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Ischemic vascular complications and rejection occur more frequently with pediatric liver transplants versus adult liver transplants. Using intrahepatic microdialysis catheters, we measured lactate, pyruvate, glucose, and glycerol values at the bedside for a median of 10 days in 20 pediatric liver grafts. Ischemia (n = 6), which was defined as a lactate level > 3.0 mM and a lactate/pyruvate ratio > 20, was detected without a measurable time delay with 100% sensitivity and 86% specificity. Rejection (n = 8), which was defined as a lactate level > 2.0 mM and a lactate/pyruvate ratio < 20 lasting for 6 or more hours, was detected with 88% sensitivity and 45% specificity. With additional clinical criteria, the specificity was 83% without a decrease in the sensitivity. Rejection was detected at a median of 4 days (range = 1-7 days) before alanine aminotransferase increased (n = 5, P = 0.11), at a median of 4 days (range = 2-9 days) before total bilirubin increased 25% or more (n = 7, P = 0.04), and at a median of 6 days (range = 4-11 days) before biopsy was performed (n = 8, P = 0.05). In conclusion, microdialysis catheters can be used to detect episodes of ischemia and rejection before current standard methods in pediatric liver transplants with clinically acceptable levels of sensitivity and specificity. The catheters were well tolerated by the children, and no major complications related to the catheters were observed. Liver Transpl 19:305–314, 2013. © 2013 AASLD.

One hundred and thirty-four patients admitted to the medical emergency ward due to suspect deep venous thrombosis (DVT) were examined. The uptake of intravenously injected porcine 99Tcm-plasmin was estimated in both legs. Thereafter, phlebography was performed using a high osmolar contrast medium. All phlebographies were evaluated independently. All patients with negative phlebography were examined clinically after 3–5 days. The plasmin test and phlebography were repeated when called for. The sensitivity of the plasmin test was 100% and the specificity 51% when compared to phlebography. The extension of the DVT as demonstrated by the plasmin test was similar to that determined by phlebography. Post-phlebographic thrombosis was very rare. It is concluded that 99Tcm-plasmin test is a rapid method, convenient to the patient and well suitable as a screening test. The results indicate that a negative plasmin test excludes DVT while a positive test necessitates additional examination by phlebography.

Cardiac arrhythmias, digoxin concentration in plasma and urine, digoxin and creatine clearances, electrolytes in plasma and in erythrocytes, and subjective symptoms have been carefully studied for 5 consecutive days in 19 patients with definite or suspected digitalis intoxication. The digoxin treatment was discontinued during the observation period. Eleven controls without any signs of toxicity were similarly followed on unchanged maintenance dosage. All patients were independently classified as toxic or non-toxic from the follow-up of extended ECG recordings and subjective symptoms. In 9 definitely toxic patients a plasma digoxin concentration 3.1 plus or minus 0.7 ng/ml was found, as compared to 1.4 plus or minus 0.5 ng/ml for the 11 controls. In the suspect toxic group 1.5-3.9 ng/ml was found. The high digoxin level in the toxic group corresponds to a low digoxin clearance. In the toxic patients cardiac arrhythmias were related in most cases to a plasma digoxin level above 2.5 ng/ml and usually disappeared when the concentration had decreased below this. Suspect toxic patients, classified as probably non-toxic, and controls had with two exceptions plasma digoxin levels below 2 ng/ml. It is suggested that digitalis toxicity should be considered at a plasma digoxin concentration above 2 ng/ml. It must be stressed that this limit is not absolute and is affected by, among other things, a disturbance of intra- and extracellular electrolytes.

Arrhythmogenic right ventricular dysplasia causes ventricular arrhythmias and sometimes heart failure. The condition is easily overlooked, but once suspected, it may be diagnosed non-invasively. This is illustrated by the case reported. The clinical features of this syndrome are discussed, with special emphasis on the non-invasive findings.

Endoscopic sinus surgery (ESS) is today a common method for the treatment of chronic rhinosinusitis. Assessment of the results has been based mainly upon subjective evaluation, and only a few reports present objective measurements. In the present study, the 133-xenon washout technique was used for preoperative and postoperative evaluation of paranasal sinus ventilation in 12 patients selected for ESS. The postoperative half-times (T1/2) of 133-xenon washout were lower in the sinuses with abnormal preoperative half-times (T1/2), especially in the maxillary sinuses, where the postoperative T1/2 was 44 (22 to 150) minutes (median and quartiles, Q1–Q3) as compared with a preoperative T1/2 of 202 (94 to 278) minutes. The postoperative evaluation included a questionnaire and a follow-up visit with endoscopy and measurements of nasal nitric oxide. The results showed that patients who declared a marked reduction in symptoms exhibited significantly improved sinus ventilation. However, no direct correlation was found between improvement in ventilation and symptom improvement. Nine of the 12 patients showed improvement on endoscopy, and these patients also exhibited improved sinus ventilation. The postoperative nasal nitric oxide levels were within the normal range in 11 of the 12 patients; the other patient showed pathological T1/2 values for all paranasal sinuses. The 133-xenon washout technique is thus a method that can be used for objective evaluation of the ventilation of the paranasal sinuses before and after ESS procedures. However, the technique cannot be used to evaluate sinuses with totally obstructed ostia or postoperative sinuses with very wide neo-ostia, as rapid washout may lead to no activity remaining at the time of measurement.

