DOCSLIB.ORG

I CEREBRAL BLOOD FLOW in HEART TRANSPLANT

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
I CEREBRAL BLOOD FLOW in HEART TRANSPLANT CEREBRAL BLOOD FLOW IN HEART TRANSPLANT RECIPIENTS AT REST AND DURING INCREMENTAL EXERCISE by JONATHAN DAVID SMIRL B.Sc., The University of Victoria, 2004 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE in College of Graduate Studies (Interdisciplinary Studies) [Health and Exercise Sciences] THE UNIVERSITY OF BRITISH COLUMBIA (Okanagan) September 2011 © Jonathan David Smirl, 2011 i Abstract Pathological impairments to cardiac output may impact cerebral blood flow (CBF). Prior studies on heart transplant recipients (HTR) have reported increases of 25-53% in CBF, 1-6 months following transplant. It is currently unknown if CBF is chronically altered in the years following transplant or during progressive exercise stress, when compared with aged- matched controls (AM). Donor population controls (DC) were included to determine if the responses observed in HTR are related to the age of the donor rather than the individual. The aim of this thesis was to examine the influence of long-term heart transplantation on the regulation of CBF velocity (CBFv) at rest and during incremental exercise. Two hypotheses were tested: 1) CBFv would be similar in HTR when compared to AM, but lower than DC; 2) that during incremental exercise, the HTR would have reduced elevations in CBFv compared with AM and DC. To address these hypotheses, HTR were tested who have a reported inability to acutely increase cardiac output during exercise. Seven male clinically stable HTR (62 ± 9 yrs of age, 9 ± 7 yrs post-transplant), seven male AM (62 ± 7 yrs), and seven male DC (22 ± 3 yrs) were recruited for this study. Bilateral middle cerebral arteries were insonated using transcranial Doppler ultrasound to obtain an index of CBFv. Data were obtained while seated and during an incremental cycling test to volitional exhaustion. A repeated measures ANOVA was applied to identify differences across exercise intensity. Comparisons between groups were performed with Fisher‟s LSD post hoc test. The main findings were: 1) Rest: CBFv was comparable between HTR and AM (40 vs. 41 cm/s), as expected, CBFv was 68% higher in the DC compared with the HTR and AM ii groups (P<0.05). 2) Incremental exercise: mean CBFv was not significantly different between the HTR and AM groups across any of the exercise intensities. In conclusion, the CBFv of long-term HTR are comparable to AM both at rest and during incremental exercise that despite a suppressed VO2 Peak (and likely Q) CBFv is well maintained during incremental exercise in long – term HTR. iii Preface This study was approved by the University of British Columbia Clinical Research Ethics Board (H11-02576 – CBF in HTR) and the University of Alberta Clinical Research Ethics Board. (Pro00011560). Chapters three, four and five are based on data collected in the Mazankowski Alberta Heart Institute at the University of Alberta by Dr. Philip Ainslie, Dr. Mark Haykowsky, Dr. Luis Altamirino-Diaz, Dr. Helen Jones, Kit Marsden, Mike Nelson and Jonathan Smirl. The data were analyzed in the cardiovascular physiology laboratory at the University of British Columbia by Jonathan Smirl. Dr. Ainslie and Dr. Haykowsky were responsible for the overall design and concept of the study, technical assistance, data collection, equipment acquisition, subject recruitment, and funding for the study. Dr. Altamirino-Diaz was responsible for the collection and analysis of the echocardiograph images. Dr. Jones, Kit Marsden and Mike Nelson assisted in the collection of the data. Jonathan Smirl was responsible for assisting in the overall study design and study concept. Jonathan coordinated the data collection involved in this study, and analyzed all of the data, including statistical analyses and writing. There has been a version of chapters three, four and five accepted for an oral presentation at Physiological 2011 (annual scientific meeting of the Physiological Society). Jonathan D. Smirl, Mark J. Haykowsky, Katelyn R. Marsden, Helen Jones, Michael D. Nelson, Luis A. Altamirano-Diaz, and Philip N. Ainslie. (2011) Cerebral blood flow in heart transplant recipients: rest and during exercise. Jonathan Smirl was responsible for the data collection, data analysis, writing, and formatting of the abstract. iv Table of Contents Abstract…….. ........................................................................................................................... ii Preface…………… .................................................................................................................. iv Table of Contents ..................................................................................................................... v List of Tables .......................................................................................................................... vii List of Figures ........................................................................................................................ viii List of Abbreviations ............................................................................................................... ix Acknowledgements .................................................................................................................. xi Dedication ............................................................................................................................... xii Chapter One: Introduction and Review of the Literature ...................................................... 