The clinical picture of mania in manic-depressive black patients

Recent studies have shown that misdiagnosis of manic-depressive illness among blacks is a frequent occurrence. There are a number of historical and institutional dynamics involved in this process that have the roots of racism as their foundation. In light of this the authors decided to look at the clinical symptoms and behaviors of manic-depressive illness among black patients to see if their interpretation might be another contributing factor in misdiagnosis.The authors found the clinical symptoms of manic-depressive illness in black patients to be essentially what one would expect as determined by criteria in the Diagnostic and Statistical Manual (DSM III). However, there were cultural and socioeconomic determinants of behavior that affected the clinical manifestations.

Acute and long-term ventilatory effects of hyperoxia in the adult sleep apnea syndrome

Eight adult patients with sleep apnea were studied to evaluate the ventilatory and cardiac effects of hyperoxia on an acute basis. Five patients then used low-flow nighttime oxygen for 30 to 90 days. The results of the acute study showed that for 30-min study periods, the total number of apneas and per cent apnea time (duration of apneas divided by sleep time) decreased significantly from the room air to the oxygen period (207 to 68, p less than 0.05; 41.1 +/- 18.3% SD to 20.5 +/- 14.4%, p less than 0.05, respectively). Also, the apnea-associated slowing in heart rate is blocked by the supplemental oxygen. Three patients receiving oxygen at home decreased their per cent apnea time by greater than 60%. These patients also responded to the acute administration of hyperoxia by a decrease in apnea time greater than 60%. One patient prolonged the apnea time, and one had a minimal positive response, both again reflecting their acute studies. These data suggested that the severe hypoxemia that develops during an apnea in this syndrome has a central ventilatory effect that propagates the apneas and is significantly reversed by hyperoxia.

Effect of inspiratory flow rate on gas exchange during mechanical ventilation

We studied the effect of changes in inspiratory flow rate (VI) on gas exchange and respiratory system mechanics during mechanical ventilation. Seven patients with respiratory failure caused by severe chronic airway obstruction (CAO group) and 6 patients with other causes of respiratory failure (ORF group) were studied at 3 VI settings, 40 L/min, 70 L/min, and 100 L/min. In the CAO group, as VI increased from 40 L/min to 100 L/min, arterial oxygen tension increased 18%, venous admixture decreased 23.2%, dead space to tidal volume ratio decreased 23.7%, and tidal compliance of the respiratory system increased 31.2%. In the ORF group, as VI increased, there was little change in most parameters measured. The changes in the CAO group may be explained by redistribution of ventilation to low ventilation-perfusion ratio units, which empty more completely during the longer expiratory times allowed at high VI. Using a simple two-compartment lung model we determined that an increase in expiratory time from 4.2 to 6.1 s (the increase observed in the CAO group as VI increased from 40 L/min to 100 L/min) will result in redistribution of ventilation to long expiratory time constant respiratory units and produce changes in lung mechanics and gas exchange similar to those observed experimentally. We concluded that mechanical ventilation at high VI in patients with CAO is associated with improvement in gas exchange and more even distribution of ventilation, which appear to be due to the increased time available for alveolar emptying.

Role of pulmonary edema in the acute pulmonary response to sepsis

There is evidence that both bronchoconstriction and accumulation of lung water may contribute to the early alterations in lung function following septicemia. Eigher of these may be mediated by blood components. To assess these proposed mechanisms the changes in hemodynamics, pulmonary mechanics, gas exchange, and gravimetric lung water were measured in the first 4 h after Escherichia coli infusion in the anesthetized dog and baboon. These species were selected because of previously demonstrated differences in the response to gram-negative sepsis. Both species developed systemic hypotension and early hypoxemia. The dogs had early transient increases in venous admixture (Qva/Qt) but not shunt or dead space, while the baboon had a more persistent increase in Qva/Qt and a late increase in dead space, Increases in nonelastic resistance and decreases in lung compliance were preceded or accompanied by decreases in the leukocyte count in both species, but the platelet count, fibrinogen, and total hemolytic complement had different changes in the two species. Postmortem lung analysis revealed increased lung weight in both species but the wet weight-to-dry weight ratio was not increased in either species. The fractional water content of the excess lung mass was less than that of whole blood. Histological examination revealed large numbers of extravasated leukocytes in the lungs, which may be sufficient to explain the increase in lung weight. We conclude that pulmonary edema does not play a role in the early pulmonary response to E. coli bacteremia in either species. The physiological changes observed are more consistent with bronchoconstriction.

Manic-depressive illness among poor urban blacks

In psychiatric epidemiology it has generally been accepted that manic-depressive illness rarely occurs among blacks and lower socioeconomic groups. The authors conducted a retrospective study to examine the frequency of manic-depressive illness among lower income urban blacks admitted to an acute psychiatric inpatient unit of an urban hospital. The medical records of a random sample of 117 black psychiatric patients were reviewed for determination of manic-depressive illness as well as socioeconomic characteristics. Eighteen subjects (15%) were diagnosed as manic-depressive. The authors present possible explanations for this finding and the ramifications for future investigations.