Ventilation of the paranasal sinuses is of great importance in sinus pathophysiology. Therefore, methods of measuring sinus ventilation are important for the evaluation of patients with sinus disease. In the present study, a 133-xenon washout technique was used to evaluate the ventilation of the paranasal sinuses in 34 healthy subjects and in 13 subjects with sinus disease (5 patients with nasal polyposis and 8 patients with chronic sinusitis). For this purpose, a 133-xenon-air mixture was insufflated in each nostril and the washout of the radioactive gas from the paranasal sinuses was monitored with a dynamic single-photon-emission computed tomography camera. The half-time (±SD) was found to be 18 ± 18 minutes for the maxillary sinus, 10 ± 8 minutes for the frontal sinus, and 18 ± 23 minutes for the posterior ethmoid and sphenoid sinuses in the healthy subjects. Repeated measurements in 18 of the healthy subjects indicated that the method had acceptable reproducibility according to a Bland-Altman plot. The 133-xenon washout was not influenced by insufflation pressure, nasal patency, or body position. The subjects with sinus disease exhibited half-times of 77 ± 101 minutes for the maxillary sinus, 91 ± 124 minutes for the frontal sinus, and 60 ± 60 minutes for the posterior ethmoid and sphenoid sinuses. For patients with nasal polyposis, the half-time was significantly longer than that in healthy subjects, while patients with chronic sinusitis did not differ from healthy subjects in this respect.

Ischemic vascular complications and rejection occur more frequently with pediatric liver transplants versus adult liver transplants. Using intrahepatic microdialysis catheters, we measured lactate, pyruvate, glucose, and glycerol values at the bedside for a median of 10 days in 20 pediatric liver grafts. Ischemia (n = 6), which was defined as a lactate level3.0 mM and a lactate/pyruvate ratio20, was detected without a measurable time delay with 100% sensitivity and 86% specificity. Rejection (n = 8), which was defined as a lactate level2.0 mM and a lactate/pyruvate ratio20 lasting for 6 or more hours, was detected with 88% sensitivity and 45% specificity. With additional clinical criteria, the specificity was 83% without a decrease in the sensitivity. Rejection was detected at a median of 4 days (range = 1-7 days) before alanine aminotransferase increased (n = 5, P = 0.11), at a median of 4 days (range = 2-9 days) before total bilirubin increased 25% or more (n = 7, P = 0.04), and at a median of 6 days (range = 4-11 days) before biopsy was performed (n = 8, P = 0.05). In conclusion, microdialysis catheters can be used to detect episodes of ischemia and rejection before current standard methods in pediatric liver transplants with clinically acceptable levels of sensitivity and specificity. The catheters were well tolerated by the children, and no major complications related to the catheters were observed.

Thirty limbs in 25 patients with chronic deep venous insufficiency and recurrent ulceration were examined by ascending and descending contrast phlebography, occlusion plethysmography, foot volumetry and ambulatory venous pressure. Superficial venous insufficiency was surgically corrected by stripping of the saphenous vein and local excision of the varicosities (op1) in 12 limbs. Perforating venous insufficiency was then corrected by extensive subfascial ligation of perforating veins (op2) in all limbs. Venous outflow capacity, measured by occlusion plethysmography, and muscle pump function, measured by foot volumetry, were not affected by either procedure. Venous reflux, measured by foot volumetry, (Q/EVrel) and by venous pressure return time (RT90) improved significantly with op1 but no change was seen after op2. Venous hypertension decreased significantly with op1 but did not change after op2, and 59% of the limbs still had severe venous hypertension (> 60 mmHg) after both procedures. Initial clinical results were good, ulcers persisting in only three limbs, but recurrences occurred in an additional six limbs within 27 months. The limbs with persistent or recurrent ulcers had severe phlebographic reflux and severe venous hypertension. These results demonstrate that improvement in venous reflux and hypertension may be achieved by correction of superficial venous insufficiency, but the addition of ligation of perforating veins seems to be of less benefit to the venous circulation.

Background Impairment of sinus ostial function is considered an important factor in the pathophysiology of sinus disease. The use of the decongestants such as α2-agonists is thought to improve sinus ostial function. Previous studies have shown an effect of α2-agonists on maxillary sinus ostial function only when administered in nasal bellows, but not as a nasal spray or nasal drops. The effect of decongestants on ventilation of the frontal and posterior ethmoidal and sphenoidal sinuses has not been studied to date. Methods In this study, the 133-xenon washout method was used to determine ventilation for all paranasal sinuses before and after administration of oxymetazoline as nasal drops in eight subjects and from nasal bellows in nine healthy subjects. Results No significant effect of oxymetazoline on sinus ventilation was seen in either group. Conclusions The results indicate that α2-agonists do not have any effect on sinus ventilation in healthy subjects. However, one cannot exclude that decongestants improve sinus ventilation in patients suffering from sinus disease and this requires further studies.

