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The types of cardiac dyspnea in this study included exertion dyspnea, orthopnea, cardiac asthma, and Cheyne-Stokes breathing. The condition of pulmonary edema accompanies orthopnea which often seems to have been used as a synonym of cardiac asthma. Although clinical reports on the signs and symptoms of cardiac asthma have hitherto been made by many and much has been discussed as to the cause of the disease, precise elucidation is yet to be made in their development. The purpose of the present study is to clarify pathophysiological aspects of cardiac asthma from clinical fingings. Consecutive observation was made of the hemodynamics of cardiac patients during day-time and at night with special reference to the attacks of cardiac asthma, and comparative studies were also undertaken with various cardiopulmonary diseases in acute stage with allied clinical symptoms. The tolerance tests with several drugs as well as exercise tests were tried in the cardiac patients in an attempt to induce attack of asthmatic dyspnea. Method and Materials Forty-four cardiac patients who had been admitted to the First Medical Clinic of Kobe University Hospital were examined. The first examitotion was routinely carried out in the supine position around 3;00 p.m. shortly after admission that is before a specific treatment was instituted. Following the examination the patients were left quiet in the supine position and allowed to sleep until about 8:00 p.m. The second examination was performed at 10:00 p. m. Hemodynamic examination was made in respiratory frequency, pulse rate, cardiac rate, blood pressure., venous pressure, pulmonary circulation time, cardiac output, stroke volume, and pulmonary blood volume. The Riva-Rocci sphygmomanometer was used for taking pressure, a modified MORIZ-TABORA method for venous pressure, UEDA'S method according to Stewart-Hamilton principle, using radio-iodinated serum albumin (RISA), for determining pulmonary circulation time and cardiac output. The pulmonary blood volume was calculated by the following fomula

Summary The foetal pH values of eighty-eight cases delivered within 30 min after foetal blood sampling were correlated with the 1-min Apgar score. With a pH of 7·20 or above the error of prediction was 1·3%. The error in cases with pH below 7·20 was 54·5%. Significantly higher pH and lower δ base deficit were present in the low foetal pH group in vigorous, as opposed to depressed infants, suggesting that infusion acidosis was present in infants with a high Apgar score. The degree of correlation between the foetal pH and the Apgar score was not significantly influenced by shortening the sampling-delivery interval to 15 min or lengthening it to 3 hr. The most significant factor affecting the degree of correlation in the present study was the setting of the critical pH. If the criterion of the critical pH was taken as 7·13 there would have been no false positive results and the error of prediction in cases delivered within 30 min of foetal blood sampling would be reduced to 1·1%.

The influence of oxygen and carbonic acid on the living tissues, has been very little investigated, either by physiologists or practitioners of medicine. I have made a great many experiments on this subject, but will relate here merely a few of them, which are sufficient to show that oxidation of the spinal cord and nerves, as well as that of muscles, increases their vital properties, sometimes in a high degree.

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Publisher Summary This chapter discusses a study examining clinical pharmacological study and EEG changes of Delta-9 tetrahydrocannabinol effects in human volunteers. Six subjects volunteered for the first group-study of Delta 9 THC effects in human subjects. After a 20 min control period of EEG recording prior to drug administration, they received a total 10 mg oral-dose of Delta 9 THC in a sesame-oil vehicle. A second EEG recording session of 90 min was followed by successive 15 min recording sessions every hour and for 5 or 6 h following THC. Blood sample was collected for 3 h after THC and urine collections 6 and 24 h later. A neurological and psychophysiological checking was taken every hour independently of the EEG's recorded on magnetic tape from five different leads and further submitted to computer's statistical spectral analysis. The EEG polygraphic recordings taken over 5 h following THC administration were scored according to Agnew and Webb (1972) procedures. The mean percentages time-course revealed a dominant arousal state during the first 2 h and then a sedated state increased toward moderate sleep in the 5th h following THC.