1 1.1. Brief Background on Heart Transplantation .........................................................1 1.2. Regulation of CBF ...............................................................................................3 1.2.1. Neurogenic Control of CBF............................................................................4 1.2.2. Influences of Cardiac Function on CBF ..........................................................6 1.2.3. Autoregulatory Control of CBF ......................................................................9 1.2.4. Regulation of CBF by PaCO2 ....................................................................... 10 1.2.5. Effects of Cerebral Metabolism on CBF at Rest and During Exercise ........... 11 1.3. Cognitive Impairment in CHF ............................................................................ 12 1.4. Influences of Cardiac Disease on CBF ............................................................... 13 1.4.1. Congestive Heart Failure .............................................................................. 13 1.4.2. Ischemic Heart Disease ................................................................................ 14 1.5. Changes in CBF in HTR .................................................................................... 15 Chapter Two: Purpose, Aims and Hypotheses .......................................................................22 2.1. Purpose of Thesis ............................................................................................... 22 2.2. Aims .................................................................................................................. 22 2.3. Hypotheses ........................................................................................................ 23 Chapter Three: Methods .........................................................................................................24 3.1. Participants ........................................................................................................ 24 3.2. Instrumentation .................................................................................................. 27 3.3. Transcranial Doppler Ultrasound........................................................................ 29 3.3.1. Validity of TCD ........................................................................................... 31 3.3.2. Principle of TCD .......................................................................................... 31 3.3.3. Technique of TCD........................................................................................ 32 3.4. Incremental Cycling Exercise Protocol ............................................................... 33 3.5. Statistical Data Analysis..................................................................................... 34 v Chapter Four: Results .............................................................................................................35 4.1. Participant Characteristics .................................................................................. 35 4.2. Incremental Exercise Test .................................................................................. 35 4.3. Rest.................................................................................................................... 38 4.4. VO2peak ............................................................................................................... 40 4.5. HRreserve Relationships ........................................................................................ 43 4.6. Mild, Moderate and Intense Exercise ................................................................. 45 Chapter Five: Discussion and Conclusion ..............................................................................49 5.1. Principle Findings .............................................................................................. 49 5.2. Influence of HT on CBF at Rest - Comparison with Previous Studies................
Load more

Recommended publications
  • «I Stole with My Eyes»: Hamilton Naki, a Pioneer in Heart Transplantation
    Gaceta Médica de México. 2016;152 Contents available at PubMed www.anmm.org.mx PERMANYER Gac Med Mex. 2016;152:636-8 www.permanyer.com GACETA MÉDICA DE MÉXICO HISTORY AND PHILOSOPHY OF MEDICINE «I stole with my eyes»: Hamilton Naki, a pioneer in heart transplantation Julio César López-Valdés* Medical Directorate, Teaching and Research Head Office, ISSSTE, Ciudad de México; Universidad Autónoma de Tamaulipas, Facultad de Medicina de Tampico Dr. Alberto Romo Caballero, Tampico, Tamps., Mexico Abstract On December 2, 1967, when Denise Darvall was hit by a car, a surgery that made medical history was unfold: Hamilton Naki, a black man, expertly removed her heart and gave it to Christian Barnard, who was preparing the receptor, Louis Washkan- sky, in an adjacent operating room. Naki’s contribution was an outlaw act, a criminal offense under the laws of apartheid due to the difference of races; the law forbade him to cut white meat or touch white blood. Naki was perhaps the second most important man in the team that day. There were few photographs where he and Barnard appeared together, but because of the nature of society was Barnard who won the world’s attention. (Gac Med Mex. 2016;152:636-8) Corresponding author: Julio César López-Valdés, [email protected] KEY WORDS: Heart. Transplant. Christian Barnard. Heart transplant. “As I entered, a kindly looking big African gentleman looked up. ‘Yes my boy, what can I do for you?’ He was clearly in the middle of an operation, and on the other side of the table stood a white surgeon.
