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Otolaryngologic involvement is rarely a manifestation of drug-induced systemic lupus erythematosus (SLE). Hoarseness developed in a 60-year-old man that was secondary to ulcerated lesions, which involved the epiglottis and aryteno-epiglottic folds, with serologic evidence of SLE after he had been treated with hydralazine for six months. Histopathologic study of an epiglottic "pseudotumor" disclosed necrotizing vasculitis. To our knowledge, this is the first reported case of laryngeal involvement as a complication of hydralazine-induced SLE.

To assess the problem of alpha-methyldopa dosing in lactating mothers with hypertension, we studied three breast-feeding women to determine simultaneous plasma and breast milk concentrations of alpha-methyldopa after a 500 mg oral dose while receiving continuous therapy. Peak excretion of free alpha-methyldopa in breast milk ranged from 0.02 to 1.14 microgram/ml. The breast milk/whole plasma ratios of alpha-methyldopa ranged from 0.19 to 0.34. In two of the three breast-fed infants, plasma levels of alpha-methyldopa were undetectable (less than 0.05 microgram/ml) 6 hours after maternal ingestion of the drug, but in one of these the plasma alpha-methyldopa concentration was 0.09 microgram/ml 10 hours after maternal dosing. It is estimated that when the mother receives 1 gm alpha-methyldopa a day, the maximal cumulative dose of alpha-methyldopa would be 855 micrograms and the average cumulative alpha-methyldopa load to the breast-fed infant would be 195 micrograms, or 0.02% of the maternal dose.

Two elderly adults presented with fever of undetermined origin. Radiogallium imaging showed intense concentration in the thyroid, without abnormal localization elsewhere. In the first case, a repeat radiogallium study performed three weeks later was within normal limits. The patient had 0% uptake of radioiodide, and no demonstrable iodine within the thyroid. This probably represented thyroiditis. In the second case, an elevated T4 (RIA) and borderline elevated T3 resin uptake suggested the "dumping phase" of thyroiditis. The two cases indicate that "benign" diseases of the thyroid can be associated with diffuse radiogallium concentration in the gland.

Eubacterium sp. strain VPI 12708 is a human intestinal isolate which has an inducible bile acid 7-dehydroxylation activity. At least two cholic acid-induced polypeptides, with molecular masses of 27,000 and 45,000 daltons, respectively, coelute with bile acid 7-dehydroxylation activity. The 45,000-dalton polypeptide appears to be encoded by a cholic acid-induced mRNA species of greater than 6 kilobases, which suggests that the gene coding for this polypeptide is part of a larger operon. A gene has been cloned which flanks the gene encoding the 45,000-dalton polypeptide, in the upstream (5') direction. This gene appears to encode a second 27,000-dalton polypeptide. The gene bears striking homology at both the nucleotide (80%) and deduced amino acid sequence (89%) levels with the gene which encodes the 27,000-dalton polypeptide that has been shown previously to be involved in the bile acid 7-dehydroxylation reaction sequence. The implications of this homology and the possible function(s) of the two homologous genes in bile acid 7-dehydroxylation are discussed. Evidence is presented which suggests that the two homologous genes involved in bile acid 7-dehydroxylation may be part of a larger multigene family in Eubacterium sp. strain VPI 12708.

We assessed blood pressure (BP) and heart rate (HR) responses in a double-blind, randomized study comparing cilazapril, a long-acting, nonsulfhydryl-group converting enzyme inhibitor, with placebo in 18 patients with mild to moderate (sitting diastolic BP, 95 to 114 mm Hg) essential hypertension. The BP and HR parameters were evaluated at rest (casual, 24 hours after administration), during treadmill exercise testing (Bruce protocol), and with 24-hour noninvasive ambulatory BP monitoring. These assessments were made after a 4-week drug washout period and after 8 to 12 weeks of therapy. After 8 weeks of therapy with cilazapril (mean dose 3.6 +/- 0.9 mg/day), casual BP decreased 19/11 mm Hg (p less than 0.01), whereas placebo lowered BP by 4/5 mm Hg (difference not significant) compared with the baseline period. The casual HR was modestly (7 beats/min) but significantly (p less than 0.05) lowered by cilazapril monotherapy. Exercise BP was reduced by cilazapril (reduction at peak HR, 23/11 +/- 10/5 mm Hg; p less than 0.05), and exercise HR was unchanged. Compared with baseline, the duration of exercise was improved with cilazapril but not with placebo (1.0 minute vs -0.2 minute; p less than 0.05). Twenty-four-hour mean, awake, and sleep BPs were reduced with cilazapril with the most impressive reduction occurring during the awake period (19/12 mm Hg; p less than 0.01). These data demonstrate that cilazapril lowers casual, exercise, and ambulatory BP with a modest but significant improvement in exercise time. Thus cilazapril may be particularly effective in the physically active hypertensive patient.

