Effect of high- and low-fiber diets on plasma lipids and insulin.

Seven healthy young adults were maintained for two separate 1-week periods on each of two very high-carbohydrate diets, one with low-fiber and one with high-fiber content. In both diets 15% of the calories were from protein, 15% from fat, and 70% were from carbohydrate. The low-fiber diet consisted of milk, glucose, and dextrins in liquid formula form, the high-fiber diet was composed of starchy foods. The crude fiber content of the high- and low-fiber diets was 18.0 and 1.0 g, respectively. The diets were isocaloric and the subjects maintained a stable weight. During the low-fiber diet the fasting triglycerides rose, reaching a peak 45% above base-line in 6 days. During the high-fiber diet the triglycerides fell to a level slightly below base-line. The cholesterol fell 16 and 23% below base-line on the low- and high-fiber diets. The glucose response to test meals representative of each diet was similar. The insulin response to a low-fiber meal was twice as great as that to a high-fiber meal containing an equivalent amount of carbohydrate. The results suggest that carbohydrate-induced hyperlipemia does not occur if the high carbohydrate diet is rich in dietary fiber, and furthermore that the insulin-stimulating potential of foods in a very high-carbohydrate diet is a critical determinant of the magnitude of carbohydrate-induced lipemia.


Some aspects of bile acid and urobilinogen excretion and fecal elimination in men given a rural Guatemalan diet and egg formulas with and without added oat bran.

Six healthy men were fed a formula diet with and without oat bran and a natural food diet typical of rural Guatemala. No significant difference in dye transit time was found between diets but the Guatemalan diet significantly decreased dye retention time and increased stool frequency. Serum cholesterol and triglyceride levels showed no significant differences among dietary treatments. Excretion of fecal bile acids significantly increased on the Guatemalan and oat bran diets, but fecal bile acid concentration was significantly lower only on the Guatemalan diet. Urinary urobilinogen excretion and fecal urobilinogen concentration were significantly lower with the Guatemalan diet.


Dietary zinc intake of low-income pregnant women of Mexican descent.

Zinc intakes of low-income pregnant women of Mexican descent were estimated by the use of 24-hr dietary recalls. Recalls were obtained during the first two trimesters for 344 women and again during the third trimester of pregnancy for 279 of the same women. The daily mean zinc intake was calculated as 9.4 +/- 3.8 mg during the first two trimesters and as 10.0 +/- 4.3 mg during the third trimester. For about 85% of the women, the reported intakes were below two-thirds of the Recommended Dietary Allowance for zinc. In a subsample of the women, no significant correlation was shown between low dietary zinc intakes and low serum zinc levels during either early or late pregnancy. Zinc and protein intakes were highly correlated in both early and late pregnancy (r = 0.83 and 0.89, respectively). Diets that provided 90 to 100 g of protein (about 125% of the Recommended Dietary Allowance) provided a mean of 13.6 g of zinc (67% of the Recommended Dietary Allowance).


A dietary survey to determine the relationship between diet and cholelithiasis.

A dietary survey was conducted to compare the dietary intakes of people with and without cholelithiasis (gallstones). A 48-hr recall method was used to collect dietary data from 91 cholelithiasis subjects (15 males and 76 females) and 86 control subjects (13 males and 73 females). Although the female cholelithiasis subjects were more overweight than the control subjects, they consumed less energy per day. It was observed that the female cholelithiasis group consumed less protein, fat, carbohydrate, and crude fiber than the female control group. Nutrient intakes per 1000 cal were similar for the female cholelithiasis and control groups. The total weekly intake of crude fiber and the intake of crude fiber specifically from bread and bakery products was significantly less for the female cholelithiasis group than for the female control group. This may indicate that it is a component of whole wheat flour that is low in the diet of subjects with gallstones. The results of this study suggest a possible relationship between cholelithiasis and a low intake of energy, protein, fat or crude fiber, but more than one of these nutrients could be involved. It is evident that further work is needed to study the relationship between diet and gallstone formation.


A comparison of triceps skinfold values as measured by the plastic McGaw caliper and the Lange caliper.

The plastic McGaw caliper and the Lange caliper were used to measure the triceps skinfold thickness of both arms of 91 volunteer subjects and of the left arms of 14 obese patients. McGaw caliper values were highly correlated with the Lange caliper values (r = 0.97) but were significantly lower than the Lange caliper values (P less than 0.01). Triceps skinfolds could not be measured by the McGaw caliper on 11 very obese patients, all of whom had Lange triceps skinfold thicknesses greater than 45 mm.


Relationship between the nutritional efficacy of a rice and bean diet and energy intake in preschool children.

Nitrogen balance and urea excretion were measured in a group of 4- to 6-year-old children receiving a rice and bean diet providing 1 g of protein per kilogram of body weight per day and three levels of calories. With diets providing 2300 and 3000 kcal/day, nitrogen retention was 41.16 +/- 29.04 and 53.30 +/- 18.46 mg/kg of body weight per day, respectively. With 1400 kcal/day, diet nitrogen retention decreased to 25.38 +/- 13.88 mg/kg body weight and urea nitrogen excretion increased. The importance of adequate caloric intake for optimum utilization of dietary protein from a rice and bean diet for growing children is demonstrated.


Ascariasis and malnutrition. A study in urban Ethiopian children.

Treatment of 13 urban Ethiopian children with mild ascariasis did not produce any evidence of improved intestinal morphology and absorption or nutritional status. Ascariasis treatment had no impact on anthropometric measures in an additional study group of 84 children. A review of the literature reveals that the nutritional consequences of ascariasis are uncertain.


Sézary syndrome. Tartrate-resistant acid phosphatase in the neoplastic cells.

Tartrate-resistant acid phosphatase has been known to be of diagnostic value in hairy cell leukemia. However, occasionally neoplastic cells of other varieties of lymphoproliferative disorders may contain tartrate-resistant acid phosphatase. The authors have studied four patients with Sézary syndrome who had typical cutaneous lesions with extensive lymphoid infiltrates and circulating atypical E-rosetting lymphoid cells. The abnormal Sézary cells accounted for 23-69% of the peripheral mononuclear cells and often showed convoluted or folded nuclei. These cells in all four patients were strongly positive for acid phosphatase resistant to tartaric acid inhibition. Enzymatic cytochemical studies for acid phosphatase with and without tartrate may be helpful in the differential diagnosis of cutaneous T-cell lymphomas from variants of chronic dermatitis.


Quantitation of hemoglobin A2. An interlaboratory study.

In the 1976 hemoglobinopathy proficiency testing survey of the Center for Disease Control (CDC), whole-blood samples from hematologically normal adults and from individuals heterozygous for beta-thalassemia were shipped to survey participants. The object of this survey was to determine the state of the art for technics used to quantitate hemoglobin A2 (Hb A2) and to test the ability of laboratories to differentiate between blood samples having normal Hb A2 levels and those having elevated levels (i.e., those from individuals with beta-thalassemia trait). The results of Hb A2 quantitation obtained from 183 volunteer participant laboratories were compared with those obtained from 24 reference laboratories. Individual values varied greatly among laboratories and among methods for both normal and elevated Hb A2 samples. The results returned by many laboratories were not within 2 SD of the reference laboratory mean and also were not sufficiently accurate to differentiate between the normal blood samples and those with beta-thalassemia trait. The results suggest that methods for quantitating Hb A2 need to be standardized and a suitable method for determining laboratory performance found.


Laboratory suggestions: Improving the sensitivity of the Fletcher factor assay.

The prolonged activated partial thromboplastin times observed with Fletcher factor (prekallikrein)-deficient plasmas become nearly normal after the plasma is incubated with contact surfaces or with an activator. Those shorter times may lead to relatively flat reference curves for Fletcher factor assays under certain conditions. The authors examine in detail the effect of incubation time upon the sensitivity of Fletcher factor assays. Four different surface activators were used in the tests to determine the optimal activation for each type. An incubation time of 1 min produced maximal sensitivity with each surface activator tested. All reagents remained stable for at least an hour at 37.5 C.


Cytochemical identification of tetrahydrofolate in human leukocytes.

Utilizing the ability of molybdenum dioxide dichloride to form a black insoluble precipitate with tetrahydrofolate, a cytochemical test for rapid detection of tetrahydrofolate in human leukocytes was developed. The test may be useful in distinguishing deficiency of vitamin B12 or folate or both from other disorders of erythropoiesis characterized by megaloblastic erythropoiesis.


An improved nitroblue tetrazolium test using phorbol myristate acetate-coated coverslips.

The endotoxin--nitroblue tetrazolium (NBT) slide test was modified by precoating coverslips with phorbol myristate acetate instead of endotoxin. The percentage of control polymorphonuclear leukocytes reducing NBT was significantly (P less than .05) greater on phorbol myristate acetate-coated coverslips (99 +/- 0.21%) than on endotoxin-coated coverslips (96+/- 1.8%). Polymorphonuclear leukocytes from patients with chronic granulomatous disease did not reduce NBT on phorbol myristate acetate- or endotoxin-treated coverslips. NBT reduction by polymorphonuclear leukocytes from proven heterozygotic carriers of sex-linked chronic granulomatous disease was intermediate between NBT reductions by those from controls and patients. A statistically significant abnormality of NBT reduction was found in polymorphonuclear leukocytes from one carrier of chronic granulomatous disease with phorbol myristate acetate-treated, but not endotoxin-treated coverslips. The phorbol myristate acetate-NBT coverslip technic is a rapid, simple, reliable way to detect deficiencies in polymorphonuclear leukocytes from patients and carriers of chronic granulomatous disease.


Peliosis of the spleen.

Peliosis of the spleen is a rare condition that accompanies peliosis hepatis. Two cases are presented, and a detailed morphologic description is given. The lesions are confined to the red pulp and appear to arise by progressive distention of splenic sinuses, with eventual thrombosis and organization. Peliotic involvement of the spleen is probably more common than realized and can have serious clinical implications.


A case of primary amebic meningoencephalitis in Zaria, Nigeria.

