Outcome of coronary artery aneurysms after Kawasaki disease

From 1974 through 1991, a total of 583 children with Kawasaki disease were seen at the Hospital for Sick Children, in Toronto, of whom 80 (13.7%) had coronary artery involvement. There were 55 boys and 25 girls, whose mean age at onset was 2.9 +/- 2.5 years, followed for a mean period of 4.0 +/- 3.6 years. Giant aneurysms (maximum diameter > or = 8 mm) were found in 22 children, moderate-sized aneurysms (> or = 4 to < 8 mm) in 44, and dilation lesions (< 4 mm) in 14. Myocardial infarction occurred in 9 (1.5%), all of whom had giant aneurysms. The persistence rate for aneurysms was 72% at 1 year and 41% at 5 years of follow-up. In multivariate analysis, the regression of an aneurysm was significantly related to the severity of coronary artery lesions, initial treatment, and gender. Although > 80% of small or moderate-sized aneurysms regressed within 5 years, giant aneurysms did not regress during the follow-up period. In patients who received immune globulin therapy, coronary lesions tended to resolve more rapidly than in those treated with salicylate therapy alone, because 91% of the lesions in the former were small or moderate. These findings suggest that the severity of coronary artery involvement during the initial stages of Kawasaki disease influences the regression of these lesions, and that immune globulin treatment may improve outcome by reducing the incidence of severe lesions.

PET imaging of opiate receptor binding in human epilepsy using [18F]cyclofoxy

We used [18F]cyclofoxy (CF), a potent opiate antagonist with affinity for mu and kappa receptors, and the Scanditronix PC1024-7B PET scanner to study 14 patients with complex partial seizures (CPS), and 14 normal controls. Epileptic foci were localized by prolonged EEG-video monitoring. EEG was recorded continuously during each scan. Immediately before CF administration, [15O]labeled water was used to measure cerebral blood flow, and showed hypoperfusion ipsilateral to the EEG focus. Blood samples (corrected for radiolabeled metabolites) and tissue time-activity data were acquired over 90 min following bolus CF injection. Anatomic regions were outlined directly on the PET images. A kinetic model was used to derive the total volume of distribution (Vt) in each brain region. Specific binding (Vs) was determined by substracting non-specific binding (Vt) measured in a receptor-poor brain region (occipital cortex). Regions with high Vs included mesial temporal lobes, thalamus, basal ganglia, and frontal cortex. Individual patients appeared to have higher binding in temporal lobe ipsilateral to the EEG focus, but there was no asymmetry for the patients as a group in mean Vt or Vs in anterior mesial, posterior mesial, anterior lateral, posterior lateral temporal cortex, thalamus, basal ganglia, or, for Vt, in regions of low specific binding: occipital lobe, parietal lobe, cerebellum.

Major electrocardiographic abnormalities in persons aged 65 years and older (the Cardiovascular Health Study). Cardiovascular Health Study Collaborative Research Group

Electrocardiographic abnormalities are often found in older patients, but their prevalence in free-living elderly populations is not well-defined. In addition, the clinical significance of many of these abnormalities is uncertain. The prevalence of major electrocardiographic abnormalities was determined in 5,150 adults aged greater than or equal to 65 years from the Cardiovascular Health Study--a study of risk factors for stroke and coronary heart disease in the elderly. Ventricular conduction defects, major Q/QS waves, left ventricular hypertrophy, isolated major ST-T-wave abnormalities, atrial fibrillation and first-degree atrioventricular block were collectively categorized as major electrocardiographic abnormalities. Prevalence of any major electrocardiographic abnormality was 29% in the entire cohort, 19% among 2,413 participants who reported no history of coronary artery disease or systemic hypertension, and 37% among 2,737 participants with a history of coronary artery disease or hypertension. Prevalence of major electrocardiographic abnormalities was higher in men than in women regardless of history, and tended to increase with age. Major Q/QS waves were found in 5.2%, and more than half were in those who did not report a previous myocardial infarction. Major electrocardiographic abnormalities are common in elderly men and women irrespective of the history of heart disease.

