Joining gut ends of unequal diameter.

Joining gut ends of unequal diameter. A simple, safe and precise method for joining ends of unequal diameter is presented. Very little septum is created by either anterior or posterior rows. The figure-eight seems to crush the septum almost flat on the posterior row and the Halsted's create an absolutely minimal septum anteriorly where they are correctly placed. The posterior row used two layers of submucosa and the anterior one, four layers, and no reliance is placed on the serosa-muscularis layer. This technique is thought to have distinct advantages relative to strength, safety, and minimal septum formation.


Influence of the postoperative state on the intracellular free amino acids in human muscle tissue. Five patients were studied before and two to three days after major, uncomplicated abdominal operation. Muscle tissue was obtained by needle biopsy from m. quadriceps femoris after eight hours overnight fast. Plasma free amino acids were analyzed in simultaneously obtained samples. In the homogenized muscle samples the intracellular concentration of each amino acid (IC) was calculated by subtracting the free extracellular part from the total amount, assuming the plasma concentration to be equal to the concentration in the interstitial fluid. Their relationships have also been calculated (IC/EC gradient). The extra- and intracellular water distribution was estimated using a modified chloride method. In similarity to the findings in normal subjects the majority of the amino acids showed much higher concentration in intracellular water than in plasma. Preoperatively all amino acids examined in muscle biopsies were formed within normal limits. Postoperatively the total amount of free amino acids in plasma and muscle was decreased, and the amino acid profiles differed from those observed in normal subjects. In plasma, as compared with normal controls, the most significant changes were an increase in phenylalanine and tyrosine and a decrease in serine, proline, histidine and isoleucine. In muscle the greatest decrease occurred in the concentrations of glutamine, arginine and lysine followed by proline and glutamic acid. The increase in taurine, valine and phenylalanine were all highly significant and in serin, glycine, alanine and leucine significant, whereas tyrosine showed only a moderate rise. Compared with normal values there were marked increases in the gradient between intracellular and plasma concentrations which were highly significant for glycine and valine and significant for serine, alanine, isoleucine and leucine. The shift in the methionine gradient was somewhat less. We confirm that alterations in the muscle free amino acid pool are not reflected in the values found in plasma. Further work is required to explore the clinical significance of the observed variations in individual amino acids.


An uncontrolled comparison of treatments for achalasia. A series of 78 patients with achalasia, seen during a 10-year period, was like those reported by others with regard to age at onset, nature of symptoms, and duration of symptoms. Analysis of the results of 5 different treatment modalities administered allows an uncontrolled comparison heretofore not available from an institution at which no one treatment was favored over all others. Those who were not treated or who received only anticholinergic medication did not become asymptomatic. Those treated by single or repeated bougienage were not improved for more than a few weeks and suffered a 6% incidence of esophageal perforation. Forty-six per cent of those treated by a single pneumatic dilatation were asymptomatic for 1 year or more. Although esophagocardiomyotomy provided symptomatic relief for 1 year or more in 85%, there was a 25% incidence of gastroesophageal reflux.


Renal artery and vein injury following blunt trauma. Blunt injuries of the renal vascular pedicle occur infrequently. The experience with fourteen cases of blunt renal vascular trauma is presented. Most patients were injured in motor vehicle accidents. The diagnosis was made immediately after admission in 6 patients, delayed in 5, and at autopsy in 3. Most patients presented with gross or microscopic hematuria. The diagnosis of renal vascular injury was suggested by IVP in most instances. Surgical management was used in the 6 patients in whom the immediate diagnosis of renal pedicle injury was made; primary vascular repair was carried out in 4 patients and nephrectomy in two. Conservative management was used in 4 of the 5 patients with delayed diagnosis, and nephrectomy was required in the fifth. Three patients received no treatment as two were dead on arrival and one die during laparotomy. Seven patients died (50%). One of the 7 survivors has a functioning kidney following repair of a renal vein laceration. Three patients with devascularized kidneys have been followed long term and have not developed hypertension. An IVP should be mandatory following severe blunt trauma, especially when hematuria is present. Renal arteriography is indicated with distortion of calyces, extravasation or nonfunction seen on IVP and allows a definitive diagnosis of renal vessel injury to be made.


Staging laparotomy in the treatment of metastatic melanoma of the lower extremities. Twenty-six consecutive patients with melanoma of the lower extremities metastatic to the superficial inguinal lymph nodes were subjected to laparotomy. No patient had preoperative evidence of tumor dissemination past the superficial inguinal nodes. However three patients (12%) had metastases to the liver or para-aortic lymph nodes documented at laparotomy and were not subjected to iliac and obturator lymph node dissection. One of these patients had concomitant local recurrence of melanoma at the ankle. The other two patients had superficial inguinal lymph nodes at least 5 cm in diameter, although two other such patients with similar 5 cm lymph nodes did not have positive intra-abdominal findings. The remaining 23 of the 26 patients underwent ipsilateral iliac and obturator lymph node dissection, which proved positive in 3/23 patients (13%). Of these 23 patients undergoing iliac and obturator node dissection, 18 had clinically positive (and microscopically positive) superficial inguinal nodes prior to their dissection, while the remaining 5 patients had clinically negative (but microscopically positive) superficial inguinal nodes. The three cases of positive dissected iliac and obturator nodes occurred among the 18 patients with clinically positive superficial inguinal nodes (17%). Among the 5 patients with clinically negative, microscopically positive superficial groin nodes, there was no detectable deep inguinal nodal spread (or hepatic or para-aortic involvement).


Adenocarcinoma of the pancreas: a statistical analysis of biliary bypass vs Whipple resection in good risk patients. A series of 297 patients with adenocarcinoma of the head of the pancreas was reviewed. Forty-eight patients was identified with disease limited to the pancreas or adjacent tissues. Twenty-four patients underwent Whipple resection. A second group of 24 patients underwent elective biliary bypass. No patient had liver, omental or peritoneal metastases. All cases of ampullary carcinoma and islet cell tumors were excluded. Assessment of clinical and laboratory parameters revealed the two groups to be statistically comparable. There were no 5-year survivors in either groups. Mean duration of survival was not significantly different. Life table analysis showed no significant difference between the survival rates of the two groups. Frequency of clinic followup, rehospitalization and reexploration were used to assess palliation. Success of palliation was poor in both groups and no statistically significant differences were noted. Surgical mortality in the resected group was 8% and did not differ from the 4% surgical mortality in the bypass group. Surgical morbidity was significantly higher in the resected group. Implications of this data in the management of patients with resectable carcinoma of the pancreas are discussed.


Is modified radical mastectomy adequate for axillary lymph node dissection? The effectiveness of axillary dissection by modified radical mastectomy was assessed by a comparison of the total axillary nodes removed by this operation to that by radical mastectomy. In a series of 121 consecutive radical mastectomies performed during the period of 1964 to 1969, we found that the number of axillary nodes removed ranged from 3 to 63 with a median of 22 and a mean of 23.4 per patient. In a subsequent series of 111 consecutive modified radical mastectomies performed between 1969 and 1973, the total axillary nodes removed ranged from 6 to 77 with a median of 24 and mean of 25.7 nodes in each mastectomy specimen. These results strongly suggest that axillary dissection in modified radical mastectomy is as complete as that in the Halsted radical mastectomy.


Wound infection in colonic surgery.

Wound infection in colonic surgery. Three hundred forty-one consecutive cases of colonic surgery performed by the Proctology service of our hospital have been reviewed. There was a total of 7 wound infections, constituting an incidence of 2.1%. The infection rate in clean contaminated cases was 0.8% and in contaminated cases, 4.7%. The mortality rate was 2.3%. Parenteral antibiotics were used in less than 50% of the operations. Our impression is that attention to one modality of wound infection prevention with disregard for the others will produce little. However, close attention to all the modalities by which we can hope to reduce wound infection appears to produce strikingly beneficial results.


Preserved allografts of dilated saphenous vein for vascular access in hemodialysis: an initial experience. Arteriovenous fistulas constructed from preserved (frozen) allograft veins provided vascular access for maintenance hemodialysis in 14 patients with inadequate vasculature for conventional autogenous fistulas. Electromagnetic flows ranged from 200 to 250 cc/min. Dialysis flow of 200 cc/min were accomplished consistently. The allografts were useable for dialysis much earlier than autogenous A-V fistulas. Arteriography demonstrated a wide vasculature channel very suitable for dialysis needles. Allografts seemed superior to bovine heterografts in both patency and susceptibility to infection. Scanning electron microscopy revealed smoother initimal surfaces if the donor received small amounts of heparin systemically while the veins were being removed. Allograft veins appear to be a useful alternative means of vascular access for hemodialysis.


Carotid endarterectomy: an analysis of 234 operative cases. This paper offers a computer-assisted analysis of the author's experience with 234 carotid endarterectomy procedures in 188 patients. The patients' ages, sex, smoking habits, symptoms, carotid bruits, arteriographic findings and associated diseases are summarized. There were 28 operations in asymptomatic patients, 170 operations in patients with transient ischemic attacks (TIA), 35-operations in patients with a completed stroke and one operation in a patient with a stroke in evolution. After surgery, transient neurologic deficits were noted in both the asymptomatic group (two instances) and the group with TIA (5 instances); permanent neurologic deficits followed 4 operations in the TIA group (2.4% incidence). Two operative deaths occurred in the TIA group (1.2% mortality), and 10 deaths occured after operation for a completed stroke (28.6% mortality). Nine of the deaths in the completed stroke group followed operations performed less than 2 weeks after a stroke. A 100% followup was obtained, and the average period of followup was 48 months. Of the patients surviving operation, all in the asymptomatic group were judged functionally normal, 94% of the TIA group were either functionally normal or improved, 76% with a completed stroke were improved, and the patient with a stroke in evolution was unchanged. There were 69 late deaths with heart disease accounting for 58% of the deaths and stroke another 17%.


Infection in war wounds: experience during the 1973 October War in Israel. The development of infections in 420 wounded soldiers, admitted to the Hadassah University Hospital in Jerusalem between October 7, 1973 and November 31, 1973, was studied. An attempt was made to relate the development of infection to the type of injury. The overall infection rate was 22%, but varied with the type of injury. Three "risk factors" were found to be associated with infection regardless of the number of injuries: 1)penetrating abdominal wounds involving the colon; 2) fractures involving the femur; 3) burns involving more than 25% of body surface. In patients with comparable injuries, the presence of infection was found to prolong the duration of hospitalization. Pseudomonas was the most common single pathogen. There were no cases of myonecrosis (gas gangrene). Of the 8 soliders who died, 5 died with or because of infection.


