) silver impregnation after CAJAL-DE CASTRO. The AA. refer the constitution of the ligament as an integration of two opposite directed systems which are made up by collagenous and mioelastic elements disposed like a twisted cord in the middle portion and enlarged like a fan toward more or less extensive areas of the left branch of portal vein and of the ensemble formed by left hepatic vein and inferior vena cava. The bundles are mainly spread by the most external layers of these vessels, and also it has been observed fibrous components that from the vessels directed to the ligament. They call attention for the amount of nerves and nerve fibers in that structure. The AA. remark, on functional bases, taking as probable the participation of the ligament on the control of the changes in the bend made up by portal vein, "pars transversa trunci sinistri" and "pars umbilicalis trunci sinistri".


Increased fructolysis of kallikrein-stimulated human spermatozoa. Significant stimulation of human sperm motility by kallikrein, a kinin-releasing proteinase, was observed to occur in semen specimens with reduced sperm motility during an incubation period of 24 hours at 22 degrees C. Parallel to an increase of the total sperm motility an increase of the fructose utilization was measured after addition of a single dose of kallikrein (1 KU/ml) within the same incubation period.


[The effect of perorally administered DDVP and malathion on spermatogenesis and Leydig cells in the juvenile rat]. Immature male rats receive orally DDVP 20 mg/kg on the 4th and 5th resp. 10 mg/kg on the 4th to the 24th day of life or malathione 40 resp. 20 mg/kg. At defined days the testes are examined histologically. The body weight does not change. The testis weight, tubular diameter, number of Sertoli cells, and of A-spermatogonia per tubular cross section as well as the number of Leydig cells is diminished. Malathione produced more  severe alterations, they disappear, however, until the 50th day of life. Refering to the metabolic mechanisms of both the phosphatic esters a local lack of testosterone causing the disturbances is discussed.


[The correlation of morphological and biochemical factors in human ejaculate in various andrological diagnoses. I. Relationship between ejaculate volume, number, motility and morphology of the spermatozoa with regard to age]. This first report from a study conducted to determine correlations between morphological and biochemical parameters in human ejaculate presents the results based on the measurement of predominantly morphological criteria in patients of various clinical diagnosis groups. The allocation of the 525 patients, who were recruited into the study during the period 1972/73 in the Department of Andrology, Hamburg-Eppendorf, to the diagnosis groups normozoospermia (196), asthenozoospermia (92), oligozoospermia (181) and azoospermia (56) was performed in accordance with the Recommendations for Andrological Nomenclature (1970). The following data were evaluated for this report: height (cm), weight (kg), age (years), ejaculate volume (ml), number of spermatozoa (mill./ml), motility (percentage of highly motile, motile and non-motile spermatozoa), round cells (mill./ml), morphology (percentage of normal-shaped/pathological spermatozoa), changes to the head, middle and tail sections (percentage of the pathological spermatozoa). Relationships between a dependent biological variable (y) and a variable to be assumed independent (x) were obtained by adaptation of polynomials of the 3rd degree: y = b0 + b1 + b2x2 + b3x3. The coefficients (b) which did not differ significantly (p greater than 0.05) from zero were eliminated step by step in regression analyses with breakdown and the resulting mean curves within the ranges covered by the sample depicted graphically. For the time being, the relationships found are described only in the sense of a collection of material. The increased occurrence of pathological spermatozoa in advancing age together with lower values for highly motile spermatozoa could be regarded as a result of a lower organ effectiveness of testosterone, which is protein-bound to an increased extent with advancing age. At the present time there is no explanation for the larger numbers of spermatozoa found with increasing age. The positive correlation between higher sperm counts and high motility, and between high motility and a lower percentage of pathological forms corresponds to expectations from earlier studies. The number of changes to the head, middle and tail sections increase proportionally in keeping with an increasing percentage of pathological forms. When the changes to the head, middle and tail sections are placed in relationship to the diagnosis groups normozoospermia, asthenozoospermia and oligozoospermia a disproportional percental participation becomes noticeable.


[The structure and function of the vena spermatica interna--the etiology of varicocele]. From 60 male corpse in the age of 13 to 77 both venae spermaticae internae were completely removed. On the basis of these specimens we investigated the incidence, localization, form and scale of the venous valves in the vena spermatica interna. All venous valves were remodeled and examined for their sufficiency on the basis of these date. In the left vena spermatica interna we found in 83% and in the right vena spermatica in 97% of the cases one or more valves. On the average the left vena spermatica contains 3.5 and the right 3.8 valves. From each vein a drawing was made, showing the remification, the localization of the valves and the valvular function. On the basis of this drawing and reconstructions of valves in the left vena spermatica interna for 90% of the cases and in the right vena spermatica for 75% of the cases a retrograde flow of the blood is possible. The absence of a varicocele can be explained by the presence of a sufficient venous valve on the left side in only 10% and on the right side in 25% of our cases. For the development of a varicocele therefore further facts are of importance.


