Analysis of the degree of pulmonary thallium washout after exercise in patients with coronary artery disease

An abnormal increase in pulmonary thallium activity may be visualized on post-stress thallium images in patients with coronary artery disease. Because this increased pulmonary thallium activity usually disappears by the time of redistribution imaging, this study was designed to assess whether measurement of the degree of pulmonary thallium washout between stress and redistribution might improve the detection of increased pulmonary thallium activity in patients with coronary artery disease. Quantitative analysis revealed abnormal (that is, greater than 2 standard deviations of normal values) pulmonary thallium washouts in 59 (64%) of 92 patients with coronary artery disease, but in only 2 (25%) of 8 subjects with angiographically normal arteries (p less than 0.06). By comparison, the visual analysis of pulmonary thallium washout and use of initial pulmonary to myocardial thallium ratio were significantly (p less than 0.05) less sensitive in detecting abnormality in patients with coronary artery disease. Abnormal pulmonary thallium washout was related to both the anatomic extent and functional severity of disease: it occurred with greatest frequency in patients with multivessel disease and in those with exercise-induced left ventricular dysfunction (p less than 0.005). When added to the quantitative analysis of myocardial scintigraphy, the analysis of pulmonary thallium washout increased the detection of coronary artery disease from 84 to 93% (p less than 0.05), but the sample size was too small to assess specificity. Thus, the analysis of pulmonary thallium washout is a useful diagnostic variable because it: 1) provides an objective measurement of abnormal pulmonary thallium activity and is more sensitive than other methods; 2) correlates with both the extent of coronary artery disease and the degree of exercise-induced left ventricular dysfunction, and 3) improves the sensitivity of quantitative myocardial thallium scintigraphy to detect the presence of coronary artery disease.

Clinical evaluation of seven-pinhole tomography for the detection and localization of coronary artery disease: comparison with planar imaging using quantitative analysis of myocardial thallium-201 distribution and washout after exercise

The development of quantitative techniques to assist in the analysis of planar thallium-201 stress-redistribution scintigrams has led to improved abilities of this modality to detect the presence of and to localize significant coronary artery disease (CAD). This fact has encouraged the reevaluation of its capabilities relative to other types of scintigraphic data collection, including seven-pinhole tomography. We have undertaken a comparison of planar scintigraphy and seven-pinhole tomography to detect in 40 exercised patients (23 with angiographically demonstrated CAD, eight with normal coronary angiograms, and nine with less than or equal to 1% likelihood of having CAD) the presence of significant CAD and to localize it correctly to an individual coronary artery. Emphasis was placed on similar imaging conditions and on analysis of images by the same quantitative program of TI-201 distribution and washout. Both techniques were found to be highly sensitive and specific for disease detection and localization. Importantly, seven-pinhole tomography did not significantly improve results.

Determination of cardiac output and ejection fraction with the dual cardiac probe

Cardiac output and left ventricular ejection fraction were determined noninvasively at the bedside in 26 patients by using a dual scintillation probe. The probe is a nonimaging detector that records a high frequency time-activity curve of the passage of an intravenously injected radioactive bolus through the heart. Results were correlated with ejection fraction measured by biplane cineangiography (r = 0.80) and cardiac output determined by green dye dilution (R = 0.86). It is concluded that the dual probe provides an accurate noninvasive means of measuring these parameters, and that it may be particularly applicable to serial measurements in patients in the intensive care unit.

Cascade control of Escherichia coli glutamine synthetase. Purification and properties of PII uridylyltransferase and uridylyl-removing enzyme

Uridylyltransferase, a component of the covalent modification cascade system that controls glutamine synthetase activity in Escherichia coli, has been purified to apparent homogeneity. The purification was facilitated by the use of an E. coli strain which carries multiple copies of a ColE1-hybrid plasmid containing the glnD gene that encodes uridylyltransferase and which overproduces its synthesis by 25-fold. Gel electrophoresis and high pressure liquid chromatography studies show that the native enzyme is a single polypeptide chain of Mr = 95,000 +/- 5,000. The purified enzyme catalyzes the uridylylation as well as the deuridylylation of the regulatory protein PII, demonstrating that a single bifunctional enzyme is involved in the covalent interconversion of PII. Gel filtration studies indicate that the enzyme undergoes slow irreversible aggregation during most steps of purification with a concomitant loss of activity.

