Influence of the sodium pump on intercellular communication in heart fibres: effect of intracellular injection of sodium ion on electrical coupling. 1. The effect of intracellular sodium injection on the electrical coupling between cardiac Purkinje cells was investigated. 2. It was found that an increase in the intracellular sodium concentration produces uncoupling in about 500 sec and increases the input resistance of the injected cell. Both effects were completely reversible. 3. Inhibition of the sodium pump by ouabain (6-8 x 10(7) M) also causes electrical uncoupling. 4. The decoupling of heart cells achieved by sodium injection was considerably accelerated in fibres treated with ouabain. 5. The influence of sodium injection on cell communication seems to be related to the intracellular calcium concentration 6. The above results indicate that the maintenance of a low intracellular sodium concentration by the sodium pump is essential for the preservation of a high junctional conductance in cardiac fibres.


Incidence of retinoblastoma in Malawi.

Incidence of retinoblastoma in Malawi. The annual incidence of retinoblastoma in Malawi seems to be two cases per 100,000 children under five or one case per 10,000 live births. A higher frequency of one case per 21,700 to 17,900 children under five or one per 4,340 to 3,580 live births has been found in the Zomba and Mangochi districts. Analyzing the cases according to sex and laterality, 61.1 percent of the unilateral cases were girls and 58.3 percent of the bilaterals were boys. Among boys, 33.3 percent were bilateral while unilateral involvement of the left eye was found in 19.1 percent. Among the girls, the frequency of bilateral cases was 18.5 percent while the unilateral involvement of right and left eye was nearly similar.


The diagnostic significance of worm tracks in cases of pseudoglioma retinae.


A superfusion technique for isotope efflux studies and concurrent electrophysiological investigation in the rat cuneate nucleus [proceedings].


A simple, inexpensive mechano transducer system using frequence modulation [proceedings].


Tapeto-retinal degeneration and familial juvenile nephronophthisis (FJN).


A simple and effective ruminal cannulation technique for sheep [proceedings].


The force generated by a visceral smooth muscle. 1. Strips of taenia coli from the caecum of the guinea-pig were mounted in an organ bath at 37 degrees C; isometric contractions were elicited with 10(5)M carbachol. Each taenia was stretched to the length at which it produced the maximum active tension; it was then fixed and embedded for measurement of the transverse sectional area. 2. The maximal force produced ranged between 96-1 and 138-3 mN. This corresponded to a force of between 251 and 513 mN.mm(2) (mean: 416 +/-28 [n = 10]). Temperature changes in the range 23-38 degrees C had little effect on the maximal force output.3. When allowance is made for the extracellular space (about 32% of the transverse sectional area), for the non-muscular cells present in the taenia (about 5%), and for the non-contractile material present in the muscle cells (about 10%), the maximal force generated was about 734 mN.mm(2) of contractile material (or almost twice as large as in skeletal muscle).4. Electron microscopy revealed terminal apparatuses at the ends of muscle cells, anchoring the cells to the connective tissue, and cell-to-cell junctions (attachment plaques). In addition, many dense patches of dense bands, sites near the cell surface where filaments are seen to end, were scattered along the entire length of the muscle cell and lay close to bundles of collagen fibrils. 5. It is suggested that the production of such a large force by this smooth muscle is partly explained by the lateral attachment of some contractile units to sites along the entire cell length, which in their turn are anchored to the collagen network; the latter may be considered a sort of intramuscular tendon.


Arachnoiditis and VECP change.

Arachnoiditis and VECP change. A five-year-old boy presented with tuberculous meningitis and subsequently developed amaurosis with optochiasmatic arachnoiditis (OCA) late in the convalescent stage of the illness. The visual evoked cortical potentials were correlated with the decreased and improved postoperative acuity. The diagnosis and classification of OCA have been discussed with emphasis given to prompt neurosurgical treatment.


Spatial properties of horizontal cell responses in the turtle retina. 1. Intracellular recordings were made from horizontal cells in the retina of the turtle Pseudemys scripta elegans. Spatial properties of the responses were determined using brief flashes of monochromatic light. 2. For a light stimulus in the form of a long narrow slit the peak response decayed approximately exponentially with displacement from the centred position. 3. With variation in the area of a centred circular patch, the peak response increased in a graded manner with stimulus area but was not proportional to area. 4. The model of electrical coupling in the horizontal cell layer proposed by Naka & Rushton (1976) was applied to the results. For the case of dim illumination a simplification is applicable, and the voltage distribution for circular and slit-shaped patches of light can be expressed in terms of two unknowns: the voltage resulting from diffuse illumination and a characteristic 'length constant'. 5. The measured variation of response amplitude was well described by the theory. Measured length constants were distributed from less than 100 mum to greater than 1 mm, and in a given cell the values determined by the slit displacement method and the area variation method were in reasonable agreement. 6. It is concluded that with dim illumination the model provides an accurate description of the voltage spread in the cells. Deviations were found to occur at higher intensities and possible reasons are discussed. 7. The implications of the model on the measurement of resistance changes during illunination are discussed.


"Tissue-drag" with polyglycolic acid (Dexon) and polyglactin 910 (Vicryl) sutures in strabismus surgery. The new absorbable synthetic sutures, polyglycolic and (Dexon) and Polyglactin 910 (Vicryl), are excellent sutures for strabismus surgery, but they have a bothersome tendency to attract adjacent tissue (tissue-drag). This difficulty is found especially with the 5-0 size suture, less so with the 6-0 size suture, and minimally with the 7-0 size suture. The presence and number of short, stubbly, protuberant strands (hooklets) seen on the surface of these sutures under high magnification correlates with the lack of ease with which the sutures pass through tissue. Other factors involved in tissue-drag include the crevices between braids in these sutures and the fiber-tissue friction due to the innate nature of the suture materials. Sutures which pass with ease through tissue, such as catgut and nonabsorbable sutures, are seen to have smooth surfaces under high magnification. Coating the 5-0 and 6-0 Dexon and Vicryl sutures to smooth their surfaces and reduce tissue-drag was ineffective with isotonic saline solution, minimally to moderately effective with glycerine and with methylcellulose and polyvinyl alcohol solutions, but highly effective with peanut and sesame oils. Though tissue-passage of Dexon and Vicryl sutures was much improved by coating with oil and entirely satisfactory, it still was not quite as good as with catgut. Clinically, the oil did not compromise the knot security or ease of handling of the sutures. No unusual postoperative reaction was seen with the use of the oiled sutures. Although oiling the synthetic absorbable sutures at time of surgery is effective, we recommend that suture manufacturers reduce the tissue-drag of synthetic absorbable sutures either by smoothing the surface in the manufacturing process or by developing an absorbable coating applied to the sutures during manufacture.


On the acid-induced abolition of reticulo-ruminal motility in sheep [proceedings].


Anomalies of the retinal veins and their incidence. Nonaneurysmal anomalies of the retinal veins were studied in 1,400 consecutive locally and systemically healthy individuals whose ages ranged from eight to 66 years. The anomalies included veno-venous crossing, triconfluence, congenital dilatation, prepapillary loop, anomalous macular veins, and retinociliary vein. Excluding the last three, these anomalies are not at all rare. Hypotheses to explain the development of veno-venous crossings and the bifurcation of retinal veins are also presented.


Collagenolytic activity in peritoneal eosinophils from rats [proceedings].


Conjugated and unconjugated pentazocine in the human foeto maternal system and neonate [proceedings].


The excitatory junction potential in tracheal smooth muscle [proceedings].


Synaptic properties of identified neurones in the cerebral ganglion of Aplysia [proceedings].


The action of noradrenaline on the smooth muscle of the guinea-pig ureter [proceeding].


Some factors influencing the vulnerability to an induced ventricular arrhythmia in the isolated rat heart [proceedings].


Some observations on abnormal pace-maker activity in endocardial Purkinje fibres surviving myocardial infarction [proceeding].


Effects of modifications of the extracellular potassium concentration on excitation-contraction coupling in frog atrial fibres [proceedings].


Congenital upper eyelid retraction.

Congenital upper eyelid retraction. This report describes a six-year-old boy born with a unilateral upper eyelid retraction resulting in mild exposure keratopathy. The fissure on that side was 4 millimeters larger and lagophthalmos was present. At the time of levator recession surgery, the muscle was found to have a restriction at the medial and lateral horns preventing downward excursion. This condition has some of the features of congenital orbital fibrosis and is postulated to have been due to an intrauterine infection or inflammation.


Delayed rectification in the skeletal muscle fibre of the crab [proceedings].


Renal excretion of ammonium and of creatinine: relation to age and to body size in the male [proceedings].


Scorpion venom-induced enzyme secretion in rat pancreatic slices [proceedings].


The relation between intercellular coupling and electrical noise in turtle photoreceptors. 1. Intracellular recordings from cones and rods in the retina of the turtle, Pseudemys scripta elegans, revealed that in darkness the cell voltage fluctuated spontaneously about its mean level. The fluctuations were reduced during bright steady illmination of the cell often to a level close to that obtained with the electrode outside the cell where the noise did not change significantly during illumination. 2. The magnitude of the intrinsic dark noise (voltage variance in darkness minus voltage variance in strong light) varied widely from cell to cell. In the noisiest cones it was about 0-4 mV2 while in quiet cones it was often as low as 0-01 mV2. The noise appeared radom and could be fitted by a Gaussian probability density function. 3. The spread of voltage in the network of coupled photoreceptors was estimated by measuring the spatial profile of the response to a brief flash of constant intensity moved across the retina. For a light stimulus in the form of a long narrow slit, the peak flash response usually decayed exponentially with displacement from the centred position. 4. For maximum responses less than about 5 mV in cones, the length constant of exponential decay, lambda, varied from less than 10 mum to greater than 35 mum, and the values obtained in opposite directions were often unequal. Background illumination did not significantly change lambda. In cells with extremely narrow spatial profiles, an exponential fit to the decay could not be made reliably. 5. Occasionally the spatial profiles had definite secondary peaks. In the most pronounced examples in a red-sensitive cone and in a rod the maxima were separated by about 20 and 50 mum respectively; for each, one peak was approximately as sharp as the optical stimulator while the second was broader. 6. Cones with short length constants displayed high dark noise while cones with long length constants were relatively quiet. 7. Three models of electrical coupling between cells were investigated: one based on a distributed network, one on a discrete square grid arrangement, and one on a discrete hexagonal array. Each model predicts a strong dependence of both noise and input resistance on length constant, and for tightly coupled cells each predicts that voltage variance is proportional to lambda-2. 8. The measured relationship between voltage variance and lambda in a large sample of cones was well described by both discrete models when the average cell spacing was taken to be approximately 15 mum. 9...


