M-mode ultrasonic localization and identification of fluid-containing pulmonary cysts. Successful ultrasonic localization of pleural fluid has been well documented in recent reports. The ability of ultrasound to detect and identify fluid within a parenchymal lesion has not been defined. We examined nine patients with cystic lesions and air-fluid levels noted on the chest roentgenogram. In all nine patients, an echo-free space that corresponded anatomically to the level of fluid noted on the x-ray film could be recorded in the M-mode presentation. The combined thickness of the wall of the chest and the overlying lung as judged by ultrasound ranged from 2 to 8 cm, with a mean of 4 cm. The following two characteristics appeared to distinguish parenchymal from pleural fluid: (1) similar characteristics of motion of the proximal and distal interfaces of the sonolucent space; or (2) the ultrasonographic pattern of overlying lung proximal to the loculation of fluid. Ultrasonograms in eight (89 percent) of nine patients demonstrated one or both of these characteristics. These findings indicate that ultrasound can detect fluid within a parenchymal structure and may be used to differentiate intraparenchymal loculations from those in the pleural space.


Incidence of ruptured chordae tendineae in the mitral valvular prolapse syndrome: an echocardiographic study. Echocardiographic studies were performed in 190 consecutive patients with mitral valvular prolapse. All patients had either midsystolic posterior motion of the mitral valve or holosystolic hammock-like movement of the valve in systole. Thirteen patients (7 percent) were noted to have ruptured chordae tendineae. In four patients, a combination of abnormalities was observed. Five patients had clinical and bacteriologic evidence of infective endocarditis, two of whom had severe intractable pulmonary edema consequent to acute mitral regurgitation which required mitral valvular replacement. At surgery, one of these patients had ruptured chordae tendineae to both leaflets, and the other had chordal rupture of the posterior leaflet. The other patients probably had spontaneous rupture of the chordae tendineae. A spectrum of clinical findings was noted. Six patients had marked mitral regurgitation, while two had isolated systolic clicks. Thus, chordal rupture does not always result in severe hemodynamic deterioration. Serial echocardiographic studies will be of value in studying the natural history and progression of disease in patients with chordal rupture.


Aggressive therapy in acute respiratory failure from leukemic pulmonary infiltrates. Three young adults with respiratory failure as a first or early manifestation of acute leukemia were hospitalized. Aggressive support with mechanical ventilation, high fractions of inspired oxygen, and positive end-expiratory pressure provided time for appropriate chemotherapy to be used. One patient was alive, with the disease controlled, 18 months after these events. The other two patients responded to therapy but died subsequently from other aspects of their disease. With the advent of effective specific chemotherapy, the onset of acute respiratory failure in the presence of certain malignancies in young adults should not be considered a terminal event when no other organ is involved.


Echocardiographic abnormalities in patients with cystic fibrosis. An echographic study was undertaken to evaluate left (LV) and right ventricular (RV) function in 30 patients with cystic fibrosis. Echographic recording of the pulmonary and aortic valve echogram permitted measurement of the phases of right and left ventricular systole. The ratio of the LV preejection period/LV ejection time (LPEP/LVET) and shortening of the LV internal dimension %SID was employed to reflect LV function, while RV preejection period/RV ejection time (RPEP/RVET) has excellent correlation with pulmonary artery diastolic pressure. RPEP/RVET and two other echographic measurements, right ventricular wall (RVW) and internal dimension (RVD) were compared with pulmonary function tests and clinical scores. RPEP/RVET correlated well with percent vital capacity(%VC), r = -0.73, percent residual volume (%RVol) r = +0.72, and clinical score, r = -0.77. Multilinear regression of RPEP/RVET, RVD, and RVW improved correlation for %VC (r = -0.80), %RVol, r = +0.82, and clinical score, r = -0.84. Patients in overt right heart failure exhibited elevated RPEP/RVET (mean = 0.48) when compared to patients not in right heart failure (mean = .33). Marked diminution of LV function was present in two patients. A variety of cardiovascular abnormalities were demonstrated echographically and were valuable in assessing the degree of cardiac involvement in patients with cystic fibrosis.


Clinical importance of the interaction of phenytoin and isoniazid: a report from the Boston Collaborative Drug Surveillance Program. Six (27 percent) of 22 hospitalized medical patients who received phenytoin and isoniazid concurrently for at least five days experienced toxic effects on the central nervous system (CNS). In contrast, only 30 (3 percent) of 1,093 patients who received phenytoin without isoniazid had toxic effects on the CNS. Thus, the risk of toxic effects from therapy with phenytoin is greatly increased among patients concurrently receiving isoniazid, probably because of isoniazid-induced impairment of the clearance of phenytoin. Schedules of dosage for phenytoin whould be appropriately adjusted to compensate for this clinically important interaction of drugs.


Systolic time intervals before and after cardioversion of atrial fibrillation. The effect of cardioversion of atrial fibrillation to normal sinus rhythm on systolic time intervals was evaluated in 18 patients. Variable results in the left ventricular ejection time index, the external isovolumic contraction time (EICT), and the ratio of the left ventricular ejection time over the EICT (LVET/EICT) and shortening of the preejection period (PEP) (P less than 0.01), the PEP index (PEPI) (P less than 0.005), and the ratio of PEP/LVET (P less than 0.001) occurred at five hours after cardioversion. Six (33 percent) of the 18 patients developed recurrent atrial fibrillation within one month after cardioversion, and the hearts of 12 (67 percent) of the 18 patients remained in sinus rhythm for one to ten months after cardioversion. Four of five patients in whom the EICT became worse at five hours after cardioversion and two of two patients in whom the PEPI became worse at five hours after cardioversion developed recurrent atrial fibrillation. The EICT and PEPI at five hours after cardioversion may be helpful in predicting subsequent recurrence of atrial fibrillation.


Hemodynamic alterations of heat stroke in the elderly. Serial hemodynamic alterations were investigated in seven elderly patients with heat stroke. Their mean age was 72 +/- 6 years. The circulatory response to heat stroke was either hyperdynamic of hypodynamic. Two patients had increased cardiac index (4.3 and 4.4 L/min/m2), increased right atrial pressure (10 and 12 mm Hg), normal pulmonary capillary wedge pressure (10 and 12 mm Hg), and decreased systemic vascular resistance (542 and 738 dyne.sec.cm-5). Five patients had decreased cardiac index (mean 2.3 +/- 0.2 L/min/m2), decreased right atrial pressure (mean 2 +/- 1 mm Hg), normal pulmonary capillary wedge pressure (mean 6 +/- 3 mm Hg), and increased systemic vascular resistance (mean 2020 +/- 204 dyne.sec.cm-5). Circulatory failure appears to be secondary to peripheral pooling of blood or hypovolemia. The inability to compensate hemodynamically when stressed by heat may predispose certain elderly individuals to develop heat stroke.


Improved oxygenation of ischemic myocardium by hemodilution with stroma-free hemoglobin solution. Experiments were conducted in anesthetized open-chest dogs subjected to occlusion of the left anterior descending coronary artery for three hours. The oxygenation of myocardial tissue was monitored by a polarographic technique capable of recording simultaneously the oxygen tension (Po2) of myocardial tissue and electrograms. Ischemic injury was monitored by means of ST-segment elevations on myocardial and epicardial electrograms. The volume of the myocardial infarct was measured at the end of each experiment by incubation of transverse slices of left ventricle in a solution of nitroblue tetrazolium and by separation of the unstained (ischemic) from the stained (normal) portions. In one group of dogs, hemodilution was performed after 15 minutes of ischemia by exchanging blood with a stroma-free hemoglobin solution (from a hematocrit reading of 45 +/- 3 percent to 23 +/- 2 percent). Changes occurring in this group were compared with those occurring in dogs that did not undergo hemodilution, underwent hemodilution with dextran 75, or were transfused with whole blood. Hemodilution with hemoglobin reduced aortic and left ventricular filling pressures while increasing coronary blood flow, increased myocardial Po2 from 2 +/- 2 mm Hg to 8 +/- 2 mm Hg (P less than 0.005), lowered the ST-segment elevation of both myocardial and epicardial electrograms, and reduced the volume of the myocardial infarct. These effects were unmatched by hemodilution with dextran or infusion of whole blood.


Mediastinal herniation of the pleural sac: occurrence in massive pleural effusion. In a review of 50 patients with massive pleural effusion, mediastinal herniation of the pleural sac occurred in 16 patients (32 percent). Right-to-left herniation (ten patients) was more common than left-to-right (six patients). Herniation occurred only in the posteroinferior mediastinum (D5-D11). Fourteen patients had displacement of the mediastinum away from the side of pleural effusion. Disappearance of herniated sac in every patient following thoracocentesis confirmed the diagnosis.


Congenital ankylosis of the temporomandibular joint: resultant upper airway obstruction and cor pulmonale. Cor pulmonale and severe congestive heart failure secondary to chronic upper airway obstruction developed in a three-year-old girl with congenital ankylosis of the temporomandibular joint complicated by frequent respiratory infections. Nearly absent mouth opening, micrognathia, and mandibular retroposition with resultant glossoptosia obstructed the airway. Medical treatment followed by a tracheostomy and bilateral condylectomy relieved the obstruction allowing normal function of the temporomandibular joint. The clinical, electrocardiographic, radiologic, and hemodynamic findings returned to normal. Congenital ankylosis of the temporomandibular joint has not been previously reported as a cause of cor pulmonale secondary to upper airway obstruction.


Tuberculous aneurysms of the descending thoracic aorta: report of a case with fatal rupture. Tuberculous aortic aneurysm is a rare disease entity. The majority of affected patients succumb to perforation and exsanguination. The only chance for survival and cure is by resection and prolonged antituberculosis chemotherapy. Our case illustrates the high risk of rupture of tuberculous aortic aneurysms. Post-mortem examination revealed that the mechanism of aneurysm formation was by direct caseous involvement of the descending thoracic aorta from a juxtaposed left upper lobe parenchymal tuberculous process. Our findings also favor the concept that miliary dissemination (in the presence of tuberculous aortic aneurysm) is the result rather than the cause of the tuberculous aortic process.


Surgical removal of a left atrial myxoma during pregnancy. Successful removal of a left atrial myxoma in a pregnant woman has not been previously reported. The patient postoperatively had an uncomplicated pregnancy, delivering at term a normal, healthy baby.


