Bowenoid papulosis of the genitalia.

We report 34 cases of bowenoid papulosis of the genitalia. In each case, the patient had numerous reddish brown or violaceous papular lesions, some distinctly verrucoid, situated on the genitalia. Although clinically the lesions invariably appeared benign, histologic examination of specimens from the genital lesions in each patient showed changes of squamous cell carcinoma in situ. Many of the patients gave a history of preceding viral lesions on the genitalia. Therapy in all cases was conservative but thoroughly ablative. We view bowenoid papulosis as a new entity whose biologic behavior if untreated is as yet unknown.


Localized herpes simplex infections in atopic dermatitis.

Herpes simplex infections, localized to areas of atopic dermatitis, were documented in ten children. The typical clinical picture consisted of low-grade fever and exacerbation of the eczema with discrete vesicles localized to affected skin, followed by punched-out ulcerations. Recurrent attacks were observed in seven cases and coincided with active attacks of herpes labialis in other family members or close friends, suggesting reinfection as the source. In no patient did a disseminated Kaposi's varicelliform type of eruption develop. Viral cultures in 30 additional patients with acute flares of atopic dermatitis without vesicles or ulcerations failed to disclose any herpes simplex.


Chronic mucocutaneous candidiasis. Successful treatment with intermittent oral doses of clotrimazole.

Treatment of chronic mucocutaneous candidiasis has included drugs, immunotherapy, and replacement of nutritional and endocrine deficiency. Although amphotericin B is the best known and most commonly used form of treatment, the imidazole antibiotic clotrimazole has shown promise as an effective agent that can be given orally with low toxicity. A 9-year-old girl responded to intermittent clotrimazole therapy with complete and prolonged remission. This form of treatment offers advantages in safety and effectiveness over other therapies for chronic mucocutaneous candidiasis.


Necrotizing sialometaplasia. A condition simulating malignancy.

Necrotizing sialometaplasia occurred in a 55-year-old woman. The ulcerated lesion on the hard palate was treated conservatively and resolved spontaneously in about three months. The histology of the lesion consisted of coagulative necrosis of the salivary gland lobules and prominent squamous metaplasia within adjacent viable lobules. Since this benign lesion has frequently been mistaken for mucoepidermoid carcinoma or squamous cell carcinoma, recognition of it may spare the patient a radical surgical procedure.


Localized Ehlers-Danlos syndrome.

A 34-year-old woman had the cutaneous features of the Ehlers-Danlos syndrome, which was strictly limited to the skin and subcutaneous tissue in the region of the left shoulder. The disorder started at approximately age 22 with the development of subcutaneous nodules. Hyperextensibility of the skin in this region developed within the subsequent five years. There was a notable lack of the usually associated joint hyperextensibility, bleeding tendency, scar formation, or the serious systemic components of the Ehlers-Danlos syndrome.


Steatocystoma multiplex. Report of a florid case and a review.

A patient had numerous cysts over almost all of his skin surface. The lesions were persistently infected, painful, and odorous, and were contributory to the patient's psychological problems. The cysts were histologically determined to be of the steatocystoma multiplex variety. Several therapeutic modalities were used but only surgical incision, drainage, and electrocautery were beneficial.


Histoplasmosis of skin and lymph nodes and chronic lymphocytic leukemia.

Nodular skin and cervical lymph node lesions of histoplasmosis, unassociated with systemic symptoms of the infection, developed in a 63-year-old man with untreated chronic lymphocytic leukemia. The histologic patterns in both the skin and lymph node were those of a lymphoproliferative disorder, but Histoplasma organisms were found within a few scattered histiocytes after a careful search. The subtle clinical and pathologic presentation might lead one to overlook the organisms and to believe that the leukemic process had progressed, resulting in potentially dangerous systemic involvement of histoplasmosis and unnecessary chemotherapy for his leukemic process. Complete remission of histoplasmosis was obtained with amphotericin B therapy.


Eruptive vellus hair cysts.

Umbilicated and nonumbilicated papules were present on the presternal area of a patient with eruptive vellus hair cysts. Histopathological examination of umbilicated papules showed penetration of vellus hairs through cyst walls, surrounding granulomatous foreign body reaction, and communication to the surface of the skin with released vellus hairs present in the pore. This suggests that resolution of some of the cysts in this disorder may occur by transepithelial elimination.


Systemic lupus erythematosus. Association with previous neonatal lupus erythematosus.

A patient previously reported to have discoid lupus erythematosus as a neonate eventually developed systemic lupus erythematosus (SLE) at age 19 years. This case illustrates that although neonatal lupus erythematosus is usually self-limited, SLE may develop in selected patients in future years.


Demodex granuloma.

A punch biopsy was done to diagnose a progressive pustular facial rash in a middle-aged woman. The biopsy specimen disclosed an intact extrafollicular Demodex folliculorum, which may be the causative organism. A review of 30 cases of granulomatous facial lesions from the Mayo Clinic indicated that this finding is uncommon.


Topical methoxsalen administration and sunlamp fluorescent irradiation in psoriasis.

Analysis of standard fluorescent sunlamps (Westinghouse) indicates that in addition to UVB (290 to 320 nm), a considerable amount of UVA (320 to 400 nm) is also present in their emissions. Since the benefits of topical psoralen administration and UVA have already been demonstrated, and prior experience by ourselves and others with UVB has indicated that some psoriasis benefited from UVB alone, localized areas and plaques of 20 patients were treated with topical administration of psoralens and fluorescent sunlamp bulbs to determine if such a light source with this emission spectrum would be advantageous. Results indicated a total resolution in 17 of 20 patients after an average of 18 treatments. Adverse blistering phototoxic reactions and excessive hyperpigmentation were not encountered. The UVB erythema response of normal skin served as the guide to light dosage in the same manner as administration of the Goeckerman regimen. Therefore, the use of psoralens was very effective when combined with fluorescent sunlamp irradiation; however, the potential risks of photocarcinogenicity makes this treatment experimental and should be reserved for recalcitrant cases.


Skin levels and vasoconstrictor assay of topically applied hydrocortisone.

Ointment containing 2.5% hydrocortisone was applied topically under occlusion to 84 subjects. Fifty-three percent of the population showed skin blanching in response to topical application of the steroid. To correlate vasoconstrictor response with drug level, hydrocortisone concentrations were determined fluorometrically in skin samples from 16 subjects in whom skin blanching was also assessed. The epidermal concentration of hydrocortisone was significantly greater in those subjects who exhibited blanching. Data suggest that a minimum epidermal reservoir of 200 micrograms of hydrocortisone per gram of lyophilized tissue is necessary to elicit a definite vasoconstrictor response.


Lymphoid follicles in subcutaneous inflammatory disease.

A review of inflammatory subcutaneous disease revealed that lymphoid follicles are observed frequently in lupus panniculitis. They are found rarely in other lymphocytic inflammatory diseases involving the panniculus, such as morphea, erythema nodosum, and erythema induratum. The lymphoid follicle may be an indication of immunoreactive and connective tissue disease, and cases should be evaluated with this in mind.


Trichomycosis pubis.

Trichomycosis is a bacterial infection of hair that involves the axilla and, uncommonly, the pubis. The causative agent of trichomycosis pubis is probably the same as that in trichomycosis axillaris, as determined by culture and electron microscopy. We believe that increased awareness of trichomycosis pubis will show it to be common in certain environments.


Hypodermitis sclerodermiformis and unusual acid-fast bacteria.