Operative management of renovascular hypertension. From 1966 to 1975, 38 patients underwent 42 procedures for renovascular hypertension; 35 operations were aortorenal bypasses and 7 were nephrectomies. Forty-five per cent of the patients were cured, 43% were improved and 12% were unimproved. There were no operative deaths and only three late deaths. Two grafts occluded and 2 became stenotic, giving a graft complication rate of 12%. Curability was best correlated with a short history of hypertension and a pathologic diagnosis of fibromuscular hyperplasia, but not with patient age. Most patients selected for surgery had elevated renal venous renin ratios, and of these 95% were cured or improved. Of those with normal renin ratios, 85% were still cured or improved. Postoperative aortography and peripheral renin measurements offered valuable information in predicting the ultimate response to surgery. Preservation of renal function was a principal indication for surgery in 11 patients. In 8, azotemia was documented preoperatively. Hypertension was cured or improved in every case and 5 patients demonstrated a 10-50% reduction in BUN and creatinine following revascularization.


Mesenteric leaf repair of pelvic defects following exenterative operations. Perineal enterocutaneous fistula and hernia are unique complications of radical pelvic exenterative operations. A technique for management of these complications is presented. A vascularized segment of small bowel mesentery is interposed as a peritoneum covered pelvic "lid" to separate the abdominal contents from the pelvic defect.


Effect of intravascular cellular aggregate dissolution in postoperative patients. It was the purpose of this study to confirm whether the increase in packed cell (PC) viscosity that occurs in humans after elective surgery is accompanied by a decrease in total body O2 consumption as previously noted in animals, and further to define the effect of resolution of intravascular cellular aggregates (ICA) on these parameters. Thirty nine patients were studied. Total body O2 consumption was 76% of normal 6 hours postop, 81% of normal 24 hours postop and 87% of normal 48 hours postop. Twenty four hours after operation PC viscosity and increased markedly. Saline infusion had no significant effect on total body O2 consumption or PC viscosity, either pre- or postop, but WB viscosity decreased linearly in proportion in the drop in hematocrit. Resolution of ICA by dextran-40 infusion was associated with return of total body O2 consumption and PC viscosity to normal; a decrease in WB viscosity was disproportionately greater than would have been seen had the decrease been due solely to the drop in hematocrit. It is concluded that in humans surgical trauma causes an increase in PC viscosity and microcirculatory impairment as evidenced by a decrease in total body O2 consumption. Resolution of ICA by dextran-40 infusion reverses that detrimental changes.


Surgical technique for creation of an arteriovenous fistula using a looped bovine graft. We have used bovine grafts in a looped configuration in the forearn in 150 patients for chronic hemodialysis and have evolved a simple technique for their successful implantation. The critical technical points include: 1) use of large-diameter long grafts (7.0-8.0 mm diameter; 34-40 cm in length); maintenance of the heterograft in a distended and pulsating state throughout the procedure to prevent distortion and twisting; 3) creation of a wide smooth-looped tunnel with Bakes dilators; and 4) anastomosis to the largest avialable antecubital vein. Thirteen cases of late graft occlusion (3-36) months) have been found to be produced by a localized obstructive lesion just distal to the venous anastomosis. These grafts were easily restored to a functional status by thrombectomy and patch graft angioplasty of the stenotic segment. The looped graft technique is not applicable to all patients requiring hemodialysis but it is especially helpful when distal vessels have been obliterated by previous procedures or when home-dialysis is planned. This surgical technique should be among the alternatives considered by surgeons concerned with problems of vascular access in patients with chronic renal failure.


Interstitial irradiation for unresectable carcinoma of the lung. From 1963 to 1971, 105 patients with histologically proved cancer of the lung were explored at Memorial Hospital and underwent interstitial implantation using encapsulated sources of radon 222 (53 patients) or iodine 125 (52 patients). These lung cancers were considered unresectable because of extension of the disease into the mediastinum with fixation or invasion of the major vessels, trachea, and esophagus or chest wall involvement. No apical lesions, which have a better prognosis, are included in this review. Sixty-nine patients had epidermoid cancer, 24 had adenocarcinoma, and the remaining 12 had various other histological types. All patients were staged according to the criteria proposed by the American Joint Committee using the TNM definitions (standing for tumor, nodes, and metastasis). Local control was obtained in 8 of 10 patients (80% with clinical Stage I and II unresectable cancers of the lung and in 44 of the 95 (46%) with clinical Stage III lung cancer. The two-year survival was 50% for Stages I and II and 7% for Stage III. Five patients have survived for five years or more. The complications, disease-free interval, local recurrences, distant metastases, and survival are presented and indications for this type of therapy outlined.


Primary cancer of the lung. A 42-year experience. Between April, 1932, and July, 1974, 3,808 patients with primary lung cancer were studied and 1,848 underwent resection. Among untreated patients, 95% were dead with a year. Unresected cancer of the lung is so lethal that efforts to streamline surgical management should not be neglected. In good-risk patients with isolated lesions the approach can be direct. If surgical excision is indicated, regardless of a positive or negative sputum cytology, bronchoscopic biopsy, or brush biopsy, such investigations become superfluous. Needle biopsy is also inconclusive and in addition is hazardous. Preoperative investigation should focus on cardiopulmonary reserve more than on ways to obtain tissue for verification. With the passage of time, the extent of resection has become more conservative. The value of palliative resection is now better appreciated in terms of quality of life, its prolongation, and, for some, a possibility for cure.


The clinical assessment of selected patients with bronchogenic carcinoma. This paper describes the clinical management of patients with malignant cells in their sputum and a normal chest roentgenogram and those with asymptomatic peripheral pulmonary masses. The source of malignant cells in the sputum of patients with no roentgenographic abnormalities can be localized by tantalum bronchography and fiberoptic bronchoscopy. Peripheral pulmonary masses can be diagnosed preoperatively by needle biopsy or transbronchial fiberoptic bronchoscopy with little morbidity and no mortality. These procedures are not necessary, however, if there is firm clinical and roentgenographic evidence of malignancy. Bronchogenic carcinomas presenting as asymptomatic circumscribed peripheral pulmonary masses have a 25% incidence of occult mediastinal lymph node metastases. In view of this relatively high incidence of metastasis, we think mediastinoscopy should routinely be performed prior to thoracotomy is asymptomatic patients with a peripheral pulmonary mass and no roentgenographic evidence of mediastinal widening.


Mitral insufficiency secondary to coronary heart disease. Twenty-four patients were operated on for mitral regurgitation secondary to coronary heart disease. Their common features consisted of a history of myocardial infarction, congestive heart failure, coronary occlusive disease, left ventricular dysfunction, low cardiac output, pulmonary hypertension, and increased left ventricular end-diastolic pressure. Fourteen patients were in intractable congestive heart failure at the time of operation. The operative procedures employed consisted of aneurysmectomy in 4 patients; mitral valve replacement (MVR) in 7;MVR and revascularization in 4; MVR and aneurysmectomy in 5;MVR, revascularization, and partial ventricular resection in 3; and MVR with closure of ventricular septal perforation in 1 patient. Six patients died, a hospital mortality of 25%, and only 42% had good results. The degree of associated coronary artery disease and the status of the left ventricular myocardium were the most important prognostic factors.


The effect of natural and surgically constructed aortopulmonary shunts on hemodynamic function in tetralogy of Fallot. A hemodynamic model has been developed for the patient with tetralogy of Fallot. Equations representing the circulatory flow pattern and oxygen balance in this disease were incorporated into a computer program. With the computer model it is possible to simulate the effect of natural and surgically constructed aortopulmonary shunt flow on hemodynamic function in tetralogy of Fallot. Graphic representations of the computer output are presented which show how aortopulmonary shunt flow influences the physiology of exercise and hypoxic episodes. An explanation is advanced for the lack of correlation between resting arterial oxygen saturation and the incidence of hypoxic episodes. The model demonstrates the effect of surgical aortopulmonary shunts in eliminating hypoxic spells.


Pulmonary edema following pulmonary valvulotomy. A previously unreported combination of critical pulmonary valve stenosis and mitral stenosis is described. The initial clinical presentation was one of right ventricular failure that obscured the evidence of pulmonary venous hypertension. Following pulmonary valvulotomy, pulmonary edema ensued because of the increased pulmonary blood flow. The importance of urgent cardiac catheterization postoperatively following an operation that increases pulmonary blood flow is discussed.


[Results of the use of the counter-pulsation balloon in experimental post coronary oclussion cardiogenic shock in closed thorax]. An experimental study of the production of cardiogenic shock together with the results of its treatment by means of the intraaortic balloon was carried out. Cardiogenic shock was produced in dogs with closed thorax and spontaneous respiration. In 13 of the 21 dogs studied, the production of acute myocardial infarction by means of selective embolism of the left circumflex artery permitted the reproduction of a model of cardiogenic shock. Embolism was produced by injecting metalic mercury through a double catheter. Six of the 8 remaining dogs died due to accidental introduction of mercury in the anterior descending coronary artery which produced irreversible ventricular fibrillation. The other 2 died due to rupture of the ascending aorta during the maneuveres to place the coronarygraphy catheter. The 13 dogs with cardiogenic shock were treated with intraaortic balloon pumping during 3-4 hours. The left ventricular systolic pressure fell from 128 +/- 12.07 to 124 +/- 4.65 mm. Hg. The cardiac index increased by 42%. These findings confirm the fact that intraaortic balloon pumping lessens the after load. The fall of the telediastolic pressure by 20% was an index of the lessening or the preload. The aortic telediastolic pressure rose by a mean value of 32.21 mm. Hg. This raises the coronary perfusion pressure thus limiting the extension or reducing the size of the infarction. A frank reduction of the electrographic subepicardiac lesion was observed after using intraaortic balloon pumping. The mean aortic pressure only rose by 8%, the central venous pressure remained unchanged and the increase in diuresis was not estimable. The maximum dP/dt was unaltered and the Vmax. rose 17%. Two dogs were left alive after the experiment and lived for 3 and 12 days respectively. To conclude the results obtained permit us to indicate that intraaortic balloon pumping when used in dogs with this standard type of cardiogenic shock produces an important reduction of the after load, a discrete reduction of the preload and a significative increase in coronary blood flow. There were no changes in cardiac frequency and although the results of myocardial contractility were not definite, they seem to indicate a moderate improvement.