    [Show full text]
  • The Medical & Scientific Library of W. Bruce
    The Medical & Scientific Library of W. Bruce Fye New York I March 11, 2019 The Medical & Scientific Library of W. Bruce Fye New York | Monday March 11, 2019, at 10am and 2pm BONHAMS LIVE ONLINE BIDDING IS INQUIRIES CLIENT SERVICES 580 Madison Avenue AVAILABLE FOR THIS SALE New York Monday – Friday 9am-5pm New York, New York 10022 Please email bids.us@bonhams. Ian Ehling +1 (212) 644 9001 www.bonhams.com com with “Live bidding” in Director +1 (212) 644 9009 fax the subject line 48 hrs before +1 (212) 644 9094 PREVIEW the auction to register for this [email protected] ILLUSTRATIONS Thursday, March 7, service. Front cover: Lot 188 10am to 5pm Tom Lamb, Director Inside front cover: Lot 53 Friday, March 8, Bidding by telephone will only be Business Development Inside back cover: Lot 261 10am to 5pm accepted on a lot with a lower +1 (917) 921 7342 Back cover: Lot 361 Saturday, March 9, estimate in excess of $1000 [email protected] 12pm to 5pm REGISTRATION Please see pages 228 to 231 Sunday, March 10, Darren Sutherland, Specialist IMPORTANT NOTICE for bidder information including +1 (212) 461 6531 12pm to 5pm Please note that all customers, Conditions of Sale, after-sale [email protected] collection and shipment. All irrespective of any previous activity SALE NUMBER: 25418 with Bonhams, are required to items listed on page 231, will be Tim Tezer, Junior Specialist complete the Bidder Registration transferred to off-site storage +1 (917) 206 1647 CATALOG: $35 Form in advance of the sale.
    [Show full text]
  • The Daily Egyptian, December 05, 1967
    Southern Illinois University Carbondale OpenSIUC December 1967 Daily Egyptian 1967 12-5-1967 The aiD ly Egyptian, December 05, 1967 The aiD ly Egyptian Staff Follow this and additional works at: http://opensiuc.lib.siu.edu/de_December1967 Volume 49, Issue 52 Recommended Citation , . "The aiD ly Egyptian, December 05, 1967." (Dec 1967). This Article is brought to you for free and open access by the Daily Egyptian 1967 at OpenSIUC. It has been accepted for inclusion in December 1967 by an authorized administrator of OpenSIUC. For more information, please contact [email protected]. , ~. Carbondale,IIIinoi5 \ Volume 49 Tue5doy, December 5, 1967 ~ Number 52 Keene Seeks Ie Promise of Less Switc~ing Tie/ Ups By George M. KUlenberg Streets must be kept open to auto traffic if the city's pro­ Mayor David Keene s;lid posed east-west couple is to be WOn't oppose mlnols Cen­ succeed. tral·s plans to drop tbe Car­ b9ndale to St. Louis passen­ In other action concerning ger service If the railroad the IC's proposed move. the Carbondale Chamber of Com­ fI absolutely assures" him that the downtown crossing tleups merce bas concluded its poll caused by the IC' s switching of member's reactions to the operations wUl be reduced In plans to drop the St. Louis the process. trains, but said that the re­ sults would not be released It was reponed in another until at least this afternoon. newspaper Frtday that tbe ma­ yor told a group of railroad Tl}e Chamber's executive FRIGID FIGURE--An ice sculpture entitled the Activities Procramin& Board -as p a r t of representatives that he would director, Harry Weeks, said the Sphinx is examined by students on the request the Inte rstate Com­ the executive body of the or­ the Season of Holid s activities.
