Breast cancer patients: substance in blood causing acceleration of erythrocyte sedimentation rate. The frequency distribution curve of the erythrocyte sedimentation rates obtained from a population of 3523 normal females was compared with the distribution found in 544 patients with benign breast disease and that for 385 patients with carcinoma of the breast. No significant difference was found between the normal female population and patients with benign lesions of the breast. This was in contrast to the distorted distribution curve of erythrocyte sedimentation rates exhibited by the population of patients having malignant breast lesions. An unknown substance present in the blood plasma of the cancer patients appears to be responsible for the abnormal sedimentation rate phenomenon.


Extracellular potassium accumulation and inward-going potassium rectification in voltage clamped ventricular muscle. Measurements of afterpotential, action potential duration, and output of a potassium-sensitive microelectrode indicate that the application of long clamp pulses (1 to 8 seconds) to frog ventricular muscle is accompanied by a change in the extracellular potassium concentration. The plot of the magnitude of the potassium accumulation against the clamped membrane potential yields an N-shaped relation similar to the "steady state" current-voltage relation. The accumulation studies confirm a strong inward-going (anomalous) potassium rectification.


Human heart and platelet actins are products of different genes. The amino acid sequences of selected cyanogen bromide peptides from human blood platelet actin and human cardiac muscle actin were compared; it was found that, at position 129, platelet actin has threonine, and that cardiac muscle actin has valine. Thus human cytoplasmic and myofibrillar actins must be synthesized under the control of different genes.


HeLa cultures defined.

HeLa cultures defined. A list is presented of references to all known publications on properties which have served to relate strains of HeLa cells to each other as well as to indict other purported human cell lines as HeLa cell contaminants. Eleven additional cell lines not previously indicted are described. When they exhibit (i) type A (fast) mobility for glucose-6-phosphate dehydrogenase, (ii) phosphoglucomutase type 1 at locus 1 and locus 3, (iii) absence of a Y chromosome by fluorescent staining, and (iv) possession of a complex of trypsin-Giemsa banded marker chromosomes present in known HeLa cells, then cell substrates regardless of designation should be considered de facto strains of HeLa.


Phytoestrogens: adverse effects on reproduction in California quail. Phytoestrogens, largely formononetin and genistein, are produced in the leaves of stunted desert annuals in a dry year. When ingested by California quail, these compounds apparently inhibit reproduction and prevent the production of young that will not have adequate food. In a wet year, forbs grow vigorously and phytoestrogenic substances are largely absent. Quail then breed prolifically and the abundant seed crop carries the enlarged population through the winter.


Photochemical air pollution: transport from the New York City area into Connecticut and Massachusetts. Photochemical air pollution resulting from primary emissions in the New York City metropolitan area is transported by prevailing winds on a 300-kilometer northeast trajectory through Connecticut and as far as northeastern Massachusetts. As a result, southwestern Connecticut has the highest ozone concentrations in the region and there is a substantial increase in ozone concentrations in Massachusetts. The ozone concentrations of air entering the New York City metropolitan area are often already above the federal standard of 0.08 part per million, but the concentration distribution is well below concentration distributions at downwind sites in Connecticut.


Plant desiccation: polysome loss not due to ribonuclease. During desiccation of the drought-tolerant moss Tortula ruralis polysome levels decline substantially before any increase in ribonuclease activity is observed. Furthermore, ribosomes in the desiccated moss are not complexed with messenger RNA fragments. It is concluded that ribosome runoff and failure to re-form an initiation complex mediate polysome loss during desiccation.


Thermal lens technique: a new method of absorption spectroscopy. Both a single beam and a dual beam (with synchronous detection) thermal lens technique have been employed in the measurement of "colorless" organic compounds in the range 15,700 to 17,400 cm-1. Combination overtones of C-H stretching vibrations in benzene have been identified and agree with previous results obtained by conventional spectroscopy with a long optical path. Extinction coefficients as low as 1 X 10(-6) liter mole-1 cm-1 have been accurately determined. The sensitivity of the technique has been further demonstrated by measuring the So leads to T1 absorption of anthracene; the spectrum compares favorably with results obtained by conventional techniques.


Sulfoxide reduction in relation to organophosphorus insecticide detoxification. Carbophenothion sulfoxide, an oxidative metabolite of carbophenothion, is reduced to carbophenothion in the living rat and by an in vitro system containing rat liver enzyme, reduced nicotinamide adenine dinucleotide phosphate, and flavin adenine dinu cleotide phosphate. Reduction of sulfoxides, formed metabolicially from certain commercial organophosphorus insecticides, may be important in ameliorating the toxicity of these compounds.


Cytoplasmic microtubule organizing centers isolated from Polytomella agilis. Basal body rootlets in Polytomella function as organizing centers for cytoplasmic microtbules in vivo. A method is described to isolate intact basal body-rootlet complexes. The integrity of the isolated complexes is confirmed by electron microscopy, and the rootlets are shown to be competent as initiation sites for the in vitro polymerization of brain microtubule protein.


Voluntary nerve signals from severed mammalian nerves: long-term recordings. An electrode unit capable of detecting voluntarily elicited nerve signals for prolonged periods of time has been developed and tested. The electrode unit has been implanted around the distal ends of severed sciatic and peroneal nerves in rabbits. This electrode may prove suitable for implantation in human amputees for the purpose of recording neural control signals to activate prostheses with many degrees of freedom.


Selective production of cis- and trans-verbenol from (-)-and (+)-alpha by a bark beetle. A unique biological system whereby optical isomers are selectively transformed to geometrical isomers is demonstrated in Ips paraconfusus. Exposure of adult male and female beetles to vapor of (-)-alpha-pinene resulted in the production of (+)-cis-verbenol, a pheromone of this species, whereas (+)-alpha-pinene was oxidized to (+)-trans-verbenol. It appears, therefore, that the ability of a bark beetle to produce its aggregation pheromone can be governed by the chirality of a precursor in the host tree.


The categories of hue in infancy.

The categories of hue in infancy. Infant looking time was monitored during habituation to the repeated presentation of a wavelength stimulus selected from one basic adult hue category and after a change in stimulation. Recovery from habituation was greater to a wavelength selected from an adjacent hue category than to a wavelength from the same category even though these two stimuli were equally distant (in nanometers) from the habituation wavelength. Differential responding evidenced infants' categorical perception of hue; that is, infants see the physically continuous spectrum as divided into the hue categories of blue, green, yellow, and red. These results help to resolve the long-standing controversy surrounding the primacy of perception over language in the organization of hue.


Specificity of neonatal, androgen-induced imprinting of hepatic steroid metabolism in rats. The specificity of the neonatal, andreogen-induced, irreversible programming of hepatic steroid metabolism in the rat was investigated. 5-alpha-Dihydrotestosterone propionate and estradiol benzoate were as efficient as testosterone propionate in inducing a male type of liver metabolism in the adult animal, whereas epitestosterone propionate, etiocholanolone propionate, and o,p'-DDT were practically inactive in this respect. These findings indicate that different mechanisms are involved in neonatal imprinting of hepatic steroid metabolism and in the well-known neonatal androgenic and estrogenic induction of persistent estrus and acyclic gonadotropin secreqion.


Premature specification of the retina in embryonic Xenopus eyes treated with ionophore X537A. Eyes excised from Xenopus embryos at stages 24 to 25 were cultured for 4 to 6 hours in a medium containing the ionophore X537A or in a control medium. The eyes were implanted either upside down or normally in host embryos at stages 28 to 30, and their retinotectal projections were mapped after metamorphosis. Treatment with X537A prevented realignment of retinal axes in eyes implanted into hosts that were capable of producing retinal axial alignment in all control eyes.


Attachment and penetration of miracidia observed by scanning electron microscopy. Scanning electron microscopy can be utilized to understand more clearly many aspects of the parasite-host relationship of schistosome miracidia and their molluscan intermediate hosts. Specialized structures on the apical papilla of the miracicium, used for attachment and penetration, become visible in greater detail.


Preneoplastic lesions in the human breast. A subgross sampling technique with histological confirmation was used to study the pathology of 119 whole human breasts, either cancer-associated (that is, containing cancer or contralateral to a cancer) or taken from random routine autopsies. Atypical lobules were observed much more frequently in the cancer-associated group than in the group of routine autopsy breasts. Atypical lobules showed varying degrees of anaplasia that formed a continuum between normal epithelium and carcinoma in situ, usually of the common ductal type. As apprarent markers for increased cancer risk, atypical lobules in the human breast may be homologous to hyperplastic alveolar nodules that are abundant in high mammary cancer strains of mice. This indirect evidence supports the hypothesis that atypical lesions are common preneoplastic lesions in the human mammary gland.


Messenger RNA induction of fast sodium ion channels in cultured cardiac myoblasts. Incubation with adult heart messenger RNA caused the appearance of fast sodium ion channels in young myocardial cells whose development has been arrested in vitro. The induction was blocked by cycloheximide, indicating dependence on protein synthesis. Thus, cardiac myoblasts can be made to differentiate in vitro, and membrane properties can be altered by exogenous RNA.


Rapid oral mixing of glucose and saccharin by rats. Within 5 minutes after initial contact rats show excessive consumption of a mixture of saccharin and glucose solutions. With a glucose solution in one bottle and the saccharin solution in another, a combination of which matches the above mixture, the rats also show large intakes. The pattern of drinking from the glucose and the saccharin bottles indicates that the rat mixes the solutions in rapid order, producing the preferred concentration of saccharin and glucose.


Stress-induced hyperphagia and obesity in rats: a possible model for understanding human obesity. Mild tail pinch administered to rats several times daily in the presence of sweetened mild induced immediate hyperphagia and led to considerable gain in body weight. Parallels are drawn with stress-induced hyperhagia and altered affective states in obese humans.


Structure, function, and evolutionary relationships of Fc domains of human immunoglobulins A, G, M, and E. Human immunoglobulins, A, G, M, and E have strong homology in amino acid sequence (about 30 percent) distributed nonuniformly throughout the Fc region. Immunoglobulins M are A are least alike in the first Fc domain and most alike in the second. Individual domains of heavy chains have evolved with different mutation rates but with conservation of essential structural features. No relation of primary structure to complement binding ability is apparent.