Objectives:To study if venous thrombectomy prevents late post-thrombotic sequelae, venous obstruction reflux, and improves venous physiology following an acute iliofemoral venous thrombosis.Design:Prospective randomised controlled study.Material:Thirty patients returned for follow-up 10 years after an acute iliofemoral venous thrombosis initially treated with conventional anticoagulation treatment (medical group, n = 17) or with thrombectomy combined with a temporary arteriovenous fistula and anticoagulation (surgical group, n = 13). Clinical assessment, radionuclide angiography, duplex ultrasound and venous physiology tests were performed.Results:Leg swelling was recorded in 12 (71%) and leg ulcers in three (18%) of the medical patients and in, respectively, six (46%) and one (8%) of the surgical patients. The surgical patients had less severe sequelae (class 0–2). Radionuclide angiography demonstrated that the iliac vein was more commonly occluded following medical (59%) than following surgical (17%) treatment (p

This investigation's aim was to study a noninvasive method for determining the ventilation of the nasal sinuses. For this purpose, different insufflation techniques using xenon 133 were tried, along with different scintillation camera techniques. Xenon 133 gas was used for insufflation in the nose and sinuses, and the half-time of the washout curves was determined with the aid of digital scintillation cameras, one of which was capable of dynamic tomography. The tomographic procedure was superior because it made it possible to study the washout from the ethmoidal/sphenoidal sinuses as well. The washout was followed for up to 150 minutes. Great variations in washout were found between different sinuses and also in the same sinus over time. The single photon emission computed tomography (SPECT) technique, which is easy to perform and gives a limited absorbed dose to the patient, seems promising for the future evaluation of sinus ventilation and ostial function.

Forty-one patients with acute iliofemoral venous thrombosis were randomised to conventional anticoagulation or acute thrombectomy combined with a temporary arterio-venous fistula (AVF) and anti-coagulation. Follow-up after 5 years in 22 medical and 19 surgical patients revealed slightly more asymptomatic patients (37 vs. 18%) and less frequent severe post-thrombotic sequelae (16 vs. 27%) in the surgical group (N.S.). The iliac vein was more frequently (P less than 0.05) normal following thrombectomy (71 vs. 30%) as demonstrated by radionuclide angiography, but occlusion plethysmography showed an outflow capacity (61 vs. 45 ml/min/100 ml) that was not significantly better. There was no obvious difference in muscle pump function (EVrel) and reflux (Q/EVrel) assessed by foot volumetry. Still, the ambulatory venous pressure was significantly (P less than 0.05) lower in the surgical group. There was a tendency towards better results following thrombectomy in patients with fresh thrombosis and a successful initial procedure. Although the numbers of observations in many cases were too small to provide statistical evidence of benefit with venous thrombectomy + AVF, this procedure seems to improve the long-term outcome following acute iliofemoral venous thrombosis. Since the difference in outcome is not very striking, anticoagulation treatment is still an acceptable alternative.

To determine the chronological changes of venous physiology following major thromboses, 20 patients were repeatedly examined for over 5 years after an acute ilio-femoral thrombosis which was treated with conventional anticoagulation. Radionuclide angiography showed that 70% of the patients had obstructive lesions of the iliac vein with only minor changes occurring from 6 months to 5 years. In spite of this, the plethysmographic maximum venous outflow increased from 31 to 45 ml/min/100 ml (P less than 0.001). The foot volumetric reflux did not change with time and about half of the patients had abnormal values. Venous reflux assessed by the refill time of foot vein pressure, deteriorated with time (P less than 0.05), and at 5 years all but one patient had a refill time less than 20 s. The muscle pump function, examined by foot volumetry, was abnormally low in about half of the patients throughout the study. The ambulatory foot vein pressure was constantly pathological (greater than 60 mmHg) in half of the patients and only two of 18 patients had normal values (less than 45 mmHg) at 5 years. Five patients with thromboses involving only the proximal veins had better physiological results than 15 patients with thromboses that extended to the peripheral veins. Three patients who developed venous claudication had iliac vein obstruction and an impaired venous outflow and three patients who developed venous ulcers had venous reflux and severe venous hypertension. Although venous outflow continuously improves following ilio-femoral thromboses, valvular competence and muscle pump function are constantly pathological, creating severe venous hypertension with a risk of post-thrombotic sequelae.

In 16 patients, where the diagnosis carpal tunnel syndrome was electrophysiologically confirmed, the pressure between the median nerve and the carpal ligament was measured peroperatively. At rest the pressure was 18-64 mmHg, mean 31 mmHg. Passive volar and dorsal wrist flexion increased the pressure about three times. Isometric or isotonic maximal contractions of wrist and finger muscles, elicited by tetanic nerve stimulation increased the pressure to three to six times the resting value. These high pressures may be one of the causes of the nerve lesion in the carpal tunnel syndrome.