Regeneration of the eighth cranial nerve in the bullforg, Rana catesbeiana

The present study was done in order to document the ability of the eighth cranial nerve of the bullfrog (Rana catesbeiana) to regenerate, the anatomic characteristics of the regenerated fibers, and the specificity of projections from individual endorgan branches of the nerve. The eighth cranial nerve was sharply transected between the ganglion cells and the brain stem in 40 healthy bullfrogs and allowed to regenerate. Anatomic studies were performed in these animals a minimum of 3 months postoperatively. Horseradish peroxidase was used to label the whole vestibular nerve or its individual endorgan branches. Labeled regenerated fibers could be identified crossing the site of the nerve section and projecting centrally to the vestibular nuclei in a pattern similar to that of normal frogs. Labeling of individual branches showed that regenerated fibers innervated the same specific areas found in normal frogs. Unlike normal animals, both thick and thin fibers projected to the medial nucleus.

Midline nasal destruction in cocaine abusers

Idiopathic midline destructive disease (IMDD) is a diagnosis of exclusion in patients who manifest midline nasal necrosis with no specific etiology such as infection, tumor, or Wegener's granulomatosis. Recently, a group of cocaine abusers has been identified that manifests a syndrome that mimics IMDD, but is less fulminant in its course. To better define the natural history of this syndrome, we reviewed the medical records, radiographs, and pathologic material from five such patients treated at the University of California, Los Angeles. Other causes of midline nasal destruction were excluded in each patient on the basis of histopathology, cultures, and laboratory tests. Biopsy material, available in four patients, demonstrated inflammation and necrosis without vasculitis. Treatment was conservative in four of the five patients, using antibiotics, local care, debridement, and cessation of cocaine use. During the follow-up period, progressive disease developed in one of the five patients, requiring radiation and steroid therapy. We conclude that the treatment of midline nasal destruction in cocaine abusers should initially be conservative, once other etiologies have been systematically excluded.

The Many Faces of Reflux: Understanding the mechanisms of gastroesophageal reflux

While gastroesophageal reflux frequently presents as heartburn, other symptoms can dominate the clinical picture. This article describes recent advances in understanding the mechanisms of gastroesophageal reflux and in diagnosing and treating it.

Grading written essays: a reliability study

The purpose of this study was to examine the interrater reliability of grades obtained by physical therapy and occupational therapy tutors in rating their students' term papers. This study was carried out in two phases. In phase 1, four student essay papers (two physical therapy students' papers and two occupational therapy students' papers) with grades that had been assigned from the previous year's course were randomly selected from a bank of papers. These papers were independently rated by three course planners (who were responsible for planning, coordinating, and tutoring in the course), and agreement as to the assignment of grades for each paper was established. In phase 2, the same students' essays were rated independently by eight course tutors. To test for differences among students' written essay papers and for differences among the raters in the subcategories of discipline (physical therapy versus occupational therapy) and level of expertise (novice versus experienced) in grading essays, a three-way analysis of variance was performed. An intraclass correlation coefficient (ICC) was calculated for interrater reliability. Although there were no statistically significant differences among the tutors with regard to their discipline and expertise, the reliability analysis produced an ICC of .79. Strategies to enhance the reliability of grading essays are discussed.

Mutations in yeast U5 snRNA alter the specificity of 5' splice-site cleavage

Recognition of 5' splice sites in pre-mRNA splicing is achieved in part by base pairing with U1 snRNA. We have used interactive suppression in the yeast Saccharomyces cerevisiae to look for other factors involved in 5' splice-site recognition. This approach identified an extragenic suppressor that activates a cryptic 5' splice site. The suppressor is a gene for U5 snRNA (snR7) with a single base mutation in a strictly conserved 9 base sequence. This suggests that U5 snRNA can play a part in determining the position of 5' splice-site cleavage. Consistent with this, we have been able to isolate other mutations in the 9 base element in U5 snRNA that specifically activate a second cryptic 5' splice site nearby.

