Purification and characterization of branched chain alpha-keto acid dehydrogenase complex of bovine kidney.

A branched chain alpha-keto acid dehydrogenase-dihydrolipoyl transacylase complex was purified to apparent homogeneity from bovine kidney mitochondria. As usually isolated, the complex (s(20,w) = 40 S) contained little, if any, dihydrolipoyl dehydrogenase. When saturated with the latter enzyme the complex had a specific activity of about 12 mumol of alpha-ketoisovalerate oxidized per min per mg of protein at 30 degrees with NAD(+) as electron acceptor. In addition to alpha-ketoisovalerate, the complex also oxidized alpha-ketoisocaproate, alpha-keto-beta-methylvalerate, alpha-ketobutyrate, and pyruvate. The ratios of the specific activities were 2.0:1.5:1.0:1.0:0.4, and the apparent K(m) values were 40, 50, 37, 56, and 1000 muM. The complex was separated into its component enzymes. The branched chain alpha-keto acid dehydrogenase (6 S) consists of two different subunits with estimated molecular weights of 46,000 and 35,000. The dihydrolipoyl transacylase (20 S) contains apparently identical subunits of molecular weight about 52,000. In the electron microscope, the transacylase has the appearance of a cube, and the molecules of branched chain alpha-keto acid dehydrogenase appear to be distributed on the surface of the cube. In contrast to the pyruvate dehydrogenase complex of bovine kidney, the branched chain alpha-keto acid dehydrogenase complex apparently is not regulated by phosphorylation-dephosphorylation. Its activity, however, is subject to modulation by end-product inhibition.


Globin mRNAs are primers for the transcription of influenza viral RNA in vitro.

Because influenza viral RNA transcription in vitro is greatly enhanced by the addition of a primer dinucleotide, ApG or GpG, we have proposed that viral RNA transcription in vivo requires initiation by primer RNAs synthesized by the host cell, specifically by RNA polymerase II, thereby explaining the alpha-amanitin sensitivity of viral RNA transcription in vivo. Here, we identify such primer RNAs, initially in reticulocyte extracts, where they are shown to be globin mRNAs. Purified globin mRNAs very effectively stimulated viral RNA transcription in vitro, and the resulting transcripts directed the synthesis of all the nonglycosylated virus-specific proteins in micrococcal nuclease-treated L cell extracts. The viral RNA transcripts synthesized in vitro primed by ApG also directed the synthesis of the nonglycosylated virus-specific proteins, but the globin mRNA-primed transcripts were translated about 3 times more efficiently. The translation of the globin mRNA-primed, but not the ApG-primed, viral RNA transcripts was inhibited by 7-methylguanosine 5'-phosphate in the presence of S-adenosylhomocysteine, suggesting that the globin mRNA-primed transcripts contained a 5'-terminal methylated cap structure. We propose that this cap was transferred from the globin mRNA primer to the newly synthesized viral RNA transcripts, because no detectable de novo synthesis of a methylated cap occurred during globin mRNA-primed viral RNA transcription. Preliminary experiments indicate that other purified eukaryotic mRNAs also stimulate influenza viral RNA transcription in vitro.


Estrogen receptor has enhanced affinity for bromodeoxyuridine-substituted DNA.

The estrogen receptor (E2R) from rabbit uterus has an enhanced affinity for BrdUrd-substituted DNA compared to unsubstituted DNA. Increasing levels of BrdUrd substitution (from 0 to 100%) in a DNA sample are associated with increasingly tighter binding of E2R to that DNA as measured by equilibrium competition experiments and by rates of dissociation (or receptor transfer experiments). Although the rates of dissociation of E2R-DNA complexes vary greatly, depending on the BrdUrd-substitution level in the DNA, no differences were detected between the rates of association of E2R with unsubstituted and fully BrdUrd-substituted DNA. The E2R-DNA complex dissociates more rapidly in 150 mM KCl than in 50 mM KCl; but, at both ionic strengths, BrdUrd substitution in the DNA confers enhanced stability on the complex. The demonstration that a specific mammalian regulatory protein has an enhanced affinity for BrdUrd-substituted DNA further strengthens the possibility that BrdUrd modulates gene expression through an altered binding of regulatory proteins.


Effect of anesthetics and pressure on the thermotropic behavior of multilamellar dipalmitoylphosphatidylcholine liposomes.

The effects of gaseous anesthetics and pressure on the thermotropic behavior of multilamellar dipalmitoyl-phosphatidylcholine liposomes were studied by using a high-sensitivity differential scanning calorimeter. It was found that halothane and enflurane decreased the transition temperature and increased the width of the transition without affecting the enthalpy change for the main gel-to-liquid crystalline transition. This demonstrated that the anesthetics decreased the degree of cooperative interaction between phospholipid molecules within the bilayer. Increasing the pressure increased the transition temperature but did not affect the transition width or enthalpy change. However, the increase in pressure reversed the effect of anesthetic on both the transition temperature and transition width. It is suggested that an understanding of the effect of anesthetics on the degree of cooperative interaction between phospholipids may be a key to understanding anesthetic action.


Asymmetric displacement currents in giant axons and macromolecular gating processes.

An electrical-chemical gating model is proposed that describes basic observations on asymmetric displacement currents and transient Na+ conductivity changes in squid giant axons. A previously developed single-parameter analysis of primary voltage clamp data yields normal mode relaxation times that agree well with the time constants of asymmetric capacitative currents, suggesting these currents as gating currents associated with charge displacement in a subunit of a complex gating system. The physical-chemical approach correlates the opening of Na+ channels with charge-charge interactions amongst displaceable membrane charges or dipoles and conformational changes in gating macromolecules. The model covers the close correspondence between the voltage dependence of the peak value of the Na+ conductance change and that of the square of the total displaced charge for small depolarizing voltage steps. The quadratic charge relationship also describes the two-mode relaxation of asymmetric displacement currents; the transiently inhibited return transition of two-thirds of the displaced charge after a prolonged depolarization is interpreted to reflect a dissipative chemical gating process.


Detection of 31P nuclear magnetic resonance signals in brain by in vivo and freeze-trapped assays.

The (31)P NMR spectrum of energy-related metabolites under strictly aerobic conditions in rapidly respiring tissues under physiological conditions has been approached by the study of the (31)P NMR signals in vivo and in freeze-trapped organs. Freezing the head of the anesthetized animal by liquid N(2), excision of the brain tissue (white and gray matter) at -196 degrees , and transfer to the NMR tube occurs without alteration of the metabolite concentrations. The sample is warmed to the region -15 degrees to -10 degrees , at which temperatures there is sufficient mobility for recording (31)P NMR at concentrations characteristic of brain tissues ( approximately 5 mM) with an adequate signal to noise ratio in 10 min but insufficient mobility for significant enzymatic activity. A approximately 0.4-sec acquisition time is adequate for nuclear relaxation and a 10-min scan gives an adequate signal to noise ratio. Metabolism of creatine phosphate, P(i), and sugar phosphates occurs by 1 hr at -10 degrees and 2 hr at -12 degrees . Extrapolation of the approximately zero order kinetics of disappearance of creatine phosphate and appearance of P(i) suggests that <10% of these two metabolites has been altered in the time of the first measurement.A comparison of the freeze-trapped state and the in vivo metabolite pattern is afforded in preliminary experiments on the head of the living mouse (brain and skeletal tissue) in aerobic and anaerobic states. Longer relaxation times and mild hypoxia due to the restricted diameter of the NMR tube gives significantly lower creatine phosphate/ATP values for this condition. Both direct in vivo and freeze-trapped assays of energy-related metabolites afford excellent approaches to the detection of anoxia and to the evaluation of metabolic control in hypoxic conditions.


Mechanism of phage Mu-1 integration: nalidixic acid treatment causes clustering of Mu-1-induced mutations near replication origin.

Frequencies of Mu-1-induced mutants of Escherichia coli have been compared under two different experimental conditions: cells in exponential growth and the same cells treated with nalidixic acid. The average of values obtained from the nalidixic acid-treated culture is 3 times higher than that obtained from the control. Individual ratios of the frequency of mutants in the two cultures yield decreasing values from 6 to 1, starting from the point of origin of DNA replication to the termini of DNA replication. These results are compatible with the idea that Mu-1 integrates at the replication fork.


Stimulation of in vitro activation and the acrosome reaction of hamster spermatozoa by catecholamines.

Capacitation and the acrosome reaction of mammalian spermatozoa are essential for fertilization. In vitro results are presented that demonstrate that catecholamines stimulate activation (a whiplash flagellar movement characteristic of capacitated hamster spermatozoa) and the acrosome reaction. Protein-free ultrafiltrates of bovine adrenal cortex and medulla preparations stimulated motility, activation, and acrosome reactions of hamster spermatozoa in the presence of bovine serum albumin. The medulla preparation was more effective than the cortex preparation in the stimulation of activation and acrosome reactions. Epinephrine (0.5-50 muM) and norepinephrine (50.0 muM) in the presence of bovine serum albumin and a partially purified protein-free cortex preparation also stimulated activation and the acrosome reactions. Both activation and acrosome reactions in the presence of epinephrine were inhibited by the adrenergic antagonists phentolamine and propranolol, suggesting the involvement of alpha- and beta-adrenergic receptors in the stimulation of capacitation and the acrosome reaction. In addition, phenylephrine, an alpha-adrenergic agonist, was as potent as epinephrine in the stimulation of acrosome reactions, but activation was reduced. Isoproterenol, a beta-adrenergic agonist, was as potent as epinephrine in the stimulation of activation, but acrosome reactions were reduced. High percentages of both activation and acrosome reactions were observed only in the presence of epinephrine, norepinephrine, or phenylephrine and isoproterenol together.


Mid-G1 marker protein(s) in 3T3 mouse fibroblast cells.

Quiescent 3T3 mouse fibroblast cells in a state of growth arrest due to serum deprivation were exposed to [14C]isoleucine. The cell cultures were then stimulated by the addition of 10% fetal calf serum. At various times after stimulation, the 14C-labeled cells were exposed to [3H]isoleucine. Cytoplasmic extracts from the double-labeled cells were subjected to sodium dodecyl sulfate/slab gel electrophoresis. By these procedures it was found that the relative rate of synthesis of a protein species of Mr 50,000 increased after stimulation of quiescent cells, reached a maximum at 5 hr, and then decreased before the 3T3 cells began to enter the S phase. The characteristic peaking profile of mid-G1 protein synthesis exhibited by the Mr 50,000 polypeptide can serve as a useful marker for the progression of events in G1 prior to exit into S.