Mechanism of phage-induced lysis in pneumococci

Earlier studies have suggested the possible role of host autolytic enzyme in the release of progeny phage from Dp-1 infected pneumococci. Several new experiments described here reinforce this notion. Specifically, the resistance of an autolysis-defective mutant to infection at low phage to cell ratios could be eliminated by prior 'coating' of the host bacteria with pneumococcal autolysin isolated from wild-type cells. Similar, productive infection was also possible by lowering the temperature of incubation to 30 degrees C, a condition that leads to a partial activation of the thermosensitive residual autolysin in the mutant cells. Other experiments, however, clearly indicate the role of the newly discovered phage-associated lysin (PAL), reported in the accompanying communication, in bacteriophage release and culture lysis; specifically, lysis was stimulated by reducing agents and inhibited by cardiolipin. It seems that both the host-related and the PAL activities are involved with Dp-1 induced lysis of pneumococci.

A phage-associated murein hydrolase in Streptococcus pneumoniae infected with bacteriophage Dp-1

A phage-associated murein hydrolase activity capable of degrading pneumococcal cell walls was isolated and purified to homogeneity from the phage-induced lysate of an autolysis-defective pneumococcal mutant infected with the bacteriophage Dp-1. Some properties of the enzyme resembled those of the wild-type (host) pneumococcal murein hydrolase: cell walls prepared from ethanolamine-grown pneumococci were resistant to the enzyme; the activity was inhibited by the Forssman antigen and was sensitive to proteolytic enzymes. The phage-associated enzyme was not inhibited by antiserum prepared against the purified pneumococcal murein hydrolase; the activity was stimulated by reducing agents and was partially inhibited by cardiolipin. The subunit molecular weight of the phage-associated enzyme was somewhat smaller (31 000) than that of the pneumococcal hydrolase (35 000). This appears to be the first description of a phage-associated murein hydrolase activity in pneumococci.

D-homoandrostanes. 4. The incubation of some D-homo-5 alpha-androstanes with Rhizopus nigricans

Nine dioxygenated D-homoandrostanes were incubated with Rhizopus nigricans to investigate the effect of D-ring modification on microbiological hydroxylation. Structure determination of the products by NMR spectroscopy, and in certain cases independent synthesis of their oxidised products, showed that in contrast to 5 alpha-androstanes the majority of the compounds were hydroxylated in the "reverse" mode, and only D-homo-5 alpha-androstane-3,17-dione was hydroxylated in the "normal" mode to any extent. Stereospecific ring D-hydroxylation at C(17 alpha) was observed for both D-homo-5 alpha-androstane-3,6- and 3,7-diones.

The noninvasive diagnosis of coronary artery disease in patients with left bundle-branch block

The prognosis in patients with left bundle-branch block (LBBB) is related primarily to the presence or absence of underlying cardiac disease. Because coronary artery disease (CAD) is the most common underlying disease found in these patients, it would be desirable, in the presence of LBBB, to have a noninvasive method of differentiating between patients with and without CAD. We reviewed our experience in patients with LBBB who had undergone coronary arteriography with regard to electrocardiographic (ECG) stress testing, exercise radionuclide ventriculography (RNV), and exercise thallium scintigraphy; we also reviewed their clinical histories. A clinical history of typical angina pectoris was specific for CAD, a false-positive history being present in only one of 12 patients without CAD. The frequency of a positive ECG ST response to exercise was equal in patients with and without CAD. False-positive ejection fraction and wall-motion responses to exercise were frequent by RNV. A modification of the usual RNV criteria for positivity improved specificity but resulted in poor sensitivity for CAD. False-positive thallium study results also were. frequent in these patients. The perfusion defects usually involved the ventricular septum; the inferior and posterior walls were involved only in patients with CAD. We conclude that the usual noninvasive diagnostic tests for CAD are of limited value in patients with LBBB.