The quality of ECG-interpretations by a computer-based ECG-recorder has been compared with those carried out visually by physicians in routine clinical practice. Independent reports have been analysed on 474 routine ECGs taken in the medical emergency and out-patient departments, as well as in general practice. Computer reports were available for all of the ECGs, but the physicians had not annotated their interpretations in 11% of them. Eighty-two per cent of the computer-interpretations were adjudged as being satisfactory. The corresponding figure for the physicians' interpretations was 64%. The computer-based ECG-recorder was found to be better than the physician at interpreting ECGs.

A new technique, based on the laser doppler principle, for measuring nasal mucosal microcirculation in humans, is presented. With this technique the relation between the blood flow and the temperature of the nasal mucosa was evaluated in healthy subjects exposed to peripheral cold stimulus. A decrease in blood flow and in mucosal temperature was found in all subjects when the feet were exposed to cold water for 5 min. The decrease in blood flow occurred almost momentarily and was restored to normal within the 5 min of exposure, while the drop in mucosal temperature was more gradual and persisted for a longer time. The implication of this study is that the laser doppler flowmeter seems to be a useful tool for estimation of changes in nasal mucosal microcirculation.

Fourteen patients with deep venous thrombosis (DVT) and a positive 99mTc-plasmin test were followed up to determine how soon a negative test was obtained. Localization and extension of the thrombi were determined by phlebography. Plasminogen activator activity in vein walls and local fibrinolytic activity after venous occlusion were measured in order to find out what the prerequisites for impaired thrombolysis are. The time required to obtain a negative 99mTc-plasmin test showed considerable variation, ranging from less than 1 week to more than 6 months. The 99mTc-plasmin test had returned to normal in 64% of the patients after 6 months. No relationship was found between vessel wall fibrinolysis and time to normalization. Instead, we found an association between the time to normalization of the 99mTc-plasmin test and the size of the thrombus, according to phlebography, as well as between the time to normalization of the 99mTc-plasmin test and the extension of leg points with a positive 99mTc-plasmin test at admission. The finding of abnormal 99mTc-plasmin test at admission. The finding of abnomral 99mTc-plasmin test results more than 6 months after acute DVT is of practical importance and warrants caution when evaluating patients with symptoms and signs suggestive of acute recurrent DVT.

In a 7-center Scandinavian double-blind placebo-controlled study of 179 patients with intermittent claudication, the effect of the serotonin antagonist ketanserin was evaluated on walking distance, brachial and ankle blood pressure, and symptoms. For all centers together, pain-free walking distance was significantly increased after 6 months with both ketanserin (+65%; 71 patients) and placebo (+42%; 78 patients), with no significant difference. However, there was large variability among centers. Classification of "responders" (doubling of walking distance) and patients who deteriorated (decrease of walking distance or dropout for inefficacy) showed significantly more patients responding and significantly fewer patients deteriorating with ketanserin than with placebo. Systemic blood pressure was significantly decreased by ketanserin in hypertensive, but not normotensive, patients, while ankle pressure was unaffected. The incidence and nature of side effects were equal with ketanserin and placebo, but there were more side effects causing dropout in the ketanserin group. An unexpected and possibly important observation was the occurrence of six serious cardiovascular events (myocardial infarction, cerebrovascular complications, and development of rest pain) in the placebo group but none in ketanserin-treated patients. Moreover, there were four additional similar complications in the placebo run-in period. Ketanserin appears to be beneficial in a subgroup of patients with intermittent claudication. A fortuitous finding of this study is that ketanserin might possess a protective effect against thrombovascular complications in patients with intermittent claudication.

Intramuscular pressures in the anterior tibial and superficial posterior compartments of the lower leg were measured by the wick catheter technique in 34 healthy individuals (17 males and 17 females, mean age 42 years). The pressures were measured at rest, during and after exercise and during venous and arterial occlusion. The pressure was 1.1 (range 0.3-3.0) kPa in the anterior tibial and 0.5 (range 0.0-2.0) kPa in the superficial posterior compartment at rest. During exercise the intramuscular pressures rose to 3.5 (range 1.0-8.0) kPa and 0.9 (range 0.1-2.8) kPa respectively. The anterior tibial compartment pressures were lower in females than in males at exercise and lower in older than in younger persons at rest. After exercise the pressures were back to the pre-exercise levels within 5 min. Venous occlusion caused an increase in the pressure which was more marked in the anterior tibial compartment than in the superficial posterior compartment. Arterial occlusion did not cause any dramatic changes in intramuscular pressures, but there was a slight elevation during the period of reactive hyperaemia.

In four patients ectopic bone formed after total hip replacement was replaced with free fat transplants. One year later the patients were free from pain, and hip flexion had increased by 60 degrees on average. Ectopic bone was completely absent in one patient, and markedly reduced in the remaining three patients. Bone scintigraphy was found to be a sensitive technique to reveal early ectopic bone formation. Fat transplantation seems to be a satisfactory complement in the treatment of ectopic bone.