Partial purification and characterization of the intercellular bridge from cultured mouse cells.

At the completion of mitosis, the two daughter cells are connected by a channel of membrane-bound cytoplasm, the intercellular bridge. This structure contains parallel arrays of spindle microtubules which are associated, at the bridge midline, with a metallophilic band called the midbody. In an effort to characterize midbody components, intercellular bridges were partially purified. The purification consisted of brief sonication of telophase populations of mouse L929 cells in order to shear intercellular bridges from daughter cells, digestion of chromatin by an excess of micrococcal nuclease, and differential centrifugation to enrich for intercellular bridges. Electron microscopy of these preparations substantiated the identity of the bulk of material as intercellular bridges. After solubilization with sodium dodecyl sulfate, the protein components of these preparations were iodinated with Na(125)I and separated by two-dimensional gel electrophoresis. From these analyses, the major polypeptide components of intercellular bridges appear to be tubulin, varying amounts of plasma membrane proteins, and a polypeptide with an apparent molecular weight of 42,000. Time-course studies reveal that this polypeptide is first detectable in a pelletable form approximately 30 min after cells are released from metaphase block, reaches maximal spot intensity in late telophase, and is no longer detectable in G1 populations. We interpret these data to suggest that the 42,000-dalton polypeptide is a component of the midbody.


Bromodeoxyuridine mutagenesis in mammalian cells: mutagenesis is independent of the amount of bromouracil in DNA.

Studies were undertaken to determine how a line of mutant Syrian hamster melanoma cells (HAB-2E) that displays unlimited growth potential when all of the thymine residues in nuclear DNA are replaced by bromouracil (BrUra) could avoid the deleterious effects of bromodeoxyuridine (BrdUrd) mutagenicity. It was found that BrdUrd could be mutagenic to these cells. However, there was a nonlinear relationship between mutagenicity and the amount of BrUra in the DNA of the HAB-2E cells. With these cells, mutagenicity apparently is determined by the concentration of BrdUrd to which the cells are exposed rather than the amount of BrUra in DNA. These results were obtained with both the induction of ouabain resistance and thioguanine resistance as markers for mutagenesis. The dependence of BrdUrd mutagenicity on BrdUrd concentration was also observed for the parental melanoma cells.


Induction of ornithine decarboxylase activity in a temperature-sensitive cell cycle mutant of Chinese hamster cells.

We have investigated the induction of ornithine decarboxylase (L-ornithine carboxy-lyase, EC 4.1.1.17) activity in a temperature-sensitive cell cycle mutant of Chinese hamster fibroblasts. This activity is not induced at the nonpermissive temperature, although the synthesis of the majority of proteins is normal. From a combination of studies with inhibitors of mRNA synthesis and maturation (alpha-amanitin, and cordycepin) and of proteins synthesis (cycloheximide, diphtheria toxin, and emetine), we conclude that the temperature-sensitive block is at the level of translation of one or more specific mRNAs.


Differences in alpha and beta polypeptide chains of tubulin resolved by electron microscopy with image reconstruction.

Electron microscopic techniques have been used to reveal two classes of subunits of tubulin in ordered arrays. Presumably the two classes correspond to the alpha and beta polypeptide chains of tubulin that have been distinguished by chemical criteria. The two types of subunits alternate along individual protofilaments in microtubules, microtubule-precursor sheets, and extended zinc-tubulin sheets. The resolution of the two types of polypeptide chains is achieved by improved negative staining methods which produce micrographs with layer lines at 28 A(-1) and 84 A(-1) in optical or computed transforms, in addition to the layer lines at 21 A(-1) and 42 A(-1) described previously [Crepeau, R. H., McEwen, B., Dykes, G. & Edelstein, S. J. (1977) J Mol. Biol. 116, 301-315]. In microtubules or microtubule-precursor sheets, adjacent protofilaments are staggered by about 10 A, but parallel, in the sense that the alpha-beta vector points in the same direction for all of the protofilaments of the microtubule. However, for the sheets assembled in the presence of zinc, adjacent protofilaments are staggered by about 21 A and oriented in an antiparallel arrangement with alternate protofilaments related by a 2-fold screw axis. The antiparallel alignment of the protofilaments in the zinc-tubulin sheets accounts for their planarity (no tubular structures are found in the presence of moderate concentrations of zinc), since the intrinsic curvature found with parallel alignment of protofilaments in the absence of zinc would be cancelled by the antiparallel arrangement.


Does 3'-terminal poly(A) stabilize human fibroblast interferon mRNA in oocytes of Xenopus laevis?

Polynucleotide phosphorylase (polyribonucleotide:orthophosphate nucleotidyltransferase, EC 2.7.7.8) purified from Escherichia coli was used enzymatically to deadenylate polyadenylated human fibroblast interferon mRNA preparations obtained from human diploid fibroblasts (FS-4 strain) induced by poly(I)-poly(C) (20 microgram/ml) in the presence of cycloheximide (50 microgram/ml, 4 hr). Both the polyadenylated and the deadenylated interferon mRNA preparations were translated into biologically active human interferon when injected into oocytes of Xenopus laevis. In the oocytes the functional stability of deadenylated interferon mRNA was indistinguishable from that of polyadenylated interferon mRNA.


Endoplasmic reticulum and autophagy in rat hepatocytes.

Electron microscopy of hepatocytes in both normal rat liver and rat liver treated to induce hyperplasia of smooth endoplasmic reticulum shows that autophagic vacuoles and residual bodies (types of lysosomes) are continuous with endoplasmic reticulum.


Inducers of DNA synthesis present during mitosis of mammalian cells lacking G1 and G2 phases.

The cell cycle analysis of Chinese hamster lung fibroblast V79-8 line by the premature chromosome condensation method has confirmed the absence of measurable G1 and G2 periods. Sendai virus-mediated fusion of mitotic V79-8 cells with G1 phase HeLa cells resulted in the induction of both DNA synthesis and premature chromosome condensation in the latter, indicating the presence of the inducers of DNA synthesis above the critical level not only throughout S phase, as it is in HeLa, but also during mitosis of V79-8 cells. No initiation of DNA synthesis was observed when G1 phase HeLa cells were fused with mitotic CHO cells. These results indicate that the presence or absence of a G1 period in the cell cycle depends on the levels of the inducers of DNA synthesis present in the cell during mitosis.


Sodium-dependent amino acid transport by cultured hamster cells: membrane vesicles retain transport changes due to glucose starvation and cycloheximide.

Enhanced alpha-aminoisobutyric acid transport by hamster cells cultured in the absence of D-glucose has been demonstrated in isolated membrane vesicles. The observed enhancement was seen in the presence but not in the absence of Na+. Kinetic analysis of transport using both the intact cells and the membrane vesicles showed that the overall enhancement was associated with an increase in Vmax. Decreases in transport activity by intact cells resulting from extended exposure of the cells to inhibitors of protein synthesis, such as cycloheximide, were also evident in membrane vesicles. The use of metabolically inactive membrane vesicles demonstrated that amino acid uptake by intact cells is a transport property of the plasma membrane. In addition, this study shows that membrane vesicle preparations can be exploited for the purpose of studying the regulation of amino acid transport. Taken together, the data suggest that carrier turnover is involved in the regulation of amino acid transport in animal cells.


Human milk stimulates DNA synthesis and cellular proliferation in cultured fibroblasts.

Human milk contains a mitogenic factor that stimulates DNA synthesis and cell division in mouse and human fibroblasts in vitro. Milk at a concentration of 1% (vol/vol) is as active in stimulating DNA synthesis as is 5% (vol/vol) human serum and 10% (vol/vol) calf serum. The mitogenic activity of human milk is destroyed by incubation with trypsin and chymotrypsin. However, neither urea, guanidine hydrochloride-dithiothreitol, nor exposure to pH 1 will inactivate the milk-derived growth factor. Gel filtration and isoelectric focusing indicate that the mitogenic activity of human milk has a molecular weight between 14,000 and 18,000 and an isoelectric point between 4.4 and 4.7.


Asymmetric budding of viruses in epithelial monlayers: a model system for study of epithelial polarity.

Infection of two different lines of polarized epithelial cells grown as monolayers with several types of enveloped viruses results, for each virus type, in a characteristic asymmetric budding of virions. Influenza virus (WSN strain), simian virus 5, and Sendai virus bud exclusively from the free (apical) surface of the cells, while vesicular stomatitis virus acquires its envelope only from the basolateral plasma membrane. Because different viruses select specific domains of plasma membrane in the same cell type, virus-infected epithelial monolayers can provide an excellent model system for studies of the mechanisms that generate regional differences in the distribution of plasma membrane components of epithelial cells.


Isolation of malaria merozoites: release of Plasmodium chabaudi merozoites from schizonts bound to immobilized concanavalin A.

The ability of concanavalin A to bind erythrocytes but not malarial parasites was used for the development of a method of merozoite isolation: cells from infected blood were allowed to bind to a column of concanavalin A linked to Sepharose beads and merozoites naturally released by maturation of the schizonts bound to the gel were collected. The principle of this method allows its application to several Plasmodium species. The kinetics of merozoite production and the quality of the preparations (purity, infectivity, and ultrastructural morphology) were investigated by using Plasmodium chabaudi.


Extent of genetic variation at a highly polymorphic esterase locus in Drosophila pseudoobscura.

The esterase-5 locus of Drosophila pseudoobscura has been screened for variation by using a wide variety of electrophoretic conditions and by testing heat sensitivity. Among 50 isogenic lines from 17 populations, 21 genetic variants were found at the locus, 18 by electrophoresis and 3 by heat denaturation. Including alleles previously known, there are a total of 30 alleles at this locus in natural populations. This represents a doubling of the previous estimates of polymorphism at this locus. The study confirms that, in contrast to monomorphic loci, loci judged polymorphic under one detection procedure show large increases in polymorphism when examined extensively.