A case of primary amebic meningoencephalitis due to Naegleria fowleri in a Nigerian child is described. This is probably the first authentic case from West Africa. The clinical manifestations, isolation of the ameba from the cerebrospinal fluid and nasal passages, poor response to amphotericin B, and ultimate fatal outcome all are consistent with the diagnosis of primary amebic meningoencephalitis. Subsequent identification based on morphologic features, flagellation, animal pathogenicity, and nuclear division proved conclusively that the ameba was Naegleria fowleri. The route of entry of the ameba proved to be nasal. In the absence of the history of swimming and in view of the dusty harmattan period during which the child was admitted, a possibility of infection by inhalation of dust harboring amebic cysts is suggested.


Abnormalities of bone marrow simulating histiocytic medullary reticulosis in a patient with gastric carcinoma.

In the proper clinical setting, phagocytosis by bone marrow histiocytes of erythrocytes, granulocytes, and platelets (panphagocytosis) is generally accepted as the morphologic hallmark of histiocytic medullary reticulosis. A patient with clinical manifestations that suggested histiocytic medullary reticulosis was found also to have histiocytic panphagocytosis in the bone marrow. Biopsy of the liver, however, revealed metastatic adenocarcinoma. In addition, postmortem examination demonstrated a gastric adenocarcinoma with massive hepatic involvement and absence of lymphadenopathy, splenomegaly, or evidence of generalized histiocytic proliferation. Therefore, histiocytic panphagocytosis is probably not specific for histiocytic medullary reticulosis, and may be a nonspecific feature of a variety of diseases.


Aspergillus mural endocarditis.

Infectious mural endocarditis is uncommon and not well documented. The clinical setting and pathologic features of five patients with Aspergillus mural endocarditis are described. Leukemia, carcinoma, renal transplantation, and hepatic failure were the primary diseases. Associated conditions include high-dose corticosteroids, cytotoxic therapy, renal failure, gram-negative sepsis, and endotracheal intubation. All patients received prolonged antibiotic therapy or treatment with three or more antibiotics. All had clinically undetected aspergillosis and severe fungal pneumonia. Fungal myocardial abscesses were present in each patient. Aspergillus mural endocarditis developed in more than 40% of patients with cardiac aspergillosis. Endocardial vegetations were contiguous with underlying myocardial infection; yet they may develop initially as a subendocardial focus rather than from a myocardial abscess. Aspergillus mural endocarditis progressed to destroy the mitral valve ring and served as a source of mycotic embolization to vital organs.


Prothrombin time after heparin removal. Application to monitoring simultaneous anticoagulation with heparin and coumarins.

Coumarin-anticoagulated plasmas from 31 subjects comprising two study groups were passed through epichlorohydrin triethanolamine cellulose (ECTEOLA) chromatography columns. Group I plasmas, which were run with nothing added, had mean prothrombin times of 21.6 +/- 5.4 sec prior to and 22.4 +/- 5.6 sec following exposure to these columns (r = 0.9449; t = 1.8307, P less than 0.100). The mean prothrombin time for Group II, 18.2 +/- 4.9 sec, lengthened with 5 u/ml heparin to 35.5 +/- 16.2 sec, and returned to 19.2 +/- 5.0 (r = 0.9763) after chromatography. Therefore, it appears that coumarin anticoagulation had no significant influence upon the capacity of ECTEOLA effectively to remove heparin in therapeutic doses. This means that virtually all prothrombin time reagent systems can be employed to monitor concurrent heparin and coumarin anticoagulation. In addition, quality control of the combined technic is simpler, and the technic more sensitive to low levels of fibrinogen and factor V.


Phenotyping of eight erythrocytic enzymes in one acrylamide gel.

A procedure has been developed to phenotype eight erythrocytic enzymes, phosphoglucomutase (PGM1), adenylate kinase (AK), 6-phosphogluconate dehydrogenase (6PGD), adenosine deaminase (ADA), glyoxalase (GLO), esterase-D (EsD), acid phosphatase (AcP), and glutamic pyruvate transaminase (GPT) in one acrylamide gel and also to detect the presence of common abnormal hemoglobins. The agar overlay technic has been eliminated. This simplified procedure renders the phenotyping of erythrocytic enzymes practical in paternity testing.


ABO hemolytic disease of the newborn.

The charts of newborn infants with positive direct Coombs' test were studied. Only cases in which the mother's blood was group O and the infant's group A or group B were studied. There was no difference between group A and group B infants in the frequency and severity of the hemolytic process caused by maternal antibodies. In group B infants, monospecific antibodies (anti-B) were associated with more severe hemolytic process than cross-reacting antibodies (anti-A,B). In group A infants there was no difference in the severity of the disease between monospecific antibodies (anti-A) and cross reacting antibodies (anti-A,B). Even though there was no significant difference in the sex distribution of affected infants, there was a higher number of boys in the more severely affected group.


Evaluation of an automated blood smear analyzer.

The performance of a diff3 System prototype instrument that does automated leukocyte differential counts, erythrocytic morphology determinations, and leukocyte count and platelet count estimates, was compared with performance by laboratory personnel for a five-week period in an active general hospital. Using experienced supervisors as the referee method, this instrument performed as well as the routine laboratory staff in all aspects of leukocyte differential counting. With respect to erythrocytic morphology, estimates of hypochromia were inferior to those of the routine laboratory staff; comparisons of estimates of macrocytosis and polychromasia were not significantly different. Leukocyte and platelet numerical estimate performance by the diff3 System was not as good as that of automated cell-counting instruments, but categorization of platelet concentration as normal or abnormal did compare favorably with estimation by laboratory personnel. The flagging of abnormal slides by the instrument was comparable in sensitivity to that by the routine laboratory staff; however, specificity was less, with a significantly greater number of false positives obtained by use of the instrument.


Visual and automated differential leukocyte counts. A comparison study of three instruments.

The authors compared referee (senior author) microscopic counts, microscopic counts by several technologists, and counts obtained with two pattern-recognition leukocyte classifiers, (1) Larc and (2) Hematrak, and a cytochemical automated method for leukocyte counting, (3) Hermalog D, using samples from (1) a random patient population, (2) a selected abnormal patient population, and (3) healthy individuals. All instruments showed good accuracy and flagged abnormal results for review. Variability in pattern-recognition counts was found to be due mainly to the distribution of the cells on prepared blood smears. The Larc classifier was found to be very sensitive to minor alterations in the cytoplasm or nucleus, and rejected a number of slides. The Hemalog D showed the greatest precision. The method of preparation of slides would be a major decision factor in selecting one pattern-recognition instrument over another.


The reliability and rapidity of the coagglutination technic and its comparison with precipitin technic in the grouping of streptococci.

Three methods of the grouping of 170 strains of beta-hemolytic streptococci belonging to Groups A, B, C, F, and G by capillary and agar-gel precipitation using Lancefield extract and by coagglutination of antibody-coated protein A-containing staphylococci were compared. Capillary and agar-gel precipitin technics correctly grouped all 170 strains, with no cross-reaction. One hundred sixty-nine out of the 170 strains were also correctly grouped by the coagglutination technic, and the one strain with a cross-reaction was correctly grouped after blood--agar subculture. Although 20 of the 170 strains showed minor cross-reactions by the coagglutination technic, the specific groups were easily and unquestionably detected, and the minor cross-reactions were easily overcome. A rapid method of grouping by coagglutination technic using 4--6-hour broth culture, done on 75 strains, showed that 73 strains could be correctly grouped by the rapid method and two after overnight incubation. Thus, the coagglutination technic of grouping was found to be easy, reliable, and economical, and could be adopted in any routine diagnostic laboratory as a rapid grouping procedure.


Hemolytic disease of the newborn due to anti-Dib.

A case of moderately severe erythroblastosis fetalis due to anti-Dib is reported. The mother was a Mexican-Indian woman who had received three units of blood following the delivery of a normal infant three years previously. The affected infant required phototherapy and two exchange transfusions. Although the units were incompatible, the infant tolerated the procedures well and appeared normal when last seen at the age of 2 1/2 months. This case brings to 11 the total number of instances of anti-Dib reported.


Glandular dysplasia in diethylstilbestrol-associated vaginal adenosis. A case report and review of the literature.

A case of diethylstilbestrol-associated vaginal adenosis in which dysplastic glands were identified and examined by light and electron microscopy is reported. Transitions between normal and dysplastic glands were documented in subserial sections. These alterations may characterize an intermediate phase in the development of clear-cell adenocarcinoma of the vagina.


Phagocytic myeloma cells.

A case of a patient with otherwise typical multiple myeloma whose myeloma cells were phagocytic is described. Phagocytosis of erythrocytes, erythrocytic precursors, lymphocytes, and platelets was found. Ingestion of latex particles by myeloma cells was demonstrated in vitro.


Crescentic glomerulonephritis and renal failure associated with malignant lymphoma.

Two cases of crescentic glomerulonephritis and renal failure associated with malignant lymphoma are reported. The relationship of the lymphoma to the immune-complex glomerulonephritis is discussed.


Cell-mediated cytotoxicity to cardiac cells of lymphocytes from patients with primary myocardial disease.

The etiology of primary myocardial disease is unknown. With the advent of immunologic technics, an immune process related to primary myocardial disease has been sought, but none has been elucidated as diagnostic or causative. The authors attempted to study the possibility of a cell-mediated component in the etiology of primary myocardial disease. Cell-mediated immunologic injury of cultured, human myocardial cells was studied in cells from patients with primary myocardial disease and controls by means of a 51chromium-release method. Significant lymphocytic cytotoxicity against myocardial cells was detected in cells from 23 (30%) of 73 patients with primary myocardial disease, compared with two (4%) of 49 normal, healthy control subjects. Significant cytotoxicity was also observed in cells from 36 (24%) of 148 patients who had other cardiac diseases, mainly rheumatic and atherosclerotic diseases. No group showed cytotoxicity against a long-term culture of Chang hepatic cells. No clinical correlation between the severity of the disease and increased cytotoxicity could be found. It is concluded that lymphocytic reactivity against myocardial cells probably results from myocardial damage due to a variety of causes, and that it is not specific for primary myocardial disease.


You can draw blood from the "IV arm" below the intravenous needle if you put a tourniquet in between.

The authors performed a comparative study of the values of 18 serum constituents of blood specimens taken simultaneously from the arm into which an intravenous solution was flowing, using a site distal to the intravenous needle, and from the other arm. Subjects of the study were 15 patients at the Norwalk Hospital. Statistical analysis showed no clinically significant difference between the levels in the two arms except for elevation of glucose in the "iv arm" when the intravenous solution contained glucose.