In 20 patients with suspect deep venous thrombosis (DVT), scintillation detector measurements were performed over each leg during the first 60 min after intravenous injection of 99Tcm-porcine plasmin. Thereafter, 99Tcm-labelled autologous erythrocytes were injected i.v. and repeat measurements were performed. Finally, scintillation camera images of both legs were obtained. Phlebography was used as a reference method. A close relationship (P less than 0.01) was found between the scintillation detector measurements, both in patients with DVT (n = 11) and in patients without DVT (n = 9). Thus, 99Tcm-plasmin is not specifically bound to the thrombus. Rather the clinical utility of the test depends mainly on circulatory changes secondary to the thrombus. Scintillation camera images of 99Tcm-erythrocytes in the legs were not useful for diagnosis of DVT in the calves but showed a high specificity for DVT in the popliteal and femoral veins.

The influence of circulatory changes, which are secondary to deep venous thrombosis (DVT) in the leg, on result of radionuclide tests was studied in eight patients. Strain gauge plethysmography, a radionuclide blood-pool test and phlebography were performed both in the acute phase and during recovery up to 6 months after the initial admission. Morphological and functional changes were correlated with results from repeatedly performed 99Tcm-plasmin tests, a test currently used for diagnosis of DVT. In the acute phase, the thrombotic leg showed an increase in pooled blood and, in the case of proximal thrombosis, also impaired venous outflow. During the 6-month follow-up complete recanalization was observed in three patients and partial recanalization in five. The circulatory changes were found to recover progressively and earlier than the morphological changes. The 99Tcm-plasmin test was pathological at admission in all patients. It was normalized in parallel with plethysmography and blood-pool test results, at a time when morphological recovery was still incomplete. These findings confirm that a positive 99Tcm-plasmin test reflects haemodynamic changes which are secondary to the DVT rather than a specific binding of the radiopharmaceutical to the thrombus. The 99Tcm-plasmin test was normalized from 1 to more than 26 weeks after an acute DVT. This finding is of practical importance when using radionuclide tests for evaluation of acute recurrent DVT.

Es wird ein neuer Impulszahler mit Schwingrohren beschrieben, der eine stufenweise Entladung eines Kondensators benutzt und erst jeden zehnten Impuls zu einem mechanischen Relais durchlast. Die Anzahl der eingetroffenen Impulse ist unmittelbar abzulesen.

Conscious rats were found to secrete saliva from the submaxillary gland when exposed to heat. In rats with sympathetically denervated glands the secretory rate was a little lower and in parasympathetically denervated glands the secretion was almost abolished. The salivary flow appeared to increase with increasing ambient temperature and the secretion started earlier at higher temperatures. The secretion elicited by heat stress was compared to the secretion evoked by electrical stimulation of the parasympathetic nerve to the gland. It is concluded that the salivary secretion evoked by heat stress is mainly mediated by the parasympathetic secretory nerves, although the sympathetic fibres also take part.

Eine neue Art von Schwingungen in einer Elektronenrohre mit positivem Gitter wird untersucht und zur Konstruktion eines Impulsenzahlers benutzt, der gewisse Vorteile gegenuber den Thyratronzahlern bietet.

An experimental set up for studying fusion reactions and other features of a hot plasma is described. A low inductance condensor bank of 60 μF has been used and high current discharges in deuterium through straight tubes have been studied. The neutron production was found to be rather critically dependent on many factors. Two new fenomena have been observed: neutrons may appear already in the first pinch and furthermore, a high frequency oscillation in the plasma may occasionally be excited just after the pinch has been formed with a subsequent, strongly enhanced emission of neutrons.

Swelling is known to occur after peripheral revascularization. In this study of 14 patients undergoing revascularization of the popliteal artery for severe ischaemia, leg swelling and intramuscular pressure were recorded before and after operation. Calf circumference increased with a maximum swelling of 3·9 ± 1·1 cm on postoperative day 6. There was a gradual increase in intramuscular pressure from 9±2 mmHg on the day before operation in the anterior tibial compartment to a maximum pressure on postoperative days 6–7 of 26±4 mmHg. Similar intramuscular pressure changes were seen in the superficial posterior compartment. These high intramuscular pressures may lead to a compartment syndrome and perhaps graft failure, which was actually observed in one case. Deep-vein thrombosis in the postoperative course may contribute to the high intramuscular pressures. Phlebography revealed a deep-vein thrombosis in 2 patients. In conclusion popliteal revascularization causes leg swelling and increased intramuscular pressure which may lead to a compartment syndrome and graft failure. Therefore followup of intramuscular pressure in patients with marked swelling after distal revascularization procedures and early fasciotomy may be considered on wide indications.