    [Show full text]
  • Sviets, Thais Whip Cong Twice in Drive for Big Holiday Victory
    LOW TIDE HIG);! TlDL 12-22-67 I '-L'::' - r:-7 3 AT 0218 ~ .;\T ,'I'll'. ,;' .. T"j-; 7 AT t400 VOL , No ISLANDS UNITED NATIONS(UPI)--U N DIPLO­ IsraelTryingto Buy SViets, Thais Whip Cong Twice MATS HAVE BEEN CRITICIZED fOR DOING NO MORE THAN TALK AND PASS RESOLU- Arms to M'Itch Arabs' TIONS If THAT'S ALL THEY DID, WASHINGTON (UPI)--lsRAEl, rEELING In Drive for Big Holiday Victory THEY DID IT WEll IN 1967 THE U.N THREATtNEO BY MASSIVE SOVIET ARMS ::lA-IGO', (U~'I)--VIET CO~G f"ORCES TRYING TO MOUNT or,EN5IVES IN THEIR PRINTING OffICE WHICH CHURNS OUT TO ITS ARAB N~IGHBORS, \[K0NG DELTA STRONGHOLD surrERED TWO SEVERE DErEATS TODAY, AND GEN. COPIES OF SPEECHES, RESOLUTIONS, IS MAKING A CONCERTED BID TO BUY \'''ILLIIIM C \-JESTMDRElAND SAID THE COMMUNISTS HAD "STRUCK OUT" IN AT­ MEETING SUMMARIES, AND WHAT_NOT MILITARY EQUIPMENT FROM THE T['F'T5 TO Wlr~.<\ ~1AJOR VICTORY BErORE THE CHRISTM.<\S TRUCt PAPER WORK, THrs YEAR PRODUCED STATES BUT US orrlCIALS ~0l'TH V,ETNAMESE TROOPS AND THEIR THAI ALLIES KILL[D 128 COMMUNISTS 5i'2,073,729 PAG£S or IT THAT REPORTED TODAY TO aE RESPONO­ W.,ILE: SUFFERlr,G ONLY rOUR or THEIR OWN MEN KilLED IN TWO BATTLES INTERNAL U N PRINTING ALONE NEGATIVELY TO ISRAELI PLEAS, THE RLLIED VICTORIES rRUSTRATED VIET CONG ATTACKS ON SAIGON'S OUTER FARM OUT SOME or THE WORK THE UNITED STATtS IS JUST PE"II~ETER QErtNSES AND ROOTED .<\ COMMUNIST UNIT OUT Of' ITS lONG-HELD CORRESPONDENTS rROM ALL OVER THE THE ONLY POSSIBLE SOURCE or SANCTUARY DEEP IN THE DELTA PADDY lANDS THEY HAVE DOMINATED rOR MORE WORLD HAD AMPLE "SOURCES"
    [Show full text]
  • Medical Journal
    Br Med J: first published as 10.1136/bmj.4.5582.757 on 30 December 1967. Downloaded from BRITISH MED ICAL JOURNAL LONDON SATURDAY 30 DECEMBER 1967 Pointers Neurological Damage in Parturition: Minor damage is not necessarily detected by classical neurological examination. Standardized quanti- tative observations are suggested to reveal handi- caps and facilitate rearing these infants (p. Cardiac Transplantation 763). Leader at p. 761. On 3 December Professor Christian Barnard and his colleagues replaced Obstetric Analgesia: Assessment by anaesthe- the heart of 55-year-old Louis Washkansky with that of a tist, patient, and midwife indicate that 0.35% 25-year-old girl methoxyflurane is suitable for intermittent self- mortally injured in a road accident. On 21 December Washkansky died, administration during labour (p. 767). apparently from pneumonia. It is worth noting that the rejection process Oral Contraceptives: Undesirable menstrual itself can cause pulmonary disease, but according to press reports the side-effects of microdoses of chlormadinone disease was infective in the present case. After a necropsy showing diminished by addition of oral oestrogens (p. that 771). death was due to pneumonia Professor Barnard was reported' as saying Pneumoconiosis: Gas transfer defect of lungs that there was no clinical evidence to suggest that rejection played a part found in 10 out of 16 patients whose radio- in the death, and there was no evidence for human heart transplants to be pacities were of pure pinhead type, but in discontinued. Despite its sad conclusion this was an outstanding none of 11 men whose opacities were micro- surgical nodular in type (p.