To assess the effect of potent vasodilator therapy in patients with severe or resistant hypertension, 10 patients underwent therapy with captopril and nifedipine alone and in combination. Blood pressure (BP), heart rate, and blood chemistry values were monitored for 4 weeks during captopril monotherapy and after 8 weeks during combination therapy with captopril and nifedipine. Compared with baseline, the BP decreased during captopril monotherapy (180 +/- 11/98 +/- 7 vs. 209 +/- 16/118 +/- 12 mm Hg; P less than 0.005). After the addition of nifedipine, the BP was further reduced (148 +/- 23/85 +/- 16 mm Hg), but there was no change in heart rate. In three patients not achieving the diastolic BP goal during combination therapy with dosing every 8 hours, automatic 24-hour ambulatory BP monitoring demonstrated lack of antihypertensive control for only the last 2 to 3 hours of the dosing interval. These data demonstrate that combination therapy with captopril and nifedipine is effective in patients with severe hypertension, but frequent dosing intervals are necessary for adequate antihypertensive control.

To determine the presence of cardiac disease in hypertensive patients with disparities between physician and out-of-office blood pressures, we prospectively studied three groups of age-matched patients identified by both casual (office) and ambulatory blood pressures: (1) office blood pressure greater than 140/90 mm Hg and awake ambulatory blood pressure of 130/80 mm Hg or less ("office" hypertensives); (2) office blood pressure less than 135/85 mm Hg and awake ambulatory blood pressure of 130/80 mm Hg or less (normotensives); and (3) office blood pressure greater than 140/90 mm Hg and awake ambulatory blood pressure of 140/90 mm Hg or greater ("daytime" hypertensives). In the patients with office hypertension, both the left atrial index and left ventricular mass index were significantly less than in patients with daytime hypertension and not statistically different from those of the normotensive subjects. Left ventricular filling rate at rest and ejection fraction at peak exercise were significantly greater in the office hypertensive group than in the daytime hypertensive group but were no different from those of the normotensive subjects. These findings demonstrate that patients with blood pressure elevation only in the physician's office have cardiac size and function similar to those of normotensive individuals. Thus, the average daily blood pressure best predicts cardiac end-organ damage.

Left ventricular hypertrophy resulting from hypertension is accompanied by significant morbidity and mortality and in advanced stages may be irreversible. Hence, early detection of cardiac changes in hypertensive patients remains an important diagnostic goal. When the hypertrophy is mild or moderate, parameters of left ventricular diastolic function and measurements of left atrial size may facilitate the distinction between normal variation and pathologic increases in left ventricular mass. We measured left ventricular isovolumic relaxation time (IVRT, the time from aortic valve closure to mitral valve opening) and left atrial dimensions and correlated them to left ventricular mass index measured by M-mode echocardiography and rapid left ventricular filling by radionuclide ventriculography. In 20 subjects with untreated mild essential hypertension, IVRT was prolonged compared to a normotensive age-matched control group (91 +/- 23 vs 65 +/- 13 msec, p less than 0.0001). Left atrial dimension index was increased in patients compared to controls (1.9 +/- 0.4 vs 1.4 +/- 0.5 cm/m2, p less than 0.001), and this increase was related to prolonged IVRT (r = 0.46, p less than 0.001). Abnormal IVRT correlated with both increased left ventricular mass and decreased rapid ventricular filling in the hypertensive subjects. Thus, prolonged IVRT and borderline left atrial dimension may help identify subtle pathologic left ventricular mass increases in hypertensive subjects.