Noninvasive assessment of the Ionescu-Shiley pericardial xenograft in the mitral position: preliminary experience

To establish noninvasive criteria for assessment of the Ionescu-Shiley pericardial xenograft in the mitral position, 29 patients with a normally functioning bioprosthesis were studied with m-mode echocardiography and phonocardiography. Two-dimensional echocardiograms were also obtained in ten of the patients. Although two-dimensional echocardiography provided simultaneous visualization of a greater number of stents and leaflets than the m-mode technique, the superior resolution of m-mode ultrasound permitted more detailed analyses of the xenograft's motion patterns. The anterior leaflet, recorded in all patients, had an average excursion of 1.2 +/- 0.22 cm. Leaflet thickness measured 4 mm or less. Coarse diastolic vibration of the anterior leaflet was recorded in two patients in the absence of both aortic insufficiency and prosthesis dysfunction. Ultrasonic estimates of prosthesis height and orifice diameter did not correlate with micrometer measurements, possibly due to the limited resolution of pulsed ultrasound in the presence of a highly reflective substance. Opening and closing of the pericardial leaflets were associated with the production of high frequency vibrations on the phonocardiogram. The potential usefulness and limitations of echocardiography for evaluating the function of bioprosthetic valves are discussed.

Choline-containing bacteriophage receptors in Streptococcus pneumoniae

Choline-containing teichoic acid seems to be essential for the adsorption of bacteriophage Dp-1 to pneumococci. This conclusion is based on the following observations: In contrast to pneumococci grown in choline-containing medium, cells grown in medium containing ethanolamine or other submethylated aminoalcohols instead of choline were found to be resistant to infection by Dp-1. Live choline-grown bacteria and heat- or UV-inactivated cells and purified cell walls prepared from these cells were capable of adsorbing phage Dp-1; ethanolamine-grown pneumococci or cell wall preparations were unable to do so. Adsorption of Dp-1 to choline-containing cell walls was competitively inhibited by phosphorylcholine and by several choline-containing soluble cell surface components, such as the Forssman antigen and the teichoic acid-glycan complexes formed by autolytic cell wall degradation. Cell walls prepared from pneumococci grown in ethanolamine or phosphorylethanolamine were inactive. Electron microscopic studies with pneumococci that had segments of choline-containing cell wall material amid ethanolamine-containing regions indicated that the Dp-1 phage particles adsorbed exclusively to the choline-containing surface areas. We suggest that the choline residues of the pneumococcal teichoic acid are essential components of the Dp-1 phage receptors in this bacterium.

Post-exercise potentiation of wall motion to identify myocardial viability

Resting left ventricular wall motion abnormalities may represent myocardial scars or areas of viable muscle which are ischemic and may thus benefit from revascularization surgery. Improvement in wall motion in the 3-6 minute post-exercise recovery period as compared to the resting state was investigated as a possible criterion to predict myocardial viability in 168 patients with coronary artery disease. Of 125 patients with abnormal resting wall motion, 14 of 14 who improved regional function post-exercise also improved following coronary bypass surgery. However, wall motion improved postoperatively in an additional 55 patients who had not demonstrated post-exercise improvement. An increase in ejection fraction post-exercise occurred in patients with coronary disease as well as an additional group of 24 normal subjects. Thus in the post-exercise period, improvement in resting wall motion is a highly specific but insensitive predictor of myocardial viability.

Initial diastolic indentation of the mitral valve in aortic insufficiency

An abnormal diastolic indentation of the mitral valve has been noted on short-axis two-dimensional echocardiograms in patients with aortic insufficiency. In order to assess the clinical usefulness of this finding, we reviewed the echocardiograms of 18 patients with this lesion who had undergone cineaortography. Results were compared with those of a control group of 100 patients. Initial diastolic indentation of the anterior mitral leaflet occurred in 8 of 12 patients with 3+ to 4+ aortic insufficiency. None of the patients with lesser regurgitation and no patients from the control group demonstrated this pattern. The presence of this abnormality appears to be a specific indicator of critical aortic insufficiency.

Premature closure of prosthetic mitral valves as a consequence of gravity

To determine the influence of gravity on premature closure of prosthetic mitral valves, we studied 17 patients in whom this phenomenon had been observed during routine examination. All patients were in atrial fibrillation and none had aortic incompetence. Patients were studied in multiple positions by means of simultaneous echocardiography, phonocardiography, and cinefluoroscopy. In all patients premature closure was observed when the atrial side of the prosthesis was below the ventricular side, resulting in a downward motion of the occluder inside the valve cage. When patients were studied in positions in which the atrial side of the valve was higher that the ventricular side, premature closure never occurred, even during extremely prolonged diastolic periods. Since minor positional changes, which were found to determine whether premature closure occurred or not, are unlikely to produce significant alterations in pressure and flow across the mitral orifice during diastole, we conclude that position-dependent premature closure of prosthetic mitral valves in patients with atrial fibrillation is best explained by the effect of gravity on the prosthetic occluder. Examination of such patients in multiple positions should be helpful in distinguishing premature valve closure caused by aortic regurgitation from gravity-related presystolic closure. Inability to produce premature closure in patients in whom it had previously been demonstrated in the presence of similar R-R intervals may even prove useful in diagnosing new orifice obstruction.