Bloody pleural effusion associated with an intralobar pulmonary sequestration. A 50-year-old male cigarette smoker with a posterior parenchymal lung mass developed a bloody, exudative pleural effusion. Pathologic examination of the resected lung confirmed the preoperative diagnosis of an intralobar pulmonary sequestration.


Spontaneous closure of atrial septal defect with cardiac failure in infancy. Two serial cardiac catheterizations before the age of four months and another at six years confirmed spontaneous closure of a large atrial septal defect which caused congestive heart failure in infancy.


Aortopulmonary window or aortopulmonary communication? Two patients had a vessel-like aortopulmonary "window" which could be ligated without the institution of cardiopulmonary bypass. While embryologically and functionally these communications are identical to the classic aortopulmonary "window," it is suggested that the term "aortopulmonary communication" is more appropriate.


Congenital pulmonary artery branch stenosis: association with renal artery stenosis. A patient had multiple bilateral stenoses of the pulmonary artery and its branches with systemic hypertension associated with mild stenoses of the renal arteries. Cardiac catheterization and angiocardiography are important in the evaluation of the degree of stenoses and pulmonary hypertension. This case suggests that in a child or young person with hypertension and a loud precordial murmur, lesions other than coarctation of the aorta may be present. Unexplained systemic hypertension requires further investigative workup which is essential for proper treatment and long-term management of these patients.


Legionnaires' disease presenting with empyema. Legionnaire's disease presenting as empyema has not been previously described, although pleural effusions are not uncommon. A 56-year-old woman had a ten-day history of pleuritic chest pain and a large loculated empyema. Legionnaires' disease was documented by serum indirect fluorescent antibody studies.


The immunosuppressive effects of 5-fluorocytosine and 5-fluorouracil. 5-Fluorocytosine (5-FC) is weakly immunosuppressive when given in lethal doses to mice, and inhibits the responses of mouse and human lymphoid cells to plant lectins at concentrations of 1 mg/ml or more. 5-FC has about 1% of the immunosuppressive activity of 5-fluorouracil in vivo and 0.1% in vitro. Deamination of small amounts of 5-FC to 5-FU or conversion to other toxic metabolities may account for its immunosuppressive effects. The in vitro effects of 5-FC could also be accounted for by the presence of traces (0.1%) of 5-FU as a contaminant.


Comprehension skill levels and prevalence of maladaptive behaviors in autistic and mentally retarded children. A statistical study. A statistical study on the comparison of the comprehension skill levels between the group with and the group without each maladaptive behavior of nine items was done for autistic and mentally retarded children. Results indicated that the group of the autistic children with hyperactivity or withdrawal had slightly, not significantly, lower comprehension skill levels than the group of those without each of these maladaptive behaviors. On the other hand, the correlation between the prevalence of hyperactivity or withdrawal and lower comprehension skill levels was seen more clearly, with statistically significant differences, rather among the mentally retarded children.


Chronic encopresis: a system based psychodynamic approach. A successful method used in treating a series of five cases of chronic encopresis is reported. The method is a system based approach, taking into account the typically underlying hostile mother-child psychodynamics accompanying encopresis.


Prediction of preschool social behavior from social-emotional development at one year. In an attempt to directly investigate later consequences of the early mother-infant relationship, several measures of social-emotional and cognitive-motivational development at 12 months of age were correlated with two measures of preschool adjustment for 26 children. Results indicated that both of our measures of early social functioning were related to more optimal adjustment in a peer-setting at three-and-a-half years of age. Taken together, the results of the study provide empirical support for the widely held, but seldom tested, hypothesis that the quality of the early mother-infant tie has important consequences for the child's subsequent development in most areas.


A four-fold model for subgrouping the hyperkinetic/MBD syndrome. The major finding of this study is that the presence or absence of aggressive symptomatology differentiates a group of 84 six to twelve year-old Hyperkinetic/MBD boys on a number of important measures at initial referral, during treatment with methylphenidate, and at subsequent five-year-follow-up. When the sample is sorted into high and low aggression groups, several findings emerge which would otherwise have been obscured. Furthermore, there are no significant interactions between aggression (control deficits, negative affect, aggressive interpersonal behavior) and hypertactivity (judgment deficits, hyperactivity, inattention). The value of differentiating between exclusive hyperactivity with aggression) is indicated by the present study.


Emotional disorders of asthmatic children. Depression, anxiety, defiance and hostility in sixty asthmatic and non-asthmatic children of school age, all with the same familial and constitutional allergic background, were measured with the Mother-Child Questionnaire. In the sample as a whole it was found that boys were more disturbed than girls and high-dependent children were more disturbed than low-dependent children. However, asthmatic low-dependent children were significantly more disturbed than non-asthmatic low-dependent children, whereas asthmatic high-dependent children tend to be less disturbed than non-asthmatic high-dependent children. The findings show that emotional disorders in the asthmatic children are associated with pathogenic maternal family relationship patterns.


Child custody consultation in abuse and neglect: a practical guide. Mental health professionals are being asked with increasing frequency to consult to the courts regarding custody in cases of suspected abuse and neglect. This paper provides practical guidelines for evaluation of these families in order to maximize the effectiveness of consultation and minimize common pitfalls usually encountered with such evaluations. The authors offer suggestions for structuring the evaluation, dealing with family reisitances, writing the report and testifying in court. It is the hope that with such practical guidelines, other mental health professionals will be willing to attempt such consultations and will be able to structure them in such a way that they can be carried out efficiently and effectively, benefiting not only the courts, but the children and their families as well.


Psychotherapy in the residential treatment of the borderline child. The concept of borderline diagnosis is defined and the goals of residential treatment are delineated. The specific aims and techniques of psychotherapy are then outlined. Concomitant work with parents is utilized. The importance of working through during termination is noted.


[The value of Adams and de Weese's technic of cava clipping]. Indications and methods of inferior vena cava interruption in the management of recurrent pulmonary embolism are discussed. The results of a collected series are analyzed with special regard to the partial interruption technique using the Adams and de Weese clip. Five of our own cases, followed up 1 year postoperatively, are presented.


[Clinical testing of an image memory in peroperative roentgen diagnosis]. The relatively high radiation exposure when applying mobile X-ray image intensifiers to surgical radiology can be distinctly reduced by the ultilzation of an electronic image memory, which makes visible as long as you like the last fluoroscopic image of a fluoroscopic scene on the viewing monitor without switching on the X-ray tube. As an average over various surgical examinations, the dose reduction compared with facilities lacking these image memories amounts to about 30%.


[Bypass enteritis. The significance of end-to-end and end-to-side anastomosis in jejunoileostomy]. Jejunoileostomy is an effective procedure in the treatment of morbid obesity. The end-to-end and end-to-side anastomoses are competitive techniques. The end-to-end anastomosis prevents a reflux of food into the shunted intestine loops, but stool reflux to the colon very often occurs over the drainage anastomosis. The patients develop an immunological disease with fever and arthritis. Resection of the infected intestinal loop is the standard therapy. The immunologic manifestation after jejunoileostomy does not occur after end-to-side anastomosis; end-to-end anastomosis should therefore no longer be used.


Operative hemorrhoidectomy versus cryodestruction. Twenty-six patients were treated for hemorrhoids by a combination of cryodestruction and closed operative hemorrhoidectomy. Patients were able to draw their own conclusions about the efficacies of these treatments. They had no difficulty in distinguishing exactly which area was causing pain. The operative site was a source of greater pain until the second day after the procedure, when the pain resulting from cryodestruction equalled surgical pain; then cryodestruction associated pain continued longer. Cryodestruction was associated with production of a foul discharge. Residual hemorrhoids were present in 50 per cent of patients' cryodestruction sites. Given the choice at the one year follow-up examination, 65 per cent preferred surgical treatment and 35 per cent preferred cryodestruction.


Irrigation vs. natural evacuation of left colostomy: a comparative study of 340 patients. A comparative study of two methods of managing left colostomy (irrigation and natural evacuation) was carried out on 340 patients who were examined and interviewed at the Stoma Rehabilitation Clinic of the Institute of Surgical Pathology of the University of Padua. Ninety-two per cent of patients who irrigated their colostomies gained fecal continence. No patient who irrigated his colostomy had any cutaneous problem, and this group had significantly better results in preventing leakage of gas and odors compared with those patients using natural evacuation. For most patients who irrigated, the ability to predict or control bowel movements overcame fears of "being dirty" and related psychological problems. These patients also had more normal social and working lives than did those patients not irrigating their colostomies. Only one patient in our series had a colonic perforation, and any chance of a repeat incident will probably disappear with the cone-shaped catheters now available. The authors conclude that in properly selected patients, irrigation is the method of choice for management of left colostomy.


Sigmoidal ulcer as a cause of acute colonic obstruction. A case of primary nonspecific ulceration of the sigmoid colon initially manifesting as acute colonic obstruction is presented. Other possible etiologies of acute sigmoidal obstruction are discussed.


Viscous lidocaine as a posthemorrhoidectomy analgesic. During hemorrhoidectomy, a standard 16-gauge plastic catheter was sutured to the operative site so that analgesic doses of viscous lidocaine solution could be delivered to the site for the first 36 hours postoperatively. Although 14 patients had urinary retention that necessitated catheterization, no complication was attributed to the analgesic method. Of 227  patients, 92 per cent were treated with this method plus orally administered nonnarcotic analgesics. Viscous lidocaine injected into the anus is concluded to provide safe, convenient analgesia following hemorrhoidectomy. Toxic reactions to lidocaine were not a problem because the doses were small, and the drug was used only intermittently over a period of 36 hours.


Adenocarcinoma of the colon and rectum: a review of surgical treatment in 302 patients. A retrospective study of 302 patients who underwent surgical treatment for colorectal carcinoma from 1952 to 1971 is presented. Resectability rate was 93.7 per cent. Operative mortality rate was 5 per cent. Complications were recorded in 12 per cent of cases. Recurrence at the anastomotic line occurred in 3.31 per cent. The actuarial five-year survival rate was 44.2 per cent for all types of cancer. The "no-touch" technique utilized after 1968 resulted in increased survival of patients who had Dukes' B and C cancers.