Stimulation of sperm motility by kinins in fresh and 24 hours aged human ejaculates. Kallikrein, a kinin-releasing proteinase, significantly stimulates human sperm motility in fresh ejaculates with primarely reduced sperm motility (asthenozoospermia) as well as in 24 hours stored ejaculates with reduced sperm motility resulting from post-ejaculatory aging processes. adiition of a kininogen source (serum) further significantly improved sperm motility of kallikrein-stimulated ejaculates. In contrast to the 24 hours lasting stimulation of kallikrein, enhancement of sperm motility by kinins is limited to 2 hours after addition of a single dose of kallidin (1 ng/ml).


The effect of epididymal and testicular fluids on the fertilising capacity of testicular and epididymal spermatozoa. It is possible that the fertilising capacity of spermatozoa in the epididymis is influenced by the epididymal secretion. We have studied this problem by obtaining spermatozoa before entry into the epididymis and after passage through it, incubating both types of spermatozoa in fluids from the rete testis and cauda epididymidis and then checking their fertilising capacity. While spermatozoa from the rete testis were infertile, rete testis fluid did not decrease the fertilising capacity of epididymal sperm from the cauda epididymidis. Fluid from the cauda epididymidis did not promote the fertilising capacity of testicular spermatozoa. These results are discussed in the light of the current understanding of epididymal physiology.


Separation of X- and Y-bearing human spermatozoa with the sephadex gel-filtration method. By means of the Sephadex gel filtration method we were able to separate a fraction rich in X-bearing human spermatozoa, in contrast with the method of Ericsson et al. (1973), which allows to obtain a fraction rich in Y-bearing sperm. The method, which is simple and not time-consuming, may allow control of sex in cases of expressed sex desire in off-spring.


Determination of sperm-antibodies in sera of sterile women by affinity-chromatography (affinity-chromatography of sperm-antibodies). The total amount of humoral sperm antibody protein is determined following its isolation by affinity-chromatography on spermatozoa. Serum proteins are eluted by Sorensen phosphate buffer. Antibodies attached to spermatozoa suspended in Sephadex G 75 columns resist elution by Sorensen buffer. They can be quantitatively washed out by 8 ml Tris HCl-buffer pH 8,9 and be determined as proteins by the Folin-Ciocalteu method.


A.I.D.-couples: psychological and psychopathological evaluation. This study is focused on the sexual-psycho(patho)logical factors of the acceptability by the couple. It is a three year research of a selected group (relative or absolute infertile) of 98 patients. The study shall attempt to weigh and answer the following questions: - What does it mean for the man, for the woman, for the couple when the physician diagnosis the man's biological relative or absolute infertility? - What does such an affirmation mean for the marital relation and how strong must this relation be for satisfactory adaption, vz., that the couple can choose as a couple: the positive choice of childless married couple, adoption, foster-family, donor-insemination. - What is expected of the doctors (gynaecologist, andrologist) who participate in giving expert advice concerning A.I.D.? (importance of the medical relation: doctor(s)-couple). The clinical findings outline the strength of the psychosexual dynamic around A.I.D. (with implications for forming relationship between the partners).


Effect of androgen on different biochemical constituents of human semen. Changes in the levels of fructose, sialic acid, ascorbic acid, cholesterol and acid and alkaline phosphatases in the semen were studied in eight azoospermic volunteers during administration of testosterone propionate over a four week period. In order of responsiveness, elevations were observed in the levels of acid phosphatase, fructose, sialic acid and alkaline phosphatase during androgen therapy. No changes were seen in the levels of cholesterol and ascorbic acid.


Sexual impotence in man.

Sexual impotence in man. An analysis as to etiology and complaints of 486 cases of male sexual impotence was performed and is presented. Psychological factors are dominant in 68%. Physico-organic or iatrogenic causes accounted for deviations in 26% of the patients examined. Educational factors took an important part mainly in ejaculation disturbances. Primary anejaculation as a consequence of educational flaws occurred in 15% of the patients. Erection disturbances were often the consequence of physico-organic affections. The loss of libido was a real complaint in 19% of the patients.