Skin window immune response to normal human IgG in patients with rheumatoid arthritis and acute poststreptococcal glomerulonephritis

The skin window technic was utilized to determine the reactivity of patients with rheumatoid arthritis (RA) and acute poststreptococcal glomerulonephritis (APSGN) to human IgG (H-IgG). The response to H-IgG was compared in nine patients with RA, 20 patients with APSGN, and 10 normal individuals. All subjects were tested concomitantly with the saline solution used as solvent for H-IgG. The normal controls and five patients were challenged, in addition, with diphtheria-tetanus-pertussis antigen (DPT) to which they had previous prophylactic exposure. The following results were obtained: 1) Four patients with RA and nine patients with APSGN responded with increased lymphocyte migration (more than 2 SD above the normal mean level) at nine and 12 hours. 2) The mean estimated immunogenic lymphocytosis (calculated subtracting the lymphocyte counts of the saline skin windows) of both patient groups was significantly higher than that of controls at the same time intervals. 3) The response of normal individuals and patients to DPT was comparable in time of appearance and intensity to the response of patients to H-IgG. Our studies that patients with RA and APSGN respond to H-IgG in a manner comparable to that observed with a known antigenic stimulus and support a clinical role for antiglobulin reactivity.

Real time computerization of two-dimensional echocardiography

A computerized system was developed for real time acquisition, enhanced processing, analysis, and display of cross-sectional images of the left ventricle derived by two-dimensional echocardiography (2DE). The new methodology couples a standard medical imaging computer system to the video output of any current 2DE unit, uses a 128 x 128 or 64 x 64 matrix window and stores the real time 30 frames/sec digitized images on a magnetic disk. Computerized beat-to-beat and frame-by-frame processing employs space-time smoothing the automatic detection of endocardial interfaces by standard threshold and second derivative techniques. Multiple views are displayed in real time with 256 levels of gray and color. The methodology was used to analyze and graphically display frame-by-frame changes throughout the cardiac cycle. In addition, regional wall motion and thickness were analyzed in 12 sectors of individual cross-sections using a standardized angular subdivision originating at the center of area and indexed by an external reference point. An algorithm was developed to correct cross-sectional interference definition from the commonly used trailing-to-leading edge to the more valid leading-to-leading outline technique. Computerized analysis of spatial and temporal variations of cardiac contraction were demonstrated in several clinical and experimental applications, including bicycle exercise testing, investigation of acute myocardial infarction, and assessment of interventions. Initial evaluation indicates that the new real time computerized digital acquisition and data analysis represents a major advances toward quantitation of left ventricular function using 2DE.

Space/time quantitation of thallium-201 myocardial scintigraphy

A comprehensive method is described for quantitation of the spatial distribution of TI-201 in the myocardium and its changes with time. The method, applied here to 51 patients, uses bilinear interpolative background subtraction to compensate for tissue crosstalk, and circumferential profiles to quantitate the relative radionuclide activity in the myocardium as an angular function with origin at the center of the left-ventricular cavity. In addition, washout circumferential profiles are calculated as percent washout from the stress circumferential profiles. Abnormal thallium distribution or washout is identified by automatic computer comparison of each patient's profiles with the corresponding limits of normal profiles, determined from the pooled profiles of 31 normal patients. In these 31, the computer output was normal in all cases. In 20 patients with angiographically documented coronary artery disease, 19 were determined to be abnormal by this method. This new computerized treatment provides accurate objective assessment of the presence of coronary artery disease.

Bacteriophages of Streptococcus pneumoniae

Properties of some of the bacteriophages of Streptococcus pneumoniae are reviewed. Studies with these phages have yielded several interesting observations and results. (1) A simple transfection system that uses DNA of mature pneumococcal phages was developed; results of studies utilizing this system have determined the intracellular events that followed infection with these bacteriophages. (2) Some pneumococcal phages have shown dependence on the bacterial (host) murein hydrolase for the liberation of phage progeny. (3) Phage Dp-1 has been described as the first lipid-containing phage with a gram-positive bacterial host. (4) Phage Cp-1, a recently isolated phage of unique morphology, promises to become a useful phage for studies of the genetic of the pneumococcus.