The Cardiovascular Health Study: design and rationale

The Cardiovascular Health Study (CHS) is a population-based, longitudinal study of coronary heart disease and stroke in adults aged 65 years and older. The main objective of the study is to identify factors related to the onset and course of coronary heart disease and stroke. CHS is designed to determine the importance of conventional cardiovascular disease (CVD) risk factors in older adults, and to identify new risk factors in this age group, especially those that may be protective and modifiable. The study design called for enrollment of 1250 men and women in each of four communities: Forsyth County, North Carolina; Sacramento County, California; Washington County, Maryland; and Pittsburgh, Pennsylvania. Eligible participants were sampled from Medicare eligibility lists in each area. Extensive physical and laboratory evaluations were performed at baseline to identify the presence and severity of CVD risk factors such as hypertension, hypercholesterolemia and glucose intolerance; subclinical disease such as carotid artery atherosclerosis, left ventricular enlargement, and transient ischemia; and clinically overt CVD. These examinations in CHS permit evaluation of CVD risk factors in older adults, particularly in groups previously under-represented in epidemiologic studies, such as women and the very old. The first of two examination cycles began in June 1989. A second comprehensive examination will be repeated three years later. Periodic interim contacts are scheduled to ascertain and verify the incidence of CVD events, the frequency of recurrent events, and the sequellae of CVD.

The potent opioid agonist, (+)-cis-3-methylfentanyl binds pseudoirreversibly to the opioid receptor complex in vitro and in vivo: evidence for a novel mechanism of action

The present study demonstrates that pretreatment of rat brain membranes with (+)-cis-3-methylfentanyl [(+)-cis-MF], followed by extensive washing of the membranes, produces a wash-resistant decrease in the binding of [3H]-[D-ala2,D-leu5]enkephalin to the d binding site of the opioid receptor complex (delta cx binding site). Intravenous administration of (+)-cis-MF (50 micrograms/kg) to rats produced a pronounced catalepsy and also produced a wash-resistant masking of delta cx and mu binding sites in membranes prepared 120 min post-injection. Administration of 1 mg/kg i.v. of the opioid antagonist, 6-desoxy-6 beta-fluoronaltrexone (cycloFOXY), 100 min after the injection of (+)-cis-MF (20 min prior to the preparation of membranes) completely reversed the catatonia and restored masked delta cx binding sites to control levels. This was not observed with (+)-cycloFOXY. The implications of these and other findings for the mechanism of action of (+)-cis-MF and models of the opioid receptors are discussed.

Failure to immortalise human AML cells using human recombinant GMCSF in vitro and in vivo

We have failed to find any evidence that human recombinant GM-CSF can immortalize human AML cells grown in liquid culture or as nodules in immune deprived mice. In previous clinical studies and a controlled trial currently underway there is no evidence of irreversible acceleration of the disease.

Primary vestibular projections in the chinchilla

The central projections of fibers from the vestibular nerve were studied in 19 chinchillas after horseradish peroxidase labelling. In addition, the limits of the vestibular nuclei and the anatomical characteristics of their neurons were also studied. All five vestibular nuclei received primary afferents, but there were extensive areas of them that received very little or no projections at all, such as the rostral part of the superior vestibular nucleus, the dorsocaudal part of the lateral vestibular nucleus, the caudal half of the medial vestibular nucleus and the caudalmost aspect of the dorsal vestibular nucleus.

Regulatory and essential light-chain-binding sites in myosin heavy chain subfragment-1 mapped by site-directed mutagenesis

Site-directed mutagenesis of the cloned subfragment-1 (S-1) region of the unc-54 gene, encoding the myosin heavy chain B (MHC B) from Caenorhabditis elegans, has been used to locate binding sites for the regulatory and essential light chains. MHC B S-1 synthesized in Escherichia coli co-migrated with rabbit skeletal muscle myosin S-1 (Mr 90,000), was recognized by anti-nematode myosin antiserum on immunoblots, and specifically bound to 125I-labelled regulatory and essential light chains in a gel overlay assay. Deletion of 102 residues from the C terminus (mutant 655) reduced regulatory and essential light-chain binding to about 30% and 20% of wild-type levels, respectively. Similar reductions in relative binding of the two light chains were seen with mutant 534, in which 38 residues were deleted from the C terminus. Potential binding sites within 75 residues of the C terminus of S-1 were mapped by construction of five other mutant S-1 clones (398, 399, 400, 409 and 411) containing internal deletions of ten to 12 amino acid residues. These showed up to 30% reductions in their ability to bind essential light chains, but did not differ significantly from wild-type in their ability to bind regulatory light chains. Another mutant, 415, containing a deletion of a conserved acidic hexapeptide, E-D-I-R-D-E, showed enhancement of binding of regulatory and essential light chains to 150% and 165% of wild-type levels. Hence, the major binding sites for both light chains are within 38 amino acid residues of the C terminus.

