Ventricular morphology in the univentricular heart.

The ventricle morphology is described in hearts in which the entire atrial inputs are committed to a single chamber in the ventricular mass, this being considered the criterion for definition of the univentricular heart. Such a definition does not exclude from the univentricular category hearts with two chambers in their ventricular mass providing that the second chamber does not receive a direct atrial input. Three types of ventricular morphology were identified: hearts with a main chamber of left ventricular pattern and a rudimentary chamber of right ventricular pattern; hearts with a main chamber of right ventricular pattern and a rudimentary chamber of left ventricular pattern and hearts with a sole chamber in their ventricular mass of indeterminate pattern. Hearts may also exist of right or left ventricular type without rudimentary chambers. Variation was noted in type and position of the rudimentary chambers. Chambers of either right or left ventricular type were found supporting either or both great arteries (outlet chambers), and also without a direct outlet (trabecular pouches). Right ventricular rudimentary chambers were usually anterior but could be right or left sided; left ventricular chambers were posterior but again could be right or left sided. Hearts with these ventricular morphologies possessed either double inlet atrioventricular connexions, or absence of the right or left atrioventriuclar connexion. In double inlet ventricles, cases were observed with two valves, a common valve, one imperforate valve, and with straddling atrioventricular valves. A straddling valve was also found in hearts with absence of one atrioventricular connexion. Further variation was found in the pattern of arterial connexions. It is concluded that ventricular morphology is an important feature of the iniventricular heart but must be considered in the context of other important and variable features.


Univentricular heart (common ventricle): preoperative diagnosis. Hemodynamic, angiocardiographic and echocardiographic features.

Univentricular heart or common ventricle can be defined as a heart that has a ventricular chamber that recieves both antrioventricular valves or one atrioventricular valve. Hallermann's angiographic modification of Van Praahg's classification is a practical and useful classification of this complex abnormality. The classification divides univentricular heart into two types namely type A, those with an outflow chamber and type C, those with an outflow chamber. The relative position of the great arteries further subdivides the types of common ventricle. Thus, common ventricles may have a normal relative relationship of the great arteries but more frequently the great arteries are transposed in a levo or a dextro position. The most common type of common ventricle in the type A-3. A review of 145 cases of common ventricle seen at the Mayo Clinic comprises the majority of this report. Age range in this series is from seven days to 38 years with a mean age of 8.4 years. Males are slightly more dominent than females roughly in a ratio of 2:1. Type A common ventricle occurred in 63 percent of the cases and tye C occurred in 37 percent of the cases. Simultaneous saturations from the pulmonary arteries and femoral arteries in this show that complete mixing occurs in approximatley 50 percent of these cases but in the other 50 percent of the cases great differences may be seen and are not related to the great vessel position. Obstruction at the bulboventricular foramen while it can be severe is usually not. M-mode echocardiography has been of great help in the diagnoisis of common ventricle and features are listed. Two dimensional real time sector echocardiography; however, forms a much more detailed diagnosis and many times showed details particularly in valvular anatomy that is not seen by conventional angiocardiographic techniques. Attention to the detail of preoperative diagnosis from a hemodynamic and anatomic standpoint will avoid many errors usually discovered at the time of surgery.


Angiocardiography in the pre-operative evaluation of patients with univentricular hearts.

Diagnosis of the univentricular heart and recognition of its most important variations depends on the establishment of atrial situs, the demonstration of the type and mode of the atrio-ventricular connexion, the identification of the presence or absence of a rudimentary chamber, the establishment of its morphology, together with that of the main chamber, and classification of the arterial connexion. A logical means of demonstrating these features is presented, depending on bronchial visualization, one or possible two injections of contrast medium into the main chamber, followed if necessary by selective injection into the rudimentary chamber, and in exceptional cases, demonstration of the atrial septum by atrial injection. The advantagess of cranio-caudal tilt and oblique projections are discussed in detail.


Echocardiography of atrioventricular valves in patients with univentricular heart.

M-Mode echocardiography in patients with univentricular heart allows the number and relations of the AV valves to be established. The absence of a posterior septum can be documented with some certainty and in many cases a stradding AV valve suspected. In addition, reduced amplitude of diastolic closure velocity is very suggestive of valve atresia or dysplasia. This information is of practical significance if corrective surgery is planned.


One dimensional echocardiography in univentricular hearts.

1. Echocardiography is diagnostic for univentricular hearts with two AV-valves. 2. Echocardiography does not substitute catheterization and angiocardiography, it is, however, apt to optimize and to supplement invasive procedures. 3. The number, the relative size, and the function of the AV-valves can be ascertained by echocardiography. 4. The relation of the great arteries may be suggested by transducer direction and position. 5. Echocardiographic measurements are indicative of relative pulmonic flow: Therefore echocardiography should be helpful in follow up studies. 6. Valvar and valvar-subvalvar pulmonic outflow obstructions may be suggested by echocardiography. 7. Septal remnants may be recognized by echocardiography. How significant their demonstration is to outlet chamber definition has still to be clarified.


Abnormal ventricular function in patients with univentricular heart. Cineangiographic study.

In order to investigate the basis of ventricular dysfunction in patients with univentricular heart, cineangiograms of 20 patients aged between 3 weeks and 22 years were digitized frame by frame and compared with left ventriculograms of patients with other cardiac malformations. Ejection fraction was at least normal (58% to 95%) and peak rate of systolic minor axis shortening was normal in all. However in only 3 patients was the change in volume achieved by virtue of the normal change in cavity shape; in 17 the end-systolic outline was abnormally circular and shape index, 4 pi (area)/(perimeter)2, changed by less than normal (p less than 0.01). In addition, abnormalities of regional wall movement were found in 12 patients. 11 showed a consistent pattern, unlike that found in ischaemic heart disease or other congenital lesions, of delayed systolic inward movement of the antero-apical wall, associated in 9 with hypokinesis. Four of these showed secondary delay of relaxation in the same region. One patient had an isolated abnormality of isovolumic relaxation. These findings were independent of age, volume overload or degree of cyanosis, but were more common in patients with absent atrioventricular connexion. We conclude that the architectural abnormalities in univentricular hearts lead to disturbances of myocardial function which particularly affect the apex. These are detectable from an early age.


Intraoperative mapping in patients with univentricular hearts.

The location of the specialized cardiac conduction system in patients with univentricular hearts may be extremely variable. Electrophysiologic studies during open heart surgery identified the intraventricular conducting tissue to be consistently located in four sites. In patients with univentricular hearts without an outlet chamber, conducting tissue may be located either at 1. along the posterior wall or 2. along the anterior free wall of the ventricle. In patients with univentricular hearts and an outlet chamber, conducting tissue is uusally located anterior and superior to the bulboventricular foramen and then extends towards the atrium either 1. in between the bulboventricular foramen and the pulmonary valve or 2. along the right margin of the pulmonary artery over the anterior free wall of the ventricle towards the junction of the inter-atrial septum and the right atrial appendage. These electrophysiologic studies are consistent with previously described locations of conducting tissue in similar hearts by histologic methods. The different locations of the intraventricular conducting tissues in patients with univentricular hearts demonstrates the valve and the need for electrophysiologic mapping of the specialized cardiac conduction system during surgical repair of univentricular hearts.


Electrocardiographic and electrophysiologic studies of the univentricular hearts.

Tachy- and bradydysrhythmias were found to be common in patients with univentricular hearts. They lead to considerable mortality. Intracardiac electrophysiologic studies may be used in these patients as in patients with normal hearts. It is anticipated that post surgical dysrhythmias will be at least as common after division of univentricular hearts as for more common repairs as tetralogy of Fallot.


Haemodynamics studies in patients with univentricular hearts.

The catheterization data including angiocardiography of 30 infants and children with different types of univentricular heart were used to study the influence of pulmonary and systemic flow as well as the position of the outlet chamber on systemic arterial saturation. All patients with normally connected great arteries displayed favourable streaming and differed significantly from those with 1-TGA as well as d-TGA, who showed varying streaming characteristics. Taking into account, however, the position of the outlet chamber, favourable streaming could be demonstrated to occur in most patients with TGA and lateral outlet chamber, and significantly less in patients with TGA and anterior outlet chamber. The influence of pulmonary and systemic flow on systemic arterial oxygen saturation was obvious only in the group with complete mixing and not in those patients, where arterial saturation was affected favourably or unfavourably by interindividual streaming differences. As expected, in patients with pulmonary stenosis the pulmonary flow was determined primarily by the degree of obstruction between ventricle and pulmonary artery. Reduced perfusion of the lungs in pulmonary stenosis does not result in increased perfusion of the systemic circulation. These results indicate that in patients with univentricular heart and ventriculo-arterial discordance, a pulmonary stenosis combined with lateral outlet chamber offers the most favourable outlook with regard to natural history.


Surgical septation of univentricular heart with outlet chamber.

From April 1973 through March 1978, 34 patients with univentricular heart and outlet chamber underwent repair by septation of the ventricle. Three had normally related great arteries in which the pulmonary artery arose from the outlet chamber. Six patients had an anterior aorta arising from an anterior or right-sided outlet chamber and 25 patients had an anterior aorta arising from a left-sided outlet chamber. The ages ranged from 3 to 36 years. Fourteen patients had had previous palliative operations. There were 13 hospital deaths and four late deaths. Four patients have a fair result and the remaining 13 patients are in good health clinically. For the more favorable types of univentricular heart with outlet chamber on the left and natural pulmonary stenosis, the risk of corrective operation is less than 20 percent. The improved clinical course of those patients who have survived and done well gives encouragement that continued refinements in the operative repair of univentricular heart should ultimately provide many of these patients with a good result.


Different concepts of univentricular heart. Experimental embryological approach.