Post-operative hypoxaemia and oxygen therapy [proceedings].


The effect of age and eye position on the normal ocular microtremor record [proceedings].


Oxygen consumption related to ambient temperature in rats of diffrent thyroid status [proceedings].


Development of thermal stability in the neonate rat [proceedings].


Stretch reflexes in forearm muscles [proceedings].


Enhancement of a phase of reduced firing in the response of spontaneously active cortical neurones to somatic stimulation [proceedings].


Comparison of the carotid sinus and adjacent common carotid artery, and the effects of noradrenaline [proceedings].


Influence of rate of pressure change upon human carotid baroreflex responses [proceedings].


Searching procedure in an ant (Cataglyphis bicolor Fab [proceedings].


Changes in size and protein turnover of skeletal muscle after immobilization at different lengths [proceedings].


Relationship between physical working capacity and body size and shape of male adolescents [proceedings].


Cardiovascular responses to distenson of the pulmonary arteries in the anaesthetized dog [proceedings].


Histamine and its metabolites in cat portal venous blood and intestine after duodenal instillation of histamine [proceedings].


The sodium-dependent absorption of sugars across the coroid plexus of the sheep [proceedings].


An investigation of the permeability of the rabbit colon [proceedings].


The effect of reversed jejunal segments on the myoelectrical activity of the small bowel [poceedings].


Epithelial membrane potentials of the epididymis in rats [proceedings].


The effect of trypsin inhibitors on the in vitro acrosome reaction of guinea-pig spermatozoa [proceedings].


The physiological changes in the vascular supply of the human palcenta - a scanning and transmission electron microscopy study [proceedings].


Chloride transport across sheep and guinea-pig amnion [proceedings].


Transient inward current underlying arrhythmogenic effects of cardiotonic steroids in Purkinje fibres. 1. Voltage-clamp experiments were carried out in calf Purkinje fibres to determine the basis of transient depolarizations (TDs) associated with digitalis-induced arrhythmias. 2. Under the influence of strophanthidin, depolarizing clamp pulses were followed by a transient inward current (TI) which was small or absent in untreated preparations. The TI also appeared in the wake of a train of action potentials. 8. The TI can help generate spontaneous depolarizations in preparations showing the low voltage oscillations which often occur with advanced digitalis toxicity. 8. The TI can help generate spontaneous depolarizations in preparations showing the 'low voltage oscillation' which often occur with advanced digitais toxicity. It was designated TI because its magnitude and timing were appropriate to account for the TD. 3. Longitudinal voltage non-uniformity during the TI was determined with two voltage-recording micro-electrodes. Although the non-uniformity was not severe, the TI wave form was observed when the voltage difference signal was used to measure membrane current density. 4. Over the diastolic range of potential, the strophanthidin-induced TI appeared superimposed upon the normal pace-maker mechanism, the decay of a potassium current, iK2. The TI could be dissociated from iK2, however, by means of its unusual kinetic properties. 5. TIs could also be recorded at holding potentials positive to -55 mV, i.e. outside the range where iK2 deactivation occurs. 6. The TI amplitude showed a slow and strongly sigmoid dependence on the duration of the preceding depolarizing pulse. Stronger depolarizing reduced the TI amplitude, while slowing and exaggerating the sigmoid time-dependence. 7. Two clamp pulses in close succession gave additive effects in evoking a subsequent TI. This finding and the sigmoid time-dependence fit with previous observations that TDs are most prominent following a series of closely spaced action potentials.


On the analysis of nerve signals deduced from metacontrast experiments with human observers. 1. This paper reviews Alpern, Rushton & Torii's (1970a-d) derivation of the size of the inhibitory nerve signal arising from after flashes in the metacontrast experiment. 2. Their geometric argument is recast in terms of simple functional equations. This form of argument clearly displays the role of their assumptions in obtaining their main conclusion: nerve signal is linear in intensity over a range of 3-4 log units. 3. Two disadvantages of their approach are discussed. First, it is noted that in the presence of the data the assumption they employ in their analysis is logically equivalent to their conclusion. 4. Secondly, accepting their claim that the nerve signal generated by the after flash is linear over a broad range of intensities, and that this inhibitory signal simply cancels the excitatory signal of the test flash, leads to the conslusion that over this same intensity range the excitatory nerve signal is a power function with an exponent of close to two. This is incompatible with the suggestion that photoreceptor signals have been measured.


Circadian and other rhythmic activity of neurones in the ventromedial nuclei and lateral hypothalamic area. 1. The frequency of firing was simultaneously recorded from single neurones of the ventromedial nuclei (VMN) and the lateral hypothalamic area (LHA) in urethane anaesthetized rats for many hours. 2. There were circadian changes of VMN and LHA neurone activity. The pattern of this circadian rhythm is as follows: throughout the day LHA neurones show higher activity than that of VMN, as indicated by higher frequency and more fluctuations in their rates of firing. In late afternoon the discharge rate of LHA neurones increases further, showing oscillations of short duration. In the early evening hours LHA neurone activity gradually goes down, as the VMN neurones become active. Throughout the night, VMN neurones are more active than those of LHA, just the opposite of the day period. In early morning hours VMN neurones gradually become quiet, while LHA neurones begin to show activity. 3. Superimposed on the circadian rhythm, at certain periods of the day, VMN and LHA neurones showed short duration oscillations in rate of firing, roughly every 7-15 sec and every 3-5 min. 4. Activities in neurones of the VMN and LHA were reciprocally related; a decrease in firing rate of one was associated with an increase in the other. This phenomenon was shown clearly by analysis of auto- and cross-correlation functions of firing patterns of VMN and LHA neurones. 5. The effects of stimulations of the prefrontal cortex and splanchnic afferents on VMN and LHA neurones depended on the basic firing frequency, thus they varied with the time of day. Definite relationships exist between basic firing frequency of a cell and the magnitude of changes evoked by these stimuli. Reactions of VMN and LHA neurones were the opposite in most instances. Septal stimulations (at more than 10/sec) always produced inhibition of LHA neurone activity. 6. Intravenous injection of glucose inhibited LHA neurones and accelerated firing of VMN cells. This was true during the day period as well as at night when background activities of VMN and LHA neurones were different from that of the day. 7. Stimulation of the septal area with subthreshold pulses at a low rate (1-0.3/sec) suppressed or altered oscillations in firing frequency of LHA neurones. Severance of connection between LHA and structures caudal thereto had no effect on LHA neurone firing rates or rhythms. Sections between the septal area and LHA, however, abolished or greatly altered the oscillatory rhythms of LHA cell activity, although spontaneous discharges continued at a somewhat lower rate for periods of hours. 8. Stimulation of suprachiasmatic nuclei with weak intensity and low frequency also changed oscillatory fluctuations in firing of LHA neurones. 9. Possible origins of circadian rhythm and oscillations of short duration in firing pattern of VMN and LHA neurones were discussed.


Short-term synchronization of intercostal motoneurone activity. 1. The hypothesis is advanced that the joint occurrence of unitary excitatory post-synaptic potentials e.p.s.p.s) evoked in motoneurones by branches of common stem pre-synaptic fibres causes short-term synchronization of their discharge during the rising phases of the unitary e.p.s.p.s. 2. This hypothesis was tested using the pre- and post-stimulus time (PPST) histogram to detect synchronized firing among groups of intercostal motoneurones discharging in response to their natural synaptic drives. 3. Motor nerve action potentials were recorded monophasically from nerve filaments of the external intercostal muscles of anaesthetized, paralysed cats maintained on artificial ventilation. 4. Computer methods were used to measure peak spike amplitude, spike amplitude, spike interval and filament identification for simultaneous recordings from four filaments. The spike amplitude histograms were derived for each filament and groups of spikes were selected for analysis. 5. With spikes of one group designated as 'stimuli' (occurring at zero time) and those of a second as 'response' the PPST histogram was computed with different time bin widths. 6. With bin widths of 100 and 10 msec the central respiratory periodicity was apparent in the PPST histogram. With 1.0 msec bins the PPST histogram showed a narrow central peak extending to +/- 3.0 msec at its base. This 'short-term synchronization' supports the hypothesis of joint firing due to common presynaptic connectivity. 7. It was shown that detection of short-term synchronization was critically dependent on a sufficient quantity of data but that provided a simple criterion of adequate counts per bin in the PPST histogram was met, short-term synchronization could be detected between intercostal motoneurones of the same and adjacent segments.


Action potentials in the rat chromaffin cell and effects of acetylcholine. 1. Electrophysiological properties of the rat chromaffin cell were studied using intracellular recording techniques. 2. The resting potential in the chromaffin cell was -49 +/- 6 mV (mean +/- S.D., n = 14) in standard saline containing 10 mM-Ca whereas that in Na-free saline was -63 +/- 9 mV (n = 17). At rest, the membrane has a substantial Na permeability. 3. Action potentials were evoked by passing current through the recording electrode. In standard saline the major fraction of the action potential disappeared either upon omission of external Na ions from standard saline or addition of 1 muM tetrodotoxin (TTX). We conclude that action potentials in the chromaffin cell are due mainly to an increase in the permeability of the membrane to Na ions. 4. Small but significant regenerative action potentials were observed in Na-free saline, and when Ca in Na-free saline was replaced by Ba, prolonged action potentials occurred. We conclude that action potentials in the chromaffin cell also have a Ca component. 5. Iontophoretic application of acetylcholine (ACh) produced a transient membrane depolarization in standard saline. 6. Spontaneous action potentials were recorded extracellularly by microsuction electrodes. They occurred at a rate of 0-05-0-1/sec in almost all cells. 7. When the perfusion fluid contained 3 x 10(-7) M to 10(-4) M ACh the spike frequency increased up to about 2/sec. This stimulatory effect of ACh was blocked by 10(-7) M atropine but not by 10(-3) M hexamethonium nor by 10(-5) M-d-tubocurarine. 8. The importance of Ca entry during action potentials for catecholamine secretion is discussed


Behaviour and aeration of the respiratory system in the domestic fowl embryo. 1. The monitoring of developmental stage and under-water dissection were used to examine the initial aeration of the respiratory system in domestic fowl embryos. 2. A virtually complete absence of free air within the chorioallantois was found before the beak had begun to make 'beak-clapping' movements, even when the membranes were already draped over its tip. 3. During the 'beak-clapping' stage, but before the membranes were pierced and before respiratory movements had begun, many embryos were found to contain free bubbles of air within the trachea and air sacs. 4. All embryos in which the respiratory system was aerated were found also to have froth in the crop or other parts of the digestive system. 5. Air was found in both the respiratory and digestive systems of all embryos examined after membrane penetration by the beak. 6. When air was injected into the chorioallantois before the stage of initial aeration it was recovered 5 min later from both the respiratory and digestive systems in under-water dissections. 7. It is suggested that lung ventilation takes place in the avian embryo in three distinct stages: the major air-ways become aerated, then respiratory movements begin and lastly the tertiary bronchi are slowly aerated. It is suggested also that movements involved in the imbibing of fluids play a part in aeration before the membranes are pierced.