Respiratory variation in Frank vectorcardiography and echocardiography in children

Forty pediatric patients underwent echocardiographic and Frank vectorcardiographic studies during normal respiration. The right ventricular minor axis (RVEDD) increased significantly with inspiration (p less than 0.005), while the left ventricular minor axis did not significantly change. The distance from the anterior chest wall to the center of the left ventricle did significantly increase with inspiration (p less than 0.005). Some vectorcardiographic parameters changed with inspiration, also. Both the maximal spatial vector to the left (MSVL) and the X to the left (X-L) significantly decreased with inspiration. Although the average magnitude of these changes was small (10-15%), there was wide variation. Five of twenty-one patients with left ventricular hypertrophy during expiration had a clearly normal Frank VCG during inspiration. It is suggested that phases of respiration should be monitored when evaluating the Frank VCG in pediatric patients.

Is postextrasystolic potentiation dependent on Starling's law? Biplane angiographic studies in normal subjects

The cineangiograms of 26 normal subjects were analyzed to study the effect of Starling's mechanism on postextrasystolic potentiation. The end-diastolic volumes (single plane and biplane) of the left ventricle were similar in the regular sinus beat before an extrasystole and sequential sinus beats after an extrasystole. However, the ejection fraction, mean normalized systolic ejection rate, mean velocity of fiber shortening and long-axis shortening were consistently larger in the first sinus beat after an extrasystole. We conclude that postextrasystolic potentiation is independent of left ventricular end-diastolic volume in normal human hearts and the compensatory pause after an extrasystole does not result in increased end-diastolic volume.

Uhl's anomaly associated with pulmonary atresia

We present a case of Uhl's anomaly associated with atresia of the pulmonary valve. The rarity of this association is noteworthy, only three cases having previously been published. Our case presents the peculiarity of a patient with a normal tricuspid valve.

Prolonging life with coronary bypass surgery in patients with three-vessel disease

In this study we examined survival after coronary bypass surgery in patients with three-vessel disease. First, survival data were analyzed from selected of patients who had a poor prognosis without surgery; second, data were analyzed in subsets classified by severity of disease. The data strongly suggest that patients with three-vessel disease, especially patient with a poor medical prognosis, benefit from coronary bypass surgery.

Mammary carcinoma--multidisciplinary treatment with bilateral mastectomy and immediate reconstruction

The classical concepts pertaining to the natural history of mammary carcinoma and its treatment must be reviewed if survival rate is to be improved. By the time diagnosis is established, a fair amount of cases of carcinoma of the breast present distant, clinically undetectable micrometastases, which will not be affected by local therapy (surgery or radiation). Increasing evidence shows that mammary carcinoma nowadays must be looked upon as a diffuse disease affecting both breasts. Postoperative radiation does not improve the 5- and 10-year survival rates and has a negative effect upon the immunological defense of the patient. Immunology plays an important role in the evolution and cure of the patient with carcinoma of the breast. The mutilation produced by radical or ultraradical mastectomy may throw the patient into mental depression which, as a consequence, may decrease the immunological competence of the patient. Multiple drug chemotherapy, started at the time of surgery and continued for several months thereafter, may kill micrometastases. Preventive immunotherapy seems to be beneficial to the patient in attempting control of metastases.

Interactions of homologous and heterologous deoxyribonucleic acids and competent Bacillus subtilis cells

Glucosylated and nonglucosylated bacteriophage T4 deoxyribonucleic acids (DNAs) are able to bind to competent cells of Bacillus subtilis, although the former does so in a rather unstable fashion, probably because of the glucosylation. Several heterologous DNAs compete with homologous DNA for the same receptors in binding and in transformation. A different pattern in competition for DNA binding was observed for homologous and T4 glucosylated DNAs in intact cells as compared with protoplasts or membrane vesicles. The results are consistent with the existence of two types of receptor sites on the membrane of competent B. subtilis cells.