A brief historical review of the main descriptions, definitions, classifications and nomenclatures of the univentricular heart within the historical context of the evolution of the technical and scientific knowledge, is made. The development of the ventricles and particularly the posterior interventricular septum (posterior smooth plus posterior trabeculated septa), were studied experimentally in the chick embryo, by the vivo labelling technics, since they are very important for the definition of the univentricular heart. It was demonstrated: 1. In the apical region of the embryonic heart only a primitive interventricular septum develops and this gives origin to the posterior interventricular septum. 2. The walls of the bulbus cordis and the primitive ventricle adjacent to the primitive interventricular septum contribute to the development of this septum. 3. Cell division and cell movement are the basic processes of development which seem to take part in the development of the posterior interventricular septum.


Changing scene in cardiac embryology.

Recent significant advances in experimental embryology and experimental teratology of the heart contribute to the renaissance in studies of cardiac development. Examples taken from the author's laboratory demonstrate the need for reference points in the description of heart morphogenesis and speak against the existence of conus resorption. The discovery of animal models of congenital heart disease, e.g. Keeshond dog or fetal mouse trisomy, represent another promising opening in studies of pathogenesis of heart anomalies. To permit a reasonable understanding of the univentricular heart following basic questions need to be answered: a) what is the origin of its rudimentary cavity, b) what is the origin of its incomplete muscular septum, c) why are one or both great vessels attached to the rudimentary chamber, d) what determines the position of the rudimentary chamber and e) why may the great vessels be normally or abnormally arranged? The experimental analysis of the proliferative and growth pattern of the right ventricle as well as the studies on embryonic hemodynamic factors are presented as examples of how to approach these fundamental questions.


Embryology of the univentricular heart.

Controversies remain concerning the nomenclature, nature and pathogenesis of the various forms of univentricular heart. Common ventricle may well represent a very large ventricular septal defect while the nature of the indeterminate or nonspecific form of univentricular heart remains in doubt. Univentricular heart, right ventricular type, could be ascribed to overshift of the embryonic atrioventricular canal to the right, resulting in both atrioventricular ostia entering a large ventricular chamber which has the morphological characteristics of a right ventricle. In univentricular heart, left ventricular type on the other hand, the rightward shift of the atrioventricular canal appears to have failed or remained incomplete, possibly due to an abnormal position of the atrioventricular canal relative to the bulboventricular septum. Normal septation of the atrioventricular canal results in both atrioventricular ostia giving access to a large ventricle which in the main has the morphological features of a left ventricle.


Formation of the heart loop and proliferation structure of its wall as a base for ventricular septation.

Controversial criteria for definition and classification of univentricular hearts are discussed from the point of view of proliferation pattern in the wall of heart tube and heart loop stage. The persistence of the primitive diffuse proliferation structure is the condition for the development of univentricular heart in which the morphogenetic mechanism forming the ventricular septum does not operate. Pseudouniventricular heart, i.e. the heart with the large main chamber accompanied by a small accessory cavity, is the result of total or partial right or left hypoplasia in which the extent of operation of the above mentioned mechanism is determined by the degree of ventricular hypoplasy. The morphogenesis of the heart wall structure and relief including the atrioventricular and arterial valves is a secondary feature, mostly dependent on the changed hemodynamic conditions.


Experimental creation of univentricular heart in the chick embryo.

An experimental study on the heart of the chick embryo demonstrates that the atrio-ventricular canal does not migrate towards the right, but that it is the inter-ampullar ring which almost completely migrates to the left. Consequently: 1. absence of migration of the interampullar ring will be responsible for the development of type A univentricular heart with an accessory chamber; 2. incomplete migration will result in a special type in which the right atrioventricular orifice overrides the septum; 3. excessive migration may be the explanation for the development of type B univentricular heart; 4. lacking or incomplete development of the inter-ampullar ring is the cause for the development of type C or D univentricular heart. In most of the cases, the univentricular heat can be considered the result of arrest of the normal embryogenesis at a more or less early state.


Problems in the nomenclature of the univentricular heart.

There are three main reasons why there are problems concerning the nomenclature of the univentricular heart. The first is that different authorities have used the same term to describe different varieties of the univentricular heart. The second is that many of the terms used in categorisation of these anomalies are derived from embryological concepts which are more or less speculative. The final reason, perhaps the major one, is that there is a lack of definition of a ventricle. Consequently there is no consensus as to precisely what constitutes a "univentricular" heart. Many of the heart described as "single" or "common" ventricle possess two chambers within their ventricular mass. For such hearts to be univentricular it is evident that one of these chambers cannot be a ventricle. Yet definitions have yet to be provided to distinguish ventricles from rudimentary chambers. The solutions to these problems can be produced firstly by using descriptive terms for categorisation of univentricular hearts which do not have multiple meanings. Secondly, the problems concerning usage of embryologic terms can be easily circumvented by eschewing all embryologic considerations in naming these malformations. The problem of definition of a ventricle is best solved by considering normal ventricles as possessing three portions -- an inlet portion, a trabecular portion and an outlet portion. It may then be proposed that the minimal requirements for a ventricle are that it possesses at least an inlet and a trabecular portion. Chambers without inlet portions are rudimentary chambers. Either ventricles or rudimentary chambers may possess a trabecular pattern of right or left ventricular type. Tue univentricular heart may then be categorised as composing all anomalies which have a sole chamber in their ventricular mass together with all anomalies which possess a rudimentary chamber.


Determination of insulin antibodies.

Insulin antibodies were determined as percentage binding of 125I-insulin in the sera of normal persons and of diabetic subjects treated and untreated with insulin. The effect of the dilution of the serum, circulating insulin and extraction of free and total insulin was evaluated. The determination of insulin antibodies in samples at a final dilution of 1:10 clearly discriminated between insulin-treated and untreated subjects. In insulin-treated subjects, the determination of insulin antibodies in samples at a final dilution of 1:100 gave false-negative results in 28 per cent. However, the determination of insulin antibodies at a final dilution of 1:100 discriminated between insulin-resistant and non-resistant diabetic subjects. Extraction of total insulin at pH 3.0 using 0.1 N HCl increased the percentage of 125I-insulin binding significantly. Extraction of free insulin by charcoal from the samples did not increase the binding of 125I-insulin. The injection of crystalline insulin 4 hours prior to withdrawing the samples did not decrease binding of 125I-insulin.


Studies with crystalline insulin from obese and lean mice of the BL/6J strain.

Crystalline insulin was extracted and purified from the pancreases of obese (BL/6J/-ob/ob) and lean mice (BL/6J and BL/6J-ob/+). The two insulin preparations were compared with respect to their radioimmunologic properties as well as their ability to stimulate glucose metabolism in rat epididymal adipocytes and epididymal adipose tissue from obese and lean mice. No significant differences could be seen between the two insulin preparations and thus an insulin of altered biological properties is not likely to be an adequate explanation for the symptoms observed in the obese mouse.


Insulin antagonism in cultured rat myoblasts secondary to chronic exposure to insulin.

Rat myoblasts grown in culture for 5 days responded acutely to insulin (10 mU/ml) over a 3 hour incubation period by stimulating C14-glucose incorporation into glycogen by 260%. When these cells were grown in the presence of insulin (10 mU/ml) for the first 4 days (no exposure to insulin during the final 24 hours), insulin had no significant acute effect. These data provide direct evidence that insulation itself may induce antagonism under certain conditions.


Comparison of the effects of insulin and insulin-like agents on different aspects of adipocyte metabolism.

The effect of insulin, spermine, cysteine, and diamide on glucose transport, glucose oxidation, and lipolysis were compared using isolated rat adipocytes. Each agent exerted insulin-like effects on glucose transport and glucose oxidation, whereas spermine and cysteine, but not diamide, inhibited lipolysis. Furthermore, the relative potencies of these agents on the various insulin responsive processes were markedly different. Thus, although these agents have much in common with insulin, the differences in relative potencies suggest that at least some of the insulin-like properties of these compounds may not be exerted through the same mechanisms as insulin.


Anomeric specificity in the response of gut glucagon-like immunoreactive materials to glucose.

An anomeric specificity of the glucose sensors of A cells and B cells of the pancreas has been reported. In this context the present authors investigated, using the canine intestinal loop prepared from the terminal portion of the ileum, how glucagon-like immunoreactive materials (GLI) of the gut would respond to glucose anomers in an attempt to explore a possible anomeric specificity of glucose-stimulated gut GLI secretion. As a result GLI was found to be more readily released into the blood stream after an intestinal alpha-glucose load than following beta-gluocse during a 15-minute observation period. It is thus suggested that gut GLI-secreting cells have glucose sensors similar to those of pancreatic A or B cells which are specific for the alpha-glucose anomer.


Cimetidine effects on prolactin release and production.

The effect of cimetidine 1600 mg. daily for three months on prolactin and related hormones is reported. Basal prolactin levels rose slightly but not significantly. There was no change in basal thyroid and sex hormone levels nor in the prolactin, gonadotrophin or thyrotrophin responses to releasing hormone stimulation. Since intravenous cimetidine induces a transient hyperprolactinemia it appears that cimetidine may facilitate release of prolactin but has no effect on its synthesis.


Postnatal maturation patterns of serum corticosterone and growth hormone in rats: effect of chronic thyroxine administration.

The effects of chronic neonatal hyperthyroidism in rats on the ontogenic pattern of serum corticosterone and growth hormone (GH) were studied. Thyroxine (T4) treated and saline injected rat pups were sacrificed under basal and stress conditions. In comparison to saline control animals, daily T4 administration (0.4 micrograms/gram body weight) produced a sustained elevation in basal corticosterone levels by day 12 and a significant elevation of serum corticosterone in response to stress by day 4. The serum GH levels in non-stressed animals were moderately decreased in response to T4 administration as compared to saline injected animals with a greater reduction in GH measured in samples obtained from stressed animals. The results indicate that chronic T4 administration influences the developmental pattern of serum corticosterone and GH under both non-stress and stress conditions.


Uptake and metabolism of exogenous and endogenous thyroxine in the brain of young rats.