The treatment of choice in acute iliofemoral venous thrombosis is still controversial. This prospective randomized study compares the results of conventional anticoagulation of 32 patients with the results obtained in 31 patients undergoing acute thrombectomy combined with a temporary arteriovenous fistula and anticoagulation. Early complications were few in both treatment groups, and significant pulmonary embolism developed in only one conservatively treated patient. At 6-month follow-up in all surviving patients, leg swelling, varicose veins, and venous claudication were more frequent after conservative treatment. Only 7% (2 of 27) of these patients were completely free from postthrombotic symptoms compared with 42% (10 of 24) of the operated patients (p less than 0.005). Contrast phlebography demonstrated an excellent venous outflow through the iliofemoral segment in 35% (9 of 26) of the conservatively treated and in 76% (16 of 21) of the operated patients (p less than 0.025). Open femoropopliteal veins with competent valves were recorded in 26% (7 of 27) in the conservative group and in 52% (12 of 23) in the thrombectomy group (p less than 0.05). Thus thrombectomy combined with arteriovenous fistula decreases early symptoms and preserves venous outflow and valvular function better than conservative treatment. This procedure is therefore recommended for young patients with acute iliofemoral thrombosis to avoid development of incapacitating postthrombotic sequelae.

The diagnostic efficiency of 99Tcm-albumin test (AT), a new radionuclide method, was evaluated in 90 consecutive patients with suspected deep vein thrombosis (DVT) admitted to the medical emergency ward. Phlebography was used as reference method. The sensitivity of the AT test was 92% and the specificity was 61%. As the method is objective, rapid and convenient for the patients, it can be recommended as an initial examination method to be followed by phlebography, in cases with a positive test result. Criteria with high specificity, 98%, have also been defined but these criteria should be further investigated.

Ten patients with congenital vein valve aplasia verified at contrast phlebography were evaluated clinically and by physiologic examinations. All had orthostatic edema and varicose veins, but leg ulcers and other "postphlebitic" sequelae were infrequent. Foot volumetry and measurement of ambulatory foot vein pressures revealed a severe deep venous incompetence with a defective muscle pump function and considerable reflux. Eight limbs were operated on with conventional varicose vein surgery and physiologically re-examined six to 26 weeks after the operation. All had an improved ambulatory pressure reduction (p less than 0.001). Foot volumetry revealed better muscle pump function (p less than 0.01), while the reflux flow was unchanged. Surgery of the incompetent superficial venous system is therefore recommended in cases with deep venous insufficiency due to congenital vein valve aplasia.

The 133Xe wash-out technique was used as a method for calculation of the blood flow in human nasal mucosa. The disappearance of 133Xe from the nasal mucosa was followed using scintillation detectors. In laryngectomies it was shown that the disappearance of 133Xe from the mucosa depended mainly on the blood flow. Leakage of 133Xe from the mucosa to the nasal air was unimportant. The disappearance rate of 133Xe was decreased by oxymetazoline and increased by histamine, mostly likely due to the effects of these vasoactive drugs on the mucosa blood flow. The 133Xe wash-out technique would seem to be a simple method to study nasal mucosal blood-flow changes in humans.

The effect of intravenous and topical glypressin, a triglycyl hormonogen of vasopressin, on the nasal mucosa was evaluated in healthy subjects. A dose-dependent reduction of nasal blood flow resulted from both intravenous and topical glypressin. The effect of the latter in gel form lasted 2 hours. Glypressin was also found to decongest the nasal mucosa. Topical application of glypressin gel might be an alternative to conventional treatment with intranasal packing in nose-bleed.

Nasal airway resistance increases at rest in the supine position and decreases during exercise due to changes of the thickness of the nasal mucosa regulated by the capacitance vessels. The resistance vessels regulating blood flow have not not been evaluated in these conditions before. In 15 healthy subjects the nasal mucosal blood flow was measured in rest and exercise with the 133Xe washout method. No change in blood flow was registered during exercise, which demonstrates that the blood flow and the blood content of the human nasal mucosa are not affected in the same way by exercise.

The influence of deep vein thrombosis on intramuscular pressure was evaluated in 22 patients by means of the wick technique. Intramuscular pressure was measured in the anterior tibial and the deep posterior compartments in both legs before and during treatment. The intramuscular pressure was significantly (p less than 0.001) higher in the thrombosed leg than in the contralateral leg (0-16 mmHg). The increase in intramuscular pressure was related to the extension of the thrombus. Iliofemoral thrombosis caused a significantly (p less than 0.001) higher pressure (17-28 mmHg) than calf thrombosis (16-23 mmHg). A compartment syndrome was found to be a part of the entity phlegmasia cerulea dolens (rest pressure 47-56 mmHg). In the treatment of phlegmasia cerulea dolens, fasciotomy is suggested additional to other therapeutic procedures.