    [Show full text]
  • History of Heart Transplantation: a Hard and Glorious Journey
    SPECIAL ARTICLE - HISTORIC Braz J Cardiovasc Surg 2017;32(5):423-7 History of Heart Transplantation: a Hard and Glorious Journey Noedir A. G. Stolf1, MD, PhD DOI: 10.21470/1678-9741-2017-0508 INTRODUCTION contractions were seen. Afterward contractions appeared and about an hour after the operation, effective contractions of This year we celebrate 50 years of the first interhuman heart the ventricles began. The transplanted heart beat at the rate of transplantation. So, I believe that it is interesting to review the 88 per minute, while the rate of the normal heart was 100 per most important steps of this glorious journey. minute. A little later tracing was taken. Owing to the fact that Heart transplantation first performed in the course of the operation was made without aseptic technique, coagulation experiments of other nature in the beginning of 20th century, occurred in the cavities of the heart after about two hours, and seen as a speculation for the future in the middle of the same the experiment was interrupted”. century, is now widely accepted by medical and lay communities Although the exact details of experiments were not known as a valuable therapeutic procedure. the most probable arrangement of anastomosis are shown in This history can be divided into an experimental and a Figure 1 adaptation in a book by Najarian and Simmons[2]. The clinical heart transplantation periods, with the first one in problem with this model is that arterial inflow is in the atrium heterotopic non-auxiliary, heterotopic auxiliary and orthotopic and aortic outflow is under venous pressure, in other words, transplantations.
    [Show full text]
  • Never Judge a Book by Its Cover
    Never Judge A Book By Its Cover: Nor Any People! 41st Annual Seminar of The American Academy of Cardiovascular Perfusion February 5 – 8, 2020 Grand Sierra Resort Reno, Nevada Compiled By: Steven W. Sutton, L.P., C.C.P. ▪ One should not form an opinion on someone or something based purely on what is seen on the surface, because after taking a deeper look, the person or thing may be very different than what was expected. ▪ This “Idiom” means to judge not by the looks. It goes back to at least the mid-19th century. It makes an appearance in the newspaper Piqua Democrat, June 1867 Piqua, Ohio: “Don’t judge a book by its cover, see a man by his cloth, as there is often a good deal of solid worth and superior skill underneath a jacket and yaller pants.” ▪ The Greatest Nation On Earth ▪ We “All” Must Contribute To Eliminating Racism – It Begins With Each Of Us! ▪ “African people in America have lost our history. In many cases it’s been taken away from us. ▪ But the problem … even more pervasive … is that we’ve lost our taste to learn our history Dr. Burnie ▪ History exposes past accomplishment, Gallman so “we don’t have to recreate” the wheel. “All we have to do is respect and study our ancestors and build upon what they did.” ▪ Dr. Evans was born June 23, 1872, in Aiken and was a Schofield graduate who attended Oberlin College in Ohio on scholarship and the Women’s Medical College of Pennsylvania, where she received her M.D.