The uptake of labelled exogenous thyroxine by the brain was determined in 10- and 30-day-old rats. It was three times higher and thyroxine was more deiodinated on day 10 than on day 30. On the other hand, the endogenous hormonal iodine content was estimated in both the brain and the isolated cortical neurones in the young rats of the same ages equilibrated with 125I. On day 10, brain and neurones contained five times more thyroid hormones than on day 30. These results are discussed in the context of the relations previously discovered between development of thyroid function and brain maturation.


Plasma concentration of antidiuretic hormone in patients with chronic renal insufficiency on maintenance dialysis.

Radioimmunoassay of plasma arginine-vasopressin (AVP) in regularly dialyzed patients with chronic renal insufficiency revealed a parallel increase of AVP and plasma osmolality (POsm) before dialysis (4.16 +/- 0.36 pg/ml and 312.6 +/- 1.80 mOsm/1) and their parallel declin to the normal range (1.93 +/- 0.27 pg/ml and 292.0 +/- 1.27 mOsm/1) during dialysis. Plasma AVP correlated with POsm before and after dialysis (r = 0.611 and 0.453, p less than 0.01 and less than 0.05 respectively). The increase of AVP before dialysis was lower than would correspond to the rise of POsm and lower than that recorded in healthy subjects during dehydration. Statistical correlation between plasma AVP and indicators of body fluid volume changes between or during dialysis were not proved. We found statistical correlation between the mean blood pressure and AVP before dialysis (r = 0.468, p less than 0.05). These findings suggest that in chronic renal insufficiency changes of POsm remain primary regulating factor of AVP secretion. The expansion of extracellular fluid volume has probably only a modifying effect. It remains to be elucidated whether the revealed statistical relationship between the mean blood pressure and AVP before dialysis plays also a pathogenetic role in the development of hypertension in chronic renal insufficiency.


Plasma catecholamine and parathyroid hormone responses in cattle during treadmill exercise at simulated high altitude.

When steers were exposed to treadmill exercise at a simulated altitude of 3500 m, plasma concentrations of epinephrine and norepinephrine as well as of parathyroid hormone increased within minutes. Heart rate, erythrocyte number and plasma lactic acid level rose at the same time, whereas plasma free fatty acids showed a later increase. It is concluded, that the elevated parathyroid hormone levels were probably caused by sympathetic stimulation.


Organ culture of mammalian testis. III. Inhibin secretion.

Mouse testes were cultured for 19--20 days at either 31 or 37 degrees C with a change of medium every 4 days. After treatment with charcoal and dextran T, the recovered testis media were incubated with rat anterior pituitary cells, and secretions of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) were estimated by radioimmunoassay 3 days later. FSH release was significantly lowered when pituitary cells were grown with media of testes cultured 31 degrees C compared to cultures grown with fresh medium or with media of testes cultured at 37 degrees C for more than 4 days. LH secretion was normal in one experiment and reduced in the other with the media of testes cultured at 31 degrees C. Treatment of testicular media by heat or trypsin reduced the inhibiting activity. After 8 days at 37 degrees C, both germinal and Sertoli cells were damaged in the testis cultures, while at 31 degrees germinal cells alone were destroyed, Sertoli cells remained normal. These studies suggest that (1) a substance which responds to the definition of inhibition (protein--preferentially acting on FSH) is secreted in the medium of testis culture; (2) inhibin is produced by Sertoli cells; (3) inhibin is secreted only if the temperature is inferior to 37 degrees C.


Hormonal influence on uterine lipids.

The effects of oestrogen (OE), progesterone (P) and oestrogen plus progesterone (OEPP) on uterine lipids of adult ovariectomized rats were studied. Administration of gonodal hormones brought about considerable alterations in total lipids, mainly due to an increase in phospholipids and glycerides in the case of OE and P groups. Even though the total cholesterol remained unaltered, a marked alteration in its fractions was evident in all the groups. Oestrogen seems to decrease all the glyceride classes while progesterone induces accumulation ot triglycerides with concomitant decrease in mono- and diglycerides. Individual classes of phospholipids show marked alterations in their distribution in all the groups studied.


Informed consent: special problems for psychiatry.

There is a growing demand for more patient autonomy in the doctor-patient relationship, and legal reformers believe that an expanded dodctrine of informed consent is the key to change. Informed consent is meant to force the doctor to give the patient the knowledge that will make his an equal bargaining partner. However, most evidence demonstrates that the majority of patients do not comprehend or retain medical information. Further, the legal doctrine of informed consent has never been coherently worked out. Informed consent in psychiatry is particularly complicated, because of the constitutional implications of right-to-refuse-treatment litigation and because patients may be incompetent to give informed consent as a result of their illness. One of the special problems for psychiatry is that complex consent requirements have been mandated by those who oppose certain somatic therapies. The author discusses the implications of these legal developments. He lists the kinds of informed-consent and refusal-to-consent situatons psychiatrists face and comments briefly on the most troublesome.


A comparative study of Asian FMG and USMG psychiatrists.

Of 367 East Asian and South Asian psychiatrists responding to a 1976 survey, 295 were identified as foreign medical graduates (FMGs) and 72 as U.S. medical graduates. Comparison of the two groups showed that the FMG'S WERE MORE LIKEly to be trained and employed in state mental hospitals and other nonacademic settings and to treat patients of other minorities. The Asian FMGs were less likely to have specialty board certification, a finding that seems to reflect their incomplete professional development and American acculturation. The authors conclude that Asian FMG psychiatrists shoulder much of the responsibility for treating minority patients in the United States, a job for which they may be ill equipped. Their need for special training in both cultural and professional areas is emphasized.


Phasing down state hospitals: integrated versus nonintegrated services.

Two mental health catchment areas in Massachusetts that were in the process of phasing down state hospitals and building up community care provided an opportunity for studying the effectiveness of an integrated service delivery model and a nonintegrated model. The area that integrated state hospital and community services was more successful in the phase-down. It had a lower admission rate, the patients who were readmitted did not stay as long, and patients discharged spent more time in the community. Specific adminstrative and clinical structures that facilitated the patients' progress included investing community-based, administrative authority in one person; having a centralized intake and referral system; and using case managers to follow the clients through the service delivery system.


The family as partner in the treatment of mental illness.

Believing that families are a valuable yet virtually untapped resource in treating and rehabilitating the mentally ill, the author surveyed 89 people to find out how they coped with their relative's long-term illness. Through trial and error, such families have developed a wealth of information about how to live with and manage chronic patients. The author also investiaged the types of service and supports families need. She urges professionals to begin dealing with relatives as allies instead of adversaries and to devise new modalities that make them collaborators in the treatment process.


Environmental interventions and therapeutic outcome.

An eveluation study to determine whether intensive environmental interventions for individual patients help their psychotherapeutic progress was conducted at a community mental health center serving a multi-ethnic, inner-city catchment area with multiple social stressors. Using the Kiresuk-Sherman goal attainment scaling method for therapeutic and environmental goals, researchers analyzed outcome levels of a random sample of 150 patients. Ninety-two of those patients received both psychotherapeutic and environmental interventions, 37 received only psychotherapy, and 21 received only environmental interventions. Evaluation indicated that environmental goal attainment effectively predicted therapeutic outcome among high-, moderate-, and low-success groups.


Assessing consumer satisfaction from letters to the hospital.

A private psychiatric hospital's evaluation research unit assessed consumer satisfaction with service by analyzing the content of letters written in response to an invitation to comment on the hospital experience. Respondents included relatives and referring agents of those who had received treatment. They expressed greatest satisfication with the helpfulness of the hospital, general patient care, and the quality of the clinical staff. They expressed much dissatisfaction with communication, such as adequacy of information about patients' treatment and progress, and with management rules and procedures. The analysis showed that the older the patient and the fewer the number of previous hospitalizations, the greater was the satisfaction expressed.


The architectural design of a psychotherapeutic milieu.

The physical environment of a treatment program affects patient outcome, but how and to what degree is not known. However, decisions about the design of the environment must be made, and they must be made in the face of cost and building-code constraints and widely varying patient characteristics and treatment models. The authors describe the design principles and philosophies they followed in the remodeling of an in-patient treatment and research service in a university psychiatric hospital and indicate where cost and code constraints resulted in a less than ideal solution. They point out that many apparent amenities, such as a ward kitchen, are significant milieu therapy resources, and they advocate the involvement of all levels of staff in the planning process.


Measuring prescribing practices in a state mental hospital system.

To determine the degree to which Nebraska's three state mental hospitals complied with recognized guidelines for prescription of psychotropic medications, a study was made for 1326 drug orders issued over a five-year period. The prescribing practices in the hospital were then reviewed in relation to the guidelines in areas of polypharmacy, daily dose frequency, time of day, use of p.r.n. orders, drug form, dosages for children and the elderly, dosages during acute and stabilized stages of illness, and brand versus generic names. The study highlighted areas of progress in drug use practices and identified areas for improvement.


A longitudinal study of neurosis in young men.

Because of the widely varying symptomatology seen in the neuroses, questions have been raised about whether they constitute a realistically defined category of illness. The authors followed 4074 Navy enlisted men diagnosed as neurotic between 1966 and 1969 and compared disposition decisions and posthospital outcomes for four major neurotic subtypes (anxiety, hysterical, depressive, and phobic-obsessive-compulsive). Neurotic patients as a group were also compared with patients in other diagnostic categories. Although posthospital outcomes were found to differ among the four neurotic subtypes, the differences were not large when compared with the differences between the neuroses as a group and other major diagnostic categories. Those findings suggest that the neuroses are a distinct group with regard to outcome, and that the use of this diagnostic category should not be abandoned without further study.


Routine thoracic radiography for psychiatric inpatients.

Screening chest x-rays are routinely obtained for psychiatric as well as other patients. The authors present data that suggest that this practice no longer has a sound medical basis and should be eliminated or modified. It is unlikely that routine radiography of the chest is of practical benefit to adult psychiatric patients who are clinically healthy and are under age 40.


Human services workers: a study of perceptions of their role.