Genetic characteristics of the HeLa cell. The genotype of the patient Henrietta Lacks from whose cervical carcinoma the HeLa cell was derived was deduced from the phenotypes of her husband and children, and from studies of the HeLa  cell. Hemizygous expression of glucose-6-phosphate dehydrogenase in HeLa, together with the deduced heterozygosity of Mrs. Lacks, is consistent with clonal origin of her neoplasm.


Visual adaptation: effects of externally applied retinal on the light-adapted, isolated skate retina. Incubation with externally applied 11-cis retinal induces a marked increase of visual sensitivity within partially bleached skate photoreceptors. This activity of 11-cis retinal is duplicated by 9-cis retinal, but not by all-trans retinal. The sensitization of photoreceptors promoted by 11-cis and 9-cis retinal is accompanied by the formation of rhodopsin and isorhodopsin, respectively.


Habituation of reflexes in Aplysia: contribution of the peripheral and central nervous systems. We studied the contribution of the Aplysia peripheral nervous system, in the siphon and gill, to habituation of the gill withdrawal reflex. After removal of one central ganglion, the parietovisceral, repeated stimulation of the siphon caused habituation of the reflex as it had with the ganglion intact, showing that there is a peripheral pathway between the siphon and gill with competence to mediate habituation. Repeated electrical stimulation of two efferent nerves to the gill, after removal of the parietovisceral ganglion, resulted in habituation of withdrawal movements, which shows that the terminals of the ganglion neurons in the gill are a site of habituation. Also, stimulation of one nerve dishabituates the withdrawal movements elicited by the other. These identify two sites of habituation in the gill in addition to sites in the parietovisceral ganglion.


Apparent modification of forces between lecithin bilayers. Small sugar solutes effect variation in the equilibrium separation of lecithin bilayers in aqueous solution. Since sugars have negligible influence on bilayer structure, they probably act by modifying interbilayer forces. The observed widening and narrowing of the bilayer separation is correlated with the predicted weakening and strengthening of the attractive van der Waals forces between lipid bilayers that occurs with increasing sugar concentrations.


Wheat gluten as a pathogenic factor in schizophrenia. Schizophrenics maintained on a cereal grain-free and milk-free diet and receiving optimal treatment with neuropleptics showed an interruption or reversal of their therapeutic progress during a period of "blind" wheat gluten challenge. The exacerbation of the disease process was not due to variations in neuroleptic doses. After termination of the gluten challenge, the course of improvement was reinstated. The observed effects seemed to be due to a primary schizophrenia-promoting effect of wheat gluten.


Intracellular edema and dehydration: effects on energy metabolism in alveolar macrophages. The effects of intracellular edema and dehydration on energy metabolism in alveolar macrophages were studied. Intracellular edema increased lactate production and reversibly decreased oxygen consumption. Dehydration caused no significant change in lactate production but irreversibly decreased oxygen consumption. These phenomena may be applicable to a wide variety of clinical problems including lung and brain edema.


Niche shifts in sunfishes: experimental evidence and significance. Three species of sunfishes segregate ecologically when stocked together in small ponds. When each species is stocked separately in replicate ponds, it exhibits competitive release through increases in growth rate and average food size. Niche shifts are indicated by convergence of these species to the same food habits in the absence of competitors. These shifts are due to phenotypic (behavioral) plasticity. The significance of niche flexibility is related to seasonal patterns in resource availability.


Reversal of acetylcholine potentials in eel electroplaque. Although the eel electroplaque is a major source of purified acetylcholine (ACh) receptor, the electrophysiological properties of the receptor have not been studied in detail. In particular, the reversal potential for the action of ACh on the postsynaptic membrane has not been measured directly. In order to obtain the reversal potential, ACh was applied iontophoretically from a micropipette onto the innervated membrane. The resulting depolarization (ACh potential) decreased in amplitude as the cell was depolarized, reached zero at a reversal potential of about -4 millivolts, and then reversed in sign as the inside of the cell was made increasingly more postive. The relation between ACh potential amplitude and membrane potential was nonlinear because of a decrease with depolarization of the peak conductance change produced by the drug.


Measurement of membrane protein lateral diffusion in single cells. Fluorescence rapidly returns to spots bleached by a laser beam in the continuous fluorescence of cultured cells labeled on the surface with fluorescein isothiocyanate. The rate of recovery of fluorescence after bleaching can be interpreted as a measure of the lateral diffusion of integral membrane proteins labeled with fluorescein.


Vitamin A: not required for adrenal steroidogenesis in rats. Previous work supporting the vitamin A dependency of adrenal function in rats neglected to take into account a secondary effect of the deficiency, a decrease in hepatic ascorbic acid biosynthesis. Vitamin A-depleted rats maintained on a diet free of ascorbate had a decrease in the activity of adrenal 3 beta-hydroxysteroid dehydrogenase, and extensive adrenocortical degeneration. The use of an ascorbate supplement prevented the symptoms. The results suggest that previous evidence for direct involvement of vitamin A in steroidogenesis may have been due to the production of a secondary deficiency, a chronic scorbutic condition.


"Serotonin depression"--a biochemical subgroup within the affective disorders? The distribution of 5-hydroxyindoleacetic acid (5-HIAA) concentrations in the cerebrospinal fluid of 68 depressed patients was bimodal. Twenty-nine percent of the patients were in the lower mode, with a concentration of 5-HIAA below 15 nanograms per milliliter. Although there were no differences in overall severity of depression between the two modes, there was a significant correlation between the concnetration of 5-HIAA and severity of depression in the lower, but not in the upper, mode. The finding suggests the existence of a biochemical subgroup of depressive disorder, characterized by a disturbance of serotonin turnover.


Adrenaline-forming enzyme in brainstem: elevation in genetic and experimental hypertension. The adrenaline-forming enzyme (phenylethanolamine N-methyltransferase) was elevated in the A1 and A2 regions of the brainstem of 4-week-old spontaneously (genetic) hypertensive rats and in the A1 region of adult experimentally (deoxycorticosterone acetate and sodium chloride) hypertensive rats. The administration of a phenylethanolamine N-methyltransferase inhibitor to experimentally hypertensive animals caused a reduction of the elevated blood pressure to normal values. These results implicate adrenaline-containing neurons in the brainstem in the development of hypertension.


Color receptor identities of goldfish cones. Goldfish retinas were exposed to spectral lights, then incubated with nitroblue tetrazolium chloride. Diformazan deposits revealed that five morphologically distinct cone types were segregated into three color classes: red long double and long single cones, green short double and long single cones, and blue short single and miniature short single cones.


Pinhole imaging in Legg-Perthes disease: further observations. Fifty-nine patients with Legg-Perthes disease and 12 others were studied using 99mTc-polyphosphate and the pinhole collimator imaging technique. Radiographs of both hips were correlated with images in each patient. In the Legg-Perthes patients, a radionuclide uptake deficiency of variable size was observed in the proximal femoral epiphysis (EOC), which we believe is related to varying degrees of impaired blood supply. During later disease stages, adjacent zones of increased radionuclide activity of revascularization were observed that would replace the uptake defect eventually. Unless radiographic evidence of new bone formation was observed in the EOC, it was impossible to predict either the  presence or extent of revascularization until bone imaging was done. Those patients with revascularization activity in the EOC exhibited a relatively short time interval (average, 3.2 months) before evidence of new bone formation radiographically. Others with increased radionuclide concentration limited to the growth plate and/or metaphysis averaged a much longer 7.8 months. In two patients there was a reversal of the initially increased activity in the growth plate, suggesting another vascular insult. There were no false-negative bone-image findings in the 12 cases that clinically and/or radiologically simulated Legg-Perthes disease. Our image studies correlate well with published histopathologic investigations, indicating to us that assessment of extent of pathologic involvement and of the disease course is facilitated by this technique. Subsequently, this could influence treatment selection and provide a more objective baseline from which to judge treatment results. Continued experience suggests pinhole bone imaging has useful clinical application in Legg-Perthes disease and other childhood hip disorders.


The bone scan in inflammatory osseous disease. The 99mTc-phosphate bone scan has become a sensitive, reliable, and safe method for evaluating the patient with suspected inflammatory disease of bone. The scan may become positive as early as the first 24 hr after the symptoms and 10-14 days before roentgenographic changes occur. It can be used to differentiate successfully a variety of diseases from osteomyelitis, and in conjunction with 67Ga-citrate scan has become a mainstay in the work-up of the patient with infectious disease. Applications of the bone scan to infectious diseases in pediatric practice are especially helpful, since these diseases are common problems in this age group. Increased experience with the 99mTc-phosphate bone scan has already defined several areas of "limitations" in evaluating inflammatory disease. "Cold" defects, negative scans in early stages of osteomyelitis, and "extended uptake" may all pose problems in interpretation, but careful correlation of the bone scan results with clinical history and physical findings, blood cultures, and roentgenography will significantly reduce these problems.


Metastatic intraocular carcinoma: clinicopathologic study of a case. This case report describes the fluorescein angiography, the radioactive scintigraphy, and the pathologic findings of an intraocular metastasis from bronchogenic carcinoma which occurred in a 64-year-old white man. In spite of extensive studies, no definitive differential diagnosis between primary and secondary eye lesion could be established before enucleation for intractable pain. This case illustrates that presently available methods are not adequate for correct differential diagnosis in such cases.


Removal of the normal uterus.

Removal of the normal uterus. The uterus is often justifiably removed when anatomically it is a normal organ. Unfortunately, such surgery often is viewed with suspicion because there is failure to communicate the justification to patients and uninformed critics. An effort is made in this manuscript to categorize procedures and thus more clearly delineate the indications for removal of the normal uterus. Reviewed is a total of 485 hysterectomies performed over a ten-year period in a medical school affiliated hospital providing training in obstetrics and gynecology for second-year residents and for third- and fourth-year medical students. Eighty-two of the 485 uteri removed (16.9%) were considered anatomically normal by the criteria set forth. The morbidity associated with these cases was minimal.


Head and neck radioangiography.

