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Das Papyrusblatt ist nur auf einer Seite beschrieben; die Schrift verlauft mit den Fasern. Drei Rander sind erhalten; nur oben ist der Papyrus abgebrochen. Zur Datierung der Schrift vgl. P.Heid. IV 297 mit Tafel V (171–176 n.Chr., vgl. BL IX 103) und P.Turner 32 mit Tafel XIII (201–211 n.Chr.). Die Vertauschung von λ und ρ in Z. 8, welche oft im faijumischen Dialekt vorkommt, weist moglicherweise auf eine Herkunft des Textes aus dem Arsinoites hin, vgl. Gignac, Grammar I, 102–107, bsd. 106–107; ferner C. Milani, λ/ρ nei papiri: un aspetto dell’interferenza linguistica in E. Bresciani — G. Geraci — S. Pernigotti — G. Susini (Hgg.), Scritti in onore di Orsolina Montevecchi, Bologna 1981, 221–229, bsd. 227.

The collectors of money-revenues of Roman Egypt were responsible for exacting money from individual tax-payers and transferring it to the local banks. Both of these operations are well illustrated by documents issuing from the collectors’ offices.

Aus Mumienkartonage gewonnen. Der rechte Rand ist verloren, an den ubrigen Seiten sind die Rander nahezu vollstandig erhalten. Das Verso ist unbeschrieben. Die Schrift, eine Kursive des 2. Jahrhunderts v.Chr., ist teilweise abgerieben. Eine genauere Datierung der Quittung wird dadurch moglich, das der Darlehensvertrag, auf den in Z. 5–8 verwiesen wird, in einem 38. Regierungsjahr abgeschlossen wurde, wofur im 2. Jahrhundert nur das Jahr 133/2 in Betracht kommt.

Die rechteckige Tafel aus hellem Holz war etwa auf der Halfte ihrer Breite nach in zwei Teile zerbrochen. Am oberen Rand befinden sich zwei Bohrungen im Abstand von 3,8 cm zueinander.1

About the sheet of papyrus used for this draft see the introduction to 9 above. On its recto here are written two apparently unconnected paragraphs, inverted top-to-foot from the text on the verso. The first, a, preserves the right half of 26 lines, of which 7–14 slightly expand the addendum in the top margin of 7.63–66 (where Harpocration’s wills appear to be mentioned for the first time), while 15–19 are paralleled in 11e.1–4,and 20–25 offer a version of the text overleaf at 9.30–36.

How this text, written transversa charta like 16, may relate to Ammon’s other petitions of A.D. 348 is not clear, since its phrasing so far as it is preserved provides no parallels with other texts in the archive. That it is a petition (probably to the prefect, see line 11 n.) is assured by άξιŵ at line 11. That it is related to the case concerning Harpocration’s slaves seems indicated by Ammon’s familiar draft-hand and by the presence on the verso of a section of Ammon’s principal petition to the catholicus (15). The cause of this appeal is not apparent.

Two small disconnected fragments bearing six consecutive lines, the left having a preserved narrow left margin, a lacuna of about 13 to 15 letters between the left and right fragments, the right extending to within 3 or 4 letters of the lost right margin. Between lines 2 and 3 on the right and lines 3 and 4, 5 and 6 on the left are interlinear insertions. The text is closely written in a small version of Ammon’s draft-hand, characteristic of the insertions and addenda he has inscribed in the margins of drafts 7 and 13, to neither of which can 8 belong. It apparently was added in the margin of still another draft not otherwise represented or recognized in the Duke and Koln collections.

In what, as far as I have ascertained, is the longest private letter surviving among the papyri, Ammon writes from Alexandria to his mother (Senpetechensis, whose Greek name is Nike [13.49], the second wife of his father Petearbeschinis1) in Panopolis, apparently the matriarch of the family. She has sent Ammon to Alexandria to negotiate pending matters of family concern, and the letter is his report on his progress thus far together with news of his brother Harpocration. His stay in Alexandria on his current mission was clearly quite extended (col. ii.13).

The poorly preserved text, on the verso of 7 but turned 90° so as to be written along the fibers, is not a continuous draft of the petition but a series of different sections or notes in nonsequential order. 11a begins with an expanded and interpolated version echoed in 7, 9 and 13; lines 11a.8–20 introduce text not preserved in extant fragments of the other drafts; a.21 and 23 are paralleled at 13.33 and 25 respectively; 11b differs from all other drafts; 11c.3–8 modify 7.23–28 (a sequence improved in turn at 13.38–42) and 9.13–16, inserting the text of c.5–6 into 9.15 as also do 7 and 13; c.10ff offer text not found elsewhere, while 11d.1–4 have a modified version of the content of 9.11–12 and 13.30–33; 11e.1–4 parallel 10a.15–19 until 11 breaks off at e.4 in mid-line. A paragraphus occurs at the left margin between lines c.2 and 3. Other paragraphi may have been inscribed preceding 11d and 11e.