Severe hypertension may be a difficult management issue, and it often requires therapy with multiple drugs at frequent dosing intervals. We report on the antihypertensive effects of the alpha-beta adrenergic blocking agent, labetalol, in combination with enalapril, a long-acting angiotensin-converting enzyme inhibitor, administered to 14 patients with severe hypertension (nine of whom had nephrosclerosis or renal artery stenosis) on other antihypertensive drug therapies. Blood pressure (BP), heart rate (HR), hematologic and blood chemistry values, and adverse side effects were monitored at 24 hours, 1 week, and 4 weeks of therapy. Rapid titration of the drugs was performed in the hospital in 10 patients; four were managed closely as outpatients. Following one month of combination therapy blood pressure decreased from 212 +/- 31/120 +/- 16 mm Hg at baseline to 155 +/- 19/86 +/- 12 mm Hg, and heart rate declined from 86 +/- 18 bpm to 70 +/- 16 bpm. Ten of the 14 patients (71%) maintained good BP control (BP less than 140/90 mm Hg) with no additional treatment. Serum potassium, creatinine, blood urea nitrogen concentrations, and hematologic parameters did not significantly change in 13 of 14 patients. Three patients developed symptomatic postural hypotension; in one patient this side effect resulted in discontinuation from the study. These data suggest that combination therapy with labetalol and enalapril is effective in lowering BP in patients with severe essential or renovascular hypertension. An additional advantage of this regimen is the twice-daily dosing interval, which may promote better long-term compliance.

The associations of age, blood pressure and cardiac structure with rapid left ventricular filling were assessed in 47 subjects (21 normotensives and 26 age-matched untreated hypertensives) by 24-h ambulatory blood pressure monitoring, sector-guided M-mode echocardiography and radionuclide ventriculography. Univariate analyses revealed strong negative correlations of the left ventricular filling rate with age, and 24-h systolic and diastolic blood pressure, and a moderate positive correlation with the left ventricular ejection fraction at rest. Multiple regression analysis was performed with these variables, left atrial size and left ventricular mass index. Left atrial size and the left ventricular mass index were dependent on 24-h blood pressure, indicating that these two cardiac structural variables were less important than left ventricular filling. Age was undoubtedly the most important correlate of left ventricular filling, since 88% of the subjects over 53 years of age had reduced left ventricular filling rates regardless of the blood pressure status. However, under the age of 53 years, only the hypertensives had reduced filling rates. Thus, our study shows that the left ventricular filling rate is more dependent on age and 24-h blood pressure than on the left ventricular mass index. Furthermore, in patients over 53 years of age, it is not possible to separate the effects of hypertension on the diastolic function of the heart from the physiological alterations associated with ageing.

To determine the associations of age, blood pressure (BP) and cardiac structure with left ventricular (LV) diastolic performance, 47 subjects (21 normotensives and 26 age-matched, previously untreated hypertensives) were studied by 24-hour ambulatory BP monitoring, radionuclide ventriculography and sector-guided M-mode echocardiography. Normotension was defined as an awake ambulatory BP less than 130/80 mm Hg and hypertension as an awake ambulatory BP greater than 135/85 mm Hg. Univariate analyses revealed strong negative correlations of LV filling rate with age (r = -0.67, p less than 0.001), 24-hour systolic or diastolic BP (r = -0.59 for systolic BP and -0.57 for diastolic BP, p less than 0.001 for both) and a modest positive correlation with LV ejection fraction (r = 0.42, p less than 0.05). After multivariate analysis, significant dependencies of both the left atrial index and LV mass index on ambulatory BP were found, which negated the significance of the relation of these 2 cardiac structural variables with LV filling rate. The final regression equation predicted LV filling rate from age, BP and LV ejection fraction. Age was the most important single correlate of LV filling, as evidenced by the 14 of 16 subjects (88%) over the age of 53 years (8 hypertensives, 6 normotensives) who had reduced LV filling rates compared with only 9 of the remaining 31 subjects (29%, all hypertensives) under the age of 53 years with reduced LV filling rates. These data demonstrate that LV filling rate is more dependent upon age and BP than left atrial or LV size.(ABSTRACT TRUNCATED AT 250 WORDS)