Caffeine- and kallikrein-induced stimulation of human sperm motility: a comparative study. Stimulation of human sperm motility by caffeine and kallikrein was compared in the same semen material. Caffeine, a cyclic nucleotide phosphodiesterase inhibitor, induced an immediate stimulation of sperm motility the intensity being relatively constant during the first two hours of incubation. Kallikrein, a kinin-releasing proteinase, induced a similar enhancement of total sperm motility, but showed a delayed type of reaction with maximum stimulation at 2 hours of incubation. In contrast to the effect of caffeine lasting some hours, enhancement of sperm motility induced by kallikrein was observed 24 hours. Simultaneous addition of serum (kininogen source) and kallikrein to semen samples led to a sitmulation of total sperm motility with higher mean values than those obtained by caffeine of kallikrein alone. However, the ratio of spermatozoa with very good forward progression was highest during caffeine stimulation. Simultaneous addition of caffeine and kallikrein led to a further improvement of sperm motility which was significantly above that produced by caffeine or kallikrein alone. This observation and the finding of a different response of the spermatozoa of two ejaculates towards caffeine of kallikrein indicate that caffeine (cyclic AMP) interferes quite differently in comparison to kallikrein (kinins) in stimulating sperm motility.


Incidence of hypospadia and epispadia in chromatin-positive men. There are described some results of examination of three patients with a Klinefelter's syndrome two of whom had a heavy form of hypospadia, and one suffered from epispadia. The disturbances of penis development are explained, with respect to findings in adult age, by the insensibility of target tissues to the effect of testicular androgen. This insensibility was already acting in the third month of intrauterine life of the fetus.


Evaluation of acupuncture anesthesia: a psychophysical study. Four volunteers judged eight levels of thermal stimuli induced by a Hardy dolorimeter, varying in intensity from extremely painful to a low level seldom even perceived. Half of the 406 stimuli were applied during acupuncture and half either before insertion or after removal of the needles. The experimental design minimized or eliminated factors other than the needles themselves, i.e., no medication was given, the subjects were scientists accustomed to objectivity and, on a preceding day or days, all had become experienced in assigning numbers (individually chosen) to the sensations produced by the different stimuli. Galvanic skin resistance was also tested. The results did not show any influence of acupuncture on perception of pain or on galvanic skin resistance.


Plasma dopamine-beta-hydroxylase activity and catecholamine levels in anesthetized dogs following acute hemorrhage. Because dopamine-beta-hydroxylase (DBH) is released from storage vesicles in adrenergic nerves and the adrenal medulla along with catecholamines, determination of circulating levels of this enzyme might serve as an index of sympathoadrenal activity. This hypothesis has been studied in dogs anesthetized with cyclopropane, isoflurane, and thiopental that were subjected to a single acute hemorrhage and followed for 5 hours. Plasma DBH activity and catecholamine levels were determined before and every 30 minutes after the hemorrhage. Changes in DBH activity did not correlate well with changes in levels of circulating catecholamines in the dog in response to this form of stress.


Local effects of anesthetics on regional hypoxic pulmonary vasoconstriction. The hypothesis that halogenated anesthetics and N2O locally inhibit hypoxic pulmonary vasoconstriction (HPV) was tested. Selective ventilation of the left lower lobe of the lung with N2 in dogs anesthetized with pentobarbital caused blood flow to the lobe to decrease 55.5 +/- 2.0 per cent and lobar vascular resistance to increase 148 +/- 8 per cent. Responses to hypoxia were remeasured during administration of various MAC multiples of inhalation anesthetics to the left lower lobe and following systemic administration of intravenous anesthetics. Isoflurane and fluorexene progressively inhibited and finally almost extinguished the vasoconstriction response as anesthetic concentration increased to 3 MAC. N2O moderately diminished HPV. Halothane had little, and intravenous anesthetics had no, significant effect on HPV. It is concluded that N2O, isoflurane, and fluroxene locally inhibit regional HPV and via this mechanism may increase total venous admixture.


Halothane-epinephrine-induced cardiac arrhythmias and the role of heart rate. The authors previously showed that cyclopropane-epinephrine-induced bigeminal arrhythmias can best be explained by a re-entrant mechanism. They have now obtained evidence for reentry in bigeminal arrhythmias during infusions of epinephrine (.5-3 mug/kg/min) in dogs anesthetized with .8 per cent halothane. Both a critical level of blood pressure and a critical increase in heart rate were necessary for arrhythmias to be induced in any given animal. Artificial elevation of the blood pressure during infusion of a subthreshold dose of epinephrine could induce bigeminy, and the arrhythmia could be aborted by a sudden reduction of blood pressure. The heart rate accelerated approximately 40 beats/min prior to the onset of bigeminy, and atrial pacing at similarly increased rates during subthreshold infusion of epinephrine could induce bigeminy. Stimulation of the peripheral end of the cut right cervical vagus reduced heart rate and converted bigeminy to sinus rhythm. Bradycardia was not the sole mechanism of the vagal effect since conversion to sinus rhythm could also be achieved with more rapid stimulation of the vagus when the heart rate was maintained constant by atrial pacing. Under these conditions further acceleration of the heart rate could reinstate a bigeminal arrhythmia that was again sensitive to further increases in the frequency of vagal stimulation, and it is concluded that the vagus acts on the spread of the re-entrant impulse. This is best shown with cyclopropane anesthesia, because AV-nodal block occurs more easily with halothane. In addition, very brief periods of increased heart rate caused prolonged periods of bigeminy, which indicates that changes in heart rate may alter the electrophysiology of the halothane-sensitized myocardium to promote bigeminal arrhythmias by a re-entry mechanism.