[Tricuspid atresia: A therapeutic problem]. 1. The authors present 80 cases of tricuspid atresia of the Children's Cardiology Service of the Instituto Nacional de Cardiología de México. They propose their own classification based on the position of the visceral suits and of the great arteries and the possible existance of a persistent truncus arteriosus. 2. The requirements that should be fulfiled to establish an anatomic and hemodynamic diagnosis are determined; and the need to know in detail the anatomy of the right ventricle; of its exit chamber, of the pulmonary valve and of the pulmonary truncus is emphasized; as well as the measures in the auricles and the left ventricle. 3. They insist upon the need, when the pulmonar arterial pressure cannot be measured directly, to introduce a catheter in a pulmonar vein, because the pressures obtained are quite similar to the pressure in the pulmonar arterial territory. 4. The fundamental data of the anatomic and hemodynamic study are discussed and illustrated. They confirm the close relation that exists between the diameter of the exit chamber of the right ventricle and of the valvular ring, the pulmonary truncus and its branches. 5. In all cases of tricuspid atresia with AQRS deviated to the right and downwards in the frontal plane; transposition of the great arteries should be thought of when it deviates to the left and upwards, in patients with crossed great arteries. 6. In the cases operated with sistemic-pulmonary fistula, there was an intrahospital mortality range of 25%, similar to that obtained by most authors. 7. The paliative surgical procedures are analyzed, and those that at present could be considered as "corrective" such as Fontan and Kreutzer's operations. The need, to gather several diagnostic parameters. To establish the surgical indication in the sistemicpulmonary and venus shunts, is emphasized.


[Aneurysm of the pulmonary artery. Analysis of 7 cases]. Aneurysms of the pulmonary artery are very rare, very few have been reported in medical literature. It is the purpose of this paper to present and discuss 7 cases. The etiology was congenital in 2, syphilitic in 2, cystic medionecrosis in 1, and mycotic in 2. The diagnosis was confirmed by necropsis in 3, and by angiography in 4. The basic clinical aspects are hemoptysis, pulmonary ejective murmur, and the radiological findings. The evolution depends on the etiology. The mycotic aneurysms ruptured and the patient with cystic medionecrosis died in heart failure. One of the syphilitic aneurysms died from an unrelated cause, and the others are alive and asymptomatic. The medical treatment is determined by the etiology.


[Phonomechanocardiography in the evaluation of the functional status of valvular prosthesis]. The FMCG in 22 patients with valvular prosthesis is analyzed and its clinical, hemodynamic and surgical correlation are established (11 from the I.N.C. and 11 from the Hospital Infantil I.M.A.N.). The average age of the patients was 15 years old, 18 had a mitral and six aortic valvulopathy, and they all required a valvular replacement. Of the mitral prosthesis, 14 were Starr-Edwards (13 of ball valve and one of disc), three Lillehei-Kaster and one Börck-Shiley. In 5 patients, the FMCG suspected disfunction that was later corroborated by catheterism in three patients and by surgery in all of them. The important differences of the FMCG between the group with good and the one with bad function were: the aparition of a rumble, a decrease in the amplitud of the closing snap, index of closing snap opering snap of less than one, lenghtening of fases PFVP and IVCP, and shortening of IVDRP. In the patients with auricular fibrilation, after long dyastoles; that would represent an adequate atrial emptying; the closing snap was more intense, the PFVP was lennthened the IVDRP was shortened when the prosthesis was not properly functioning. All the aortic prosthesis were ball valve Starr-Edwards type; in one the FMCG suspected disfunction and the patient had a sudden death outside of the Hospital. The significant differences of the FMCG were the decrease in the intensity of the opening snap, with a Hylen index of less than one, lengthening of the PFVP, IVCP and of the expulsive period (EP). The authors conclude that the FMCG is a good method for an early detection of the disfunctions of valvular prosthesis.


[Phonomechanocardiographic analysis in patients with artifical pacemaker]. Eighteen patients with artificial pacemakers have been studied by phonomecanocardiographic means. All had complete atrio-ventricular block. Ten had an endocardial electrode in the right ventricle and 10 an epicardial in the free wall of the left ventricle. Two patients were studied, first with a temporal endocardial pacemaker and then with a permanent one. The studies were divided in 3 groups: Group I. In six cases comparison was made between the systolic tunes of the normally conducted cycles, and the ones produced by direct ventricular stimulations. The beats produced by direct ventricular stimulation showed a statistically significant diminution of the function of the left ventricle. This was reflected by a shorter relative ejection period. This diminution can possibly be explained by one of two mechanisms: absence of the "atrial kick", or alteration in the sequence of depolarization and ventricular contraction, producing an asynchrony in the contraction. This would lead us to suppose that the best site for contact of the electrode would be the middle third of the left aspect of the ventricular septum, where the activation starts normally. Group II. Ventricular function was compared in 20 cases, depending on the site of electrical stimulation: endocardium of right ventricle or epicardium of the left ventricle: there were no statistically significant differences. Group III. On 14 cases we studied cycles in which an effective contribution of the atrial kick could be expected, because the interval between the P wave and the electrical artifact was less than 300 msec. These were compared with others with a larger, statistically significant, improvement of the left ventricular function it was observed as a longer ejection period in the cases with a P wave-electrical artifact pause shorter than 300 msec.


[Value of the electrocardiogram to predict the pattern of left ventricular contraction in ischemic cardiopathy]. A correlative electrocardiographic and ventriculographic study was performed in a series of 100 patients with clinical and electrocardiographic diagnosis of ischemic heart disease. The analysis was focused on the possibility of predicting ventricular contraction pattern (VCP) disturbances, through electrocardiographic signs of coronary insufficiency. Two main groups were separated on the basis of the presence of necrosis. There were 66 cases with necrosis, and 34 without it. The type of VCP was calssified in accordance with the criterion of Herman et al. in: asyneresis, akinesis and dyskininesis. The degree of coronary narrowing was arbitrarily evalued as less than 50%, between 50 and 75%, and over 75% of the lumen.


[The effects of imolamine on auriculo-ventricular conduction by recoil of His potential]. The electropharmacological action of imolamine was studied using Hiss bundle electrography.  In dogs with spontaneous sinusal rhythm, imolamine decreases Hiss-Purkinje and total intraventricular conduction, without affecting auriculoventricular conduction time. In dogs with paced sinusal rhythm (180/min), imolamine increases atrial and ventricular thresholds and atrial refractory period, and decreases intra-atrial and intraventricular conduction; no significant modification of auriculoventricular conduction was noted at therapeutic dosages. In ouabaïn-intoxicated dogs, imolamine suppresses digitalis rhythm disorders and antagonizes the action of the glycoside on A-V node, as does diphenylhydantoïne, but, in contrast to this drug, it increases slightly intraventricular conductivity.


[QRS in mitral stenosis: Electrohemodynamic correlation]. The electrocardiograms of 50 patients with mitral stenosis in sinus rhythm were reviewed (axis of QRS and T in the frontal and horizontal planes, with each one of their modules, Lewis index and right Sokolow-Lyon, quotient R/R + S in V1, time of beginning of the intrinsecoide deflection of QRS), they were related with the hemodynamic data; and the existence of clear relations between both methods of exploration were confirmed. 1. The QRS axis in the frontal plane kept a good relation with the hemodynamic data (mainly thzontal axis there proved to be a closer relation than in this one. 2. The quotient R/R + S in V1 was the parameter that best correlated with the mean pressure of the pulmonary artery and with the pulmonar capillary pressure. 3. Although the right Sokolow-Lyon index is not a definite criterion for recognizing a right ventricular hypertrophy; it is very useful in correlating the total pulmonary resistances with the mean pulmonary arterial pressure, even if it did not reach pathologic values. The same can be said the Lewis index, although the dependence is less important. 4. The horizontalization of the frontal axis of T becomes more important with the increase in the hemodynamic repercution. 5. As an expression of the systemic hemodynamic alteration, the decrease in time of inscription of the intrinsecoid deflection, of the left ventricle in V6 became evident when the mitral area diminished or by increase of mean pressure of the pulmonary artery. 6. The electrocardiographic characteristics that allow to recognize the existence of a mitral area smaller than 0.8 cm2, with a possibility of error of less than 5% (false positives), are: -- a horizontal axis of QRS less or equal to + 9 degrees -- a right Sokolow-Lyon index of more than 21.56. 7. The existence of a mean pressure of more than 25 mm. Hg in the pulmonary artery can be acknowledged, with a possibility of false positives of less than 5%, by the apparition of one or more of the following data: -- a frontal axis of QRS more or equal to + 87 degrees -- a Lewis index of less than -7.44. 8. The diagnosis of mean pressures of the pulmonary artery of more than 35 mm. Hg can be established, with the same degree of possibility, by: -- a T frontal axis of less or equal to + 10 degrees -- a horizontal axis of QRS of less or equal to + 13 degrees -- a right Sokolow-Lyon index of more than 19.71 -- a quotient R/R + S in V1 more or equal to 0.88. 9. The only finding that permits to establish of a pulmonary capillary pressure higher of 25 mm. Hg, with false positives possibility of less of 5% is: -- quotient R/R + S in higher or equal to 0.07 in V1.


[Electro-ventorcardiographic manifestations of ventricular inversion with transposition of great arteries]. Electrocardiograms obtained in two groups of patients with inversion of the ventricles and transposition of the great arteries, were analyzed: group I corresponding in situs solitus and group II to situs inversus. This series comprises 36 cases (29 of group I and 7 of Group II), in which the diagnosis of the main congenital heart disease --ventricular inversion-- and of the associated defects was established by angiocardiography. In 7 cases of group I and in one of group II, the angiocardiographic diagnosis was proved at least in part during open heart surgery. Direct anatomic study was possible in 5 more cases of group I and in 2 more of group II. Each group comprises two subgroups: A, without RBBB, and B, with RBBB of different degrees. Group I consists of 11 cases of subgroup A and 18 of subgroup B. In group II there were 2 cases of subgroup A and 5 of subgroup B. Vectorcardiograms were obtained following Grishman's method in 17 cases of group I (8 of subgroup A and 9 of subgroup B) and in 3 cases of group II (1 of subgroup A and 2 of subgroup B). In 7 cases of group I (5 of subgroup A and 2 of subgroup B), it was possible to record also the vectorcardiographic curves following Frank's method. Electro and vectorcardiographic findings were correlated with hemodynamic data and, in some cases, also with anatomic ones.