The distribution of blood pressure (BP) values over the day and night was assessed in a group of 30 never previously treated patients with mild-to-moderate essential hypertension via 24-hour ambulatory BP monitoring. Elevated BP values during the awake hours (greater than 140/90 mm Hg) and sleeping hours (greater than 120/80 mm Hg) were used to calculate the total percentage of abnormal BP values (load) in each patient. The relationship between BP load and several indexes of hypertensive cardiac target organ involvement was compared to the relationships among office (casual), 24-hour average BP values, and cardiac indexes. Casual systolic and diastolic BP values did not correlate with left ventricular mass index, left atrial index, or peak left ventricular filling rate. Both 24-hour average BP and systolic and diastolic BP loads correlated with all indexes of cardiac target organ involvement. The BP loads were related to left ventricular mass index and left atrial index more strongly than were the mean 24-hour BP values; however, they were equally correlated for peak left ventricular filling rate. If greater than 40% of the ambulatory BP values were elevated, the likelihood of increased mass or decreased filling was greater than 61%, whereas if less than 40% of the BP values were elevated, the incidence of an abnormal cardiac test result decreased to less than 17%. These data show that the percentage of elevated BP values that includes both the awake and asleep periods is predictive of cardiac target organ involvement in patients with mild-to-moderate hypertension. Patients with mild hypertension who have more than 40% abnormal BP values should strongly be considered for antihypertensive therapy.

Left ventricular hypertrophy is associated with abnormal left ventricular diastolic filling in patients with hypertension. To assess the effects of antihypertensive therapy on the heart in nine previously untreated patients with echocardiographically-detected left ventricular hypertrophy, left ventricular mass and rapid left ventricular filling rate were compared before and after 6 months of treatment with metoprolol monotherapy. Metoprolol was given in doses of 100 to 400 mg/day (average dose, 167 mg/day in two divided doses) and significantly reduced both casual, office blood pressure (150/101 to 130/86 mm Hg, p less than 0.01) and 24-hour ambulatory blood pressure (139/91 to 126/79 mm Hg, p less than 0.05 for systolic, p less than 0.01 for diastolic). Following treatment with metoprolol, left ventricular mass index decreased from 135 +/- 20 to 120 +/- 13 gm/m2 (p less than 0.05), while rapid left ventricular filling rate increased from 1.89 +/- 0.24 to 2.09 +/- 0.27 end-diastolic volumes/sec (p less than 0.01). The reduction in left ventricular mass index was secondary to decreased posterior and septal wall thicknesses (13% and 11%, respectively, p less than 0.05 for both), as there were no changes in the left ventricular internal dimensions. Neither resting nor exercise left ventricular ejection fraction changed on metoprolol therapy compared to the baseline values. These data demonstrate that regression of left ventricular hypertrophy in never-previously-treated hypertensive patients is accompanied by improved diastolic performance following beta-adrenergic blocker monotherapy.

We studied blood pressure (BP) and heart rate (HR) responses in 12 patients with hypertension who were receiving cetamolol, a cardioselective beta-blocker with intrinsic sympathomimetic activity. The BP and HR parameters were evaluated at rest (casual, office readings), with ambulatory BP monitoring, and after treadmill exercise testing. At a mean (+/- SD) dose of 46 +/- 21 mg/day, casual supine BP decreased by 10/12 mm Hg (P less than 0.05 for systolic; P less than 0.01 for diastolic) compared with placebo, while HR decreased 4 bpm. Cetamolol resulted in a significant reduction in the mean 24-hour systolic BP. The most striking reduction occurred in the BP at work (23 mm Hg), with almost no decrease in the BP during sleep. Ambulatory HR reductions occurred while the subjects were at work (9 bpm; P less than 0.05) but not while at home (awake) or during sleep. The mean duration of exercise was the same during cetamolol and placebo phases, but both HR and BP fell significantly at peak performance after cetamolol. These data suggest that cetamolol reduces BP without lowering HR at rest. During periods of increased adrenergic activity such as work and dynamic exercise, both HR and BP are reduced.