We described two patients with localized, chronic, painful, scleroderma-like lesions of the lower part of the leg associated with venous stasis. This type of lesion has been termed "hypodermitis sclerodermiformis," and we review the literature pertinent to this entity. In addition, skin biopsy material was studied for the presence of acid-fast microbes. In both cases, Fite-Faraco-stained tissue sections contained many acid-fast coccoid and giant microbial forms suggestive of transitional L forms. Culture of the lesion in both cases was positive for Staphylococcus epidermidis. Until the cause is fully clarified, the search for acid-fast bacteria appears warranted in formed of pseudoscleroderma such as hypodermitis sclerodermiformis.


Identification of a neutrophil chemotactic inhibitor in a patient with recurrent pyoderma.

Host defense mechanisms were studied in a patient with recurrent pyoderma of the scalp. Evaluation of the patient's inflammatory response demonstrated normal yeast phagocytosis, normal capillary tube migration, normal results from a nitroblue tetrazolium dye test, and significantly decreased neutrophil chemotactic response (NC). The impaired NC was associated with a heat labile plasma inhibitor. Chromatography of the patient's and of normal human plasma demonstrated three distinct protein peaks. Chemotactic inhibitory activity was found in the third peak of the patient's plasma but not in the control plasma. Normal in vitro NC was restored when greater than 40% normal human plasma was added to the column fractions that contained the inhibitor. Based on these findings, a subsequent exacerbation of the patient's pyoderma was treated with fresh frozen plasma, and dramatic clinical improvement occurred within 72 hours.


Transient neonatal pustular melanosis.

A black male infant had congenital lesions that consisted of pigmented macules, many of which had a peripheral collarette of scale, and vesicopustules. The appearance of this patient fit the clinical syndrome of transient neonatal pustular melanosis, a newly described vesicopustular disease of the newborn. Differential diagnosis in this patient included the following conditions: erythema toxicum neonatorum, staphylococcal pyoderma, and herpes simplex.


Persistent subcutaneous abscesses following Pseudomonas sepsis. Treatment by surgical incision and drainage.

Despite appropriate and adequate antibiotic therapy, multiple subcutaneous abscesses developed in a child with Pseudomonas aeruginosa spesis and meningitis. The patient's condition remained toxic until the abscesses were incised and drained.


Alkaptonuria with extensive ochronosis.

A 59-year-old woman with previously documented alkaptonuria was examined for extensive ochronosis of recent onset. The cause of the extensive skin pigmentations were thought to be secondary to decreased renal clearance of homogentisic acid because of a decline in the patient's renal function. If extensive or rapidly progressive skin pigmentation is noted in a patient with alkaptonuria, then evaluation of the patient's renal status should be done because unrelated renal disease has been reported in patients with severe ochronosis.


Cutaneous chylous reflux. The weeping scrotum.

The cutaneous lesions associated with reflux of lymphatic fluid and chyle from the skin have received little attention in the dermatologic literature. We describe a patient with such lesions, and discuss the clinical, histopathologic, and lymphangiographic manifestations. We review the classification of lymphedema and the commonly seen cutaneous lesions.


A congenital ichthyosiform syndrome with deafness and keratitis.

This is a report on two children with a syndrome characterized by an extensive congenital ichthyosiform eruption, neurosensory deafness, hypotrichosis, partial anhidrosis, and vascularization of the cornea. The facial involvement is distinctive. Other features are dystrophy of the nails and tight heel cords. Both children are of normal intelligence. The inheritance pattern is unknown.


Subungual osteochondroma. Differential diagnosis and treatment.

Subungual osteochondroma, a rare disorder of the fingers and toes, occurred in five patients. Clinical features of the condition include nail deformation, history of long, slow growth, and characteristic radiologic features. Surgery is directed toward total tumor resection with preservation of the nailbed to achieve normal nail growth. Differential diagnosis included bony, cartilagionous, and soft tissue tumors as well as cystic lesions. Malignant tumor should be suspected by not confused with this benign disorder. Roentgenologic examination is indicated in the differential clinical diagnosis of any subungual mass.


Hereditary acrolabial telangiectasia. A report of familial blue lips, nails, and nipples.

We describe a mother and two daughters who had the following clinical manifestations: bluish discoloration of the vermillion ridge of the lips, nipple areolae, and nail beds; discrete telangiectasia of the chest, elbows, and dorsa of the hands; varicosities of the lower part of the legs; and (in the two daughters) migraine headaches. Routine histologic examination of tissue from the lips and elbows disclosed extensive, dilated, horizontal subpapillary telangiectases. Enzyme histochemical stains demonstrated activity of adenosine triphosphatase and leucine aminopeptidase around these dilated vessels. Alkaline phosphatase activity was strikingly absent from the dilated subpapillary vessels. By electron microscopy, these vessels were demonstrated to be postcapillary venules. We propose an autosomal dominant mode of inheritance.


Unilateral blepharochalasis.

True blepharochalasis occurring in young adults and associated with recurrent bouts of eyelid swelling and eventual lid laxity is an uncommon entity. We report the case of an 18-year-old woman who had a nine-year history of unilateral blepharochalasis. A skin biopsy specimen that showed the absence of stainable elastic tissue confirmed the clinical impression, and appropriate surgical correction was carried out.


Effect of tolazoline in severe hyaline membrane disease.

Tolazoline hydrochloride was given as a pulmonary vasodilator to 20 preterm infants with severe hyaline membrane disease requiring mechanical ventilation who developed persistent severe hypoxaemia. The drug was only given when deterioration persisted despite changes in ventilation techniques and thus there were no control infants. A significant improvement in arterial oxygenation was observed, particularly in those infants without intracranial haemorrhage or pneumothroax. Nine of 10 infants who had an obvious clinical response to tolazoline survived, whereas only 2 survived out of 10 who failed to respond, both being subsequently shown to have pneumothoraces. There appears to be a place for the use of tolazoline in a severely hypoxaemic infant with hyaline membrane disease who is being ventilated and in whom arterial oxygenation cannot be improved by further increase in the inspired oxygen concentration or by alteration of ventilator settings, provided pneumothorax has been excluded.


Factors affecting neonatal jaundice.

Plasma bilirubin was estimated on 690 term infants on about the 6th day of life. Perinatal factors were recorded and the results analysed. Hyperbilirubinaemia was defined as a level greater than 205 micromol/1 (12 mg/100 ml) and this was present in 20% of cases. Three factors--epidural analgesia, breast feeding, and poor weight recovery--showed highly significant associations with jaundice. The relative importance of these is discussed and compared with recent reports. Induction of labour, for reasons other than postmaturity, and a gestational age less than 39 weeks showed a slightly increased incidence of jaundice. There was no correlation with other factors tested including oxytocic drug administration. Despite the high incidence (20%) of hyperbilirubinaemia, only 2.5% infants needed treatment and none required exchange transfusion. Radical changes in obstetric management or infant feeding are not indicated.


Antigen-antibody complexes in the serum of patients with juvenile chronic arthritis.

IgG-containing antigen-antibody complexes were detected in the sera of all of 7 patients with the systemic form of juvenile chronic arthritis, usually at high levels. Only 9 of 25 patients with the polyarticular form had such complexes, usually at low levels. Three patients had low levels of serum IgA which were probably drug induced; the one patient with low C2 and the 3 with low yeast opsonisation were probably not more than to be expected in a random population.