    [Show full text]
  • Christiaan Neethling Barnard
    406 Hanisberg, Govendrageloo, Hunter, Levin incompetence following ductal occlusion are DB. Valvar regurgitation in normal children: is it clinically significant? Cardiol Young 1992;2:291-7. needed. The factors to be considered would 3 Brand A, Dollberg S, Keren A. The prevalence of valvular include the size of the duct, continuous blood regurgitation in children with structurally normal hearts: A colour Doppler echocardiographic study. Am Heart J pressure monitoring, and direct measurements 1992;123: 177-80. of systemic vascular resistance. 4 Kostucli W, Vandenbossche J, Friart A, Englert M. Pulsed Doppler regurgitant flow patterns of norrnal valves. Am J Cardiol 1986;58:309-13. 1 Yoshida K, Yoshikawa J, Shakudo M, Akasaka T, Jyo Y, 5 Ward JB, Sholler GF. Aortic run-off in children with arterial Heart: first published as 10.1136/hrt.77.5.406 on 1 May 1997. Downloaded from Takao S, et al. Color Doppler evaluation of valvular regur- shunts or persistent arterial duct-characteristics of flow gitation in normal subjects. Circulation 1988;78:840-8. detected by Doppler techniques in the descending aorta. 2 Mattos SdaS, Severi R, Cavalcanti CV, Freire M da F, Filho Cardiol Young 1995;5:51-5. STAMPS IN CARDIOLOGY Christiaan Neethling Barnard (1922-) South Africa issued a set of two stamps in 1969 ond patient was a dentist, Dr Philip Blaiberg, to commemorate the first heart transplant and who received a transplant on 2 January 1968. the 47th South African Medical Association He lived for one year and seven months and Congress. The 21 cent stamp depicts Professor was the first good medium term survivor.
    [Show full text]
  • The Man with a Young Woman's Heart 30 November 2017
    The man with a young woman's heart 30 November 2017 Fifty years ago South Africa stunned the world: A Human Heart". surgeon in Cape Town, Christiaan Barnard, successfully transplanted the heart of a woman 'It's going to work!' into the chest of a dying man. The operation starts in the early hours of December Here is a narrative, largely based on AFP reporting 3. at the time, of the extraordinary details surrounding the first human-to-human heart transplant. Denise's heart is removed and placed in a 10-degree Celsius (50-degree Fahrenheit) solution A terrible accident for transfer to an operating room where around 20 doctors, nurses and technicians are gathered Ann Washkansky could not have imagined that the around Louis. traffic accident she comes across on December 2, 1967, would bring both life and fame to her The tension is knife-edge, a young intern who was terminally ill husband. present recounts in an AFP story filed the following day. As Washkansky is driving back from visiting her husband at Groote Schuur Hospital in Cape Town "When the last anastomosis (connection) was when she sees a vehicle slam into Denise Darvall, done, it was the moment of truth. Everyone craned a young bank worker, as she is crossing a busy their necks for a better view. In the complete road. silence, Professor Barnard murmured: 'Christ, it's going to work!'," says the intern, whose name is not Her body flies through the air and her head given. smashes into a parked car, fracturing her skull.