Lymphocyte transformation and changes in leukocyte count: effects of anesthesia and operation. The transformation of lymphocytes in response to phytohemagglutinin stimulation was investigated in 77 patients undergoind anesthesia with and without coincident surgical operation. A depression of lymphocyte transformation apparent immediately following major operations was related primarily to the extent of tissue trauma and not to the  anesthetic agent or technique. No depression of lymphocyte transformation followed anesthesia for treatment of pain or for minor operations. The total leukocyte count increased following general anesthesia for prolonged, traumatic operations, primarily because of an influx of neutrophils into the circulation. The leukocyte count did not increase after comparable operations performed with regional anesthesia. Postoperative depression of lymphocyte transformation is primarily due to nonspecific stress, perhaps because of associated sympathetic and adrenocortical stimulation. The depressant effect of anesthesia alone is minimal.


Hypoxic ventilatory drive in dogs during thiopental, ketamine, or pentobarbital anesthesia. The ventilatory responses to isocapnic hypoxia and hypercapnia were studied in seven chronically tracheostomized dogs awake and during anesthesia with pentobarbital (30 mg/kg, iv), ketamine, or thiopental (10 and 15 mg/kg, respectively, followed by infusion). Isocapnic hypoxic ventilatory drive (HVD) was expressed as the parameter A such that the higher the A, the greater the hypoxic drive. HVD(A) was significantly reduced from 259 +/- 28 (mean +/- SEM) in awake dogs, to 96 +/- 14 after pentobarbital, 161 +/- 27 after thiopental, and 213 +/- 23 after ketamine. Hypercapnic ventilatory drive (HCVD) as measured by S (slope of the VE-PACO2 response curve) was significantly reduced from 1.3 +/- .32 in awake dogs to 0.4 +/- .13 after pentobarbital, 0.5 +/- .12 after thiopental, and 0.6 +/- .11 after ketamine. In addition, hypercapnia-induced augmentation of hypoxic drive was markedly diminished by the two barbiturates but was unaffected by ketamine. Therefore, ketamine at this dose level afforded greater protection during exposure to hypoxia than did barbiturates. (Key words: Ventilation, hypoxic response; Hypoxia, ventilation; Oxygen, ventilatory response; Carbon dioxide, ventilatory response; Anesthetics, intravenous, ketamine; Anesthetics, intravenous, thiopental; Hypnotics, barbiturates, pentobarbital.)


Differential membrane effects of general and local anesthetics. The authors studied the effects of varying Na+ and Ca++ concentrations and of replacing H2O with D2O in Ringer's solution upon the actions of general and local anesthetics on isolated frog sciatic nerves. This experimental model was used to study whether general anesthetics affect excitable membranes in a manner similar to that of typical membrane stabilizers (local anesthetics). Procaine (2.5-7.5 mM), halothane (9, 18, and 36 mM), enflurane (8 mM), and ketamine (0.15 and 0.73 mM) raised threshold and lowered spike amplitude, and their effects were facilitated by reducing Na+ concentration in the Ringer's solution. The local anesthetic effects of procaine (2.5-7.5 mM) and ketamine (0.73 mM) were antagonized by Ca++, while the axonal depressant effect of halothane was facilitated by increasing Ca++ concentration in the Ringer's solution, indicating a different mode of action. General anesthetics also differed from local anesthetics in their interaction with water: replacement by D2O of H2O in the Ringer's solution selectively increased the axonal depressant effects of halothane and enflurane but not those of ketamine or procaine. Since D2O differs from H2O in its greater ice-likeness, these results are consistent with the view that general anesthetics stabilize excitable membranes via stabilization of the water-biopolymer lattice, as predicted by the hydrate-microcrystal theory of anesthesia. In contrast, local anesthetics may stabilize excitable tissues by binding to the same fixed negative charges of the membrane to which Ca++ is normally bound. (Key words: Theories of anesthesia, hydrate-microcrystal; Nerve, mode of action of anesthetics; Anesthetics, volatile, halothane; Anesthetics, volatile, enflurane; Anesthetics, local, procaine; Anesthetics, intravenous, ketamine.)