Eosinophilic gastroenteritis involving the ileocecal area. Eosinophilic gastroenteritis, an idiopathic inflammation of the alimentary canal, is characterized by infiltration of the intestinal wall by eosinophils, massive submucosal edema, and peripheral eosinophilia. It is generally confined to the gastric antrum and proximal small intestine. A young woman had an eosinophilic infiltrate that involved the distal ileum and right colon only. Barium studies showed severe narrowing and shortening of the cecum and ascending colon. Symptoms of intestinal obstruction did not respond satisfactorily to conservative measures. Adhesions over the ileocecal area as well as thickening and induration of the terminal ileum and proximal right colon were found on hemicolectomy. The remaining intestine and the peritoneal cavity were felt to be normal. Histologic examination showed a cellular infiltrate with prominent eosinophils in the mucosa, submucosal edema and fibrosis. During a 40-month follow-up period after the hemicolectomy, the patient has not shown clear evidence of recurrence or extension of the disease to the stomach or proximal small intestine. It is concluded that idiopathic eosinophilic gastroenteritis may primarily involve the ileocecal area. In that location it must be specifically differentiated from intestinal tuberculosis, amebiasis, and Crohn's disease.


Pneumatosis intestinalis: a clinical classification. Review of our experience with pneumatosis intestinalis has allowed identification of three major clinical groups of patients. In each of these groups, the etiology of pneumatosis intestinalis usually can be identified, and it frequently has an ominous prognosis. Treatment should be directed to the underlying condition when possible, and hence must be individualized. Those patients who would be categorized as Group I can simply be kept under observation. Patients in Group II might obtain relief from breathing increased concentrations of oxygen. For patients in Group III vigorous therapeutic measures generally are necessary to ensure survival. The increasing use of mechanically controlled ventilation and positive end-expiratory pressure may be contributing to the incidence of pneumatosis intestinalis. The ileus sometimes observed in these patients may accompany or precede the development of intramural air, a condition identifiable on roentgenographic examination. Awareness of the possible presence of intramural air may help in identifying patients who may not need operation. But even when roentgenographic examination has confirmed the presence of intramural air, abdominal exploration still may be necessary to rule out a diagnosis of perforated viscus. We hope that these concepts and our emphasis upon individualization of treatment may improve the prognosis for patients who have pneumatosis intestinalis.


Fournier's syndrome following anorectal examination and mucosal biopsy. We have presented a rare instance of Fournier's synergistic gangrene following anorectal examination and biopsy. Early diagnosis and extensive debridement were necessary. Extensive debridement necessitated a significant reconstruction task. This technique of genital reconstruction should be familiar to surgeons dealing with colonic and rectal disease.


Juvenile colonic polyposis with villous adenoma and retroperitoneal fibrosis: Report of a case. A 25-year-old Nigerian black woman was found to have polyps involving the rectum, rectosigmoid, and sigmoid colon on air-contrast barium-enema examination. Resection of a segment of sigmoid colon revealed numerous polyps that were predominantly of the juvenile type, in keeping with the diagnosis of juvenile polyposis of the colon. This case is unusual because of the coexistence of retroperitoneal fibrosis with juvenile polyposis of the colon. In addition, one of the colonic polyps was a villous adenoma. The implications these findings are discussed in relation to polyposis syndromes reported previously.


[On the infectiousness of HBs-antigen-positive medical personnel (author's transl)]. Electronmicroscopic study of 29 HBs-antigen-positive personnel of a large hospital demonstrated virus material in the blood in all instances. In nine cases Dane particles, which are the infectious principle of the hepatitis B virus, were also seen. Dane-particle-positive personnel in a hospital could well be a risk to the patients if the carrier status or infectiousness of the person is not known.


[Characterisation of activity of a biphasic monocomponent insulin (author's transl)]. 13 automated continuous measurements of blood glucose over a period of 24 hours were registered in 10 diabetics with two daily doses of highly purified biphasic monocomponent insulin Rapitard (Novo) using an automated analysis system based on the autoanalyser II (Technicon). It was shown that the action of MC Rapitard insulin starts within 30 minutes after subcutaneous injection. There is a pronounced initial activity which is clearly superior to that of MC Monotard insulin. The maximum of activity is after 2-4 hours and lasts at least for 8 and sometimes 11 hours after application. Not counting two men with brittle diabetes MC Rapitard insulin was able to keep postprandial blood glucose changes within narrow limits. Thus there is a good effectiveness against hyperglycaemic peaks. Despite the b.i.d. application of this relatively long acting intermediary insulin there were no undesirable effects of an overlap. As expected the effectiveness of MC Rapitard insulin does not differ from the earlier non-chromatographically purified Rapitard insulin preparation.


[The diagnosis of hydatid disease of the liver by ultrasound (author's transl)]. Demonstration and localisation of hydatid disease in the liver by ultrasound was successful in 41 patients (35 with cystic and 6 with alveolar disease). In cystic hydatid disease the demonstration of a cyst which contains a daughter cyst (5 of 35 cases), as well as a cystic conglomerate enclosed in a smooth capsule (17 of 35 cases), is typical for the disease. In 22 patients ultrasound alone provided the correct diagnosis. In the alveolar form the ultrasound findings were not typical for the parasite and could not be differentiated from solid or necrotising malignant tumour of the liver. The ultrasound method is thus of great value in the diagnosis of cystic hydatid disease, but if the findings are unclear--especially if the alveolar type of disease is suspected--further studies of the disease, in particular angiography, must be undertaken.


[Benign surgical icterus (author's transl)]. Among 3192 operations on the gall bladder and biliary ducts clinically and chemically a benign icterus was found in 318 patients (9.9%) (maximal serum bilirubin values 21 mumol/l). 140 patients (44%) had a typical biliary history over many years, 173 patients (54%) had only cholelithiasis, 98 patients (30.9%) had concrements in the gall bladder and biliary ducts and 9 patients (2.8%) had concrements in the biliary ducts only. In 141 patients (44.3%) additional complications were found. The post-operative mortality was 5% among which were 9 patients dying of the final stages of their basic disease or its complications; 7 patients died of cardiopulmonary complications. An improvement of the prognosis can only be reached by early operation of patients with gallstones.


[Rheology of the blood during treatment of hypertension with xipamide (author's transl)]. The possible effect of xipamide on flow properties of blood were studied in groups of eight patients each with essential hypertension. It was demonstrated that 10 mg xipamide (a long-acting diuretic) given daily had no deleterious effect on flow property, while 20 mg daily produced a haemoconcentration which negatively affected it, apparently in relation to the urine volume excreted per unit time. At higher dosages the effect on blood flow properties was shifted in time, which indicates that the increased diuresis in the first day leads to a cumulative effect on the flow properties of the blood. Erythrocyte deformability was not affected. It is possible that combined preparations which contain a diuretic should be specially examined with respect to any undesirable effect on flow properties of the blood.


Salivary and plasma IgA of seizure subjects receiving phenytoin. Immunoglobulin A, phenytoin, and protein were determined in plasma, unstimulated and stimulated whole saliva and stimulated and unstimulated parotid saliva from seizure subjects, aged 18 or more, who had ingested phenytoin for 1 year or more from controls. Patient subgroups with low plasma IgA and with gingival overgrowth were evaluated separately. Plasma and salivary phenytoin and ratios of salivary to plasma phenytoin concentrations corresponded to published reports. Plasma IgA was significantly decreased in the total patient group. However, salivary IgA expressed as the concentration or as the proportion of salivary protein, with one exception, was not significantly decreased in any type of saliva from the total patient group or subgroups. Significant phenytoin induced increases in salivary IgA were noted. IgA secretion rate by the parotid gland was significantly increased in the total patient group. This investigation does not indicate a deficiency of oral IgA from chronic phenytoin ingestion. Thus, it appears unlikely that decreased oral IgA with a consequent enhanced susceptibility to inflammation contributes to phenytoin associated gingival overgrowth.


Treatment of bacterial infections in pregnancy. Treatment of bacterial infections in pregnancy requires an understanding of the unique problems related to the administration of antibacterial agents to pregnant women. The clinician must be aware not only of the antibiotic-associated untoward effects which may develop in the mother, but also of the possibility that adverse reactions may occur in the fetus. Precise knowledge of the microbial aetiology of those infections which occur during pregnancy and an understanding of the intricacies of antibiotic administration to pregnant women will assure the greatest likelihood that bacterial infections in pregnancy will be effectively, and safely, treated.


Estimation of plasma unbound phenobarbital concentration by using mixed saliva. Relationships among plasma total (Ct), plasma protein unbound (Cf) and mixed salivary (Cs) concentrations of phenobarbital (PB) were studied in 29 epileptic patients. A highly significant correlation was observed between Ct and Cf. Although a significant correlation was observed between Cf and Cs, Cs/Cf ratio was only 0.63. When Cs was corrected by using pKa (7.41) and pH of saliva to estimate free PB concentration (Cest f), a highly significant correlation was obtained between Cf and Cest f, and Cest f/Cr ratio was 0.96. The temporal course of Cest f obtained from Cs after an oral single dose of 50 mg PB in a healthy adult male volunteer was approximated as a triexponential equation. The peak time was 2 hr after ingestion and apparent half life was 66 hr. The prediction of minimum concentrations at steady state on the basis of these parameters corresponded well with actually obtained Cest f following repetitive administration of PB.


Physical exercise modifies the effect of high cholesterol-sucrose feeding in the rat. 1. Adult male rats were fed a basic chow (less than 0.01% cholesterol) and the same diet modified to contain 0.2% cholesterol and 20% sucrose. 2. Cholesterol-sucrose diet increased the erythrocyte cholesterol and the liver cholesterol. This diet decreased the epididymal fat weight and the biliary cholesterol and it improved the micellar solubility of cholesterol in the bile. 3. Swimming daily for 1 h for 94 days modified the effect of cholesterol-sucrose feeding: it induced plasma lecithin-cholesterol acyltransferase (LCAT), it decreased erythrocyte cholesterol, plasma total and unesterified cholesterol, and adipose tissue phospholipids to a level even beyond that of the animals on the basic chow. These changes in lipid levels induced by exercise suggest an important role of LCAT in cholesterol transport. 4. Exercise did not effect micellar solubility of cholesterol in the bile probably because cholesterol biosynthesis was already suppressed by dietary cholesterol. 5. Exercise promotes cholesterol esterification and transport from the peripheral tissues to the liver not only on a low cholesterol diet (our previous reports) but also when feeding a diet high in cholesterol and sucrose.