Head and neck radioangiography. An analysis of one year's experience at our institution with 781 cerebral radioangiograms is reported. In patients who had follow-up radioangiographic evaluation, an overall accuracy of 88% was achieved using the anterior method. Accuracy in detecting carotid occlusive lesions alone was 83%. Detection of subdural hematomas by radioangiography was exceptional. Our results correlate well with those of others in detection of cerebrovascular occlusive disease, other vascular lesions, and avascular lesions. In our experience, the extremely high yield of information and the simplicity of performing radioangiography of the head and neck justify its routine use in all cases referred for brain scanning.


Attitudinal changes in medical students taking a course in human values. A semantic differential test was used to find out whether a course in human values in medicine produced changes in the attitudes of students who took the course as compared with the attitudes of those who did not. The results showed that students taking the course retained certain positive values as compared with the student group not taking the course, which showed only negative shifts in values. Possible reasons for these changes are discussed.


Adenocarcinoma of the colon and rectum in young adults. A retrospective analysis was made in 47 young adults (20 to 40 years of age) with adenocarcinoma of the colon and rectum. Rectal bleeding was the most frequent presenting symptom. Tumor grade had no correlation with survivial. Smaller tumors were associated with better prognosis. Depth of invasion was a most important prognostic factor. There was no operative mortality. The five-year survival rate in these young adults compares favourably with the overall survival statistics for colorectal carcinoma.


Lymphangiography as an aid in staging bladder carcinoma. Eighty patients with histologically proven carcinoma of the urinary bladder had pedal lymphangiography as part of their assessment for metastatic disease. Results were correlated with surgical findings within three months of the lymphangiographic interpretation in 49 patients. There were no false-positive lymphangiograms, and only five (10%) false-negative readings were recorded. The finding of positive lymphangiograms in 9% of patients with stage B disease, 16% of patients with stage C disease, and 57% of patients with a fixation of the tumor to the pelvic or abdominal wall emphasizes the value of the procedure in limiting unnecessary surgical exploration.


Suicidal ingestion of isoniazid: an uncommon cause of metabolic acidosis and seizures. Despite the widespread use of isoniazid, suicidal ingestion is rare. Two patients are presented who ingested 5 gm and 12 gm respectively, both having seizures within two hours and severe metabolic adisosis. They were treated successfully with intravenous administration of diazepam and bicarbonate, and forced diuresis. Both patients showed a mild rise in levels of serum glutamic oxaloacetic transaminase and lactic acid dehydrogenase. Physicians should be alerted to the possibility of isoniazid ingestion in patients with an unexplained severe metabolic acidosis and seizures.


Pulmonary cryptococcosis in chronic lymphocytic leukemia. A patient with chronic lymphocytic leukemia developed extensive pneumonia due to Cryptococcus neoformans. A presumptive diagnosis based on results of a Wright's stain of the sputum was made and appropriate antifungal therapy was started. C neoformans was cultured in COUNTS AS HIGH AS 8 X 10(5)/ml of sputum and was present morphologically for three weeks after sputum cultures had become negative. During the patient's first week of hospitalization, C neoformans was cultured from sputum and on cough plates but from no other source in his room. This suggests the possibility of transmitting the fungus to susceptible persons by droplets from patients having extensive pulmonary cryptococcosis.


Displaced tibial shaft fractures: a comparison of treatment methods. Eighty-five overriding tibial shaft fractures (46 open, 39 closed) were treated at Ochsner Foundation Hospital between 1960 and 1972. Nine different treatment methods were employed by seven orthopedic surgeons. The best results were obtained in the nine patients treated by open reduction and either compression plating or external skeletal fixation with compresssion. All healed primarily in the briefest time and none had a complication.


Surgical treatment of colovesical fistula: the value of a one-stage procedure. The records of all patients (43) with colovesical fistulas at Ochsner Clinic were reviewed retrospectively. The presenting symptoms are more often related to the bladder and not to the colon; fecaluria and pneumaturia are almost pathognomonic. The diagnosis may be difficult to obtain on proctoscopy, cystography, or intravenous pyelograms. Roentgenograms after barium enema and cystoscopy are the best means of diagnosis, though operation is necessary in some instances for definitive diagnosis. Primary resection and anastomosis with closure of the bladder has been successful in our experience with little morbidity and only one postoperative death. The controversy regarding primary colon resection in treatment of colovesical fistulas is perplexing. We do not believe that it is "foolhardy" to save the patient extra time, morbidity, and expense by doing one instead of three procedures. Primary resection of the colon with simple closure of the bladder is our recommended treatment for chronic colovesical fistula. We have had no recurrences.


Familial occurrence of multiple myeloma. Two brothers with multiple myeloma, both with immunoglobulin IgGK, are described. Although the cause and pathogenesis of this disease in instances of familial occurrence are uncertain, genetic predisposition and environmental factors may play a significant role.


Contraception with norethindrone 0.35 mg administered continuously. Microdose norethindrone (0.35 mg taken each day without interruption) was used as an oral contraceptive agent by 168 women for 4,264 months over a five-year span. Seven pregnancies occurred with regular use and two with irregular use, resulting in a drug-effectiveness rate of 1.9 and a use-effectiveness rate of 2.5 per 100 woman-years. Cycle length was variable. During the five years of study there was a tendency toward weight gain, but no definite trend in blood pressure changes was noticed; however, there were no comparable control groups for these latter two observations. Results of metyrapone tests done after 17 to 33 months of treatment were normal.


Office and emergency room care of the injured hand. A careful initial evaluation and proper treatment of the injured hand can minimize morbidity and assure early recovery. Various hand injuries encountered and their appropriate treatment are discussed. Emphasis is placed on the initial care, and in some instances the definitive treatment, which can be given in the physician's office or the hospital emergency room.


Partial laryngectomy as therapy for cancer of the larynx after irradiation failure. The evoluation of therapy for recurrences of cancer of the larynx after radiation therapy is presented. Four case histories of patients having partial laryngectomies after receiving radiation therapy are reported.


Ischemic necrosis of multiple major joints: report of two cases. Two patients with idiopathic ischemic necrosis of multiple major joints are described. One had both humeral and femoral heads involved and the other had involvement of the humeral heads and one femoral head. These combinations are uncommon. Specific causes could not be found in the histories, although one patient was a chronic alcoholic and and other was severely allergic to coffee dust. In the care and follow-up of patients with ischemic necrosis, attention should be given to the possibility of involvement of multiple major joints.


Familial cardiac dysrhythmias: classification and review. Disorders of cardiac rhythm and conduction are described in multiple members of one family spanning three generations. The literature is reviewed regarding other aspects of familial cardiac arrhythmias, permitting a classification of the latter. The entity is not rare, and familial screening is imperative in instances of sudden death, fainting episodes, or rhythm disorders in young individuals.


Psychomotor-psychic seizures treated with bilateral amygdalotomy and orbitotomy. A 26-year-old woman developed seizures and psychiatric disorders after having been in coma with encephalitis for a protracted period at age 11. Seizures were psychomotor, minor motor, and major motor with auras of fear, panic, and olfaction. The patient hallucinated, had paranoid ideas, was depressed, and attempted suicide. Medical and psychiatric treatment with anticonvulsants and tranquilizers was ineffective. Depth and surface EEG recordings revealed bilateral discharge abnormality in temporal, frontal, and thalamic areas. Lesions were placed in the temporal and orbitofrontal area bilaterally for the psycho-motor-psychic seizures and in the left thalamus for the minor motor seizure. The seizures were relieved without the incapacitating complications that occur with standard lobotomy and temporal lobe resection. Improvement of the psychic component of the seizures is believed due to interrupting seizure discharging circuitry in the temporal and frontal areas. The term temporofrontal seizures is proposed for the anatomic designation of psychomotor-psychic seizures.


Unilateral renal agenesis associated with multiple skeletal abnormalities. Two cases are presented in which an association between unilateral renal agenesis and multiple skeletal abnormalities is found. The pathologic agents responsible for the URA act similarily on other organ systems, including the skeleton. The skeletal abnormality can be diagnosed easily and promptly and may be an indicator for anomalies in other systems as well, especially the urogenital system.


The use of enzyme analysis of peritoneal blood in the clinical assessment of abdominal organ injury. Seventy patients with blunt and penetrating abdominal trauma and hemoperitoneum were evaluated by the analysis of the enzyme content of peritoneal blood using automated laboratory methods. The enzyme levels in peritoneal blood were evaluated relative to the simultaneous levels in peripheral blood to identify enzyme differences in organ-related peritoneal and periheral blood. The findings in this study indicate that isolated liver injuries are associated with significant elevation of lactic dehydrogenase levels in peritoneal blood and glutamic-oxalacetic transaminase levels in peritoneal and peripheral blood. A multiplicity of abdominal organ injury results in elevation of lactic dehydrogenase and glutamic-oxalacetic transaminase levels in peritoneal blood. The occurrence of isolated small intestinal injury and small intestinal injury combined with other organ injury produces a significant elevation of glutamic-oxalacetic transaminase, lactic dehydrogenase and alkaline phosphatase levels in peritoneal blood. The alkaline phosphatase elevation in peritoneal blood is associated with normal mean values in peripheral blood; therefore, combined alkaline phosphatase in peritoneal and peripheral blood has potential for use in the identification of small intestinal injury in patients with hemoperitoneum of traumatic origin.


A diagnostic technique for acalculous cholecystitis. Routine oral cholecystography with Telepaque frequently will show normal visualization of the gallbladder in the presence of acalculous cholecystitis and cholesterolosis. Roentgenograms of the abdomen that show persistent opacification of the gallbladder 36 hours after the administration of Telepaque are suggestive of cholecystic disease. Twenty-six patients with previously normal cholecystograms but with continuing symptoms of biliary tract disease were studied with 24 hour delayed films of the gallbladder. All had persistent  visualization of the gallbladder, and all had diseased gallbladders verified at operation and by pathologic examination.