Teratocarcinoma cells as vehicles for introducing specific mutant mitochondrial genes into mice.

The immediate purpose of the experiment was to establish a means of introducing specific mitochondrially encoded mutant genes into mice. Mouse teratocarcinoma stem cells were used as vehicles for the cytoplasmic markers because of their known capacity for normal somatic and germinal differentiation after injection into blastocysts. The mutation of choice, chloramphenicol resistance (CAP(R)), was first produced in a melanoma cell line by mutagenesis and selection. The CAP(R) trait was then transferred from a resistant melanoma cell to a sensitive (CAP(S)) teratocarcinoma cell by fusing to the latter only the cytoplasmic portion of the CAP(R) donor. This indirect route demonstrated the cytoplasmic provenance of the mutation. Protein synthesis in mitochondria isolated from the cybrid, or cytoplasmic hybrid, cells was barely affected by chloramphenicol, in contrast to the inhibitory influence of the drug on mitochondria of the parent teratocarcinoma line. Cells of the cybrid clone resembled teratocarcinoma cells and retained their ability to form diverse tissues in solid tumors produced from subcutaneous grafts. Cells from the tumors were retransplanted and were tested periodically by culture in chloramphenicol; they were found to be stably CAP(R) even after 16 weeks in vivo in the absence of the selective agent. The CAP(R) cybrids were microinjected into blastocysts of another inbred strain and, after transfer to foster mothers, mosaic mice were obtained. They comprised both cybrid- and blastocyst-derived cells in various tissues, as indicated by strain-specific nuclear markers. These results demonstrate successful normal differentiation of the CAP(R) lineage in vivo. Teratocarcinoma cybrids thus offer a practical portal of entry of preselected mitochondrial genes into mice. This will ultimately permit in vivo investigation of maternally transmitted traits, of mitochondrial genetic influences in specialized cells, and of possible roles of cytoplasmic genes in clinical and disease states.


Serological analysis of cell surface antigens of malignant human brain tumors.

Sera from 30 patients with astrocytoma were tested for antibody reacting with cell surface antigens of cultured autologous astrocytoma cells. Ten percent of the patients had antibody detectable by mixed hemadsorption assays, approximately 50% by immune adherence and protein A assays, and 100% by anti-C3-mixed hemadsorption assays. Absorption analysis of reactive sera with autologous, allogeneic, and xenogeneic cells permitted the definition of three classes of astrocytoma cell surface antigens. Class I antigens showed an absolute restriction to autologous astrocytoma cells. Class II antigens were shared by all astrocytomas tested and could be detected also on neuroblastoma, sarcoma, and some (but not all) melanoma cell lines; these antigens were not found on cell lines derived from carcinomas or normal tissues. Class III antigens were widely distributed on cultured normal and malignant cells of human and animal origin. In this series, sera from 2 patients recognized class I antigens, 4 patients' serum recognized class II antigens, and 13 patients' sera recognized class III antigens. Absorption tests have shown that the AJ (class II) antigen of astrocytoma is serologically related to the previously described AH (class II) antigen of melanoma; in tests of nine melanoma cell lines, there was a correspondence between the AJ and AH phenotypes. This method of autologous typing provides a way to classify the cell surface antigens of astrocytomas and to assess the clinical significance of humoral immunity to these antigens.


Systemic bacillus Calmette-Guérin (BCG) activates natural suppressor cells.

Addition of normal C57BL/6 mouse bone marrow cells to an in vitro culture of normal C57BL/6 spleen cells and allogeneic P815-Y tumor cells inhibited the development of cell-mediated immunity. Bacillus Calmette-Guérin (BCG) enhanced the suppressive activity of these bone marrow cells as early as 2 days after its intravenous administration to donor mice and elicited similar activity in the spleen by 7 days. Concomitant with the appearance of suppressor cells in the spleen there was a decrease in bone cell number and an increase in spleen cell number. While normal spleen cells failed to inhibit immunization, spleen cells from thymectomized, irradiated, bone marrow-reconstituted mice were inhibitory. Administration of BCG further increased the suppressive activity of spleen cells in these T cell-deprived mice. From this evidence it appears that systemic administration of BCG activates natural suppressor cells in the bone marrow and elicits suppressor cells in the spleen through the migration and colonization of the spleen by bone marrow elements.


Appearance of beta-endorphin-like immunoreactivity in human ventricular cerebrospinal fluid upon analgesic electrical stimulation.

beta-Endorphin-like immunoreactivity in human ventricular cerebrospinal fluid was measured with a specific radioimmunoassay. The subjects were undergoing a surgical procedure for relief of chronic intractable pain. This procedure involved the focal stimulation of a medial thalamic site adjacent to the wall of the third ventricle. Samples were collected before and during the analgesic stimulation. No beta-endorphin-like immunoreactivity could be detected prior to stimulation, suggesting that baseline levels are below 25 fmol/ml of cerebrospinal fluid. Electrical stimulation led to substantial increases (13- to 20-fold) in immunoreactive material in every subject. These results suggest that beta-endorphin-like material can be released into the ventricular system and may contribute to the pain blockade that results from periventricular stimulation.


Influence of hyperinsulinemia, hyperglycemia, and the route of glucose administration on splanchnic glucose exchange.

The effects of hyperinsulinemia, hyperglycemia, and the route of glucose administration on total glucose utilization and on net splanchnic glucose exchange were studied in 20 normal volunteers with the hepatic venous catheter technique. Euglycemic hyperinsulinemia [induced by a priming plus continuous infusion of insulin resulting in plasma insulin levels of 400-1200 muunits (international)/ml and a variable glucose infusion] caused a 5- to 6-fold increase above basal in total glucose turnover. However, net splanchnic glucose uptake (0.5 +/- 0.2 mg/kg per min) accounted for only 4-5% of total glucose utilization. When hyperglycemia (223 +/- 1 mg/dl) was induced in addition to hyperinsulinemia by the intravenous infusion of glucose, splanchnic glucose uptake increased 100% to 1.0-1.1 mg/kg per min but was still responsible for only 10-14% of total glucose utilization. In other studies hyperglycemia (223 +/- 2 mg/dl) was maintained constant by a variable intravenous infusion of glucose for 4 hr and oral glucose (1.2 gm/kg) was administered at 1 hr. After the oral glucose, net splanchnic glucose uptake increased to values 6-fold higher than with intravenous glucose despite unchanged plasma glucose levels and plasma insulin concentrations well below those observed in the studies with euglycemic hyperinsulinemia. The results indicate that hyperinsulinemia or hyperglycemia induced by intravenous infusion of glucose or insulin causes minimal net uptake of glucose by the splanchnic bed despite marked stimulation of total glucose turnover. In contrast, administration of glucose by the oral route has a marked stimulatory effect on net splanchnic glucose uptake. These findings suggest that orally consumed glucose causes the release of a gastrointestinal factor that enhances insulin-mediated glucose uptake by the liver.


Rescue by coenzyme Q10 from electrocardiographic abnormalities caused by the toxicity of adriamycin in the rat.

The administration of adriamycin to rates increased (P less than 0.01) the interval, measured in msec, of the electrocardiographic QRS traces in rats, and the magnitude of the increase was ca. 50%. The administration of coenzyme Q10 to such adriamycin-treated rats allowed "rescue" or restoration of a normal QRS complex after 7 days of administration of coenzyme Q10. The QRS complex then remained normalized during the subsequent period of 21-30 days, by which time the cumulative dose of adriamycin had reached 24 mg/kg. Also, the QRS interval was lower (P less than 0.01) on day 33 than it was for rats treated to the same day with adriamycin alone. Coenzyme Q10 offers promise of rescue from at least some of the cardiotoxicity occurring in adriamycin-treated cancer patients, probably by a similar mechanism to that of the clinical rescue from toxicity of methotrexate by a cofactor of folic acid (citrovorum factor).


Changes in transmitter release induced by ion-containing liposomes.

The changes in quantal transmitter release induced by egg phosphatidylcholine liposomes with different internal ionic composition were examined at the frog neuromuscular junction by using conventional electrophysiological techniques. It was found that liposomes containing calcium or sodium ions increase both evoked and spontaneous transmitter release, while liposomes containing potassium do not. The results suggest that phosphatidylcholine liposomes are able to transfer their aqueous medium into the presynaptic nerve terminal.


beta-Endorphin induces nonconvulsive limbic seizures.

The endogenous opioid peptide, beta-endorphin, induces nonconvulsive limbic epileptiform activity when administered intraventricularly to rats. Epileptiform activity is elicited by beta-endorphin in doses that are devoid of analgesic or behavioral signs. Equimolar intraventricular doses of morphine or of the enkephalin analog [DAIa2,Met5]enkephalin-NH2 fail to elicit this limbic epileptiform activity. These observations, together with the recent immunohistochemical localization of beta-endorphin to midline limbic structures, suggest that beta-endorphin may have an important role in the regulation of limbic excitability.


Growth cone formation in cultures of sensory neurons.

Three experimental situations have been found in which cultured sensory neurons from embryonic chicken will form growth cones from positions along the length of the neurite. If the neurons are dissected with a remaining short axonal stump and plated into serum-free medium, they can form a morphologically normal growth cone from the stump within 15 min, even in the presence of cycloheximide or puromycin. When neurites growing in culture media with low levels of serum are cut at any point with microneedles, growth cones are produced quickly from the amputated stump, usually within 20 min. Treatment of growing neurons with low concentrations of colchicine, Colcemid, or podophyllotoxin results in the progressive appearance of lateral filopodia and regions of flattened cytoplasm that closely resemble growth cones except for their preterminal positions. These observations show that the potential to form growth cones is distributed throughout the neuron and suggest that this normally repressed in some way by the neuronal microtubules.


Regeneration of olfactory axons and synapse formation in the forebrain after bulbectomy in neonatal mice.