Regeneration of the eighth cranial nerve. III. Central projections of the primary afferent fibers from individual vestibular receptors in the bullfrog

The projection site in the central nervous system of individual end-organ branches of regenerated vestibular nerves was documented in bullfrogs. The eighth cranial nerve was surgically sectioned in 12 bullfrogs (Rana catesbeiana) and allowed to regenerate. Horseradish peroxidase was used to label the primary vestibular afferent fibers from the whole nerve (one frog) and the whole anterior branch (two frogs), and the individual receptor end-organ branches to the anterior semicircular canal (three frogs), the horizontal semicircular canal (three frogs), and the sacculus (three frogs). A sufficient number of fibers from the individual receptors were labeled in nine specimens to allow a description of their central projection pattern. The overall pattern of central projections of the regenerated nerves was similar to the pattern of normal nerves. In the eighth nerve root proper and in the area proximal to the vestibular nuclei, fibers from the anterior semicircular canal were ventral, fibers from the sacculus and posterior branch were dorsal, and fibers from the horizontal semicircular canal were in an intermediate position. In ventral, superior, and descending vestibular nuclei, a projection pattern was also identifiable in some specimens. The fibers of the anterior semicircular canal projected ventral to the fibers of the horizontal semicircular canal, with fibers from the posterior branch more dorsal. The saccular fibers projected to the dorsal aspect of the ventral nucleus and the ventral aspect of the dorsal nucleus. For the most part, projections in the regenerated specimens, as verified histologically, were comparable to individual end-organ projections previously identified in normal frogs. The only major discrepancy between the findings from the regenerated specimens and those from normal frogs was in the position of the vestibular tract and the innervation to the medial nucleus. The regenerated vestibular tract was shifted laterally in the brain stem. Regenerated thick and thin fibers were intermixed in the tract and projected to the medial nucleus. Normally, the thin fibers are lateral to the thick fibers in the tract. Therefore, the regenerated afferent fibers of the vestibular nerve selectively reinnervated the vestibular nuclei, and the fibers to the individual end-organs selectively reinnervated particular parts of the nuclei. In addition, the thick and thin regenerated fibers preserved the type of bouton endings normally found. The regenerated thick fibers had rare boutons en passant and a great number of collaterals, while the thin fibers had numerous boutons en passant and only a few collaterals.(ABSTRACT TRUNCATED AT 250 WORDS)

Specific accessory sequences in Saccharomyces cerevisiae introns control assembly of pre-mRNAs into spliceosomes

In experiments involving deletion and rearrangement of intron sequences two small regions of the intron in the yeast CYH2 ribosomal protein gene were found to play important roles in splicing of the pre-mRNA. One element lies downstream of the 5' splice site, and the other is upstream of the branchpoint sequence UACUAAC. Deletion of the element upstream of the branchpoint prevents spliceosome formation and blocks splicing in vivo and in vitro. Deletion of the element downstream of the 5' splice site does not on its own block splicing but rescues spliceosome formation and splicing of pre-mRNA lacking the element upstream of the branchpoint. These elements correspond to two regions of sequence complementarity which are a conserved feature of the introns in yeast pre-mRNAs. Mixing and matching of the elements from the ACT1 and CYH2 gene introns showed that these elements can cooperate in an intron-specific fashion to control spliceosome assembly.

Intramedullary spinal cord metastasis in Hodgkin's disease. Rapid diagnosis and treatment resulting in neurologic recovery

Intramedullary spinal cord metastases are uncommon in Hodgkin's disease and have a poor prognosis. This prognosis reflects the refractory or widely disseminated status of the disease at the time of development of neurological symptoms and difficulties in diagnosis. Computerized tomography and magnetic resonance imaging have enabled more rapid and specific diagnosis of spinal cord diseases. The authors report a patient who presented with Brown-Sequard syndrome due to intramedullary spinal cord infiltration from Hodgkin's disease. This patient was diagnosed promptly and with rapid initiation of radiation and chemotherapy, she has had neurologic recovery.