Reduction of insulin dose on changing diabetic children from standard to monocomponent insulins.

21 diabetic children requiring greater than 50 units of standard insulin daily were changed to a monocomponent insulin. During the 3 months before the change the insulin dose had risen significantly from a mean of 70 to a mean of 77 units daily. During the 3 months after the change the dose fell significantly to a mean of 53 units daily. This decrease in insulin requirement was associated with a general improvement in diabetic control. This was assessed clinically and measured in 10 children by an analysis of home urine tests and in 8 children by an analysis of 24-hour urine glucose excretion.


Interferon synthesis by human colostral leucocytes.

The antiviral potential of human colostral leucocytes was assessed by their capacity to produce interferon. Leucocytes cultured from colostrum were stimulated by mitogens or Newcastle disease virus (NDV) to produce interferon which, by metabolic and physicochemical criteria, corresponded to normal human leucocyte interferon. Prepartum cells produced higher levels than postpartum cells. Colostral cells were less efficient producers than blood leucocytes.


Duodenal bile acids in infants with protracted diarrhoea.

Bile acids were estimated in the duodenum of infants with protracted diarrhoea and compared with those in a control group. Significantly lower levels of total bile acids were found in infants with protracted diarrhoea, a finding which may be due to ileal dysfunction. Low concentrations of total bile acids may contribute to the poor nutritional state of these patients by impairing the normal digestion and absorption of dietary fat and fat-soluble vitamins. The absence of deconjugated bile acids in the duodenal juice of most infants with protracted diarrhoea suggests that they do not contribute significantly to the pathophysiology of this disorder.


Familial partial trisomy of the long arm of chromosome 3 (3q).

A case of partial trisomy of the long arm of chromosome 3 (3q21 leads to qter) is described. The clinical findings are compared with those in 5 previously reported cases. There is hirsutism and characteristic facial dysmorphism, the common features of which are a square-shaped face, prominent nasal bridge, everted nostrils, hypertelorism, and palate abnormalities; occurring less often are abnormalities of vertebrae, thorax, and digits, or cardiovascular, urinogenital, and central nervous system. New features noted in this present case are absence of right eye from orbit and spina bifida. The spectrum of this syndrome is discussed, with possible relation to the degree of trisomy. The present case is the 6th to be reported with partial trisomy of the long arm of chromosome 3.


Familial occurrence of omphalocele suggesting sex-linked inheritance.

A family is described in which 4 males in two generations had omphalocele. There was no case of omphalocele in any of the women. It is suggested that the mode of inheritance could be a sex-linked recessive trait.


Nonaccidental poisoning in childhood.

A boy aged 7 years 10 months was admitted to hospital on several occasions in an unconscius state with twitching and apnoeic episodes. Initial investigations failed to show a specific cause. During his time in hospital he had recurrent episodes of loss of consciousness and, on the last occasion, hypotension and ventricular tachycardia. A diagnosis of imipramine poisoning was established by the presence of imipramine in stomach washings and blood. The drug was being given to the child, both at home and in hospital, by his mother. The possibility of nonaccidental poisoning must be considered if there is no obvious cause for a child's illness. In this case the mother responded to psychiatric treatment.


Quantitation of digital clubbing by shadowgram technique.

Finger clubbing was quantified from the magnified silhouette of the right index finger in controls and patients with clubbing, using a simple shadowgram technique. There was good correlation between clinical assessment and measurement of both the profile angle and the hyponychial angle. The hyponychial angle appeared to be a more accurate indicator of clubbing than the profile angle.


Fatal bleeding from gastric ulceration during first day of life--possible association with social stress.

Death from haemorrhage is described in a 21-hour-old baby boy with acute gastric ulceration. Particular note is made of the very high level of psychosocial maternal stress during the last trimester of pregnancy. A causal relationship of this stress and the peptic ulceration is suggested, with gastrin as the mediator.


Phenothiazine-induced dystonia associated with an increase in serum creatine phosphokinase.

A transient but considerable rise in serum creatine phosphokinase (CPK) levels occurred in six boys aged between 8 and 11 years and suffering from phenothiazine-induced dystonia. In one boy (Case 4), after the CPK level had returned to normal after withdrawal of the drug, its reintroduction orally at lower dosage caused a slight increase in the level of CPK in the absence of any recurrence of the dystonia.


Striatal degeneration in childhood.

The clinical features, and the radiological and neuropathological findings of 3 unrelated children with striatal degeneration are presented. In one case the father had recently developed choreiform movements while in the other two the family history was negative for neurological disorders. Two patients had juvenile onset of psychiatric symptoms, seizures, and rigidity. The 3rd child presented with focal seizures at 9 weeks of age. The neuropathological findings are virtually identical in all 3 cases. The classification of striatal degeneration in childhood is discussed.


Results of a regional cord blood screening programme for detecting neonatal hypothyroidism.

Our regional cord blood screening programme for detecting neonatal hypothyroidism using initial cord blood thyroxine (T4) determinations, with supplemental thyrotropin (TSH), and triiodothyronine resin uptake (T3U) measurements, gave an incidence of thyroid abnormalities of 1/3000 births, with 1/5000 infants having severe primary hypothyroidism. No hypothyroid infant detected in the programme had been suspected clinically before the screening and, in retrospect, only a few babies had any signs of hypothyroidism. Supplemental TSH and T3U determinations were required on 8-12% of the population screened initially with a T4 test to avoid missing affected cases. With an initial T4 and supplementary TSH and T3U testing on cord blood serum, recalls to exclude primary hypothyroidism were reduced to 0.16% of the screened population. The incidence of abnormalities detected in this cord blood screening programme was comparable with that reported by others using neonatal dried blood screening methods, indicating that cord blood screening can be effective provided the appropriate recall criteria and transport conditions are used. Nevertheless, for several practical reasons, neonatal dried blood methods are recommended as the screening test of choice for surveying large populations over extensive geographical areas.


Response of term babies to a warm environment.

The response of healthy term babies to warm environments was assessed by placing them naked in incubators and increasing the air temperature in steps until either sweating occurred or the rectal temperature reached 37.9 degrees C. The rate of evaporation of water from the skin was measured by a method based on the estimation of vapour pressure gradient. When a 50% increase in the rate occurred at a given site, sweating was judged to have begun. 39 studies were made on 30 babies, aged from 4 hours to 11 days. As babies approached the point of sweating, spontaneous activity usually ceased, the skin reddened, and a sunbathing posture was adopted. Sweating was found on 35 occasions. It was most pronounced and often was found initially on the forehead but it was also detected on the trunk and limbs. No thermal sweating was noted on the palms or soles. Sweating generally began when the incubator air temperature exceeded 34 degrees C and the rectal temperature exceeded 37.1 degrees C, but there was wide individual variation. Older and more mature babies tended to sweat at lower air temperatures.


Clinical evaluation and comparison of the Infrasonde, Arteriosonde, and mercury sphygmomanometer in measurement of blood pressure in children.