Physiological properties and receptive fields of mechanosensory neurones in the head ganglion of the leech: comparison with homologous cells in segmental ganglia. A study of the head ganglion of the leech was made to compare the properties of specific sensory cells in this ganglion with those of homologous neurones in the segmental ganglia. 1. In the head ganglion, cells were identified that had electrical properties, sensory modalities and adaptation properties similar to those of touch (T), pressure (P) and nociceptive (N) cells in the segmental ganglia. The cell bodies of these neurones were situated in characteristics positions that could be correlated with those in the segmental ganglia. Several lines of evidence suggested that they were primary sensory neurones. Fewer T, P and N neurones were identified in the head ganglion than would be expected from its six constituent segmental ganglia. 2. The receptive fields of identified T, P and N cells were situated on the external surface of the head and the interior of the mouth with considerable overlap. They were generally smaller in size than those situated on the main part of the body. The receptive fields were also displaced anteriorly so that some of them were situated in segments anterior to those of the innervating cells. 3. The morphology of the sensory cells in the head ganglion was studied by intracellular injection of horseradish perioxidase. The general branching characteristics of the cells and the structural appearance of their processes resembled those of homologous cells in the segmental ganglia. However, the routes taken to the periphery by some of the cells were not constant from head ganglion to head ganglion. This variability was confirmed by electrophysiological evidence, and differed from the constancy seen in segmental sensory cells.


Receptive fields, geometry and conduction block of sensory neurones in the central nervous system of the leech. 1. In segmental ganglia of the leech, the cutaneous mechanosensory neurones responding to to touch innervated the skin of their own segment and of part of the anterior and posterior adjacent segments. Each touch receptive field could be divided into three non-overlapping areas: a central part innervated by the branches of the cell which ran in the nerve roots of the ganglion containing the cell body, and anterior and posterior parts innervated by its branches which ran in the nerve roots of the anterior and posterior adjacent ganglia. 2. Impulses originating from the anterior and posterior parts of the receptive fields were susceptible to conduction block within the central nervous system when the touch cells fired repetitively at frequencies that could readily be elicited with weak mechanical stimulation. In contrast, impulses originating from the central part of the receptive fields were less susceptible to block. 3. The morphology of touch cells revealed by intracellular injection of horseradish peroxidase suggested that conduction block occurred at specific bifurcation points where small cell processes joined the main process. Different physiological experiments supported this conclusion. 4. In some touch cells, bifurcation points with particularly low safety margins of conduction operated as low-pass filters, limiting the frequency of impulses capable of invading certain branches. 5. The results suggest that mechanical stimuli which would likely be encountered by the animal can lead to conduction block within its central nervous system and as a result modify its integrative activities.


The thermal sensitivity of the polymodal nociceptors in the monkey. 1. The static and dynamic sensitivities to thermal and mechanical stimuli of polymodal nociceptors in hairy skin of the anaesthetized monkey have been investigated by recording activity in their primary nerve fibres. 2. Polymodal nociceptors responded to skin pricking, pinching and heating to temperatures higher than 40 degrees C. They did not respond to touch, stretch or cold. The conduction velocity of their axons was from 0.6 to 1.1 m/sec. 3. Three types of cutaneous receptive fields have been observed: single spot-like areas of 1-2 mm2; multiple spot-like areas of 1-2 mm2; and larger areas up to 25 mm2 with heterogeneous sensitivity. 4. Polymodal nociceptors were subjected to heat stimuli that commenced from a 33 or 37 degrees C adapting temperature. A series consisted of heating their receptive fields to 43, 45, 47 and 50 degrees C from one or the other adapting temperatures at a constant rate of 0.2 degrees C/sec. Each heat stimulus intensity was maintained for 4 min after which the skin was returned to the adapting temperature. Immediately after the first series the identical series was repeated in order to determine the effect of prior heating upon the dynamic responses to re-heating. The dynamic responses were characterized by three phases: an initiation of a discharge at a threshold level of skin temperature; a dynamic discharge during the suprathreshold change, that reached a peak frequency when the temperature reached its maximum; and an adaptation phase while the temperature remained at the high intensity. Adaptation was rapid initially, and then slowed during the final minutes at the high intensity. 5. Adapting the receptive field to either 33 degrees C or to 37 degrees C before the heat stimuli did not affect the sensitivity and the discharge pattern of the polymodal nocicpetors. 6. During the first series of stimulations, the threshold at which the individual polymodal nociceptors began to discharge to heat stimuli varied from 40 to 46.5 degrees C. The mean threshold of the population was 42.5 degrees C. 7. No change in the threshold was observed when responses to 0.2 and 1.5 degrees C/sec rates of heating were compared...


Predictors of pain during prepared childbirth.


Headache and personality.

Headache and personality.


Heart rate and sleep latency in young men.


Microvibration and autonomic functions.

Microvibration and autonomic functions.


Scaling the seriousness of illness: a methodological study.


Body image--an apparatus for measuring disturbances in estimation of size and shape.


Nocturnal hormonal profiles in massive obesity, anorexia nervosa and normal females.


A possible relationship between anxiety in pregnancy and puerperal depression.


Live mass gains and wool production of merino sheep: three treatment programmes for parasite control. A trial is described comparing the live mass gains and wool production of three groups of Merino sheep treated either at four-weekly intervals, strategically or not at all for the control of helminths and Oestrus ovis during a 19 month period. The group treated at four-weekly intervals had the greatest gain in masass was not greater than that of the group treated strategically. At both shearings the four-weekly treated group produced more wool than did the strategically treated group. The latter group produced more wool in total than did the untreated group. The seasonal incidence of nematodes, cestodes and Oestrus ovis on the trial farm was determined by the slaughter of tracer lambs at regular intervals.


Immunization against coccidiosis in fowls. Immunity plays a major role in the control of coccidiosis. With the presently practised system of "protected exposure" under chemoprophylactic medication, problems are encountered because of seasonal variation in litter moisture and coccidial challenge. The alternative, "controlled exposure" or "vaccination" products a more solid immunity and more reliable results. This was found to be the method of choice in coccidiosis control in replacement pullets in the semi-arid subtropical climate of Rhodesia.


The comparative incidence of subclinical bacterial bovine mastitis in 17 herds when using two sets of diagnostic criteria. On the single examination of 6804 quarter milk samples during a routine mastitis survey in 17 herds it was found that whereas 12,4% of quarters were diagnosed as subclinically mastitic when using the IDF standard set of diagnostic criteria, only 2,4% were positive when applying the additional criterium of a positive test for bovine serum albumin. The remaining 10% of quarters were then classified as being affected with septic inflammation of the ducts. The ratio of true subclinical septic mastitis to duct and test canal infections is recorded and the implications of the findings are briefly discussed.


Subclinical septic bovine mastitis: critical evaluation of intramammary immunoglobulin therapy. A series of 152 quarters affected with subclinical staphylococcal and streptococcal mastitis was treated at random by intramammary infusion with one of 4 formulations containing inert solvent, specially prepared immunoglobulin (Ig) and antibiotics (penicillin G and streptomycin) in various combinations. The effect of treatment was measured by assessing the conversion of mastitic quarters to a normal or mastitis-negative state over a post-treatment period of 28 days. Considering the solvent as a placebo, solvent plus Ig had no significantly better effect than solvent only; solvent plus antibiotics gave results that were highly significant after 14 days even though about a third of the strains of S. aureus were resistant in vitro to one or both of the antibiotics; solvent plus antibiotics and Ig gave results that were highly significant during the whole 4 weeks after treatment. The Ig solution appeared to be considerably more effective against staphylococcal than streptococcal mastitis, but the small numbers precluded statistical analyses. It was concluded that use of the particular batch of Ig alone had no value in the treatment of the common forms of subclinical bacterial mastitis but that in combination with antibiotics the Ig had a somewhat better effect than was obtained with antibiotics alone.


Creative dramatics: an outlet for mental handicaps.


Canine systemic lupus erythematosus. The disease, clinical manifestations and treatment. The similarities between human and canine systemic lupus erythematosus are enumerated, using the incidence of symptoms reported for man as a guide to the possible incidence of clinical signs in the dog. Differences between the human and canine diseases are listed. Four clinical cases of the disease are reported. Diagnostic procedures were confined to the observation of clinical signs and serological and haematological methods.


The blood grouping systems of dogs.

The blood grouping systems of dogs.


The determination of plasma bicarbonate levels as an aid in the treatment of canine biliary fever.


Canine tetanus.

Canine tetanus. A report of tetanus in a dog is presented. The symptoms were typical and the dog was successfully treated. The differential diagnoses and the therapy of tetanus are discussed with emphasis on the dose of antitoxin required.


Violence to the spirit of independence.

Violence to the spirit of independence.


A search for linkage in cystic fibrosis. Linkage between the locus for cystic fibrosis and other genetic markers was explored in 40 families from Birmingham and 20 from Manchester. No strong evidence was found for linkage with any of the markers examined. There was evidence against close linkage with ABO, HLA, and Rh.