In the preambles to two of the drafts of his petition to the catholicus Flavius Sisinnius in December A.D. 348 (7.3f and 13.9f) Ammon says of himself “While I myself, to be sure, know that a quiet life free from intrigue befits those educated in philosophy and rhetoric...” As if to document his claim, he has left us in his archive the fragments of a private memorandum written in his own informal hand listing the principal philosophers with whose works he had become acquainted in the advanced education he had received, presumably in Panopolis, in preparation for his profession as scholasticus. The hand of the memorandum is so similar to that of his drafts of 348 that it appears to have been written not long before. The verso is uninscribed.

Despite the contract which has been negotiated between Ammon and Eugeneios in Panopolis and which provided for a division of the slaves, Ammon has received a summons to appear before the court of the catholicus Flavius Sisinnius, named here for the first time in the papyri. He arrives in Alexandria just before the expiration of the appointed twenty-day interval (beginning 27 Hathyr = 23 xi 348) on 11 Choiak (7 xii 348) and for two days searches in vain to make contact with Eugeneios. In order to establish that Eugeneios can offer no pretext at the expiration of the interval, Ammon draws up this document for presentation to the catholicus through a public notary (ταβοeλάριος). On such notifications for the purpose of protecting one’s rights see Mitt. Grundz. pp.33f and Meyer, Jur.Pap. p.314. A parallel to our text is P .Ant. II 88 (probably A.D. 221)1 and the affidavit addressed to the Idios Logos, Mitt. Chr. 68 (A.D. 14), in which the parties likewise charged in an informer case (the Nestnephis case) declare their presence at the conventus in Alexandria. On unexcused failure to appear at a court-appointed date see A. Steinwenter, Studien zum romischen Versaumnisverfahren (Munich 1914) pp.73–91. On assessment of a fine for unexcused absence cf. P. Flor. I 6.24.

This is the first surviving draft to contain the fully elaborated preamble to the petition, which would have been preceded only by the address in a final copy. The text is further revised and expanded by 13.

Through 3 we learn of Ammon’s intervention with the high-priest of Alexandria and All Egypt in the attempt to secure for his nephew Horion II appointment to the propheteia of the Panopolite nome in succession to his father Horion I, Ammon’s elder half-brother now deceased. Although the required fee (eίσκριτκόν) seems to have been paid, it appears that neither Ammon’s efforts nor Harpocration’s appeal to the emperor have been successful, for the following petition of Horion II apparently to the prefect, composed and written for him by Ammon in his best formal hand, seeks the prefect’s authority to overrule the high-priest. Obviously this copy of the petition was not submitted, for reasons that can be only speculated, perhaps because the high-priest complied in the meantime.

On a tall sheet of papyrus of which only the right half is preserved in the Duke collection, Ammon has written drafts of paragraphs for inclusion in his formal petition to the catholicus. Apparently he had cut a length from a roll that had the same height (27–28 cm) as 7 and 13, which indeed may have been cut from the same roll; the length reveals two kolleseis about 17.5 cm apart, each overlapping about 2 cm. He rotated this sheet a quarter-turn so that the fibers of what had been the verso of the roll were now horizontal; making this the front of his vertical sheet on which he wrote first along the fibers, he then turned it over upside down and wrote P.Duke inv. 18r against the fibers (l0a and 10b).

The phenomenon of isolated mechanical alternans of the right ventricle is described in the setting of right ventricular infarction. We also discuss the resemblance of right ventricular infarction to cardiac tamponade or pericardial constriction.

Although postoperative constrictive pericarditis is rare, the diagnosis should be considered when unexplained right-sided heart failure develops after cardiac surgery. Within a 6 week interval, evidence of constrictive pericarditis developed in three patients who had recently undergone myocardial revascularization. One patient presented with biventricular failure, pericardial effusion and suspected tamponade. Severe constrictive pericarditis was demonstrated at subsequent operation. An apparent postpericardiotomy syndrome preceded evidence of right heart failure in the other two patients. Etiologic considerations include the possibility that pericardial irrigation with povidone-iodine (Betadine) solution may have contributed to subsequent fibrosis.

A national study was carried out to determine the relative costs of PTCA and CABG. Baseline clinical criteria for the 2 groups were similar. Data were collected in 186 sets for the PTCA group and 175 sets for the CABG group. Male patients make up 81% of the PTCA group and 80% of the CABG group. Mean hospital stay was 12 +/- 5 days in the CABG group, compared with 4 +/- 2 days in the PTCA group (p less than 0.001). The base charges for hospital and professional components of the CABG procedure were $15,580 +/- $2,159, whereas the same charges for the PTCA procedure were $5,315 +/- $2,159 (p less than 0.001). With an 80% primary success rate, which was the group mean success rate, the average dollar savings per PTCA procedure would be $7,149, or $7,149,000 per 1,000 cases. Thus, PTCA for revascularization in 1-vessel CAD is significantly more cost-effective than CABG in the short term.