    [Show full text]
  • Catalogue 09-2019 Science and Medicine, 21 New Arrivals
    Catalogue 09-2019 Science and Medicine, 21 new arrivals To access our website for more images, click on the author's name! Anatomy: ............................................................................................................... 4, 11, 20 Astronomy & Astrophysics: ................................................................................. 15, 17, 18 Botany: .............................................................................................................................. 3 Geology & Geophysics: ...................................................................................................... 9 Mathematics: ........................................................................................................ 5, 14, 16 Medicine: ..................................................................................... 1, 2, 6, 10, 11, 13, 17, 21 Pharmacy: ........................................................................................................................ 10 Physics including Optics: ......................................................................................... 7, 8, 12 Norman Catalog: ............................................................................. 5, 7, 12, 14, 17, 20, 21 Milestones of Science Books phone +49 (0) 421 1754235 www.milestone-books.de . [email protected] Member of ILAB and VDA Catalogue 09-2019 Copyright © 2019 Milestones of Science Books. All rights reserved Page 2 of 23 Announcing the discovery of Alzheimer's disease 1 ALZHEIMER, Alois. Über
    [Show full text]
  • Locating the Moment of Death
    three Locating the Moment of Death For some time thoughtful men have been increasingly troubled by the present attitude in the medical profession: “You’re dead when your doctor says you are.” Desmond Smith, The Nation At the end of the 1960s, when transplant surgeons first contemplated the systematic use of patients believed to be irreversibly unconscious as a source of human organs, a new legal definition of death was urgently needed to prevent physicians from being charged with murder. It was essential that the new death be a diagnosable event and that it be timed to allow the removal of organs while they remained “fresh” and rea- sonably well oxygenated. No longer based on the commonsense notion of the end of life—a failure of the heart and lungs—the new death is determined by the condition of the brain alone, even though the body clearly remains biologically alive, albeit with mechanical assistance. Identification of the moment of brain death was designed primarily to avert legal complications, but it was also necessary to reassure the public. The very existence of ventilator-dependent patients raised two concerns: first, the fear of being counted dead before one’s time and overhastily designated an organ donor; second, the fear of being kept alive too long, as a “vegetable,” with severe, irreversible brain damage, but not technically brain-dead (Pernick 1999:4). Although this development has depended on technological innova- tion, it is rarely attributed to technology alone. The ventilator is simply a tool at our service. It is the moral status of “living cadavers” as alive or dead that has been troubling.
    [Show full text]
  • B; Riln~ T to Pres· Ent Newplan Fo~: Britain's Entry Into
    University of Nebraska at Omaha DigitalCommons@UNO Kabul Times Digitized Newspaper Archives 1-4-1968 Kabul Times (January 4, 1968, vol. 6, no. 224) Bakhtar News Agency Follow this and additional works at: https://digitalcommons.unomaha.edu/kabultimes Part of the International and Area Studies Commons Recommended Citation Bakhtar News Agency, "Kabul Times (January 4, 1968, vol. 6, no. 224)" (1968). Kabul Times. 1672. https://digitalcommons.unomaha.edu/kabultimes/1672 This Newspaper is brought to you for free and open access by the Digitized Newspaper Archives at DigitalCommons@UNO. It has been accepted for inclusion in Kabul Times by an authorized administrator of DigitalCommons@UNO. For more information, please contact [email protected]. -.. ,,' '.• .., ., i , .'. '. , . , ., " - ,. I ... ~V _ < • IV I,~: ~AGE 4'" ... - ":, :.>fuE .~~. TIMES , ..' '--'":"---:-'~~ '~'....;.. ,,:"i...,"":'='=;"~" ~':"'_':';;',...:...:;..::.....:..,.. , ., , --- ---.-_...... ------------ ....;..:.---...:..:..:..,,"....::'....' ',,:. -'.-;r....:... .......:.......;._.:- • I ,I ' ,','I .i', " .":;:";1, j '\. • I ' ~ .'. t •• , .,'.' If. • 'I ••r.. \ .., .- " , -' '. ' , , .".<, " •. , ·S~ " sc.viet. /I , ".: \,1 " " Escalation Canlf '~e' uS . ' . ,. '. 'E"S'" Players , Toj) ,, 'In Vietnam, Says Brezh~v " , '. :' ::, , British. Champs . , :, t, . •' I '~ .'.• ".. )~!'. ~ .• ,' ...,. ~ .. ," BUDAPEST, Jan. 3. (AFP).­ tnbute to Hungary for offering \ , . , , "'~,~.'1, ( ',' .,!,'{('.1 ,," . " '!' .• ," . ,', . ~~: 'I';:~: ~,",\; Soviet Communist Party
    [Show full text]