We removed the right olfactory bulb in neonatal mice, leaving the bulb on the left side intact as an internal control. At 5 days of survival time, we observed that the right cerebral hemisphere was displaced forward to occupy the region made vacant by removal of the bulb. The frontal cortex was, consequently, in close proximity to the lamina cribrosa. As a result of bulb ablation and severance of the fila olfactoria, the sensory perikarya underwent total retrograde degeneration, which peaked at 8 days. New neurons differentiated in the neuroepithelium from basal stem cells and, at 30 days of survival, mature sensory neurons were reconstituted. These new elements sent their axons through the lamina cribrosa to reach the protruding cerebral hemisphere, penetrating it and forming glomeruli-like structures directly in the host tissue. The "glomerulization" of the sensory fibers persisted and actually expanded between 60 and 120 days. The new glomeruli were organized intimately within the brain tissue, and large neurons of the cortex were observed to be in close  proximity. Ultrastructural observations of the newly formed glomeruli demonstrated that typical sensory axon terminals profusely branched and synapsed with unidentified postsynaptic processes that penetrated the glomeruli from the surrounding cerebral tissue.


Sleep-promoting factor S: purification and properties.

Sleep-promoting factor was purified from acid/acetone extracts of whole brains of rabbits and from brainstems of slaughterhouse cattle. Intraventricular infusion of extracts purified by means of ion exchange and gel filtration induced excess slow-wave sleep in rabbits for 5-10 hr. The procedure is simple and provides material suitable for physiological studies. Further treatment by partition chromatography and electrophoresis yielded an active product that was purified at least 1 million-fold. This product was inactivated by incubation with mixed carboxypeptidases A and B. Amino acid analysis of acid hydrolysates indicated that the effective dose was less than 150 pmol per rabbit and the original concentration in brain tissue was of the order of 30 pmol/g of brain.


Nature of differential sympathetic discharges in chemoreceptor reflexes.

In a study of autonomic reflexes it was found that some produce a generalized, bilaterally uniform response whereas others have an asymmetric or laterality of action. Recordings from vertebral nerve fibers (mainly vasoconstrictors to forelimb muscles), right and left cardiac sympathetics, and renal nerves show that baroreceptors evoke a bilaterally uniform inhibition but chemoreceptors of the carotid sinus and aortic arch initiate a differential discharge. In the chemoreceptor reflex the vagi are activated and bradycardia generally occurs. Vertebral and renal sympathetic fibers increase their activity bilaterally commensurate with the increase in arterial pressure. Sympathetic discharges to the heart, however, are not uniform; they show ipsilateral inhibition and a strong contralateral increase in activity. Stabilization of blood pressure or inactivation of baroreceptors abolishes the ipsilateral inhibition. In isolation, therefore, the chemoreceptor-induced cardiac sympathetic discharge is just quantitatively stronger contralaterally. In the absence of vagi, heart rate changes differ depending on which chemoreceptors are stimulated, because the pacemaker is on the right. Asymmetrical discharges do occur and, in the eventual response to stimulation of chemoreceptors, reflex interactions actually augment the laterality of effects. Peripheral interactions, in the sense that changes effected by one may induce another reflex, are responsible in part for the balances of autonomic activity ultimately seen as the body reacts to stimuli.


Gilles de la Tourette's syndrome with direct evidence of organicity.

A severe manifestation of Gilles de la Tourette's syndrome (GTS) which developed about six months subsequent to angiographic complications is reported. Acute, post-angiographically derived neuropsychiatric symptoms which continually bridged the interval between central damage suffered, and the final onset of GTS strongly favored the case for underlying organicity. This case probably represents the first direct report of preceding brain lesion triggering off GTS and negates previous trends to attribute psychogenic causes to GTS. As to pathophysiologic mechanisms possibly governing hyperkinesias common in GTS, the neuronal functional rules of denervation and denervation supersensitivity are applied to striatal dopamine-facilitated nerve cell populations.


Primary treatment of craniofacial injuries.

This presentation offers analysis of findings and treatment of 15 patients who suffered cranio-facial injury. 4 of them sustained isolated fractures of the glabella and supra-orbital margin; the remainder suffered disruption of the facial and cranial skeleton. In all cases, the possibility of dural tear with C. S. F. leak, should be considered. The advantages of primary treatment of cranio-facial injuries by a joint neuro- and maxillo-facial team are as follows:--The risk of meningitis is greatly reduced.--The precise diagnosis of injury and maximum conservation of tissue is possible.--Most of the dissection necessary for repair is carried out by the force of impact and no fibrous tissue is present to hinder reconstruction.--Finally, primary surgery gives the best possible cosmetic results. Secondary skeletal surgery, even on the scale proposed by Tessier, often falls short of the results possible with adequate primary treatment.


[Study of the variability of pre-maxillary angulation in relation to maxillo-mandibular basal separation in an antero-posterior direction. 109 orthodontic cases (author's transl)].

On the basis of a routine study in 109 children of variations in pre-maxillary angulation, the authors feel that the pre-maxilla is a typical example of a basic osseous structure whose direction of growth is adapted to the muscular conditions which surround it.


[Desmoid fibroma of the mandible. One case (author's transl)].

The authors report a case of desmoid fibroma of the mandible in a 75-years-old woman. This benign bone tumour, described for the first time by Jaffe in 1958, would seem to be rare in this site. Sixteen other cases have been found in the literature. The diagnosis is based upon histological examination of the operative specimen.


[About a cyst of frontal sinus (author's transl)].

A case of true cyst of frontal sinus has been reported. The authors pointed out the good exposure given by the coronal incision approach. Differential diagnosis was discussed, no finding mentioned was pathognomonic. Difference with mucocele was made by microscopic examination. Because the bone destruction of posterior wall of the frontal sinus, an exclusion of the sinus was performed without filling of the cavity. Good result was obtained one year after operation.


[A case of epidermal cyst of the maxilla (author's transl)].

In the light of one case of epidermal cyst of the maxilla, the authors emphasize the operative difficulties and the need, in the presence of a severe abnormality of the pedicles of the upper wisdom teeth, to perform a careful tomographic examination of the head.


[A new case of basal cell naevomatosis (author's transl)].

The authors, in the light of a new case of naevomatosis, review the description of the disease, emphasising its symptoms and signs, and inheritance, drawing attention to the need for surveillance of such patients in view of the risk of malignant change in the naevi. The other signs of the disease must be sought following the discovery of multiple epidermal cysts of the maxilla and mandible.


[Cerebro-costo-mandibular syndrome (author's transl)].

This rare condition associates a Pierre Robin syndrome with costal and intellectual abnormalities. It usually rapidly results in death from pulmonary complications.


[Tricho-rhino-phalangeal syndrome (author's transl)].

Tricho-rhino-phalangeal syndrome, of genetic origin, consists invariably of an association of finger malformations, changes in the hair system and nasal malformations. There may also be other facial abnormalities. Plastic surgery may improve the appearance of these subjects.


[Orbital fractures by blow-out (author's transl)].

The prevalence of orbital fractures by blow out remains open to discussion. Operative decisions are taken after clinical and radiological study, being based above all on evaluation of the forced duction tests and upon frontal tomographies.


[Changes in compensatory inclination of the alveolar processes (author's transl)].

When facial growth occurs in a manner outside general rules, progressive adaptation of the dental system to slow modification in the anatomical relations of the upper and lower jaws occurs by means of progressive compensatory inclination of the alveolar processes. This results, according to the direction of movement, in an increase or decrease in the space available for the teeth. In the two cases presented as examples, teleradiography of the head in lateral and vertical views demonstrated changes in the length and width of the dental arcades.


[The dysorexia-sialomegaly-amenorrhea syndrome (author's transl)].

The enlarged parotid glands seen in both poor nutritional states and in women with amenorrhea have always been considered to be separate entities. Thirteen observations are reported of a syndrome consisting of dysorexia (or anorexia), swelling of the salivary glands (sialomegaly), and menstrual disturbances (hypomenorrhea or amenorrhea). This syndrome can be defined as a clinical entity combining the symptomatology of parotid enlargements due to poor nutrition and those caused by sex-hormone disorders. In the Dysorexia-Sialomegaly-Amenorrhea syndrome, the salivary gland swellings are due to poor nutrition and the amenorrhea, which is of the hypothalamic type, is also secondary to poor nutrition.


[Traumatic lesions of the parotid salivary system. 15 cases (author's transl)].

On the basis of 15 cases, the authors define their attitude to traumatic lesions of the parotid salivary system. In the first place, such lesions must be accurately diagnosed by careful examination and catheterisation of the papilla. This simple manoeuvre makes it possible to avoid emergency sialography. Secondly, treatment varies according to the type of lesion: with a lesion of the facial nerve, suture or nerve graft in the case of loss of substance; with a minimal parenchymatous lesion, observation is necessary after the avoidance of surgery or drainage; with a severe parenchymatous lesion, parotidectomy is necessary, with exploration of the facial nerve.


[A case of non-neuralgic facial pain (author's transl)].

The author wished to report the cure of a case of facial pain treated unsuccessfully for two years, during hospitalization for an acute melancholic episode.


[Strampelli's osteoodontokeratoprosthesis--indications, personal surgical methods and clinical experiences].

Keratoprosthetics, twenty years ago, was regarded as technically without solution. Today, merely biological questions remain. Although clinical experience does not allow us to give a final judgement, it seems more than probable that osteoodontokeratoprosthesis will obtain its indication as last resort for otherwise hopeless cases.


[Trends in dental radiology--a review of the literature].

Dental radiology is experiencing a marked improvement in equipment and its comfort of use. The production of intensifying screens with calcium tungstate stratification causes considerable diminution of radiation damage although at the price of changes in the structure of the picture. Xeroradiography is stagnating after promising beginnings. The protection of the patient against radiation has improved and recent work shows that in the dental field, more care must be given to preserve the lens of the eye from radiation hazard. Pantomography as a diagnostic means is progressing although it has not been able to substitute for the conventional radiography. TMJ radiography does not make exception in the same sense, so the knowledge of the correct use of special cranial radiographs remains.


[Preventive extraction of the lower wisdom teeth: radiological criteria].

Many lower wisdom teeth are impacted. Various authors advocate systematic and prophylactic removal of all third molars. The reasons for such procedure are not always clear, and often, radiological evaluation is missing. A study of over 200 patients was carried out to determine whether systematic extraction of wisdom teeth is justified. Another study was undertaken, to observe the development of 42 lower impacted third molars. It was tried to find conclusions which might justify the radiological criteria for such an extraction. The factors, leading to diagnosis and radiographic analysis were discussed and four radiological criteria were finally established. In conclusion, it seems that early radiological evidence (age 16--17) is very important.