Theoretical analysis of surface EMG in voluntary isometric contraction. A new stochastic model of the surface EMG is suggested and the spectral density of the surface EMG is studied theoretically and experimentally to confirm the validity of this model. Theoretical results show that while the contraction level is not so high, the shape of the spectral density (distribution) does not change and its amplitude is directly proportional to the motor unit firing frequency and recruitment. To illustrate the theoretical results, experiments were carried out for rectus femoris and biceps brachii. The surface EMG was lead off by bipolar surface electrodes. And the spectral density of the surface EMG was calculated using FFT algorithm. From these experimental results, it was confirmed that our theoretical results were almost valid.


[Modification of the Hoffmann reflex in function of athletic training (author's transl)]. The present study measures the values of the Hoffmann reflex and principally the relationship between the maximum reflex response and the maximum direct motor response (H max/M max) and their evolution. The subjects were athletes, performing aerobic and anaerobic type activities, divided into six groups (swimmers; soccer players; tennis players; sprinters; middle and long distance runners; and nonspecific athletes). The results show the average values of the H max/M max (53%) to be not different from those of nonathletes. When separated into aerobic and anaerobic groups, significant differences were found: the values are significantly inferior for subjects participating in anaerobic sports (37%) whereas we found an increase (from 55-75%) in the relationship for swimmers performing aerobic activities after 3 years of regular training. The results suggest, in accordance with previous authors, the possibility of a correlation between the modifications of the H max/M max and the type of activities (aerobic or anaerobic).


The effects of different levels of heat production induced by diathermy and eccentric work on thermoregulation during exercise at a given skin temperature. The thermal responses of two healthy male subjects have been studied at the same mean skin temperature (Tsk) during negative work, positive work and positive work in which additional heating was induced by diathermy. The results showed that for a given metabolic heat production (M) rectal (Tre) and oesophageal (Toes) temperatures were higher in negative work and positive work with diathermy than normal control experiments. In resting experiments with diathermy, Toes rose to the same level as when an equal amount of heat was produced metabolically by exercise. In negative work and positive work with diathermy sweat loss (Msw) was higher for a given M and Tsk than found for normal exercise, but in all three forms of work the relationship of Msw to total heat production (H) was identical. During positive work with and without diathermy the differences in Msw could be accounted for by using a previously developed model of relative sweating rate: %Msw = -constant + alphaTre (or Toes) + betaTsk. In negative work, removal of the difference between predicted and observed %Msw required the inclusion of a further factor into the equation based on muscle temperature. The results suggest that the core temperature in exercise rises to meet the requirements of heat dissipation mainly by stimulating Msw and establishing a heat transfer gradient from core to periphery and is not necessarily or uniquely related to M or to the rate of working. The study underlines the usefulness of negative work and diathermy as physiological tools for the further understanding of thermoregulation during exercise.


[The local and time-dependent temperature field in the body of a homeothermic organism in case of sudden changes of quantity and local distribution of internal heat production (author's transl)]. For the local and time-dependent temperature field in a homeothermic organism the symmetry of constant mean surface curvature is a geometrical adequate descriptive form. The according form of the partial differential equation of heat conduction with a suitable source function has been solved for sudden changes of the internal heat production. The thermodynamical difference between decrease and increase of the body heat content is discussed. The solution formula is also valid in case of sudden change of heat loss, caused for example by changes of the climatic conditions of the environment, clothing, or wetness of the skin surface. The results of the calculations are in good agreement with experimental data of other authors.


Capillary supply and mitochondrial content of different skeletal muscle fiber types in untrained and endurance-trained men. A histochemical and ultrastructural study. The number of capillaries per fiber, per mm2, around each fiber type and relative to fiber area was determined in six untrained subjects (UT) and six elite cross-country skiers (ET). Average values for maximal oxygen uptake were 49.8 ml . kg-1 . min-1 (UT) and 77.9 ml . kg-1 . min-1 (ET). Type I fibers constituted 39.2% (UT) and 68.6% (ET), type II A fibers 39.6% (UT) and 19.2% (ET), while 12.8% (UT) and 6.6% (ET) of the fibers were type II B. The mean fiber area for the type II A fibers was significantly greater (p less than 0.01) than the areas for type I and II B in the untrained group. The average numbers of capillaries around each fiber type (CA) were 4.76-4.84-2.94 (UT) and 7.79-6.63-4.5 (ET) for type I, II A, and II B, respectively. There was a significant difference (p less than 0.01) in the CA values relative to fiber area for all fiber types in both groups, being highest for type I and lowest for type II B. The CA increased linearly with increasing size of the fibers for all fiber types in both groups. The mitochondrial content was determined semiquantitatively for each fiber type. The differences in capillary supply between the fiber types are accompanied by similar differences in mitochondrial content. The results indicate that endurance training increases the capillary supply of all fiber types in the human quadriceps muscle. The fact that light microscopical studies have given lower capillarization values than those obtained with the electron microscope is discussed.


Pulmonary blood volume and interventricular circulation time in physically trained and untrained subjects. Resting pulmonary plasma and blood volumes (PPV and PBV), interventricular circulation time (IVCT), cardiac and stroke index (CI and SI), heart rate (HR), total plasma and blood volumes (PV and BV) were determined in athletes (two male groups representing different types of sport activities, and one female group) and compared with those of non-athletes (one male and one female group). In addition to high maximal aerobic power, the athletes were characterized by greater SI, BV and PV and lower resting HR than non-athletes, PPV and PBV were significantly larger and IVCT significantly longer in the trained than in the untrained groups, probably reflecting an improved capacity of the pulmonary circulation. PPV as per cent of PV was almost equal in all the groups, indicating the same distribution of plasma between the pulmonary and systemic circulation. The data also indicate that total blood volume is an important determinant of the magnitude of the pulmonary vascular bed. The increased volume of flowing blood and increased stroke volume in athletes probably allows for a reduction in flow velocity and thereby a reduction in kinetic energy.


Determination of Leb-active oligosaccharides in urine of pregnant and lactating women by radioimmunoassay. Antiserum obtained by immunizing a goat with lacto-N-difucohexaose I, a Leb blood-group hapten, coupled to poly-L-lysine was used in a radioimmunoassay to detect Leb-active oligosaccharides (chiefly lacto-N-difucohexaose I) in urine of 138 pregnant and lactating women of different ABO and Lewis blood groups. Specificity of the method was determined by comparing inhibitory activities of 18 oligosaccharides. Only women who belonged to the Leb blood group excreted Leb-active oligosaccharides in urine. Leb-active oligosaccharides increase during pregnancy, reaching levels up to approximately 70 mumol lacto-N-difucohexaose I equivalents per pmol creatinine in the third trimester and early post-partum period. Excretion varies considerably but tends to be highest in those individuals who strongly express the Leb antigen on their red blood cells or who belong to blood group O. Leb-active oligosaccharides were detected in plasma of a few individuals but at concentrations 1000-fold lower than in urine.


The role of the reactive disulfide bond in the interaction of cholera-toxin functional regions. The chemical reactivity of disulfide bonds towards reducing agents, in the absence of denaturing conditions, in cholera toxin has been studied. Treatment of the toxin with dithiothreitol or other mercaptans gave selective reduction of one of the six disulfide bonds of the protein. This reactive disulfide links two distinct functional regions of the toxin, fragment alpha, which activates adenylate cyclase, and fragment gammabeta5, which recognizes the cell surface receptors. Upon reduction, the two fragments remain bound together and the secondary structure of the protein is retained. The two functional regions have been separated and purified only by methods based on charge differences. When mixed together, purified alpha and purified gammabeta5 fragments spontaneously and rapidly re-form the disulfide bond. However, reduction of the disulfide bond is an absolute requirement for freeing the catalytic site of the alpha functional region. Thus, while other non-covalent binding regions are involved in maintaining cholera toxin molecular structure, the reactive disulfide bond may play a role in the mechanism of cell intoxication.


A new method for screening for hyperammonemia. A new method for the detection of hyperammonemia, using a kit based on the principle of microdiffusion of ammonia, is described. The method requires only one drop of blood and takes only 15 min to complete. Experiments for recovery and reproducibility were satisfactory, and good correlation was obtained when compared with an enzymatic method for blood ammonia determination. The new method is considered to be useful for routine, low-cost mass-screening of newborn infants for hyperammonemia. It will also be useful for monitoring blood ammonia levels at the bedside in cases with hepatic disease or receiving parenteral nutrition.


New chromosomal dysmorphic syndromes. 3. Partial trisomy 3q. Chromosome analysis in a newborn, the daughter of diabetic parents, who showed multiple dysmorphic signs and malformations revealed direct duplication of a long arm segment of chromosome 3(3q2100 leads to 3q2700). Both parents have normal karyotypes. Compilation of the phenotype stigmata with those of 7 other patients and 1 fetus with partial trisomy 3q confirmed that clinical recognition of this syndrome is possible. It is characterized by hypertrichosis, typical craniofacial dysmorphia, frequent organ malformations and skeletal anomalies, as well as a peculiar dermatoglyphic pattern. It is a severe genetic disturbance, leading to death in the first months of life in many cases and only symptomatic care is advised.


Superoxide dismutase and glutathione peroxidase in polymorphonuclear leucocytes. Superoxide dismutase (SOD) and glutathione peroxidase (GPX) protect aerobic organisms against the toxic superoxide anion and hydrogen peroxide, which are generated during phagocytosis by polymorphonuclear leucocytes (PMNs). PMNs of children with bacterial infections and with infectious hepatitis contained significantly elevated SOD activity, whereas GPX activity remained in the normal range. In contrast, PMNs of children with viral infections and rheumatoid arthritis exhibited a decreased SOD activity, while GPX activity was again unchanged. The children's age, sex or treatment did not effect the enzyme activities in PMNs. Since SOD generates bactericidal hydrogen peroxide and regulates the release of the toxic superoxide radical into the surrounding tissues, this study may add new understanding to the pathophysiological aspects of acute and chronic inflammatory processes.


Epidemiological and preventive aspects of cerebral palsy and severe mental retardation in Sweden. The epidemiology and changing panorama of cerebral palsy and severe mental retardation in Sweden are briefly surveyed. Based upon the Swedish experience, present and future preventive measures are discussed. The main differences in the preventive approach when tackling cerebral palsy in comparison with severe mental retardation are outlined and summarized in Table 3.