[Comparison of the antiarrhythmic effects of PGA1, PGA2, PGE1, PGE2 and PGF2 alpha on a barium chloride arrhythmia model in unanesthetized rabbits]. Experimental studies on BaCl2 induced arrhythmias in unanaesthetized rabbits showed an antiarrhythmic effect of prostaglandins A1, A2, E1, E2 and F2a by infusions of 0,1 to 6,0 mug/kg/min over 3 min. There was a maximum antiarrhythmic effect between 50% and 80%. Ajmaline was similarly effective when given in doses 100-1000 times higher. PGA1 and PGE2 were most effective in this model; the ED50-values of the other PGs were 2-3 times higher. The mode of action of PGs is unknown; the following factors are discussed: the influence on the ionic movements, the negative feedback mechanism on the release of adrenergic transmitter and central nervous effects.


Comparison between the effects of ST 600 and clonidine. The effects of the antihypertensive imidazoline compounds 2-(5 fluor-0-toluidine)-2-imidazoline hydrochloride (ST 600) and 2-(2, 6 dichlorophenylamine)-2-imidazoline hydrochloride (ST 155, clonidine, Catapres) on intra-arterial pressure, cardiac output, stroke volume, heart rate, total peripheral resistance, renal blood flow, glomerular filtration rate, renal vascular resistance, plasma volume, plasma renin and aldosterone concentration were studied in five patients with essential hypertension. The antihypertensive action of both compounds was similar and was accompanied by a reduction in heart rate and in cardiac output, total peripheral resistance being unchanged. There was no significant decrease in renal blood flow and glomerular filtration rate. Plasma volume and plasma concentrations of renin and aldosterone also did not change significantly. In the face of similar reductions in blood pressure, no differences were observed between cardio-renal haemodynamic responses after ST 600 and clonidine. However ST 600 had a longer lasting effect (8-12 hours).


[Value of interacardiac recordings in the evaluation of positive QRS in V1 provoked by stimulation of the right ventricle]. The analysis of the common bundle and of the ventrical filtered electrograms has incrased our knowledge of the intraventricular conduction following the simulation of the PVS as well as the different types or reciprocating that can be produced by premature beats. 2. The positive QRS complexes in V1 produced from PVD by St2 can be explained as a greater degree of incomplete recuperation of the right ventricular wall than in the interventricular septum. In contrast with what happened in the basal beats, where the front took longer to reach the TSVD than the VI. 3. The refractarines of the transitional tissues that serve as the phisiological banier was longer than the banal myocardium. The intraventricular propagation, and therefore the morphology and direction of QRS, depended of this one; while the moment of arrival of activation retrogradly to the common bundle was conditioned by the transitional tissues. 4. Episodes of ventricular taquicardies with QRS positive complexes in V1 can be due to a re-entry throught the bundle branches or in (or around) an area that has been recently injured.


[Acut aortic insufficiency caused by rupture of a normal valve during labor]. We are presenting a case of a young woman with sudden onset of heart failure and several episodes of syncope, after a prolonged labor. The findings at physical examination suggested the diagnosis of acute aortic insufficiency, that was confirmed by cardiac catheterization. At surgery, the aortic valve showed a round perforation in the non coronary cusp. Pathological examination of the valve showed no significant abnormality. We conclude that the stress of labor was the cause of the rupture of a previously normal aortic valve.


[Agenesis of the right branch of the pulmonary artery, diagnosis by lung scan]. The white thrombus is formed due to the platelet adhesiveness to the vascular wall, and to their agglutination mediated by the liberation of ADP, the adenosine inactivation and the deposit of calcium and accelerating factors of coagulation as well. The red thrombus is formed by the thromboplastic activity, combined with the action of several coagulation factors, fibrin, erythrocytes and leucocytes. For the above mentioned facts, we may try to avoid the white thrombus formation by means of antiadhesive platelets drug, and the red thrombus production with the use of anticoagulants. If the thrombus is already formed, the drugs of choice are the fibrinolytics, to intend the dissolution of the clot. In the present paper, the mean characteristics as well as the actual concepts on the use of these three groups of drugs, are described.


Loperamide antagonism of castor oil-induced diarrhea in rats: a quantitative study. The time-course of castor oil-induced diarrhea in fasted rats was quantified by weighing stools every 15 minutes for 8 hours after the challenge and then after 24 hours. Diarrhea began within 1 hour as a series of rapidly occurring evacuations over 20 to 40 minutes. The mean weight of these stools was 5.7 g; later irregular evacuations increased the weight to 9.4 g at 8 hours. The area of individual time-weight diagrams had a median value of 432 units. Pretreatment with 0.16 mg/kg of loperamide, a new antidiarrheal drug, significantly decreased the area of similarly obtained diagrams; 0.31 mg/kg caused a 50% reduction. This antagonism by loperamide of castor oil-induced diarrhea may involve reduction in the severity of inflammatory changes in the intestinal wall.


Direct renal hemodynamic effects of two vasodilators: diazoxide and acetylcholine. The direct renal hemodynamic effect of two different vasodilators, diazoxide and acetylcholine, in the anesthetized dog, were studied. In 12 dogs (Group 1), diazoxide was given first directly into the renal artery and was followed by the addition of acetylcholine. In 6 dogs (Group 2) the order of drug administration was reversed. The glomerular filtration rate (GFR), the effective renal plasma flow (ERDF), and the excretion of sodium, potassium, chloride, and urine output were determined for both control and experimental (infused) kidneys. Both drugs when given alone resulted in a significant increase of all parameters tested on the experimental kidney, except the ERPF which was spuriously decreased by diazoxide. The addition of either drug upon the first given did not produce and further effect. It was, therefore, concluded that the hemodynamic changes, as well as the handling of electrolytes and water by the kidney, were solely due to the vasodilating properties of both compounds. A local renal tubular effect by diazoxide concerning sodium excretion could not be substantiated by our studies.


Effects of suprofen, an inhibitor of prostaglandin biosynthesis, on platelet function, plasma coagulation and fibrinolysis II. In vivo experiments. Suprofen, an inhibitor of prostaglandin biosynthesis, was found to affect certain aspects of platelet function after in vivo administration in various species. In guinea-pigs, platelet aggregation induced by collagen and Thrombofax, and secondary A.D.P. aggregation were reduced in a dose-dependent way by suprofen (single oral administration) from 0.08 mg/kg on. In dogs, the effect of a single oral dose of 2.5 mg/kg of suprofen on collagen-induced aggregation started 30 min after administration, lasted for at least 8 h and had disappeared after 24 h. Plasma coagulation parameters were not affected by the compound in this species. In rats, suprofen prolonged tail bleeding times, but did not modify fibrinolysis, platelet adhesion to glass beads or plasma coagulation. Sub-chronic administration of comparatively high doses of the compound resulted in potentiation of the anti-coagulant effect of warfarin in this species.


In vitro influence of steroidal hormones on protein and glucose metabolism of isolated granulomatous tissue cells. A standard method of preparing isolated cells from granulomatous tissue capsules was developed. Results of morphological and chemical studies indicated that the cells were intact and functional. An inhibitory effect of glucocorticoids added in vitro was demonstrated for the first time, and this effect was consonant with the influence of glucocorticoids on granulomas in vivo. The isolated cells were predominantly monocytes, macrophages and lymphocytes with smaller numbers of polymorphonuclear leucocytes, mast cells and fibroblasts. Dimethyl sulfoxide, used to aid steroid solubilization (0.0016 ml/ml), had no influence on protein synthesis or on glucose oxidation. Cholesterol, a nonhormonally active sterol (1 x 10(-4) M, 3 x 10(-4) M), had no effect on labeled glycine incorporation. Methylprednisolone (1 x 10(-4) M, 3 x 10(-4) M) decreased protein synthesis after 30 min of incubation indicating that this might be one important early mechanism of action. Methylprednisolone (1 x 10(-4) M) had no influence on glucose oxidation. Deoxycorticosterone (1 x 10(-4) M, 3 X 10(-4) M) inhibited both protein synthesis and glucose oxidation after 30 min of incubation.


Contractor effect of barbiturates on smooth muscle. Four different convulsant barbiturates and also thiopental, methohexital and pentobarbital were tested for in vitro contractor effects on rabbit jejunal segments, aortic strips and tracheal chains. The two convulsants that elicited lethal, tonic seizures in vivo contracted all three types of isolated preparation; however, two other convulsants that elicited intense but nonlethal, clonic seizures lacked contractor effect. Methohexital and pentobarbital also lacked contractor effect. In aortic strips, contractions induced by the two convulsants were not impaired by concentrations of phenoxybenzamine (10(-5) M) that blocked all contractor response to 10(-4) M norepinephrine, acetylcholine or histamine. Thiopental also contracted aortic strips but the effect differed from that of the convulsants in that it was much less intense, was partially antagonized by pretreatment with phenoxybenzamine, and was greatly potentiated by the presence of norepinephrine. Intense contractor effects, independent of adrenergic mechanisms, seem characteristic of a particular group of convulsant barbiturates; there are also similar with respect to structure, stimulant potency, and seizure pattern.


Comparison of animal models for predicting bronchodilator efficacy in man. In vitro and in vivo models of bronchodilation were compared to assess their relative usefulness for  predicting clinical efficacy. Drugs studied were isoproterenol, isoetharine, salbutamol, hexoprenaline, terbutaline, ephedrine and aminophylline. In vitro preparations were guinea pig perfused lung, tracheal strip and spontaneously beating right atria. In vivo, drugs were compared by three routes in conscious guinea pigs and anesthetized dogs and relative  potency estimates and separations of bronchodilator and heart rate effects of these agents were determined. The  Spearman rank correlation coefficient was statistically significant when the effects of the drugs were compared for guinea pig perfused lung and tracheal responses, in vivo guinea pig and dog intravenous and oral (or intraduodenal) responses. Aerosol results did not correlate, most likely due to differences in experimental techniques. Relative potency estimates were in general agreement with human data in the literature and support the use of these tests for the study of bronchodilator agents.


Effects of atropine and neostigmine on receptor interaction at the neuromuscular junction. Rats treated chronically with atropine or atropine and neostigmine showed marked alterations in the responsiveness of receptors at the neuromuscular junction. Receptors in the phrenic nerve-hemidiaphragm interacting with d-tubocurarine were unaffected by atropine but exhibited a supersensitivity after neostigmine administration. Succinylcholine-sensitive sites developed a subsensitivity with both atropine and neostigmine treatment. Acetylcholine-induced contractures in the denervated hemidiaphragm showed a hypersensitivity after both drug administrations, but responses to carbamylcholine were unaffected. It is suggested that there exists a heterogeneous population of receptors at the mammalian neuromuscular junction who can be identified by their responses to the effects of chronic drug application.