To the Editor.— Treating acute psychogenic hyperventilation by rebreathing into a paper bag restores arterial carbon dioxide pressure (PCO2) to normal, and leads to relief of symptoms. We compared the retention of CO2during rebreathing in three different types of bags to determine their clinical usefulness. A plain paper bag, a paraffin-treated ("oily") paper bag, and a clear plastic bag of the same size (No. 12) were tested. Bag gas was sampled continuously through a small catheter, and CO2concentration was measured with an infrared CO2analyzer. With the bag held tightly over the mouth and nose, a subject hyperventilated at a constant rate, and the rise in bag CO2was recorded. When the plain paper bag was used, CO2reached a plateau of 43±7 (mean±SD) mm Hg after 15 to 20 breaths. In contrast, CO2rose slightly faster in the "oily" paper

To the Editor.— In the letter "The 'Oily' Paper Bag and Hyperventilation" (229:638: 1974), Dr. Riley mentioned that the increased carbon dioxide pressure when rebreathing from the bag held tightly over the mouth and nose lasts for three to four minutes. During this time, the oxygen concentration must fall to quite low levels, inducing a hazard in patients with coronary artery disease, and probably also in others. It would be of interest to know whether the oxygen pressure was measured.

Chronic catarrhal laryngitis is a continuous passive inflammation of the laryngeal mucous membrane. Its etiology is multifarious. The most influential causes are nasal stenosis, liquor drinking, tobacco smoking, vitiated air, and an intemperate use of the vocal organs. Nasal stenosis necessitates mouth breathing—an abnormal respiration, by which we have carried into the laryngeal cavity an air pregnant with dust, that soon begets an inflammatory process. Chronic alcoholism produces an abnormal activity of the mucous glands of the mouth and fauces, which, during sleep, drops depraved excretions into the larynx, thereby producing a permanent inflammation. Tobacco smoking causes to be deposited daily in the air passages the liquid alkaloid nicotina, which produces partial paralysis of the vasomotor nerves of this locality, and a resultant permanent injury to the mucous texture. Vitiated air, in illy ventilated apartments, is one of the commonest causes of chronic laryngitis. Air reeking with noxious vapors poisons

[Your attention is invited to a subject which from the humanitarian standpoint is of the greatest importance and of practical value to us as surgeons. Much of the effort of our profession is directed toward the relief or prevention of pain. Distinct advances in our art followed the introduction of the various narcotics, and the science of surgery took a long step forward when the use of sulphuric ether for anesthesia was discovered Sept. 30, 1846, by Dr. Wm. T. G. Morton, of Wellesley, Mass., and chloroform by Sir James Simpson, of Edinburgh, on Nov. 4, 1847; and these names will ever live in our memory. But the great boon of narcosis is not unalloyed. Thousands have died from the effects of the volatile anesthetics, and every time we administer them we take upon ourselves the responsibility of a human life. Ether kills once in 15,000 administrations; chloroform once in

Dr. J. A. Stucky, Lexington: Any method which simplifies anesthesia diminishes the quantity of the drug used and the dangers that attend its administration is to be hailed as a great advance. I have contended, and still do contend, that the patient should be practically from under the influence of the anesthesia by the time the operation is finished to insure rapid recovery. This can be facilitated by the administration of a small dose of morphin hypodermieally—⅛ to ¼ gr. with from 1/150 to 1/200 gr. atropin. I raiely give more than ⅙ gr. of morphin. I am glad Dr. Miller used the term "charging the patient with ether;" I have used the word "soaking." Charging the patient with any anesthetic is dangerous. Chloroform is a dangerous anesthetic in any adenoid or tonsil operation, and especially when there is a tendency to the status lymphaticus.