Nitrogen control in Salmonella: regulation by the glnR and glnF gene products

The product of the glnR gene is required for nitrogen regulation of the synthesis of glutamine synthesis (Gln synthetase) [L-glutamate:ammonia ligase (ADP-forming), EC 6.3.1.2] and two periplasmic transport proteins that are subject to nitrogen control in Salmonella. Strains with mutations to loss of function of the glnR product [e.g., a strain with a Tn10 insertion or one with an ICR-induced (frameshift) mutation in glnR] have about 3% as much Gln synthetase as a fully derepressed wild-type strain and are unable to increase synthesis of this enzyme or periplasmic transport proteins in response to nitrogen limitation. The structural gene for Gln synthetase, glnA, and those for the periplasmic transport proteins are unlinked on the chromosome; thus, glnR appears to encode a diffusible positive regulatory element. Consistent with this, the mutant glnR allele is recessive to the wild-type allele with regard to expression of glnA (synthesis of Gln synthetase). Although glnR is closely linked to glnA, strains with mutations to complete loss of function of the glnR product can be distinguished from glnA strains by their ability to produce detectable Gln synthetase and to grow in the absence of glutamine. To demonstrate unequivocally that glnR is distinct from glnA, we have purified and characterized Gln synthetase from a strain with a Tn10 insertion in glnR. Because the properties of Gln synthetase from the insertion mutant, most importantly the carboxyl-terminal sequence of amino acids, are the same as those of synthetase from wild type, the Tn10 insertion cannot be in glnA (if it were, the carboxyl terminus of Gln synthetase would have to be altered); therefore we conclude that the Tn10 insertion is in a regulatory gene, glnR, which is distinct from glnA. A model for the function of the glnR product together with the previously defined glnF product in mediating nitrogen control is discussed.

Effect of a physical conditioning program upon left ventricular ejection fractions determined serially by a noninvasive technique

6 clinically normal subjects underwent a 3-month physical conditioning program with the ejection fractions determined before and after physical conditioning using a scintillation probe. All subjects achieved a conditioning effect as evidenced by increased treadmill test duration after conditioning (mean duration before conditioning: 658 vs. 715 sec after conditioning; p less than 0.02). All 6 subjects increased resting ejection fractions after conditioning (mean ejection fraction before conditioning: 54.5 +/- 5.4%; mean ejection fraction after conditioning: 67.0 +/- 9.0%; p less than 0.01). Thus, an aerobic physical conditioning program appears to increase resting ejection fractions in normal subjects.

Associative transfer and stimulus selection in classical conditioning of the rabbit's nictitating membrane response to serial compound CSs

Four experiments were conducted to determine whether in conditioning to a serial compound, CS1-CS2-UCS, there are (a) associative mechanisms operating to extend conditioning beyond the bounds of a CS-UCS contiguity gradient and (b) stimulus selection processes acting to attenuate the potency of CS-UCS contiguity. In Experiments 1 and 2, the CS2-UCS interval was held at .35 sec while the CS1-UCS interval was varied across groups from .75 to 2.75 sec. CS1 test trials revealed substantial CR acquisition at all CS1-UCS intervals. Moreover, Experiment 2 indicated that when the contribution of cross-modal generalization from CS2 to CS1 was factored out, there still remained a substantial level of conditioning, which Experiment 3 indicated was attributable to an associative mechanism like higher-order or sensory conditioning. The observation of CR acquisition at CS1-UCS intervals of 4.75, 8.75, and 18.75 sec in Experiment 4 suggested that serial compound training yields conditioning to CSs located well beyond the single CS contiguity gradient for the rabbit's nictitating membrane response. Experiments 1 and 2 also indicated the presence of stimulus selection processes because, at the shorter CS1-UCS intervals (.75 and 1.25 sec), the levels of test-trial responding to CS2 fell below those observed to the less contiguous CS1.