We compared simultaneous, same-arm blood pressure (BPs) obtained with the Accutracker, an ambulatory blood pressure (BP) monitor, which uses R-wave gating for Korotkoff sounds to those of both a blinded, skilled clinician using a mercury column and a three-channel graphic display of cuff pressure tracings, Korotkoff sounds, and ECG tracing. Eighteen subjects, with a wide variety of BPs, heart rates, and ages, participated in the study. The systolic BP obtained by the ambulatory recorder, clinician, and the three-channel strip chart recorder were 132 +/- 23 mmHg, 132 +/- 24 mmHg, and 133 +/- 25 mmHg, (all NS), respectively. Accutracker recorder-determined systolic BP correlated highly both with the clinician and strip chart readings (r = 0.98 and 0.97, respectively; p less than 0.0001 for both). The diastolic BP obtained by the Accutracker recorder was slightly, but significantly, lower than the clinician's readings (76 +/- 12 mmHg vs. 81 +/- 13 mmHg; p less than 0.005) and similar to the strip chart recorder readings (76 +/- 12 mmHg vs. 77 +/- 12 mmHg; NS). In 32 young, healthy subjects with no activity restrictions, 91% of the raw BP data from 24-hour ambulatory recordings was acceptable using strict deletion criteria. These data demonstrate that the Accutracker is highly accurate compared with clinician-determined blood pressures. The lower diastolic BP readings may stem from the ability of this device to detect softer Korotkoff sounds than can be detected by the clinician. These findings should be taken into consideration when using ambulatory BP monitoring in clinical trials of antihypertensive drugs.

The rarity of reported cases of cutaneous ulcerations in heroin abusers prompts this report of a 25-year-old man with a painless, slightly necrotic and purulent ulcer of the dorsal shaft of the penis. The differential diagnosis of the lesion and cutaneous manifestations of heroin abuse are reviewed. To our knowledge, this is only the second reported case of penile ulcer from heroin injection.

To assess the problem of continuing atenolol in a breast-feeding mother with hypertension associated with thyrotoxicosis, studies were performed to determine simultaneous plasma and breast milk concentrations of atenolol after a single dose of 50 mg and on continuous therapy of varying weekly dosages. Peak atenolol concentrations in breast milk were 3.6 times higher than simultaneous plasma atenolol concentrations after single-dose administration and 2.9 times higher after continuous-dose administration. A single plasma concentration obtained in the infant following a peak level feeding was less than 10 ng/ml. Although it would seem unlikely that the amount of atenolol excretion in breast milk should warrant interruption of breast-feeding because of maternal medication with ordinary doses, the infant should be evaluated for signs of beta-blockade.

Eubacterium sp. strain VPI 12708 is an intestinal anaerobic bacterium which possesses an inducible bile acid 7-dehydroxylation activity. Two cholic acid-induced polypeptides with apparent molecular weights of 27,000 and 45,000, respectively, coeluted with bile acid 7-dehydroxylation activity upon anaerobic high-performance gel filtration chromatography of crude cellular protein extracts. The 45,000-dalton polypeptide was purified to greater than 95% homogeneity by high-performance liquid chromatography gel filtration and high-performance liquid-DEAE chromatography. The first 28 amino acid residues of the N terminus of this polypeptide were determined by gas-phase sequencing, and a corresponding mixed oligonucleotide (20-mer) was synthesized. Southern blot analysis of EcoRI total digests of chromosomal DNA showed a 2.6-kilobase fragment which hybridized to the 32P-labeled 20-mer. This fragment was enriched for by size fractionation of an EcoRI total digest of genomic DNA and ligated into bacteriophage lambda gt11. Recombinant phage containing the putative gene encoding the 45,000-dalton polypeptide were detected with the 32P-labeled 20-mer by plaque hybridization techniques. The insert was 2.6 kilobases in length and may contain the entire coding sequence for the 45,000-dalton polypeptide. The 2.6-kilobase insert was subcloned into pUC8 and transformed into Escherichia coli DH5 alpha. However, the 45,000-dalton polypeptide was not detected in cell extracts of this organism when specific antibody was used. Preliminary nucleic acid sequence data correlated exactly with the amino acid sequence. A cholic acid-induced mRNA species of greater than 6 kilobases in size was identified by Northern (RNA) blot analysis of total RNA, suggesting that the gene coding for this polypeptide is part of a larger operon.