Chronic pericarditis due to a streptomyces species.

Streptomyces species include a group of aerobic actinomycetes that are generally considered to be saprophytes. Effusoconstrictive pericarditis of mixed etiology developed in a previously healthy patient. The cause of the chronic pericarditis was a Streptomyces species.


Alport's syndrome associated with macrothrombopathic thrombocytopenia.

The combined occurrence of hereditary nephritis with nerve deafness (Alport's syndrome) and macrothrombocytopathic thrombocytopenia is very rare. The authors have had the opportunity to study such a case in a 20-year-old man who had been followed since birth. The clinical history, renal biopsy, platelet studies, and autopsy findings are presented. The renal pathologic findings are well defined; however, the hemostatic abnormalities and the hearing loss are not well characterized. In this paper, an attept is made to clarify the diverse platelet functional and morphologic abnormalties.


Serologic studies of Streptococcus intermedius, Streptococcus constellatus, and Streptococcus morbillorum by crossed immunoelectrophoresis.

A reference antigen-antibody system for Streptococcus intermedius, Streptococcus constellatus, and Streptococcus morbillorum was established with crossed immunoelectrophoresis. A comparison of S. intermedius, S. constellatus, and S. morbillorum with crossed immunoelectrophoresis and crossed immunoelectrophoresis with intermediate gel indicated that S. intermedius and S. constellatus are closely related antigenically with as many as six common cytoplasmic antigens. S. morbillorum was antigenically more distinct; antiserum of one strain of S. morbillorum was monospecific, indicating that specific serogroups of S. morbillorum exist. Crossed immunoelectrophoresis and tandem crossed immunoelectrophoresis revealed that S. intermedius, S. constellatus, and S. morbillorum also share some common antigens with Streptococcus sanguis and Streptococcus mitis, but S. intermedius, S. constellatus, and S. morbillorum are antigenically distinct from Streptococcus mutans and Streptococcus bovis.


Nodular regenerative hyperplasia of the liver in a case of myelofibrosis with extramedullary hematopoiesis and secondary portal venous hypertension.

Nodular regenerative hyperplasia of the liver was identified at autopsy in a patient with myelofibrosis with extramedulary hematopoiesis, an association not previously reported. Portal venous hypertension, documented during the patient's terminal hospitalization, was ascribed, in part, to a high rate of blood flow through the enlarged spleen. Possible mechanisms accounting for the development of nodular regenerative hyperplasia of the liver, and evidence provided by this case pertinent to these mechanisms, are discussed.


Statistical analysis of method comparison data. Testing normality.

A Lilliefors test of normality has been applied to data from precision and accuracy studies. Most data sets tested as non-normal. Simulation studies showed that the test is extremely sensitive to the rounded, narrowly distributed data that are typical of method performance studies in clinical chemistry. The Lilliefors test can be modified to be applicable to rounded data so that it gives fewer indications of non-normality. The authors conclude that the selection of a test of normality requires careful study of the properties of the test. Otherwise, the subsequent choice between parametric and nonparametric statistics may not be meaningful.


Clinical estimation of creatinine clearance.

One hundred fifty-four 24-hour urine collections from 16 patients with stable renal function from whom careful urine collections were made were used to compare the "error" in determining renal function (creatinine clearance) when it is estimated using measured 24-hour creatinine excretion versus when creatinine excretion is predicted from serum creatinine, sex, age, and weight, using a simple estimation scheme. These "errors" were comparable (the coefficients of variation were 10% and 13%, respectively). Thus, the prediction scheme is as acceptable as direct measurement of creatinine excretion for purposes of estimating creatinine clearance in stable patients, and is simpler to perform. Two hundred twenty-two 24-hour urine collections from 86 patients having urine collections performed in a routine fashion were also analyzed in this manner. The routinely assessed patients demonstrated markedly greater intraindividual variability (coefficient of variation, 27%) in measured creatinine excretion than did the carefully studied patients (10%). The authors suspect that the excess variability was due to inaccurate urine collection. If so, the prediction scheme may also be acceptable in the routine clinical setting.


Nephrotic syndrome with mesangial-cell proliferation in children--a distinct entity?

Various morphologic patterns have been identified in renal biopsies of children with the idiopathic nephrotic syndrome. Children with focal segmental glomerulosclerosis have clinicopathologic features sufficiently distinct to warrant a separate subclassification. "Immunoglobulin M (IgM) nephropathy" and other morphologic patterns are less well defined. The clinicopathologic characteristics of eight patients with the nephrotic syndrome, increased mesangial cellularity on renal biopsy, and hematuria (mesangioproliferative nephropathy) were evaluated. Response to standardized prednisone therapy was poor. Of the seven children followed for 7-29 months, only two were in remission at the time of writing, and each of these had had one prior relapse. The eighth patient was lost to follow-up after one month. Although the number of patients studied was small, there was a strong correlation between degree of mesangial-cell proliferation and failure of primary treatment. As concepts of the pathogenesis of idiopathic nephrotic syndrome in children continue to evolve, the mesangioproliferative lesion should be recognized and marked for further study.


Comparison of the diagnostic values of biopsies of the pleura and cytologic evaluation of pleural fluids.

Results of a comparison of the diagnostic efficacy of percutaneous needle biopsy of the parietal pleura with that of cytologic examination of pleural fluid sediment obtained concurrently from 166 patients with benign or cancerous pleural disorders are reported. Of 44 patients with confirmatory evidence of cancer involving the pleural surfaces, 43 had positive cytologic findings, whereas pleural biopsies were diagnostic in only 16 cases. Of a total of 122 patients with benign pleural diseases, cytology provided the diagnosis in two cases of eosinophilic pleurisy, and pleural biopsy contributed the diagnosis in four of ten cases of tuberculosis. The data indicate that percutaneous needle biopsy of the parietal pleura is less efficacious in the diagnosis of malignant pleural disease than is cytologic evaluation of the fluid sediment, whereas in the diagnosis of tuberculous pleurisy, pleural biopsy proved superior.


Differentiation by TICAS analysis of cell populations of tracheal aspirates from hamsters with squamous-cell carcinoma.

Individual cells from the tracheal aspirates of hamsters exposed to benzo-a-pyrene were scanned at .5 mum in three colors. Features relating to size, shape, and color were extracted and calculated by computer. The single cells were then classified by these features into separate populations with varying degrees of atypia, extending up to frank cancer cells. A high degree of accuracy was attained in classification by these methods.


Microcytosis associated with sickle cell anemia.

Sickle cell (Hb SS) anemia is considered a normochromic-normocytic hemolytic disorder. In 53 patients with Hb SS (mean reticulocyte values 16.8%), the authors observed that mean corpuscular hemoglobin (MCH) was 29.8 +/- 2.4  mu microgram and mean corpuscular hemoglobin (MCV) was 88.1 +/- 6.8 cu micrometers. In contrast, patients in a comparable hemolytic-disease group unrelated to hemoglobinopathies (mean reticulocyte count = 15.7%) had a higher MCH (33.0 +/- 1.8 mu microgram) and larger MCV (97 +/- 5.3 cu micrometers). These data indicate that Hb SS disease is associated with "relative microcytosis," presumably a consequence of reduced hemoglobin production.


The zeta sedimentation ration (ZSR) as the routine monitor of disease activity in a general hospital.

Nine hundred eighty-one requests for sedimentation rates in a clinical laboratory were received and the zeta sedimentation ratio (ZSR) test was performed. The results were correlated with the patients' diagnoses and disease activity. This test was found to be a useful monitor of disease activity in a clinical setting. Substitution of the ZSR for the standard erythrocyte sedimentation rates (ESR) appears to be acceptable. The test is simple, rapidly performed, and reproducible.


Comparison of hematocrit determinations by microhematocrit and electronic particle counter.

Hematocrit determinations by microhematocrit and electronic particle counter technics were obtained using newborn and adult blood samples. Coulter Model S hematocrit values greater than .47 were found to be significantly lower than those obtained by using the microhematocrit technic. These differences assume clinical importance when considering partial plasma exchange transfusion for the treatment of polycythemia and associated hyperviscosity.


Computer-assisted heparin monitoring.

Heparin monitoring during procedures involving cardiopulmonary bypass using the Bull protocol has been programmed using a microcomputer. The program displays the in-vivo heparin tolerance curve and the patient's effective plasma heparin level along this curve. It calculates the incremental dose of heparin necessary to achieve effective anticoagulation throughout the procedure. At the conclusion of the procedure, the dose of protamine needed to neutralize the "on-board" heparin is calculated and displayed. The program also flags unusual in-vivo heparin response curves and suggests to the operator possible explanations for these unusual responses. Training time to use the equipment and program is approximately 5 min.


Percentiles as reference values for laboratory data.

It has been suggested that laboratory results be reported, not only in conventional units, but also in terms of equivalent percentiles from a reference population. This would afford the clinician an easily interpretable measure of how unusual such a result would be in the reference population. This paper describes a modified method for estimation of reference percentiles. This method does not require any assumption about the distribution of the reference population, but it has a smaller variability than that from earlier methods based on interpolation. This method is now being used to furnish percentile values for spirometric data in the authors' laboratory.


Lymphatic invasion in pigmented nevi.

All 124 pigmented nevi registered at the Canadian Tumour Reference Centre between July 1958 and May 1969 were reviewed. Nevus cells invading endothelial lined spaces were observed in serial sections from five cases. The significance of this finding is discussed in relation to published reports of the presence of nevus cells in lymph nodes.


Identity degradation and mental disorder: an empirical assessment of the Conduct Impairment Scale.