Associative transfer and stimulus selection in classical conditioning of the rabbit's nictitating membrane response to serial compound CSs

Four experiments were conducted to determine whether in conditioning to a serial compound, CS1-CS2-UCS, there are (a) associative mechanisms operating to extend conditioning beyond the bounds of a CS-UCS contiguity gradient and (b) stimulus selection processes acting to attenuate the potency of CS-UCS contiguity. In Experiments 1 and 2, the CS2-UCS interval was held at .35 sec while the CS1-UCS interval was varied across groups from .75 to 2.75 sec. CS1 test trials revealed substantial CR acquisition at all CS1-UCS intervals. Moreover, Experiment 2 indicated that when the contribution of cross-modal generalization from CS2 to CS1 was factored out, there still remained a substantial level of conditioning, which Experiment 3 indicated was attributable to an associative mechanism like higher-order or sensory conditioning. The observation of CR acquisition at CS1-UCS intervals of 4.75, 8.75, and 18.75 sec in Experiment 4 suggested that serial compound training yields conditioning to CSs located well beyond the single CS contiguity gradient for the rabbit's nictitating membrane response. Experiments 1 and 2 also indicated the presence of stimulus selection processes because, at the shorter CS1-UCS intervals (.75 and 1.25 sec), the levels of test-trial responding to CS2 fell below those observed to the less contiguous CS1.

Early stages in Bacillus subtilis transformation: association between homologous DNA and surface structures

The addition of ethylenediaminetetraacetate to competent cultures of Bacillus subtilis irreversibly inhibited the transformability as well as the cellular binding of DNA. Our results show that the inhibition of DNA binding by ethylenediaminetetraacetate in whole cells, protoplasts, and membrane vesicles is mainly due to a permanent alteration of the DNA receptors. Transformation absolutely requires free magnesium ions, whereas DNA binding is a magnesium-independent step. In contrast to ethylenediaminetetraacetate, the absence of Mg2+ does not irreversibly affect the capacity of the competent cells to be transformed DNA-binding receptors located at the cell surface remain associated with the plasma membrane after protoplasting and after isolation of membrane vesicles. A Mg2+-dependent endonucleolytic activity associated with the membrane appears to be responsible for the lower levels of binding by protoplasts in the presence of this ion.

Late deterioration in tetralogy of Fallot: unusual findings and successful correction

A patient with tetralogy of Fallot who underwent a successful Blalock shunt procedure as a child was evaluated 28 years later because of clinical deterioration. Results of cardiac catheterization and angiography disclosed, in addition to a functioning shunt, evidence of an infundibular, subvalvular tumor and a large anastomosis between the left circumflex coronary artery and the bronchial arteries of the right lung with the possibility of "coronary steal". At operation, the Blalock and coronary-to-bronchial artery anastomoses were ligated; and total correction was performed including resection of the pulmonary valve and infundibulum, excision of the tumor, closure of the ventricular septal defect, and application of an outflow patch to enlarge the pulmonary annulus. The patient was discharged nine days after surgical correction.

Is the treadmill exercise test useful for evaluating coronary artery disease in patients with complete left bundle branch block?

To aid in the study of coronary artery disease, 57 patients with complete left bundle branch block underwent clinical evaluation, treadmill exercise testing and cardiac catheterization. The patients were classified into two groups according to coronary angiographic findings: 30 patients with significant stenosis (70 percent or greater luminal narrowing) of at least one major vessel and 27 with no significant coronary artery disease. There was no difference in age, presenting symptoms or previous medical treatment between the two groups. There were more men in the group with coronary artery disease. Exercise-induced S-T changes were similar in the two groups; the sensitivity and specificity of these changes for the diagnosis of coronary artery disease were unacceptable irrespective of the criterion chosen. With additional S-T depression of either 1 or 2 mm below the baseline value, the predictive accuracy was only 53 percent. Combined exertional chest pain and 1 mm S-T depression increased the predictive accuracy of exercise testing to 71 percent. These data indicate that exercise-induced electrocardiographic changes do not facilitate detection of coronary artery disease in patients with complete left bundle branch block.

Ultrasonic evaluation of thrombosis of Björk-Shiley aortic valve prosthesis

Recognition of thrombosis of a Björk-Shiley aortic valve prosthesis 4 years after insertion in a patient was based upon sudden clinical deterioration, loss of prosthetic sounds, and development of new stenotic and regurgitant murmurs. Thrombotic fixation was confirmed by diagnostic alterations on the echocardiogram. All manifestations reverted to normal after successful surgical debridement of the prosthesis. Echocardiography is a valuable noninvasive adjunct in the differential diagnosis of prosthetic valve malfunction.