Delayed rupture or delayed diagnosis of rupture of the spleen. Delayed rupture of the spleen was seen in only six of 302 patients undergoing splenectomy for splenic injury following blunt abdominal trauma. Only one of these six patients was asymptomatic for two days following the accident. This is an incidence of 2 per cent delayed rupture as compared with the 15 per cent quoted in the literature. An aggressive approach to the diagnosis of intra-abdominal injury has helped to eliminate the delay in recognition of rupture of the spleen. Peritoneal lavage has accurately identified those patients with intra-abdominal injury. We conclude that delayed rupture of the spleen is, in reality, usually a delay in diagnosis of splenic rupture.


The chemical composition of circulating fat emboli released during total hip prosthesis. Lipids of fat emboli released in the circulating blood of seven patients undergoing hip prostheses were compared with those of plasma, adipose tissue and bone marrow taken simultaneously. Similar in composition to bone marrow, fat emboli, as compared with plasma lipids, contain negligible amounts of free esterified cholesterol, a relative decrease of oleic acid and an increase of palmitic acid in triglycerides and a lower percentage of linoleic acid in phospholipids. The results of this study validate the theory that fat emboli originate from bone marrow in fractures of the long bone.


A method by which burn units may compare their results with a base line curve. Burn units that treat relatively few patients need a technique by which they may make valid comparisons between their results and mortality curves derived from larger series of data. While the technique described is consistent with the probit mode, the most widely accepted statistical model for studying burn mortality, it aboids the cumbersome calculations associated with probit analysis.


Antibiotic concentrations in hepatic interstitial and wound fluid. This study in dogs using tissue-implanted capsules indicates that cephalothin, cefazolin, ampicillin and tetracycline are excreted in the bile, appearing in this fluid at concentrations greater than the concomitant serum levels. Hepatic interstitial fluid concentrations of these agents differed little from levels achieved in soft tissues elsewhere in the body, indicating that compounds which are concentrated in bile do not necessarily achieve high levels in the hepatic parenchyma. The selection of an antimicrobial agent for the therapy of hepatic parenchymal infection or obstructive cholecystitis should, therefore, be based on susceptibilities of the suspected organism rather than on the relative tendencies of various agents to be concentrated in bile.


Gastric pull-up operation for replacement of the cervical portion of the esophagus. The gastric pull-up operation is a useful, effective method for immediate restoration of alimentary continuity after resection of the larynx, pharynx and esophagus for carcinoma of the hypopharynx or cervical portion of the esophagus or both. It is suitable only for those patients whose general condition is sufficiently satisfactory to tolerate the one stage combined abdominal cervical operation. When successfully used, the results are striking in comparison with those usually obtained from other methods of esophageal reconstruction.


Changing clinical trends in patients with peripheral arterial emboli. One hundred and twenty-four patients treated by Fogarty balloon catheter embolectomy from 1964 through 1973 were reviewed and compared to an earlier series of 82 patients treated by direct extraction during the interval from 1948 to 1963. In patients undergoing embolectomy, the incidence of rheumatic heart disease (RHD) declined from 55 to 27 percent, and that of arteriosclerotic heart disease (ASHD) rose from 39 to 55 percent. The operative mortality rate of those with RHD was unchanged and that of patients with ASHD declined from 74 to 36 percent. This was attributed, in part, to the lesser degree of operative stress entailed by the Fogarty catheter and the local anesthesia. Limb salvage was 82 percent when ischemic symptoms were less than 24 hours in duration and 66 percent when such symptoms were more than 24 hours in duration. The amputation rate for the entire group was 22 percent. The low 2 year survival of patients with ASHD and of amputees was ascribed to the wide extent of their atherosclerotic cardiovascular disease. This was emphasized by the fact that 44 percent of late deaths were due to myocardial infarction.


The effect of severe trauma on urine loss of insulin. Six trauma patients and five healthy volunteers were given an intravenous glucose infusion (5 Gm. per hour) for 6 hours. The serum insulin response and urine insulin excretion were measured and compared in the two groups. Glucose intolerance and serum insulin levels which were elevated but inappropriately low for the degree of glycemia characterized the trauma patients. Urine insulin concentrations and total urine insulin were increased significantly in the trauma patients. Renal function was similar in both groups, as determined by serum creatinine, blood urea nitrogen, and creatinine clearance. The increase in urine insulin concentration in the trauma patients reflected the higher serum insulin concentrations, but no correlation existed between serum insulin and urine insulin concentrations. A negative correlation was found between "insulin clearance" and serum insulin in both groups, indicating altered renal handling of insulin following injury which may be a contributory factor to the relative hypoinsulinemia of trauma.


Peritoneal cysts: a complication of ventriculoperitoneal shunts. Large abdominal cysts are not a common complication of peritoneal shunts. In our experience only 11 of 1,585 peritoneal shunts developed this complication (0.7 percent). We believe that infection, particularly by S. epidermidis and multiple-shunt revisions, is related to the development of the cysts. Simple parencentesis and replacement of the shunt usually are sufficient treatment for this complication if infection is not present.


Central nervous system regeneration and ophthalmology. Various adult lower vertebrates are capable of optic nerve, and even retinal, regeneration with functional recovery of vision. Possible factors responsible for regenerative failure in mammals are discussed. It is suggested that potentially neuroregenerative agents be tested in the mammalian retina in an attempt to induce visual pathway regeneration.


Emergence of resistance to amikacin during treatment of burn wounds: the role of antimicrobial susceptibility testing. Amikacin has been used to treat Providencia stuarii infections on the Burn Service at Los Angeles County/University of Southern California Medical Center since March, 1973. The median minimal inhibitory concentration (MIC) of strains collected on this service prior to the introduction of amikacin was 3.13 mug. per milliliter, whereas the median MIC of strains collected during the last 4 months of the study was 12.5 mug per milliliter. High bactericidal concentrations (MBC) noted at the time of initial studies predicted the emergence of resistant clones, with MBV values rising to as great as 100 mu per milliliter. Further, isolates from burn patients during the initial 5 days of treatment with amikacin had a median MIC of 6925 mug per milliliter, in contrast to values of 25 mug per milliliter in strains isolated after 5 days of treatment. The epidemiologic significance of intensive treatment of gram-negative infections occurring in a close population with selected antibiotics is discussed. The performance of susceptibility tests which included determination of bactericidal concentrations was a major tool in the recognition of the potential for selection of resistant micro-organisms.


Choroidal melanoma with massive retinal fibrosis and spontaneous regression of retinal detachment. An unusual case of choroidal malignant melanoma with heterochromia iridis, massive subretinal hemorrhage and fibrosis, spontaneously resolving retinal detachment, and subretinal seeding is reported. Clinical and pathological findings are presented and discussed. The unusual aspects of the case are further considered by Drs. Andrew Ferry and Mark Tso.


Preliminary report: Evaluation of tissue ingrowth into experimental Replamineform vascular prostheses. A new experimental arterial prosthesis has been developed by replacing the minimal surface microporous calcite structure of sea urchine spines. Prostheses having a 4 mm. inside diameter and a homogenous 15 to 20 mu porous network have been prepared in bioelectric polyurethane and segmented polyurethane. Ten prostheses were placed in the femoral and carotid arteries of dogs weighing 27 to 35 kilograms and were harvested at a time interval of 3 to 14 days to characterize the tissue ingrowth. Eight of the ten prostheses were widely patent at time of harvest, with tissue ingrowth evident as early as the third day and with complete fibroblastic and capillary penetration of the 1 mm. thick walls developed by the end of one week. By 2 weeks there was uniform formation of 50 to 100 mu well organized neointimal surfaces.


Gastroduodenal arterial aneurysms: report of a case and review of the literature. Aneurysms of the gastroduodenal artery are rare. Only nine cases have been reported previously. These aneurysms are extremely difficult to diagnose preoperatively. A case of ruptured gastroduodenal artery aneurysm, which was diagnosed by aortography prior to operation, is reported, and the literature is reviewed.


Catamenial pneumothorax.

Catamenial pneumothorax. Consistent clinical features of catamenial pneumothorax are its recurrent nature, repeated involvement of the right hemithorax, and a temporal relationship to the onset of menstruation. A personal case with endometrial implants and defects of the the diaphragm is presented. A review of the entire 41 cases reported in the literature reveals that the syndrome is more common than previously believed; there is a definite relationship with endometriosis; and the air allowing the pneumothorax does not appear to enter the chest by way of the genital tract, as originally postulated.


Levodopa-enhanced recovery from paralysis induced by air embolism. In this study levodopa was chosen as an agent that might ameliorate the clinical manifestations of paralysis induced by air embolism because of reported effects of this drug on muscle spasticity and locomotion. In order to induce air embolism, the aorta of rats was cannulated chronically. Fifteen days later, after full recovery of the animals, air was administered through the chronic cannula into the descending aorta of each rat (0.35 ml. of air per 100 Gm. during 4 seconds). The paralysis of both hind legs was observed one to 10 minutes later. Only animals that had total paralysis of both hind legs, without any sensation, were used in the experiments. levodopa was administered 2 minutes after experimentally induced paralysis. The levodopa treatment was repeated every day for 6 days. After 6 days, six levodopa-treated (intraperitoneally) animals in a group of eight and ten levodopa-treated (intra-arterially) animals in a group of 12 recovered fully from the paralysis. Only three animals in a group of 13 (untreated) or two animals in 12 (solvent administration) recovered without the levodopa treatment.


Massive hemorrhage from ileostomy and colostomy stomas due to mucocutaneous varices in patients with coexisting cirrhosis. Enterostomal varices have been recognized as a cause of serious recurrent hemorrhage in patients with portal hypertension secondary to cirrhosis. Most often the varices at the mucocutaneous junction are the source of the hemorrhage. Three patients--two with hemorrhages from ileostomies and one with hemorrhages from a colostomy--are presented. Local measures have proved successful in controlling hemorrhages. Occasionally direct pressure alone will prove sufficient; more often the bleeding varix will need ligation. Complete revision of the enterostomy under local anesthesia can effect total disruption of the protal-systemic shunt and temporarily can eliminate local hemorrhage. Surgically created portasystemic shunts may be considered in good risk patients in order to eliminate hemorrhage from the stomal varices. Palliative local measures, however, remain the treatment of choice in the high-risk, cirrhotic patient who is unlikely to survive a major operation.