Proponents of the medical models have held that mental disorder is best measured in terms of some inventory of symptoms indicative of an underlying disease. Alternatively, critics have argued that mental disorder is the result of a degraded ascribed role, a discrepancy between the person and his environment, or the degradation of identity. The issue goes beyond academic debate, with important implications for case-finding and program development in community mental health. Theodore Sarbin has developed a 58-item "Conduct Impairment Scale" to operationalize the concept of "Identity Degradation" and proposed it as a substitute for the medical model. Three dimensions are posited: status, value, and involvement. An appropriate level of reliability and clustering of scale items are reported by Sarbin. In order to subject the scale to a more rigorous test, it was administered to a random sample of 208 respondents in four neighborhoods in Grand Rapids, Michigan, as part of a larger epidemiological study. In an effort to assess the validity of the scale, factor analytic methods were employed. A principal components model with varimax rotation was performed. It was found that items purporting to tap the three theoretical dimensions explicated by Sarbin did not load in the expected pattern. Additionally, the first three extracted factors accounted for only a small proportion of the total variance. Efforts to assess the reliability of the scale were more fruitful. A corrected split-half of .82 and coefficient alpha of .86 were obtained. It was concluded that the validity of the scale was not adequately demonstrated, and its use as an alternative to the medical model open to serious reservation.


Student physical symptoms and the social climate of college living groups.

Student physical symptoms were related to the social climates of university living groups. A Physical Symptom Risk Scale, a new subscale of the University Residence Environment Scale, which relates consistently to physical symptom complaints for male, female, and coed living groups, was developed. Living groups characterized by high student physical symptoms were perceived by students as low in involvement and support, high in competition, and low in student influence. The results indicate that certain types of social environments may be "high risk" settings in that they support and possibly facilitate complaints of physical symptoms. These settings may be amenable to early "environmental diagnosis," preventive counseling, and change-oriented social systems intervention.


Responsive parenting: an approach to training parents of problem children.

Two behavior modification groups for parents of problem children between the ages of two and ten were conducted along the lines of the Responsive Teaching Model. The two groups met for 10 and 8 weeks, respectively, with six families represented in each group. In Responsive Parenting (RP), parents are taught to observe and measure their children's problematic behavior. Subsequently, each parent develops a home project designed to modify this behavior; 11 of the 12 parents developed a successful home project. In addition, the attendance was approximately 90% and the completion of weekly assignments was close to 100%. Paper-and-pencil measures revealed that the parents were very satisfied with the parent-training group and rated their children as improved on a bipolar adjective checklist. These results are discussed with regard to implications for the delivery of mental health services for children. Future research directions are delineated.


Effects of midterm integration on state and trait anxiety in black and white elementary school children.

This study investigated the effects of stress associated with school integration on state and trait anxiety for 637 Black and White fourth- fifth- and sixth-grade children. A court-ordered integration plan resulted in the transfer of children from all-White and all-Black schools into integrated schools 2 months before the end of the school year. The State-Trait Anxiety Inventory for Children (STAIC) was administered 1 week prior to the transfer and 6 weeks following transfer. Females who were transferred had higher state anxiety scores than nontransferred females, but there were no differences for males. Transferred Black and White children did not differ in state anxiety, but transferred Blacks were higher in trait anxiety than transferred Whites.


An evaluation of a community outreach program.

A contact and counseling service for youth was examined with regard to the awareness of the program and its nature, the utilization of it, and the evaluation of it by the population of youth at risk. The program was evaluated both by a novel, unobtrusive approach to data-collection for use in a milieu where conventional methods were inoperable, and by an analysis of records from the agency. In addiction, process and activity observations of staff and clients were found to be useful for the evaluation of the agency's activities. The results indicated high levels of consumer awareness, mixed levels of utilization, positive evaluation, and an appropriate perception of goals and activities by the potential and actual users.


Systems issues in psychiatric treatment of adolescents in their community.

The psychiatric treatment of adolescents is analyzed as having, on the one hand, staff and client subsystems interacting continuously and, on the other hand, cross-boundary transactions between the treatment program and two other systems, the neighborhood and the community mental health system of which the program is a part. Through the use of the concepts of boundaries and mirroring, it is possible to explain more clearly how certain dramatic events relate to adolescent psychology and to the treatment tasks.


Significance of endoscopically visible blood vessels as an index of atrophic gastritis.

The endoscopic criteria for atrophic gastritis are. 1. pale mucosa; 2. shiny surface and 3. prominent submucosal vessels. To evaluate the diagnostic accuracy of circumscribed atrophic gastritis based on these findings, we studied 184 consecutive upper gastrointestinal endoscopies. The endoscopic diagnosis of atrophic gastritis was made only if two endoscopists both agreed on the findings and interpretation. The location of the atrophic pattern and whether it was circumscribed or diffuse were recorded. Two biopsy specimens were than obtained. Histologic material was interpreted by a pathologist who had no prior knowledge of the endoscopic findings. Twenty-five patients (13%) had atrophic gastritis endoscopically; in four it was diffuse and in 21 it was circumscribed. Utilizing the criteria of Whitehead, et al, atrophic gastritis was diagnosed histologically in three of four patients with diffuse gastritis but in one of those considered to have circumscribed atrophic gastritis. It is concluded from these preliminary data that a circumscribed atrophic mucosal pattern is a frequent endoscopic finding that does not necessarily represent atrophic gastritis histologically.


Dye clearance studies in Rotor's syndrome.

Plasma clearances of sulfobromophthalein sodium (BSP), indocyanine green (ICG) and unconjugated bilirubin were studied in six patients with Rotor's syndrome. A marked retention of these three substances in the plasma was observed. At 60 minutes after injection, serum BSP consisted almost entirely of the unconjugated form. In three patients, BSP Tm and BSP S were significantly reduced. Clearance of unconjugated bilirubin was markedly impaired. This, together with the conjugated hyperbilirubinemia may be interpreted to reflect reduced storage. These results indicate that Rotor's syndrome is marked by reduced hepatic storage capacity and excretory function of BSP, ICG and bilirubin.


Effect of phenoxybenzamine (POB) on portal venous pressure in patients with portal hypertension.

In order to assess an effect of phenoxybenzamine (POB) on portal circulation, POB (0.5-1.0 mg./kg.) was administered intravenously to six patients with portal hypertension and two patients without portal hypertension. In patients with portal hypertension, POB reduced portal venous pressure (PVP) from 362.5 +/- 53.8 mm. H2O to 282.5 +/- 50.4 mm. H2O (P less than 0.001) where central venous pressure (CVP) was maintained constant. In patients without portal hypertension, change in PVP was in parallel with that in CVP where the decrease in PVP was regarded as not specific. This preferential reduction of PVP in portal hypertension seemed to implicate functional vasoconstriction of the portal venous system. In the treatment of bleeding esophageal varices, use of POB with blood transfusion after decompression of the Sengstaken-Blakemore tube should be beneficial because of its prolonged effect of lowering PVP and preventing ischemic liver damage.


Endoscopic resection of squamous papilloma of the esophagus.

Squamous papilloma is a rare, benign esophageal tumor which may be confused with verrucous carcinoma of the esophagus. The case of a 45-year old male who was found to have an esophageal squamous papilloma is presented. This case serves to demonstrate the important role of fiberoptic endoscopy for the transendoscopic resection of this tumor.


Choledochal cyst presenting as pancreatitis.

A patient with choledochal cyst presenting with recurrent pancreatitis is described. The cyst was suspected on endoscopic retrograde cholangiography (ERCP), then was diagnosed by intravenous cholangiography and abdominal angiography. It was confirmed at surgery. The clinical, radiological and surgical features of this disorder are described and the importance of this entity as a possible correctable cause of pancreatitis is stressed.


Partial duodenal obstruction in presence of complete rotation of the colon.

Two children were admitted with partial obstruction of the duodenum due to its incomplete rotation and fixation. The colon in both cases was rotated normally. Our experience with these children, along with embryological evidence to understand the above entity, is presented.


Primary pulmonary hypertension presenting as portal hypertension.

A two and a half-year old child is described who presented with signs of portal hypertension (hematemesis, hepatosplenomegaly, ascites). Her subsequent work-up revealed that the "pressure-head" originated within the pulmonary arterial bed. Indeed, severe changes of primary pulmonary hypertension were found at autopsy. What is unique about this case is the absence of cardiopulmonary symptoms prior to the development of suprahepatic portal hypertension. In addition, the pulmonary disease developed in the absence of underlying chronic hepatic disease or extrahepatic portal vein thrombosis which, reportedly, can lead to pulmonary hypertension.


Low incidence of bacteremia following endoscopic retrograde cholangiopancreatography (ERCP).

Fifty patients (29 females) undergoing ERCP were studied prospectively for the occurrence of bacteremia associated with this endoscopic procedure. Each patient had blood samples drawn for aerobic and anaerobic cultures before endoscopy, after entering the duodenum, 5 and 15 minutes after cannulation of the papilla of Vater. Subcultures were made at 24 and 48 hours for a total of 1,200 cultures. No positive cultures were obtained in 48 patients. One patient developed a Staphylococcus epidermidis bacteremia during the procedure. The cleansing technic for the instruments consisted of alcohol and water only. Prophylactic antiobiotics were not administered. In contrast to other gastrointestinal procedures, our results suggest that bacteremia is an uncommon occurrence in ERCP despite the longer duration of the procedure and instrumentation of a sterile duct system.


Definitive diagnosis of pancreatic carcinoma with percutaneous fine needle aspiration biopsy under ultrasonic guidance.

Definitive diagnosis of pancreatic cancer presents difficulties in that positive identification is often possible only by intraoperative biopsy. Recently, ultrasonic visualization of the pancreas has made preoperative diagnosis possible by furnishing a guide to percutaneous biopsy via a flexible 23-gauge, 0.6 mm. needle.


Brucella-induced cholecystitis.

Acute cholecystitis is a rare complication of systemic brucellosis. This report details the occurrence of acute noncalculous cholecystitis in which Brucella suis was cultured from both the blood and the gallbladder. A discussion of the various diagnostic tests and the recommended therapy for brucellosis is included.


Neonatal duodenal obstruction.

The records of 40 infants with intrinsic duodenal obstruction have been reviewed. Of these more than half had no bile in the vomit. Persistent vomiting had been considered as the major factor of doubt regarding duodenal obstruction. The incidence of other associated congenital abnormalities was 70%. The over all mortality rate was 42.5%. The association of mongoloidism to the intrinsic duodenal obstruction was found approximately in every third infant. The low birth weight without other congenital abnormality has very little effect on the mortality rate.


Unusual presentation of pulmonary inflammatory pseudotumor (plasma cell granuloma) as esophageal obstruction.