Metabolic substrates, muscle fibre composition and fibre size in late walking and normal children. In 10 children with delayed walking, muscle specimens were obtained by needle biopsy from the vastus lateralis muscle for determination of ATP, creatine phosphate (CP), glycogen and lactate concentration, as well as fibre composition and fibre size. The values obtained are compared with corresponding results for a control group of 25 children aged 2 months--11 years. Details of the control series are given and its validity as a reference group is discussed. Six children (group I) who showed minor gross motor delay but otherwise normal development at follow-up were found to have lowered ATP, CP and glycogen concentrations, compared to 4 children (group II) who had general developmental delay, and to the control group. The children in group I were shown to have smaller fibre size and a greater difference between type 1 and 2 fibres than the children in group II and in the control group. No differences in the concentrations of metabolic substrates or the morphometric values could be detected between group II and the control group.


Muscle abnormalities in coeliac disease: studies on gross motor development and muscle fibre composition, size and metabolic substrates. In 11 children with coeliac disease gross motor development was assessed before and during diet treatment using the gross motor subscale of the Denver developmental screening test. ATP, creatine phosphate (CP), glycogen and lactate concentrations, muscle fibre size and fibre composition were measured in specimens obtained by needle biopsy from the vastus lateralis muscle. Before treatment, gross motor development was delayed. ATP, and to a lesser extent, CP and glycogen concentrations were lowered compared to a control group. After treatment, gross motor development was normal and no differences in ATP, CP or glycogen concentrations were found compared to the control group. Fibre size seemed unaffected by the disease. The percentage of type 1 fibres was significantly lower before treatment, compared to values obtained during treatment and from the control group. Whether these metabolic changes were due to the coeliac disease per se or the inactivity which it causes was not possible to establish. In humans, only altered neurogenic influence on the muscles has been previously shown to give changes in fibre composition.


Intranasal DDAVP-test in the study of renal concentrating capacity in children with recurrent urinary tract infections. Intranasal administration of DDAVP (1-deamino-8-D-arginine vasopressin), a synthetic analogue of vasopressin, followed by measurement of urine osmolaity 6 h afterwards, represents a convenient, reliable and simple method for the estimation of renal concentrating capacity in children. The DDAVP-test is as accurate and reproducible as the water deprivation test, irrespective of the degree of concentrating capacity. Mean urine osmolality after DDAVP in children without renal disease was found to be 984 +/- 218 mosmol/kg water (m +/- 2 SD). In children with recurrent pyelonephritis, urine osmolality after DDAVP was decreased. The values were significantly lower with bilateral changes than with unilateral changes of chronic pyelonephritis in the i.v. urograms. In chronic pyelonephritis the concentrating capacity appears to be earlier impaired than other parameters of renal function.


18q- syndrome in mother and daughter.

18q- syndrome in mother and daughter. The 18q- syndrome is described in a mother and her daughter. In both of them an identical, apparently balanced 18q-/14p+ translocation was found (Karyotype: 46,XX,t(14;18)(p11;q21), suggesting that chromosomal material was lost in the process of translocation. The segment deleted and responsible for the 18q- phenotype must be located in or near band 18q21, in which the break is assumed to have occurred.


Rectal bladder. Indications, contraindications and advantages. Experience is reported on more than 700 patients submitted to rectal bladder over the last 20 years. The main indications were total cystectomy due to bladder neoplasias and palliative surgery in patients in whom cystectomy was impossible. The rectal bladder, even of the Mauclaire type, is the most useful and best accepted urinary diversion. Separation of urime from faeces avoids serious ascending infections and involvement of renal function. These observations are supported by the long survival of patients submitted to derivative surgery in the absence of neoplastic disease.


Effect of flavoxate on hyperactive detrusor muscle. The effect of Flavoxate on hyperactive detrusor contraction was studied in 37 patients, including 11 patients in whom the drug was administered intravenously during the urodynamic study. Beside the evaluation of frequency, nocturia and enuresis, the amplitude and the onset of uninhibited detrusor contraction (in correlation to bladder volume) was registered. The results showed subjective improvement in 61.3%. The complaints mentioned above improved in approximately 50%. The urodynamic data showed diminishing of the mean pressure during uninhibited detrusor contraction by almost 50% and the delay of the onset by 80% of bladder capacity. However, average bladder capacity increase was only 19%. It finally became obvious that the effect of Flavoxate was markedly worse in the neurogenic bladder group in comparison to the motoric urge patients.


Ultrasonic diagnosis of the retroperitoneal space. A precondition for ultrasonic diagnosis of the retroperitoneum is an optimal preparation of the patient to eliminate flatulence in the intestines. If the large vessels of the retroperitoneum are well demarcated, the optimal examination conditions are present. Tumorous and cystic changes of 2 cm or more, can be visualized. Difficulties, however, in the coordination and the differentiation of retroperitoneal tumors from organic tumors (pancreatic tail, splenic and gynecological tumors) can arise. Tumor changes in the lymphatic nodes, the adrenal gland and the sympathetic trunk, tumors in the retroperitoneum from other causes, and aortic aneurysms are discussed.


Interferometric laser holography for determination of the localization and extent of bladder tumor. In male giant rabbits (n = 10) with and without bladder carcinomas, holographic interferometric investigations with a double impulse rubin laser were made for testing the sensitivity of this method in detection of elasticity changes of the bladder wall caused by tumors. It could be shown that the holographic interferometry enables a distinction to be made between healthy and tumorous regions of the bladder wall by the various interference patterns.


Submicroscopic investigations on calcium oxalate stone genesis. Scanning electron microscopy of calcium oxalate stones indicates a zonary structure of the Weddellite crystals of urine concrements which is due to concentration-dependent growth oscillations representing the precipitation of various calcium oxalate hydrates. In addition to the phenomenological demonstration of Weddellite crystal shapes, incubation experiments with different solutions give rise to the postulation of a dehydration process of primary Weddellite crystals via dissolution and recrystallization to Whewellite. The solvent attack starts at energetically preferred corners, edges and lattice disorders of the Weddellite crystals. The Weddellite-stabilizing role of urinary Mg ions is emphasized.


Leiomyoma of the urethra.

Leiomyoma of the urethra. A case of a large leiomyoma of the female urethra causing acute obstruction excised by the vaginal route. The urethra had to cut across but complete continence was achieved following repair.


Enterocystoplasty and two-stage urethroplasty in urogenital tuberculosis. A case report. A case of extensive urogenitary tuberculosis treated by enterocystoplasty and two-stage urethroplasty is reported. 10 years after the last surgical procedure, the evacuation of the bladder enlarged by the sigmoid colon through the reconstructed urethra is satisfactory. The low micturating pressure and the mucus secretion do not cause disturbances in micturation.


Recurrent urinary incontinence treated with quite another type of prolapse operation. A case of neurosurgical treatment of recurrent urinary incontinence caused by detrusor hyperreflexia is reported. The importance of cystometry in the diagnosis of recurrent urinary incontinence is stressed.


The trigonointestinal implantations.

The trigonointestinal implantations. The author reports the indications, operative technique and long-term results of trigonosigmoidostomy in 26 cases of bladder exstrophy. The long-term results were considered as excellent in 20 cases, satisfactory in 4 and bad in 2. Even after a long period of up to 20 years, the function of the ureterotrigonal junction remains intact and ascending pyelonephritis does not occur. Social life is normal and sexual function is possible. In cases when internal diversion is counterindicated, the trigone can be successfully implanted into an isolated loop of the ileum or colon.


Renal cancer steroid receptors: biochemical basis for endocrine therapy. The hypothesis of hormone dependence of human renal cancer, based on experimental and clinical data, has recently been supported by estradiol-receptor (ER) and progesterone-receptor (PR) studies. ER and PR, found in experimental renal cancer as well as in normal human kidney and in human renal cell carcinoma (RCC), have been measured in 27 RCCs from patients submitted to surgery and endocrine therapy, in an attempt to predict the response to progestational therapy . Of these 27 tumors, 59% were positive for ER and 59% for PR; 37% were positive and 19% were negative for both ER and PR. The follow-up of 23 patients so far investigated showed that progestational therapy, commenced in 18 patients, has given favorable results in 14 patients and negative results in 3 patients with ER-PR- renal cancer. Antiestrogenic therapy, started after nephrectomy in 1 patient with ER+PR- renal cancer and lung metastases, failed since the patient died 8 months after surgery.


Paranephric abscess: a changing concept. The aetiology of the paranephric abscess has been greatly modified since the introductiion of antibiotics. Its frequency has decreased but its prognosis has not been improved. 20 cases of paranephric abscess have been studied retrospectively. Its main cause is no longer the haematogenic staphylococcus infection but primary kidney infection. The disease is difficult to diagnose as the evolution is slow and the symptoms unspecific. The main symptoms are: abdominal pain, feeling of physical prostation, subfebrility, acute pain in the flank and significant increase in blood sedimentation rate. The infection is due in most cases to a silent kidney or a kidney stone with pyonephrosis. Accompaying diabetes mellitus was often observed.


Progestogens in renal cell carcinoma. A retrospective study. A retrospective study of 88 cases of renal cell carcinoma is presented with emphasis on the follow-up and progestogens administration. Between the statistically homogeneous groups of patients treated with progesterone capronate and with other therapeutic regimens, no statistical difference in actuarial survival rate could be detected.


High fluid-low calcium intake: not all renal stone formers adhere to this simple treatment. FActors predisposing to renal stone formation have been studied in 309 patients. Dehydration before diagnosis of urolithiasis was due in 12% of the cases to frequent diarrhea and in 36% to bad working conditions. Daily fluid intake was less than 1 liter in 25% of the patients before stone formation and was persistently low in 11% after stone discovery. 41% of the patients drank irregularly over the day, before stone formation, and 11% continued to do so after its detection. Immobilization was present in the patient's history in over 20% of the cases. Normocalcemic hypercalciuria was found in 26% of the patients. 24% of the patients drank water with a calcium concentration of 100--500 mg/l before the lithiasis was diagnosed; 21% continued to do so after stone discovery or paradoxically even drank harder water than before stone detection.


Correlation between angiographic and ECG signs location in unstable angina. The authors examine if the modifications of the ventricular repolarisation in patients with unstable angina have a value in localizing the site of the coronary stenoses. The relationship between ECG changes and angiographic abnormalities, as yet unrecognized, is studied in 200 patients. The subendocardial signs have little value in predicting the place of the narrowings, they often involve the lateral leads and join with diffused coronary lesions. Subepicardial ECG changes, however, have a good value for prediction: the involvement of inferior leads implies a right coronary stenosis, and that of septal leads a left anterior descending stenosis. The importance of a systematic recording of these ECG changes in unstable angina before performing coronary angiography is discussed. They should be able to specify the ischemic area of the myocardium and then help clinicians to decide when coronarography (and bypass surgery) is indicated.