Adenosine deaminase levels in blood type A patients with metastatic tumor. A lack of adenosine deaminase activity has been associated with severe combined immunodeficiency and decreased enzyme activity observed in acute lymphocytic leukemia. We have measured enzyme activity in lymphocytes, red blood cells, and plasma of patients with a variety of metastatic tumors. Patients with tumor had a significantly lower erythrocyte adenosine deaminase activity (p less than 0.025) and statistically higher enzyme activity in their lymphocytes (p less than 0.010) when compared with control plasmaphoresis donors. Interestingly, blood type A tumor patients showed a significant decrease in their erythrocyte enzyme concentration compared with blood group A controls (p less than 0.001) as well as a collective group of type B and O tumor patients (p less than 0.001). Type A patient lymphocyte adenosine deaminase activity was not increased and was not statistically different from control group A donors. Tumor patients with blood groups B and O considered collectively had a statistically significant increase in their lymphocyte enzyme concentration compared with group B and O controls (p less than 0.001).


Age distribution of patients with carcinoma of the colon in a general hospital in Iran. One hundred and eighteen consecutive patients with histologically confirmed diagnosis of carcinoma of the colon discharged during a 10 year period (1962 to 1971) from a general hospital in Tehran were studied. Twenty-five patients (21 percent) were younger than 30 years of age and six patients were under 18 years of age. None had familial polyposis or ulcerative colitis. The data are suggestive of a younger age distribution of this disease in our population as compared to that of the Western countries.


An index of healing in below-knee amputation: leg blood pressure by Doppler ultrasound. Preoperative Doppler ultrasonic assessment of below-knee (BK) arterial signals and systolic blood pressures was performed on 50 patients undergoing 53 BK amputations for advanced ischemia. No patient was excluded from initial BK amputation unless gangrene at that level or severe joint contracture was present. Failure of healing of the BK amputation occurred in all five limbs with an undetectable Doppler arterial signal (and thus pressure) below the knee. Failure of amputation occurred in four of 16 limbs with detectable arterial signals and BK pressures less than 70 mm. Hg. Healing occurred in all 32 limbs with BK pressures greater than 70 mm. Hg. The differences in healing between these three groups are highly significant (p less than 0.005). This study suggests that Doppler ultrasonic assessment of BK arterial signals and pressures may be a simple hemodynamic correlate of healing of a BK amputation. Absence of a detectable arterial signal below the knee may be an indication for initial above-knee (AK) amputation in advanced ischemia.


Vascular laboratory criteria for the management of peripheral vascular disease of the lower extremities. From experience gained in over 4,500 vascular laboratory procedures, segmental Pulse Volume Recorder (PVR) tracings, systolic pressure measurements, and other noninvasive laboratory techniques have been found extremely useful in the management of patients with arteriosclerotic peripheral vascular disease. Both PVR recordings and limb pressures were found to be important and are used in complementary fashion. Although arteriography is essential in defining structural lesions and in establishing graftability, noninvasive vascular studies provide an inexpensive, accurate, reproducible method for assessing functional significance of arterial disease. These studies contribute to the diagnosis, definition of severity, and establishment of an objective baseline prior to medical or surgical therapy. Because they may be used in a repetitive manner, they are extremely useful in establishing success of a given therapy and in the long-term follow-up of patients. Based upon our experience, laboratory criteria have been developed which allow accurate identification of ischemic rest pain, aid in predicting healing of foot lesions or below-knee amputations, and quantitate the functional disability of claudication.


Intra-arterial embolization in the management of arteriovenous malformations. Eighteen patients with arteriovenous malformations (AVM's) involving the extremities, pelvis, or head are reported and their treatment is discussed. Our experience has led us to the following conclusions: (1) careful selective angiography is mandatory to delineate the vascular anatomy, extent, and major afferent vessels supplying the AVM; (2) ligation of afferent vessels to an AVM never is indicated; (3) intra-arterial embolization (IAE) can be used prior to surgical removal of extensive but resectable AVM's; (4) IAE may be employed for symptom control of inoperable AVM's.


The accuracy of the supraorbital Doppler examination in the diagnosis of hemodynamically significant carotid occlusive disease. The supraorbital Doppler technique was used to study 102 carotid arteries prior to arteriography. A carotid stenosis was defined as being hemodynamically significant if the diameter of the lumen were reduced by more than 50 percent. The Doppler examination gave a false-positive result in only two of the 61 arteries which did not demonstrate significant stenoses. False-negative Doppler results occurred in 22 percent of the 41 significant carotid lesions. The presence or absence of significant carotid lesions were predicted in 96 percent of 67 arteries for which the results of the supraorbital examination and carotid auscultation were in agreement. False-negative results occurred in association with significant ipsilateral external and common carotid stenoses and in the presence of unusually efficient collateral circulation via the circle of Willis. The supraorbital Doppler examination is a valuable technique for the identification of patients with hemodynamically significant carotid stenoses.


The predictive accuracy of renal vein renin activity in the surgery of renovascular hypertension. In a consecutive group of 38 patients undergoing operations for renovascular hypertension, there were 24 arterial reconstructions and 16 nephrectomies. Thirty-two patients were available for late observation, and 25 (78 percent) had a successful result. The renal vein renin ratio (RVRR) correctly predicted successful results in 76 percent of the patients with a RVRR of 1.5 or more but was correct in predicting an unsuccessful result in only one of the six patients with an RVRR less than 1.5. This high incidence of "false-negative" results has appeared in several other reports but has received insufficient emphasis. The presumed causes include inadequate sodium depletion prior to the renal blood vein samplings or, less likely, the effects of renin-suppressing drugs such as alpha methyldopa, propranolol, or reserpine. Because five of the six patients with RVRR less than 1.5 enjoyed a successful result from operation, it is apparent the clinical factors and the aortogram should be determinant when the RVRR, performed under the conditions described, is not diagnostic of renovascular hypertension. Nonetheless, when all diagnostic factors, i.e., the aortogram, the rapid-sequence intravenous pyelogram, and the RVRR, support such a diagnosis, a successful surgical result is nearly certain.


Intraoperative autotransfusion in major elective vascular operations: a clinical assessment. Six patients undergoing major elective vascular operations received an average of 1,700 ml. of intraoperative autotransfusion of shed blood. The patients were anticoagulated systemically during operation. The mean platelet count (156,000 per cubic millimeter and fibrinogen value (257 mg. per 100 ml.) were normal in autotransfused blood and the mean hemoglobin level was slightly below normal (11.5 Gm. per 100 ml.). Plasma hemoglobin values were variable. No patient suffered any complication that could be attributed to autotransfusion. Donor blood transfusion was avoided in five of the six patients by salvage and reinfusion of shed blood. No evidence of coagulopathy was found in any patient as measured by platelet count, fibrinogen level, prothrombin time, partial thromboplastin time, euglobulin clot lysis, and fibrin degradation products. The technique of intraoperative autotransfusion is described in detail.


Infection control in cardiac surgery.

Infection control in cardiac surgery. This report relates the results of a multifaceted, 4 year program directed toward reduction of infection in patients undergoing cardiac operations and extracorporeal circulation in a large teaching hospital. Retrospective analysis of all superficial and deep wound infections and prosthetic valve infections for the period of 1966 to 1970 and a prospective study of the period of 1970 to 1974 were made. The multifaceted program begun in 1970 consisted of (1) renovation of a cardiac operating room with incorporation of a high flow, vertical unidirectional ventilation system, (2) change in the gown and draping material for improvement of barriers to bacteriologic shedding, (3) frequent steam sterilization of prosthetic valves, (4) routine use of an antistaphylococcal agent in patients receiving valve replacement, and (5) an unannounced bacteriologic monitoring program of the cardiac operating room personnel. Studies of airborne particulates and bacteria and adequacy of skin preparation and hair removal also were conducted. The studies showed that (1) a high-flow HEPA filtered vertical ventilation system and altered operating room clothing reduced the concentration of airborne particles and the concentration of bacteria at the wound by a factor of 10 compared to conventional operating rooms, (2) the incidence of markedly contaminated scrubbed and unscrubbed hands decreased, (3) shedders and carriers were identified, and (4) current patient skin preparation and hair removal practices were satisfactory. The results of the program were a reduction of the deep wound infection rate from 2.9 to 0.6 percent (p less than 0.01) and a concomitant total wound infection decrease from 6.6 to 3.3 percent. Prosthetic valve infection rates decreased fourfold, from 5.6 to 1.4 percent. It is concluded that careful attention to possible endogenous sources of infection from the patient and a multifaceted program directed to exogenous sources of infection can lower infection rates in cardiac surgical patients.


Acute hematogenous osteomyelitis: an experimental model. The injection of barium sulphate (micropaque) contaminated with Staphylococcus aureus into the nutrient artery of the canine tibia produced typical inflammatory bone changes. This alteration, similar to those observed in human hematogenous osteomyelitis, consisted of medullary destruction, spontaneous fractures, and intense periosteal new bone formation. This system seems to mimic the characteristics of some clinical bone infections and may provide a model for therapeutic trials.


[Relationship between the veterinarian and animals, their rights and duties (author's transl)]. The vulnerable position of the human organism with in kingdom of organisms entitles man to subsist as a species. Far-reaching specialization towards animality, resulting in high degree of differentiation, has rendered man extremely vulnerable and thus compelled him to search for possibilities to utilize his environment. However, the fact that he is inherently bound up with this environment imposes limitations on this right to manipulate within it. This right of man is not exclusive but analogously includes the rights of animals. This implies that man should accept the intrinsic value of animals. An animal is a value, not a person, and therefore only has rights analogously. Animals are constantly under the direct influence of man who influences or even destroys their biotopes. The only basic principle to be stressed in this regard is the right of animals to remain in their oecological niche wherever possible, taking into account the effects of selection and mutation which have eventually resulted from their association with man. In view of the above, the following code of conduct is suggested for veterinarians: (1) When man takes animals into his home as pets, he should at least see to it that these animals will be able to develop a natural behaviour in order to safeguard the intrinsic value of the animals wherever possible. (Keeping sporting dogs and greyhounds in flats is not permitted.) (2) Veterinarians should not tolerate symptom-suppressive forms of treatment. (Declawing a domestic cat is not permitted for the simple reason that the owner will usually have caused the abnormal behaviour of the animal.) (3) As an educator, the veterinarian will have to expose any tendency to humanize animals as a devaluation of man. (Laying out animal graveyards and fattening small animals.) (4) On an interdisciplinary basis and from the point of view of the subsistence of mankind, the veterinarian should raise the question of the responsibility of man as a social creature for the kingdom of organisms, not only his fellow-men but the entire environment. (5) The question can be asked to which extent the veterinarian is under an obligation to direct studies and research towards the selection of organisms still capable of establishing a relationship with man in this slum-dwelling called earth.