Summary. The effects of fetal heart arrhythmias were examined serially in two pregnancies by three non-invasive methods: fetal ECG, fetal phonocardiography and ultrasonic measurement of fetal blood flow. In a case of supraventricular arrhythmia, there was evidence suggesting that the stroke volume varied with ventricular filling according to the Frank - Starling law. In a case of total atrioventricular block the mean blood flow in the fetal descending aorta and in the umbilical vein was within the normal range. Blood flow velocity in the inferior vena cava of the fetus reflected atrial contractions. In the phonocardiogram, a phenomenon similar to‘bruit de canon’ was found. Both pregnancies had good outcomes and subsequent development of the infants was normal except for the persisting dysrhythmias. The two cases exemplify how fetal heart function can be assessed in utero.

Congenital vein valve aplasia is often misdiagnosed and its symptoms misinterpreted as being caused by previous deep venous thrombosis. The present article reviews the literature providing data on etiology, symptomatology, and phlebographic appearance in congenital vein valve aplasia. A personal experience with 10 cases focuses on the clinico-physiological results with compression therapy and surgical treatment of superficial venous insufficiency. Compressive support with a tourniquet or a compressive stocking did not improve muscle pump function or venous reflux, as assessed by foot volumetry, and venous hypertension was not affected. Nevertheless, no patient developed leg ulcers during consistent use of compressive stockings. Surgical removal of incompetent saphenous veins, perforators, and varicosities in a subgroup of 6 patients (8 limbs) was followed by an improved muscle pump function and decreased venous hypertension which persisted 4 years post-operatively. Only 1 patient has been suited for deep venous reconstruction with transplantation of a valve-containing vein segment from the axillary vein to the popliteal vein, but it is still too early to assess the results of this procedure. Our findings demonstrate that consistent compressive therapy is paramount in the management of patients with congenital vein valve aplasia. Surgical treatment of the superficial venous insufficiency provides a long-lasting improvement of muscle pump function and venous hypertension. “Curative” vein valve transplantation or transposition is possible only in a minority of these patients.

The pressure between the ulnar nerve and the arcade bridging the two heads of the flexor carpi ulnaris muscle was recorded peroperatively in ten patients with electrophysiologically confirmed ulnar neuropathy at the elbow. At rest, with the elbow extended, pressures ranged from 0 to 19 mm Hg but increased in flexion and during isometric contraction of the flexor carpi ulnaris muscle to maximal values above 200 mm Hg.

The allergic reaction in the nasal mucosa is a complex pathophysiological process with several chemical mediators involved. One of the primary mediators is histamine. This investigation was performed to study separately the effects of an allergic reaction and of histamine on the human nasal mucosal blood flow with the 133Xe wash-out method. An allergic reaction was provoked by pollen allergens and blood flow was estimated before and after provocation. In healthy subjects and in subjects with allergic rhinitis and off pollen season, the effect of histamine injected into the mucosa was studied. The allergic reaction decreased the blood flow but histamine had a converse effect in both allergic and normal subjects. This indicates that histamine alone is not responsible for the vascular effects in allergic rhinitis. Different mechanisms responsible for the decreased blood flow in the allergic reaction are discussed.

Serial perfusion lung scanning and chest radiography were used to study the incidence of pulmonary embolism in patients with acute iliofemoral venous thrombosis. The efficacy of conventional anticoagulation and surgical thrombectomy in controlling embolism and the risk of creating emboli during thrombectomy were also evaluated. Lung scans obtained on admission in 49 patients were normal in 37 per cent, inconclusive in 18 per cent and positive for embolism in 45 per cent of the patients. Symptoms suggestive of embolism were present in only 24 per cent of the patients and correlated poorly with lung scans. Massive embolism was present in only two patients. Additional, usually asymptomatic, emboli developed within one month in 21 per cent of 29 patients treated conservatively with anticoagulation alone and in 20 per cent of 20 patients having acute thrombectomy combined with a temporary arteriovenous fistula and systemic anticoagulation. Only one conservatively treated patient required caval interruption. Pulmonary embolism, usually of minor degree, is thus present in nearly every other patient with acute iliofemoral venous thrombosis. Anticoagulation alone or in conjunction with thrombectomy and arteriovenous fistula in most cases effectively prevents further embolization and the risk of creating additional emboli by the surgical procedure is insignificant.

Elmer, M. and P. Ohlin. Salivary glands of the rat in a hot environment. Acta physiol. scand. 1970. 79. 129–132. A marked hypertrophy of the normally innervated submaxillary gland was observed in rats subjected to heat (34°C) for 3 weeks. The increase in weight of parasympathetically de-xiervated glands was much less while that of sympathetically denervated glands was still pronounced. The size of both synipathetically and parasympathetically denervated glands was not affected in a hot environment. It seems likely that the hypertrophy of the submaxillary gland is to a large extent secondary to an increased secretory activity elicited by the para-sympathetic secretory fibres. A corresponding increase in weight of the sublingual gland was not seen.

The size of the rat's submaxillary gland and the total activity of choline acetylase in the gland were markedly and similarly increased after repeated teeth amputations. Preganglionic parasympathet-ic denervation caused an atrophy of the gland and a pronounced decrease in enzyme activity. It did not inhibit the effects of repeated teeth amputations. Postganglionic sympathetic denervation alone caused a slight decrease in gland weight and an increase in choline acetylase activity. The effect of repeated teeth amputations was partly inhibited in sympathetically denervated glands. It was completely abolished in both parasympathetically and sympathetically denervated glands.