A prospective series of 100 patients undergoing coronary artery bypass was divided into two groups for analysis of myocardial preservation by topical hypothermia with and without cold cardioplegia. The aorta was irrigated with a single bolus (750 cc) of cold cardioplegic solution in the study group. In addition, local hypothermia was achieved with cold topical saline. Local hypothermia alone was employed in the control group. Core cooling to 28° C was utilized for both groups. Fifty-two patients returned for late follow-up evaluation including biplane left ventriculography and coronary arteriography. Five had perioperative myocardial infarction and were eliminated from the study. Comparison of postoperative with preoperative ejection fraction (EF) in the remaining 47 showed no significant change in the study group. There was some decrease of the EF in the control group but the change was not highly significant (p = 0.083). Comparison of the change of the EF between the two groups was not statistically significant. There was no significant difference in the pre- and postoperative levels of serum glutamic oxaloacetic transaminase (SGOT) or creatinine phosphokinase (CPK), and electrocardiograms failed to demonstrate superiority of either preservation technique. The serum lactic dehydrogenase (LDH) enzymes were significantly lower in the study group on postoperative days 1, 2, and 3 (p = 0.01). Failure to demonstrate a definite advantage for use of cold cardioplegia may have derived from the method of application, which consisted of a single bolus of solution. We believe that assessment of any method of cardioplegia should include an objective index of myocardial performance such as EF measured by identical techniques before and after operation.

Angiographers may inappropriately avoid the transfemoral access route when a prosthetic aortic bifurcation graft exists. An aortofemoral graft will necessitate overdilatation of the femoral puncture site to allow adequate manipulation. If the puncture transverses both walls of the femoral limb of the graft into the native artery, further withdrawal of the catheter will allow reentry into the graft. When an aorta-to-external-iliac, end-to-side graft is present, transfemoral catheterization will frequently result in the guide wire or catheter tip terminating in the occluded common iliac artery. By choosing the proper catheter, entrance into the distal limb of the proximally communicating graft may be achieved. For the unwary operator, these confusing situations may result in failure to properly catheterize the graft. The methods of successfully overcoming these problems are discussed and illustrated.

Coronary artery disease (CAD) and myocardial perfusion were assessed by arteriograms and scintigrams (Technetium-99 microspheres alone or combined with Iodine-131 albumin macroaggregates) in 178 angina pectoris patients with and without the electrocardiographic (ECG) syndrome of septal fibrosis and with greater than or equal to 70% obstruction in one or more coronary arteries. The ECGs of 96 patients without angiographic evidence of obstructive CAD were also examined for the ECG syndrome of septal fibrosis. Patients with the ECG syndrome of septal fibrosis have significantly higher incidences of positive exercise stress test, of greater than or equal to 70% narrowing of the proximal left anterior descending (LAD) artery, of severe proximal LAD disease, and of more extensive left ventricular hypoperfusion than patients without the ECG syndrome. The fact that only 4% of patients without obstructive CAD have the ECG syndrome of septal fibrosis indicates the usefulness of the syndrome in identifying a subset of angina pectoris patients with advanced CAD of the proximal LAD and diffuse left ventricular hypoperfusion.

A three-dimensional left coronary bypass graft catheter with a sidewinder configuration is described. It is best suited for superior origins of left coronary bypass grafts. This graft catheter has been used successfully from the femoral route in more than 620 patients without serious complications. The method for using this catheter from the femoral route is described.

The hemodynamic response to nitroglycerin administration, to sublingual or oral administration of isosorbide dinitrate, or to a placebo was evaluated and compared in 37 patients with unstable angina pectoris under resting, pain-free conditions. Patients with congestive heart failure were not included in this study. Serial measurements of mean arterial blood pressure (MAP), pulmonary arterial end-diastolic pressure (PAEDP), cardiac index (CI), and heart rate (HR) were obtained for one hour following nitroglycerin administration and for four hours following sublingual or oral administration of isosorbide dinitrate. Echocardiographic end-diastolic volume (EDV) measurements were obtained for the groups receiving isosorbide dinitrate or placebo. There was a significant (P less than 0.05 or less than 0.1) reduction of the MAP (5 to 10 mm Hg) that persisted for more than four hours following both sublingual and oral administration of isosorbide dinitrate. The changes in the PAEDP, HR, and CI following sublingual or oral administration of isosorbide dinitrate were small and not significant. In the group receiving isosorbide dinitrate sublingually, the EDV was reduced by more than 30 ml below the placebo group (P less than 0.1) for up to four hours. The effects of nitroglycerin administration were similar in magnitude but of much shorter duration (three to four hours for sublingual and oral administration of isosorbide dinitrate vs 15 to 30 minutes for nitroglycerin). These data demonstrate that the duration of the hemodynamic effects of sublingually and orally administered isosorbide dinitrate in patients with unstable angina pectoris and normal resting hemodynamics is 8 to 12 times longer than that of nitroglycerin.