Renal carbuncle: early diagnosis by retroperitoneal ultrasound. The diagnosis of renal carbuncle has been prolonged from the time of onset of symptoms to the institution of treatment producing a significant rate of mortality. The use of retroperitoneal ultrasound is demonstrated as a noninvasive method for making an earlier diagnosis of renal carbuncle than has been afforded by more conventional means. This report illustrates the technique of nephrosonography and briefly reviews the medical and surgical approaches to this disorder. To our knowledge, this is the first reported case wherein ultrasound, and not pyelography, demonstrated a carbuncle without the aid of invasive arteriography.


Pelvic lipomatosis.

Pelvic lipomatosis. Three cases of pelvic lipomatosis are presented. Excretory urogram revealed characteristic elevation and elongation of urinary bladder base and relative hyperlucency of pelvic cavity. Associated varying degrees of hydronephrosis and hydroureters are seen secondary to distal ureteral obstruction. Barium enema showed elongation and elevation of rectosigmoid colon.


Pseudotumor of adrenal gland.

Pseudotumor of adrenal gland. A sixty-two-year-old male underwent medical evaluation because of hypertension. A suprarenal mass was detected on pyelography and subsequently confirmed by tomography, angiography, sonography, and adrenal venography. In spite of these positive diagnostic studies surgical exploration revealed a normal adrenal gland surrounded by dense fibroadipose tissue which appeared to account for the pseudotumor.


Sexual function and fecundity after treatment for testicular tumors. Questionnaires were mailed to patients who had undergone either radiotherapy, lymphadenectomy, or a combination of both as treatment for malignant disease of the testis in an attempt to define the effects of their therapy on sexual function, ejaculation, and fecundity. The forms returned by 29 patients with seminoma treated with irradiation alone indicated that little change had occurred in their sexual performance or sex drive. Diminished semen volume was reported by 10 patients but was severe in only 1. Two of 3 patients who desired children after therapy were successful. In patients with nonseminomatous testis tumor treated surgically, 42 of 50 reported a significant decrease in semen volume, but 7 of 12 who desired children following therapy were successful. The physiology of ejaculation is reviewed, and comments are offered on the means by which retroperitoneal lymphadenectomy may disrupt normal ejaculation.


Serum proteins in prostatic cancer. III. Relationship of levels of immunoglobulins and complement to clinical stage of disease. The relationship between the level of the three major serum immunoglobulins, IgG, IgA, and IgM and of the third component of complement (C')C'3(B1A-globulin) and the clinical Stage of prostatic cancer was evaluated. While, statistically significant (P less than 0.05) differences in the levels of these proteins compared with their levels in patients with benign prostatic hypertrophy (applied only to the study of C'3) and healthy adults were observed, the levels of these proteins in each of the Stages evaluated were not significantly different from each other. The absence of a correlation between the Stage of disease and the levels of these humorally mediated effectors of immunologic responsiveness is in keeping with observations of cell-mediated effectors of immunologic responsiveness in prostatic cancer patients. Observation of the association of prostatic cancer with a deficiency of B-cell function and of C'3 is noted.


Diagnosis of hyperparathyroidism.

Diagnosis of hyperparathyroidism. Hyperparathyroidism is an important cause of calculous disease. A simple reliable protocol for evaluation of patients has been developed. In 20 patients with hyperparathyroidism this protocol has produced no false positive studies. Normocalcemic hyperparathyroidism can be diagnosed by this convenient method, and this protocol can be carried out in any hospital as part of an out- or inpatient workup.


Postpartum onset of urinary incontinence associated with ureteral ectopia. The onset of urinary incontinence in adult women in association with extrasphincteric ureteral ectopia is rare. Herein we report 2 cases of this unusual occurrence. The incontinence in both patients began after significant obstetric trauma. Ureteral ectopia should be included in the differential diagnosis of incontinence beginning in the immediate postpartum period.


Ruptured renal cyst in polycystic disease. A patient with polycystic disease was admitted with acute abdominal pain. This was caused by a rupture of one of his right renal cysts into the collecting system, with extravasation into the subcapsular space. With conservative therapy, the patient returned to his status prior to this episode. The extravasation was absorbed, and the cyst became smaller. He will continue under supportive care for his polycystic disease.


Neonatal urinary tract infection with petechiae and thrombocytopenia. Thrombocytopenia and petechiae were signs of urinary tract infection in 2 neonates. Both infants had significant anomalies of the urinary tract. In each case antimicrobial therapy eliminated the infection and thrombocytopenia, allowing the surgical correction to be performed when the infants were clinically well. The importance of urine cultures and excretory urography in such cases is emphasized.


"Acute scrotum" in Henoch-Schönlein syndrome. Two patients with Henoch-Schönlein syndrome presented with clinical pictures mimicking testicular torsion. No evidence of testicular torsion was found. A review of the literature revealed that testis torsion is very rarely associated with testicular involvement in Henoch-Schönlein syndrome, and hence only rarely is surgical exploration required.


Penetrating renal injuries.

Penetrating renal injuries. A retrospective analysis of 81 penetrating renal injuries revealed a need for surgical exploration in only 39 per cent, and the following conclusions are made: (1) Criteria for classifying a traumatic renal injury as major and therefore requiring further evaluation (arteriography) or appropriate urgent surgery, include urographic nonfunction or extravasation, persistent or severe hematuria or retroperitoneal hemorrhage, and deteriorating clinical status. (2) Preoperative urologic assessment is mandatory to avoid needless renal exploration; 58 per cent of patients with minor injuries were in this series operated on. (3) It is doubtful that late sequelae of penetrating renal injury occur so frequently that immediate surgery to prevent them is advisable.


Transurethral resection of prostate via perineal urethrostomy. Prospective study. A controlled, prospective clinical study was undertaken to determine the incidence and cause of urethral strictures after transurethral resection. Patients were assigned to 1 of 3 groups. Group A consisted of patients in whom it was considered preferable for various reasons to perform prostatic resection through perineal urethrostomy; therefore, these were excluded from randomization. All other patients were randomized using a sealed-envelope method into Group B who underwent resection via perineal urethrostomy and Group C who underwent resection via the entire urethra. Strictures occurred in 6 of 42 patients in Group C postoperatively while patients in Group B remained free of strictures. This difference was statistically significant (p less than 0.05). It was concluded that strictures which occur result from the use of the resectoscope through the entire urethra and not from the use of indwelling catheters, and that performing prostatic resection via perineal urethrostomy is valuable in preventing the occurrence of such strictures.


Retroperitoneal liposarcoma in a child.

Retroperitoneal liposarcoma in a child. Retroperitoneal liposarcoma is a rare tumor in children and has been reported previously on only three occasions. This is the fourth such case, presenting with a large mass on the left side which displaced the sigmoid and ureters to the right. The patient was treated with surgery, radiotherapy, and chemotherapy. She is alive and well more than four years after therapy was instituted. A review of the pertinent literature cites the need for radio- and chemotherapy especially when surgical removal is incomplete.


Primary carcinoma of fossa navicularis.

Primary carcinoma of fossa navicularis. A case of primary carcinoma of the fossa navicularis of the male urethra is discussed. The lesion presented as an ulcerative process that circumferentially involved the external urinary meatus in a sixty-three-year-old man. Initially, the lesion was confused with a superficial carcinoma of the penis, since results of urethroscopic examination were normal. Following midshaft penectomy, despite normal gross appearance of the distal urethra, histologic examination indicated poorly differentiated epidermoid carcinoma along the mucosa of the distal urethra up to the line of surgical resection. Subsequent total penectomy showed only a small area of residual tumor at the line of previous resection. Lymphadenectomy was not performed. The patient remains alive without evidence of residual disease five years later.


Perirenal hemorrhage in newborn.

Perirenal hemorrhage in newborn. An unusual cause of a palpable abdominal mass in the newborn is adrenal hemorrhage with a secondary perirenal hematoma. All the urologic diagnostic modalities including sonography can be used to diagnose this benign condition. Surgical exploration should be considered when the possibility of a malignancy cannot be excluded.


Rationale of incidental appendectomy.

Rationale of incidental appendectomy. In an effort to settle the controversy regarding use of incidental appendectomy, we have reviewed the literature regarding the function of the appendix and its role in the development of cancer, incidence of acute appendicitis, pathologic findings in incidentally removed appendices, and morbidity of incidental appendectomy. Considering all parameters we conclude that incidental appendectomy is a service to the patient and should be done except where specifically contraindicated.


Crossed renal ectopia in children.

Crossed renal ectopia in children. Nine children were treated with crossed fused renal ectopia, and in 8 there were serious other urinary tract malformations which were surgically correctable. The finding of crossed fused renal ectopia warrants complete urologic investigation including cystogram and cystoscopy to rule out surgically correctable pathology in the urinary tract.


Endocrine changes after diethylstilbestrol therapy. Effects on prostatic neoplasm and pituitary-gonadal axis. This study was undertaken to determine the effects of DES (diethylstilbestrol) on prostatic neoplasms and of different dosage levels on the pituitary-gonadal axis. It is recommended that when DES is chosen for treatment plasma testosterone be monitored carefully and for long periods of time to evaluate the ability of the dose to achieve levels comparable to castration in each patient.


Sisomicin in urinary tract infection: Tolerance and efficacy study. Twenty-one patients with gram-negative urinary tract infections were treated with sisomicin, a new aminoglycoside antibiotic. Bacteriologic cure was achieved in 62 per cent of patients, and improvement in another 33 per cent. Mild transient elevation of serum creatinine occurred in 3 patients. No other toxicity was observed. Further clinical trials with more frequent dose administration and in combination with other antibiotics is suggested.