Lymphocyte infiltration of gut epithelium in fetal and neonatal rabbits

Lymphocytes infiltrate the epithelium of small intestinal villi of fetal rabbits as early as day 28 of gestation. They appear within the lateral spaces between the columnar absorptive cells. At this time, the epithelial cells transport compounds, such as injected horseradish peroxidase, through these intercellular spaces to the subjacent lamina propria. The possibility for in utero interaction between intraepithelial lymphocytes and antigen in swallowed amniotic fluid is discussed. There is an increase in the number of intraepithelial lymphocytes from 1 per 500 epithelial cells on day 1 to 16 per 500 epithelial cells on day 21 of postnatal life. Each segment, duodenum, jejunum and ileum, shows an increase in the number of lymphocytes during this period.

Role of platelet serotonin in the canine pulmonary response to endotoxin

There is evidence suggesting a role for platelet serotonin (5-HT) in the immediate pulmonary response to endotoxin in the dog (J. Appl. Physiol. 23: 47, 1967). To further define this role, autologous canine platelets were labeled with 5-[14C]HT in vitro and then reinfused. Subsequently Escherichia coli endotoxin (0.55:B-5, Difco), 2.5 mg/kg, was injected. Within 5 min dynamic compliance (CL) fell by more than 50%, and nonelastic resistance (RL) increased by more than 200%. Despite a 95% decrease in platelet count, less than 10% of the platelet 5-HT was released as determined by changes in the radioactivity of platelet-poor plasma (PPP) prepared from both aortic and pulmonary artery blood. As a positive control, injected of bovine collagen produced a similar decrease in platelet count that was associated with a significant increase in the radioactivity of aortic and pulmonary artery PPP. FInally, rapid injection of a dose of 5-HT equivalent to 25% of the 5-HT in circulating platelets did not cause a change in CL or RL equivalent to that produced by endotoxin. From these data we conclude that endotoxin injection does not cause immediate massive platelet activation and that platelet 5-HT does not play a major role in the immediate pulmonary response to endotoxin.

Effect of methysergide on the acute lung mechanics response to endotoxin

The effect of the serotonin antagonist methysergide on the acute lung mechanics response to endotoxin in anesthetized, paralyzed, mechanically ventilated dogs was investigated. In five dogs given 0.25 mg/kg Escherichia coli endotoxin only, the pulmonary nonelastic resistance (RL) increased to 238% of control and dynamic compliance (CL) decreased to 50% of control. In a second group of five dogs, methysergide (0.25 mg/kg) was shown to markedly attenuate the lung mechanics response to serotonin (0.04 mg/kg), which alone had produced changes in lung mechanics greater than endotoxin. In these same dogs endotoxin administered after injection of methysergide produced an increase in RL to 377% and a decrease in CL to 33% of control. In a third group of five dogs whose lung mechanics response to serotonin was also greater than to endotoxin alone, endotoxin administered after injection of saline produced an increase in RL to 168% and a decrease in CL to 58% of control. Since the response to endotoxin after injection of methysergide exceeded the response after saline, we conclude that serotonin is not a mediator of the acute lung mechanics response to endotoxin.

Studies on local immunity to sperm-dissolving of cervical mucus by use of bromelin with retention of antibody activity

The complete dissolving of human cervical mucus was achieved with bromelin. The adequacy and the mildness of this procedure were studied by making both solutions and simple extracts of a number of mucus samples. Both types of preparation were tested for sperm antibody by our methods of agglutination and immobilization. The comparisons showed a high degree of concurrence between these two types, with the bromelin solutions showing positive results more often than the extracts. Other control tests showed that addition of bromelin did not perturb the antibody testing of positive and negative sera. We concluded that addition of bromelin, in a 1/3 volume, gives a quick, thorough and undamaged solution of cervical mucus, on which sperm antibody tests can be done with ease and reliability.

Alterations in lung volume and pulmonary function in relation to hemodynamic changes in acute myocardial infarction

To characterize the changes in lung volumes after acute myocardial infarction (AMI), and the relationship of these changes to other alterations in lung function which correlate with the severity of pulmonary vascular congestion, we made measurements of pulmonary hemodynamics, lung volume, closing volume, frequency dependence of total pulmonary resistance to forced oscillation, and arterial PO2 in 18 subjects with AMI. The most consistent finding was reduced lung volume which correlated with the severity of pulmonary diastolic hypertension. Frequency dependence of resistance showed a small but significant correlation with pulmonary hemodynamics. Closing volume measurements by the resident gas method in nine subjects was not related to hemodynamics. Follow-up studies at the time of hospital discharge revealed a significant return toward normal for arterial PO2, all lung volumes, and total pulmonary resistance at 9 Hz. Based on measurements in healthy subjects, the reduced lung volume after AMI may explain the changes in resistance. In acute and follow-up studies the degree of lung volume reduction and the severity of hypoxemia were strongly correlated.