Complete atrioventricular canal associated with conotruncal malformations: anatomical observations in 13 specimens. Conotruncal anomalies associated with atrioventricular (AV) canal defects are more common than is generally appreciated on clinical grounds. Among 39 specimens of AV canal malformations, 13 (33%) presented with conotruncal abnormalities: a complete form of AV canal has been observed in all. 5 cases exhibited visceral situs solitus, 5 situs ambiguus with asplenia and 3 situs ambiguus with polysplenia. In the first group, conotruncal anomalies were tetralogy of Fallot in 3 cases, bilateral conus with double outlet right ventricle (DORV) in 2, one with subpulmonary ventricular septal defect (VSD) and the other with doubly commited VSD. Survival in these patients was relatively longer (average 20 mth) and the clinical course was mainly determined by the degree of the pulmonary outflow obstruction: surgical correction should have been feasible in these cases. Patients with situs ambiguus, both with asplenia and polysplenia, had further severe cardiovascular malformations associated with AV canal which led to early death (average survival 12 days): anomalous pulmonary and systemic venous return and univentricular hearts. In the latter patients, tetralogy of Fallot, bilateral conus with DORV and pulmonary atresia were the conotruncal malformation. Retrospectively, in no case of the last category a complete repair had been accomplished. All but one specimen presented the complete form of AV canal with 'free floating anterior leaflet' and hypoplastic anterior tricuspid component. This hypoplasia could be interpreted as missing conal tissue in the development of the anterior tricuspid cusp. For this leaflet a dual embryological origin, both from the dextro-dorsal conal ridge and the right lateral AV cushion, is suggested.


Myocardial release of inosine, hypoxanthine and lactate during pacing-induced angina in humans with coronary artery disease. The applicability of the adenosine triphosphate (ATP) catabolites, inosine and hypoxanthine as markers of myocardial ischemia in humans with coronary artery disease has been investigated. Inosine and hypoxanthine were assayed enzymatically after separation by a new column chromatographic method. The myocardial lactate extraction at rest (17 +/- 13%) changed to production values (-23 +/- 28%) during pacing-induced angina (P less than 0.0005). Coronary venous inosine values increased from 535 +/- 185 nmol/l at rest to 1030 +/- 740 nmol/l during angina (P less than 0.005), the arterial values amounted to 770 +/- 325 nmol/l and 805 +/- 515 nmol/l respectively (P, NS). The calculated myocardial uptake of inosine at rest (27 +/- 16%) changed to production values (-25 +/- 29%) during angina (P less than 0.0005). Coronary venous hypoxanthine increased from 1000 +/- 760 nmol/l at rest to 1235 +/- 800 nmol/l during angina (P, NS), the arterial values amounted to 1300 +/- 1040 nmol/l and 1235 +/- 800 nmol/l respectively (P, NS). The myocardial extraction changed from 20 +/- 18% at rest to -5.4 +/- 29% during angina (P less than 0.0025). The significant positive correlation (r = 0.61, P less than 0.0025) between myocardial release and uptake of inosine and lactate during severe angina demonstrates that anaerobic glycolysis is accompanied by ATP breakdown. During a second pacing period at less increased pressure--rate product after nitroglycerin, lactate production (-1.7 +/- 22%) already occurred whereas extraction of inosine (19 +/- 19%) and hypoxanthine (24 +/- 15%) did not change. In conclusion, lactate functions as a sensitive marker of myocardial ischemia and inosine is useful in detecting ischemic myocardial energy deficiency by the indication of insufficient glycolytic ATP supply.


Electrophysiological effects soon after intravenous beta-methyldigoxin. The digitalis derivative beta-methyldigoxin has been shown to be quickly and well absorbed from the gut and, in hemodynamic studies, to start acting rapidly after intravenous administration. However, when tested on 6 patients suffering from paroxysmal reciprocating atrioventricular tachycardia, or having an accessory pathway who might develop this disorder, there was no effect on induced tachycardias or on AV conduction during rapid atrial pacing or the extrastimulus test. One of the 6 patients showed some increase in refractoriness of conduction through the AV node within 25 min after the injection. Beta-methyldigoxin does not appear to be a satisfactory alternative to other effective agents available for the prompt correction of paroxysmal reciprocating atrioventricular tachycardia.


Effect of calculation stress on hemodynamics and plasma catecholamines before and after beta-blockade with propranolol (Inderal) and mepindolol sulfate (Corindolan). The effect of calculation stress on hemodynamic parameters and plasma adrenalin and noradrenalin was studied in two groups of 6 male subjects, before and during beta-Blockade. One group received propranolol 15 mg i.v. and the other received mepindolol sulphate 0,5 mg i.v. There was an increase in heart rate, cardiac output and blood pressure during mental stress. A significant increase in plasma adrenalin but not in noradrenalin occurred at the same time. The stress-induced rise in HR but not that in blood pressure could be prevented by beta-receptor blockage with propranolol and mepindolol sulfate. The peripheral resistance (PR) and diastolic blood pressure in stress were even higher after propranolol than in the control study. Propranolol had no effect on the increased adrenalin concentration during stress, but it was prevented by mepindolol sulfate. There was no correlation between the increase in HR and that in adrenalin during stress, but the HR in stress and the HR reaction to infused isoproterenol were highly correlated.


Changes in the human light reflex as a measure of the anticholinergic effects of drugs. A comparison with other measures. Single oral doses of atropine, nortriptyline, procyclidine and lactose dummy were administered double-blind to eight healthy young subjects in a balanced, crossover study. Television pupillometry was used to measure the anticholinergic effects of these drugs on the pupil diameter in darkness and the reflex response to light flashes. The sensitivity of this method was compared with conventional autonomic function tests, viz. salivary secretion, radial pulse, forearm sweat gland activity and distance to visual near point. Visual analogue scales were used to obtain subjective measures of sedative drug effects. The expected inhibition of parasympathetic activity was found in most instances with two exceptions: firstly, that nortriptyline failed to affect the pupil despite causing a tachycardia and secondly, that procyclidine gave a bradycardia. The results are discussed with reference to the possible advantages of television pupillometry over conventional pupil measurement in the detection of anticholinergic drug effects.


Absolute bioavailability of chlorthalidone in man: a cross-over study after intravenous and oral administration. Seven normal human volunteers each received a constant-rate infusion of chlorthalidone for 2 h, and the same (commonly 50 mg) single oral dose on separate occasions. The concentration of unchanged chlorthalidone was analyzed over a 100 to 220 h period in plasma, red blood cells, urine and faeces after both dosage forms. A three compartment model was required to describe the intravenous plasma concentrations in five of the subjects. A two compartment model sufficed to account for the decay of the oral plasma concentrations in all seven subjects. The mean plasma t1/2 after i.v. dosing was 36.5 h (+/- 10.5 SD), and the mean plasma t1/2 after oral doses was 44.1 h (+/- 9.6 SD). The mean red blood cell concentration t1/2 after i.v. doses was 46.4 h (+/- 9.9 SD), and the mean red blood cell t1/2 after the oral doses was 52.7 h (+/- 9.0 SD). The shorter i.v. half-live was not equally manifest in all subjects, being mainly apparent in three of them. In all cases the urinary excretion rate plots were parallel to the plasma concentration curves. As the faster decay after i.v. administration was not accompanied by increased renal clearance, the difference must have been due to non-renal mechanism. The mean total of 65.4 (+/- 8.6 SD) % of the intranvenous dose was excreted in urine over infinite time, whereas the mean total excretion after the oral dose was 43.8 (+/- 8.5 SD) %. Faecal excretion ranged from 1.3--8.5% of dose in the i.v. study to 17.5--31.2% of dose in the oral study. The sum of the amounts present in urine plus faeces pointed strongly to an important metabolic route of elimination of chlorthalidone. Bioavailability estimates (F) from three sets of data were--a mean F of 0.61 from plasma concentrations, 0.67 from urinary excretion measurements and 0.72 from the erythrocyte concentrations. Simulations with a non-linear model indicated lesser validity of the estimate from erythrocyte concentrations. It was concluded that the average of plasma and urine data, F = 0.64, yielded the best estimate of the oral availability of chlorthalidone 50 mg in man.


Systemic availability of ergotamine tartrate after oral, rectal and intramuscular administration. Plasma ergotamine levels were measured in 33 volunteers (subgroups 11, 12 and 10) after a single dose of ergotamine administered by various routes. Ergotamine tartrate was given in doses normally used in the treatment of acute migraine--2.0 mg orally, 2.0 mg combined with 100 mg caffeine rectally and 0.5 mg i.m. Plasma ergotamine concentrations were determined by radioimmunoassay. The highest and longest lasting levels were found after i.m. administration, the peak concentration being 1.94 +/- 0.34 (SEM) ng/ml at 1/2 h. The corresponding maximum concentrations after oral and rectal administration were 0.36 +/- 0.08 ng/ml at 2 h and 0.42 +/- 0.09 ng/ml at 1 h. In most of the subjects the plasma ergotamine level began to rise again at 24 to 48 h. The cause of the elevation is not known but it might favour possible accumulation of the drug. Absorption from suppositories was at least as good as after oral administration and the former route may therefore be advantageous for migraine patients in whom nausea and vomiting during an attack may prevent efficient oral medication.


The metabolism of methaqualone in patients with biliary cirrhosis or secondary carcinoma of the liver. The metabolism of methaqualone has been studied in three patients with secondary carcinoma of the liver and two with biliary cirrhosis. The urinary excretion of five C-monohydroxy metabolites and the N-oxide was studies in the 24 h period immediately after oral dosing with 250 mg methaqualone (Melsed). In both patients with biliary cirrhosis and one with primary carcinoma of the bile duct or pancreas with secondaries in the liver the pattern of metabolites was normal. In a patient with oat cell carcinoma with secondaries in the liver some metabolite patterns were disturbed and increased metabolite excretion occurred. A patient with primary carcinoma of the breast with secondaries in the liver gave a completely abnormal metabolite pattern.