Cardiovascular and antiarrhythmic effects of carnitine. Thresholds for electrically induced atrial fibrillation were measured in response to IV carnitine. Mean arterial pressure, heart rate, and mean aortic flow rate were also monitored. Carnitine 100 mg/kg resulted in an increase in mean aortic blood flow. The antiarrhythmic effect was much less than with 5 mg/kg quinidine, but after atropinization, 100 mg/kg carnitine was similar in antiarrhythmic effect to quinidine and did not result in the blood pressure depression seen with quinidine.


Effects of L-dopa on myocardial contractile force: a reappraisal. The apparent decrease in myocardial force of contraction observed after L-dopa, 10 mg/kg i.v., is artifactual since the maximum rate of left venticular isovolumic pressure rise (dP/dt) remains elevated. The apparent decrease is due to shrinkage in heart size secondary to venous "pooling". The decrease in contractile force parallels a decrease in cardiac output. A peripheral decarboxylase inhibitor and L-dopa produce a decrease in both contractile force and dP/dt. Strain gauge arch recordings may produce false-positive data during marked venous pooling.


The effect of ethylurethane on hematocrit, blood pressure and plasma-glucose. Intraperitoneal (i.p.) injection of 25% ethylurethane (i.e. 2.8 M) in a dose of 1 g/kg causes a rise in hematocrit (Hct) accompanied by an identical rise in erythrocyte count but by a fall in plasma protein. This effect is absent after intra-arterial (i.a.) and oral administration and much reduced after subcutaneous (s.c.) injection. The hemoconcentration is not caused by osmotic attraction of fluid but by leakage of blood plasma into the peritoneal cavity. The higly concentrated urethane solution causes superificial damage of intra-abdominal organs. Extensive local damage is also observed after s.c. and intramuscular injection of 25% urethane. The fall in blood pressure which is found after i.p. injection, but is absent after i.a. injection, can be explained by the loss of blood plasma. Plasma-glucose rises after i.p. injection but not after i.a. injection. This hyperglycemia may be initiated by stimuli arising in the damaged tissues.


Effect of amantadine on blood pressure responses induced by vagal and sympathetic stimulation. Amantadine antagonizes the blood pressure responses evoked by electrical stimulation of the central and peripheral end of the vagus. Blood pressure responses on sympathetic stimulation are also attenuated. These results could be explained on the basis of a possible effect on autonomic ganglia.


The effects of dexetimide on pimozide-, haloperidol- and pipamperone-induced inhibition of brain self-stimulation in rats. Pimozide (0.04, 0.16, 0.63 and 2.50 mg/kg), haloperidol (0.01, 0.04, 0.16 and 0.63 mg/kg) and pipamperone (2.50, 10.0, 40.0 and 160 mg/kg) were given subcutaneously to rats, pressing a lever for brain-stimulation through electrodes implanted in the lateral hypothalamic region of the medial forebrain bundle. The lowest dose of each neuroleptic did not affect self-stimulation; the second dose inhibited the response rate by approximately 50%, whereas the two highest doses completely suppressed self-stimulation behaviour. The centrally acting anticholinergic dexetimide (0.63 mg/kg, s.c.) completly antagonized the pimozide-induced inhibition; the haloperidol-induced inhibition was also completely antagonized except at its highest doses, whereas the effects of the sedative neuroleptic pipamperone were not antagonized. These data are consistent with a presumed dopaminergic cholinergic striatal interaction and show brain self-stimulation to be an effective measure of neuroleptic-anticholinergic interaction.


Dichlorvos and the cholinergic system: effects on cholinesterase and acetylcholine and choline contents of rat tissues. The inhibition of cholinesterase by 50 mg/kg/5 ml, p.o., dichlorvos and subsequent recovery of enzyme activity was uniform in all brain regions studied. This uniformity was not observed in liver, erythrocytes and plasma. Acetylcholine levels were elevated in brain areas from 48 to 171% at 15 minutes after treatment. However, a biphasic effect was seen on choline metabolism in the brain. The cortex was found to be more cholinergic than the striatum in terms of per cent increase in acetylcholine and choline.


The effect  of 1-sarcosine, 8-leucyl angiotensin II on glycerol-induced acute renal failure. Several studies have suggested that increased activity of the renin-angiotensin system plays an important role in the pathogenesis of acute renal failure. An analog of angiotensin II, 1-sarcosine, 8-leucyl angiotensin II (AIIA), a potent antagonist of the pressor response of angiotensin II (AII), was injected (16 mug/200 gm) or infused (1.5 mug/200 gm/min) intravenously into glycerol treated (8 ml/kg) rats to evaluate the involvement of the renin-angiotensin system as a mediator in the pathogenesis of acute renal failure. Dehydrated animals, whether untreated, given AIIA, or saline became progressively azotemic and died with 72 hours after glycerol administration. Plasma renin activity, as measured by radioimmunoassay, decreased below dehydrated control levels at one hour after glycerol administration (7.45 ng/ml/hr +/- 1.29 (SE) to 3.24 +/- 0.64), and progressively increased to a maximum 9.9 +/- 0.98) at 17 hours; there was no difference between dehydrated control levels and those obtained 24 and 48 hours after glycerol. Nondehydrated glycerol treated rats were studied as above. These animals developed a non-lethal form of acute renal failure, the severity of which was also unaffected by AIIA administration. These observations indicate that AIIA neither prevents nor alters the development of glycerol induced acute renal failure.


[The influence of treatment with cocaine on the synthesis and liberation of cerebral noradrenaline]. The influence of cocaine (10 mg/kg, i.m.) on the synthesis and the release of noradrenaline (NA) has been studied in rat brain. Cocaine pretreatment reduced significantly the amount of NA-3H synthetized from tyrosine-3H (TY-3H) in the whole brain and various cerebral structures. The synthesis rates of NA (estimated by calculation of the ratio: amount of NA-3H/tissular specific activity of TY-3H) were reduced by 40% in the whole brain, 30 and 60 min after administration of TY-3H. The rise of the NA endogenous level 10 min after administration of a monamine  oxidase inhibitor (ranylcypromine) was inhibited after cocaine treatment. The release of NA has been studied after inhibition of its synthesis by alpha-methyl-paratyrosine. Cocaine pretreatment significantly delayed the disappearance rate of cerebral NA. The possible mechanisms by which cocaine reduced NA turnover are discussed.


[Accumulation of ephedrine, norephedrine, amphetamine and tyramine labeled with carbon 14 in pigmented and non-pigmented eyes in two races of rats]. The pigmented eyes of non albino rats (PVG) accumulated ephedrine, norephedrine and amphetamine. After 15 min accumulation of ephedrine and amphetamine was larger than of norephedrine. Autoradiographic studies showed that accumulation occurred in melanin containing iris and choroid and also in lacrymal glands which lack melanin. Accumulation of tyramine did not occur in eyes containing melanin. The non pigmented eyes of albino rats did not accumulate ephedrine, amphetamine, norephedrine and tyramine. It appeared that in pigmented eyes melanin was a site of loss of ephedrine,  amphetamine and norephedrine; hence a smaller amount of drug will be available for interaction with adrenergic neurons and a smaller mydriatic effect will occur. Accumulation is possible only when metabolism is low, as observed with alpha-methylated amines. The four sympathomimetic amines used did not accumulate in the pigmented skin of black and white rats.


Preventive effect of estrogen on postmenopausal bone loss. Follow-up studies of bone mineral content in the radius were done in 82 postmenopausal women 4 to 10 years after the first examination. These patients were subdivided into four groups depending on the type of menopause (artificial or natural) and estrogen administration (treated or untreated). Bone mineral mass and combined cortical thickness decreased significantly in both groups of untreated women. Both mineral loss per year for the untreated women was -9.1 mg/sq cm for castrates and -6.9 mg/sq cm for those with a natural menopause. In neither group was the rate of loss correlated with age. The change in bone mineral mass per year in the estrogen-treated subjects (mean +3.25 mg/sq cm) differed significantly from that of untreated subjects (mean -7.99 mg/sq cm). The findings suggest that postmenopausal osteoporosis could be prevented by estrogen treatment.


A reappraisal of staging and therapy for patients with cancer of the rectum. I. Development of two new systems of staging. Existing systems of staging for patients with rectal cancer depend almost exclusively on anatomic evidence. Consequently, the stages cannot be determined in advance of therapeutic decisions and cannot be used for patients treated without surgery. Furthermore, the stages contain no provision for important prognostic distinctions, that cannot be discerned from anatomic data. After preparing a taxonomy for hiterto unclassified medical data, we developed and tested two new systems of staging in a cohort if 318 patients. The first system which can be applied before treatment, is divided into four composite stages that contain elements of symptomatic, chronometric, co-morbid, and para-morbid data, as well as information obtained from physical examination, sigmoidoscopy, and roentgenography. The second system, applicable to patients with resected tumors, is based on a combination of pre-therapeutic clinical information and post-surgical anatomic evidence. The two systems produce prognostic gradients that are clinically distinctive and statistically efficacious.


A reappraisal of staging and therapy for patients with cancer of the rectum. II. Patterns of presentation and outcome of treatment. Two new biologically composite systems of staging were used to analyze the patterns of presentation, therapy, and outcome for 318 patients with rectal cancer. Selectional bias was evident in therapeutic decisions. The patients chosen for surgical exploration and possible resection came mainly from prognostically favorable stages and had higher survival rates than the "inoperable" patients wven when the tumor was not resected. In patients with tumors located 8 cm or higher above the anus, survival rates in each composite symptom-anatomic (S-A) stage were essentially similar with radical and simple resections. Radical surgery gave better survival rates than simple surgery for tumors at 5 to 7 cm and was an anatomic necessity to remove tumors at 0 to 4 cm. Regardless of the extensiveness of surgery, the S-A stages were directly related to rates of postoperative infection, postoperative death, subsequent quality of life, and deaths due either to cancer or to noncancer causes.


Physiologic and biochemical abnormalities in self-induced drug overdosage. The following abnormalities were observed during the first 24 hours of admission for 162 drug overdosage (OD) episodes in 152 patients: abnormal chest x-ray films; increased A-aO2 gradient; elevated white blood cell (WBC) counts; elevated serum enzyme levels; gross myoglobinuria; skin lesions suggestive of pressure necrosis; and abnormal electrocardiograms. Many sputum cultures were positive for single or multiple potentially pathogenic organisms. These correlations existed: all patients with OD duration of less than 12 hours were hyperthermic; as temperatures increased so did WBC counts; hyperthermic patients had higher creatine phosphokinase (CPK) values than those with hypothermia or normothermia; patients with skin lesions had higher temperatures and CPK values and longer OD duration; serum enzme levels increased with increasing OD duration; patients with CPK levels greater than 10,000 mU/ml had myoglobinuria; and patients with the most abnormal chest x-ray films had higher temperatures and larger A-aO2 gradients. Incidence of pneumonitis is low, even with abnormal chest radiograms, leukocytosis, hyperthermia, and positive sputum cultures. Abnormal temperatures and leukocytosis are probably secondary to stress, hypoxemia, acidosis, and specific drug ingestion rather than infection.