[Use of a semi-rigid plastic material: value and possibilities].

The use of semirigid plastic material is shown in its use in orthodontia, in the chair and in the laboratory. The products: vestibular screen, shaped in the mouth, the "bumper" for the correction of fan shaped lower anteriors, tooth positioners which serve to correct slight positional occlusal dysharmonies. The use of this material saves time for the practitioner while it allows to the devices thus obtained to retain their qualities and advantages within their respective indications.


[Differential diagnostic significance of clinical gingival changes].

By way of introduction the author discusses the significance of periodontal disease symptoms in establishing a diagnosis and evaluates the various symptoms. The most important major and minor symptoms peculiar to the basic forms of periodontal disease are explained, and examples of the substantivation of clinical changes are given.


[Significance and evaluation of gingival and bony pockets].

The reproducibility of measurements of gingival pocket depth was tested on a total of 200 patients and assessed by statistical analysis. Significantly differing values were observed only in the region of the upper molars, whereas consistent values were found in all the other regions. The measurement of pocket depth is an easy-to-determine reproducible parameter in periodontal diagnostics. A gross information about the presence and depth of intrabony pockets cannot be obtained from clinical values for pocket depth.


[Value and significance of tooth mobility measurements].

1. The measurement of tooth mobility by manual and instrumental techniques is necessary for establishing a diagnosis, since it is of considerable importance for decisions in the framework of prophylaxis and therapy. 2. The significance of the measurement of tooth mobility depends upon the respective problem and the sensitivity of the measuring technique used. 3. The specifications for the precision of the measuring technique will be determined by the specific objective of the examination. 4. The instrumental measuring techniques are reproducible and, therefore, imperative in scientific studies.


[Evaluation of bone structure].

Changes in the bone structure, the periodontal space and the interdental alveolar septa are decisive criteria for evaluating the state of health of the alveolar bone. The pathological processes of alveolar bone destruction are subdivided into: reduction in height, vertical reduction and a mixed from resulting from these two.


[Relationship between diagnostic parameters and epidemiological findings in periodontology].

Numerous epidemiologic studies performed in the People's Republic of Poland during the years 1966-1975 make evident that the morbidity of periodontal diseases in children and adolescents, 7-18 years of age, varies from 5.5 to 66.6%. But the results from these studies could not be compared with each other, because there were considerable differences in group sizes, methods (as to indices) and the examinators' special training for epidemiologic investigations.


[Plaque indices].

The objective quantitative evaluation of the extent of plaques is necessary for epidemiologic studies and for the estimation of the effects of various cleaning methods and agents. Numerous indices have been elaborated for this purpose. Relation planimetry is used for the detection and exact evaluation of small differences. The surfaces are measured with a compensating planimeter, the slides to be evaluated being projected on a white sheet by means of a microfilm reader. In this way, the plaque covered surfaces are determined as percentages of the total surfaces.


[Periodontal disease index].

Periodontal disease indices are a must in epidemiologic studies, analytical epidemiology making special demands. The indices hitherto commonly used do not meet all demands; consequently, they can be applied only in certain studies, especially in the sense of descriptive epidemiology. For 15 years, the periodontal disease index according to Kötzschke has proved to be useful for large-scale correlation calculations, being well suited for making evident the effects of the most different factors. At the beginning of any experiment and investigation, exact considerations must be given to the aim and special objectives of an index.


[Formation of a computer-assisted register in periodontology - results of a study for evaluating a standardized examination chart].

On the basis of a co-ordinate study of 16 periodontal facilities in the GDR, a standardized documentation system was developed for recording and processing patient-oriented informations in periodontology. This documentation system is the basis for building-up a computer-based periodontal register in the GDR. This register might assume the following tasks: storage and management of data about patients subjected to specialized periodontal treatment, problem orientation methods of automated information processing, inquiries, scientific evaluation.


[The use of miniature plastic splints in dentistry].

The use of the miniature plastic splint, manufactured by means of deep-drawing, is illustrated by some examples: immobilization of subluxated teeth, treatment of fractures in the maxillofacial region, wound protection.


[General anesthesia in ambulatory dental and oral surgery interventions--report of experience].

General anaesthesia is also justifiable in dental and maxillofacial interventions on an outpatient basis. Having dealt with the indications, the authors concern themselves with preliminary examinations and premedications. Finally, they comment on, and evaluate from the viewpoint of practice-relevance, anaesthetizing methods, such as intravenous short anaesthesia, ketamine anaesthesia and mixed anaesthesia, which have proved a success for a total of 20 years of interdisciplinary co-operation of dentists and maxillofacial surgeons and anaesthetists.


[Bony changes in chronic odontogenic maxillary sinusitis].

The authors undertook histological studies on the bone of the facial wall of the maxillary sinus from 64 out of 84 patients who had been operated on for chronic maxillary sinusitis of dental origin in the course of 16 months. Apart from mucosal changes, the specimens from 16 patients showed also osseous changes in the form of periosteal reactions of varying extent. With regard to therapy, it is concluded that patients suffering from odontogenic sinusitis should for preference be treated by surgical intervention, because the conservative treatment will not necessarily result in complete healing.


[Etiology and occurrence of lateral midfacial fractures].

The present paper deals with 198 cases of isolated lateral midfacial fracture treated at the Clinic and Policlinic of Stomatology of the Magdeburg Medical Academy during the years 1966-1975. In view of a comparison with data from the literature, these cases were statistically analysed with regard to the frequency and the causes of this type of fracture and with regard to treatment.


[Intraosseous screw splinting of mandibular fragments].

Fractures in the frontal region of the mandible may be treated by intra-ossal splinting without the risk of injuring nerves or vessels. Function-stable fixation of the reposited fragments was achieved in 15 patients by means of a transfragmental screw with metric thread. The advantages of this procedure consist in the easy removability of the material and the superfluidity of new developments of material or instruments. As the possibility of early functional treatment prevents the late impairment of the articular function, this procedure is particularly indicated in case of concurrent paramedian and articular fractures.


[Studies on the setting behavior of dental gypsum. 1. Experimental characterization of the hardening process].

Using penetration tests, the authors studied the setting of dental gypsums (alpha- and beta-hemihydrate) under different conditions of processing (temperature of the mixing water, mixing time, addition of electrolytes). The suitability of penetrometry as a standardizable testing procedure for characterizing the setting process of gypsums is demonstrated and the effects of different materials and processing parameters on setting are discussed.


[Does dental care influence the progression of caries in children and adolescents?].

The caries-statistical date from 1.500 subjects aged between 7 and 16 years showed that the caries incidence in children and adolescents who had received complete dental treatment was by 31% lower, after two years, than that in children and adolescents who had not received complete dental treatment. Thus, the restorative functions of single fillings are completed by a complex preventive aspect.


[Glucocorticoids in dental surgery and maxillofacial surgery].

Indications for the use of glucocorticoids in surgical stomatology are: 1. emergencies, 2. bullous and allergic diseases of the oral mucosa and therapy-resistant cases of chronic recurrent aphthae, erosive lichen planus and sialoses (for systemic therapy), 3. therapy-resistant temporomandibular complaints and hyperplastic tissue responses and, in combination with an antibiotic, diseases of the maxillary sinus (for local therapy). Preliminary clinical examination, case controls at short intervals, and circadian or alternating prescription will help to reduce undesirable side-effects. In patients receiving sustained glucocorticoid therapy, dental-surgical procedures require special consideration of the change in reactivity.


[Requirements and time factors in dental activities].

The exact determination of the demands on, and the allowed times for, the stomatological activity is an essential prerequisite of fixing measures for the increase in quality and efficiency of the stomatological care and for the control of their success. The results of a discriminating work analysis on the basis of an independent study on a representative sample of dentist-nurse collectives are compared with the findings of other authors. After resolution of the stomatological basic activities into partial activities and after calculations of the arithmetic means of the respective allowed times, the authors establish synthetic allowed times for the basic activities by summing up the adjustable, necessary and defined partial activities.


[Immunology and immunotherapy of leukemia (basic results of 8-years research)].

In the paper, the main results of some investigations, conducted in the Institute laboratories during 1969--77, are summarized. Special attention is given to the detected first phenomenon of functional antagonism of antibodies in leukemia and to the recognition of the specific humoral immune responsiveness of acute leukemia patients. The author reports the results of clinical trials of "the method for regulation of the specific immunity", which practically gives a 100% remission in comparatively short terms for children with acute lymphoblastic leukemia. Also, a longer remission term and survival were gained in children, subjected in the remission period to chemotherapy in combination with BCG injections as compared with patients treated only by chemotherapy.


Production and life-span of platelets and of fibrinogen in acute leukaemia. 75Se-selenomethionine- and 51Cr (Na-chromate)-studies.

The life-span of platelets and of fibrinogen was studied by the use of 75Se-selenomethionine and 51Cr in 28 cases of acute leukaemia (AL), and in 2 cases of chronic myelocytic leukaemia with blast-cell transformation. The patients were grouped on the basis of clinical remission or activity. In all groups, whether examined by means of 75Se or 51Cr, a reduction of variable degree was found in platelet life-span, and platelet turnover was reduced in the majority of the cases. The sequestration data were atypical. Simultaneous 75Se studies for platelet and fibrinogen life-span revealed a latent diffuse intravascular coagulation (DIC) in three cases, the process being still in progress in one case and in remission in two cases at the time of observation. Fibrinogen life-span was reduced in some of the cases. Thrombocytopenia in AL is attributed to a complex origin in which infiltration of the bone marrow, the destructive effect of antimetabolic therapy, abnormally increased consumption of storage of the functionally impaired platelets, possibly latent DIC or episodic excessive sequestration may be equally involved. Remission may be accompanied by normalization of both thrombopoiesis and platelet kinetics.


Continuous oxygen uptake determination.