Alterations of phenytoin protein binding with in vivo haemodialysis in dialysis encephalopathy. Protein binding of phenytoin was assesed in one patient with dialysis encephalopathy before and after haemodialysis. Phenytoin concentrations were measured by radioimmunoassay and continuous ultrafiltration was used to assess phenytoin binding. At a serum concentration of 60 micromol.1-1 the percentage of phenytoin bound to serum albumin was considerably lower in the patient serum (79.95% predialysis; 92.09% postdialysis) than that in three normal sera (97.90 +/- 0.17%). Analysis of Scatchard plots indicated two classes of binding sites. In class I both the affinity and capacity for binding phenytoin were reduced in the pre and post-dialysis serum, whereas in class II the capacity of the uraemic serum was increased although the intrinsic association constant was greatly reduced. It was concluded that in vivo haemodialysis is associated with large fluctuations in the protein binding of phenytoin, in which the concentration of endogenous dialysible metabolites are strongly implicated.


The effect of dantrolene sodium on rat skeletal muscle in relation to the plasma concentration. Dantrolene sodium is a muscle relaxant used in the treatment of spasticity. It has been shown to interfere with calcium release from the sarcoplasmic reticulum and thus to inhibit excitation--contraction coupling. The effect of dantrolene sodium on the twitch tension of the tibialis anterior muscle of the rat was measured after 2 mg/kg i.v. or 25 mg/kg orally. Plasma concentrations were estimated at maximum twitch depression and during recovery from the block. In a separate series of experiments the half-life of labelled dantrolene sodium was measured in blood plasma, skeletal muscle and heart muscle of rats. Dantrolene sodium 2 mg/kg i.v. gave a maximal block of approximately 47%, the mean dantrolene sodium concentration was then 5.8 microgram/ml. A half-life for distribution of 1.1 min and an elimination half-life of 31 min after intravenous administration were observed, elimination rate constants in skeletal and heart muscle were comparable. Recovery from the block went much slower, the half-time of the process being approximately 80 min. Dantrolene sodium 25 mg/kg orally gave a maximal block of approximately 38% at a mean plasma concentration of 3.6 microgram/ml after 14 min. The recovery was again very slow. These experiments demonstrated that dantrolene sodium acts according to a two-compartment pharmacokinetic model.  There was a discrepancy between duration of effect and plasma concentration of dantrolene sodium in the rat.  This suggests that the receptor for dantrolene sodium is not located in the central compartment.


The effect of morphine pretreatment on hypothermia induced by morphine in mice. Morphine caused an apparently dose-dependent hypothermia in mice. Co-administration of naloxone antagonised this effect. Pretreatment with a single dose of morphine induced detectable tolerance to the hypothermic effect of a second dose of morphine given 3 h later and naloxone was more effective in antagonising the hypothermic effect of morphine in morphine-pretreated mice than in saline-pretreated animals. The present study has shown that morphine pretreatment can augment the antagonistic effect of naloxone towards the hypothermic action of morphine.


The role of cardiac receptors in clonidine-induced vagal bradycardia. In chloralosed, spinalized and beta-blocked cats, clonidine, 10 microgram/kg i.v. caused a vagally mediated bradycardia which was further analysed with particular attention to cardiopulmonary receptors. Cardiovascular deafferentiation, with preservation of vagal cardiac efferents, abolished the bradycardia. However, in animals with arterial baroreceptors denervated but with vagal cardiopulmonary pathways intact, clonidine decreased heart rate simultaneously with an increase in left atrial pressure to an extent known to activate cardiac receptors with unmyelinated vagal efferents. Clonidine somewhat enhanced the bradycardia to efferent vagal stimulation and also had a slight positive chronotropic effect on the non-innervated heart. The reflex bradycardia from electrical stimulation of unmyelinated cardiac afferents was augmented by the drug but not more than could be accounted for by the changed neuroeffector sensitivity. The data suggest that clonidine can reflexly augment vagal tone on the heart by an increased activity in vagal cardiac afferents, secondary to the drug's peripheral vasoconstrictor action, whereas no evidence for any central facilitation of these reflexes has been found.


Actions of piperidine and dimethylphenylpiperazinium (DMPP) on afferent discharges of the cat's carotid body. Chemoreceptor discharges were recorded in vivo from fine filaments of carotid sinus nerve; their frequency was used as index of receptor activity. Effects of piperidine on chemoreceptors were studied and compared with those of dimethylphenylpiperazinium (DMPP) on chemoreceptors in adult cats. Intracarotid-arterial injections of piperidine produced a transient increase in chemoreceptor discharges, the threshold dose ranging from 10 to 50 microgram i.a. The excitatory effect of piperidine was not affected by atropine, hexamethonium or GABA. DMPP (0.2-0.5 microgram i.a.) induced a marked increase in chemoreceptor discharges, which was abolished by hexamethonium, but not by atropine. DMPP ((2--5 microgram i.a.) induced sinus baroreceptor excitation, but piperidine did not. The results indicate that piperidine exerted excitatory effects on carotid body chemoreceptors, possibly acting on nerve endings of chemoreceptor afferent fibers.


Denervation supersensitivity to noradrenaline in the guinea-pig vas deferens in vivo: absence of the postjunctional component. The effects of denervation and cocaine on the responsiveness of the guinea-pig vas deferens to noradrenaline (NA) were studied. The magnitude of the denervation supersensitivity differed in vivo and in vitro. Cocaine-induced supersensitivity to NA was similar in vivo and in vitro. Only denervation increased the maximum response in experiments in vitro. It is suggested that in the guinea-pig vas deferens the postjunctional component of denervation supersensitivity to NA could result from the experimental conditions involving the isolation procedure.


Clearance and micropuncture studies of the diuretic xipamide in dogs. Effects of the diuretic xipamide were examined by clearance and micropuncture techniques, and compared to clorothiazide. Xipamide decreased GFR and phosphate excretion. Reabsorption by superficial proximal tubules was unchanged. Since xipamide reduced single nephron filtration rate and GFR, a small effect on the proximal tubule may have been masked. Chlorothiazide decreased GFR but additionally decreased reabsorption by the proximal tubule. Xipamide was more chloruretic than natiuretic and probably inhibits reabsorption in the distal tubule.


Synthesis and pharmacology of a prohormone angiotensin antagonist. A prohormone angiotensin antagonist, Sarcosyl1-Alanyl8-angiotensin I (Sar1-Ala8-A-I) was synthesized and its pharmacological properties were evaluated in three biological systems. It was found to be a good inhibitor in vivo in the rat blood pressure assay, somewhat less active in guinea pig ileum and a relatively weak antagonist in rat uterus. In vivo the inhibitory effect was greatly attenuated by the presence of the converting enzyme inhibitor BPP5alpha.


Activation of rat sympathetic ganglia SIF cell dopamine metabolism by muscarinic agonists. The biochemical responsiveness of the dopamine-containing small intensely fluorescent (SIF) cells to cholinoceptive drugs was evaluated in rat superior cervical ganglion (SCG), middle-inferior cervical ganglion and celiac ganglion. Amines and metabolites were analyzed by mass fragmentography. The major metabolite of dopamine (DA) in all ganglia was 3,4-dihydroxyphenylacetic acid (DOPAC). Stimulation of muscarinic receptors with carbachol induced a 3-10 fold increase of DOPAC concentration in the ganglia, the celiac ganglion being the most responsive and the SCG being the least. Pretreatment with atropine blocked the rise of DOPAC. The rise of DOPAC after activation of muscarinic receptors was not the consequence of blocking the removal of this acid from the ganglion. We concluded that DA metabolism in SIF cells is enhanced by stimulation of muscarinic receptors and that the magnitude of the DOPAC increase in a ganglion may reflect the importance of DA in ganglionic transmission.


Anaphylaxis in guinea-pig peripheral airways in vitro. The contributions made by histamine, prostaglandins (PG) and slow reacting substance (SRS-A) to anaphylactic contractions in isolated guinea-pig lung were investigated. Histamine, PGF2alpha and SRS-A induced isometric contractions in lung parenchymal strips and in tracheal smooth muscle. The effective concentrations of the autacoids were the same in lung strips and tracheas. Anaphylactic contractions in lung strips from bovine serum albumin sensitised animals were not affected by mepyramine (5 X 10(-6)M), or indomethacin (3 X 10(-5)M) but were markedly reduced by FPL 55712 (5 X 10(-5)M) suggesting that SRS-A plays a major role in the anaphylactic response. The effect of isoprenaline on anaphylactic histamine release and contractions was also examined. Anaphylactic contractions in lung strips were inhibited by isoprenaline (10(-10)--10(-7)M). Isoprenaline also inhibited anaphylactic histamine release from lung parenchyma. 10(-7)M isoprenaline inhibited contractions by 85.6% and reduced histamine release by 27.9%. The results suggest that histamine release does not contribute markedly to anaphylaxis in peripheral airways.


Effects of some vasodilators on calcium translocation in intact and fractionated vascular smooth muscle. The "lanthanum method" was used to measure the effects of vasodilators on the 45Ca influx induced in isolated strips of rabbit main pulmonary artery after replacement of NaCl by KCl in the bathing solution. Two Ca antagonists, verapamil and Ro 11-1781, produced dose-dependent inhibitions of 45Ca influx with IC50 values of 3 X 10(-7) and 4 X 10(-6)M, respectively. Papaverine was virtually equipotent with Ro 11-1781 (IC50 = 2 X 10(-6)M). High concentrations of diazoxide (10(-4) to 10(-3)M) and nitroglycerin (10(-3)M) were required to cause inhibitions which did not exceed 40%. While prazosin 3 X 10(-4)M stimulated 45Ca influx, sodium nitrite and sodium nitroprusside had no effect. A comparison of the effects of vasodilators on contraction and 45Ca influx indicated that, of the drugs studied, only Ca antagonists and papaverine may cause relaxation by interfering with Ca influx. While high concentrations (greater than 10(-4)M) of verapamil, papaverine and nitroglycerin produced an inhibition of 45Ca uptake by membrane fractions from rabbit aorta, the other vasodilators tested were inactive.


Inhibition of aminopyridine-induced contractile activity in skeletal muscle by tetrodotoxin and by magnesium. The effects of tetrodotoxin and magnesium have been studied on aminopyridine-induced contractile activity seen in the absence of nerve stimulation. In the chick biventer cervicis muscle both tetrodotoxin and magnesium pretreatment prevented the development of fasciculations and contractures in the presence of 4-aminopyridine and 3,4-diaminopyridine. Both tetrodotoxin and magnesium abolished aminopyridine induced fasciculations and contractures. Tetrodotoxin did not reduce postjunctional sensitivity to the agonists acetylcholine and carbachol whereas magnesium produced some reduction of postjunctional sensitivity. It is concluded that conducted action potentials must be involved in the aminopyridine-induced contractile activity. In the frog sartorius muscle aminopyridines occasionally induced repetitive endplate potentials suggesting that the compounds induce repetitive nerve activity. In both tetrodotoxin and magnesium treated preparations 4-aminopyridine produced only a moderate increase in miniature endplate potential frequency. It is concluded that aminopyridines increase nerve membrane excitability resulting in the generation of repetitive action potentials in the absence of nerve stimulation.