Both systolic and diastolic pressures can be measured in children with the mercury sphygmomanometer, the Arteriosonde and the Infrasonde. Estimates made blindly with these instruments were compared with directly measured intra-arterial blood pressures in 50 children aged between 4 days and 14 years. Systolic and diastolic estimates with the three techniques showed highly significant correlations with simultaneous intra-arterial measurements (P less than 0.001). The Infrasonde diastolic estimates were least satisfactory and the slope of the regression line against the intra-arterial pressure differed significantly from unity (y=0.54x+29.53). In 11 small children a satisfactory diastolic estimate could not be obtained with the mercury sphygmomanometer. While the mercury sphygmomanometer should remain the standard hospital equipment, an Arteriosonde would be valuable if it is difficult to hear Korotkoff's sounds on auscultation and if a diastolic pressure is required. For research investigations into childhood blood pressure an Arteriosonde or mercury sphygmomanometer, coupled with a device to exclude observer bias, is probably most suitable. Although the Infrasonde is not sufficiently accurate for research purposes, it is acceptable for routine ward use.


Dosage schedule for intravenous aminophylline in apnoea of prematurity, based on pharmacokinetic studies.

15 preterm infants were treated for recurrent apnoea with theophylline. 5 were given oral choline theophyllinate, but this was erratically absorbed. 14 were given IV aminophylline on 23 occasions. Apparent volume of distribution of theophylline in 12 infants was 0.71 +/- 0.18 1/kg (mean +/- SD). Plasma clearance rate measured in 11 infants at steady state was 18.6 +/- 4.8 ml/kg per hour. Calculations show that a loading dose of 6.2 mg/kg aminophylline intravenously and maintenance of 4.4 mg/kg per day would produce serum levels of between 6 and 12 mg/l in all but one of the infants studied, with no infant having toxic levels.


Plasma xanthine levels in low birthweight infants treated or not treated with theophylline.

The use of theophylline in the management of apnoea in the newborn was studied in 33 preterm infants. Infants received a dose of 3 mg/kg, 13 of them every six hours, the remaining 20 every eight hours. All the infants had significantly fewer apnoeic episodes. In a pharmacokinetic study, the half life of theophylline was 30.3 +/- 7.2 hours and the clearance rate was 23.9 +/- 5.06 ml/kg per hour (means and SD). The plasma theophylline level remained constant at between 13 and 15 mg/l from the 5th day of treatment but, at the same time, the plasma levels of caffeine rose to a mean level of 4.4 mg/l. Caffeine was detectable in plasma at birth, and in preterm infants not receiving theophylline; plasma levels of caffeine tended to be similar to the levels in their mothers' milk. These observations have led to clear conclusions on the optimum timing and dosage of theophylline, and on the need to monitor plasma levels of both theophylline and caffeine in newborn infants treated with theophylline.


Medulloblastoma--a changing prognosis?

87 of 90 consecutive cases of medulloblastoma diagnosed at The Hospital for Sick Children, London, in the 10-year period 1965-74 were followed-up until death or until 1 January 1978. Only one patient survived in the 1st 5-year period and is a cure. In the 2nd 5-year period 17 (41%) of 41 patients presenting are alive and, of these, 11 are 5-year survivors (=39% of possible 5-year survivors). Reasons for this improvement are discussed; it is thought likely that the main contribution is improved radiotherapeutic techniques.


Serum gastrin levels in hypertrophic pyloric stenosis of infancy. Response to a gastrin secretion test.

The aim of this study was to look for a difference in fasting serum gastrin levels or in serum gastrin response to oral feeding between infants with hypertrophic pyloric stenosis and normal controls. Fasting serum gastrin levels were measured by radioimmunoassay in 10 patients with pyloric stenosis, before pyloromyotomy and 7 and 15 days after it, and in 11 controls. In addition, the serum gastrin responses to a casein hydrolysate meal were studied in both groups (in the patients, 7 days after operation). The fasting serum gastrin levels in the patients did not differ from those in the controls before operation, but they did so after it. The serum gastrin response to feeding in patients after pyloromyotomy was no greater than in controls.


Lysozyme in the tears of newborn babies.

Tear lysozyme concentration was measured in term, preterm, and small-for-dates infants using a modification of the lysoplate technique. The lysozyme concentration was greater in the term infant than in preterm and small-for-dates infants. The values were found to increase with birthweight and gestation to a term value which is similar to that described in adults. There was no relationship between the lysozyme concentration and the rate of tear production.


Lomotil poisoning in children.

45 children were admitted to hospital after ingesting varying quantities of diphenoxylate (Lomotil). One died and 44 recovered without any sequelae. Four patients were comatose, 32 were drowsy, and 9 suffered respiratory depression. No correlation was found between ingested dose and the severity of symptoms. Because of its action in rendering the gut atonic, removal of diphenoxylate by gastric lavage is mandatory, even in patients admitted at least 24 hours after drug ingestion. Naloxone is the narcotic antagonist of choice, and should be used in all cases where suspected diphenoxylate poisoning leads to respiratory depression or coma. The use of Lomotil as an antidiarrhoeal agent in children is difficult to justify.


Foot length--a new and potentially useful measurement in the neonate.

The foot length, occipito-frontal head circumference (OFC), crown-rump, and crown-heel length (CHL) of 123 neonates of gestational ages 26-42 weeks, were measured between 12 hours and 5 days. A gauge, designed and constructed at St Mary's Hospital, Manchester, was used to measure foot length. In term babies (37-42 weeks) who were of weights appropriate for gestational age (AGA) the scatter about the mean of foot length measurements was small (coefficient of variation = 4.5%) compared with birthweight (coefficient of variation = 12.0%). The wide range of foot length measurements in babies of different gestational ages prevented maturity being accurately estimated. The mean birthweight of term light-for-dates (LFD) babies was 30.9% lower than term AGA babies, whereas the mean foot length, OFC, and body length of LFD babies was reduced by only 4.2-8.8%. There was a positive linear correlation between foot length and other indices of body size in LFD and AGA babies of all gestational ages. However, in premature babies (less than 37 weeks) the correlation between foot length and birthweight (r = 0.95) and foot length and CHL (r = 0.96) was pronounced. The 95% confidence limits of the regression lines were +/- 327 g and +/- 2.3 cm respectively. Birthweight and CHL of premature babies can therefore be estimated from a measurement of foot length that is performed simply and rapidly. Measurements of foot length are valuable in premature babies who are too ill at birth for conventional anthropometric measurements to be made, and in whom such measurements cannot be carried out subsequently because of the encumbrance of the incubator and intensive care apparatus. Drug dosages and intravenous fluid requirements based on body weight or surface area can be indirectly calculated from a measurement of foot length.


Mycoplasma hominis. A cause of neonatal meningitis.

Two cases of Mycoplasma hominis meningitis in the newborn are described. These infants demonstrate the need to consider M. hominis as a cause of neonatal meningitis, especially if the Gram stain is negative, conventional cultures yield no growth, and there is a history of maternal infection. CSF cultures on appropriate medium can quickly confirm the diagnosis.


Cefuroxime plasma and CSF levels in children with meningitis.

Cefuroxime (25 mg/kg) given intravenously every four hours to 7 children with bacterial meningitis resulted in satisfactory therapeutic blood and CSF levels. All children made a full recovery and side effects were absent.


Idiopathic hypoparathyroidism with extrapyramidal and myopathic features.

A case of idiopathic hypoparathyroidism and basal ganglia calcification with extrapyramidal motor and myopathic features is described. The extrapyramidal motor and myopathic features disappeared when normocalcaemia was restored with treatment, suggesting that they resulted from hypocalcaemia.


Half life of theophylline in the preterm baby with apnoeic attacks.

Plasma theophylline levels were measured by an enzyme immunoassay method in 6 preterm babies. The method gave accurate and rapid results. The study showed a considerably prolonged half life of an oral preparation.