The product of a newly identified gene, gInF, is required for synthesis of glutamine synthetase in Salmonella

The product of a newly identified gene, glnF, which is distinct from the glutamine synthetase structural gene (glnA), is required for synthesis of glutamine synthetase [L-glutamate:ammonia ligase (ADP-forming), EC 6.3.1.2[ in Salmonella typhimurium and probably in Escherichia coli. Salmonella strains with ICR (2-chloro-6-methoxy-9-[3-(2-chloroethyl)aminopropylamino]acridine dihyodrochloride)-induced (frameshift) mutations in glnF are glutamine auxotrophs; they have less than 10% oof wild-type glutamine synthetase activity or antigen and are unable to derepress the synthesis of the enzyme. The mutant allele is recessive to the wild-type allele, indicating that the glnF gene encodes a diffusible product. Mutant glnF strains have normal activities of all proteins involved in covalent modification of glutamine synthetase: adenylyltransferase (EC 2.7.7.42), PII, uridylyltransferase, and uridylyl removing enzyme. In addition, they have glutamate synthase (EC 1.4.1.13) and glutamate dehydrogenase (EC 1.4.1.4) activities. Thus, glnF does not encode the structure of any of these proteins. The above evidence suggests that the product of the glnF gene is (or produces) a positive regulatory factor that is required for synthesis of glutamine synthetase; it indicates that auto-regulation cannot account for control of the synthesis of glutamine synthetase in Salmonella.

Growth of coliphage BF23 on rough strains of Salmonella typhimurium: the bfe locus

Coliphage BF23 develops in Salmonella typhimurium rough strains. The phage is neither restricted nor modified by S. typhimurium. The growth patterns of the phage were slightly different in S. typhimurium than in Escherichia coli, although phage propagated on S. typhimurium is identical to the phage propagated in E. coli by several criteria used. Mutants of S. typhimurium resistant to BF23 were isolated and found to map (by P22- and Pl-mediated transduction) in the same position as bfe mutants of E. coli. The order of genes was: metB - argC - bfe - rif - purD - metA. Phage BF23 does not form plaques on smooth S. typhimurium strains, since the phage fails to adsorb irreversibly to smooth cells. Nevertheless, on solid agar, the phage prevents growth of many (but not all) smooth strains. Moreover, UV- and alkali-inactivated phage BF23, although unable to form plaques on sensitive hosts, retains the ability to prevent growth of the host on solid medium. This ability is sensitive to protease and resistant to DNAse and RNase. Heat treatment of the phage causes rapid loss of the cell-growth-preventing-ability whereas the ability to form plaques is lost much more slowly. These results lead to a proposal that phage BF23 virions carry a colicin-like factor that kills sensitive cells.

Influence of several nucleotides on the competence development of Bacillus subtilis

The influence of adenosine-3',5'-cyclic monophosphate (cAMP) and other nucleotides on the competence development of Bacillus subtilis was studied. The stimulation of competence which can be achieved by exposing physiologically low-competent cells to supernatants from highly competent cultures can be inhibited with different cAMP doses. When the same cells were suspended in a minimal medium with cAMP, varying degrees of stimulatin- of competence were observed depending on the time of addition of the drug. This effect is not specific for cAMP. It appears to be correlated to an increase of the amount of DNA bound to the competent cells. cAMP activities were antagonized by equimolar doses of adenosine-triphosphate (ATP) and guanosine-triphosphate (GTP).

Surgical repair of atrial septal defect in patients over 60 years of age. Long-term results

In order to evaluate results of surgical repair of secundum atrial septal defect (ASD) in patients 60 years of age or older, a review was made of 16 patients who had undergone such operation between January 1964 and December 1974. Before operation eight patients were in functional classification III (New York Heart Association), seven were in class II, and one was in class I. Twelve patients had a left-to-right shunt greater than 3:1. Pulmonary artery systolic pressure was greater than 40 mm Hg in 12 patients and greater than 60 mm Hg in five. Four patients had documented paradoxical emboli and were being treated with Coumadin. Before operation all patients but one were receiving digoxin. Repair was accomplished by direct suture in two patients and Dacron patch graft in 14. No deaths occurred during the postoperative period. Postoperatively, ten patients were in class I, five in class II, and one remained in class III. The hospital stay ranged from eight to 20 days (average 11 days). Two patients died one year and another (at the age of 77) five years after surgery. The remaining 13 patients are alive and well three months to 11 years after surgery. We conclude that repair of secundum ASD in patients over the age of 60 is safe, has low morbidity, and produces considerable clinical improvement.