A 12-year old boy had a five-year course of dysphagia secondary to lower esophageal obstruction by a posterior mediastinal extension of an inflammatory pseudotumor of the lung. The case illustrates the capacity of pseudotumor to behave in a locally aggressive manner and to present in extrapulmonic sites.


Fiberendoscopic removal of long foreign bodies from the stomach using a colon stiffening tube as a protective sheath.

A colonoscopic stiffening tube was effectively used as a protective sheath in the esophagus during the endoscopic removal of a long ballpoint pen and a writing pencil from the stomach.


Unusual outcome of percutaneous transhepatic cholangiography.

In a 72-year old male with fever, mild jaundice and moderate enlargement of both liver and spleen, percutaneous transhepatic cholangiography resulted in direct filling of the portal vein system. Both trunc and left and right hepatic lobe branches showed a typical pattern of incomplete portal vein thrombosis, with mural irregularities and radiolucencies within the lumen. On subsequent operative cholangiography the biliary tract was shown to be normal. At autopsy multiple intrahepatic abscesses of pylephlebitic origin were found. The significance of visualization of the portal vein system during PTC is briefly discussed in comparison with other angiographic technics.


Endoscopic electrocoagulation of actively bleeding arterial upper gastrointestinal lesions.

Emergency endoscopy to find the site of upper gastrointestinal bleeding is now accepted as the diagnostic method of choice. Endoscopic electrocoagulation in uncontrolled series has been successful in 98% of patients so treated (142 of 147). If a vessel is seen in an ulcer bed, some preliminary data would support surgical treatment. In my opinion, electrocoagulation is favored to prevent further bleeding. While some physicians have found electrocoagulation safe and effective, there are some who remain guardedly cautious. In the near future, a multicenter randomized study will begin to further assess the usefulness, effectiveness and safety of endoscopic electrocoagulation. Endoscopic electrocoagulation has opened a Pandora's box to exciting research in finding ways of treating acute upper gastrointestinal hemorrhage. Currently, electrocoagulation is the front runner.


Diagnosis of early gastric cancer.

Early gastric cancer is being encountered with increasing frequency in Germany as well as Japan and elsewhere through greater awareness, selection of high risk patients and improved diagnostic methods. We consider endoscopy superior to radiology in the detection of early gastric cancer. Polypoid lesions of the stomach need endoscopic biopsy or removal for proper diagnosis. Gastric ulcers should be followed by endoscopy and guided biopsies until healing is complete. Adequate sampling of a suspected gastric lesion may require multiple biopsy specimens for accurate histological interpretation.


Effect of monopolar electrocoagulation on esophagus, stomach and duodenum in dogs.

The effects of electrocoagulation on the esophagus, stomach and duodenum of mongrel dogs were studied. A commercially available electrocoagulator unit and suction electrode were used. Various dial settings and duration times were used. The total number of sites electrocoagulated was 945; histologic section of each site was prepared. A dial setting of 7 and duration of 5 seconds was safe for the canine esophagus and duodenum; for the stomach it is a dial setting of 7 and duration of 3 seconds. This information will be useful in safe application of electrocoagulation to superficial bleeding lesions in the canine esophagus, stomach and duodenum.


Crohn's disease of the appendix, manifested as acute appendicitis with postoperative fistula.

Two cases are reported of Crohn's disease localized to the appendix and manifested as acute appendicitis; after appendectomy a fistula developed. In none of 18 patients with Crohn's disease reported by other authors, where the appendix was the primary site, did a fistula develop postoperatively. When the appendix is the primary site of Crohn's disease the presence of mild inflammation of adjacent organs such as the terminal ileum may be mistakenly attributed to ordinary appendicitis. If, at exploratory laparotomy performed on a tentative diagnosis of appendicitis, Crohn's disease is suspected in the adjacent intestine, it is proposed that appendectomy should be followed by at least 10 days of total parenteral nutrition to minimize the risk of a fistula developing.


Umbilicated gastric polyposis. An indicator of metastatic gastric tumor.

A case of multiple centrally umbilicated gastric polyps is presented. Several endoscopic biopsies of the various polyps rapidly established the histological diagnosis of amelantoic melanoma. The significance and differential diagnosis of this endoscopic lesion is discussed.


Plasmacytoma of the stomach.

A case of gastric plasmacytoma is presented. A detailed study including a selective angiogram described this unusual gastric neoplasm. Pathological examination by both light and electron microscopy confirmed the diagnosis of primary gastric plasmacytoma. The diagnosis and treatment of primary gastric plasmacytoma is discussed and pertinent literature is reviewed.


Traumatic hemobilia. Diagnosis by endoscopic retrograde cholangiography.

A patient with traumatic hemobilia documented by retrograde endoscopic cholangiography and treated by right hepatic artery ligation, is described. The role of ERCP in making the diagnosis of traumatic hemobilia is discussed.


Hemoperitoneum from a ruptured varix in cirrhosis. Case report and literature review.

A cirrhotic patient with hemoperitoneum is presented. The diagnosis of ruptured retroperitoneal varices was made at laparotomy and the patient becomes the second reported case to survive hospitalization for bleeding intra-abdominal varices. The formation of varices as a consequence of portal hypertension is discussed; the differential diagnosis and evaluation of hemoperitoneum is considered and the seven previously reported cases of intra-abdominal variceal hemorrhage are reviewed.


Ascending colon volvulus due to a vitelline duct remnant in an elderly patient.

A 77-year old female is presented with volvulus of the ascending colon due to torsion around a vitelline duct remnant. Symptoms were mild and intermittent. Roentgenograms are presented which demonstrated this lesion preoperatively. At surgery the ascending colon was found to be twisted around a fibrous band extending from the umbilicus to the ileum.


Caroli's disease. description of a rare clinical case with monolobar localization.

A case of monolobar localization of Caroli's disease with intrahepatic cholesterol gallstones is described. The patient was successfully treated with left hepatic resection. Residual intrahepatic cholesterol gallstones causing frequent cholangitis dissolved with chenodeoxycholic acid treatment.


Malignant carcinoid of the appendix: case report with radiographic and angiographic demonstration.

An unusual case of a malignant carcinoid of the appendix is reported, together with a brief review of the pertinent literature. The case exhibited mesenteric invasion, peritoneal seeding, terminal ileal ischemia and features of the carcinoid syndrome. The radiographic and angiographic documentation are unique in the literature.


Electrical wiring configurations and childhood cancer.

An excess of electrical wiring configurations suggestive of high current-flow was noted in Colorado in 1976--1977 near the homes of children who developed cancer, as compared to the homes of control children. The finding was strongest for children who had spent their entire lives at the same address, and it appeared to be dose-related. It did not seem to be an artifact of neighborhood, street congestion, social class, or family structure. The reason for the correlation is uncertain; possible effects of current in the water pipes or of AC magnetic fields are suggested.


Risk factors for brain tumors in children.

An exploratory case-control study was conducted in 15 hospitals in the Baltimore, MD, SMSA of possible etiologic factors associated with brain tumors in children. Eighty-four children with brain tumors were compared to normal children and to children with other malignancies. Parents of these children were interviewed about a variety of possible etiologic factors. The findings included: 1) children with brain tumors as well as children with other cancers had a greater tendency than normal children to have been first births and to have had higher birth weights; 2) more children with brain tumors had a sibling with epilepsy or seizures than did normal children, and several of the mothers of children with brain tumors had themselves had epilepsy or a stroke at a relatively young age; 3) there were no significant differences between the groups with regard to several maternal characteristics, including smoking during pregnancy and prior radiation exposure; 4) more children with brain tumors and children with other cancers were found to have had exposures to insecticides than had normal children; 5) fewer children with brain tumors or with other cancers were reported to have had tonsillectomies than normal children; and 6) more of the children with brain tumors as well as the children with other malignancies were reported to have been exposed to farm animals and to sick pets. This exploratory study is one of the first case-control studies of the epidemiology of brain tumors in children, and the results suggest directions for future epidemiologic studies in this relatively uncharted field.


Time course studies of blood pressure in children--the Bogalusa Heart Study.

Blood pressures (BPs) were taken with a mercury sphygmomanometer and an automatic recorder on 3524 children representative of an entire geographic community. For all children ages 5, 8, 11, and 14 years in the initial examination, age-specific systolic and diastolic (4th phase) selected percentiles were assessed. Of these children, 1101 were reexamined after one year. Observations from a group of 35 fifth-graders examined monthly for eight months were pooled to observe intra-child BP variability. This estimate was used to reduce to zero in a statistical adjustment the regression toward the mean of the BPs for the after-one-year reexamined children. It was found that those children initially in the top ten percentiles had, upon reexamination, on the average only 3 mmHg lower systolic and 1 mmHg lower diastolic levels. In a multiple regression analysis, the previous year's BP contributed a partial correlation coefficient of 0.6--0.7 for each age cohort to the variability of the BP, controlling for other determinants. These findings, based on reliable, basal-like measurements, point to a degree of persistence which is quite high. The higher the degree of tracking the more likely that primary hypertension begins early in life.


Blood pressure survey on the Navajo Indian reservation.

The authors conducted blood pressure screening on the Navajo Indian reservation in northeastern Arizona and northwestern New Mexico. Six hundred forty Navajos over 19 years of age were surveyed at various sites. The mean systolic and diastolic blood pressures in Navajo men and women did not show as great increases with age as those seen among white and black Americans. Navajos also had generally lower blood pressures and lower prevalence of hypertension than white and black Americans. The authors were unable to demonstrate any association between degree of acculturation and blood pressure, but they did find that obesity in both men and women and alcohol use in men were associated with a higher prevalence of elevated pressure in the Navajos.


Sperm count depression in pesticide applicators exposed to dibromochloropropane.

Male pesticide applicators who worked with the nematocide dibromochloropropane (DBCP) were examined to determine the possible testicular toxicity from this exposure. Infertility and azoospermia which were first noted among factory workers exposed to DBCP were not observed among the applicators. Sperm count depression, however, was associated with the duration of exposure in the current year but not with exposure in past years. The extent of exposure to DBCP in the current year was also associated with an elevation of serum follicle stimulating hormone (FSH) but not of luteinizing hormone (LH). Sperm count depression was limited to applicators involved in irrigation setup work and in the calibration of equipment. These results suggest that the testicular toxicity of DBCP for men may occur in a shorter period than was previously reported, that the effect may be reversible in men with mild sperm count depression, and that public health measures might be directed at controlling specific application techniques.