Long-term observations of glucose tolerance in thyrotoxic patients. In an attemp- to clarify the clinical importance of glucose intolerance associated with acute thyrotoxicosis, 22 patients had evaluations performed for glucose tolerance while thyrotoxic and at mean follow-up times of 8.8 months and 11.6 years after adequate antithyroid treatment. High incidences of glucose intolerance at long-term follow-up (32%) and of histories suggestive of diabetic diathesis (43%) support the hypothesis that there is an inherited relationship between diabetes mellitus and thyrotoxicosis and suggest that initial testing of all thyrotoxic patients for glucose intolerance is advisable. In addition, all thyrotoxic patients displaying diabetic glucose intolerance after a return to the euthyroid state should be considered to have permanent diabetes mellitus until proved otherwise.


Evidence for mild reversible hyperparathyroidism in distal renal tubular acidosis. Circulating levels of immunoreactive parathyroid hormone were measured in six patients with distal renal tubular acidosis before and during two years of long-term alkali therapy. Parathyroid hormone level was elevated modestly in five patients before treatment and fell, gradually during treatment to normal or near normal levels. Urine calcium level fell, serum calcium level rose, and renal phosphorus reabsorption rose during treatment. Stopping treatment briefly caused reversion of serum parathyroid hormone and calcium levels and renal phosphorus reabsorption to pretreatment values within eight weeks. Mild hyperparathyroidism is present in renal tubular acidosis and reverses with alkali treatment.


Misplacement of central venous pressure catheters and unilateral pulmonary edema. Two instances of misplacement of a central venous pressure monitoring catheter into a pulmonary artery are presented. In one case, reported in detail, unilateral pulmonary edema developed during administration of 0.5N saline for the treatment of diabetic acidosis via the misplaced catheter, and it reverted following repositioning of the catheter in the superior  vena caca. Experiments were carried out in dogs to explore possible causes of this phenomenon. The results of these experiments suggest that the release of vasoactive substances, stimulation of neural reflexes, or both are the pathophysiological mechanisms responsible for the development of the pulmonary edema.


Tetany, malabsorption, and mastocytosis. Mastocytosis is characterized by increased proliferation of mast cells. Two patients had systemic mastocytosis involving the skin and gastrointestinal tract, complicated by malabsorption and tetany. Absorption studies in these patients suggested that the entire small bowel was involved and that the defect was mild in the absence of diarrhea. Small bowel biopsies disclosed infiltration of the lamina propria and submucosa by mast cells, and gastrointestinal tract x-ray films showed nodular densities, edema, and thickening of the bowel wall. Tetany was due in part to combined hypocalcemia, hypomagnesemia, and hypokalemia. Diarrhea and malabsorption were due to mast cell infiltration of the bowel rather than to histamine. patients with signs of systemic mastocytosis should have careful evaluations and be followed up to prevent development of malabsorption and tetany.


Empty sella syndrome. Sequela of the spontaneous remission of acromegaly. Untreated acromegaly is usually a progressive disorder resulting in early death from cardiovascular or pulmonary complications. Although spontaneous remission of the metabolic features of acromegaly is not uncommon, its correlation with return to truly normal serum growth hormone concentrations is not routinely documented. This study reports a patient with the empty sella syndrome occurring as a sequel to the spontaneous remission of acromegaly. This association, as well as the preservation of normal anterior-pituitary function, suggests that selective tumor infarction resulted in the "empty sella" and cessation of active acromegaly.


[Quantitative analysis of the electroencephalographic activity during human sleep]. Correlation of hormonal changes and EEG activity requires objective measurements to define the behavior of the different frequency bands during sleep. With this purpose, EEG activity of six healthy male volunteers (19-22 years) was recorded throughout all night during spontaneous sleep. The C4-left mastoid EEG combination was channeled to a frequency analyzer with four band pass filters (beta, alpha, theta, and delta) using a one minute averaging interval. Analyzer data were fed to an IBM-1130 computer, programmed with RC filter recursive algorithm. Sleep stages were characterized in the polygraphic record (Rechtshaffen criteria), and identified in the smoothed profile. The latter was computed for mean voltage value of each band during the sleep stages. Differences in the behavior of each band throughout sleep stages were statistically tested. Delta activity showed the highest discriminatory capacity characterized by a statistically different mean voltage value in all sleep stages, with the exception of R-I. The method is proposed for quantitative correlation of the EEG sleep phenomena with another physiological parameters.


Halobacterium volcanii spec. nov., a Dead Sea halobacterium with a moderate salt requirement. A halophilic bacterium was isolated from bottom sediment from the Dead Sea. The organism possessed the properties of the halobacteria, but differed from the known species in two important respects, 1) the cells were disc shaped and often cupped when grown under optimum conditions, 2) the optimum requirements for sodium chloride was in the range 1.7--2.5 molar which is about half of that generally reported for the halobacteria. The organism was assigned to the genus Halobacterium and described as Halobacterium volcanni spec. rov. The optimum sodium chloride concentration for growth was close to that found in the Dead Sea. The tolerance for magnesium chloride was very high; the organism grew well in media containing magnesium chloride in the concentrations found in the Dead Sea. Halobacterium volcanii is therefore remarkably well fitted for life in the Dead Sea.


[Electron microscopy of ageing cells of Pseudomonas rhodos: fine structure of native and isolated tubular membranes (author's transl)]. During a 10 day-incubation on agar surfaces at 30 degrees C, cells of the gram-negative soil bacterium Pseudomonas rhodos pass through three phases distinguishable by physiological and morphological criteria. When viewed by electron microscopy, typically "rolled" mesosomes could frequently be observed in young cells. In aged cells instead, loosely rolled or stretched-out, flattened tubules could be discerned, presumed to be degenerate mesosomes. Tubular flattened structures have been isolated from these cells by lysozyme treatment or sonication and were concentrated by differential centrifugation. Electron micrographs of these preparations showed long, straight tubules which sometimes appeared sealed at one end. Their width was 34 +/- 5 nm. They contained a lining of material, which could be digested by trypsin leaving behind an electron-transparent matrix. In rare cases, isolated tubules showed a periodic fine structure composed of ellipsoidal subunits. Optical diffraction analysis yielded a lattice consisting of subunits arranged in helices of pitch-angle 27 degrees; the unit cell dimensions were shown to be 112 X 56 A. Owing to their sensitivity to trypsin, components of the regular lattice are supposed to consist of protein. It is postulated that these protein components are layered onto a tubular membrane. These tubules are clearly distinguishable by their shape and fine structure from the periodic structure of a P. rhodos cell wall layer, which exhibits a tetragonal pattern, and also from polyheads and polysheaths of defective bacteriophages. Their possible origin from intact mesosomes in discussed.


The active species of "CO2" utilized in ferredoxin-linked carboxylation reactions. The active species of "CO2", i.e. CO2 or HCO-3(H2CO3) utilized by enzymes catalyzing ferredoxin-linked carboxylation reactions was determined. The enzyme investigated was pyruvate synthase from Clostridium pasteurianum (EC 1.2.7.1; Pyruvate: ferredoxin oxidoreductase). Data were obtained which were compatible with those expected if CO2 is the active species. The dissociation constant (Ks) of the enzyme-CO2 complex was measured. At pH 7.2 Ks for CO2 of pyruvate synthase was found to be approximately 5 mM.


[Deoxyribonucleic acid hybridizations among some vibrio-like marine bacteria (author's transl)]. The genotypic relationships established by DNA/DNA hybridization in vitro confirm the results obtained by earlier phenotypic analyses of certain vibrio-like marine bacteria. These strains are closely related to the species Photobacterium fischeri, and do not belong to the genus Vibrio. The group of marine, vibrio-like bacteria that require Na+ for growth is genotypically very heterogeneous.


Variations in the carotenoid content of Chlamydomonas reinhardii throughout the cell cycle. Synchronous cultures of Chlamydomonas reinhardii have been examined for the total amounts of carotenoid and chlorophyll present throughout a 12 hrs light -- 4 hrs dark life cycle. Variations in the carotenoid distribution at different points within the cell cycle have been found. During the greater part of the light period all major carotenoids increased at a proportionally similar rate. However, the increases in lutein and violaxanthin preceded those in beta-carotene and neoxanthin by some 2 hrs and that in loroxanthin, and algal xanthophyll, by abour 3 hrs. A marked drop in total carotenoid accumulation, corresponding to similar temporary falling away in the accumulation of beta-carotene, lutein and violaxanthin occurred at 9 hrs. The correspondence of this with the established drop in RNA accumulation and the break-up of the nucleolus was pointed out. Considerable redistribution among the carotenoids occurred during the dark period, notably the amount of beta-carotene increased relative to the total xanthophylls. The full significance of these results can not be estimated in the absence of comparative data on related organisms.


B-Phycoerythrin from Rhodella violacea: characterization of two isoproteins. Two isoproteins of the "native" B-phycoerythrin of the red alga, Rhodella violacea, were purified from crude extracts by preparative polyacrylamide gel electrophoresis and subsequently characterized. The slower moving pigment in gel electrophoresis was designated B-PE I, the faster as B-PE II. Both were found to occur in about equal amounts. B-PE I has a molecular weight of about 280000 and an IEP at 4.39, B-PE II a molecular weight of nearly 265000 and an IEP at 4.23. B-PE I and II are characterized by absorption maxima at 568 and 542 nm and a shoulder at 500 nm in the visible part of the absorption spectra. Their absorption coefficients at 542 nm differ with values of 5.54 and 5.63, respectively. The fluorescence emission spectra show a single maximum at 575 for B-PE I and at 578 nm for B-PE II. Both spectra have a shoulder at 630 nm. The fluorescence yield of B-PE II is lower by 25%. In calibrated SDS gel electrophoresis of the purified pigments B-PE I and II show two subunits of molecular weights of 18900 and 29200 and 18500 and 29900, respectively. Quantitative amino acid analyses indicated, that the isoproteins are very similar. B-PE II, however, has a significantly higher content of acidic amino acids and a lower percentage of basic residues, which is in keeping with its lower isoelectric point. Functional aspects of the occurrence of two isoproteins of B-phycoerythrin are discussed.


