Herbert L. Abrams

Influence of Age, Body Weight, and Sex on Susceptibility of Mice to the Lethal Effects of X-radiation.

Summary and Conclusions (1) The age at which mice are irradiated profoundly alters their resistance to a single exposure of whole body irradiation. Mortality is low after irradiation at 1 and 15 days of age, very high at 30 days, and decreases rapidly with increasing age thereafter. The possible mechanisms of this effect are discussed. (2) The response of mice to whole body irradiation is not related to body weight except insofar as weight reflects a particular age range. (3) In general, sex appears to exert no significant influence on the capacity of mice to withstand whole body irradiation.

Bidirectional Shunting in a Coronary Artery-Right Ventricular Fistula Associated with Pulmonary Atresia and an Intact Ventricular Septum

A case of an anomalous arteriovenous-like communication between the right ventricle and a single right coronary artery with pulmonary atresia and an intact ventricular septum in a 6-year-old boy is presented. The dynamics of blood flow through the anomalous vessel are demonstrated for the first time in the literature by means of cineangiocardiography. Factors affecting the flow of blood through the vessel, theories of the embryologic etiology of the condition, and clinical features allowing diagnosis during life and determining therapeutic management are discussed.

Persistence of Fetal Ductus Function after Birth The Ductus Arteriosus as an Avenue of Escape

Within recent years there has been increasing interest in the presence of reversed flow through the ductus arteriosus. Most reported cases have been in older children and young adults. There is a group of cases in which the ductus serves as a site of a veno-arterial shunt in infancy, and thus continues to perform its fetal function. The conditions under which veno-arterial shunting persists after birth are illustrated and analyzed, and an effort is made to clarify the common features of these lesions.

Can the Twenty-Fifth Amendment Deal with a Disabled President? Preventing Future White House Cover-Ups

Presidential infirmity, accompanied by a failure to fully inform the public, has been stamped indelibly on our history during the past two hundred years. Fourteen of the eighteen American presidents in the twentieth century had significant illnesses while in office.(1) Presidents also have faced physical threats leading to incapacity and death. Of the eight presidents who died in office, four were the victims of bullet wounds. From 1789 to 1958, there were eight assassination attempts against presidents; from 1963 to 1994, there were ten attempts, one successful. The threats are increasing in number.(2) Among the presidents in this century, Warren Harding, Woodrow Wilson, Franklin D. Roosevelt, Dwight Eisenhower, John F. Kennedy, and Ronald Reagan all had illnesses that were either concealed from the American people or underreported.(3) In response to Eisenhowers demand for a mechanism whereby a disabled president might transfer power temporarily to the vice president, the Twenty-fifth Amendment to the U.S. Constitution was passed by Congress in 1964,(4) was ratified by the states, and became the law of the land in 1967.(5) Its central purpose was to preserve cognitive competence in the White House at all times by ensuring that a sick or injured president, incapable of decision making in a crisis, will be temporarily relieved of the burdens of office.(6) A second goal was to forestall concealment of presidential disability by making the transfer of power to the vice president temporary, thereby assuring the president that he could reclaim office once he was able to do so. John D. Feerick, the most knowledgeable historian and legal scholar of the Twenty-fifth Amendment, observes, Since its adoption, the amendment has been implicated at least five different times and has proven its utility in providing for a quick and efficient transfer of presidential and vice presidential power.(7) Elsewhere, however, ` states that the amendment worked quite well in handling the presidential succession crises of 1973 and 1974 (dealing only with section 2 on replacement of the vice president) but that it did not work as it was intended in 1981 and 1985 (involving the important sections 3 and 4 on disability).(8) These two statements contradict each other; the generalization of a quick and efficient transfer of power cannot be equated with the failure to invoke it when President Reagan was disabled by John Hinckleys bullet in 1981.(9) Feerick contends that the fiascoes of 1981 and 1985 (when Reagan had surgery for colon cancer) do not reflect a basic weakness in the amendment but rather were born out of political considerations.(10) Can there be any doubt that such considerations will be operating at full steam whenever the possibility of presidential disability arises? How can we be sure that politics will not block the implementation of the Twenty-fifth Amendment in the future, at a time when the nation requires a strong, rational leader in full command of his intellectual and cognitive faculties? Senator Birch Bayh, the architect of the Twenty-fifth Amendment, has himself deplored the fact that sections 3 and 4 have not worked as the framers intended.(11) The amendments central problem is threefold. First, the issue is deeply embedded in a political culture where those who surround the president and are closest to his aberrant behavior or disabling illness are dependent for their positions and prestige on keeping him in office.(12) Second, a political judgment of disability by the vice president and the Cabinet must be based on a sound medical determination of impairment of such a degree that it impedes the presidents ability to discharge some or all of the duties of office. Third, a mechanism for providing this type of unbiased, accurate information on the presidents health never has been formally addressed. (To the extent that it has been considered, primary responsibility has been placed on the White House physician, who is enmeshed in a profound conflict of interest. …

Radiologic Aspects of Operable Heart Disease II. Retrograde Brachial Aortography

Patent ductus arteriosus and coarctation of the aorta are common causes of congestive heart failure in infancy, yet are more difficult to diagnose than in later life. Retrograde brachial aortography is a relatively simple method of establishing the diagnosis with assurance. A description ofthe technic is followed by a discussion of the normal aortogram in infancy. A relatively large series of cases, in which a high diagnostic yield was obtained, is analyzed. The hazards of the procedure are few if highly concentrated media are avoided and careful attention is paid to details of technic.

Cinefluorographic equipment in cardiovascular studies.

Summary Cinefluorographic systems presently available have been described with respect to their components and methods of operation. Brief discussions of cameras, film, processing, projection, and optical reduction printing have been included. Some of the applications of cine technic to clinical and investigative areas have been summarized, and the advantages and disadvantages of cine compared with those of large rapid filming technics.

Human Reliability and Safety in the Handling of Nuclear Weapons

The problem of accidental or inadvertent nuclear war has been couched largely in terms of superpower confrontations during a crisis. Whether the focus is on the major powers, or on developing nations with ballistic missiles and probable nuclear weapons capability, stability in those who handle weapons and effective safeguards on use are essential preventive measures. The United States and the USSR have been careful to guard against unauthorized launch. All nuclear nations have been concerned with retaining ultimate control of nuclear weapons in civilian hands; with monitoring the reliability and stability of the forces that handle the weapons; and with preventing weapons from coming into the possession of outsiders. In 1986, an analysis of the sources of human instability in those who handle nuclear weapons concluded that thousands of unstable individuals were involved in “minding our missiles.”1 The present paper serves as an update on the problem and links it to potential areas of increasing risk as the...

Radiologic Aspects of Operable Heart Disease: VI. Changes Following Surgical Closure of Patent Ductus Arteriosus

The preoperative and postoperative radiologic findings in 71 patients with patent ductus arteriosus treated surgically were investigated. The purpose of the study was to determine the magnitude, character, and rapidity of the changes observed, as well as the relationship of the postoperative change to complicating cardiovascular lesions. Serial examinations were compared with the preoperative studies and with each other, including an analysis of over-all heart size, individual chamber size, the pulmonary vessels, and the aortic silhouette. The results were tabulated and their significance was evaluated.

Symposium on the medical implications of nuclear war/Summary and perspective: With some observations on informed consent

A Symposium on the Medical Implications of Nuclear War, organized under the auspices of the Institute of Medicine, was held at the National Academy of Sciences, Washington DC, on 20–22 September 1985. The proceedings have been published in book form: The Medical Implications of Nuclear War,