Ultrastructural changes of the rabbit lung after a 5 ppm nitric oxide exposure.

Four male rabbits were continuously exposed to 5 ppm nitric oxide for 14 days. Four rabbits served as controls. Specimens from pulmonary arterioles and alveolar tissue were examined by light and transmission electron microscopy. The most conspicuous findings were fluid-containing vacuoles inside the arteriolar endothelial cells and/or in the intercellular junctions. Thickening of the alveolo-capillary membrane due to accumulation of edema fluid in the interstitial space was also observed.


Inner-city housing and respiratory disease in children: a pilot study.

This cross-sectional pilot study, designed to examine problems and methodology of studies on the relationship of housing and health, focused on respiratory disease in inner-city black children in Baltimore. Public housing was contrasted to the older row private housing. History of illness, familial, and demographic characteristics were obtained by questionnaire, and a small subsample of children received physical examinations. The condition of the indoor environment was evaluated and measurements of indoor temperature, volume, relative humidity, and carbon monoxide were made. Children in public housing had higher illness rates than those in private housing. Evidence of self-selection into housing type was found. Carbon monoxide levels were found to be greater inside than outside the homes. Preliminary analysis suggests public housing-private-housing classification is less important than other variables, including socioeconomic variables.


Cancer risks associated with employment in the leather and leather products industry.

A recent study of relationships between occupation and cancer at Roswell Memorial Institute, Buffalo, New York, identified significantly high risks of bladder among men and women with a history of employment in plants manufacturing leather and leather products. Among males, the relative risk increased with duration of employment and remained elevated after adjustment for smoking habits. Among male leatherworkers, significantly increased risks were seen for cancers of the buccal cavity and pharynx and larynx that could not be explained by differences in smoking habits. Malignant lymphomas were also associated with elevated risks among men and women who had worked in the leather industry. Review of processes and agents found in leather manufacture reveals several areas with exposure to potentially carcinogenic materials, including azo and other synthetic dyes that have induced cancer in laboratory animals. Further studies of person employed in the leathermaking and fabrication industries seem advisable to characterize the nature of exposure-response relationships.


Effects of low levels of carbon monoxide on visions of smokers and nonsmokers.

The scotopic sensitivity, reaction time, eye movements, and visually evoked cortical potentials of 12 nonsmokers and 6 smokers were measured during the course of 3 hr of exposure both to air and to 200 ppm CO in air. No significant degradation in performance was observed for any of these measures in either group during the course of the exposure.


Effect of tobacco smoke on the metabolism of rat lung.

The authors have studied the effect of cigarette smoke on the uptake and metabolism of 3H-palmitate, 3H-leucine, U14C-glucose and 14C-glucosamine utilizing slices of rat lung. The rats were exposed daily for 30 days to University of Kentucky research cigarettes (brands 1A1 or 1R1) in the Walton smoking machine. One group of rats served as intact controls and another were introduced into the machine, but were not exposed to smoke. All animals were weight-matched at the beginning of the experiment (180 +/- 5 g); machine control rats gained 25% less weight, 1A1-exposed rats 40%; and 1R1-exposed rats 26-40% less than controls. Exposure to tobacco smoke had no effect on palmitate uptake and synthesis of phospholipids; exposure to 1A1 cigarettes caused a 25% increase in 14CO2 production and a 30% higher incorporation of glucose into lipids. Exposure to 1R1 cigarettes had no effect on glucose metabolism. Protein synthesis was 30% lower in 1R1-exposed rats and glycoprotein synthesis increased two-fold in both 1A1 and 1R1 exposed rats.


Effects of cigarette smoke residue on rabbit tracheal epithelium in organ culture.

The effects of tobacco cigarette smoke residues on rings of rabbit tracheal epithelium in organ culture were examined. Residue from cigarette smoke was collected through continuous suction and the residue from one cigarette was used for each two tracheal rings. Epithelium exposed to residue showed cellular desquamation, initially of only scattered columnar cells. As exposure time increased the entire columnar cell layer was lost, resulting in exposure of basal cells to residue. Columnar cell loss occurred through breakdown of intercellular junctions. Alteration was also observed in columnar cell mitochondria, cilia, and microvilli. Loss of columnar cells and subsequent exposure of basal cells to tobacco smoke residue may account for the hyperplasia and metaplasia observed by other investigators after long-term in vivo exposure of tracheal epithelium to cigarette smoke.


Influence of sex and dietary calcium on intestinal cadmium absorption in rats.

The influence of sex and dietary calcium on whole-body retention of orally administered 115mCdCl2 has a half-life of 43 days, distinguishing it from 115Cd of half-life 2.3 days was studied in one-year-old control and gonadectomized male and female rats. Gonadectomy was performed at the age of four months. Each of the four experimental groups was divided into three subgroups that were fed rat food with a different calcium content (2.4, 0.7, and 0.3% Ca) throughout the experiment. Regardless of sex and gonadectomy the mean percent values of 115mCd retention in the whole body decreased with increasing dietary calcium level. Male rats retained less cadmium than all other experimental groups of animals. These data clearly point out that sex and diet might influence the level of ingested cadmium in the body.


Changes in the blood count of growing rats irradiated with a microwave pulse field.

A group of 20 male rats of mean initial body weight of 65.53 g were irradiated for 7 wk (5 days per wk, 4 hr per day) with an electromagnetic pulse field of the following parameters: working frequency 2,736.5 MHz; repeated frequency 395 Hz; pulse width 2.6 musec; vertical polarization; mean power density 24.4 mW/cm2; accuracy of measuring +/- 6%. The rectal temperature of experimental animals increased during irradiation by a maximum of 0.5 degrees C. Blood was taken before irradiation, at the end of the 1st, 3rd, 5th, and 7th wk of irradiation, and at the end of the 1st, 2nd, 6th, and 10th wk after irradiation was completed. The parameters under study included the hematocrit value; number of leukocyte differential count in both absolute and relative proportions; activity of alkaline phosphatase in neutrophil leukocytes; and body weight increase. The results were compared with parallel data obtained from a control group of 20 animals and evaluated by Student's t test at a significance level of 1%. In the second half of the irradiation period the experimental animals exhibited significantly lower mean hematocrit values, lower numbers of leukocytes, and lower absolute numbers of lymphocytes. These changes disappeared gradually within 10 wk after completed irradiation. Activity of alkaline phosphatase in neutrophil leukocytes was significantly increased in the 1st wk of irradiation and dropped transiently after the irradiation. In the post-irradiation interval experimental animals displayed significant decline in rate of body weight increase. The level of the other examined parameters did not differ from the controls.


Childhood lead poisoning: a re-evaluation.

Long recognized as an environmental toxin of fearsome lethality, lead effects are commonly described as extremely serious, particularly as regards the central nervous system. It is postulated here that this represents only part of the pathologic spectrum. Ohter lead-related conditions, as yet unrecognized, may include a wide range of central nervous system dysfunctions that although severe, are not so acutely dramatic or widely destructive as the classic encephalopathic or preencephalopathic states. These conditions remain etiologically unrecognized primarily because of (1) the variable nature of onset, (2) the variable nature of the manifestations, (3) the relative subtlety of the dysfunctions, and most importantly, (4) the absence of consistant, unequivocal evidence demonstrating the relationship of lower blood lead levels with pathologic effects. This last is seen as pivotal, and an extensive examination of the reasons for its absence is presented. It is postulated that biological variability, a concept widely used in medicine but rarely invoked in the researching of lead toxicity, is a crucial ingredient in lead research. It is further asserted that the grevious lack of etiologic recognition will continue until that factor is incorporated into research designs.