Conjugation in the yeast Saccharomycopsis capsularis Schiönning. Cells of the yeast Saccharomycopsis capsularis fused in pairs after disolving of part of the cross wall between them near the lateral wall. After nuclear migrations through the opening, the cross wall was closed again and the cells at both sides became asci. The wall of the ascospores developed from a prospore wall. Between the two unit membranes a very thin dark layer broadened to the dark layer of the wall and after that, the light inner layer developed. Immature spores in the strain studied had a ledge which disappeared during maturation.


Competitive ability of amylolytic bacteria in activated sludge. Shifts were induced into the microbial community of activated sludge by the pulse addition of soluble starch. The subsequent changes of amylolytic and proteolytic microbial populations were recorded. Four amylolytic strains were isolated and characterized with regard to carrying capacity, specific surface and growth kinetics. The competitive ability of these strains was studied by means of two-member competition experiments. These experiments were analysed according to the Lotka-Volterra model and the de Wit method. The different results obtained suggest that the dominance of the amylolytic Pseudomonas sp. (code 01) is based on a combined occurrence of high amylolytic activity, large relative cell surface, high maximum specific growth rate and reduced sensitivity towards associated proteolytic populations.


Morphology and physiology of Spirochaeta aurantia strains isolated from aquatic habitats. 1. Seven strains of Spirochaeta aurantia were isolated from pond and swamp water by means of a selective technique which utilized the ability of these organisms to move through bacterial filters and to diffuse through agar media. Although most of the isolations were accomplished when enrichment media low in carbohydrates were used, all seven strains were found to be exclusively saccharolytic. 2. The isolates could be divided into two groups on the basis of cell morphology: a loosely coiled group, and a tightly coiled group with markedly smaller wave length and wave apmlitude. Spirochetes of the latter group possessed a slightly lower GC content in their DNA. The isolates were facultative anaerobes, synthesized carotenoid pigments which conferred an orange color to aerobic colonies, and utilized a variety of carbohydrates--but not amino acids--as energy sources. Exogenous thiamine was required by six isolates tested, riboflavin by four, and biotin by one. The major products of glucose fermentation were acetate, ethanol, CO2 and H2. Growth of the isolates was inhibited by a variety of antibiotics. Determinations of GC contents of DNA showed that strains of S. aurantia are phylogenetically distant from spirochetes classified in the genera Treponema and Leptospira. 3. S. aurantia populations inoculated in the center of agar medium plates migrated in the form of growth rings toward the periphery of the plates. The rate of migration of glucose-utilizing rings was greatest at low glucose concentrations (e.g., 0.02 g/100 ml). It was concluded that migration of cells present in these rings was mainly due to a chemotactic response to glucose which served both as the attractant and the substrate. Chemotaxis of S. aurantia toward glucose may be used as a selective factor in isolating this bacterium from natural environments. 4. The subspecific epithet stricta is proposed to recognize, taxonomically, the tightly coiled strains of S. aurantia.


Photochemical reaction centers from Rhodopseudomonas capsulata. A photochemically active bacteriochlorophyll-protein complex (reaction center) has been isolated from the carotenoidless mutant A1a+ of Rhodopseudomonas capsulata by treatment of membranes with lauryl dimethyl amine oxide. Three proteins with molecular weights of 20,500, 24,000 and 28,000 (molar ratio 1:1:1) were detected in the reaction center preparations. After mild treatment of intracytoplasmic membranes with Na-dodecyl sulfate (0.5%, 30 degrees C, 1 min) succeeded by polyacrylamide gel electrophoresis two pigmented bands were obtained. Material of one fraction could be bleached reversibly by actinic light and contained two proteins with molecular weights of 20,500 and 24000. The second band is photochemically inactive.


[Pichia lindnerii sp. n., a new methanol assimilating yeast from soil (author's transl)]. A new undescribed species of yeast could be detected in forest soils in the area of Berlin, Germany. A description of the new homothallic species including latin diagnosis is given.


Effect of vanadium on growth, chlorophyll formation and iron metabolism in unicellular green algae. In the presence of vanadium, growth of Scenedesmus obliquus and Chlorella pyrenoidosa was increased five to sixfold as determined by dry weight, when cultured under autotrophic conditions for 7 days. The stimulation by vanadium decreased with increasing stability towards hydrolysis of the iron(III)-compounds added. Pentavalent vanadium (20 mug V/1 as NH4VO3) was able to overcome completely a limited iron-deficiency in the algae following growth in presence of 1.8 - 10(-5) m ferric chloride. Vanadium did not alter the iron uptake into the algal cells. 90% of offered 48V was taken up by Scenedesmus obliquus during 5 days of growth, and 21% thereof were found in the chloroplast fraction. In presence of vanadium, the chlorophyll formation was stimulated in Scenedesmus obliquus. This stimulation by vanadium was found to be light-dependent but occurred to a certain extent in the dark also. The main porphyrin of the yellow mutant 211-11h/20 of Chlorella vulgaris was identified as protoporphyrin-IX. The formation of this compound was stimulated by vanadium within 10 days up to 83%. The role of vanadium in the biosynthesis of chlorophylls is discussed.


Gene transfer agents, bacteriophages, and bacteriocins of Rhodopseudomonas capsulata. Thirty-three wild type strains of Rhodopseudomonas capsulata were examined for ability to engage in genetic recombination through mediation by "gene transfer agent" (GTA) particles. The genetic exchange assays were based on capacity of strains to produce or receive GTA required for restoration of photosynthetic growth competence to a non-photosynthetic "white" mutant or for acquisition of resistance to  rifampicin. A majority of the strains could either produce or receive GTA, and it was demonstrated that the agent is species specific. Possible relations between GTA and bacteriophages or bacteriocins were investigated. Sixteen types of virulent phages active on Rps. capsulata were isolated and their host ranges determined. Tests for transduction by the phages gave uniformly negative results. The viruses showed strict species specificity, but there was no apparent correlation between capacity of the Rps. capsulata strains to donate or receive GTA and susceptibility to the phages. A comparable survey disclosed that most of the bacterial strains were sensitive to or capable of producing bacteriocins; the latter also appear to be unrelated to GTA activity. The collection of bacterial strains was also screened for detection of lysogenic properties. None of the isolates is a "true" lysogen, but phages were detected in cultures of two strains, which may be "phage carriers" or pseudolysogens.


Chemical and structural differences in mycelial and regeneration walls of trichoderma viride. When incubated in Winge medium, protoplasts from Trichoderma viride obtained by treatment with Micromonospora chalcea or Streptomyces venezuelae RA lytic systems first synthesized an aberrant wall, different from the normal one; it was aseptate, larger and irregular in size and length. They then regenerated a new wall, similar to the original one from which they were liberated. Analysis showed that the wall polymers were mainly beta-(1-3) glucan, beta-(1-6) glucan and chitin in the normal walls, whereas chitin was absent in aberrant tubes. These results are discussed below together with electron micrographs of aberrant and normal walls.


Sulphate uptake and metabolism in the chrysomonad, monochrysis lutheri. The intracellular concentration of inorganic 35SO4 in Monochrysis lutheri cells exposed to 0.513 mM Na235SO4 for up to 6-hr remained constant at about 0.038 mM. The exchange rate of this 35SO4 with the external unlabelled sulphate was negligible compared to the rate of influx across the plasmalemma (0.032 mu moles/g cells/hr). The flux of free 35SO4 to organic 35S was 0.029 mu moles/g cells/hr. Assuming an internal electrical potential in the cells of -70 mV, this intracellular concentration of inorganic 35SO4 was well in excess of that obtainable by passive diffusion as calculated from the Nernst equation. These results indicate that sulphate is accumulated by an active mechanism rather than by facilitated diffusion. Sulphate uptake appears to occur via a carrier-mediated membrane transport system which conforms to Michaelis-Menten type saturation kinetics with a Km of 3.2 X 10(-5) M and Vmax of 7.9 X 10(-5) mu moles sulphate/hr/10(5) cells. Uptake was dependent on a source of energy since the metabolic inhibitor CCCP almost completely inhibited uptake under both light and dark conditions and DCMU caused a 50% decrease in uptake under light conditions. Under dark conditions, uptake remained at about 80% of that observed under light conditions and was little affected by DCMU, indicating that the energy for uptake could be supplied by either photosynthesis or respiration. A charge and size recognition site in the cell is implied by the finding that sulphate uptake was inhibited by chromate and selenate but not by tungstate, molybdate, nitrate or phosphate. Chromate did not inhibit photosynthesis. Cysteine and methionine added to the culture medium were apparently capable of exerting inhibition of sulphate uptake in both unstarved and sulphate-starved cells. Cycloheximide slightly inhibited sulphate uptake over an 8-hr period indicating, either a slow rate of entry of the inhibitor into the cells or a slow turnover of the protein(s) associated with sulphate transport.


Ultrastructure of the sporangiospore of Piptocephalis unispora (Mucorales). Sporangiospore structure in Piptocephalis unispora Benjamin was studied using light microscopy, freeze-etching, scanning and transmission electron microscopy, and compared with that of other members of the Mucorales. A merosporangial wall, plasmalemmal invaginations, and wall protuberances were demonstrated in sections and their possible significance discussed.


Synthesis of beta-glucanase and other extracellular proteins by cells and protoplasts of the yeast Pichia polymorpha: effect of 2-deoxy-D-glucose. The synthesis of beta-glucanase either by cells or by protoplasts of the yeast Pichia polymorpha has been found to occur in the presence of 2-deoxy-D-glucose in the growth medium. On the other hand, the synthesis of typical extracellular proteins such as invertase and acid phosphatase is strongly affected by the presence of the drug. The degree of inhibition is, however, directly related to the 2-deoxy-D-glucose concentration.


Sulfur metabolism in Thiobacillus denitrificans evidence for the presence of a sulfite reducatase activity. The relatively high specific sulfite reductase activity of 25 mU/mg protein was found in extracts from Thiobacillus dentrificans. The absorption spectrum of the partially pruified enzyme was similar to the siroheme containing sulfite reductases from other sources. It is suggested that the T. denitrificans sulfite reductase may function during the oxidation of reduced sulfur compounds.


[In-vitro studies on the break-down of chlormequat (chlorcholinchloride) in the rumen]. Under anaerobic conditions chlormequat did not undergo microbial breakdown in samples of rumen contents or rumen juice. Comparison with other forms of microbial breakdown of chlormequat, such as in soil, showed that oxidative processes were responsible.