A GREAT deal of work has been done on the use of soda lime for carbon dioxide absorption in anaesthesia, much of which has been described by Adriani (1946). In the course of a laboratory study of carbon dioxide absorption, some further information has been obtained, and this is described here. This paper does not deal expressly with the carbon dioxide absorptive efficiency (which determines the concentration returned to the patient) or the effective life of a charge of soda lime, as these depend to a very large extent on the apparatus in which the soda lime is used. Several of the items discussed in this paper, however, have considerable bearing on these topics, and these influences are described.

—Effects of acute or chronic administration of ethanol and its withdrawl on the steady-state levels and turnover rates of certain neurotransmitters have been investigated in mice. The influence of long-term administration of ethanol on the activities of enzymes involved in the metabolism of these transmitters has also been studied. Acute administration of ethanol or acetaldehyde or chronic administration of ethanol resulted in a decrease in the cerebral contents of acetylcholine, acetylCoA and CoA. Brain levels of 5-hydroxytryptamine, norepinephrine and choline remained unchanged after acute administration of ethanol. However, chronic administration of ethanol resulted in a decrease in the norepinephrine content without significantly affecting 5-hydroxytryptamine or choline contents. Cerebral levels of γ-aminobutyric acid increased with both acute or chronic administration of ethanol. The total incorporation of [3H]choline into acetylcholine in brain was depressed upon acute administration of ethanol. After withdrawal of ethanol for one day cerebral levels of norepinephrine returned to normal; however, γ-aminobutyric acid and acetylcholine returned to normal levels at 2 and 4 days after ethanol withdrawal, respectively. Pretreatment of mice with pyrazole, an inhibitor of alcohol dehydrogenase, prevented the ethanol-induced decrease in cerebral acetylcholine levels. The activities of cerebral choline acetyltransferase and glutamic decarboxylase were decreased after 2 weeks of chronic ethanol administration. However, the activities of acetyl cholinesterase and GABA-transaminase remained unaffected after 2 weeks of ethanol treatment

1. A method for measuring interstitial ‘fluid’ pressure by using a wick consisting of long-stranded cotton wool at the interface of the tissue is described. 2. A correct measurement of hydrostatic fluid pressure was obtained when the wick, connected to a suitable transducer, was applied to filter paper in which the channels contained fluid at a known subatmospheric pressure. 3. A mean subatmospheric pressure of −1.6 cmH2O was recorded in the subcutaneous tissue of the normally hydrated frog; pressure fell with dehydration and rose with overhydration. 4. A mean subatmospheric pressure of −2.8 cmH2O was recorded in the subcutaneous tissues of the abdominal wall and scalp of the normally hydrated rat. Simultaneous measurements made at symmetrical sites showed a high degree of correlation. 5. A comparison of interstitial ‘fluid’ pressure in the subcutaneous tissues of the scalp (measured by a wick) and the abdominal wall (measured by a Guyton capsule), in both anaesthetized and conscious rats showed some degree of correlation. There was, however, a wide scatter of values. 6. The interstitial ‘fluid’ pressure in the rat, measured by both wick and capsule, became more negative when the animals underwent frusemide diuresis; the capsule pressures fell more rapidly for a given degree of fluid loss. 7. The wick method was applied to the subcutaneous tissues of the arm in normal man; a mean atmospheric pressure of −3.4 cmH2O was recorded in five subjects. There were no untoward sequelae. 8. The forces responsible for the measured pressure have been analysed. The recorded subatmospheric interstitial ‘fluid’ pressure in the rat rose towards atmospheric pressure and sometimes became positive when the wick was removed, soaked in increasing concentrations of hyaluronic acid, and reinserted in the tissues. This did not happen in similar experiments in which the wick was soaked in bovine albumin, rat plasma or saline. The large macromolecules of hyaluronic acid therefore exert a force which opposes the forces responsible for the subatmospheric interstitial pressure. 9. It is suggested that the apparent subatmospheric hydrostatic pressure is due to the osmotic forces developed by the hyaluronic acid molecules in the interstitial tissues trapped by their mutual entanglement in a sieve of collagen fibrils acting as a semipermeable membrane.