Chronic seminal vesiculosis. Distressing syndrome with surgical cure. Six cases in which a symptom complex suggestive of chronic seminal vesicular dysfunction are described. Transvesical seminal vesiculectomy was performed with good results and no disturbance of sexual potency. Seminal vesiculectomy appears to provide a reasonable means for cure of those patients who meet the specific criteria outlined.


Vasectomy without complication.

Vasectomy without complication. In a four-year period 500 outpatient vasectomies were performed by the author. Bilateral scrotal incisions were used in all cases as were metal clips to occlude the vas deferens. Operating time rarely exceeded fifteen minutes. No failures and no sperm granulomas were encountered. Complications were rare and included a single scrotal hematoma and six minor infections. Unilateral absence of the vas deferens was noted in 2 patients. The technique to be described is a simple, complication-free method of vasectomy.


Testicular neoplasm in siblings.

Testicular neoplasm in siblings. Two sets of testicular tumors involving nontwin siblings are reported. The possibility dysgenesis and dysgonesis and the totipotentiality of the cells in the pathogenesis of these tumors are described and discussed


Bolus nephrotomography in diagnosis of lesions of kidney. Bolus nephrotomography was employed in the study of 100 patients with renal adenocarcinoma and 100 patients with renal cyst. A retrospective review of the vascular and nephrographic phases of this study was made. A diagnosis of renal adenocarcinoma could be made with confidence by bolus nephrotomography in 82 per cent of cases with the remaining cases indeterminate and requiring further investigation; the vascular phase was of greater diagnostic value than the nephrographic phase. A diagnosis of renal cyst could be made with confidence by bolus nephrotomography in 85 per cent of cases with the remaining cases indeterminate and requiring further investigation; the nephrographic phase was of greater diagnostic value than the vascular phase.


Preoperative diagnosis of xanthogranulomatous pyelonephritis. Preoperative diagnosis of xanthogranulomatous pyelonephritis may be correctly made in a significant proportion of affected patients thus preventing unnecessary radical surgery especially in the poor-risk patient. The diagnosis should be suggested in the patient with a history of chronic urinary tract infection and certain radiologic features. These include unilateral renal enlargement (either localized or diffuse), nonfunction on excretory urography, presence of renal and/or ureteral calculi, angiographic demonstration of avascular mass or masses with stretched, attenuated intrarenal vessels, prominent capsular and periureteric vessels, and an irregular impaired nephrogram with prominent avascular areas.


Cystometry. VI. Interpretation.

Cystometry. VI. Interpretation. Cystometry should be performed under direct supervision of a physician, and interpretation must be supplemented by additional test procedures.


Central areolar pigment epithelial (cape) dystrophy. A family with a unique hereditary macular dystrophy is presented. The disorder is transmitted as an autosomal dominant trait having high penetrance and variable expression. The characteristics of this dystrophy are: childhood onset; nonprogressive areolar depigmentation of the central macula; and with the exception of one eye with a macular hemorrhage, normal vision acuity and retinal-function studies.


Gyrate atrophy of the choroid and retina: clinical, ophthalmologic, and biochemical considerations. A case of gyrate atrophy of the choroid and retina associated with hyperornithinemia has been subjected to extensive clinical and biochemical investigation. The familial occurrence of the ocular disease and of abnormality of amino acid was unique to this 28-year-old male, being absent in parents and siblings. He presented with progressive visual loss, and was found to have cataracts and large areas of peripheral lacunar atrophy. Clinically there was no other abnormality. However, he was hyperuricemic and has an abnormal EEG. Despite otherwise normal biochemical indices of hepatic, renal, and muscle function; selective catheterization of an artery, the hepatic vein, the renal vein, and a deep forearm vein showed all of these circulatory beds to be producing ornithine according to arteriovenous difference measurements. Cerebrospinal fluid and urine contained increased amounts of ornithine. Though electromyography was normal, the muscle biopsy was abnormal. Clinical tests including arginine loading, glucose tolerance testing, and other measurements of blood variables provided inferences as to the metabolic locus of the abnormality. The syndrome is a systemic multiorgan disorder in which the choroid and retina would appear to be target organs and the hyperornithinemia to be of, as yet, undetermined cause and pathogenic significance.


Further observations on the diagnosis, etiology, and treatment of endophthalmitis. This report of 54 suspected cases of endophthalmitis emphasizes the following findings: 1. That vitreous aspiration is more sensitive in making a culture proven diagnosis than anterior chamber paracentesis. 2. That Staphylococcus epidermidis is a much more common cause of endophthalmitis than previously apprediated. 3. That intraocular antibiotics in the recommended dosage, are reasonably safe clinically and add a new dimension to the treatment of endophthalmitis.


Posterior form sympathetic ophthalmia.

Posterior form sympathetic ophthalmia. Two cases of posterior form sympathetic ophthalmia are presented. The histologic abnormalities in one of them are described. Based on findings in these two cases and other descriptions of posterior form sympathetic ophthalmia in the literature, the authors conclude that except for absence of anterior uveal tract involvement, there is no histopathologic difference between posterior form sympathetic ophthalmia and classical sympathetic ophthalmia. Although there is disagreement in the literature, the authors also conclude that the therapy and prognosis of posterior form sympathetic ophthalmia does not differ from that of classical sympathetic ophthalmia.


Optic pits and posterior retinal detachment. Six cases of congenital pit of the optic nervehead associated with posterior serous retinal detachment are presented. All were treated by photocoagulation along the disc margin in the area of retinal detachment. In five cases reattachment of the retina occurred, after the clinical development of a film chorioretinal adhesion at the disc margin, and appeared to be secondary to the treatment. The sixth case (Case 4), although treated, appeared to represent a spontaneous reattachment. This disorder, which frequently results in permanent decrease of central vision, affected the better, or only, eye in two of the six cases herein reported. Fluid, probably from the vitreous cavity, appears to gain access to the subretinal space via the pit. Reattachment in treated cases occurred only if an effective chorioretinal adhesion was created over the entire area of the fistulous detachment at the disc margin. Field defects after treatment appear to be secondary to either the optic pit itself or the longstanding retinal detachment, oftern accompanied by pigmentary degeneration and cystic macular degeneration, rather than juxtapapillary photocoagulation treatment.


The roto-extractor in pediatric ophthalmology. The Roto-Extractor, designed by Nicholas Douvas, M.D., was used by the authors in 66 eyes for cataracts, secondary membranes, and persistent hyperplastic primary vitreous. The average age of the patients with congenital cataracts was 2.4 years, for traumatic cataracts 16.4 years. The pupil wal cleared well in 63 of these eyes. There was no vitreous to the wound in any of the eyes. Unplanned iridectomies and prolonged inflammation were the major complications.


Inherited hyaloideoretinopathy and skeletal dysplasia. Twenty-one patients from five families displaying the ocular defects of dominantly inherited hyaloideoretinopathy as originally described by Wagner were surveyed radiographically for skeletal defects. A mild generalized epiphyseal dysplasia was found in twenty. A comparison of the skeletal dysplasia associated with arthro-ophthalmopathy and that found in families with Wagner's disease reveals more similarities than differences. It is concluded that Wagner's disease is a dominantly inherited syndrome of ocular defects that includes myopia, vitreous syneresis with membranes, and radial perivascular chorioretinal degeneration. It is associated with radiographically demonstrated generalized epiphyseal dysplasia that is manifested clinically by flattening of the mid-face and palatoschisis.


The induction of refractive errors by retinal detachment surgery. This report consists of a retrospective clinical study of the effect of retinal detachment repair, specifically the encircling procedure, on induced spherical refractive error. The analyze the findings we include optical and supplementary clinical and in vitro studies of corneal curvature, axial length, and anteiror chamber depth. The results of each of these help confirm and are sufficient to explain the discoveries of the original clinical study.


In vitro biology of corneal epithelium and endothelium. Four main areas are explored: (1) the proper culture medium for corneal tissue; (2) the effect of serum on in vitro tissue growth; (3) the in vitro interrelationships between corneal epithelium and endothelium; and (4) the biology of cultures of whole corneas (organ cultures). Modified Eagle's minimal essential medium (MEM) proved to be an excellent culture fluid. Corneal tissue could be grown in MEM without serum or clot, thus providing a defined culture medium. The in vitro biology of outgrowths of multilayered corneal epithelium and monolayered corneal endothelium are discussed. Contact inhibition between epithelium and endothelium is demonstrated in whole corneal (organ) cultures.


Gonioscopic differences between eyes with primary open-angle glaucoma and normal eyes in subjects over the age of forty. Gonioscopy was performed on 110 patients with primary open-angle glaucoma over the age of 40 and an equal number of normal subjects matched by race and age. The frequency distribution of various angle features differed in two groups. In the glaucoma group there were more iris processes at all levels of insertion, a higher insertion of the iris root, and more trabecular pigmentation. We believe that a congenital angle anomaly is an important factor in the pathogenesis of the elevated intraocular pressure.


The management of glaucoma in nanophthalmos. Patients with nanophthalmos are prone to develop a chronic painless type of glaucoma in middle age, probably due to the natural increase in the size of the lens which is already relatively too large for the small eye. Although the underlying mechanism is obscure, a slowly progressive "creeping" chronic angle-closure is postulated, but gonioscopic evaluation is difficult due to the shallow anterior chamber, with grade I and slit angles. Response to medical treatment is poor and miotics may even make the condition worse by producing relative pupillary block and by relaxing the lens zonule. Ordinary glaucoma surgery is to be avoided in nanophthalmos because of the fear of postoperative ciliary-block malignant glaucoma. Periopheral iridectomy performed in five eyes at an advanced stage of the chronic angle-closure did not facilitate glaucoma control in three eyes, and in two eyes in which the operation was combined with posterior sclerotomy, the eyes became blind from vitreous hemorrhage. Lenx extraction in five eyes controlled the glaucoma but was followed by choroidal effusion and nonrhegmatogenous retinal detachements in two eyes and blindness in another eye when combined with a posterior sclerotomy. No firm therapeutic recommendations can be made on the basis of the author's experience in the six reported cases. Conventional medical therapy seems ineffectual even when begun early in the glaucoma. Conventional glaucoma surgery must be performed early, before permanent damage to the outflow mechanism occurs but removal of the lens must be anticipated. The surgeon must also remain aware of the high incidence of serious posterior-segment complications which inexplicably follow glaucoma or lens surgery in nanophthalmos, as described by Brockhurst.