[Consistometric studies on meat and meat products. V. Determination of consistency of raw and smoked bacon at various temperatures of bacon]. Penetration values for the superficial (cutaneous) part of bacon in the raw state were smaller than the deeper (subcutaneous) part, because of the high connective tissue content of the superficial part. The course of the curve of penetration in relation to temperature varied within the range of 1 to 60 units in cutaneous bacon, and up to 90 units in subcutaneous bacon; penetration values increased with increasing temperature. Penetration values for the superficial and deep parts of smoked bacaon were similar to those of unsmoked bacon.


[Tolerance of condenser impulses in cattle]. Extensive testing of electric fence equipment on cattle confirmed the effectiveness of the current intensities laid down by Koeppen and Osypka. Condenser discharges within the grade I of current intensity were tested for safety and effectiveness using standard equipment ("Cerberus" type). These condenser discharges were much more effective than induction current impulses. The risk of accidents to human beings and animals, and veterinary and zootechnical applications of condenser impulses were discussed.


[Effects of Turisynchron and Suisynchron on the thyroid gland in rats during simultaneous administration of TSH]. Thyrotrophin was injected i/p at 2 I.U. daily simultaneously with oral administration of Turisynchron at 100 mg/kg or Suisynchron at 125 mg/kg daily for five days to Wistar rats. The uptake of radio-iodine by the thyroid was reduced, and there were slight changes in thyroid structure. Suisynchron produced a milder inhibition of thyroid regulatory mechanisms than Turisynchron.


[Calcium, magnesium, phosphorus, chloride and glucose in the blood of cattle following intravenous infusion of solutions with various calcium and magnesium concentration aimed at improving the treatment of hypomagnesemia]. Recent findings on changes in the mineral content of tissues in bovine hypocalcaemia and hypomagnesaemia show the necessity of using different mineral solutions for the treatment and prevention of these conditions. Infusion of 2% CaCl2-6H2O with 10% MgCl2-6H2O and 5% glucose one after the other or in combination produced severe functional changes in cardiac activity and respiration. Recommended concentrations for treatment or prophylaxis of hypomagnesaemia were 10 g magnesium chloride and 2 g calcium chloride, or alternatively 12 g magnesium adipate and 5 g calcium gluconate, in 100 ml of distilled water (total dose 500 ml). This was well tolerated and it overcame the mineral deficiency in tissues.


[Experimental bedsonia infections in calf. 2. Pathomorphologic studies]. Tracheal inoculation of bovine strains of Bedsonia was often followed by inflammatory processes in lung, trachea, nasal mucosa and also spleen, lymph nodes and brain. Lesions in the duct system and alveoli of the lung consisted of exudates containing neutrophilic granulocytes and proliferation of epithelial and mesenchymal cells. The initial changes were evidently located in the bronchioli. Elementary bodies were present in variable numbers. The formation of lesions seemed to be influenced by route of infection and concentration of the causal organisms in the inoculum.


[A method for the rapid pick-up of bioelectric potentials from the unprepared body surface of animals, with special reference to cardiac action potentials]. Established methods of obtaining cardiac action potentials indirectly are laborious and require much time and apparatus. A rapid method of picking up bioelectrical potentials from the intact body surface was developed by using rapid-contact proximity electrodes and a simplified conduction technique. Useful cardiograms were obtained without changing the normal posture of the animal.


[Prevention of tetanus in man and animal following injury]. The effect of heterologous and homologous antitoxin is the same if an equal amount of antitoxin is present in the organism. In man there are no circulating antibodies in the blood after the first injection of the toxoid because there is no natural immunity against the tetanus antigen. After the second injection, man develops the same immunity as animals. Large antitoxin doses protect people for a longer period than small doses. Normally 3,000 I. U. of the heterologous antitoxin protects people for 2 to 3 weeks. In man and sheep 2 ml of the adsorbed vaccine produces an earlier and longer-lasting immunity than 0.5 ml. Simultaneous active and passive prophylaxis is superior to passive prophylaxis alone. To achieve a long-lasting active immunity, 2 ml of the vaccine should first be injected and a booster dose 7 to 10 days later, and again 6 to 12 weeks after the first dose. Immediate vaccination against tetanus following an injury will not protect a person who has not been vaccinated previously, as the active immunity will start too late.


[Phosphoric acid ester preparations used in cattle, swine and sheep with special reference to cholinesterase activity. 3. Use of phosphoric acid ester preparations and their effect on acetylcholinesterase activity in swine]. The use of organophosphorus preparations in the treatment of ectoparasites and endoparasites of pigs is discussed. Treatment of 43 store pigs with preparations produced in the German Democratic Republic by washing and by the pour-on method resulted in considerable inactivation of acetylcholinesterase, which implies good systemic action. Overdosage increased this effect, but without producing signs of toxicity. The oral dosages for pigs cited in the literature were confirmed. Repeated treatment was recommended for the best results, as pigs rapidly break down the preparations. It is necessary to take into account adverse effects of oral administration on palatability of the ration and on weight gain. Addition of a preparation to a batch of food for a group of pigs is likely to be less successful than individual dosing, which is the best method for sows.


[Phosphoric acid ester preparations used in cattle, swine and sheep with special reference to cholinesterase activity. 4. Use of phosphoric acid esters and their effect on acetylcholinesterase activity in sheep]. The use of organophosphorus preparations for the control of ectoparasites and endoparasites of sheep, particularly systemic application, is discussed. Experiments on 13 groups of sheep with five preparations produced in the German Democratic Republic in various formulations and concentrations showed that external application had good contact activity, but little was absorbed. Acetylcholinesterase activity was not inhibited, except by pour-on application of doses several times the normal dose. The preparations were arranged in order of cholinesterase inhibition. In contrast to cattle, diminished cholinesterase activity was unreliable as in indicator of systemic toxicity of organophosphorus preparations in sheep.


[Histochemical studies of acid phosphomonoesterase activity in experimental inflammation of the rat's paw caused by carrageenin]. During the primary phase of inflammation of connective tissue of the paw there was an increase in enzyme activity among the resident connective tissue cells, probably as a result of catabolic processes (lytic processes, phagocytosis). As early as two days after the start of inflammation it was possible to recognize a close relationship between regeneration of the altered tissue (anabolic processes) and the increase of phosphomonoesterase activity in resident cells of the inflamed tissue. The role of the enzyme during inflammation was discussed.


Modification of some hematologic and biochemical indices in mice consecutive mecadox administration. Mecadox addition to the diet of laboratory mice in doses of 25 mg/kg/day for 30 days resulted in some hematologic and biochemical modifications: 1. Red cell count declined moderately, leucocyte and neutrophile count was higher and reached their normal values 15 days following treatment. 2. Modifications of liver transaminases expressed by a diminution of GOT and GPT activities were observed together with a reduction of free nitrogen. Values returned to normal within 15 days after treatment. 3. Mecadox stimulated weight gain in treated animals during the first 15 days of treatment. No significant differences were observed in weight gain between the two groups during the period which followed treatment.


[Effect of anemia on various reactions of the domestic swine due to physical exertion. I. Initial values and characteristics of anemia]. In six anaemic and six healthy pigs at rest the following values were determined:--rectal temperature, heart rate, respiratory rate, haemoglobin (Hb), haematocrit (Hk), total haemoglobin (THb), plasma volume, blood volume, plasma osmolarity, lactic acid and glucose content of plasma, blood pH, carbon dioxide tension and base excess. There were significant differences between anaemic and normal pigs in Hb, THb, relative THb, Hk, mean cell haemoglobin concentration, lactic acid content; in the ECG there were differences in QT and ST intervals and the ratio of diastole to systole.


[Effect of anemia on various reactions of the domestic swine due to physical exertion. 2. Components of cardiovascular function and body temperature]. The following measurements were made in six anaemic and six healthy pigs during and after physical exertion on a belt moving at 70 m/min for 10 minutes at environmental temperature of 22-24 degrees C and relative humidity of 55-65%:--rectal temperature (RT), heart rate, total haemoglobin, plasma volume (PV), blood volume (BV) and plasma osmolarity (PO). The increase: in RT and PO, heart rate during exercise, respiratory rate after exercise, and the fall in PV and BV during exercise as well as changes in erythrocytes were all more pronounced in anaemic pigs than in healthy pigs.


[Effect of anemia on various reactions of the domestic swine due to physical exertion. 3. Changes in plasma glucose and lactic acid concentrations]. Six anaemic and six healthy pigs were exercised for ten minutes on a belt moving at 78 m/min. Initial blood glucose values in healthy pigs averaged 71.2 mg/100 ml, and they changed very little during and after exercise. Initial values were similar in anaemic pigs (70.7 mg/100 ml), but they increased continuously, during exercise, reaching a peak of 157.4 mg/100 ml one minute after the end of exercise. Blood lactic acid increased from 1152 to 2463 mmol/litre in healthy pigs during the first minute of exercise, and then fell gradually. In anaemic pigs it increased from 1652 to 8478 mmol/l during the ten minutes of exercise, and then fell gradually. Correlations between lactic acid and haemoglobin content, between rectal temperature and Hb, and between lactic acid and changes in rectal temperature were discussed.


[Effect of anemia on various reactions of domestic swine due to physical exertion. 4. Changes of serum acid-base equilibrium]. Carbon dioxide tension, pH and the excess of base were determined in blood samples obtained from the posterior vena cava of six healthy and six anaemic pigs subjected to ten minutes of exercise on a belt moving at 78 m/min at 22-24 degrees C and relative humidity of 55-65%. The fall in these values during physical exertion was greater in anaemic than in healthy pigs. The roles of buffering capacity and rise in body temperature, and the relationship between blood lactic acid and base excess were discussed.


[LD 50 and selenium concentration in organs following intravenous administration of sodium selenite in the rabbit]. In experiments on 72 rabbits, the LD50 of sodium selenite by intravenous injection was found to be 2.24 mg/kg body weight. The clinical picture and pathological changes associated with acute selenium poisoning are described. The increase in selenium concentration was up to nine times the normal in liver and up to six times in kidney and muscle. There was no sign of a return to normal values 24 hours after administration.


[Relationships between chemical constitution and germicidial effect. 28. Preparation, antimicrobial and anthelminthic effect of diiosothiocyanates]. In comparison with monoisothiocyanates, diisothiocyanates were either less active or of the same activity against bacteria and fungi. None of the compounds tested possessed antimicrobial activity worth investigating further. However, compound No. 2 (2,4-diisothiocyanatomethyl ethoxybenzol) and compound No. 5 (1,3-dimethyl-4,6-diisothiocyanatomethylbenzol) were more active as anthelmintics against Enchytraeus than the p-phenylene diisothiocyanates.