There are several reports that a protein-free extract of heart muscles from mammalian animals dilates coronary vessels (1, 2), increases the amplitude of heart (3), and improves the efficiency of contractions in heart lung preparations (4). Clinically, the extract has been used as an antianginal drug (5, 6), and a drug for heart failure contradictorily (7, 8). One of the main approaches to antianginal drugs has been studies of coronary dilators. However, the majority of pharmacological studies have been carried out in animals with a normal coronary circulation and the results obtained may not predict the status of the abnormal coronary circulation. Certainly, studies in man indicate that the coronary bed of the anginal patient is incapable of dilatation so that nitroglycerin produces no increase in coronary flow (9, 10). Furthermore, some reports show that dipyridamol having specific potent coronary vasodilating activity is not effective for angina pectoris (11-13). Thus, many other approaches have been tried to investigate antianginal drugs. Clinically, ST segment depression in electrocadiogram of patients of angina pectoris is very common phenomenon, and we consider ST segment depression in rats produced with vasopressin or adrenaline might be one of the experimental models of angina pectoris. Lindner et al. have shown that the vasopressin induced ischemia of the dog heart was improved after three daily injections of the large doses of a heart extract (14). Black have shown that oral administration of a heart extract for two weeks produced improvement on the above mentioned ischemia in rabbits (15). This paper describes a modification of similar experimental methods in rats and the identification of components which improves the ST segment depression in the heart extract.

Five age groupings of subjects ranging from 21 months to 69 years old were studied using the EEG as a probe. The EEG was recorded in the conventional manner on paper tape for sleep stage analysis and was analyzed on line by electronic integrators. The results display the course of sleep in terms of integrated EEG values alone. From these values an index of the total night of sleep can be computed. This index reflects individual differences between the sleep of subjects as well as a high within-subject reliability. Age of the subject was found to be a powerful variable in determining the amplitude of the sleep EEG. Finally, analysis of the integrated EEG values associated with the different stages of sleep revealed considerable overlapping of values such that one cannot use integrated EEG values alone to differentiate one stage of sleep from another except in the case of the very large amplitudes associated with stage 4 sleep.

In order to relieve hypoproteinemia associated with Banti's syndrome and brought about by the application of pump-oxygenator for open heart surgery, Plasmanate (Cutter) has been administered to 3 cases of Banti's syndrome and 2 cases of open heart surgery with pump-oxygenator.The effect of Plasmanate on the patients with Banti's syndrome revealed increase of serum albumin, rise of A/G ratio, increase of urinary out-put, and marked improvement of edema following the administration. Administration of Plasmanate was also effective in preventing postoperative hypoproteinemia following open heart surgery with pump-oxygenator.Protein fraction of Plasmanate was analysed with the method of paper electrophoresis which revealed 4.8% of albumin on average with no trace of gamma-globulin. Side effect of Plasmanate following the administration has not been noticed up to the present time.

The uptake of 14C-neostigmine in striated muscles was studied after intravenous injection into rats and in the isolated rat diaphragm. 120 minutes after the intravenous injection of 14C-neostigmine (100 μg/kg) the 14C-concentration in the quadriceps, sternomastoid and intercostal muscles was 1/3-1/2 of the concentration in the plasma, whereas the 14C-concentration in the diaphragm was about double the concentration in the plasma. After continuous intravenous infusion of 14C-neostigmine the distribution pattern was the same as after a single injection. Paper chromatography showed that the radioactivity in the diaphragm was due partly to unchanged neostigmine, partly to a metabolite. In the isolated diaphragm unchanced 14C-neostigmine accumulates against an apparant concentration gradient. The uptake is partly saturable and energy-dependent. It is suggested that intracellular accumulation of neostigmine and/or its metabolites may be causally related to the respiratory failure following overdosage of neostigmine.