Choosing the parameter for a 2 x 2 table or a 2 x 2 x 2 table analysis.

Fourteen 2 x 2 table measures of association are compared and six 2 x 2 x 2 table measures of synergism are compared. The presentation is based on a conceptual population model for the true association between the disease and the risk factor(s). Each measure is judged as to potential use and identified with the study designs under which it can be estimated. It is shown that prior information about the correct population model is required to adequately measure synergism.


Temporal variation in suicide and homicide.

In this study of all of the violent deaths in the US over two years, clear monthly and daily variations were found. Suicide peaked in the Spring and Fall; homicide in July and December. Suicide was more common on Mondays; homicide on Saturdays and Sundays. Homicide was more common on national holidays, while suicide tended to be less common. No lunar variation was found.


Components of the difference in hemoglobin concentrations in blood between black and white women in the United States.

Hemoglobin and the per cent transferrin saturation (TS) distributions of 742 black and 3074 white women drawn from a large probability sample of the US civilian noninstitutionalized population (HANES I) were examined to ascertain the magnitude and nature of an observed systematic difference in hemoglobin levels. This significant hemoglobin difference was primarily related to a different relationship between hemoglobin and TS for blacks and whites, and not related to differences in TS between the races. This difference between the races in the relationship between hemoglobin and TS explained almost all of the difference in hemoglobin concentration at the mean, the median and higher percentiles, and half or more of the difference at the first and third percentiles of the cumulative hemoglobin distributions of the white and black populations sampled. The practical implication of these findings is that white hemoglobin diagnostic criteria (standards) are inappropriate for blacks, and vice versa, both at the mean and at the lower hemoglobin levels of clinical interest.


Influenza surveillance by age and target group.

Surveillance for influenza virus infections began in mid-1976, continued through three small influenza A outbreaks (mixed A/Victoria and A/Texas outbreaks in Spring, 1977, and Winter, 1977-1978 and an A/USSR outbreak peaking in March, 1978). Nasopharyngeal specimens were collected for virus isolation from febrile respiratory disease patients coming from four sources: 1) the Sunday walk-in clinic of the Group Health Cooperative of Puget Sound; 2) 200 families under continuous surveillance for respiratory viral infections; 3) patients referred by interested community physicians or self-referred persons in vaccine evaluation studies; and 4) students presenting at the University of Washington health center. Influenza virus isolation rates were as high in children as adults and peaked earlier in adults than in children in all three epidemics. Although referred patients and university students yielded the highest isolation rate, nearly 30%, all four community sources were important in detecting an impending epidemic.


Path analysis of environmental and genetic influences on blood pressure.

Familial aggregation of a trait (determined by the intraclass correlation coefficient) may result from genetic influence or from environment common to a household. The authors used path analysis to separate aggregation into the proportion of population variability due to genetic influence (h2 = heritability) and the proportion due to environment common to a household (c2). They used data from full siblings and maternal half siblings, aged two to 18 years, from Bogalusa, Louisiana, a biracial community. The statistically significant aggregation they found could be explained by either h2 or c2 except for two cases: systolic measurement in the pooled (black and white) sample requires h2; diastolic measurement in the white sample requires c2. The authors present a simplified explanation of the techniques they used.


A rank statistic for assessing the amount of variation explained by risk factors in epidemiologic studies.

A statistic, Q, based on the ranks of the estimated probabilities of disease is proposed for assessing the effectiveness of regression models used with dichotomous dependent variables in epidemiologic studies of risk factors for chronic diseases. The pitfalls of R2 are discussed, and the proposed statistic is compared with R2 utilizing 8.6-year incidence data from the national cooperative Pooling Project and 15-year mortality data from the Chicago Peoples Gas Company Study. Based on the risk factors, systolic blood pressure, serum cholesterol, and smoking status for middle-aged males, the proposed statistic, Q, attains from 27-44% of its maximum value for the endpoint, the first major coronary event, and from 35-46% of the maximum for death from the cardiovascular diseases.


Altitude and ischemic heart disease in tricultural New Mexico: an example of confounding.

The relationship of male white ischemic heart disease (IHD) death rates to altitude falls to negligible levels when New Mexico populations are separated into Hispanic and Anglo. Low rates of IHD mortality characterize Hispanic males in New Mexico regardless of altitude. In comparison, New Mexico Anglo males have rates near the US average. The variable showing the most consistent positive relationship with altitude is per cent Hispanic. Mortimer et al. (N Engl J Med 296:581--587, 1977) reported a reduction in coronary heart disease mortality in New Mexico white males with an increase in altitude. The current authors claim that this is an example of confounding. They find that the relationship between IHD mortality and altitude is largely due to the intervening variable, per cent Hispanic. Ethnicity demands major attention in epidemiologic studies in tricultural New Mexico.


Mortality patterns among workers in a gray iron foundry.

The long-term mortality experience of 2861 men employed for at least one month in the period 1938 to 1967 in a gray iron foundry was examined to determine if they experienced unusual death rates for specific causes indicative of exposure to hazardous materials in the work environment. Both white and non-white workers experienced favorable mortality for most major disease categories compared to general population rates, even men employed five or more years. No deaths from pneumoconiosis were observed nor were deaths from other chronic respiratory diseases in excess. Analysis of detailed cancer sites showed no significant departures from expectation overall. However, in the subgroup of men who achieved five or more years employment prior to 1938, a twofold increase in mortality from digestive cancer (14 observed deaths vs. 7.4 expected) and respiratory cancer (8 observed deaths vs. 4.0 expected) was seen. Absence of information on specific foundry jobs held by the subjects and associated exposures limits full interpretation of the findings. However, the excess observed for respiratory cancer among long-term employees followed for 30 years is consistent with previous reports.


Studies on hematopoietic stem cells: XI. Lack of erythroid burst-forming units (BFU-E) in patients with aplastic anemia.

The marrow concentration of erythropoietic precursors was examined in normal donors and patients with idiopathic aplastic anemia using a plasma clot culture system. On time course observations the heterogeneity of human erythroid precursors assayable in culture was demonstrated. To evaluate human erythropoiesis in vitro, the benzidine-positive colonies were divided into three groups: small colony, containing 8-50 cells; medium-sized colony, containing 50-500 cells; and large colony, containing more than 500 cells. The majority of the large colonies assumed the morphology of erythropietic bursts (BFU-E) consisted of several subcolonies. The small colonies were counted as CFU-E1, the medium-sized as CFU-E2, and the large as BFU-E to evaluate the erythroid precursor cell compartment in aplastic anemia. The marrow concentration of CFU-E1 and CFU-E2 was shown to be quantitatively diminished in aplastic anemia. In addition, there was no ability of the marrow cells from aplastic patieints to grow BFU-E in vitro even in the presence of a large dose of erythropoietin. This lack of BFU-E colony growth may play an important role in the mechanism of the erythropoietic deficiency in aplastic anemia.


Heterogeneity of hemoglobin gamma chains in normal newborns and in cases of alpha and beta thalassemia.

The ratio of Ggamma to Agamma was studied in 13 normal healthy newborns and in eight neonates with hydrops fetalis due to homozygous alpha-thalassemia. The findings in the normal healthy newborns agreed with those of earlier reports. In homozygous alpha-thalassemia the Ggamma and Agamma ratio appeared generally lower than in healthy control newborns, but one of the hydrops fetalis cases had a very high Ggamma value. In all 13 normal healthy newborns, in 8 patients with homozygous alpha-thalassemia, and in 4 patients with homozygous beta-thalassemia, Tgamma chains with threonine at position 75 were detected in addition Igamma chains with isoleucine at position 75. In homozygous alpha-thalassemia, the Tgamma-to-Igamma ratio seemed lower and in homozygous beta-thalassemia higher than in normal newborns.


Giant platelet granules in a child with the Chediak-Higashi syndrome.

Previous ultrastructural investigation have not identified abnormal lysosomes in platelets obtained from humans or animals with the Chediak-Higashi Syndrome. We report here a patient whose megakaryocytes and platelets were found to contain giant granules when viewed by light and electron microscopy. The granules measured up to 1.5 micrometer in diameter, contained either homogeneous or heterogeneous material, were acid phosphatase positive, and were present in approximately 30% of bone marrow megakaryocytes and 5% of circulating platelets. A decrease was observed in serotonin containing dense granules, serotonin uptake and serotonin release as reported previously. Microtubules in platelets and megakaryocytes were intact and no other morphologic abnormalities were identified. No clinical evidence of bleeding was observed in this patient and platelet counts have been normal. The lack of giant platelet lysosomes in other reported cases of Chediak-Higashi Syndrome attests to significant heterogeneity in this disease with a spectrum of clinical and laboratory findings.


Acute leukemia and preleukemia in eight males in a family: an X-linked disorder?

Eight males in a family died of acute leukemia or a potentially preleukemic blood disease. Three patients were descendants of a man through his first wife, and the other five through his second wife. The pattern of disease in the family suggests X-linked inheritance through the two wives, although other mechanisms cannot be excluded. No detectable action of environmental leukemogens was observed in this family disorder.


Heritable fragile sites on human chromosomes II. Distribution, phenotypic effects, and cytogenetics.

Individuals and families have been documented in which there are a number of fragile sites on chromosomes. These include sites at 2q11, 10q23, 11q13, 16p124, 16q22, 20p11, and Xq27 or 28. Fragile sites reported in the literature are compiled. The cytogenetics of the sites is discussed. The phenotypic effects of the sites are considered, and it is speculated that homozygosity of the autosomal sites might be deleterious as is hemizygosity of the site on Xq. These sites are used in the previous report which documents the effect of tissue medium components on their expression.


Chromosomal mosaicism in amniotic fluid cell cultures.