Adaptations to ozone in reference to mucociliary clearance.

Adaptation to ozone in respiratory tract mucociliary clearance was investigated in this study. Eighty rats inhaled insoluble radioactively labeled particles in order to permit monitoring of clearance. The respiratory tract and the feces were counted for radioactivity at fixed intervals to determine clearance rates. A brief challenge to 1.2 ppm of ozone following particle deposition caused a substantial delay in rapid (mucociliary) clearance. This delay (or "ozone effect") however, was eliminated by brief pre-exposure to 0.8 ppm of ozone 3 days prior to deposition of particles. When a 13-day period intervened between the ozone pre-exposure and challenge, a substantial delay (or "ozone effect") was again seen. Thus, the pre-exposure to ozone appeared to afford essentially complete protection at 3 days, and no protection by 13 days.


Protective clothing as a means of reducing nicotine absorption in tobacco harvesters.

Green tobacco sickness is an occupational illness of tobacco illness of tobacco harvesters that is thought to be caused by dermal absorption of nicotine from contact with green tobacco leaf. Wearing of rubberized nylon rainsuits effectively prevented nicotine absorption in volunteers who picked wet tobacco. Nicotine absorption was demonstrated in workers who wore clothing that was not waterproof.


Pulmonary function and health status of children in two cities of different air quality: a pilot study.

The present study was designed to examine the pulmonary function and health status of selected samples of young children in the two cities of different air qualities. There appears to be an overwhelmingly consistent trend for more respiratory-related symptoms in Grade One children from the Windsor core area than from the London core area. Not only was the trend, without exception, in favor of a greater prevalence for Windsor children, but some of the differences were statistically significant in spite of the small sample size (N = 100). Detailed analysis tends to preclude the size of family and history of respiratory illness in Windsor siblings and parents as the main reason for greater respiratory morbidity in their children.


A structure-activity relationship of some chlorinated hydrocarbons.

Partition coefficients of water/air, blood/air, oil/air, and oil/water for twenty chlorianted hydrocarbons, which were determined by means of a vial-equilibration method, were examined in relation to their chemical structures and threshold limit values (TLVs) recommended by the American Conference of Governmental Industrial Hygienists. The TLV was correlated closely with the blood/air partition coefficient and with the product of the water/air and the oil/air partition coefficient except for carbon tetrachloride and o-dichlorobenzene. A relation between partition coefficients and toxicity of these hydrocarbons is also described.


Etiology of pleural calcification: a study of Quebec chrysotile asbestos miners and millers.

A review of 15,689 chest radiographs of Quebec chrysotile miners and millers, representing the latest film prior to November 1, 1966, for all such persons ever x-rayed, identified 206 men with pleural calcification. Of these, 198 had worked in the Thetford Mines area, 6 at Asbestos, and 2 at St. Remi de Tingwick; 2.5%, 0.08%, and 1% of the films from these areas, respectively. A series of case-control studies revealed that pleural calcification was concentrated in men employed at a small group of mines in Thetford Mines and occurred more often among miners and maintenance personnel than among millers. Calcification was not related to past history of illness or injury, place of residence, or employment in other industries. The distribution of pleural calcification in this Quebec industry suggests that it is related to some characteristic of airborne dust or mineral closely associated with the chrysotile that is encountered during mining in Thetford Mines but not in other mining areas. Possible minerals include mica, talc, and breunnerite.


Hypochlorhydria and hypergastrinaemia in rheumatoid arthritis.

In order to evaluate the incidence and aetiology of hypergastrinaemia 53 patients with seropositive rheumatoid arthritis were examined for gastric acid secretion, fasting serum gastrin concentration, circulating parietal cell antibodies, and some parameters of the activity of inflammation of rheumatoid arthritis. The basal and maximum acid output was found to be subnormal in this group (P less than 0.01), and in 11 of these patients (23%) the fasting serum gastrin levels were raised (P less than 0.05). This hypergastrinaemia correlated strongly with maximum acid output. Only in cases of achlorhydria or hypochlorhydria (maximum acid output less than 2 mmol/l) was the serum gastrin level markedly raised. Two out of 5 patients with achlorhydria were found to have circulating parietal cell antibodies, and 1 had decreased absorption of vitamin B12. No relationship was found between serum gastrin and duration or activity of rheumatoid arthritis; nor was there a relationship between basal serum gastrin and the various antirheumatic drugs administered.


Collagen breakdown and ammonia inhalation.

Measurement of several urinary metabolites of hydroxylysine indicates that considerable collagen degradation occurred in four individuals immediately after they had inhaled concentrated ammonia vapors. Since clinical and/or radiological evidence of intense upper respiratory and pulmonary inflammation were evident, it is likely that collagen degradation occurred at the level of the respiratory system.


Behavioral and neurological effects of symptomatic and asymptomatic lead exposure in children.

Forty-five children 4 to 8 yr of age who had been exposed to environmental lead were studied, consisting of an acute encephalopathy group and groups with short- and long-term exposure but without encephalopathy. Control children were matched for age, sex, race, and socioeconomic status with lead-exposed subjects, but lived in post-1945 housing and had negative neurological history and blood tests. The encephalopathy group had a significantly higher incidence of neurological deficits, retarded mental development, and higher hyperactivity than control subjects. Children with short- and long-term exposure short of encephalopathy were somewhat inferior to matched control subjects, but not to a statistically significant extent.


Vertebral sclerosis in adults.

Narrowing of the intervertebral disc space with sclerosis of the adjacent vertebral bodies may occur as a consequence of infection, neoplasia, trauma, or rheumatic disease. Some patients have been described with backache and these radiological appearances without any primary cause being apparent. The lesions were almost always of 1 or, at most, 2 vertebrae and most frequently involved the inferior margin of L4. We describe 3 patients with far more extensive vertebral involvement and present the clinical, radiological, scintiscan, and histological findings. The only patient we have seen with the better known, isolated L4/5 lesion was shown on biopsy to have staphylococcal osteomyelitis. For this reason we would still recommend a biopsy of all such sclerotic vertebral lesions if they occur in the absence of other rheumatic disease.


Rheumatoid arthritis in Kenya. I. Clinical observations.

76 Kenyan Africans with classical or definite rheumatoid arthritis are described. Their age, sex ratio, and pattern of joint involvement closely resembled that seen in Europe and the USA and differed from that described in West Africa and rural South Africa. However, they showed a marked lack of systemic nonarticular complications, with relatively little functional incapacity. Radiological grading was carried out on 58 cases, and the changes were found to resemble more closely those seen in an English series than in a Nigerian series.


Viral hepatitis and hydraulic parameters: an alternative hypothesis.

Point source outbreaks of viral hepatitis have been associated with the consumption of contaminated food and water, yet epidemiologic analysis of the disease in the general population usually provides strong correlations with sub-standard socioeconomic conditions. However, statistical analysis of municipal public health records in Worcester, Massachusetts showed that significant correlations existed between the incidence of viral hepatitis and certain water and sewer parameters. A 5-yr period spanning the epidemic outbreak of 1969 to 1970 was analyzed. Significantly higher incidences of the disease occurred in those areas of the city served by old water and sewer pipes, combined sewers and the low pressure water distribution system. Based on this epidemiologic evidence, the authors propose that an alternate hypothesis, based on hydraulic arguments, can be made which will explain the observations. Although neither hypothesis, socioeconomic or hydraulic, can be excluded solely on the basis of epidemiologic results, this new hypothesis may prove useful in the design of methods for environmental control of viral hepatitis.