A new, open-circuit, flow-through technique for frequently repeated measurements of energy expenditure is described. It is designed mainly for subjects lying in bed and can be applied to severely injured patients. The measurement will not cause any discomfort to the subject, who does not have to co-operate. The energy expenditure was assessed at +/- 2.6% when the pulse technique was used with ambient air as the calibration gas. No systematic error (95% tolerance limits) was found compared with the conventional Douglas-bag method. The technique described is flexible, because all calculations are performed in a computer connected to the system.


The EEMG--a practical index of cortical activity and muscular relaxation.

In a continuing study of the EEG as a monitor of cortical activity during anesthesia using a time-domain wave analyzer, the contamination of the EEG by scalp muscle activity was observed. A measure of this EMG activity was extracted from the combined EEG/EMG wave obtained from two electrodes placed over the left frontalis muscle and right mastoid process. Clinical work with this variable showed that the EMG can serve both as a reliable guide to patient muscular relaxation and an indicator of unacceptable muscle contamination of the EEG. This extracted variable in conjunction with the analyzed EEG has served as a valid indicator in the assessment of the anesthetic state. The system has been successfully employed in the management of nearly 1000 surgical patients.


Acute ascending poliomyelomalacia after treatment of acute lymphocytic leukemia.

This paper reports the case of a 16-year-old girl with acute lymphoblastic leukemia who received chemotherapy including intrathecal injections of methotrexate and preventive irradiation of the brain, but not of the spinal cord. Several months later, she died from an acute ascending poliomyelitic syndrome evolving during 10 days. Clinical, bacteriological, and viral investigations failed to demonstrate any pathological agent. Autopsy revealed an acute ischemic lesion involving both anterior horns of the whole spinal cord and extending from the lower segment up to the mesencephalic region, without significant alteration of the white matter. Neither tumoral invasion, nor vascular obstruction was found. The pathogenesis of this yet undescribed lesion remained unclear but a metabolic disorder seemed the most plausible pathological factor.


Gilles de la Tourette syndrome. Interactions with other neuropsychiatric disorders.

Gilles de la Tourette syndrome is a neuropsychiatric disease with a childhood onset below age 16, characterized by chronic involuntary movements, obsessions, compulsions, utterances, echolalia, coprolalia and aggressive behavior symptoms. Two unique case histories are described in this report, one with an intercurrent history of primary anorexia nervosa and the other with rheumatic encephalitis. They were successfully treated; the former with chlorimipramine, and the latter with combination of L-tryptophan, nicotinic acid, and pyridoxine HCl. These two cases illustrate the possibility that one neuropsychiatric syndrome may induce another during its evolution when the same anatomo-biochemical loci of the brain are involved.


Anorexia of infection as a mechanism of host defense.

The role of anorexia of infection as a mechanism of host defense was studied by force-feeding infected mice to a normal energy intake. Their mortality and survival times were then compared with those of infected mice feeding ad libitum. Mortality was increased and survival time shortened in force fed animals. Our observations suggest that anorexia, by reducing energy intake, has a significant role in the early defense of the host.


A family with acute leukemia, hypoplastic anemia and cerebellar ataxia: association with bone marrow C-monosomy.

The eldest brother in a sibship of five children died of acute myelogenous leukemia at 10 years of age. The second and third eldest brothers died of hypoplastic anemia at ages five and nine years, respectively. A surviving 6 year old brother, the proband of the study, has abnormalities that suggest a preleukemic state: mild pancytopenia, platelet dysfunction, immunodeficiency, and bone marrow hypoplasia with approximately 18 per cent blast forms. His 17 year old sister has a mild normochromic normocytic anemia. Cytogenetic studies revealed C-group monosomy in the bone marrows of the proband and the third brother (45, XY, -C); band studies demonstrated that a No. 8 chromosome was missing in the proband (45, XY, -8). At least four of the siblings and their father had cerebellar ataxia, and evidence of a small cerebellum at autopsy examination or by computerized axial tomography. The disorder in this family has major features of two autosomal recessive preleukemic diseases, ataxia-telangiectasia and Fanconi's anemia. However, these and other inherited conditions were excluded by clinical or laboratory criteria, and no environmental causes of the familial disorder were found. The constellation of abnormalities in the family may constitute a new genetic syndrome.


A radiographic evaluation of the response of previously avulsed teeth and partially avulsed teeth to orthodontic movement.

Orthodontic movement, as documented in this study, can be accomplished successfully in the case of completely avulsed and partially avulsed teeth which have been reimplanted. These teeth respond to normal orthodontic forces and duration of treatment time by conventional orthodontic techniques and retention. Apical root resorption does occur more readily in these teeth before, during, and after orthodontic treatment. Six of the eighty-one involved teeth were lost because of complete root dissolution. The involved teeth which were reimplanted immediately without pulpal treatment and their integrity protected as living tissue were successfully treated orthodontically with no known losses as of this writing. It will be interesting to observe the tissue response of these avulsed teeth in the years ahead. How will time and circumstances deal with these teeth?


The maxillary orthopedic splint.

Craniomaxillary orthopedic correction of the skeletal imbalance of Class II malocclusions is often the desired method of treatment in these cases. The ability to apply a "pure" orthopedic force to the maxillary complex has so far eluded research efforts. However, the use of a maxillary splint with a high-pull extraoral traction assembly has been shown to be most effective in reducing Class II skeletal dysplasias through a combination of dentoalveolar and basal bone changes. Force delivery to the maxillary complex in Class II skeletal jaw disharmonies is through the teeth. The philosophy behind the use of the maxillary splint is that if the force delivered to the upper jaw involved the use of all the upper teeth (and hard palate) rather than only the maxillary first molars, as in conventional extraoral orthodontic therapy, the effect on the jaws would be more orthopedic than orthodontic in nature. The advantages of the use of the maxillary splint in the younger patient with a severe Class II malocclusion are that it reduces the vulnerability of the maxillary incisors to accidental fracture, while concomitantly reducing the Class II dysplasia, thereby effectively shortening the later-stage multiband corrective time and procedures. Further advantages of the maxillary splint described are ease of construction and clinical application, which makes it an attractive appliance for use in dental clinics or institutions in which patient volume, infrequent visits, and ecomomic factors are major considerations. This preliminary report on the philosophy of treatment procedure and description of the appliance design is to be followed by a further cephalometric and clinical evaluation of results achieved with its use.


A cephalometric study of the craniofacial skeleton in trichorhinophalangeal syndrome.

A prominent feature of the trichorhinophalangeal syndrome is a very characteristic facies. This study quantitates differences in craniofacial skeleton between affected and unaffected members of the same kindred. Standard scores for various measurements taken from lateral cephalometric radiographs were compared for statistical significance, and these were further correlated with similar data calculated from length measurements of the middle phalanx of the second digit. The affected group had a shortened posterior face height (p less than 0.01) associated with a short mandibular ramus (p less than 0.01) as well as a reduced and superiorly deflected posterior cranial base (p less than 0.01). These craniofacial changes result in a steep inclination of the lower border of the mandible (p less than 0.01) and suggest disturbances in the epiphyseal growth sites of the skull as demonstrated by a high degree of correlation between the dysplasia of the cranial base, shortening of the posterior portion of the face, and shortening of the middle phalanx of the second digit.


The 'ballista spring" system for impacted teeth.

The ballista spring system is a simplified orthodontic system for treating impacted teeth. The impacted tooth is retracted by a spring that accumulates a continuous force from being twisted on its long axis. The necessary operation on the impacted tooth is simple and less traumatic. The force exerted on the tooth is vertical, without compressing the impacted tooth toward the adjacent roots. This force is well controlled and easily modified. By the lack of appliance on the front teeth during a great part of the treatment, the esthetic side of the treatment is respected. Complicated impacted teeth in adults can be treated.


The activated face-bow: simple, safe, extraoral traction.

A simple and safe extraoral traction model is described. This consists of a face-bow with activated outer arms and a neck strap or headgear without any elastic force, such as rubber bands, elastic ribbons, coil springs, etc. The appliance cannot be withdrawn from the mouth by acident; therefore, the patient is protected from possible injuries.


The proportionate template as a diagnostic aid.

Many traditional cephalometric analyses used do not consistently reflect the extent of anteroposterior or vertical jaw dysplasias. Nor do such analyses give accurate information as to which jaw(s) is at fault. The proportionate template is designed as a diagnostic aid which enables the clinician to identify and determine rapidly the extent of craniofacial skeletal jaw discrepancies in adults. The template is found to be particularly useful for orthodontists and surgeons engaged in orthognathic surgery. (Proportionate templates are available upon request from the author).


Avoiding patient relation stress in an orthodontic practice.

1. Consumer rights apply to the practice of orthodontics as well as other areas of health care. 2. To avoid consumer complaints, the orthodontist must be prepared to deal with personality problems as well as treatment complications in his practice. 3. Only by careful questioning of the patient before treatment will the orthodontist be able to detect possible future problems. 4. An explanation of informed consent by the orthodontist and an acknowledgement of it in writing, signed by the parent or responsible party, is now regarded as essential to avoid misunderstandings and complaints. 5. An informed patient leads to a better relationship with the orthodontist as well as a healthier atmosphere in which to practice.


Interobserver reliability in xeroradiographic cephalometry.

Observer agreement on cephalometric landmarks was compared between xeroradiographs and conventional radiographs of twenty-nine patients. Of fourteen landmarks evaluated, four (condylion, infradentale, Ptm, and ANS) demonstrated clinical significance in favor of the xeroradiograph. In addition, six other landmarks favored the xeroradiograph but not to the degree of statistical significance.


The mandibular plane angle in activator treatment.

The long-term results of activator treatment were investigated in 15 subjects with a small and 13 subject with a large pretreatment mandibular plane angle. The results of the investigation revealed the following: 1. Activator treatment resulted in a general improvement in the sagittal and vertical incisor relationship in both large and small angle cases. 2. Overjet relapse was more frequent and overbite relapse less frequent in large angle cases than in small angle cases. 3. During the period before treatment follow-up examination the frequency of patients with open bite increased in the large angle group and decreased in the small angle group. 4. The mandibular intercanine arch width was smaller and the frequency of crowding in the mandibular incisor segment was higher in the large angle group than in the small angle group. 5. A large pretreatment mandibular plane angle, per se, was not a primary factor in treatment failure. However, an unfavourable mandibular growth in combination with an atypical tongue function seemed to be the main reason for the relapse found in the large angle subjects.