Over the past 6 years, using in situ processing methods, we have identified 32 cases of mosaicism in amniotic fluid cell cultures prepared from 1,100 samples. Two of these (45,X/46,XX and 46,XX/47,XX, + 21) were called true mosaics because multiple colonies demonstrated the same abnormal chromosome complement, and on subsequent evaluation of the newborn blood or fetal tissues, mosaicism was confirmed. Of the remaining cases, 29 were designated as pseudomosaics because only single or partial colonies exhibited an aberrant chromosome complement, 12 having a trisomy 2 line. In the final case, a double trisomy was demonstrated in only one of eight colonies in the first culture, but in the culture from a repeat sample an additional two colonies showed the same double trisomy. Since no abnormal cells were observed in infant blood, it was postulated that the mosaicism may only have been present in the extraembryonic tissues. It is our conviction that the use of these cloning methods should diminish the danger of misdiagnosis in genetic amniocentesis.


Genetic drift in sex-linked lethal disorders.

A model is considered to calculate effects of genetic drift on the expected proportion of new mutants amongst males affected by a sex-linked recessive lethal. We show how to relate the number of cases of the disorder in males to the expected deviations from the deterministic value of the proportion of new mutants. For small values of alpha (= 3N mu), where N is the size of the female population, and mu is the mutation rate from wild-type to lethal allele, the standard deviation (SD) of the proportion of new mutants is large. However, if alpha more than 50, the potential effect of genetic drift is probably less important than the many other sources of error and bias.


Maximum likelihood estimation by counting methods under polygenic and mixed models in human pedigrees.

For pedigree data, the maximum likelihood estimates of the parameters in polygenic and mixed models are derived analytically although not in closed form but in terms of "counting equations" allowing an iterative solution. Likelihood computations, tests of significance, and tests of goodness of fit are presented. Accelerating the (linear) rate of convergence by a very simple method is demonstrated.


Multifactorial inheritance with cultural transmission and assortative mating. II. a general model of combined polygenic and cultural inheritance.

A general linear model of combined polygenic-cultural inheritance is described. The model allows for phenotypic assortative mating, common environment, maternal and paternal effects, and genic-cultural correlation. General formulae for phenotypic correlation between family members in extended pedigrees are given for both primary and secondary assortative mating. A FORTRAN program BETA, available upon request, is used to provide maximum likelihood estimates of the parameters from reported correlations. American data about IQ and Burks' culture index are analyzed. Both cultural and genetic components of phenotypic variance are observed to make significant and substantial contributions to familial resemblance in IQ. The correlation between the environments of DZ twins is found to equal that of singleton sibs, not that of MZ twins. Burks' culture index is found to be an imperfect measure of midparent IQ rather than an index of home environment as previously assumed. Conditions under which the parameters of the model may be uniquely and precisely estimated are discussed. Interpretation of variance components in the presence of assortative mating and genic-cultural covariance is reviewed. A conservative, but robust, approach to the use of environmental indices is described.


Major gene analysis of quantitative variation in blood clotting factor X levels.

Blood clotting factor ten (X) levels measured in 149 people in six pedigrees were found to fit a mixture of normal distributions. No environmental effect could be identified to account for the wide separation in the means of these distributions. Pedigree analysis reveals that the data are compatible with an autosomal, one locus, two allele genetic model affecting factor X activity. Goodness of fit tests suggest that the allele for low levels of factor X is dominant, though on the basis of likelihood tests, mean heterozygote levels are different from mean homozygote levels. A similar bimodal distribution for factor X levels observed previously in a separate sample of 207 young men, indicated that the proposed dominant allele has an estimated population gene frequency of .53. The earlier estimate is remarkably similar to that obtained with the currently ascertained pedigrees. The postulated major gene accounts for more than half of the variation in factor X levels.


Familial X-linked mental retardation, verbal disability, and marker X chromosomes.

Cytogenetic and verbal studies were done on members of four families with non-specific X-linked mental retardation. Cytogenetic analysis was done using media 199 and GTG-banding; one family had a marker X with a fragile site in band Xq27 or 28. Preliminary results indicate variation of culture conditions can effect the frequency of the marker X. A generalized language disability was found which tended to concentrate in the areas of auditory reception, auditory sequential memory, visual closure and grammatic closure. Articulation errors involved the same sounds which are late in normal development and occur most frequently in both the general population and a Down syndrome population.


Assuring the quality of intravenous admixture programs.

Several aspects of quality assurance (QA) methods in i.v. admixture programs are discussed, and a basic framework for developing QA programs for admixture services is presented. The objective of QA is to insure that admixture products: (1) are therapeutically and pharmaceutically appropriate to the patient; (2) are free from microbial and pyrogenic contaminants; (3) are free from undesirable levels of particulate or toxic contaminants; (4) contain drugs in correct amounts; and (5) are labeled, stored and distributed under principles of good drug control. Three types of QA criteria bases which may be used as indicators of quality are discussed (resources, facilities and organization; required procedures; end-products or results). Because end-product monitoring has certain limitations in the admixture setting, QA must rely heavily on procedure-centered review methods. General guidelines for developing QA programs are outlined. Adherence to procedure is the key to assuring the quality of admixture products. In developing a QA program, the highest priority should be given to the education and training of admixture personnel, particularly with respect to aseptic technique and pharmaceutical calculations.


Pharmacist management of anticoagulant therapy in ambulant patients.

The development, operation, patient management protocol and teaching activities of a pharmacist-managed anticoagulant clinic for ambulatory patients are described. Pharmaceutical services provided in the ambulatory clinic include (1) contribution to the problem-oriented medical record; (2) patient education; (3) therapeutic response monitoring; (4) drug information; (5) drug distribution; and (6) inservice education. A pharmacist completes a medication history on initial visit; assesses and adjusts anticoagulant therapy based on physical examination, detection of adverse drug reactions and laboratory test results; schedules return clinic visits; provides patient education; and records, in the patient's medical record, the assessment and results of treatment. Treatment adjustments made by the pharmacist are based on an oral anticoagulant protocol and reviewed by the clinic cardiologist. The clinic serves as a teaching site for undergraduate pharmacy students, Doctor of Pharmacy students and hospital pharmacy residents. The anticoagulant clinic gives the pharmacist a unique opportunity to provide comprehensive pharmaceutical services, to establish effective, long-term professional relationships with ambulant patients and their families, and to foster interdisciplinary health team activities.


Hospital pharmacy purchases and inventories.

The results of the hospital pharmacy purchases and inventories portion of a 1978 national mail survey of pharmaceutical services in short-term hospitals are reported. A sample of 815 hospitals was selected randomly from among 5,200 U.S. short-term hospitals that employ a pharmacist on at least a part-time basis. The inventory question had a response rate of 67.7%, the purchasing question, 62.2%; inventory turnover was calculated based on a response rate of 60.5% to both questions. Inventories were inordinately large in small hospitals. Inventory turnover rates, which increased with hospital size, were somewhat less than optimal in small and medium hospitals. The Pacific region's inventory/bed and purchases/bed values were substantially greater than those of any other region. Large hospitals had a 20% higher annual purchases/bed figure than the smaller hospitals, perhaps because of their relatively greater volume of outpatient services. Based on their respective demand (as measured by adjusted inpatient days), the drug purchases of the New England and Mid-Atlantic regions were less than expected, while the Mountain and Pacific regions' drug purchases were much greater than expected. Total 1979 purchases of pharmaceuticals and related supplies by pharmacies in all short-term hospitals are estimated to reach $2,215 to $2,772 million.


Transient monoclonal proteins in drug hypersensitivity reactions.

Two patients were studied in whom monoclonal (M) immunoglobulin G (IgG) proteins developed during the course of a serum sickness-like drug hypersensitivity reaction to cloxacillin (Orbenin) and sodium cephalothin (Keflin), respectively. The clinical evidence and time sequence of events support this association. In both patients there was evidence of an active antibody response to the given antibiotic and to the benzylpenicilloyl group as well. However, protein fractions obtained by agar gel preparative electrophoresis failed to show a higher antibody concentration where the M peak was located, and absorption experiments performed with penicillin G-, cloxacillin- and cephalothin-coated red cells failed to absorb these M proteins. These transient paraproteins can be seen in association with antibiotic(s) administration in the context of a hypersensitivity reaction and do not apparently represent a specific immune response.


Macrocytic anemia, thrombocytosis and nonlobulated megakaryocytes: the 5q-syndrome, a distinct entity.

The clinical, hematologic and histologic characteristics of six patients with refractory anemia with deletion of the long arm of chromosome No. 5 are described. These patients had a distinct hematologic picture with macrocytic anemia of mild to moderate severity, normal to low leukocyte count and increased platelet count. The long arm of chromosome No. 5 was deleted in the majority of bone marrow metaphases. The main cause of anemia was underproduction with decreased erythroid precursors in the bone marrow and no increase in peripheral blood reticulocytes. Two of five patients responded transiently to the administration of androgens. In vitro evaluation of the bone marrow growth pattern in semisolid agar culture system was performed in three patients and was found to be normal and distinct from that in patients with preleukemia. In a follow up of up to five years, no patient had changed hematologically and in none had leukemia developed. The 5q-syndrome is a distinct hematologic entity and probably more common than hitherto realized. This diagnosis may have therapeutic and prognostic implications.


Systolic time intervals in hypothyroidism: end organ function as a reflection of clinical status.

Systolic time intervals (STI) were determined in 14 hypothyroid patients who did not have congestive heart failure or atrial fibrillation, and who were not taking cardiotropic drugs. Compared to normals, there was a significant decrease in the left ventricular ejection time (LVET) and there were significant increases in the pre-ejection period (PEP) and the PEP/LVET ratio. The prolongation of the PEP primarily reflected lengthening of the isovolumic contraction time. Serial recordings during thyroxine therapy in seven patients showed consistent changes in STI toward normal values. These results in hypothyroid patients complement our earlier data in hyperthyroid patients; they indicate that STI's are a sensitive measure of the heart as an end organ over the entire range of thyroid hormonal activity.


The relation between aerobic fecal and oropharyngeal microflora in hospitalized patients.