Human services workers at the Veterans Administration Hospital, Brentwood, are involved with patients from the time they are admitted to the hospital until they are discharged and adjust to the community. As part of an evaluation of their role, a study was done of their tasks as perceived by themselves, by their supervisors, by other paraprofessionals, and by patients. In general, human services workers were perceived to be most involved in assisting patients in the hospital, followed by involvement in treatment planning; discharge; therapy; assisting patients in the community; support activities; community activities; patient admission and evaluation; and research, education, and program evaluation.


Using the resources of AA in treating alcoholics in a general hospital.

At Cleveland Metropolitan General Hospital a small number of staff and a large number of volunteers from Alcoholics Anonymous have collaborated to meet the treatment needs of the community's alcoholics. Recovered alcoholics serve as volunteers staffing a friendship room, located close to the emergency room and open weeknights between 6 and 10 p.m. They also provide counseling on AA, escort patients to AA meetings, help in postdischarge follow-up, and act as casefinders in the community. The hospital staff have become more aware of problems of alcoholism and are better able to treat alcoholics and to provide counseling and referral services.


Auditing dietetic services.

In this last article of a four-part series on auditing dietetic services, the authors present a detailed description of a quality assurance program for dietetic services.


Psychological care aided by RN counselors.

Three RNs working on master's degrees in counseling helped hospitalized patients and their families, nurses, and physicians deal with psychological aspects of illness.


Recession: what can hospitals expect?

Although not all the experts are agreed, it seems likely that there will be a recession beginning in 1979. This article takes a look at what people who are concerned with hospital planning can expect as a result of a recession.


FMGs, hospitals, P.L. 94-484, and the future.

In this first of two articles, the origins and provisions of the Health Professions Educational Assistance Act of 1976 (P.L. 94-484), which restricts entry into the United States by foreign graduates, are examined.


Employees help to define their jobs.

Using a system of mutual goal-setting, this district hospital improved the quality of its performance appraisal system and provided managers and supervisors with more useful management tools.


Family, heal thyself.

Although the technique is still not widespread, family therapy, in which the entire family unit is part of the therapeutic process, promises to speed results.


Support team helps patients cope with stress.

Grant Hospital of Chicago recently adopted a new concept in psychiatric support of the physically ill patient. The medical staff believes it has improved hospital-patient relations.


The big ones in Congress--health and taxes.

Congressman John Duncan endorses the concept of flexibility in the delivery of health services/He believes the bulk of contributions to health care should be made by industry.


Study projects mursing staff needs, budget.

Nursing service uses method that accurately determines staffing requirements for each unit, as well as the required budget for such staffing.


Britain's NHS: problems we all may face.

Is Britain's nationalized health care system experiencing and coping with pressures that other nation's health care systems will have to face in the future?


Intensive care for relatives.

Begun in the neurosurgery department, program provides support services for the relatives of patients with serious illness.


Patient scheduling studied, refined.

Two hospitals used different approaches to devise equally efficient systems for scheduling and processing inpatients and outpatients for radiology procedures.


Volunteers also have needs.

If volunteer programs are to succeed, potential candidates must be carefully interviewed to ensure that they and the program have been suitably matched.


Is the nation prepared for an emergency?

Government, health care professionals, and consumers must join forces to educate and train professional and citizens in emergency preparedness.


Heart risks identified by program.

Hospital-based cardiac stress test has permitted the identification of persons with serious risk of heart problems without the need for excessive costs.


Teamwork, planning keys to success.

To ensure a successful psychiatric unit in a general hospital, the hospital must determine needs, plan with all involved parties, and follow up with sensible control measures.


Vision and planning help to develop the multihospital system.

Multihospital systems provide an important alternative to a health care system controlled by payers or regulators/It has the potential to be more effective in meeting society's expectations.


New tax laws require slight shifts in hospitals' funding strategies.

Recent tax laws that affect hospitals' deferred compensation plans, employment taxes, annuities, foundation grants, unrelated business income, and gifts of appreciated property will not seriously affect charitable giving to hospitals.


Human response to color and light.

Sound principles, based on technical studies of the psychological and physiological effects of color on hospital patients, can help hospital administrators and designers choose interior colors with function in mind.


Employee interest key to successful incident-reporting system.

If employees are actively involved and interested during training sessions on writing incident reports, they are likely to retain and apply much of the information that is presented/In addition, their understanding of the importance of the incident report will be enhanced.


Nosocomial infection linked to handwashing.

Study showed that sinks throughout a hospital harbored antibiotic-resistant gram-negative bacteria that had caused nosocomial infections and that could contaminate hands during washing.


Small hospitals can save on maintenance.

An in-house biomedical equipment maintenance program can be set up in a small hospital at little cost/The benefits of on-call technical aid can be great.


In-house medical device maintenance.

The establishment of a medical engineering department in this 600-bed institution has proved to be cost-effective and has improved the hospital's environment.


Hospitals respond to rising rape rate.

As the rape rate increases, hospitals increasingly are being called upon to treat rape victims/Proper evidence collection and sympathetic care can help law enforcement officials as well as victims.


Is there a satellite in your future?

Satellite communications have made great advances in recent years and offer an opportunity to provide instantaneous information to large numbers of people/They can provide low-cost patient and professional education, data transmission, and important information.


Speak up for children!

During 1979, the International Year of the Child, the United Nations General Assembly has asked its member nations to examine and improve their services for children.


The PR war isn't the real war.

Although hospitals are losing the competition for headlines and television news time, public opinion can make itself evident with astonishing force when hospitals are threatened.


Catholic health care institutions and social justice.

What implications for the health care apostolate lie in the programs and plans of the National Conference of Catholic Bishops and the United States Catholic Conference? This question is explored through looking at the relationship of the health care ministry to NCCB and USCC priorities--social justice, family life, parish renewal, and evangelization.


Bioethical issues and the moral matrix of U.S. health care.

Solutions to ethical-moral issues will be influenced by the growth of medical technology, by the escalating cost of medical care, and by the involvement of public entities in health care delivery. The major areas of concern that will be affected by these factors are care of the dying, genetics, euthanasia, sterilization, behavior control, reproductive interventions, abortion, informed consent, and distributive justice.


The health care system vs women and the poor.

This three-part article discusses some unresolved socioeconomic issues in the primary health care system. The first section centers on the socioeconomic impact of primary health care delivery on poor persons and some women, and the second section analyzes the implications of this impact. This third section reviews the system's response.


Sponsorship issues and trends.

Religious congregations are challenged to maintain the Catholic health care ministry at the local level despite the pressures of rising costs and decreasing religious personnel. In response, they are creating delivery systems and are experimenting with ways of increasing lay leadership.


In vitro fertilization: legal and ethical implications.

HEW funding for research involving in vitro fertilization would support acts that are ethically inappropriate and of questionable legality.


In vitro fertilization: a moratorium is in order.

A moratorium on in vitro fertilization would serve the society. The IVF issue is fraught with moral and legal problems surrounding the subject of IVF experimentation--the embryo--and the effect of this experimentation of individuals, families, and society.


Benefits of self-insured hospitalization programs.

As part of hospitals' continuing efforts to control costs, many have begun to consider implementing self-insured hospitalization programs for their employees. Not only can self-insurance provide cash flow savings and actual cost savings but it can also promote prevention among hospital employees.


Actions speak louder.

This article examines five common negative nonverbal practices of hospital personnel and describes how to turn them into actions having positive effects on patients.


The Sister trustee.

As the number of religious sisters decreases and as hospitals are increasingly managed and staffed by laity, there is a national trend toward religious sisters who do not work in the hospital serving on its board of trustees. These sisters are fully responsible board members lending their considerable life experience and their sense of mission to dedicated service and Catholic witness on hospital boards.


The trustee as steward for the community and the sponsor.

As a social institution, trusteeship is under fire; and board members (both lay and religious) should understand some common misconceptions about their role and should reassess their obligations to the health care facility, the sponsoring group, and the community at large.


Helping staff to manage conflict well.

A hospital that trains its staff to deal assertively with conflict can become more effective in terms of productivity, cost effectiveness, and patient satisfaction. A training model for handling conflict in the work setting is described.


Using simulation in decision making.

The health care administrator can use digital simulation as a quantitative decision-making technique. Understanding its conceptual framework will enable the administrator to work with a technical specialist to formulate and solve problems.


The minister's suffering--a resource in caring for the dying.

The interior struggles and resources of pastoral care ministers are their most valuable assets in ministering to the spiritual needs of dying patients. Out of their personal experience of weakness, they can more meaningfully witness to the reality of God's mercy and forgiveness.


Rheumatoid arthritis.

Why self-perpetuating joint destruction is intermittent in some patients and unrelenting in others remains largely unknown, but progress has been made in identifying the different types of clinical course and tailoring specific treatment regimens for each.


Fc receptors on human lymphocytes detected with double-coating indirect rosette formation.

The Fc receptor (FcR) on human lymphocytes is studied by using soluble immune complexes in antigen excess, prepared between ferritin and rabbit anti-ferritin, and a modification of Coombs' antigolbulin reaction (double-coating indirect rosette formation). 12% of human blood lymphocytes are shown to have Fc receptors. The FcR on lymphocytes is sensitive to pronase treatment, partially sensitive to trypsin digestion, and is inactivated after short glutaraldehyde fixation of lymphocytes. By cell fractionation experiments, FcR-positive lymphocytes were enriched in cell populations enriched with B cells.


A simpler method for combined detection of human peripheral lymphocyte subpopulations.

A method for the simultaneous enumeration of human lymphocyte subpopulations was developed by mixing lymphocytes, sheep red blood cells and immunobeads. Thymus-dependent lymphocytes (T cells) are detected by rosette formation with AET-treated sheep blood cells, and thymus-independent lymphocytes (B cells) are identified by rosette formation with polyacrylamide gel coated with antibody specific to both light chains (chi and lambda) of immunoglobulin. The major advantage of this technique is that it is simple, convenient and reproducible. This method also detects lymphocytes possessing both T and B cell markers (double-marker lymphocytes). Three different types of rosettes are distinquishable under light-microscopic observation, and this method may be valuable in clinical use.