Cigarette smoke components and alveolar macrophage protein synthesis.

A comparison was made of the effects of acrolein and aqueous cigarette smoke extracts on amino acid incorporation into protein by rabbit pulmonary alveolar macrophages. Studies were on cells maintained in vitro as adherent monolayers. Freshly prepared acrolein inhibited amino acid incorporation by significant amounts after approximately 30 min and aqueous smoke extracts after approximately 15 min of incubation. Fifty percent inhibition by acrolein occurred with a dose of 5.5 microgram acrolein/ml, an amount four times that in the amount of aqueous smoke extract required for 50% inhibition according to previously reported findings. Analysis by a dual-isotope technique and sodium dodecyl sulfate polyacrylamide gel electrophoresis showed the inhibitory effect of acrolein to be nonspecific, as had previously been found for aqueous smoke extracts. The presence of the sulfhydryl reagent cysteine, reduced the inhibitory effect of acrolein by 57.5%, but reduced inhibition induced by aqueous smoke extracts by only 12.2%. These results suggest the effects of acrolein are both quantitatively and qualitatively different than those of aqueous smoke extracts.


Monitoring exposure of brewery workers to CO2: a study of cellar workers and controls.

Carbon dioxide exposure of nineteen cellar workers and twenty nonexposed controls in a medium size brewery was assessed by determining base excess and standard bicarbonate of the plasma before work on Monday and after work on Monday and Friday. Standard bicarbonate averaged 0.6mEq/L higher in the cellar workers than the controls when samples taken at the same time were compared. This difference was not statistically significant. Standard bicarbonate and hemoglobin concentration declined significantly in both groups between Monday before work and Friday after work, suggesting that hemodilution had occurred. This may have been related to the comsumption of large amounts of beer or other fluid. The air breathed by three cellar workers was monitored continuously during working hours for one wk. Carbon dioxide concentrations varied widely, but yielded a time-weighted average of 1.08% carbon dioxide. The time-weighted average was inordinately difficult to establish under the working conditions in the brewery and was irrelevant with respect to acutely hazardous exposures.


Rheumatoid arthritis in Kenya. II. Serological observations.

Sera from 48 Kenyan Africans with rheumatoid arthritis, 43 patients with other diseases, and 98 blood donors were tested for the presence of rheumatoid factor by latex fixation tests using human European, human African, and rabbit immunoglobulin, and a sheep cell haemagglutination test. In the patients with rheumatoid arthritis the frequency of rheumatoid factor was comparable to that reported in series from Europe and the USA, thus differing from the findings in West Africa. In the control patients and blood donors a high frequency of positive tests for rheumatoid factor was found; a similar result has been obtained from population studies in other African countries. Broadly similar results were obtained with each of the latex tests, and these were found to be less specific for rheumatoid arthritis than the sheep cell haemagglutination test.


Mechanism and treatment of hypertriglyceridaemia in gout.

Using the Intralipid lipid tolerance test we could not demonstrate any direct effect of serum triglyceride on uric acid or any influence of hyperuricaemia on triglyceride removal. This result supports previous studies suggesting that hyperuricaemia and hypertriglyceridaemia are linked through the association of obesity and alcohol excess rather than a direct cause and effect mechanism. It was possible to demonstrate significant reductions of serum triglyceride in patients with gout by reducing either their alcohol intake or body weight. Reduction of serum uric acid by probenecid had no effect on serum triglyceride or cholesterol. Similarly, allopurinol had no significant effect on serum triglyceride, but a significant fall of serum cholesterol was observed.


Leucapheresis in severe rheumatoid arthritis.

Two patients with severe seropositive rheumatoid arthritis previously unresponsive to conventional therapy have been treated with leucapheresis. This technique involves continuous cell separation daily to remove primarily lymphocytes. Clinical improvement was recorded with the use of standard rheumatological measures of inflammation. It is concluded that leucapheresis may help in the management of severely active rheumatoid arthritis when conventional therapy has been unsuccessful.


Erbium--169 versus triamcinolone hexacetonide in the treatment of rheumatoid finger joints.

Erbium--169 was compared with triamcinolone hexacetonide in the topical treatment of 32 patients suffering from rheumatoid arthritis. Erbium--169 was injected into 83 and triamcinolone hexacetonide into 54 proximal interphalangeal or metacarpophalangeal joints. Both treatments produced alleviation of joint pain and swelling and improvement of grip strength. At every check-up (1--18 months) the percentage of remissions was higher after triamcinolone hexacetonide injection than after erbium--169. The difference was significant at 1, 3, and 6 months.


Methotrexate in Reiter's disease.

Three cases of severe Reiter's disease were treated successfully with methotrexate after failure of conservative therapy, including systemic corticosteroids in 2 instances. The usefulness and potential hazards of such therapy are discussed, and some evidence that corticosteroids may aggravate the dermatological manifestations of Reiter's disease is presented.


Chemical composition of human femoral and head cartilage: influence of topographical position and fibrillation.

Topographical variations in the composition of cartilage have been described in post-mortem femoral head cartilage. Weight bearing cartilage of the superior region was considerably thicker and had a higher glycosaminoglycan content and lower water and collagen content than cartilage at the periphery and below the fovea. These topographical variations in composition may result both from variations in thickness of the cartilage and from regional areas of degeneration. The composition of cartilage at different depths and with different surface characteristics from different areas of the femoral head was measured. Fibrillated cartilage both from the inferior and superior perifoveal areas had a reduced glycosaminoglycan content and higher water content than intact post-mortem specimens. Cartilage adjacent to fibrillated areas from the superior region did not differ in composition from intact areas of cartilage from the zenith of the femoral head.


Glycolytic activity in human synovial lining cells in rheumatoid arthritis.

It was conceivable that the previously reported elevated pentose-shunt activity in human rheumatoid synoviocytes could be at the expense of glycolytic activity. To test this possibility the activities of glyceraldehyde 3-phosphate and lactate dehydrogenase, the two dehydrogenase enzymes of the latter pathway, have been investigated in the synovial lining cells in fresh sections of nonrheumatoid and rheumatoid synovial tissue. To measure the activity solely in the lining cells, apart from that in underlying infiltrating cells, quantitative cytochemical reactions have been used; the activities were measured by microdensitometry. The results showed highly and significantly increased activity of both enzymes in the rheumatoid cells. Increased activity was also found in synoviocytes in nonrheumatoid synovial tissue after trauma, so that the increased activity of these enzymes is not characteristic of the rheumatoid condition. However, the results indicate that the increased pentose shunt activity in rheumatoid synovial lining cells is not at the expense of glycolytic activity but may be part of an enhanced potential for utilising glucose 6-phosphate in these cells.


Ankylosing hyperostosis: a study of HLA A, B, and C antigens.

HLA A, B, and C antigens were studied in 25 patients with ankylosing hyperostosis. There was no evidence of an increased frequency of any antigen in association with the condition itself. However, a high frequency of several antigens was found, reflecting the predominance of Jewish patients in the series.


Circulating immune complexes and monocyte Fc function in autoimmune diseases.