A family study of coarctation of the aorta. Families of 100 patients with coarctation of the aorta and 50 controls for age, sex, and social status were studied to assess the influence of genetic and environmental variables in the aetiology. A tendency to familial aggregation of the condition and other congenital heart defects compatible with multifactorial inheritance was discerned. Recurrence risk for sibs is approximately 1 in 200 for coarctation of the aorta, and 1% for any form of congenital heart defect. The heritability of coarctation is estimated at 58%. The tendency for other non-cardiac defects to occur in the patients with coarctation does not appear in their sibs and is not so pronounced as in some other congenital heart conditions. Of the several environmental variables examined, there was no definitive association with any other than season of birth, which implies a possible association with maternal infection; there is also a suggestion of a paternal age effect, but these require investigation in a prospective survey.


Infantile cystinosis in France: genetics, incidence, geographic distribution. A national distribution of 66 French patients, from 49 sibships, has been studied. Segregation analysis, using the maximum likelihood method, was found to agree with the theoretical values expected in recessive autosomal inheritance. The birthplaces of these patients show an unequal geographic distribution of cystinosis, the incidence being higher in Western France. Compared with the total number of live births during the period 1959 to 1972, the minimum incidence of the condition in the province of Brittany is 1 per 25 909, and the gene frequency 0.0062. In the rest of France, the minimum incidence is 1 per 326,440 and the gene frequency 0.0018. Application of Dahlberg's formula gives a similar result. The mean inbreeding coefficient is 530 X 10(-5), a figure 23 times higher than the mean coefficient of France. An indirect test of inbreeding, the distance between parental birthplaces, was studied, first using the French administrative boundaries, second by using kilometers. This distance was constantly smaller for the parents of patients than for the parents of controls. Analysis of two erythrocyte polymorphisms (ABO and Rh) showed a large excess of group A patients when compared with overall French data. These findings are difficult to interpret on genetic grounds. The genetic reasons for the unequal geographic distribution of cystinosis in France are discussed.


Pyloric stenosis in the Oxford Record Linkage Study area. The files of the Oxford Record Linkage Study were employed to identify 220 infants presenting with infantile hypertrophic pyloric stenosis (IHPS) in the 6-year period 1966 to 1971. Information on these infants was obtained from birth certificates and maternity notes. The overall incidence was 2.5 per 1000 livebirths. There was a distinct seasonal variation, with highest incidence to infants born in the third quarter of the year as well as variation in incidence with area: the cities had much lower rates of IHPS than the adjacent rural or small urban areas. It was shown that the rates in the south and east of the area studied were far greater than in the north and west. In the present study there was no excess of primiparae, the peak maternal age group was 20 to 24; there was a slight excess of parents of social classes I and II; and a significant association with mothers who were Rhesus negative. The rate of IHPS among sibs was 85 per 1000. Though there was the usual correlation with the male sex (M:F ratio = 5.5:1), there was no variation with birthweight and only among the females was an association found with prolonged gestation. There appeared to be an inverse relation between gestation and age on admission to hospital.


Finger replant patient undergoing rehabilitation.


Lowe's syndrome: identification of carriers by lens examination. Lens examinations were performed on 7 obligate and 7 possible carriers of the X-linked gene for Lowe's syndrome, and on 117 controls. By quantitatively grading punctate cortical opacities, it was possible to discriminate between the obligate carriers and the controls with a fair degree of confidence. In the age group most important for genetic counselling, that of child bearing, the data are too limited for the derivation of precise estimates, but may, nevertheless, be useful. More such data are needed.


Avocational evaluation and work adjustment: a deterrent to dependency.


Congenital scalp defects with distal limb anomalies: report of a family.


Hereditary index finger polydactyly: phenotypic, radiological, dermatoglyphic, and genetic findings in a large family. Index finger polydactyly in a Turkish family is reported. The transmission of the malformation fits the pattern of regular autosomal dominant inheritance. Some of the affected individuals had one or two phalanges on their first digits, but all had triphalangeal second fingers. Subjects with polydactyly had very interesting dermatoglyphs, such as an extra a triradius under the super-numerary index finger, the proximal radiant of this triradius (an extra A-line) ending on the radial border of the hand, and arch tibials in the hallucal areas. The carpal bones, beginning with os multangulum majus, or alternatively with the extra one were articulated with two metacarpals. A similar finding was found in the feet.


Haemoglobin E Saskatoon beta 22 Glu replaced by Lys in the Shetland Islands. A survey of blood samples from the inhabitants of the Shetland Islands has revealed the presence of a variant haemoglobin in 1 individual out of the 345 tested. The rariant haemoglobin accounted for 46% of the total haemoglobin. Tryptic digestion and amino acid analysis indicated that the variant haemoglobin was caused by the substitution of a glutamic acid residue at position 22 in the beta chain by a lysine residue. This is the same amino acid substituion as found in haemoglobin E Saskatoon.


Dicentric X isochromosomes in man.

Dicentric X isochromosomes in man. Four cases of Turner's syndrome are presented in which an apparent X isochromosome i(Xq) has been found to possess two regions of centromeric heterochromatin. It is suggested that these chromosomes were isodicentric structures capable of functioning as monocentric elements as a result of the inactivation of one centromere. The prevalence of mosaicism is believed to be a consequence of the dicentric nature of these chromosomes, and it is considered possible that a high proportion of X isochromosmes are structurally dicentric. Banding patterns showed that the exchange site involved in the formation of the dicentric chromosome was different in at least three of the cases.


Severe mental retardation in a boy with partial trisomy 10q and partial monosomy 2q. A severely mentally subnormal child with many physical stigmata was shown to have the karyotype 46,XY,-2,+der(2),t(2;10)(q31;q24)pat. Full evaluation of this patient's karyotype depended on the family studies. It was shown that a balanced translocation t(2,10) was present in 4 normal males in 3 generations.


Atypical serum cholinesterase in a family with congenital distichiasis. This paper describes the coexistence of genetically determined reduced cholinesterase activity and congenital distichiasis in the same family. The pedigree suggests that these two autosomal dominant diseases are segregated independently and do not show evidence of linkage.


Triple X female and Turner's syndrome offspring. A mentally retarded young female having 47 chromosomes with a triple X karotype produced a child with Turner's syndrome associated with mental defeciency. To our knowledge this is the first example of a triple X female giving birth to a child with Turner's syndrome.


Renal function studies in an infant with 4p (-) syndrome. An infant with the syndrome of deletion of the short arm of chromosome 4 is described. In addition, this child had renal insufficiency, which is found rarely in association with the 4p(--) syndrome. Previous reports of this syndrome have described only isolated gross structural abnormalites of the urinary tract. In the case discussed here, we present clinical and functional data which indicate that this patient had bilateral renal dysplasia.


A case of partial trisomy 3q.

A case of partial trisomy 3q.


A case of ring chromosome.

A case of ring chromosome. A girl with a G22 ring chromosome is described. There are few physical abnormalities, performance quotient is in the low normal range but verbal skills are much retarded.


Familial Ebstein's anomaly.

Familial Ebstein's anomaly. A family is described in which both a father and son are affected with Ebstein's anomaly, while several other family members manifest different cardiac malformations. Five additional instances of familial Ebstein's anomaly were found in the literature and compared with our family. Inspection of possible modes of inheritance in this group of families suggests that Ebstein's anomaly is probably inherited as a polygenic character with a threshold phenomenon.


Partial trisomy D: a diagnostic and cytogenetic dilemma. An 18-month-old proposita with psychomotor retardation and other congenital abnormalities is presented. Chromosomal analysis of both parents proved normal. However, the karyotype of the proposita contained 47 chromosomes in both lymphocytes and cultured fibroblasts. The marker chromosome proved to be a deleted No. 14 or 15. Comparison of the reported cases of partial trisomy D indicates that a definitive clinical syndrome is not apparent in either case.


Larsen syndrome in two generations of an Italian family. This paper describes a familial case of Larsen syndrome. Typical anomalies were present in the propositus and 2 of his 6 daughters. In addition, all patients had progressive deafness and the 2 daughters had cleft palate. The certain exclusion of any consanguinity between the couple, suggests, in this instance, the dominant mode of transmission of the syndrome.


Self-assembly of bovine epidermal keratin filaments in vitro.


RNA synthesis in plant leaf tissue: the characterization of messenger RNA species lacking and containing polyadenylic acid.


Units of functional stability in bacteriophage messenger RNA.


Fluctuational opening of the double helix as revealed by theoretical and experimental study of DNA interaction with formaldehyde.


Molecular packing of collagen: three-dimensional analysis of electrostatic interactions.


Transcription of bacteriophage phi-X174 in vitro: selective initiation with oligonucleotides.


Transcription of bacteriophage phiX174 in vitro: analysis with restriction enzymes.


A tobacco mosaic virus mutant with non-functional coat protein and its revertant: relationship to the virus assembly process.


Effects of isoproterenol on myocardial lipid metabolism in rat hearts perfused with and without exogenous substrates.


Biochemical and contractile properties of heart muscle after prolonged alcohol administration.


Changes in high-energy phosphate compounds of isolated rat hearts during Ca2+-free perfusion and reperfusion with Ca2+.


Evolutionary divergence and length of repetitive sequences in sea urchin DNA. The organization of repetitive and single copy DNA sequences in sea urchin DNA has been examined with the single strand specific nuclease S1 from Aspergillus. Conditions and levels of enzyme were established so that single strand DNA was effectively digested while reassociated divergent repetitive duplexes remained enzyme resistant. About 25% of sea urchin DNA reassociates with repetitive kinetics to form S1 resistant duplexes of two distinct size classes derived from long and short repetitive sequences in the sea urchin genome. Fragments 2,000 nucleotides long were reassociated to Cot 20 and subjected to controlled digestion with S1 nuclease. About half of the resistant duplexes (13% of the DNA) are short, with a mode size of about 300 nucleotide pairs. This class exhibits significant sequence divergence, and principally consists of repetitive sequences which were interspersed with single copy sequences. About one-third of the long duplexes (4% of the DNA) are reduced in size after extensive S1 nuclease digestion to about 300 nucleotide pairs. About two-thirds of the long resistant duplexes (8% of the DNA) remains long after extensive SI nuclease digestion. These long reassociated duplexes are precisely base paired. The short duplexes are imprecisely paired with a melting temperature about 9 degrees C below that of precisely paired duplexes of the same length. The relationship between length of repetitive duplex and precision of repetition is confirmed by an independent method and has been observed in the DNA of a number of species over a wide phylogenetic area.