The treatment of cases of barbiturate poisoning has been improved in recent years by the introduction of more efficient techniques for the removal of the circulating drug. These include forced diuresis (Ohlsson, 1949 ; Ohlsson and Fristedt, 1962) and forced diuresis and alkalinization (Mollaret, Rapin, Pocidalo, and Monsallier, 1959 ; Lassen, 1960 ; Myschetzky and Lassen, 1963). The infusions used include urea, solutions of electrolytes, and, more recently, mannitol (Cirksena, Bastian, and Barry, 1962). The mortality rate and incidence of compli cations have been reduced by these regimes, the prompt applica tion of which should also reduce the need for haemodialysis. Haemodialysis is the most efficient and rapid way of eliminating barbiturates (Alwall, Lindgren, and Lunderquist, 1952 ; Berman, Jeghers, Schreiner, and Pallotta, 1956 ; Linton, Luke, Speirs, and Kennedy, 1964). This paper reports our experience of 15 patients with severe barbiturate poisoning, all of whom required assistance from a respirator, and seven of them had a cardiac arrest. Some of the problems arising in the management of such patients are discussed and an attempt has been made to define the criteria for haemodialysis.

Urinary metabolites before dental treatment were compared in a group of patients with dental phobia and in a matched control group. Plasma adrenaline, noradrenaline, and free fatty acids were estimated before treatment, immediately after sedation with diazapam 0.2 mg/kg body weight in the phobic patients, during induction of oral anaesthesia, and during and after surgery. Patients with dental phobia had significantly higher levels of adrenaline, which were only temporarily lowered by sedation, and which during treatment remained consistently higher than those of control patients.

I N comparing the different solutions used for anesthesia of the mucous membranes of the urinary tract, we shah consider here onIy the more common ones. This comparison is based on the most important factors: (I) Toxicity, (2) effectiveness, (3) promptness of action, (4) duration of anesthesia, (5) stabihty in sohrtion, (6) soIubiIity, (7) primary irritabiIity and (8) antiseptic in soIution. Toxicity is placed first because it is without doubt a most important factor when we recaI1 the number of deaths reported and unreported that have taken pIace due, not onIy to absorption from the mucous surface of the urinary tract, but aIso from the mucous membrane of the eye. RandaII in 1923 pubIished a paper based on his own experience. in addition I

This paper evaluates the use of metoclopramide (Maxolon) in emptying human stomach contents into the duodenum and beyond. A method of quantitative assessment of content by barium swallow radiography is used in the study, and the method is recommended as a diagnostic manoeuvre in patients presenting for emergency surgery in whom the stomach content is in doubt. Oral metoclopramide was found effective in emptying stomachs challenged by water load, and the intravenous route has been found effective in emptying semisolid contents in emergency clinical situations. A radiographic scan of the resting stomach was made on patients waiting for routine surgery who had received a variety of common premedication; it was shown that significant residues occur. We believe that metoclopramide deserves further investigation in order to exploit its potential in reducing the hazard of regurgitation and vomiting in patients requiring emergency anaesthesia and surgery.

This paper reports a double-blind trial of a new antianginal drug, perhexiline. Fifty-five patients suffering from angina pectoris were studied for periods of 12 or 24 weeks in a cross-over comparison against a placebo in four centres in the United Kingdom and Ireland. Perhexiline was effective in most patients as judged by reducing the number of anginal attacks in 84% and the consumption of glyceryl trinitrate tablets in 64%. The major side effect, dizziness, noted in one-third of the patients, may be dose/body-weight related. Perhexiline is a valuable new agent for the treatment of patients with angina, especially those who do not respond to other antianginal agents.

The methods used to screen patients for malignant hyperpyrexia at present are not sufficiently accurate. This paper reports more specific methods of detecting patients liable to develop malignant hyperpyrexia. A motor-point muscle biopsy is performed for histopathological examination and to detect muscle contracture in vitro after exposure to halothane and suxamethonium.