Regeneration of the eighth cranial nerve. II. Physiologic verification in the bullfrog

Two experiments were performed to document the functional capacity of the regenerated eighth cranial nerve. In experiment 1, the eighth cranial nerve was sectioned preganglionically and allowed to regenerate in a group of bullfrogs with normal contralateral eighth nerve and labyrinth. Posture and reflex to lateral tilt were measured preoperatively and postoperatively for a minimum of 3 months. Similar measures were performed in a second group of bullfrogs in which the eighth nerve had been destroyed by ganglionectomy and in a third with peripheral labyrinthectomies. In experiment 2, the eighth nerve was sectioned and allowed to regenerate in bullfrogs in which the contralateral nerve had previously been destroyed. Posture and reflex to lateral tilt were measured as in experiment 1. Similar measures were performed in a group of bullfrogs that had undergone bilateral nerve destruction. Regeneration of the eighth cranial nerve in bullfrogs in both experiments was documented histologically by labeling the regenerated fibers with horseradish peroxidase (HRP). In both experiments, posture recovered completely only in the bullfrogs in which the eighth cranial nerve was allowed to regenerate. Reflex to lateral tilt recovered more rapidly in the bullfrogs with regenerated nerves than in any of the other bullfrogs.

Eikenella corrodens infection of the hand--a case report and literature review

Eikenella corrodens, a gram-negative, slow-growing rod, belongs to the normal flora of mucous membranes. Infections of the hand including this pathogen, are described in human bite and clenched fist injuries. Our case demonstrates another possibility of wound contamination with normal oral flora causing Eikenella corrodens infection. The consequences due to the delay of appropriate therapy are discussed.

Mutational analysis of the coordinate expression of the yeast tRNAArg-tRNAAsp gene tandem

tRNA genes occur in the yeast genome as highly dispersed and independent transcriptional units. The 5'-tRNAArg-tRNAAsp-3' gene tandem, separated by a 10-base-pair spacer sequence, thus represents a rare case of tight clustering. Previous in vitro studies did not reveal any primary transcript from the tRNAAsp gene, but rather a dimeric precursor containing both gene sequences plus spacer, which undergoes a series of maturation steps. This seems anomalous since the tRNAAsp gene contains the sequences necessary for its own transcription. We found that site-directed mutation of the highly conserved C at position 56 to a G in the tRNAArg gene suppresses all transcription and does not activate the tRNAAsp gene. Precise deletion of the entire tRNAArg gene gives a similar result. Rescue of tRNAAsp gene transcription is effected either by the precise deletion of both the tRNAArg gene and spacer or by the precise deletion of this gene with concomitant introduction of an artificial RNA polymerase III start site in the spacer. This artificial start site is ineffective if the tRNAArg gene is present upstream.

Regeneration of the eight cranial nerve. I. Anatomic verification in the bullfrog

The regenerative capacity of the eight cranial nerve of the bullfrog, Rana catesbeiana, was investigated. The nerve was sectioned between the ganglion and the brain stem in 16 experimental animals. Horseradish peroxidase was extracellularly injected distal to the site of the nerve section five or more weeks postoperatively. Labeled fibers were identified histologically and their central nervous system projections studied. The findings were as follows: 1. The eight cranial nerve of the bullfrog regenerated after preganglionic axotomy. 2. Fibers of all sizes regenerated. The regenerated fibers in the nerve were disorderly at the site of nerve section. Most fibers entered the brain stem and formed a vestibuloauditory tract, although some "escaped" and coursed along the brain stem. 3. The regenerated vestibuloauditory tract was situated more laterally than normal, with thick and thin fibers intermixed. 4. Regenerated tertiary fibers were long and tortuous and had unusual trajectories. 5. All vestibuloauditory nuclei received thick and thin afferent fibers.