Hemoglobin Vancouver [alpha2beta2(73)(E17) Asp replaced by Tyr]: its structure and function. Hemoglobin Vancouver is a new abnormal hemoglobin with an amino acid substitution of the normal aspartyl residue 73 of the beta chain by a tyrosyl residue. It was discovered in a man of Chinese descent in association with beta thalassemia. It was subsequently detected in a sister in association with normal Hb A. The oxygen affinity of the abnormal hemoglobin is decreased but its subunit interaction is normal. The Bohr effect may be slightly increased. This is the fourth abnormal hemoglobin to be found with a substitution at beta73. The others are Hb C-Harlem (alpha2beta2 6Glu replaced by Val and 73 Asp replaced by Asn), Hb Korle-Bu (alpha2beta2 73Asp replaced by Asn), and Hb Mobile (alpha2beta2 73Asp replaced by Val). Although Hb Mobile was found in the present studies to have a decreased affinity for oxygen, Hbs C-Harlem and Korle-Bu have been reported to be normal. These observations of functional differences for variants of beta73 added to earlier observations of the role of the normal beta73 residue to the aggregation of sickle deoxyhemoglobin indicate that this position of the molecule may be important in intra as well as intermolecular interactions.


Congruency of phylogenies derived from different proteins. A molecular analysis of the phylogenetic position of cracid birds. This communication examines the question of phylogenetic congruency--i.e., whether or not the branching order of evolutionary trees is independent of the protein studied. It was found that trees constructed for birds on the basis of immunological comparison of their transferrins, albumins, and ovalbumins agree approximately with a published tree based on the amino acid sequences of their lysozymes c. This congruency is especially noteworthy with respect to the phylogenetic position of the chachalaca, a Mexican bird classified on morphological grounds in the family Cracidae of the order Galliformes. At the protein level, this species differs as much from non-cracid galliform birds as does the duck, which belongs to another order. Despite the organismal similarity between cracid and non-cracid galliform birds, the molecular relationship is remote. If this contrast between organismal and molecular results had been based on comparative studies with only lysozyme, one could have ascribed the contrast to the possibility that chachalaca lysozyme was paralogous, rather than orthologous, to the other bird lysozymes c. Examination of several proteins is thus desirable in cases of possible paralogy.


The effects of atropine on atrio-ventricular conduction in patients with Wolff-Parkinson-White syndrome. Studies with His bundle electrogram. The effects of atropine on normal and anomalous A-V pathways were investigated using HBE in 40 cases consisting of 25 subjects without pre-excitation (group I) and 15 cases with WPW syndrome (group II). In group I, A-H interval shortened with a mean decrease of 30% following the administration of atropine (p less than 0.001), while P-A and H-V intervals as well as QRS duration remained unchanged. In group II the electrocardiogram showed WPW syndrome pattern (pattern W) in 12, normalization (pattern N) in 1 and both patterns (pattern WN) in 2 cases during the control study. In 10 cases pattern W persisted after atropine. Atropine changed pattern W to WN in 2 cases, WN to W in 1, WN to N in 1 and N to WN in one case. P-d interval remained constant. Atropine had no effect on the conduction time within atrium. His-Purkinje system and anomalous A-V pathway, but accelerated the transmission through A-V node. Atropine decreased the QRS duration of pattern W in 11 of 13 cases showing pattern W or WN both before and after atropine. Since the QRS duration showing pattern W correlated with P-H interval and (see article) and had the negative correlation with H-d interval (p less than 0.001), fusion mechanism was considered as the genesis of electrocardiographic pattern in most cases with WPW syndrome. Atropine influence was negative on QRS complex of pattern W i2 cases showing the co-existence of Kent bundle and James fibers or exclusive Kent bundle conduction. In the latter case the selection of antiarrhythmic agents should be made with caution. A-V dissociation with junctional rhythm developed in 9 cases (4 in group II) within 2 and a half minutes after atropine. The duration was as short as 15 seconds or less in 6 cases. The continuous tracing is necessary not to miss the AV dissociation. The disappearance of delta wave after atropine was observed during the change to pattern WN and the occurrence of A-V junctional rhythm or beat in 5 of 12 cases showing pattern W prior to the drug administration, and right bundle branch block was disclosed in 2 cases. The normalization of QRS complex also made it possible to measure His-Purkinje conduction time. In this point atropine is superior to the other antiarrhythmic agents which prolong H-V interval. Paroxysmal supraventricular tachycardia induced after atropine revealed shorter A-H with fixed H-V and V-A intervals, compared with the tachycardia before atropine in one case. The administration of atropine serves as an aid to evaluate the participation of anomalous A-V pathway in the tachycardia circuit.


A basic study of the Hanssen technique for evaluation of single nephron glomerular filtration rate. The purpose of this study was mainly to examine some basic problems of the Hanssen technique for the evaluation of single nephron glomerular filtration rate (SNGFR). Firstly, experiments were performed using Wistar rats to determine the amount of C14-ferrocyanide necessary to give sufficient C14 radioactivity in dissected nephrons. Using 200 muCi of C14-ferrocyanide, the samples of dissected nephrons provided only twice as much as background. Hence, we chose the amount of 600 to 700 muCi of C14-ferrocyanide for each rat in the later experiments, which yielded the radioactivity 5 to 6 times as much as background. Secondly, the homogeneity of intrarenal C14-ferrocyanide distribution was tested. Five superficial (SUP) and juxtamedullary (JM) proximal tubules four different regions were dissected and the radioactivity of those nephrons was counted. The distribution of C14-ferrocyanide in each piece was representative of the overal distribution. The summary of morphologic and clearance studies were as follows. The mean lengths of proximal tubules of 40 SUP nephrons, 5.3 +/- 0.2 mm, and 39 JM nephrons, 6.3 +/- 0.1 mm, were significantly different (P less than 0.01). The mean glomerular diameter of the JM nephrons, 110 +/- 2.7 mu, was significantly greater than that of the SUP nephrons, 95 +/- 3.1 mu (P less than 0.01). The mean SNGFR of 129 SUP nephrons, 23.4 +/- 4.2 nl/min/100g Body Weight (BW), and that of 130 JM nephrons, 34.5 +/- 5.1 nl/min/100g BW, were significantly different (P less than 0.01). The ratio of superficial/juxtamedullary nephron glomerular filtration rate (S/JM Ratio) was 0.85 +/- 0.02. We conclude that C14-ferrocyanide is regularly distributed to the kidney and that it is necessary to infuse sufficient amount of C14-ferrocyanide in this technique.


Origin of organic compounds on the primitive earth and in meteorites. The role and relative contributions of different forms of energy to the synthesis of amino acids and other organic compounds on the primitive earth, in the parent bodies or carbonaceous chondrites, and in the solar nebula are examined. A single source of energy or a single process would not account for all the organic compounds synthesized in the solar system. Electric discharges appear to produce amino acids more efficiently than other sources of energy and the composition of the synthesized amino acids is qualitatively similar to those found in the Murchison meteorite. Ultraviolet light is also likely to have played a major role in prebiotic synthesis. Although the energy in the sun's spectrum that can be absorbed by the major constituents of the primitive atmosphere is not large, reactive trace components such as H2S and formaldehyde absorb at longer wavelengths where greater amounts of energy are available and produce amino acids by reactions involving hot hydrogen atoms. The thermal reaction of CO + H2 + NH3 on Fischer-Tropsch catalysts generates intermediates that lead to amino acids and other organic compounds that have been found in meteorites. However, this synthesis appears to be less efficient than electric discharges and to require a special set of reaction conditions. It should be emphasized that after the reactive organic intermediates are generated by the above processes, the subsequent reactions which produce the more complete biochemical compounds are low temperature homogenous reactions occurring in an aqueous environment.


Experimental studies of effects of acute renal venous congestion on renal function --with particular reference to renal arterio-venous plasma sodium difference. Effects of acute renal venous congestion on renal function were studies. In anesthetized mongrels with intermittent or sustained elevation of the renal venous pressure produced experimentally by unilateral constriction of the renal vein, changes in renal function were investigated with the clearance method and plasma concentrations of electrolytes, protein and Ht of collected arterial and venous blood oals were divided into two groups according to the initial conditions concerning the various level of renal arterio-venous plasma sodium. In dogs (Group A) whose initial values of renal arterio-venous plasma sodium difference were not less than -1 mEq/L, the difference showed a negative tendency both during intermittent and during continuous congestion. In dogs (Group B) whose initial values of the difference were less than -1 mEq/L, the difference showed a positive tendency during renal venous congestion. (2) In dogs of Group A, i) the sodium reabsorption rate increased when renal physiological values (GFR and RPF) remained unchanged (during intermittent congestion) as well as when these values decreased (during continuous congestion). ii) The calculated "postglomerular" oncotic pressure and the sodium reabsorption rate were strongly correlated at the control period, showing a slightly less correlation during intermittent renal congestion, whereas during sustained congestion, the latter increased independently of the former. iii) The NCPF/CPAH remained unchanged or slightly increased during intermittent congestion and was remarkably elevated during sustained congestion. (3) In dogs of Group B, i) Diminution of renal functions such as GFR and RPF was prominent during renal congestin and satisfactory recovery of renal functions to the initial level did not occur even after release from congestion. ii) No significant increase of sodium reabsorption rate was obtained during continuous renal congestion. (4) The balance of sodium ion between the kidney and blood of dogs of Group A was discussed. The effects of acute renal venous congestion on renal function were divided into two groups and it was concluded that this renal arteriovenous plasma sodium difference is a most significant factor.