A previously healthy 29-year-old man developed multiple hepatic abscesses secondary to Fusobacterium nucleatum. No underlying local disease was found. The leading portal of entry for the bacterium may have been the oral cavity; 4 days before the onset of his illness he had had extensive dental work. Immunological evaluation during the illness and in late convalescence (16 weeks after onset) revealed a persistent B cell abnormality characterized by markedly depressed in vitro secretion of immunoglobulins in response to pokeweed mitogen; however, serum immunoglobulins and IgG subclasses were normal. Abnormal numbers of suppressor T cells (OKT8+) and increased suppressor function were also present. Anaerobic pyogenic liver abscesses may occur in the absence of obvious underlying disease, but this case suggests that there may be an association with in vitro abnormalities of the immune system.

Eubacterium species V.P.I. 12708 has inducible bile acid 7-dehydroxylase activity that can use either 7 alpha or 7 beta bile acids as substrates. Cell extracts prepared from bacteria grown in the presence of cholic acid catalyzed the rapid conversion of free bile acids into a highly polar bile acid metabolite (HPBA). This conjugation activity co-eluted with bile acid 7-dehydroxylase activity on high performance gel filtration chromatography (GFC). The HPBA was purified by a combination of high performance GFC and reverse-phase high performance liquid chromatography (HPLC). The intact HPBA eluted earlier from reverse-phase HPLC than deoxycholyl-CoA and had a Mr of 1102 by Bio-Gel P-2 (GFC). The HPBA had an absorption peak at 255 nm and was sensitive to treatment with phosphodiesterase I or nucleotide pyrophosphatase. The HPBA has a free phosphate as shown by an increase in elution volume on reverse-phase HPLC following treatment with alkaline phosphatase. Treatment of the purified HPBA with nucleotide pyrophosphate plus alkaline phosphatase yielded adenosine, whereas, treatment with nucleotide pyrophosphatase alone generated 5',3'-ADP. A bile acid metabolite was also generated by nucleotide pyrophosphatase treatment. The bile acid metabolite had different chromatographic properties (HPLC and TLC) than the corresponding free bile acid. Gas liquid chromatography-mass spectrometry showed the bile acid metabolite to be 12 alpha-hydroxy-3-oxo-4-cholenoic acid. We hypothesize that the HPBA is an intermediate in 7-dehydroxylation and consists of this compound linked at the C-24 with an anhydride bond to the beta phosphate (5') of ADP-3'-phosphate. These results suggest a novel mechanism of bile acid 7 alpha/7 beta-dehydroxylation in Eubacterium sp. V.P.I. 12708.

A culture filtrate from Trichoderma viride was used as a source of cellulose degrading enzymes. This filtrate, when added to a barley ration fed to chicks, improved growth and feed efficiency by 19% and 8%, respectively. The response was saturable since increasing amounts of filtrate above 50 mg/kg produced no further improvement. Barley eta-glucan was added to a corn-based diet (10 g/kg) to evaluate the effect of the culture filtrate on the viscosity of beta-glucan in the chick intestinal contents. Barley beta-glucan increased the viscosity of the supernatant of the chick intestinal contents threefold and the culture filtrate reduced the viscosity to near control levels when combined with the diet containing beta-glucan. The presence of beta-glucan in barley probably limits growth of chicks by increasing viscosity of intestinal contents.

Research conducted during the past decade has led to an understanding of many of the mechanisms responsible for the oceanic and atmospheric variability associated with the El Niño-Southern Oscillation (ENSO). However, the reason for one of the fundamental characteristics of this phenomena, its quasi-periodicity, has remained unclear. Recently available evidence from a number of sources now suggests that the ENSO "cycle" operates as a natural oscillator based on relatively simple couplings between the tropical atmospheric circulation, the dynamics of the warm upper layer of the tropical ocean, and sea surface temperatures in the eastern equatorial Pacific. This concept and recent field evidence supporting the natural coupled oscillator hypothesis are outlined.