Effects of orthodontic intermaxillary Class III mechanics on craniofacial structures. Part I - photoerlastic analysis.

The relation between active growth and induced anatomic changes was examined using photoelastic stress techniques. The following can be concluded from this investigation: 1. Utilization of Class III mechanics on the photoelastic skull affected the zygomaticotemporal, zygomaticofrontal and frontomaxillary sutures. 2. The stress trajectories observed in the mandible lead to the conclusion that Class III traction affects mandibular growth and opening, as well as condylar repositioning. 3. Evidence of stress was observed in a section of the condyle due to the external pterygoid muscle. 4. The stress concentrated at the outer surface of the pterygoid plate was due to the action of the external pterygoid muscle. 5. The effect of the simulated Class III traction created concentrations of stress mesial and distal of the second molars and at the apical and midroot areas of first molars.


Effects of orthodontic intermaxillary class III mechanics on craniofacial structures. Part II - computerized cephalometrics.

The relation between active growth and induced anatomic changes was examined using a computerized cephalometric analysis of ten Class III cases treated with intermaxillary traction. The following can be concluded from this investigation: 1. Mandibular growth was redirected and mandibular opening was observed due to maxillary molar extrusion and counterclockwise rotation of the maxilla. 2. Condylar repositioning was noted to occur in all cases due to the effect of the external pterygoid muscle and a possible translatory movement during mandibular rotation. 3. Counterclockwise palatal development occurred in most of the treated cases through vertical action of the Class III mechanism. 4. The effect of the Class III traction was also observed in the mandibular incisor and molar teeth. The incisors retruded and the molars either were located in the predicted position or farther distally. 5. The soft tissue profile was less concave than the predicted value due to less mandibular growth and more retruded incisors in the treated cases. 6. Evidence was shown that a positive relationship exists between computerized cephalometrics and photoelastic techniques in the analysis of ten treated cases. This relationship is based on the fact that specific changes which took place during treatment were found to be consistent with the results of the photoelastic analysis.


Facial growth associated with a cranial base defect - a case report.

A skull was described possessing posterior cranial base defect and resultant asymmetric growth of this structure. It was hypothesized that compensatory restraining influences of surrounding soft tissues prevented a more severe facial malformation from occurring.


Soft tissue changes associated with mandibular subapical osteotomy.

Sophisticated treatment planning for those individuals with severe dental and facial disproportions requires accurate prediction of posttreatment results. Preand posttreatment cephalometric X-rays for a group of twelve patients treated by a combined orthodontic-oral surgical approach were evaluated. The surgery was of either the standard mandibular subapical osteotomy or Kole type of procedure. Surgical repositioning of the anterior mandibular alveolus resulted in various changes in hard tissue and soft tissue profile. In summary, these changes were: 1. Decreased lower facial height. 2. More relaxed lip posture as revealed by an increased superior vermilion lip length and decreased inferior vermilion lip length. 3. Stomion moved inferior and posterior relative to the lower facial plane. 4. Superior labial sulcus became less concave. 5. Inferior labial sulcus became more concave. 6. Superior vermilion and inferior vermilion moved posterior relative to the lower facial plane. 7. Chin radius and lip-chin-throat angle decreased. 8. Overbite and overjet increased while Wits analysis decreased. 9. Facial contour angle was unchanged. Changes were similar for both standard subapical and Kole groups with the main difference being a greater reduction in facial height with the Kole group.


A study of craniofacial form.

There are differences in the craniofacial skeleton, dental arch, and tooth dimensions between brachycephalics and dolichocephalics. Furthermore, the craniofacial complex appears to be more intergrated biologically in dolichocephalics than brachycephalics.


Narcotism: dimensions of the problem.

It is evident that the indirect indicators that are used to provide some estimate of heroin use trends are susceptible to distortion by variables having little to do with total heroin use. A panel of indicators, employed together, moving in the same direction, are seen as the best information available, and confidence can be placed in their implications. We have witnessed a rapid increase in the use of heroin in the decade that began in 1960. From 1970 to 1973 a decrease occurred followed by an increase in prevalence that lasted about two years. Since 1975 there appears to have been a levelling off or even a slight decrease in heroin use with a shift of higher use patterns to the West Coast. These changes are the result of many factors on both the demand and the supply sides of the equation. There is reason to believe that the curve could slope sharply upward again if substantial efforts are not made to control the quantity of available heroin, to prevent the recruitment of new users and to treat those now overinvolved with the drug. However, heroin prevalence rates will not recede to the pre-1960 level in the foreseeable future, and immediate goals include lowering them even more.


Malignant melanoma of choroid developing in the eye of a three-year-old boy.

An apparently normal, healthy 3-year-old boy developed redness of the left eye. An ophthalmologist discovered an intraocular tumor which he believed arose from the choroid. The child's 17-year-old mother developed osteosarcoma of the right femur during pregnancy and died a short while after his birth. Because of the rarity of malignant melanoma of the choroid in this age group, an exhaustive study was made resulting in firm evidence that this was probably a melanoma. The eye was enucleated. Pathologic study demonstrated a malignant melanoma with unusually pleomorphic cells.


Leukaemic hypopyon in acute lymphoblastic leukaemia after interruption of treatment.

A 7-year-old girl was successfully treated for acute lymphoblastic leukaemia, and remained in remission after treatment had been completed in 3 years. Four months after cessation of treatment, iridocyclitis with hypopyon developed in one eye. Exudate from the anterior chamber contained numerous lymphoblasts. Local radiotherapy led to complete resolution of the ocular lesions, and the patient remains well 22 months later.


An analysis of interdental cleaning habits.

A study using a method of questioning regarding the interdental cleaning habits of 766 patients in the Periodontics Department of the Brisbane Dental Hospital revealed: 1. Only 11.5 percent used an interdental aid once or more daily. 2. Only 14.3 percent of those who had received regular dental treatment used an aid at least once daily. 3. Thirty percent of patients who had received regular dental treatment had received some instruction in the use of interdental aids. 4. Significantly more patients receiving periodontal treatment used an aid once daily. 5. There was no difference between institutional and private practice patients in the use of an aid, but more of the last named continued to follow instructions in their use. 6. Significantly more daily users of woodsticks than of dental floss were found. These findings demonstrate a major defect in dental health communication in the sample studied which is probably reflected in a more widespread fashion in a broad cross section of the population.


A modular approach to dental studies.

At the commencement of the 1979 Academic Year a "modular approach" to degree studies in Dentistry will be instituted at the University of Papua New Guinea. This course of studies will be comprised of four progression modules and includes a one-year programme of community service and clinical experience in a dental clinic of the Department of Health.


A simple method of assessing community orthodontic needs.

A method based on a survey of 336 children is described for making measurements of occlusions and converting the results into a form which permits an assessment of the community's need for orthodontic treatment. Measurements of the incisal overjet and crowding are used to produce a score related to the severity of the malocclusion, and the results suggest further investigation is warranted.


University dental services.

An investigation was conducted to determine the appropriate dental services for a university using one university dental service as a model. After examination of the aims, population, demands and needs, possible alternative strategies were considered by comparing the organizational structure of three different types of university dental service.


Effects of different diuretics on urinary calcium excretion in a general population.

Calcium excretion by users and non-users of thiazide diuretics and frusemide was studied during a health survey. Men taking thiazides excreted less calcium than age- and weight-matched controls. Both men and women taking thiazides excreted less calcium relative to sodium than controls. Women taking thiazides excreted significantly less calcium than women taking frusemide. Both men and women taking thiazides excreted less calcium relative to creatinine than sex-matched groups taking frusemide.


Definite myocardial infarction in Auckland.

A 40% representative sample of definite myocardial infarctions in Auckland was studied to give incidence figures and data relating to demographic variables, personal characteristics and habits, cardiovascular history, the acute phase and events over the subsequent 28 days. The incidence results showed figures comparable with other centres in Europe and the USA, as expected from New Zealanders' high consumption of dietary saturated fats and westernized life style.


Sudden death in Auckland.

A representative sample of all sudden cardiac deaths occurring in Auckland in one year is reported. Data describing demographic variables, personal characteristics and habits, previous symptoms, prodromal symptoms, the acute phase and post mortem results, is presented. Incidence values are very close to those of other similar communities. The syndrome of "sudden death" probably defines a heterogenous group of cases. Deaths were significantly more common in the cooler months, and in the lowest social class. Some evidence is presented consistent with the hypothesis that a high alcohol intake is associated with sudden death. No differences were found between cases dying within five minutes and those dying later but within 24 hours, considering several variables. Myocardial fibrosis at post mortem was a common finding. The role of the coronary ambulance is briefly discussed.


Occurrence of large proximal splenic artery aneurysms in chronic liver disease.

Two cases are reported of large pre-splenic aneurysms of the splenic artery in patients with chronic liver disease, and three others cited from the literature. Four of the five died from rupture of the aneurysm. All patients were parous females with chronic liver disease, and in four of the five this was known to be present before pregnancy. It is suggested that proximal splenic artery aneurysms in such patients are due to both haemodynamic changes of portal hypertension and the endocrine changes of pregnancy. This concept may lead to early recognition of these lesions, although there are as yet no certain indications for investigation or surgical intervention in asymptomatic patients.


Toxic autonomous thyroid nodule following neck irradiation.

A 37-year-old male with a history of neck irradiation in childhood presented with thyrotoxicosis due to an autonomous thyroid nodule. Adjacent to the nodule was a radiation scar from radiotherapy administered 35 years previously. Hemithyroidectomy was performed and histological examination excluded malignant change. Long term follow-up should continue to detect possible nodule formation in the contralateral lobe.


Iatrogenic fluorosis.

A 69-year-old spinster presented with a history of generalised bone pains in September 1977. She was asthmatic and had been treated with 60 mg sodium fluoride and three Calcium Sandoz tablets daily for three years in an attempt to minimize steroid-induced osteoporosis. She was subsequently found to have fluorosis as shown by radiological osteosclerosis in vertebrae and pelvis with histological changes of osteomalacia on bone biopsy and a high bone fluoride content. A trial regimen for osteoporosis which is currently being assessed in various centres includes fluoride along with supplementary calcium and Vit D to prevent the production of osteomalacia which may occur with the fluoride salt alone. The case described here emphasises the potential toxicity of therapeutic dosages of fluoride when prescribed with calcium alone and emphasises the need for careful clinical and biochemical monitoring in all patients receiving therapeutic dosages of fluoride.