Effect of changes in inputs to atrioventricular node on AV conduction. The effect of different inputs into the atrioventricular node (AVN) on orthograde impulse transmission was studied. In rabbit AVN preparations, two stimulating electrodes were placed posteriorly in the crista terminalis (P) and anteriorly in the interatrial septum (A). Electric stimuli were given individually (P,A) or simultaneously (P + A). Premature stimulation, when properly timed (e.g. 70-100 msec at the basic cycle length of 400 msec) achieved AV conduction only in P + A but not in either P or A. Action potentials (APs) in AVN in this situation revealed an incomplete depolarization in P and A, but became a fullsized AP in P + A. This might be explained by summation. The site of simmation appeared to be in the upper node, because APs distal to the middle node as well as APs in the His bundle behaved in an "all or none" fashion. Time intervals between the stimulus artifact and the His bundle AP upstroke (S-H) were shorter in P + A was enhanced with the decrease of the S-H difference between P and A suggested an accelerated conduction by summation in AVN. A hyperpolarizing current flowing through the suction electrodes which were attached in the vicinity of AVN caused different amounts of S-H shortening between P and A input. The above data support the view that AVN has a summating property engendered by the slow inactivation of ionic channel on which the upstroke of AP depends and by the limited number and sites of atrial inputs which might connect with some preferential paths within the AVN.


Responses of the His-Purkinje conducting system to supraventricular premature beats--in vitro and in vivo canine experiments on ventricular aberrant conduction.


Automaticity and time-dependent conduction disturbance produced in canine ventricular myocardium. New aspects for initiation of ventricular arrhythmias. 1) In isolated canine ventricular myocardium, automaticity could be induced by a passage of small depolarizing DC-currents. The mechanism was attributed to inflowing Ca++ and Na+ currents and time-dependent deactivation of outward K+ current under a condition of high membrane resistance due to an anomalous rectification. Significance of the automaticity was discussed in relation to the ventricular arrhythmias encountered in very early stage of myocardial infarction. 2) In in situ canine hearts, chloropromazine induced time (preceding cycle length)-dependent decrease in conduction velocity within the ventricle. Thus QRS-duration of non-premature beats was lenghtened at rapid pacing rates while QRS-duration of atrial premature beats was lengthened also at short coupling intervals in the drug-treated dogs. These slow conductions were not due to reduced take-off potential of action potentials bue due to drug-induced slow recovery of rapid Na+ system. The phenomenon may be responsible for reported QRS-prolongation and fatal ventricular arrhythmias encountered in the patients receiving phenothiazines.


Role of slow inward current in the genesis of ventricular arrhythmia. Action potentials of premature beats in ventricular muscle fibers showed a transient prolongation of duration as well as an increase in second depolarization of the plateau phase when the preceding diastolic intervals were progressively shortened. These changes were abolished by manganese ions. Voltage clamp experiments also disclosed a transient increase in slow inward current in premature excitations, of which time course was very similar to that in action potential changes. These results suggested that prolongation of action potential durations was mainly brought about by changes in slow inward current and this was partly related to the characteristics of recovery from inactivation of this current. An increase of slow inward current produced depressed conduction on the subsequent beat and it also shared the effects to extend the areas of slow response. These effects may accelerate the occurrence of re-entry.


Mechanism of supraventricular tachycardia and pharmacological effects on it. Electrophysiologic study in 30 patients with documented SVT, 16 of whom had preexcitation, and in 24 control subjects were reported. The mechanism of SVT were found to be various and to include reentry confined to the AV node, SA node or the atrium, reentry through accessory pathway and ectopic atrial automaticity. It was noted that some of SVT might use concealed accessory pathway in VA direction while the some of SVT in WPW syndrome might not utilize accessory pathways. Electrophysiological properties in cases with SVT did not differ from those observed in controls. There were no differences in the mode of electrophysiological action of drugs between XVT and control groups. Both propranolol and procaine amide slightly depressed AV conduction. However, the action of the drugs on echo zone were not the same. The basic mechanisms of the action of the drugs in SVT were discussed.


Role of the autonomic nerves in the pathogenesis of primary ventricular fibrillation: experimental and clinical studies in dogs and man.


Electrophysiological mechanisms for digitalis arrhythmias.


Purification of host DNA synthesis-suppressing factor (DSF) produced by infection with measles virus. Host DNA synthesis-suppressing factor (DSF) produced into culture fluid of cloned HeLa cells (HeLa C-9) infected with a small plaque variant of Toyoshima strain of measles virus was purified by precipitation with ammonium sulfate, chromatography on CM-cellulose and DEAE-cellulose, and gel-filtration on Sephadex G-100 and G-200. The specific activity of the finally purified DSF was 302 units/mg of protein representing approximately 300-fold purification. The molecular weight of DSF was estimated to be about 55 000. By isoelectric focusing, two kinds of DSF having isoelectric points of 4.24 and 5.24 were detectable. The purified DSF was able to suppress host DNA synthesis of HeLa cells, continuous human lymphoid cells (NC-37), mouse L cells and Meth-A cells derived from an ascitic tumor of the mouse. The activity of the purified DSF was inactivated by heating at 56 C for 30 min or by treatment with trypsin.


Isolation of a small rod with lytic activity against Vibrio parahaemolyticus from fresh sea water. A small rod, capable of formine crater-like plaques on lawns of Vibrio parahaemolyticus, was isolated from a marine environment. The isolate was a gram-negative straight rod with round ends and was small in size, equal to that of halophilic Bdellovibrio strain 5501. The isolate appeared to have close taxonomic relationships to Cytophaga, since this bacterium moved slowly in a gliding manner on a solid agar surface, hydrolyzed agar and starch, contained yellow pigment and was halophilic. The isolate was able to grow not only under host-dependent but also under host-independent conditions when low nutrient media were used for cultivation, and its bacteriolytic mode was different from that of Bdellovibrio, an endoparasite. The isolate was halophilic and required Mg++ and Ca++ in addition to 3% saline for growth. The isolate showed a broad host rnage when tested for plaque-forming activity on gram-negative bacteria but not on the gram-positive bacteria tested so far.


Binding of tobacco mosaic virus to membrane material isolated from tobacco leaves. Binding of tobacco mosaic virus (TMV) to disrupted tobacco leaf membrane was studied. Membrane isolated from tobacco leaves was treated successively with (NH4)2SO4, Li-diiodosalicylate and then pronase. TMV-binding substance was thus isolated in a soluble form. From enzymatic digestion experiments, it was suggested that the binding substance was composed of lipid and carbohydrate.


Mycobacterium intracellulare from public bath water.


Lymphocyte responsiveness to phytohemagglutinin (PHA) and serum inhibitory effect in patients with gastric cancer. The in vitro lymphocyte response to PHA was determined in patients with gastric cancer in various stages prior to the surgical treatment. The lymphocyte responsiveness in the presence of homologous pooled AB serum in patients of stages II, III and IV were markedly reduced as compared with that in healthy controls (stages II, III; p less than 0.05, stage IV; p less than 0.01). Inhibition of normal lymphocyte responsiveness to PHA by serum from patients in stages III and IV were statistically significant only in the advanced stage. It was concluded that the suppression of the immune response in the early stage of gastric cancer was mainly due to the impairment of lymphocyte itself, which advanced with the progress of the stage and was modified by the serum inhibitory effect in advanced stages. In patients with advanced cancer, the higher was the lymphocyte responsiveness to PHA and PWM prior to the initial treatment, the more effective was the immunotherapy. This shows that the indication of the immunotherapy in patients with advanced cancer could be initiated. Furthermore, the correlation between the lymphocyte responsiveness to PHA and the clinical results of immunotherapy was discussed.


Carcinomas of the stomach in the young adults. The clinical and pathologic characteristics of the gastric carcinomas in the young adults were described in special comparison with the carcinomas in the old men. They were found to be similar in many respects, but had some different features like the histologic findings with particular references to the histogenetic background.


Evaluation of hepatic reserve for surgical treatment in portal hypertension. Based on a hepatic hemodynamic study, estimated by hepatic catheterization technique in 233 patients of portal hypertension, a classification of hepatic reserve is proposed. Surgical treatments for preventing esophageal variceal bleeding which does not decrease portal pressure may safely be applied to the patients whose effective hepatic blood flow of over 300 ml/min/M2, intrahepatic shunting rate below 40 per cent, IGC disappearance rate of over 0.04 min-1, or BSP 30 minute retention rate of below 35 per cent.


Percutaneous transtracheal ventilation.

Percutaneous transtracheal ventilation. The technique of percutaneous transtracheal ventilation (intermittent  jets of oxygen under high pressure, 50 pounds per square inch [psi]) has been used for resuscitation during anesthesia and prior to tracheostomy, and has been established as an important adjunct to life-support techniques. The technical aspects are described together with experimental evidence that intermittent jet ventilation is necessary to eliminate carbon dioxide. The complications occurring with a series of 80 patients are reported along with experimental work in ventilation of dogs with compressed air sources, including truck tires. Emergency physicians should be familiar with this technique and equipment for its use should be readily available in the emergency department. The potential role of transtracheal ventilation in the mobile intensive care unit at accident sites has been explored and appears promising. Conventional airway support techniques should be applied prior to resorting to transtracheal ventilation.


Caffeine intoxication: a case of paroxysmal atrial tachycardia. Caffeinism is a syndrome resulting from the excessive ingestion of caffeine and characterized primarily by cardiovascular and central nervous system manifestations. A variety of tachyarrhythmias and extrasystoles are believed to reflect the toxic, cardiotonic effects of caffeine. A case of paroxysmal atrial tachycardia (PAT) related to caffeine abuse is PAT. The importance of considering this and other less frequent conditions as potential causes for this arrhythmia is stressed.


Hydrocarbon ingestion in children: a six-year retrospective study. The results of a six-year retrospective study of 116 children admitted with the diagnosis of hydrocarbon ingestion showed that the major toxicity of hydrocarbons was to the respiratory tract, with 79 patients (68%) developing pneumonia. There was a significantly higher initial white blood cell count in children who developed pneumonia (15,900/cu mm vs 12,000/cu mm, p less than .001). All hydrocarbon products studied had a similar incidence of complicatons, except turpentine products, which had a significantly lower incidence of pneumonia (p less than .005). There was no correlation between amount ingested and development of complicatons. Initial treatment, which consisted of induced vomiting, gastric lavage, administration of oil or saline cathartics, was not associated with fewer complications. Oil administration correlated with higher incidence of pneumonia (p less than .025). The present study recomends only supportive treatment following hydrocarbon ingestion in children.