Specific stimulating effect of glycine on 3H-dopamine efflux from substantia nigra slices of the rat. The effect of glycine was studied on the efflux of tritium-labelled dopamine, 5-HT and GABA from small slices of rat substantia nigra in vitro. A depolarising stimulus (50 mM KCl) stimulated the efflux of 3H-5HT, 3H-dopamine and 3H-GABA in a calcium-dependent fashion. Glycine (50 and 100 micromoles) stimulated the spontaneous efflux of 3H-dopamine but not that of 3H-5HT or 3H-GABA. Taurine, GABA and beta-alanine, all at 100 micromoles, had no effect on release of radioactivity after prelabelling nigral slices with 3H-dopamine. In keeping with a transmitter role for glycine at this site, 3H-glycine was taken up by small slices of rat substantia nigra by both high affinity (Km = 2.4 micromoles) and low affinity systems (Km = 5.96 mM). However 50 mM KCl was without effect on the efflux of radioactivity from nigral slices prelabelled with 3H-glycine.


Pain and the bulbospinal noradrenergic system: pain-induced increase in normetanephrine content in the spinal cord and its modification by morphine. Experiments were carried out to determine whether noxious stimulation produced biochemical changes in noradrenergic neurons in the spinal cord of rats and whether morphine induced different biochemical effects in the presence and the absence of noxious stimuli. Noxious stimuli, but not stress, significantly increased the normetanephrine (NM) concentration only in the dorsal half of the spinal cord without affecting the noradrenaline concentration. The NM increase induced by noxious stimuli remained after transection at the inter-collicular level. The NM increase induced by noxious stimuli remained after transection at the inter-collicular level. When the noxious stimulation was blocked by lidocaine at the peripheral level, the NM increase disappeared. THe NM concentration elevated by pain, was further increased by morphine. The data suggest that the bulbospinal noradrenergic system works as a pain control system: pain itself slightly activates this system, but not to the extent of producing analgesia and the addition of morphine further activates this system to a level sufficient to produce analgesia.


The vestibular nuclei in the domestic hen (Gallus domesticus). Stereotaxic injections of small quantities of horseradish peroxidase (HRP) are made in the vestibular complex in the hen and the labelled cells due to retrograde transport of the tracer enzyme are studied, especially in the vestibular complex but also in other parts of the brain stem. The superior vestibular nucleus sends commissural fibres to the superior, medial, and descending nuclei and to Deiters' complex. The cell group A projects to the contralateral superior nucleus and to the Deiter's complex. The medial nucleus projects to the contralateral superior and descending nuclei, Deiters' complex, as well as strongly to the medial nucleus. The descending nucleus projects commissurally to the superior nucleus, the medial nucleus and the Deiters' complex, as well as heavily to the descending nucleus. The nucleus Deiters ventralis, the nucleus Deiters dorsalis, the cell group B and the trangential nucleus do not project to any other vestibular nuclei. Furthermore, the medial nucleus projects to the superior and descending nuclei and the Deiters' complex on the same side. The descending nucleus projects to the superior and medial nuclei on the same side. Finally, the superior nucleus, the medial nucleus, the descending nucleus, and the Deiters' compelx receive fibres from the ipsilateral nucleus of Darkschewitsch and the nucleus ectomammillaris, as well as bilaterally from the pontine but mainly from the bulbar reticular formation.


The pontine projection onto longitudinal zones of the paramedian lobule in the cat. The distribution of labeled cells in the pontine nuclei was studied following microinjections of horseradish peroxidase into three longitudinal zones in the paramedian lobule in the cat. Labeled cells were only found when the staining of the cerebellar cortex included the granular layer. The labeled cells were present contralateral to the injection site in the cases with the smallest injections, in the others there was a bilateral distribution with a contralateral preponderance. The labeled cells lie concentrated in three groups medially, ventrally, and laterally to the peduncle. No indication of a different projection from these three groups to the three longitudinal paramedian zones was found, although in the same material a zonal projection exists for the climbing fibers from various parts of the inferior olive to the same cerebellar lobule (Brodal and Walberg, 1977).


On the central generation of locomotion in the low spinal cat. A central network of neurones in the spinal cord has been shown to produce a rhythmic motor output similar to locomotion after suppression of all afferent inflow. The experiments were performed mainly in acute spinal cats (th. 12), which had received DOPA i.v. and the monoamine oxidase inhibitor Nialamide. In some preparations all dorsal roots supplying the spinal cord were transected, in others phasic afferent activity was suppressed by curarization. The activity was recorded as neurograms from nerve filaments or as electromyograms. It is concluded that: 1. alternating activity between flexors and extensors of foot, ankel, knee, and hip of one limb can still occur 2. the duration of the flexor discharges vary less with the cycle duration than the extensor discharges 3. different flexor muscles may retain individual patterns 4. the activity at different joints can be dissociated 5. there is at least one network for each limb. 6. the coordination between the two hindlimbs can be alternating as in walking or be more closely spaced as in galloping 7. alternating activity in the ankle remains even when only segments L6, L7 and S1 are intact.


Responses of single cells in cat's lateral geniculate nucleus and area 17 to the velocity of moving visual stimuli. Neuronal responses to moving visual stimuli were recorded in the lateral geniculate nucleus (LGN) and area 17 of cats. Response duration (DE), number of spikes (NT), and mean frequency (FM) were estimated from the response histograms and analysed for their dependence on stimulus velocity. In the LGN, for about 2/3 of cells these response parameters changed monotonically with velocity up to about 100 degrees/s. In 1/3 of the cells, the response frequency was tuned to velocity. The speed at which individual cells reached a peak or plateau firing rate was correlated with their receptive field size. In area 17, most neurones were tuned to velocity. Nine out of 59 cells were insensitive to stimulus speed in that they responded equally well at stimulus velocities up to about 10 degrees/s. The results suggest that at higher levels in the nervous system information about velocity is represented in discrete groups of neurones. It is pointed out that different response parameters may be relevant for different perceptual phenomena associated with movement. The significance of integrational properties and lateral inhibition of nerve cells for the development of complex response properties is discussed.


Modification of orientation sensitivity of cat visual cortex neurons by removal of GABA-mediated inhibition. The effects of an inhibitor of GABA synthesis, 3-mercaptopropionic acid (MP), and of the GABA antagonist bicuculline (BIC), on the direction and orientation sensitivity of visual cortical neurons were investigated using a computer-controlled stimulus presentation system. Intravenous administration of MP, which was usually more effective than if administered microelectrophoretically, induced a slight, but significant reduction in these properties of about half of the neurons tested. The effect of electrophoretic BIC was in the same direction but clearer than that of MP. In 71% of the simple cells, direction sensitivity was virtually lost during administration of BIC while orientation sensitivity was never completely eliminated in any neuron tested. Simultaneous administration of both drugs (MP systemically, BIC electrophoretically) caused more complete modification of the sensitivities than single administration of each. In four out of thirteen neurons tested, orientation sensitivity was completely abolished. The excitatory receptive fields slightly increased in size and became virtually round. The response magnitude to the optimal stimulus was increased by each drug along and by both. The present results further support the hypothesis that intracortical inhibition plays a major if not an exclusive role for the orientation and direction sensitivity of cortical cells.


Effect of gamma-aminobutyric acid on cell-free protein synthesizing systems from mouse brain. GABA stimulates the amino acid incorporating activity of cell-free protein synthesizing systems from mouse brain within a concentration range between 1 muM and 1 mM. This stimulating effect can be measured in systems with free and membrane-bound polysomes as well as in systems with mitochondria or synaptosomes. There is, however, no GABA effect on cell-free systems with polysomes or mitochondria from mouse liver. In the presence of 100 muM GABA aminoacylation of brain tRNA distinctly exceeds the in vitro loading of tRNA in control systems without GABA. Saturating the polysomal systems with precharged [14C]Phe-tRNA results in a loss of GABA stimulation, which is also observed if brain tRNA is charged by pH 5 enzymes from mouse liver. According to these data, GABA seems to have an organ-specific stimulating effect on cell-free systems from mouse brain. In the polysomal systems the site of this GABA effect within the step sequence in protein biosynthesis is the aminoacylation of tRNA and the target of its action seems to be the tRNA itself.


Typical albino retinofugal projections despite severe congenital optic nerve malformations in adult albino rats. Albino rats with severe congenital malformations of the optic nerves consisting of kinks, folds, or loops were examined for possible abnormal central visual projections using the Fink-Heimer method. No abnormal projections were seen in any of the visual areas studied.


Ultracytochemical observations of choline acetyltransferase neurons in the rat neostriatum. The fine structural localization of ChAc activity was studied in the rat neostriatum by a ultracytochemical method. The reaction products of ChAc activity were seen in the cisternal structures and plasma membrane of some medium-sized neurons. Some boutons with ChAc-positive vesicles were observed to make an axo-dendritic or axo-somatic symmetrical synapse.


Pattern discrimination and visuomotor behavior following rotation of one or both eyes in kittens and in adult cats. Sixteen cats, each of which had one or both eyes rotated at the time of natural eye opening (group K), were tested for visuomotor behavior and for learning and interocular transfer of two-choice visual discriminations. Their behavior was compared to that of two cats given monocular rotations in adulthood (group A) and to two normal controls (group N). These animals were all reared in the same colony. All cats, including those with monocular rotations up to 180 degrees and those with binocular rotations up to 80 degrees in each eye, showed good visuomotor behavior when using the rotated eye (i.e., with the normal eye covered). Both the group K and group A animals showed comparable visuomotor adaptation. All animals except those with monocular rotations of 180 degrees were able to learn several oriented pattern discriminations and showed considerable though incomplete interocular transfer of such information. The three animals with 180 degrees rotations were able to learn brightness, but not pattern discriminations. Seven further animals with large rotations were used for histological studies of the retina and primary visual pathways. Areas of reduced ganglion cell density were not observed in whole mounts of the retinae, nor were regions of reduced transport of 3H-proline from the retina to the lateral geniculate nuclei or superior colliculi detectable from autoradiographs.