Use of polytetrafluorinated ethylene compound in peripheral nerve grafting. An experimental study

The suitability of polytetrafluorinated ethylene compound (Gore-tex) tubing in peripheral nerve grafting was studied using a rat sciatic nerve model. Thick-walled (0.36 mm) tubing was compared with thin-walled tubing (17 mm). Thin-walled tubing gave a favorable functional and microscopic result in five of seven animals, while thick-walled tubing gave a favorable graft result in three of six animals. The results achieved with the thin-walled tubing were comparable to those achieved using nerve grafts and vein interposition grafts.

Genetic basis for species vulnerability in the cheetah

A population genetic survey of over 200 structural loci previously revealed that the South African cheetah (Acinonyx jubatus jubatus) has an extreme paucity of genetic variability, probably as a consequence of a severe population bottleneck in its recent past. The genetic monomorphism of the species is here extended to the major histocompatibility complex, since 14 reciprocal skin grafts between unrelated cheetahs were accepted. The apparent consequences of such genetic uniformity to the species include (i) great difficulty in captive breeding, (ii) a high degree of juvenile mortality in captivity and in the wild, and (iii) a high frequency of spermatozoal abnormalities in ejaculates. The species vulnerability of the cheetah was demonstrated by an epizootic of coronavirus-associated feline infectious peritonitis in an Oregon breeding colony in 1983. Exposure and spread of the coronavirus, which has a very low morbidity in domestic cats (approximately 1 percent), has decimated a heretofore productive and healthy captive population. The extreme genetic monomorphism, especially at the major histocompatibility complex, and the apparent hypersensitivity of the cheetah to a viral pathogen may be related, and provide a biological basis for understanding the adaptive significance of abundant genetic variation in outbred mammalian species.

Lariat structures are in vivo intermediates in yeast pre-mRNA splicing

Transcripts from an ADC1-actin gene fusion containing the yeast actin intron are efficiently spliced in vivo. Four distinct forms of the excised actin intron are found in poly(A)- RNA from yeast carrying this transcription unit on a multicopy plasmid. Two of them migrate abnormally slowly in polyacrylamide gels, and one of these contains a block to reverse transcription at the conserved UACUAAC sequence (TACTAAC box). We also detect a larger RNA in the poly(A)+ fraction with abnormal gel mobility and the same reverse transcriptase block. Analysis of the major species of excised actin intron, labeled with 32P in vivo, reveals the presence of a branch at the third A in the UACUAAC sequence. This A is linked via a 3'-5' phosphodiester bond to the downstream C, and via a 2'-5' phosphodiester bond to a G, presumably from the 5' end of the intron. Thus this intron RNA is in the form of a lariat.

Teratomas of the head and neck in childhood

Teratomas are tumors consisting of tissue arising from all three embryonic germ layers. Their occurrence in the head and neck region is rare. Three patients with this lesion are presented. Although exhibiting progressive uncoordinated growth, histologic evidence of malignancy in the head and neck form of this tumor is distinctly uncommon. Mortality associated with teratomas is most often secondary to respiratory compromise. Complete surgical extirpation is the treatment of choice to lower mortality and recurrences. The use of fine needle aspiration in the management of neck masses in children is discussed.

High Pressure Liquid Chromatographic Determination of Oxazepam Dosage Forms: Collaborative Study

A reverse phase high pressure liquid chromatographic method for the determination of oxazepam in tablets and capsules was collaboratively studied by 9 laboratories. Collaborators were supplied with 6 samples that included synthetic and commercial formulations. Tablet and capsule composites are diluted with methanol and filtered. Oxazepam is determined at 254 nm by using a C18 column. Mean recoveries of oxazepam from synthetic tablet and capsule formulations were 97.2 and 99.0%, respectively. Mean coefficients of variation for tablets and capsules ranged from 1.85 to 2.86%. The method has been adopted official first action.

Smoking reduction: a comparison of the effectiveness of rapid smoking and increasing delay training

The relative effectiveness of two treatment procedures in facilitating self-control of smoking behavior was compared. One week before treatment, subjects self-monitored number of cigarettes smoked. On the days of treatment, subjects were given pre- and postsession self-control tests; subjects were given a lit cigarette and were asked to withstand the temptation of taking a puff during an imposed delay period. After five days of two-hour sessions in which subjects' smoking was paced with either increasing delays or rapid smoking, subjects again were asked to self-monitor their smoking for one week. Increasing delay induced better self-control scores than did rapid smoking. Both groups were not significantly different in number of cigarettes smoked.