Physiologic effects of bronchopulmonary lavage in alveolar proteinosis

The clinical and physiologic effects of bronchopulmonary lavage of both lungs at separate times in 14 patients with alveolar proteinosis proved by biopsy were followed for 2 to 96 months. Before lavage, all patients had moderate to severe dyspnea on exertion. Twelve had a nonproductive cough, and 2 had a productive cough; both were smokers. Nine had generalized fatigue, and 4 had weight loss. Twelve of 14 had fine inspiratory rales. All of the patients had abnormal chest roentgenograms, and 13 of 14 had an increased lactate dehydrogenase concentration. After lavage, all patients had loss of fatigue and improved exercise tolerance, with most returning to normal activity. Cough cleared in 12 of 14 and remained only in the cigarette smokers. Inspiratory rales cleared completely in most patients (11 of 12) and partially in one. The rales usually returned during exacerbations. Physiologic measurements that changed significantly after bilateral lavage included: vital capacity, total lung capacity, resting room air PO2, exercise PO2, PO2 while breathing 100 per cent O2, and DLCO. Because all measurements were made within 5 days of the second lavage, one must attribute the acute improvement to the removal of proteinaceous material from the alveoli. The long-term effects varied; some patients required annual or semiannual lavages, wherease others remained in remission after lavage for 36 to 96 months. Exacerbations were accompanied by increased dyspnea, reappearance of rales, and deterioration of the gas-exchange parameters noted previously. Repeat lavage reversed the clinical symptoms and physiologic abnormalities in patients who had recurrences.

Effect of pulmonary vascular engorgement on respiratory mechanics in the dog

The immediate effects of pulmonary vascular engorgement (PVE) on lung and chest wall mechanics were studied in anesthetized, paralyzed dogs with the chest wall intact. A balloon-tipped catheter advanced retrograde into the left atrium was used to produce partial mitral valve obstruction and increases in pulmonary artery and left atrial preassures equal to 15 and 20 cm H2O, respectively. This increased pulmonary blood volume (PBV) by 50% and reduced dynamic lung ocmplicance 14%. With the airway occluded at different lung volumes, transient PVE produced a 6% decrease in compliance on the deflation limb of the pressure volume curve of the lung and a shift in the chest wall pressure-volume curve, which was consistent with an increase in chest wall volume equal to the increase in PBV. During apnea with the airway open, PVE reduced lung gas volume and increased chest wall recoil. We conclude that the changes in chest wall recoil associated with PVE are the result of an increase in total lung displacement volume.

Cytochemical localization of catalase and peroxidase in sinusoidal cells of rat liver

The cytochemical localization of catalase and peroxidase in various sinusoidal cells of rat liver, i.e., in Kupffer cells, endothelial cells, and fat-storing cells has been investigated. The alkaline 3,3'-diaminobenzidine technique reveals distinct "catalase-positive particles" in all three cell types. The particles are round to oval-shaped, measuring 0.1 to 0.3 mum. in diameter. The diaminobenzidine reaction product is distributed uniformly over their matrix, often obscuring the distinct limiting membrane. In fat-storing cells the particles appear in close proximity of lipid droplets. No evidence of fusion of the limiting membrane of the particles with that of phagolysosomes containing latex particles was observed. The "catalase-positive particles" appeared often in close proximity of endoplasmic reticulum, but by examining consecutive serial sections we could not find any convincing evidence of direct continuity between the two organelles. In addition to catalase there is an endogenous peroxidase in the endoplasmic reticulum and nuclear envelope of Kupffer cells. Whereas peroxidase is sensitive to aldehyde fixation and has its optimal pH in the neutral range, the staining for catalase requires prior fixation with glutaraldehyde and isoptimal at pH 10.5. By using proper fixation and incubation conditions the two enzymes have been visualized selectively, and it is demonstrated that they occupy two distinct intracellular compartments within the Kupffer cells: the catalase in the matrix of particles and the peroxidase in the endoplasmic reticulum. The possible functional role of catalase in various sinusoidal cells is briefly discussed.

Light and heavy chain components of gamma globulins in urines of normal persons and patients with agammaglobulinemia

A heavy chain component of gammaG-globulins in normal urines has the characteristics of the proteolytic digestion product, Fc-fragment. This fragment is estimated to compose up to 15% of the gamma globulins present in urines. In contrast to urinary light chains, the urinary Fc-like fragment probably represents a catabolic component in normal gammaG-globulin metabolism. The light chains of the urine constitute more than half the total gamma globulin present. The calculated kappa/lambda ratio of light chains averaged 1.9 in ten urines, but the ratio in individual urines varied widely to either side of this figure. In two adult patients with agammaglobulinemia whose sera contained less than one-hundredth the normal gamma globulin levels, the urinary Fc-like fragment was absent, whereas the light chain levels were only one-tenth the average normal level. Treatment with exogenous gamma globulins resulted in normal or near normal Fc-like fragment excretion, whereas light chain excretion was only modestly affected.