The aerobic fecal and oropharyngeal bacterial flora was examined in 75 patients hospitalized, but not given antibiotics; in 70 patients given antibiotics during hospitalization and in 25 nonhospitalized controls. In all subjects, when first examined, normal throat flora were predominant. At the end of 21 days, however, a gram-negative bacilli became predominant in 17 (22.7%) of the Hospital Group and 33 (47.1%) of the Antibiotic Group. Newly appearing genera of gram-negative bacilli in the pharynx were almost always represented those present in the fecal flora. The Hospital Group all had recognizable components of the normal oropharyngeal flora present at 21 days, but 12 (17.1%) of the Antibiotic Group had no demonstrable normal oropharyngeal flora at 21 days. The findings suggest that hospitalization alone can be associated with the appearance of gram-negative bacilli in the oropharynx, and that the intestinal tract is their most likely point of origin.


Endotoxin shock in the beagle dog.

The hemodynamic and metabolic responses to endotoxemia were assessed in seven splenectomized, chronically instrumented, conscious but lightly sedated beagle dogs. Measurements included: cardiac output (CO), right and left atrial pressures (RAP, LAP), systemic and pulmonary arterial pressures (SAP, PAP), and heart rate (HR). Arterial blood samples were measured for blood gas tensions, pH, lactate, and pyruvate. After a brief control period, 1 mg/kg endotoxin (Difco 026:B6) was given as an intravenous bolus. Two hours later, each animal was treated with low-molecular weight dextran (LMDX), 2 ml/kg/min for 15 minutes. Endotoxin initially produced a precipitate decline in CO, HR, RAP, LAP, and SAP with concurrent pulmonary hypertension; both pulmonary and systemic vascular resistance increased significantly, then declined to control values as the animal partially recovered. A progressive metabolic acidosis with excess lactate accumulation developed. LMDX produced a significant increase in CO, SAP, PAP, and LAP with a decrease in HR; RAP increased slightly. With hydration, hemodilution was noted along with relief of the metabolic acidosis and the oxygen debt. We conclude (1) neither pulmonary nor systemic vasconstriction persisted in the shocked dog, (2) the response of the pulmonary and systemic vascular beds to endotoxin was qualitatively similar, and (3) oncotic fluid therapy appeared to restore the hemodynamic and metabolic parameters to preshock values.


Severe dysplasia and carcinoma in situ of the vagina.

Papanicolaou smears for early detection of carcinoma in situ of the cervix has been a well-recognized method of screening patients for over 30 years. The necessity for Papanicolaou smears following hysterectomy, especially for benign disease, has been a controversial subject. Twenty-two cases of carcinoma in situ of the vagina, over a period of 18 years, at the Huntington Memorial Hospital in Pasadena, California, are presented. Ninety-five percent of the lesions were first suspected by use of the Papanicolaou smears. Approximately half of previous hysterectomies were performed for benign disease. The various methods of treatment employed and the complications in these patients are discussed.


Aspects of folate metabolism in lactating women studied after ingestion of 14C-methylfolate.

Radioactive methylfolate (14C-5CH3H4PteGlu) (10-14 microgram/kg) was fed to four lactating women presenting with breast abscesses necessitating cessation of lactation. The appearance of radiofolate in milk, plasma and urine over the next 24 hours was investigated. In spite of a minimal postabsorption rise of plasma biofolate, plasma radiofolate (including a dialysis-resistant (bound) fraction) increased steadily to 1.26 to 5.11 microgram/l at 24 hours. Urinary radiofolate excretion was considerable. Total milk biofolate rose significantly by 15 to 28 microgram/l, in contrast with a much smaller radiofolate fraction (1.95-3.88 microgram/l) which at 24 hours was comparable with that of plasma. Milk radiofolate included a dialysis-resistant fraction rising to 0.75 to 1.15 microgram/l at 24 hours. On chromatography (Sephadex-DEAE-A50) plasma, urine and milk showed a nonbound radiofolate peak suggestive of 10-CHO.H4PteGlu. This folate may originate predominantly from the apocrine mammary glands. The in vitro labelled radiofolate milk binder could not be identified chromatographically, but it was shown that the in vitro milk binders of PteGlu and 5CH3H4PteGlu could be separated chromatographically.


Does adoption affect subsequent fertility?

A hypothesis derived from the old wives' tale that adoption increases subsequent fertility was tested by analysis of follow-up data obtained from 895 couples who were "at risk" of pregnancy and of adoption after they had registered in the Stanford Infertility Clinic between 1963 and 1977. Of the 767 couples who did not adopt, 329 later conceived; of the 128 who did adopt, 41 later conceived. Simple comparison of the percentages or, indeed, of the life tables suggests reduced fertility after adoption. However, this is probably a spurious effect related to a number of factors which differ between two groups. These differences were controlled in the statistical analysis by methods which take into account the length of time each couple was at risk of either conception or adoption and the presence or absence of explanatory variables. The relative risk of conception estimated by the Cox model was not significantly different from 1 and the Mantel-Haenszel statistic (m = 0.208) indicates no significant difference in subsequent conception rates between adoptive and not-adoptive couples. The same methods were used to control for seven covariates, including age and duration of infertility, which could affect conception rates. In each instance, the estimate of relative risk of conception for adoptive versus not-adoptive couples was not significantly different from 1. Therefore, our data do not support the hypothesis that adoption affects subsequent fertility.


Bilateral internal iliac artery ligation in cervical pregnancy: conservation of reproductive function.

Like other forms of ectopic gestation, cervical pregnancy is a serious complication with potentially life-threatening consequences. Excessive bleeding almost invariably follows an attempt to evacuate this rare ectopic pregnancy. In most reported cases, hysterectomy has been required to control the severe hemorrhage. This paper reports for the first time the successful conservative management of cervical pregnancy in two patients by bilateral internal iliac artery ligation alone. Early recognition of the cervical pregnancy and prompt internal iliac artery ligation are stressed.


Renin-angiotensin-aldosterone system, electrolyte homeostasis and blood pressure in alloxan diabetes.

The effect of a chronic glucose osmotic diuresis on electrolyte homeostasis was evaluated in alloxan diabetic rats with urine volumes greater than 150 ml/day and glycosuria of 4 to 10 gm/day. Results were compared with control rats for periods up to 84 days. Sodium and potassium intake and urinary losses were significantly higher in diabetic animals throughout the study periods. Negative Na balance, however, persisted for only four days, and negative K balance for only 18 days. Blood volumes were elevated probably secondary to the osmotic effect of hyperglycemia (serum glucose greater than 600 mg %). Plasma renin activity decreased progressively, in part because of an early decrease in renin substrate at a time when renin concentration was normal. Despite hyperkalemia, mean plasma aldosterone was not increased compared with that in control rats, suggesting diabetic rats had relative hypoaldosteronism. Although three diabetic rats became hypertensive, no significant difference in mean blood pressure was observed between the groups. The results suggest that diabetic rats have losses of Na and K early in their diabetes, following which mechanisms to conserve Na and K are activated preventing further electrolyte depletion despite continuation of the osmotic diuresis. Decreased renin activity with inadequate stimulation of aldosterone would contribute to K conservation. Maintenance of Na balance must be explained by increased Na intake and other renal Na conserving mechanisms.


Vasa previa.

An active obstetric service can expect to have one perinatal death each year due to vasa previa. Unfortunately, little has been done to improve the diagnosis and treatment of this condition, which presents no risk to the mother but is often fatal to the fetus. The various clinical pictures which can be associated with vasa previa are presented, along with a discussion of the techniques readily available for making the diagnosis: palpation and visualization, amnioscopy, fetal heart monitoring, and various tests for the presence of fetal hemoglobin.


Cephradine in the treatment of infective endocarditis.

Ten patients with a mean age of 34.1 years with infective endocarditis (55% of cases due to Staphylococcus aureus) were treated with cephradine. The peak serum levels of cephradine (8-42 microgram/ml) were 3- to 17-fold higher than the minimum inhibitory concentrations of cephradine against pathogenic strains of S aureus (1.2-4 microgram/ml). Patients treated with cephradine became afebrile in 2 to 13 days of therapy, and their white blood cell count returned to a normal level in 3 to 30 days. Cephradine therapy was well tolerated without any incidence of phlebitis. The drug could be administered by three different routes. Cephradine is a useful cephalosporin for treatment of nonenterococcal gram-positive endocarditis in young heroin addicts.


Cholelithiasis in sickle cell anemia: a case for elective cholecystectomy.

Ten patients with sickle cell anemia over the age of 10 who had cholecystectomy are reported. All had symptomatic cholecystitis; three had biliary tract obstruction. Transfusions were given preoperatively and with attention to oxygenation and fluid and electrolyte balance. There were few complications, none serious. Based upon the frequency of gallstones over the age of 10, the likelihood of symptoms or serious complications and the apparent ease with which the properly prepared sickle cell patient comes through surgery, we recommend routine cholecystograms in all adolescent and adult sickle cell anemia patients with elective cholecystectomy for those who have stones.


Pregnancy complicated by diabetes mellitus in private practice: a review of ten years.

Two hundred private diabetic patients delivered of their infants (202) in a private hospital were evaluated for a 10 year study period (1968 to 1977). There were no maternal deaths. An 88% overall survival rate of viable infants compared favorably with that of other reported series. Analysis of each of the 10 years demonstrated marked changes in management and consequent changes in fetal survival, morbidity, and mortality rates. No neonatal deaths occurred during the last 3 years of the study period and the mortality rate in viable infants was 6.8%. There has been no significant temporal change in the incidence of toxemia or hydramnios. Fifteen stillbirths and ten neonatal deaths were analyzed to identify significant factors or parameters. Attention is directed to sex ratios (male:female) of 3:1 for stillbirths and 3:2 for infants affected with respiratory distress syndrome. Conservative use of accessory testing and antepartum hospitalization was obvious. The question of the necessity for expensive and intensive regimented institutional management is addressed. A minimum management regimen is proposed to be used in conjunction with the private obstetrician's clinical judgment and expertise.


Urinary tract endometriosis: enigmas in diagnosis and management.

The diagnosis and management of endometriosis presents several enigmas. This review, of eight patients with endometriosis involving the urinary tract, from three large clinical services in the City of Los Angeles, highlights some very difficult problems. Not only diagnostic errors but also inappropriate conservatism and inadequate surveillance have led to compromised function, resection, and/or destruction of the kidneys, ureters, or bladder. The series indicates those findings which are likely to result in urinary tract destruction and points out those clinical situations in which delays or conservative management must be undertaken only with pressing indications and then only with continued and careful surveillance.