Jarisch-Herxheimer reaction. Case report. The Jarisch-Herxheimer reaction is a response to the treatment of syphilis. The most common findings are fever, malaise, headache, and exacerbation of cutaneous lesions. The reaction is thought to be due to the effects of treponema breakdown products, and it should not be confused with an allergic reaction to the antibiotic employed. Thus, further therapy must not be withheld. Treatment is symptomatic.


A conceptual framework for emergency care planning. The experience of functional program planning, in addition to facilitating the planning process for a new emergency unit, has had additional benefits. It has given the staff a common conceptual framework for analyzing patient care as provided and for identifying areas where improvements can be made. Also, a new approach has been developed for communicating with other departments and with hospital administration about day-to-day operating problems which may be useful for addressing other resource allocating and operating room time schedules. By developing a planning framework, it is possible to integrate the expertise of various services, while retaining an integrated overall orientation within which the efficacy of different proposals can be judged. This approach is critically important in helping to avoid the adverse effects of fragmented planning.


The emergency joint: arthrocentesis and synovial fluid analysis. Arthrocentesis and the subsequent evaluation of synovial fluid is often the definitive diagnostic procedure for the patient presenting with a joint effusion or intrasynovial hemorrhage. The difficulty of performing arthrocentesis varies with the joint in question, but those joints most frequently involved are easily entered. The indications and contraindications for this procedure are discussed. Effusion-producing pathologic processes often yield fluids of a characteristic nature permitting their classifications into categories of noninflammatory (Group I), inflammatory (Group II), septic (Group III), and hemorrhagic. This categorization of the effusion may permit specific diagnosis or the narrowing of the differential diagnosis. Criteria are established on the basis of joint fluid features to differentiate septic arthritis, which requires inpatient treatment, from those entities for which the patient may reasonably be treated as an outpatient.


The American College of Emergency Physicians in the bicentennial year.


A cautionary note about PTV.

A cautionary note about PTV.


Cold injury from skin refrigerants.

Cold injury from skin refrigerants.


Insect sting reactions.

Insect sting reactions.


Algorithm-directed triage in an emergency department. At Brooke Army Medical Center the Emergency Services Section has developed an algorith,-directed triage system to be used by "screeners" who may be basic medical corpsmen but sometimes have had no previous medical experience. After 25 hours of classroom and 120 hours of on-the-job training, the screeners use the algorithms to triage patients into one of three treatment areas in the emergency section or to clinics outside the emergency section during the day and evening. The screeners may consult with a triage physician if the algorithm-directed disposition appears inappropriate, Triage dispositions of 78,822 patient visits during the calendar year 1975 are presented.


Effectiveness of nurse triage in the emergency department of an urban county hospital. The effectiveness of patient triage by a specially trained registered nurse in the emergency department of an urban county hospital, San Francisco General Hospital, was evaluated over a three-month period. Ambulatory patients thought to have nonemergent illnesses were directed to the Walk-In Service for physician evaluation and treatment; the remainder were seen in the Emergency Service. In three months, 11,329 patients registered for care, and 4,150 (37%) were referred to the Walk-In Service. Of the 77 admitted patients, six were thought to require treatment within a few hours, 67 within hours to days, and four were considered elective admissions. There were no deaths. Error in triage was about equally divided between mistaken diagnosis and underestimated severity of illnes. The overall accuracy of triage was 98%.


Laryngotracheal trauma: recognition and management. In 23 patients with laryngotracheal trauma at the Louisville General Hospital during a ten-year period, 19 survived. One death was directly atributable to the airway injury. The most common postinjury complication was hoarsensess attributable to direct injury to the cords or recurrent nerve paralysis. One patient had further operation for subglottic stenosis. In general, blunt injuries were more severe than penetrating injuries. Subcutaneous emphysema, aphonia or dyshonia, hemoptysis, signs of injuries, a sucking wound, are presumptive findings of laryngotracheal injury. Appropriate endoscopy and radiographic studies should confirm the diagnosis. Control of the airway is achieved by emergency tracheostomy or intubation followed by tracheostomy. Prompt operative intervention and primary repair follow.


Rape evidence kit: simplified procedures for the emergency department. The crime of rape requires medical evaluation and therapy concomitant with the collection of legal evidence for potential prosecution. A practical, inexpensive evidence kit has been disigned that meets the needs of the local health department, police department, hospital emergency centers, and district attorney personnel. Costs of assembly and specimen analysis are assumed by the police department. Chain of custody is assured through tamper-proof bags, appropriate reporting forms and police involvement in specimen pick-up. Victims participate in chain of custody by sharing in collection and authorization. The requirement for physician appearance in court is thus lessened. Standardization of examination and reporting prompts all community hospitals to share in examinations, preventing over loading of a single, busy facility. Six months' experience had borne out the anticipated simplification of collection, standardization of reporting, and reduction of physician involvement in legal procedures.


Public relations in the emergency department.


Status epilepticus.

Status epilepticus.


The role of the emergency physician in mass casualty/disaster management. ACEP position paper.


Quo vadis--UA/EMS? (University Association for Emergency Medical Services)


The President of the United States of America: a neglected person in our emergency medical system.


Drugs given or prescribed in the emergency department.


Emergency medicine and family practice - room for both.


Updated reprint filing system for the emergency physician.


The crush injury: a high risk wound.

The crush injury: a high risk wound. A standardized experimental impact injury model was developed to produce soft tissue trauma that simulated impact injuries to soft tissue overlying the cranium. An aluminum impact instrument was constructed so as to deliver a measured amount of energy to a finite area of soft tissue over a fixed foundation. Impact injury resulted in readily demonstrable changes in the morphology of the tissue and its blood flow. As measured by the distribution of fluorescein dye, the blood flow to the impact site was considerably less than that to unwounded tissue. The magnitude of this reduction in blood flow to the site of injury was proportional to the level of energy absorbed by the tissue. The injury to skin resulting from the impact was restricted primarily to the subcutaneous tissue and panniculus carnosus. Loss of adipose tissue and necrosis of skeletal muscle fibers in these layers were associated with the development of a dense inflammatory infiltrate. The structural damage to the tissue and its reduced perfusion were correlated with the tissue's increased susceptibility to infection by bacteria delivered either by direct infection or as a result of a bacteremia. The magnitude of this damage to the host's defenses is, again, directly related to the amount of energy absorbed per unit area of soft tissue. Antibiotics did suppress the growth of bacteria in these experimental soft tissue impact wounds, even when treatment was delayed eight hours. While the therapeutic efficacy of antibiotics was readily apparent in soft tissue impact wounds, the degree to which they could suppress bacteria in these wounds was less than that encountered in the treated control wounds not subjected to impact.


Provider performance in the recognition and treatment of telemetered electrocardiogram patterns. A test of electrocardiogram diagnostic skills in the form of a ten-slide presentation of six-second rhythm strips was administered to 25 emergency department nurses, 23 intensive care unit (ICU) nurses, 34 cardiac technicians (CRT, EMT) and 37 physicians. The ICU nurses had the best performance overall. Physicians had difficulty with mechanical problems, viz, loose leads, flat line and inverted leads. ICU nurses had less difficulty identifying and treating flat line than did emergency department nurses. The study's limitations were that the sample was self-selected and that the providers might respond differently to a real life situation.


A unique academic approach to critical care-emergency medicine training. The four-year program for training physicians in critical care-emergency medicine at Sacramento Medical Center, University of California, Davis School of Medicine is described. Its purpose is to train the physician in resuscitation, emergency care for life-threatening conditions, and intensive care, so that the graduate can staff community hospital emergency departments and intensive care units, be director of an emergency department or intensive care unit, or pursue an academic career in emergency medicine.


Abscess formation as a complication of parenteral methylphenidate abuse. Case reports of five patients suffering from either skin abscesses or cellulitis following parenteral methylphenidate abuse are presented. Four patients had similar lesions consisting of abscesses or cellulitis which demonstrated typical signs and symptoms of an infective process and were treated with local symptomatic therapy, incision and drainage if indicated, and systemic antibiotics. The fifth patient suffered from a circular, necrotic, nonpurulent ulcer on the dorsum of the right foot which produced no local or systemic toxic effects. Attempts to culture a responsible organism yielded Streptococcus viridans, an organism which is normal flora of the skin and, although opportunistic, is generally considered nonpathogenic. These cases further substantiate the belief that local vasospasm, chemical irritation, or both, produced by the methylphenidate solution may primarily cause a necrotic ulcer susceptibble to secondary bacterial infection.


Xylocaine viscous as an aid in the differential diagnosis of chest pain. Sixty patients with chest pain, chest and epigastric pain, or predominantly epigastric pain, not explained by electrocardiographic (EKG) changes or pulmonary findings, were given 20 cc of Xylocaine Viscous orally. Thirty-seven out of 60 experienced complete or almost complete relief within 10 to 15 minutes. Of this group, none were found to have suffered a myocardial infarction. Of the 23 patients who did not experience pain relief, six had a myocardial infarction and seven were diagnosed as having cardiac angina. Determination of serum lidocaine levels after oral ingestion of 20 cc of Xylocaine Viscous in patients with normal gastric function demonstrated a maximum level of 0.55 mu/ml--a serum level unlikely to result in adverse side effects.


Can the well trained EMT-paramedic maintain skills and knowledge? Reliable criteria exist to assess emergency medical technician (EMT)-paramedic team and individual competence. In addition to written and oral examiniation, reliable individual manipulative skill data, and on-scene observation of emergency care by responsible physicians, EMT-paramedic team competence may be assessed by using tracer conditions that reflect patient outcome converted to a standard base population per unit time. Using standard definitions of "resuscitation" and "save," and the pulseless, nonbreathing patient as tracer, 75 (31%) of 241 patients were resuscitated and 34 (14%) were saved. Team manipulative skill competence may also be determined by an appropriate tracer.


A caveat for xylocaine viscous and chest pain.