B cell leukaemia distinguished from chronic lymphocytic leukaemia by surface markers.

Four cases of lymphocytic leukaemia were distinguished from CLL by surface marker analysis. CLL cells have relatively little SIg and have the mouse erythrocyte receptor. Cells in these cases had denser Slg and lacked the mouse erythrocyte receptor. The group presented a fairly uniform picture with onset in sixth or seventh decade, very high lymphocyte counts, splenomegaly (gross in three), heavy infiltration of marrow, relative resistance to chemotherapy and response to splenectomy. The lymphocytes were somewhat larger than those usually found in CLL and histological examination showed a quasi-nodular pattern in lymph nodes with diffuse infiltration of the spleen. Difficulties of classification are discussed. The addition of surface marker analysis to clinical and morphological parameters allows these cases of B-lymphocytic leukaemia (mouse erythrocyte-negative B leukaemia) to be distinguished clearly from chronic lymphocytic leukaemia. The mouse erythrocyte receptor is particularly useful in making this distinction.


Polymyositis presenting with severe weakness involving only one arm.

A woman presented with severe weakness and wasting involving only one arm. A definite diagnosis was not made until almost six years later when she developed proximal weakness in the legs as well, and a muscle biopsy showed changes of polymyositis. Asymmetry of weakness in polymyositis has been noted previously in the literature, but is rare. In previous reports asymmetry as marked as in the present case has not been noted.


Emergency obstetric calls in the Wimmera.

This paper analyses emergency obstetric calls in the Wimmera Plains over the 10-year period, 1967-1976. There were 120 calls and 39 of these were managed at the local hospitals. In a district of this type there is a place for a visiting obstetric emergency service.


Pregnancy-specific beta-1 glycoprotein (SP-1) in normal and abnormal pregnancy.

Maternal serum levels of a pregnancy specific beta-1 glycoprotein (SP-1) were measured by radial-immunodiffusion in 369 normal pregnancies. Mean levels rose progressively to approximately 200 mg/l at 36 weeks of gestation followed by a plateau and a fall at term. The 95% confidence limits were established for SP-1 logarithmic correction of the positively skewed raw data and certain theoretical and practical advantages were demonstrated in the use of SP-1 compared with human placental lactogen (HPL) measurement in the assessment of fetal-placental growth and function. In a preliminary study of abnormal pregnancy states it was found that maternal serum SP-1 assay may aid in the early detection of retarded intrauterine growth, and that it provides a better monitoring system than HPL in this condition. SP-1 levles were normal in pregnancies complicated by hypertension without retarded intrauterine growth.


An assessment of vulval lichen sclerosus.

Vulval lichen sclerosus (L.S.) has been assessed clinically, colposcopically, and histologically to ascertain the suitability of including this condition in the nomenclature proposed by the International Society for the Study of Vulval Disease (I.S.S.V.D). In many cases the macroscopic appearance of lichen sclerosus is characteristic, but this is not always the case. Histologically, the appearances of the dermal hyaline change, the reduction in the length and the number of rete pegs, to a lesser extent thinning of the dermis and sometimes thinning of the epidermis are characteristics. The presence of dermal inflammatory cells and changes in the thickness of the keratin layer are, however, much more variable. Exact measurements of the various layers of the vulval skin are not necessary in the routine assessment of lichen sclerosus. The present study justifies the inclusion of lichen sclerosus on histological criteria in the I.S.S.V.D.'s nomenclature.


The effect of oestradiol valerate therapy on coagulation factors and lipid and oestrogen levels in oöphorectomised women.

The effect of oestradiol valerate on levels of blood cholesterol, triglycerides, free oestradiol and coagulation factors, as well as on urinary oestrogens and free cortisol was measured in 10 oöphorectomised women. Despite the very high urinary oestrogen levles obtained, there was no significant change found in the other parameters during and after treatment. These findings are discussed, as is the significance of the metabolism of both endogenously produced and orally administered oestrogens in the menopausal woman.


Clinical features and plasma hormone levels after surgical menopause.

This study reports the plasma levels of follicle stimulating hormone, luteinising hormone, oestradiol and testosterone in 43 women who had undergone bilateral oöphorectomy. Age was the only variable of those investigated which appeared to influence a hormone level; testosterone levels were found to decrease with increasing age. Two significant associations were found between clinical features of the menopause and the plasma hormone levels measured. Low levels of oestradiol were associated with pruritus vulvae and high levels of testerone were associated with headaches.


Relative bradycardia: a sign of acute intraperitoneal bleeding.

Acute intraperitoneal bleeding with hypotension may be accompanied by a relatively normal pulse rate instead of the tachycardia usually produced by blood loss. Four cases of intraperitoneal bleeding of diverse, though pelvic, origin, are described. In each patient, symptomatic hypotension occurred with a pulse rate less than 80 per minute, thereby initially confusing the diagnosis of internal bleeding. The hypotension and relative bradycardia responded to atropine followed by fluid replacement. Response to atropine implies that the reflex that produces bradycardia is mediated by the parasympathetic nervous system. It is concluded that relative bradycardia occurring with intraperitoneal haemorrhage may be the cause of both diagnostic difficulty and disproportionately severe hypotension.


Compound presentation following external version.

Two cases of compound presentation following external version are presented. The frequent combination of the feet with the vertex following this procedure and its association with a higher fetal mortality, interference rate, and obstructed labour than the hand and vertex combination are highlighted. The aetiology, problems in diagnosis, and management are discussed. Measured to prevent and deal with this complication are suggested.


Conjoined twins.

A case of thoracopagus conjoined twins is described in which ultrasonography was helpful in achieving an antenatal diagnosis and in allowing consultative decision on management.


Duffy haemolytic disease of the newborn.

A case is reported of mild haemolytic disease of the newborn due to anti-Fya (Duffy). This brings to 19 the number of cases of Duffy haemolytic disease recorded in the English literature.


Comparison of spontaneous and contraceptive menstrual cycles on a visual discrimination task.

21 women with spontaneous ovulatory menstrual cycles, and 7 women who were regular users of oral contraceptives were investigated over two consecutive menstrual cycles. There two groups were compared on their two flash threshold performance and on mood ratings. It was found that, for women with ovulatory menstrual cycles, visual sensitivity was enhanced during the late follicular phase of the cycle, as ovulation approached. At other phases of the menstrual cycle (paramenstrual and luteal) visual sensitivity remained constant and comparable to the values found in women who were taking to the values found in women who were taking contraceptives. Women who were taking contraceptives showed no significant variation in visual sensitivity with phase of the menstrual cycle. The overall level of anxiety, as reflected by mood ratings was higher in women with spontaneous cycles compared to those taking contraceptives. Neither group, however, showed significant variation in anxiety with phase of the cycle.


A prospective study of premenstrual tension symptoms in healthy young Australians.

Thirty healthy young women volunteered to complete questionnaires concerning physical and psychological symptoms during a full menstrual cycle. A maximal incidence of minor physical and psychological symptoms was observed in the first few days of menstruation. This was preceded by a gradual rise in the level of symptomatology during the premenstruum.


Mothers and children in hospital.

Between 1965-1972 244 individual mothers were admitted on 283 occasions accompanied by 287 children to a general hospital unit. This cohort has been followed up to ascertain re-admission to any New Zealand psychiatric facility for two follow-ups at 1-8 years and 5-12 years. A postal survey of attitudes was also carried out. The content of the replies has been analysed, with statistical and anecdotal accounts of patients' and husbands' expressed feelings and attitudes. These are compared with observations in the literature about themes of hostility and anxiety. The circumstances surrounding the homicide of a baby in this series together with our various rationalisations, value judgements and assessment of the situations are described.


Family structure and relationships of 50 female anorexia nervosa patients.

Family features of the first 50 anorexia nervosa patients referred to a psychiatrist from a defined geographic area are documented. Information about the families was obtained from personal interviews with the parents during the course of the patients' treatment. High socio-economic class, absence of non-white population, older age of parents, instability factors in the parents' backgrounds and high incidence of both physical and psychiatric illness in the parents suggest multiple factors may be aetiological. Possible pathogenic factors are equally distributed between mothers and fathers.


Marital interaction in depression.

The great majority of depressed patients are currently married or formerly married and depression is commonest at ages when marital satisfaction is least. Study of patterns of marital interaction in depression may provide useful leads for understanding the aetiology and therapy of depressive syndromes. Theoretical views of depression as loss, as coerced behaviour and as coercive behaviour suggest useful hypotheses. Both marital interaction and depression are complex variables to define and measure. A literature review suggests reduced general affective involvement, reduced expressions of affection, increased criticism, increased husband domination and a marked struggle for interpersonal control in the marriages of depressed persons. Marital therapy may be the most useful psychotherapeutic approach for depression.


Urban-rural differences in student mental health: the Hong Kong scene.

Student mental health of Hong Kong urban and rural fifth formers and sixth-formers was assessed by examining their scores obtained from the General Health Questionnaire twice administered. The first administration was done soon after commencement of a school term and served as a baseline measure, and the second was done six weeks before the fifth-formers took an important public examination, a significantly stressful event. The results indicated that all groups of fifth-formers showed an increase in mean scores, reaching statistical significance only in urban boys and rural girls. The latter finding was used to explain urban-rural differences in mean scores. The significance of severe examination distress and its possible late psychiatric sequelae remained unanswered.


Posted summaries of marital therapy.

Summaries of marital therapy sessions, similar to those used in group psychotherapy by Yalom, were posted to reach couples three or four days after each session. The summaries of 600 to 4,000 words included a narrative account of the session and some editorial comment by the therapist. Couples completed a questionnaire assessing the use of the summaries. Replies to questionnaires and clinical impressions indicate the summaries had good acceptability. Couples felt the summaries increased their focus on marital problems between the sessions and provided helpful clarification.