Air pollution and respiratory mortality in Los Angeles. An epidemiologic study in Los Angeles showed a regular statistical association between respiratory mortality and the spatial distributions of ozone and particulate matter. There was an irregular association of respiratory mortality with maximum temperature. These findings are consistent with those of other studies relating respiratory morbidity to oxidant and particulate air pollution, and suggest that these pollutants may be health hazards.


Acupuncture in Nevada, second report.

Acupuncture in Nevada, second report. The State of Nevada has now given its fourth series of acupuncture licensing examinations. In all, 62 candidates have taken examinations. Licenses have been granted to 27 persons as master acupuncturists (Doctors of Traditional Chinese Medicine or Doctors of Acupuncture) and to 6 as Acupuncture Assistants. At present, 4 acupuncturists practice in the Reno area and 13 in Las Vegas.


Argon laser management of cutaneous vascular deformities. A preliminary report. Twenty-two patients with cutaneous vascular malformations were treated with an argon laser. Promising results were obtained in patients with port-wine stains, hemangiomas, telangiectasia and varicose veins. The argon laser shows promise as an effective clinical tool in the treatment of all such cutaneous vascular abnormalities. However, further study of clinical as well as laboratory data is necessary over a long period of time before this modality can be definitely recommended as the treatment of choice for vascular deformities of the skin.


The management of benign bone lesions.

The management of benign bone lesions. The almost bewildering variety of lesions that can affect bone contrasts sharply with the limited potential of bone to differentially respond to those lesions. This paradox can create a challenging problem when a bone lesion is shown on an x-ray film. Although heavily populated with pleuripotential primitive mesenchymal cells, there is seldom a histologic or radiographic change in the involved bone specific enough to allow a comfortable diagnostic autonomy to be enjoyed by surgical pathologists, radiologists or orthopaedic surgeons. Even when diligent and astute clinical evaluation has excluded infectious, parasitic, metabolic and metastatic causes of the change seen on x-ray studies, a physician is often still uncertain as to the exact nature of the lesion. A knowledge of the relative frequency of the common lesions, an acceptance that biopsy studies and treatment must be combined at times, an appreciation of the possibility of malignant change in a given lesion and a tendency to seek early consultation will likely lead to timely and accurate diagnosis. Once the diagnosis is made, optimum management must be selected. The best current opinion categorizes the lesions into treatment groups consisting of observation, curettage and graft, block excision, cryotherapy and radiotherapy.


[Value of long-term ECG monitoring in the diagnosis of coronary disease--comparison of 8-hour ECG monitoring and double Master exercise test with a clinical coronary index]. The use of the long term Ecg (dynamic Ecg) in the diagnosis of coronary artery disease (CAD) has been investigated in 83 patients and its sensitivity compared with the double Master two step test. The average ECG registration time was 8 hours. The presence of CAD was assumed when the clinical index according to Cohn et al. revealed a pathological value. If a horizontal or downsloping ST-segment depression of greater than or equal to 0,5 mm was chosen for the diagnosis of CAD a sensitivity of 82% resp. 64% was found for the dynamic Ecg and the double Master two step test. The specificity of the dynamic Ecg however was with 77% slightly inferior compared with the Master-test. The superiority in sensitivity of the dynamic Ecg was also present when the diagnosis of CAD was based on a ST-segment depression of greater than or equal to 1,0 mm. We believe that the dynamic Ecg can provide besides arrhythmia detection valuable information in the diagnosis of CAD and careful interpretation of the ST-segment should therefore be undertaken. The number of false positive results in the diagnosis of CAD was not influenced by the women included in the study.


[Post-transfusional hepatitis as a complication of surgery using the heart-lung-machine in childhood]. After open-heart surgery with extracorporeal circulation on 41 children with congenital heart disease in 13 (about 32%) a hepatitis with a long incubation period developed. In 6 out of 13 children (46%) HBS-Ag and in 2 additional ones anti-HBS could be detected. In 6 of 13 cases (46%) a chronic hepatitis ensued, which could be proved histologically in 4 cases.


[Influence of interval training on the physical capacity and peripheral circulation in patients with intermittent claudication]. Physical performance on treadmill and calf blood flow (venous occlusion plethysmography) were determined in 6 patients with symptoms of intermittent claudication before and after a 10-weeks period of intervall training. Arteriosclerotic occlusions of femoral artery were proved on arteriography in all cases. After training, a significant improvement of the claudication distance and the work performed on the treadmill on an average of 44% were stated, whereas nnd. The peripheral blood flow at rest and after 3 minutes circulatpressed as area under the blood flow curve during reactive hyperaemia) on an average of 54%. The benefits of a controlled home-training program as the necessity of investigation at maximal stress, when assessing the haemodynamic effects of physical training, are pointed out.


[Pressure-depending venous capacity in relation to age and sex in an average population group]. Pneumatic segment-plethysmography (Barbey et al.) was used to investigate the pressure-dependent venous capacity of the lower extremities on 443 test persons (a cross-section taken from the population aged between 15 and 64 years). The middle pressure-volume diagrams of men and women with no apparent blood-vessel disorders, of men and women with varicous-veins disorders and of men and women with obvious postural circulatory instability were compared. From 308 men with no blood-vessel disorders normal values were established for men in five age groups. There is a significant correlation between pressure-dependent venous capacity and age, applying to both men and women. In relation to healthy men healthy women have a significantly lower pressure-dependent venous capacity.


[Diagnostic value of the systolic part of the arterial pulse curve, registered using a bloodless technic]. Left ventricular contractility of 20 patients, measured by heart catheterization was compared with simultaneously but unbloody registrated pulse wave of A. carotis. Furthermore the crest time of femoralis and dorsalis pedis pulse wave was correlated to ejection time, pulse wave velocity, blood pressure and the length of the arteries between heart and foot of 1112 patients suffering from hypertension, arteriosclerosis, circulatory dysregulation and of 182 healthy sportsmen. The indices of left ventricular contractility: dp/dtmax, dp/dtmax/IP and t-dp/dt correlated highly significant with the time between the onset of the systolic upstroke and the first peak in the carotis pulse wave. No correlation was found with ejection time and the last systolic peak of the carotis pulse. Crest time is always shorter in the pulse wave of the foot arteries than in the femoral artery. The crest time in the femoral- and foot pulse correlates in all groups significantly with ejection time, patients with hypertension have the shortest, patients with arteriosclerosis the longest crest times, the last independent from the ejection time. The time between the start of the systolic upstroke and the first systolic peak in the unbloody registrated carotis pulse wave gives indication to the pressure development in the left ventricle. A long crest time in the peripheral pulse (pulsus tardus) is a typical symptom of generalized arteriosclerosis. The combination of slow pulse wave velocity in the leg and long crest time in the foot arteries (quotient greater than 20.5) indicates a stenosis in the arteries of the leg.


[Ballistocardiography on a model of the human cardiovascular system]. The linear relationship between the initial acceleration of blood flow and the I-wave as well as the HI-jerk of the acceleration ballistocardiogram is shown by experiments with a physical model of the cardiovascular system.


[Myocardial infarct with a normal coronary angiogram]. In this paper evidence is presented that in few patients with clear cut myocardial infarction as judged by physical signs, ECG and laboratory findings, the arteriography and morphology still may indicate healthy, unaffected coronary arteris. In those cases first of all the differential diagnosis has to include a silent myocarditis by whatever origin. This assumption may also be correct, if there are no or only few signs for this disease. Extensive diagnostic precedures should be performed under those circumstances.


The cardiologist's responsibility for preventing coronary heart disease. The recent increase in coronary heart disease is real  and the causes must mainly be environmental. Consequently the condition should largely be preventable. The application of what is already known is likely to be a far more effective way of reducing the mortality rate than all attempts at palliative treatment, but vigorous action will be necessary. Much greater sums are being expended  on coronary-care units and cardiac surgery than in preventing the need for them, although there is little evidence that they have significantly lowered the over-all mortality rate. Conventional treatment is immensely expensive. Prevention could in the long run be much cheaper. Cardiologists on their own are unlikely to succeed in a program of prevention. They need the help of many others, including community nurses, nutritionists, public health workers, sociologists, and of course general practitioners, but they have responsibility for leadership and for providing background knowledge. For the detection of certain risk factors, health examinations are necessary and should be part of general practice. Also, advice is best given on an individual basis. The chief-known risk factors (hyperlipidemia, hypertension, smoking, physical inactivity) could be controlled. CHD occurs in adults but atherosclerosis starts many years before. Prevention should begin with appropriate infant feeding, whenever possible with breast milk, and continue into childhood, when habits are formed and attitudes to life can best be influenced. It should be possible to bring up children virtually free from risk factors. It may never be possible to prove the effectiveness of such a multifactorial program by prospective controlled intervention studies, but the evidence indicates strong probability. The stakes are too high to delay action any longer. Physicians daily give advice in areas where the evidence is much less certain. Such a program for the control of coronary artery disease is urgently needed and could become one of the most rewarding activities for the medical profession.


Double mitral leaflet prolapse: echocardiographic-phonocardiographic correlation. Ten per cent of all patients referred to the echocardiography laboratory for diagnostic evaluation had mitral valve prolapse. Of these 35 patients, 19 (54 per cent) had prolapse of both the anterior and posterior mitral leaflets. Of the 19 patients, 13 had Type A or midsystolic prolapse, whereas six had Type B or pansystolic prolapse of the mitral leaflets. Simultaneous phonocardiographic examination of the patients revealed either midsystolic click and late systolic murmur, pansystolic murmur, or isolated click and short systolic murmur. There was no apparent correlation between the echocardiographic prolapse pattern and the auscultatory events. One patient with Type A prolapse had no auscultatory abnormalities at the time of the examination. It is suggested that the abnormal sounds may be generated by a redundant mitral leaflet rather than chordae tendineae.