The portable Doppler: practical applications in EMS care. The practical application of a new, commercially available, portable Doppler ultrasound device to the operation of a busy city-county emergency department and ambulance service was investigated. An initial evaluation using healthy volunteers confirmed accuracy and reproducibility of the Doppler blood pressure readings comparable to that of auscultatory and palpatory measurement. In selected patients, the Doppler readings correlated well with readings from patients who had intra-arterial lines. When used in several low flow states, such as testing adequacy of cardiopulmonary resuscitation (CPR) and verification of electromechanical dissociation, the Doppler aided the clinical evaluation and treatment in many cases where traditional methods were useless. The Doppler was also helpful in the evaluation of local arterial injury but this unit was not found sensitive enough for venous disease. Finally, the Doppler enhanced the obtaining of vital signs in the noisy environment of our ambulances.


Public Law 93-641 and the emergency physician.


Plea for research in emergency medicine.


Phenothiazines and anticholinergics in heat stroke.


Prehospital use of the military anti-shock trouser (MAST). Complications of prehospital use of the military anti-shock trouser (MAST) in treating hypotensive and hypovolemic patients have been few and minor. Undesirable consequences--compromised respiratory excursion or autonomic disturbances such as emesis, urination or defecation--were rare. Forty-seven (88.7%) of 53 patients with conditions classed as potentially lethal or severe survived. Close communications between prehospital and emergency department personnel can assure accurate transmission of circumstances of MAST application and result in optimal responses and improved inhospital patient care. Both "false positives" (supposed initial hypotension or hypovolemia) and "false negatives" (seeming stability in the face of major anatomic derangements) require a carefully structured operational sequence. Further evaluation of the device, particularly in cardiovascular/cardiopulmonary cases, is in progress.


Resuscitation--opening the airway. A comparative study of techniques for opening an airway obstructed by the tongue. The effectiveness of three techniques for opening an airway obstructed by the tongue was studied and compared. The research involved patients who were anesthetized for elective surgery. The first group of patients, not breathing on their own, were ventilated by mouth-to-mouth breathing. The second group was unconscious, making spontaneous respiratory effort, but had total airway obstruction produced by the tongue from relaxation of the lower jaw. The three techniques--neck lift, chin lift, and jaw thrust--were performed on all patients in both groups. The adequacy of ventilation was compared subjectively and by measuring air flow with a Wright Respirometer. Results indicate that the chin lift technique provides the most consistently adequate airway.


Spontaneous bladder rupture: rare cause of peritonitis. Spontaneous rupture of the urinary bladder is an uncommon, but important, cause of generalized peritonitis. It is a surgical emergency which may be rapidly fatal if diagnosis and treatment are delayed. Bladder disease or obstruction, coupled with a sudden increase in intra-abdominal pressure usually accounts for the rupture. Characteristic symptoms are acute lower abdominal pain followed by generalized peritonitis. In most cases, the rupture is intra-peritoneal.


Emergency medicine condition/skills list.


Hypothermia--a sign of hypoglycemia.

Hypothermia--a sign of hypoglycemia. Hypothermia may occur in association with hypoglycemia, and indeed may be the only sign. Two cases are presented. In one, the patient presented with hypoglycemic encephalopathy. In the insulin dependent diabetic, the condition is life-threatening. Subnormal temperature is a clue to hypoglycemia in the alcoholic. The mechanism of hypothermia has been extensively studied, but remains unclear.


Emergency medical technician-paramedic training. With a nationally standardized emergency medical technician-paramedic training program soon to be adopted, certain factors in the planning of training programs should be emphasized. (1) The facilities should provide an opportunity for the paramedics to gain clinical experience in intensive care units and emergency departments. Teaching must be appropriate to the students' educational background. (2) The course content should include advanced life-support. (3) Full-time and part-time programs must be developed, possibly using a modular format. (4) The operating procedure should conform to local medical and legal practice. (5) Mechanisms for evaluation and recertification must be developed. (6) Continuing education, as important or more important than the original training, should be included in program planning.


Clinical use of the "G-suit".

Clinical use of the "G-suit". The "G-suit," a device for combating hypovolemic shock with external pneumatic counterpressure, represents an application of an old idea to a relatively common medical problem. Its simplicity of use and quick therapeutic effect buys time for the patient with hypovolemic shock, whether the suit is applied in the prehospital or emergency department setting.


An emergency intravenous route for the pediatric patient. In pediatric patients, percutaneous venipuncture is preferable to cutdown, especially in inexperienced hands. The best route for maintenance fluid administration is a  No. 19, No. 21 or No. 23 scalp vein needle or No. 18 or No. 20 plastic cannula placed in a superficial hand or foot vein. An incision 1 cm proximal to the medial malleolus of the tibia over the great saphenous vein is the classic pediatric cutdown. Other alternatives are brachial vein, saphenous vein distal to the medial aspect of the knee and, in extreme emergencies, the external jugular vein or cephalic vein in the arm. The cutdown technique with facilitating suggestions and possible dangers is described.


Southern California frostbite.

Southern California frostbite.


Splint the patients, not the fractures, where they lie.


Treatment of choice for brown recluse spider bites.


On-the-scene emergency care by the primary physician. One year's experience with on-the-scene emergency responses by a rural family physician equipped for advanced life-support is analyzed. Three (6.7%) out of 45 consecutive emergency responses were lifesaving, specifically because the physician was there. No definite reduction in morbidity was documented. Accurate assessment of emergencies when reported and at the scene of spontaneous events was enhanced by the physician's familiarity with  the patient and/or the reporter. Economic considerations, useful equipment, and special problems encountered in on-the-scene emergency care are discussed. The primary physician is a reasonable candidate to provide on-the-scene emergency care, especially in communities where advanced life-support is otherwise inadequate. His properly equipped vehicle deserves emergency vehicle status. Simultaneous summoning of the physician along with other emergency personnel by a central dispatching agency would be ideal in these communities.


Airway obstructed by foreign material: the Heimlich maneuver. To investigate the application of a cough-creating thrust for the removal of airway-obstructing foreign material, the thrust was applied to six adult male anesthetized volunteers at the waist, at the low chest level, and at the midchest level, with the subjects in both the horizontal-lateral and the sitting positions. Air volume, peak air flow rate, and airway measurements were made. Both the low chest and midchest thrusts produced significantly better results than did the abdominal thrust. There were no side effects attributable to the thrusts. The ease of application and consistently better level of results indicate that the chest thrust is the technique of choice. The application of the chest thrust should be integrated into the concepts of basic life-support and cardiopulmonary resuscitation.


Psychiatric training for emergency medicine residents on a multidisciplinary team. The Cincinnati General Hospital Emergency Department has a training program for emergency medicine residents on a multidisciplinary emergency psychiatry team. This essential training should occur in the emergency department setting rather than in psychiatric inpatient units of state hospital settings. There are advantages and disadvantages to this arrangement. Nonmedical members of the emergency psychiatry team train and support emergency medicine residents in a multidisciplinary approach to treatment. Some observations are made about how the emergency medicine residents deal with emotionally disturbed patients. Finally, 80% of emergency medicine residents responded to questionnaire on their reactions to the multidisciplinary emergency psychiatry team.


Nerve blocks of the foot.

Nerve blocks of the foot. Emergency treatment of foot injuries can be made less painful by regional block anesthesia. There is limited medical literature on these techniques and many physicians, while familiar with regional anesthesia of the upper extremity, are not experienced with nerve blocks in the lower extremity. Infiltration anesthesia of the plantar structures of the foot and toes can be very painful and may inhibit healing. Regional anesthesia avoids both of these problems and can prove effective and useful. This paper discusses the techniques and possible complications of nerve block anesthesia of the foot.


Botulism.

Botulism.


Relief of airway obstruction.

Relief of airway obstruction.


Upper airway obstruction.

Upper airway obstruction. A large number of diseases may present  with respiratory distress. In adults, upper airway obstruction (UAO) is relatively rare. Consequently, UAO may initially be overlooked in the differential diagnosis of the dyspneic patient. Because it may progress rapidly, delays or errors in diagnosis can be critical. During an eight-month period in one emergency department, seven adult patients with potentially life-threatening diseases of the upper airway were seen. To reacquaint physicians with the syndrome of mechanical obstruction of large airways, several illustrative cases are presented and the syndrome is discussed.


The teaching of life-support technics in medical schools.


Electrocardiographic changes in traumatized patients.


ED surgery for the embedded broken-off needle.


Plasma cortisol in tuberculosis.

Plasma cortisol in tuberculosis.


The etiology of transmissible murine colonic hyperplasia. The etiology of a transmissable colonic mucosal hyperplasia of mice was investigated. Hyperplasia was produced in mice inoculated with unfiltered colonic suspension from affected mice, but infectivity was lost after passage through a 0.45 mum filter. The etiologic agent was subsequently identified as a variant of Citrobacter freundii. The organism induced colonic mucosal hyperplasia when inoculated into germfree mice, and it was recovered in pure culture from the affected animals.


Vaginal septa in mice: incidence, inheritance, and effect on reproductive, performance. Dorso-ventral vaginal septa were observed in 38% of the recently weaned BALB/cJ female mice in the production colony at The Jackson Laboratory. The frequency of septa in two other BALB/c substrains and eight different inbred strains ranged from 0 to 8%. The vaginal anomaly was similar regardless of genetic background although individual variations were observed. The remainder of the reproductive tract was normal. Microscopically, the septum consisted of a fibrous partition covered by normal epithelium. Genetic analysis was undertaken by outcrossing septate BALB/cJ females to C57BL/6J, DBA/2J, or BALB/cBy males. Examination of female F1 and F2 progeny indicated more than one recessive gene was involved and genetic background influenced expression of these genes. Reproductive performance of septate and nonseptate BALB/cJ females was compared using several criteria. Fewer septate females were fertile, but the fecundity of fertile septate females was not affected.


Effect of repeated halothane anesthesias on Syrian hamster lung lipids. Sixteen adult Syrian hamsters were exposed 33 times over a 19-day period to enough halothane to induce a deep surgical plane of anesthesia. The exposures caused no significant change in the total amount of lipid in the exposed lungs; however, the percentage of neutral lipid due to cholesterol increased from 29 +/- 5% to 43 +/- 7% while the percentage of free fatty acid decreased from 33 +/- 3% to 22 +/- 5%. Among the phosphoglycerides, there was a slight shift toward more phosphatidyl choline and less phosphatidyl serine, phosphatidyl glycerol, and phosphatidyl ethanolamine.