Delayed type hypersensitivity to bovine serum albumin and to lipid-conjugated bovine serum albumin in mice.

Delayed type hypersensitivity (DTH) to bovine serum albumin (BSA) and to lipid-conjugated BSA were studied comparatively. Unlike the case of BSA with which no DTH can be detected with native antigen, injection of butyric-conjugated BSA (Bu-BSA) in sensitized mice provokes a typical DTH for an early and limited period. Alum-precipitated Bu-BSA (Al-Bu-BSA) provokes from the beginning a stronger DTH which persists a much longer period.


Non-immunogenicity of a purified sodium hyaluronate preparation in man.

The immunogenicity of a sodium hyaluronate preparation for clinical use (Healon, Healonid, Pharmacia AB, Sweden) in ophthalmology and certain joint diseases has been tested in man. For immunization, two subcutaneous injections of 10 mg of sodium hyaluronate were given at an interval of 1 week. The following criteria were used as indicators of immunogenicity: skin prick test, microprecipitation test and complement analyses. No evidence for immunogenic properties was obtained in any of these tests. This refers to sodium hyaluronate itself and to the trace amounts of protein components contained in the preparation.


Adjuvant properties of retinol on IgE production in mice.

Mice treated with varying doses of retinol in Tween 80 showed no primary IgE response to ovalbumin in saline; however, reimmunization with ovalbumin in saline produced high IgE titers. Retinol-treated mice immunized with ovalbumin absorbed to Al (OH)3 also showed no primary IgE response, but high secondary responses. Significantly, animals treated with Tween 80 only prior to immunization with ovalbumin adsorbed to Al(OH)3 also demonstrated no primary IgE response, indicating that Tween 80 inhibited the primary IgE response.


Effect of environmental exposure on bronchial sensitivity to antigen.

Bronchial sensitivity to grass and ragweed extracts was determined in four adult asthmatic subjects at the beginning and end of the grass and ragweed pollen seasons. 4 subjects with ragweed sensitivity had increased bronchial sensitivity to ragweed antigen at the end of the ragweed season. 2 of 3 grass sensitive subjects demonstrated increased bronchial sensitivity to grass antigen after the grass pollen season. This study suggests that natural environmetnal exposure to pollen antigens may induce priming in the lung.


In vitro production of IgE and IgG by sensitized human peripheral lymphocytes.

Antigenic stimulation of peripheral lymphocytes was made in two different groups of atopic patients, testing their capabilities to produce IgE and IgG in vitro. For this purpose, Marbrook's technique was used in the cultures. The immunoglobulins produced were measured in the supernatants by a sensitive double-antibody method. Results demonstrate that it is possible to produce enough IgE and IgG to be detected. Some important parameters had to be considered: appropriate selection of the patients and the antigens used in the antigenic stimulation, as well as the number of cells and the duration of the culture.


L-alanine--an essential amino acid for growth of lymphocytes in vitro.

A factor an ultrafiltrated (UM 10) extracts of calf thymus, liver and spleen stimulated the uptake of 3H-thymidine in DNA of cultured lymphocytes. The factor was purified by ion-exchange chromatography and gel chromatography and identified as alanine, which is lacking in the culture medium, RPMI 1640. An optimal amount of L-alanine increased the uptake of 3H-thymidine in DNA of lymphocytes from different species by about 100%. L-alanine should be regarded as a growth factor for lymphocytes in vitro and should be added to RPMI 1640, when this tissue culture medium is used for lymphocytes.


Effect of levamisole on the auto-antibody formation in nude mice.

The effects of levamisole on the formation of antibody to double-stranded DNA (ds-DNA), an auto-antibody, and to some thymus-dependent antigens were studied in nude (nu/nu) mice. The antibody titre to ds-DNA in nu/nu mice treated with levamisole was lower than that in control animals. The number of Thy-1-antigen-positive (Thy-1+) cells in the spleen from nu/nu mice treated with levamisole was higher than that from non-treated animals. It is suggested that the Thy-1+ cells were induced by levamisole in nu/nu mice and these cells suppressed the formation of antibody to ds-DNA, whereas the formation of antibody to a DNP-conjugate (OVA) and SRBC, thymus-dependent antigens, was not evoked in nu/nu mice after the treatment with levamisole.


An investigation of the experimental induction of hypersensitivity in the guinea pig by material containing chromium, nickel and cobalt from arc welding fumes.

Sensitization of guinea pigs by chromium, cobalt and nickel was compared by four methods. The most effective was the maximization test of Magnusson and Kligman. Sensitizing properties of particles from fumes of either manual metal arc (MMA) or metal inert gas welding were demonstrated. Potent sensitization was attributed to chromium.


A comparison of two in vitro methods for studying a defect in leucocyte movement in rheumatoid arthritis.

Filter and agarose plate techniques have been used to study an abnormality of polymorphonuclear leucocyte movement in patients with rheumatoid arthritis. The chemotactic response of normal cells towards activated rheumatoid plasma was significantly less than that towards activated control plasma when examined in Boyden chambers. This defect was not observed using the agarose plate method where the response of both control and rheumatoid cells towards activated rheumatoid plasma was identical. The existence of the plasma defect, which has been shown to be cell-directed, would not have been apparent had the agarose plate method been used alone. The choice of suitable in vitro methodologies for studying leucocyte movement in pathological conditions is therefore of some importance.


Humoral mediator of antigenic competition demonstrated in vivo.

To determine if a soluble mediator of antigenic competition could be demonstrated in vivo, various groups of mice received implants of intraperitoneal Millipore diffusion chambers containing normal spleen cells and sheep erythrocytes (SRC). Priming and boosting the chamber hosts so that a vigorous secondary immune response to horse erythrocytes (HoRC) coincided with chamber implantation resulted in the suppression of the anti-SRC response of the chamber-enclosed cells. Similarly, passive immunization of the chamber hosts with SRC-absorbed anti-HoRC hyperimmune serum suppressed the response of the chamber-enclosed cells to SRC. Thus, serum from hyperimmune mice contains a humoral suppressor substance which mediates antigenic competition.


Effects of levamisole and D-penicillamine in rat paw oedema induced by carrageenan and by kaolin.

Levamisole potentiated paw oedema induced by carrageenan in the rat whereas penicillamine was without effect. On the other hand, levamisole inhibited paw oedema induced by kaolin, penicillamine again having no effect. The copper complex of penicillamine was inhibitory in the carrageenan test but failed to show inhibition in the kaolin model of inflammation. These results show that levamisole and penicillamine are capable of exerting anti-inflammatory activity in the rat but only under certain conditions.


Purification of two types of sea-squirt antigens.

Under monitoring the antigenic activity by radioimmunoassay (RIA), one of the major sea-squirt antigens was isolated by gel chromatography after treatment of the extract from internal organs of sea-squirt with QAE-Sephadex. This antigen was fairly homogenous as judged from its elution profile in chromatography on a column of Ultrogel AcA 44 with respect not only of the antigenic activity but also to UV absorption. Furthermore, the antigen inhibited the binding of the 125I-labeled tracer antigen to rabbit anti-sea-squirt antibody in a similar mode to the case of Ei-2, one of the sea-squirt antigens previously prepared, but its specific activity was as high as 2.33 times that of Ei-2. Accordingly this isolated antigen was corresponded to the major antigenic substance in Ei-2 and referred to as Ei-M. In addition, the other antigen of Gi-x was also isolated by chromatography on a column of Sepharose 6B as the major antigenic substance in Gi-2, the other one of the previous antigens. Gi-x was apparently different from E-M in the mode of inhibition of the binding of the tracer antigen to the antibody, although its antigenic activity against the asthmatic patients in vivo was as high as that of Ei-M. Thus, it was considered that sea-squirt contained at least two types of antigens of Ei-M and GI-X.


How arachidonic acid depresses thymus weight.

Subcutaneous injection of arachidonic acid depresses thymus weight. This is unlikely to be a stress effect, since arachidonic acid is equally active in adrenalectomised animals. Amongst other fatty acids tested, those capable of being metabolised to arachidonic acid have greater thymolytic activity than those which are not arachidonic acid precursors. Thymolysis is significantly inhibited by indomethacin, a drug which blocks the conversion of arachidonic acid to prostaglandins.


Cholinergic modulation of anaphylactic dopamine release from calf lung.

Dopamine was released by specific antigen from sensitized calf lung in vitro. Dopamine release was potentiated by carbachol and inhibited by atropine. Nicotine enhanced dopamine release and this action was enhanced by tubocurarine. It is suggested that anaphylactic dopamine release is modulated by a vagal (muscarinic) mechanism in calf lung.


Systemic persistence of homologous guinea pig skin-sensitizing antibodies.

Homologous guinea pig skin-sensitizing antibodies of the IgG1 class (as characterized by heat stability and persistence in skin for 7 days) were shown to persist systemically for 28-35 days. Persistence was shown by the anaphylaxis induced in guinea pigs following the intracardiac administration of the antiboy and subsequent antigenic challeng by aerosol. Skin-sensitizing antibody of the IgE class, characterized by heat lability and persistence in skin for 14 days, still caused systemic anaphylaxis for 42 days after the intracardiac administration of antibody. The IgG serum fraction from nonimmunized rabbits blocked systemic anaphylaxis in the guniea pig induced by aerosol following the passive transfer of heterologous (rabbit) and homologous IgG antibodies to ovalbumin, but not following the passive transfer of homologous IgE antibodies to ovalbumin.


Relationship between serum IgE levels and intestinal parasite load in African populations.

Serum IgE determinations and coproparasitological analyses were carried out on 161 individuals from two distinct ethnic groups (Hutus and Twas) from two regions in Rwanda (North and South). The cumulative parasitosis index (calculated for each individual as the sum of the scores for the four most frequent intestinal parasites) show a linear relation with IgE levels up to a plateau, with no clear pattern of correlation between the score for any given parasite and the IgE level. Such a direct quantitative (but not qualitative) relation reproposes the question on the role of IgE immunoglobulins in intestinal parasitoses.