Smoking reduction: a comparison of the effectiveness of rapid smoking and increasing delay training

The relative effectiveness of two treatment procedures in facilitating self-control of smoking behavior was compared. One week before treatment, subjects self-monitored number of cigarettes smoked. On the days of treatment, subjects were given pre- and postsession self-control tests; subjects were given a lit cigarette and were asked to withstand the temptation of taking a puff during an imposed delay period. After five days of two-hour sessions in which subjects' smoking was paced wtih either increasing delays or rapid smoking, subjects again were asked to self-monitor their smoking for one week. Increasing delay induced better self-control scores than did rapid smoking. Both groups were not significantly different in number of cigarettes smoked.

Conventional oral cholecystography versus single-visit oral cholecystography

The conventional manner of preparing ambulatory patients for oral cholecystography with six tablets of iopanoic acid yields results which are essentially equal to those obtained by single-visit oral cholecystography (two-day preparation with 12 tablets of iopanoic acid). Also, it is more convenient for patients and referring physicians. The conventional method of preparation is recommended for hospitalized patients as well.

Alexithymic characteristics in patients with inflammatory bowel disease

Twenty patients with inflammatory bowel disease and twenty psychoneurotic patients were studied to assess differences in psychopathology, verbal expression and fantasy formation. The method combined clinical observation, self-assessment questionnaires and quantified projective tests. The psychoneurotic patients showed a higher level of psychopathology, were more verbally expressive, more able to verbalize emotion, and better able to modulate their emotions. Differences in fantasy formation were found. The results provide partial support for the concept of alexithymia (pensée opératoire), a cluster of cognitive traits which have been reported in many psychosomatic patients.

Glucoregulation and simulated diving in the harbor seal Phoca vitulina

Plasma glucose, glucagon, and insulin concentrations were measured in the harbor seal, Phoca vitulina, during a 6-min dive and a 30-min recovery period. Studies were performed in the fasting state and following intravenous glucose. During diving in the fasting state, values of plasma glucose, glucagon, and insulin are not significantly different from prediving values, presumably because of the loss of perfusion to the pancreas. In the postdiving period, plasma glucagon increases significantly. The increased glucagon levels reach a peak at 6 min into the postdiving period. By 4 min postdiving, plasma glucose values increase. The hyperglycemia appears to be at least partially related to hyperglucagonemia. Despite hyperglycemia, insulin levels do not change significantly. The net effect is to increase glucose availability, particularly for non-insulin-requiring tissues (brain). Preadministration of glucose eliminates the postdiving increase in glucagon. Plasma glucose and insulin concentrations also show no significant changes during the diving and postdiving periods. These results suggest that hormonally mediated glucose conservation serves to maintain brain glucose supplies and to restore peripheral carbohydrate stores during the postdiving period.

Cervical spine disease and dysphagia. Four new cases and a review of the literature

Four cases of dysphagia associated with disease of the cervical spine have been presented. One of the patients had cervical spondylosis with osteophyte formation while the other three had Forestier's disease or ankylosing hyperostosis. Symptoms of dysphagia dominated the clinical picture and led to their referral for further management. Two patients underwent surgical procedures and one died in the postoperative period. Two patients were managed conservatively, one with antibiotics, and both did reasonably well. The literature of 40 cases published in the last 54 years has been reviewed. We suggest that dysphagia due to cervical spine disease while an uncommon complication of these bony growths, is by no means rare. The dysphagia may be due to bony protuberances into the hypopharynx or into the esophagus and may be accompanied by soft tissue inflammation. Although most patients have been treated surgically, there may be a role for anti-inflammatory or antibiotic therapy in the first instance as surgery is often morbid and sometimes fatal.

Pressure-infusion venography

A new, simple pressurizing technique using air injection into an infusion bottle, makes rapid intravenous infusion of radiopaque contrast medium possible. This method permits the use of 30% solutions in a large volume to obtain excellent venograms while eliminating the complications of pain and thrombophlebitis which often occur with more concentrated solutions.