The secretory activity of the submaxillary gland in the conscious rat is increased in the acute experiment when the secretion from one or more of the other salivary glands is prevented from reaching the oral cavity. In chronic experiments the weight of the submaxillary gland is augmented after duct ligation of other salivary glands. It seems likely that increased secretory activity as observed in the acute experiments, is the cause of this glandular hypertrophy.

Summary. Secretion from the submaxillary and parotid glands has been studied in rabbits under urethane anaesthesia. The submaxillary gland, but not the parotid, shows a continuous secretion, which probably occurs spontaneously. The secretory responses of the glands to various drugs have been investigated. The parotid gland of the rabbit seems to be a valuable substrate for experiments on supersensitivity to chemical agents. Supersensitivity has been produced by extirpation of the superior cervical ganglion or treatment with the parasympathicolytic agent Hoechst 9980.

The effect of repeated teeth amputations on the secretory responses and the activities of succinic dehydrogenase, cytochrome oxidase and fumarse was studied in the rat's submaxillary gland.Repeated teeth amputations cause and enlargement of the gland.The secretory responses to adrenaline were found to be increased while those to acetylcholine, methacholine or stimulation of the parasympathetic secretory nerve were unchanged.The total activities of succinic dehydrogenase and fumarase were increased while that of cytochrome oxidase was unchanged.

Some experimental work is described which concerns two different ways of obtaining a constricted ring discharge in deuterium at about 0.01 mm Hg. In one type of experiment a constant external magnetic toroid field is applied, and an E centered pinch is formed by means of discharging a condenser bank of 60 mu f at about 35 kv. In a second type of experiment a very large bank of condensers is used giving a stored energy of about 1 million joules, which induces a variable toroidal magnetic field with a time constant of about 1 msec. This produces an H centered pinch. (auth)

As is known, there exists a discrepancy between earlier determinations of h/e obtained from the short wave-length limit of the continuous X-ray spectrum and the value of h/e calculated from Bohr's formula for the Rydberg constant. Thus most of the determinations of h/e by the X-ray method have given values that are 0.3–0.4 per cent lower than the value calculated. This difference is several times greater than the stated limits of error, indicating the presence of systematic errors in the measurements. An error of this nature, due to too high a pressure in the X-ray tube, has previously been pointed out by me1. This error can amount to 0.1–0.15 per cent and is therefore too small to account for the whole of the discrepancy. Further, a number of determinations of h/e have been carried out by means of technical X-ray tubes in which the pressure was sufficiently low.

To investigate whether effort-related dorsal forearm pain could be due to an increase of the intracompartmental pressure (ICP) in the dorsal forearm compartment, the normal range of the ICP at rest and during exercise was first determined in 11 volunteers using a wick catheter. The ICP at rest was 6 mm Hg (range, 2-11 mm Hg), and during exercise the pressure rose to about six times the resting level. Fourteen patients with pain in the dorsal forearm during exercise were similarly examined. In six patients the pressure at rest and/or during exercise was more than twice that of the normal persons or that of the healthy forearm. After fasciotomy four of these six patients were relieved of pain within three weeks, which might suggest a relation between ICP and pain.

One hundred eight patients with lower leg pain of unknown cause underwent intramuscular pressure measurements by the wick technique. Fifteen patients (14%) were found to have a chronic anterior tibial compartment syndrome. In these patients the intramuscular pressure was significantly increased at rest and during and after exercise as compared with normal subjects. The pressure increase after exercise was long-lasting (40 minutes). Biopsies of the anterior tibial muscles showed increased water content, which may explain the elevated pressures. Muscle blood flow during exercise as measured by the xenon-133 clearance technique was decreased, and muscle lactate concentration was increased in the anterior tibial muscles. Fasciotomy relieved pain and normalized intramuscular pressure, muscle blood flow, and skeletal muscle metabolism.

IN recent years several determinations of h/e from the short wave-length limit of the continuous X-ray spectrum have been made. The results obtained from this method, however, disagree definitely with the value of h measured by other methods. According to Kirchner1 the most accurate determinations of h/e by the method of isochromats give h = 6·614 × 10-27 erg sec., provided e = 4·803 × 10-10 E.S.U., e/m = 1·759 × 107 E.M.U./gm. and R∞ = 109·737 cm.-1. This discrepancy has not yet been explained. Also the shape of the isochromats, especially in the vicinity of the short wave-length limit, causes a problem. Instead of running straight down to zero, thus giving a sharp radiation limit, the isochromats run asymptotically down to zero. This 'foot' of the curve indicates that some electrons hit the anticathode with a velocity which is greater than that corresponding to the voltage applied on the X-ray tube. Various hypotheses have been put forward to account for the existence of such electrons.