Pain as a joint function of alcohol intake and customary reasons for drinking.

Nonalcoholics who, on a problem drinking inventory, responded "yes" to items reflecting a psychological dependence on alcohol, tended after alcohol ingestion to report a decrease in pain experienced in a cold pressor test. Conversely, those whose responses indicated no psychological dependence on alcohol tended to report pain increases after the consumption of alcohol.


Planning for management information systems in drug treatment organizations.

An attempt to set up a management information system for individual drug abuse programs throughout a state is described. The principles upon which the system is based are discussed along with the problems encountered in its implementation. A series of guidelines for establishing management information systems in operating human services agencies is included.


Beverage specific drinking contexts.

The contextual differentiation of beverage specific consumption is examined in a metropolitan area household survey of current drinkers. The findings indicate that beverage specific consumption is related to such structural proportions as presence/absence of food, drinking location, type of companion, and duration. Wine, for example, is frequently associated with mealtimes, at home, and with relatives.


Methadone evaluation: some additional thoughts.

This study of 460 patients showed that the 37% of the patients who were terminated as program failures did significantly worse than the active patients in terms of drug abuse, criminality, and social productivity. These findings suggest that methadone maintenance is at best a marginally effective modality for those large numbers of patients who drop out. Assuming that it is preferable for these dropouts to be on a program rather than on the streets, methadone maintenance treatment programs probably need to be more flexible so as to retain a larger number of these dropouts.


The relationship between female criminality and drug use.

A 2-year study of four groups of women (N = 268)--addicts, prostitute-addicts, prostitutes, and female offenders--reveals that the link between female criminal activity and female drug involvement is significant. All four groups report "drug costs" as a major percentage of their monthly expenses. Prostitutes and female offenders report purchasing drugs mainly for resale. Female offenders report most of their income as coming from drugs sales, shoplifting, and larceny. For all of the women addicted to heroin, reselling drugs and prostitution were the usual means of support. There is insufficient evidence at this point in the research to link the use of a specific category of drugs to specific types of offenses. The main determinants in choice of crime for these subjects were skill and opportunity.


Drug use among public and private secondary school students in Puerto Rico.

This paper reports results of the first wave of a two-wave panel survey carried out on a representative sample of Puerto Rican public and private secondary school students in the 1974--1975 academic year. Twelve percent of the students reported the use of one or more illicit drugs. The illicit drug most frequently used was marijuana. A greater proportion of adolescents have used alcohol and tobacco than any of the illegal drugs. Private school students of both sexes reported more use of illicit and licit drugs than their public school peers, suggesting that socio-economic factors may be influencing Puerto Rican adolescent drug behavior. Differences between Puerto Rican adolescents vary significantly depending on sex and suggest that Puerto Rican sociocultural conditions may have an important effect upon male-female drug use patterns. One of the most significant findings of the study is the high frequency of drug use among Puerto Rican adolescents who ever lived in other countries.


Differentiation of long-term methadone patients from their admission cohorts.

The background characteristics of 45 heroin addicts who had received methadone continuously for over 4 years were compared with those of 1,228 heroin addicts who had not. The results indicated that the continuers were at admission older, White, not dependent on medical assistance, previously treated, using less heroin, and smoking less marijuana than the noncontinuers.


Detoxification from heroin using self vs physician regulation of methadone dose.

Self-regulation of methadone dose during detoxification was compared to a fixed dose schedule. Self-regulators tended to maintain themselves on a stable methadone dose until forced to detoxify, but used less heroin and remained in treatment longer than the control group. The results suggest that a longer initial period of methadone stabilization may be useful in enabling addicts to detoxify successfully.


The pharmacokinetics of dapsone and acetylated dapsone in serum and saliva.

The concentrations of dapsone (DDS) and its acetylated derivatives (MADDS and DADDS) were determined in the serum and saliva after one oral dose of dapsone until 72 hr. The peak serum concentrations of DDS and MADDS were reached, on average, at 3.8--4.3 hr after the dosage. The amounts of DADDS were negligible. The elimination half-life of the first order kinetics was, on average, at 20--21 hr for both DDS and MADDS. The study group included 6 rapid acetylators and 4 slow acetylators with the mean ratios MADDS/DDS 1.0 and 0.19, respectively. No difference in the pharmacokinetics of DDS or MADDS could be seen between the rapid and slow acetylators. The protein-free fractions of DDS and MADDS were 50 and 41 per cent, respectively, of the total serum concentrations as measured at 8 and 32 hr after the dosage. The salivary concentration of DDS was, on average, 49 per cent of the total serum concentration during the whole study period. The salivary concentration of MADDS was 40 per cent, respectively. The elimination half-life of DDS and MADDS in saliva did not differ from that in serum. Between the salivary and serum protein-free concentrations a strict correlation existed (p less than 0.001). The salivary concentration of dapsone and its monoacetyl derivative reflect the protein-free, active drug in serum.


Plasma protein binding of salicylate and quinidine in patients with multiple myeloma.

The plasma protein binding of salicylate, a representative acidic drug, and of quinidine, a representative basic drug, has been studied in patients with multiple myeloma, a disease characterized by a profound alteration of the plasma protein pattern. Abnormal binding of salicylate was detected only in patients with high values of circulating abnormal protein. Plasma protein binding of quinidine was not altered in any of the patients studied.


Pharmacokinetics of Amikacin (BB-K8) in patients with normal or impaired renal function.

The pharmacokinetics of Amikacin (BB-K8) were determined after a single i.v. injection of 7.8 mg of the antibiotic/kg of body weight. It was administered to 10 patients with normal renal function and 19 patients with varying degrees of renal impairment. The elimination of Amikacin from plasma was seen to follow the course of an open two-compartment model system. From patients with normal renal function, values for the following pharmacokinetic parameters were obtained: alpha = 4.219 hr-1; beta = 0.292 hr-1; K12 = 2.218 hr-1; K21 = 0.859 hr-1; K13 = 1.432 hr-1; Vc = 3.125 1; Vp = 8.068 1 and Vdss = 11.193 1. As the relationship K12/K21 is greater than 1, it may be seen that there is a tendency for the antibiotic to accumulate in the peripheric compartment. Impaired renal function significantly diminishes the values recorded for alpha, beta, K12, K21, K13. Distribution volumes are significantly increased in patients with renal impairment. A linear relationship between the K13 of Amikacin and creatinine clearance is demonstrated. Adjustment of Amikacin dosage, according to the individual degree of renal impairment, may be obtained by spacing out the injections.


Pharmacokinetics of terbutaline after subcutaneous administration.

The pharmacokinetics of terbutaline has been studied after subcutaneous adminsitration of a therapeutic dose of 250 microgram in 14 patients. Short absorption half-lives of about 7 min resulted in a fast uptake of the drug. Serum concentrations of terbutaline were measured up to 10 hr after administration, depending on the individual. An open one-compartment model appeared adequate for the mathematical description of the kinetics in most patients. Elimination constants of 0.27 +/- 0.07 hr-1 were observed. The elimination process was biphasic in 5 patients with a mean elimination constant of the second phase of 0.10 +/- 0.04 hr-1. This resulted in a comparatively high concentration of 0.7 ng/ml 10 hr after administration. Regular use of terbutaline did not influence the pharmacokinetic data in a significant way.


Digoxin clearance and glomerular filtration rate.

The authors have studied the correlation between digoxin clearance and glomerular filtration rate. This correlation was better than between digoxin clearance and creatinine clearance without reducing the error of a programed therapy.


Hypervitaminosis A combined with calcium deficiency in rats.

Weanling male rats were fed for 24 days on a meat diet. Some received supplements of CaCO3, but others did not. For the final 14 days of the experiment some of the rats were given massive doses of retinol as retinyl acetate, but others were undosed. Some of the rats not given retinol had their food intakes paired with those given retinol. Skeletal examinations were made by radiography, and postmortem by measurement of the femur ash contents. The meat diet regularly reduced the femur ash to about half its normal level, but the CaCO3 supplements prevented any reduction. Skeletal fractures occurred consistently in all the rats given retinol, and with little if any difference in severity between the Ca-deficient and Ca-supplemented animals. Histological studies confirmed the accumulation of abnormal amounts of lipid round the liver Kupffer cells in hypervitaminosis A. Chemical estimations of liver fat gave higher values for the retinol-dosed animals than for their controls on paired food intakes. For control rats on unrestricted food intakes, however, higher values than for the retinol-dosed animals were found, but without lipid depositions round the Kupffer cells.


Hepatic lysosomal enzymes in young rats fed retinol.

Oral administration of one dose of 6.0 and 12.0 mg retinol for one day significantly increased percentage free activities of protease (cathepsins), cathepsin B1 and acid ribonuclease, whereas feeding of one dose of 1.5 mg retinol for one day did not release the above enzymes in younger rats. However, feeding of 1.5, 6.0 and 12.0 mg retinol daily for two days did not significantly increased the percentage free activities of these lysosomal enzymes except that of acid ribonuclease which was still increased in young rats fed 12.0 mg retinol. Retinol feeding either for one day or two days did not affect the release of acid phosphatase and aryl sulphatase in young rats. Retinol inhibited in vitro the activities of protease (cathepsins) and cathepsin B1.


[Effects of ingestion of an antioxidant, BHT, on the metabolism of ascorbic acid and vitamin A in rats].