Abnormal left ventricular diastolic performance, an early manifestation of hypertension in the heart, may precede the development of left ventricular hypertrophy. To assess effects of antihypertensive therapy on the heart, left ventricular mass (determined by echocardiography) and rapid left ventricular filling rate (determined by radionuclide ventriculography) were compared before and after 6 months of treatment of 16 patients. Nitrendipine (a dihydropyridine calcium channel blocker) was given alone or in combination with either propranolol or hydrochlorothiazide, or both, and significantly reduced blood pressure (156/103 +/- 12/7 to 137/89 +/- 10/6 mm Hg). In 6 of the 16 patients, left ventricular mass decreased by more than 10% (270 +/- 95 to 193 +/- 47 g, p less than 0.01); in the same patients, left ventricular filling rate increased (2.03 +/- 0.35 to 2.30 +/- 0.45 end-diastolic counts/s [EDC/s], p less than 0.01). In the one patient whose left ventricular mass increased (137 to 195 g), left ventricular filling rate decreased from 2.01 to 1.78 EDC/s. In the remaining nine patients who had no change in left ventricular mass, there was no significant changes in left ventricular filling. The changes in ventricular mass and filling could not be related to the extent of change in blood pressure or heart rate. These data suggest that regression of left ventricular mass during antihypertensive therapy with nitrendipine is accompanied by improved diastolic function.

Because of evidence of immunoregulatory effects of short-term administration of pooled donor gamma globulins, the effects of intravenous immune serum globulin were studied in nine adult patients with common variable hypogammaglobulinemia over a two-year period. Baseline assessment prior to immune serum globulin replacement included evaluation of B cell function, suppressor cell activity, and T cell subsets. These analyses were subsequently performed during the course of a first-year treatment period of intravenous immune serum globulin at doses of 100 to 200 mg/kg per month and a second-year trial at doses of 300 to 400 mg/kg per month. Five patients were re-evaluated following discontinuation of the intravenous immune serum globulin therapy for four months between the first and second treatment periods. During both treatment periods with intravenous immune serum globulin, suppressor cell activity increased markedly compared with baseline, and declined following discontinuation of drug therapy in the five patients. Suppressor cell activity was reversed by either irradiation of the T cell fraction or removal of the T8-positive cell fraction by flow cytometry. There was a reduction in the absolute number of total lymphocytes, the T3-positive cells (total T cells), and the T4-positive cells (helper cells) following intravenous immune serum globulin therapy; however, the percentages of the T cell subsets did not change significantly. Following immune serum globulin therapy, the number of T8-positive cells was not significantly changed but the T4:T8 ratio decreased from 2.1 at baseline to 1.5 after therapy (p greater than 0.05). These data demonstrate that long-term intravenous immune serum globulin administration modulates the immune system by increasing suppressor T cell functional activity but is not accompanied by changes in the number of T8-positive cells in the peripheral blood.

Topical anesthetics have always had a place in anesthetizing mucous membranes. The earliest writing in Greek medical literature makes reference to the use of these topical anesthetizing agents. Previous studies utilized a mixture of tetracaine, Adrenaline, and cocaine in the pediatric population with increased patient compliance. In contrast, another study cites the increased risk of infection in cases where topical anesthetics in combination with potent vasoconstrictors are used. To examine the efficacy and safety of a tetracaine and a tetracaine, Adrenalin, and cocaine mixture (TAC), a randomized, double-blind study was undertaken. A total of 68 patients participated in the study, with 36 receiving TAC and 32 receiving tetracaine. The results indicate that the most efficacious use of TAC is on facial lacerations, regardless of length or depth. Of the 46 participants available for follow-up, one patient in the tetracaine group reported a wound infection. A recommendation of increased use of TAC on facial lacerations, in both the adult and pediatric populations, is made based on the results of this study.

The characteristic blue color of the mineral kyanite is shown to be caused by traces of Ti(+++) in the range of a few parts per million. Evidence from the intensity and position of optical absorption bands indicates that the unusually intense color probably arises from electron delocalization into narrow d-bands.