The antioxidant foor additive, BHT, was fed to male rat for 28 days at a 0.5% concentration in a diet containing ascorbic acid or not. BHT intake had no effect on ascorbic and dehydroascorbic acid contents in the adrenals, spleen or liver, whether or not the diet contained ascorbic acid. When the ration included 100 mg/kg of ascorbic acid, BHT intake caused a sharp rise in urinary excretion of this compound. This data confirm the work of other authors studying an ascorbic acid-poor diet. These results indicate that BHT intake leads to increased synthesis of ascorbic acid. This augmentation would be the result of stimulating the biosynthesis pathway of uridyl-di-phospho-glucuronic acid, which is necessary to the elimination of BHT in the form of glucuroconjugate. BHT intake in an ascorbic acid-rich diet reduces hepatic vitamin A concentration by 44 p. 100 and the hepatic reserve of this vitamin by 22 p. 100. BHT detoxication, as that of other exogenous compounds, thus seems to cause increased vitamin A utilization.


[Vitamin B2 nutritional status of pregnant rats and their offspring in relation to dietary riboflavin intake].

Four groups of gestating female rats were fed diets containing respectively 1, 2, 4, 6 mg of riboflavine per kg. Measurements of the changes in vitamin excretion as related to the dietary intake during various periods of gestation support the hypothesis that riboflavin requirement increases in the last days of gestation. On the other hand, measurements of riboflavin concentration in tissues show that, when the vitamin is given in suboptimal quantity, it is priorly fixed by the foetus. Qualitatively these results are similar to those we obtained in our corresponding study with thiamin. However, the magnitude of the changes in riboflavin urinary excretion or fixation by organs, as related to the dietary intakes, are much more limited as compared to those obtained with thiamin.


Polyglutamate forms of folate in liver of folic acid-deficient rats.

In view of role played by pteroylpolyglutamates as actual folate coenzymes in single-carbon unit metabolism, the effect of folic acid deficiency on the distribution of these compounds in rat liver has been studied. In deficient rats the liver levels of pteroylpolyglutamates and in particular of those containing a higher number of glutamyl residues are more decreased as compared with monoglutamates. In fact penta- and other higher polyglutamates: mono-, di- and tri-glutamates ratio is lower in deficient rats than that in control rats. The decreased amount of these coenzymic forms observed in this condition may be considered as the consequence of the severe alterations of process which adds glutamate moieties to monoglutamate forms.


Folate intake by teenage girls and by pregnant women.

In a dietary analysis comprising 110 girls aged 13-15 years and 87 pregnant women the mean folate intake proved to be less than one-third of the Recommended Dietary Allowances. Among the girls there was a significantly positive correlation between folate intake and energy intake, while this did not apply to the pregnant women. The reason was that the excess energy intake during pregnancy was only modest, and in many cases it was met by energy calories of low nutritional value. If supplements of folic acid are needed during pregnancy, it is recommended to start prophylaxis as early as possible, as folate intakes by potential mothers (teenage girls) are insufficient to secure a high depot level for folates before pregnancy.


Vitamin C deficiency in guinea pigs: variable sensitivity of collagen at different sites.

1. The synthesis of collagen in several tissues, including the C1q component of complement in serum, was measured in vitamin C-deficient and control guinea pigs by incorporating labelled proline into hydroxyproline in vivo. 2. Of the tissues examined, by far the greatest specific effect of vitamin C deficiency was observed in skin. Bone was second in order of sensitivity; skeletal muscle, lung, heart and kidney exhibited only small effects, which were difficult to distinguish from those of inanition, while liver, C1q, and the ethanol-soluble components of serum were virtually insensitive. The effect on urinary hydroxyproline was also extremely small. 3. The lack of sensitivity of C1q confirms previous conclusions (BATES, LEVENE, OLDROYD and LACHMANN 1978), based on total protein bound hydroxyproline levels and total C1 activity in plasma. Since C1q, which turns over rapidly, is insensitive, the high sensitivity of "repair" tissues to vitamin C deficiency is unlikely to be connected with their high turnover rate. Differential concentration of vitamin C by different tissues seems more likely to be the critical factor.


Effects of high level of vitamin C on tissue antioxidant status of guinea pigs.

Two groups of weanling male Hartley guinea pigs maintained on vitamin E deficient diet were supplemented with 0.4 I.U./100 g body weight/day of vitamin E and either 2 (Group A) or 10 (Group B) mg/100 g body weight/day of vitamin C for 5 weeks. As compared to Group A, the degree of erythrocyte hemolysis and liver TBAR level of Group B were significantly increased while plasma vitamin E and erythrocyte GSH levels were significantly decreased. In another experiment, two groups of guinea pigs were given 0.8 I.U./100 g body weight/day of vitamin E and 2 (Group C) or 30 mg/100 g body weight/day (Group D) of vitamin C. Levels of plasma vitamin E and erythrocyte GSH of Group D were significantly lower than those of Group C: however, erythrocyte hemolysis and liver TBAR were not affected by the level of vitamin C supplementation. The results suggest that the high levels of vitamin C supplementation lowered tissue antioxidant potential of animal when vitamin E was marginally adequate, and the hemolytic and peroxidizing effect of high level of vitamin C may be counteracted by increasing the level of vitamin E.


The plasma membrane of the rabbit lens cortical fiber. I. Isolation, characterization, and biosynthesis of two membrane intrinsic polypeptides.

Rabbit lens cortical fiber plasma membrane polypeptides were isolated and two membrane intrinsic proteins were characterized by SDS-PAGE. A polypeptide with a molecular weight of 26 kilodaltons is the major constituent of the plasma membrane. The molecular weight and antigenic properties of the other polypeptide studied are similar to polypeptides of cortical water-soluble alpha-crystalline. Biosynthesis of these two polypeptides was studied. After initially high rates, synthesis of both of these polypeptides decreased considerably and maintained a steady rate for the rest of the culture time.


Prevention of stromal ulceration in the alkali-burned rabbit cornea by glued-on contact lens. Evidence for the role of polymorphonuclear leukocytes in collagen degradation.

Stromal ulceration of the alkali-burned rabbit cornea was found to be associated invariably with phagocytically active polymorphonuclear leukocytes (PMNs). A glued-on methylmethacrylate lens applied to corneas soon after burning, however, prevented re-epithelialization and also prevented PMN infiltration of the stroma and stromal ulceration. Subsequent partial detachment or complete removal of the lens resulted in epithelial resurfacing of the stroma, PMN infiltration, and stromal ulceration. Glued-on lenses applied to already ulcerating corneas arrested further ulceration by prohibiting additional PMN infiltration. Either surface debridement or glued-on methylmethacrylate rings also prevented re-epithelialization and ulceration in stromas not infiltrated by PMNs, but neither treatment was sufficient to prevent ulceration in corneas already containing numerous PMNs. The data suggest the possibility that the epithelium stimulates infiltration of the stroma by PMNs which then participate in stromal matrix degradation. Although no claim is made that only PMNs mediate matrix destruction in corneal ulceration, the efficacy of the lens would seem to be due to exclusion of the epithelium and the consequent prevention of stromal infiltration by PMNs.


What prior uniocular processing is necessary for stereopsis?

In order to induce stereoscopic depth, retinal images in the right and left eyes must differ. Our experiments demonstrate that these uniocular differences for simple three-line configurations at stereo-threshold cannot usually be distinguished one from the other. We confirm that depth values are associated with individual features by virtue of their disparity, rather than by a comparison of their image separations in the two eyes. In ordinary stereoacuity patterns, no prior identification of monocular relationships is needed to produce discriminable depth differences. For certain patterns, disparity of the positions of the averages of the targets' internal light distributions in the two eyes can substitute for disparity of pattern contours in stereoscopic depth discrimination.


Slow build-up of optokinetic nystagmus associated with downbeat nystagmus.

Eye movement recordings in two patients with downbeat nystagmus demonstrated an unusual finding of severely impaired smooth pursuit and relatively unimpaired optokinetic nystagmus (OKN). OKN was characterized by a remarkable, slow build-up of slow-component velocity, similar to that found in afoveate animals. Optokinetic after-nystagmus (OKAN), or transient persistence of nystagmus after cessation of visual stimulation, typical of the optokinetic response of normal human subjects, was also preserved in these patients. These observations suggest that the normal contribution of smooth pursuit to the ocular motor response to rotation of the visual environment can be selectively removed by a lesion at the level of the craniocervical junction.


Image formation in fundus cameras.

Imaging in a fundus camera depends more on design of the system than on correction of the first fundus image as formed by the ophthalmoscopic lens. We show here that the designer may use the free parameters of the ophthalmoscopic lens (contact or noncontact) to correct the latter for observation and illumination of the fundus. In both contact and noncontact systems the fundus is illuminated by forming a ring of light on the patient's cornea around a central area (the corneal window) reserved for observation. On the first surface of the crystalline lens, the light also forms a ring which must accomodate the total entrance pupil (TEP) of the observation system in its middle and which is limited on the outside by the patient's iris. The restrictions that result from this situation define the entrance pupil of the bundle of rays that image the marginal point of the retina. The limits of this bundle are imposed by the choice of the angular field of view and by the size of the patient's pupil.


Light-triggered rod disc shedding in Xenopus retina in vitro.

The present study was designed to determine whether light-induced rod outer segment disc shedding occurs when the eye is isolated from the rest of the organism. Whole eye explants of Xenopus laevis were maintained in vitro and either exposed to 5 min of light or kept in darkness. In both the in vitro eyes and in vivo controls exposed to the same conditions, a significant degree of disc shedding occurred within 1 hr of the light stimulus. The disc shedding response was larger in the explanted eyes than in the intact animals. In explants exposed to [3H]leucine for 24 hr, a radioactive band formed at the base of rod outer segments. Thus both light-stimulated disc shedding and disc synthesis occur in the eye kept in vitro. The results of this study are compatible with other recently reported results suggesting that rod disc shedding is initiated within the eye.


Effect of dipyridamole on prostaglandin-induced ocular hypertension in rabbits.

The effect of intraperitoneal injections of dipyridamole on the elevations of intraocular pressure and anterior chamber aqueous humor protein produced by topical application of prostaglandin E2 was studied in rabbits. Pretreatment with 100 mg/kg dipyridamole inhibited the prostaglandin E2--induced ocular hypertension and rise of aqueous humor protein. Systemic administration of dipyridamole did not alter the responses of the eye to instilled nitrogen mustard. Topical instillation of dipyridamole was ineffective. Dipyridamole, a clinically available drug, may be useful in the treatment of ocular inflammatory disease.


Subject cooperation and the visual evoked response.

The effects on the visual evoked response (VER) of subject behavior, such as accuracy of fixation, stability of eye position, and degree of concentration, are poorly documented. Experiments were performed on 20 normal subjects to investigate the effects on the VER of eye movements, off-center stimulation, concentration on another task, and voluntary defocusing. It was found that there are some conditions under which a normal subject can produce an abnormal VER which could lead to misdiagnosis.


Vitamin E deficiency and the retina: photoreceptor and pigment epithelial changes.

To investigate the role of normal vitamin E levels and the interrelationships between vitamin E and A in maintaining the visual cells of the retina, weanling female Sprague-Dawley rats were fed vitamin E-free diets differing tenfold in their vitamin A content (0.8 and 8.0 mg of retinol per kilogram of diet). Rats on vitamin E-free diets with the higher vitamin A level exhibited marked disruption of photoreceptor outer segment membranes and a fivefold increase in the number of lipofuscin granules in the pigment epithelial cells which ingest these membranes. Rats on vitamin E-free diets with the lower vitamin A level showed the same retinal damages plus significant loss of photoreceptor cells compared to age-matched rats on control diets. Rods and cones were involved equally, and their pattern of loss was not like that found in vitamin A deficiency. Normal levels of vitamin E probably protect photoreceptor membranes from oxidative damage and retard the accumulation of their remnants and other products of lipid breakdown in the pigment epithelium. The vitamin A status of rats has a significant influence on the extent of damage induced by vitamin E deficiency.


Alterations of lens protein synthesis in galactosemic rats.

A differential effect on protein synthesis has been demonstrated in the lenses of galactosemic rats. During galactose cataract development the synthesis of lens crystallins is depressed, whereas that of noncrystallin proteins is unaffected. This effect correlates with the influx of Na+ and loss of K+ from the lens. Removal of the galactose diet results in a gradual recovering of crystallin synthesis to normal levels. In vitro the nuclear cataractous lenses leak crystallins into the media; however, upon 5 day's recovery no leak-out of crystallins could be detected. Both decreased synthesis and leak-out probably account for the marked loss of dry weight of cataractous lenses. These results support the hypothesis that crystallin synthesis may be affected by cation imbalance or changes concomitant with such an imbalance.


Rapid assessment of visual function: an electronic sweep technique for the pattern visual evoked potential.

We have developed an electronic spatial frequency sweep technique for electrophysiological assessment of visual acuity and pattern vision. The technique allows an accurate and reliable measurement of VEPs to a full range of spatial frequencies in just 10 sec. Because the measurements are so rapid, the technique suggests several new improvements in the assessment of visual function. Sweeping spatial frequency linearly and extrapolating the high-frequency region of the VEP spatial-tuning function to zero voltage allows an estimate of acuity which correlates highly with psychophysical estimates of acuity. Variants of the procedure are appropriate for the assessment of refracture error, determination of equality of visual function for the two eyes and of binocular interactions, and for sequential assessment of therapeutic conditions.


Suprathreshold spatial frequency detection and binocular interaction in strabismic and anisometropic amblyopia.

We have investigated suprathreshold contrast sensitivity and binocular interactions in strabismic and anisometropic amblyopes using a reaction time paradigm. For every spatial frequency, reaction time increased as the grating contrast decreased. At all spatial frequencies and contrast values the reaction times using the amblyopic eye were prolonged compared to the nonamblyopic eye, but most markedly at high spatial frequencies. In the middle range of spatial frequencies, the contrast vs. reaction time function for the nonamblyopic eyes was biphasic, suggesting that two separate mechanisms detect gratings at high and low contrast levels. These functions in deep amblyopia were monotonic, and in shallow amblyopia the break in the functions was present but shifted to lower contrast levels. Binocular interaction experiments showed that binocular summation was absent at all contrast levels, but binocular occlusion was evident at high contrast levels for amblyopic observers.


Interocular alignment following visual deprivation in the cat.

Kittens were placed in the dark just after birth and then removed at various ages for the study of interocular alignment. It was found that kittens dark-reared for 4 months or longer were characteristically incyclotorted with respect to normal animals. Deprivation periods of less than 2 months were ineffective in producing these changes. Divergence of the visual axes was also observed in some dark-reared cats. Pupillary constriction in response to light was much more pronounced in dark-reared cats than in normal cats. This enhanced pupillary reaction persisted for at least 3 weeks after the deprived animals were brought into an illuninated environment. When dark-reared cats were allowed a recovery period in a normally lit visual environment, their ocular alignment changed markedly. The incyclotorsion and divergence of the visual axes disappeared, and instead cats allowed recovery from deprivation could display excyclotorsion and/or convergence of the visual axes. These anomalies of ocular alignment associated with the recovery from visual deprivation could occur following periods of initial deprivation as short as 30 days or as long as 2 years. The mechanisms and possible significance of such anomalies are considered.


Role of visual cortex in interocular alignment.

The role which the visual cortex plays in the development of interocular alignment in the cat was examined by removing this structure bilaterally in 4 groups of subjects. These included (1) kittens 10 to 14 days of age, (2) 10- to 14-day-old kittens in which one eyelid was sutured shut at the same time, (3) normally reared adult cats, and (4) cats dark-reared until 4 months of age. If the cortex is removed in young kittens, interocular alignment appears to develop normally until the kittens are 60 to 80 days of age. At this time, an abrupt change in alignment resulting in incyclotorsion of the optic axes is observed. If binocular vision is prevented in kittens with neonatal visual cortex lesions by suturing one eyelid shut, convergent strabismus and/or incyclotorsion are frequently observed. This characteristic incyclotorsion does not develop if similar lesions are made in adult cats; no significant alterations of eye alignment occur in these animals even after postoperative survival times of more than 6 months. Incyclotorsion characterizes dark-reared cats when they are first brought into the light, but this diminishes with time and may even be replaced by excyclotorsion after the animals spend a few weeks in the light. If dark-reared cats are decorticated on being brought into the light, these changes are largely prevented. Such animals remain permanently incyclotorted relative to normal cats. The results indicate that the visual cortex plays an important role in the development of torsional alignment of the eyes.


The effects of prolonged dark exposure on visual thresholds in young and adult rats.

A comparison of electroretinogram (ERG) thresholds measured on rats reared in continuous darkness and under cyclic lighting conditions shows that by 30 days of age the dark-reared animals have achieved significantly lower thresholds than the animals reared under cyclic illumination. Ten days of continuous dark exposure produces this same increase in sensitivity in adult rats reared in cyclic lighting. These changes in sensitivity appear to reflect structural changes occurring within the rod outer segments.


Retinomotor activity and the c-wave of the hypoxic trout retina.

The teleost retina exhibits retinomotor activity in response to changing light intensity. We have shown that hypoxia interfers with normal retinomotor activity in the dark-adapted rainbow trout, so that the retina assumes an essentially light-adapted configuration with the cones contracted, the rods extended toward the pigmented epithelium, and epithelial pigment expanded. These cell movements appear to be correlated with the marked increase in ERG c-wave amplitude which we consistently observe during hypoxia in trout. Since the a-wave is not immediately affected by hypoxia, this increase in c-wave amplitude may be related to the movement of the rods toward the pigmented epithelium, which would cause a greater than normal change in extracellular [K+] near the apical membrane in response to a light stimulus, leading to an increase in c-wave amplitude.


Topical induction of delayed hypersensitivity in the bladder.

Delayed hypersensitivity reactions have been elicited by topical application of dinitrofluorobenzene to the bladder mucosa of sensitized dogs and rats. The resultant animal models may be of value in assessing the role of topically induced delayed hypersensitivity in the attempted immunotherapy of bladder cancer.


Ureteral reimplantation with proximal urinary diversion: laboratory investigation.

In an effort to determine whether or not urine flow is necessary for proper healing after ureteral reimplantation, a laboratory study was carried out using mongrel dogs. Twelve animals underwent three separate surgical procedures in order to show whether ureteroneocystostomy in the presence of proximal urinary diversion would lead to subsequent stenosis of the reimplantation sites. Our findings indicate that stenosis does not occur regardless of whether or not dry ureteral implants are stented. These studies were carried out in ureters of normal caliber and animals otherwise free of disease. It is our contention that under these circumstances, dry ureteral reimplantation will result in satisfactory healing without stricture or stenosis


Static testicular imaging utilizing 201Tl.

Successful testicular imaging of rat and rabbit testes was achieved utilizing the radiopharmaceutical Thallium-201. These observations indicate the usefulness of Thallium-201 as an agent for testicular imaging and suggest a clinical application in localizing the impalpable testis in humans.


Testicular steroid secretion and peripheral serum steroid concentrations in patients with prostatic carcinoma after short-term estrogen treatment.

The short-term effects of the administration of estradiol on testicular steroid production were assessed by measuring the serum concentrations of testosterone, and a number of its precursors and metabolites, in the spermatic and peripheral veins of five inguinal hernia patients and one untreated prostatic carcinoma patient, as well as in 18 patients with advanced prostatic carcinoma, treated for 1 to 9 days with a single injection of 80 mg of polyestradiol phosphate (Estradurin). With the exception of progesterone, the treatment resulted in a significantly decreased testicular production of all steroids measured in spermatic vein serum; the same finding holds true for concentrations of testosterone, 5 alpha-dihydrotestosterone, and 17 alpha-hydroxyprogesterone in peripheral vein serum before and after treatment. By comparing the steroid concentrations in the spermatic and peripheral veins it is evident that the testicular production of all steroids measured persisted, although at a decreased level, even 7 to 9 days after Estradurin administration; this was most pronounced in the case of testosterone and 17 alpha-hydroxyprogesterone. It is apparent that the effect of estradiol on testicular steroid production is a gradual process which takes several days before it is clearly evident.