The phagocytosis of separated and adherent monocytes of patients with systemic lupus erythematosus is subnormal as compared to controls on the basis of latex and yeast uptake. The monocytes from the same patients react with antibody-coated sheep red blood cells in a significantly higher degree than normal monocytes. There is a correlation between the percentage of reactive monocytes and the serum immune complex content. After brief treatment of patients with levamisole the phagocytic function of monocytes is restored and at the same time the circulating immune complex content is decreased.


Juvenile rheumatoid arthritis with rice bodies: light and electron microscopic studies.

Rice bodies obtained from a young man with juvenile rheumatoid arthritis were found by light and electron microscopy to contain cells that appeared viable. The majority of these cells closely resembled type B synovial lining cells. Type A-like cells were also seen. The cells contained few mitochondria but often much lipid and glycogen, observations which suggested a dependence on anaerobic metabolic pathways in the avascular synovial fluid environment. Cells within the rice bodies lay in a matrix of collagen fibres, fibrin, and amorphous material. The source of the collagen appeared to be the cells themselves. The relatively normal appearance of the cells suggested that they were protected from many of the inflammatory stimuli present in rheumatoid synovia. This 'reversion' towards a normal appearance suggested that the stimuli inducing chronic rheumatoid inflammation might not originate in the synovial lining.


Hydroxyapatite phagocytosis by human polymorphonuclear leucocytes.

Hydroxyapatite crystals were incubated with human polymorphonuclear leucocytes and samples examined by light and electron microscopy after 3, 8, 30, and 120 minutes' incubation. Phagocytosis of crystals occurred at 3 minutes and increased with incubation. Degranulation of neutrophils, loss of cytoplasmic density, and cell necrosis were greatest in cells mixed with apatite and increased with time. Avid in vitro phagocytosis of hydroxyapatite crystals lends further support to the potential of these crystals as causes of human arthritis.


Monitoring of experimental arthritis in rabbits.

The effect of ambient temperature and air flow on the radiometric measurement of experimental arthritis in rabbit knee joints has been studied. Temperature changes due to inflammation in such joints could be detected up to 70 days after induction of the arthritis by the use of radiometry. The method has been used to quantitate the anti-inflammatory activity of intra-articularly injected cortisol acetate and orally administered aspirin. It is suggested that this method of noninvasive monitoring has a number of advantages over other procedures.


[Classical interstitial pneumonitis and mixed cryoglobulinemia in a male with Turner phenotype. Report of a case and review of the literature].

We report a male patient, chromosomal complement 44 XY with Turner's phenotype, who has multiple skeletal, genitourinary and mild cardiac abnormalities, without hypogonadism. This patient developed a diffuse infiltrative pulmonary disease which result in pulmonary fibrosis, respiratory insufficiency and cardiac failure. He has also mixed cryoglobulinemia (Type III) with antigammaglobulin antibodies. The relationship among these problems and his phenotype is discussed. Apparently there is only a coincidental association.


[Incidence of coronary disease and other metabolic diseases in 80 gout patients].

A study about gout associated with hypertension, diabetes, ischemic cardiopathy and different alterations in the sanguineous levels of lipids was conducted on 80 patients of the Rheumatology Service at the National Institute of Cardiology in Mexico City. We found abnormal levels of tryglicerids in the blood of 55% of the patients and a high level of cholesterol in only 5%. In 27% of the patients, some alteration showed in the carbo-hydrates methabolism, and in 22,5% of them we found systemic arterial hipertension. Slight ischemic cardiopathy was showing in a 37% of the patients, but uric acid level in blood seemed to be of little importance for the frequency, type or severity of the coronary heart disease. We made a comparison between the results we obtained through these studies and those found among the Mexican population and with information found in international medical publications.


[High frequency electrocardiography. Study of childhood ventricular repolarization in function of the depolarization process].

On an experimental basis the authors studied the process of repolarization and depolarization in high frequency electrocardiograms of 30 healthy children. The negativity of the T wave in V1 and V2 corresponds with the repolarization of the left ventricle and the positivity with that of the right ventricle. The vectors of repolarization of both ventricles were identified and found to be situated on a horizontal plane. In all tracings the electrical systole of the right ventricle was found to be greater than that of the left ventricle. The number of components of high frequency tracings in the intrinsecoid deflexion was greater on the right ventricle. The authors suggest that the high frequency electrocardiogram is a valuable procedure in clinical investigation.


[Inter- and intra-atrial blocks].

Inter and intra atrial-blocks are secondary to disorders in the conduction through the auricles of the sinusal impulse. These blocks are a consequence of important relays in the stimulation of the left auricle in respect to the right one. In these intra-atrial blocks there are two areas to auricular level, responding to different rhythms, because they are separated by a bi-directional block. In this paper we present three patients with various diseases; the first showed a persistent inter-atrial block, and the other two tanscient, intra-atrial blocks which persist through the whole acute process causing the interment of the patient in our Hospital.


[Lupus erythematosus and chorea (report of 3 cases)].

We present here three cases of systemic Lupus Erythematosus which fulfilled the diagnostic criteria of the American Rheumatism Association. These three cases also had Chorea. This kind of association is not frequent and the cases here described are the last three of 32 published until now. We discusse in this paper the significance of the Chorea Syndrome and the probable causes originating it.


The limited utility of fibrinogen I 125 leg scanning.

Using venography as the reference procedure, this study examined the utility of fibrinogen I 125 scanning for the detection or demonstration of deep venous thrombosis. The results demonstrate the inability of leg scanning to detect accurately the presence or absence of thrombi in the deep venous system. Most striking was the lack of sensitivity of this procedure in areas where the propensity for embolization is greatest. Sensitivity is extremely low in the anatomic areas where leg scanning demonstrates reasonable specificity. The results are nearly identical in the extremity not operated upon. The validity of all prior studies relying heavily or exclusively on 125I leg scans to determine the presence or absence of thrombi must be critically reassessed.


Outpatient treatment and outcome of prescription drug abuse.

Forty-six consecutive patients who voluntarily sought outpatient treatment for abuse of one or more prescription drugs were studied. Barbiturates, amphetamines, and diazepam were the most common drugs abused. Desired treatments by patients included counseling, medical withdrawal, or medical maintenance with the drug of abuse or a chemically related drug. Twenty-two (47.8%) patients left treatment and relapsed within one month; another eight (17.4%) patients relapsed between one and three months after entering treatment. Only 13 (28.3%) reported abstinence 90 days after entering treatment. This experience suggests that a wide range of medical, social, and psychologic resources are required to treat prescription drug abuse, and that long-term drug abstinence is difficult to achieve with all patients.


Racial analysis of the volume-renin relationship in human hypertension.

We studied 29 normotensive men (14 black, 15 white) and 36 hypertensive men (27 white, nine black) to examine the association of race with blood pressure, blood volume, and peripheral renin activity (pra). Blood volume was lower in white hypertensive men than in white normotensive men, but was similar in all blacks. When subjects were tested in the supine position, PRA was lower in black normotensive subjects than white normotensive subjects. The PRA did not differ among groups tested in an upright posture, while furosemide-stimulated PRA was lower in hypertensive than normotensive subjects of both races despite lower blood volumes in white hypertensive subjects. Differences of volume and renin measurements appear to reflect basic differences between whites and blacks with essential hypertension. We emphasize the need to consider race in the investigation of human hypertension.


[Behavior and hemodynamics of ventricular communication in relation with the area of the septal defect].

We studied 32 cases of isolated intra-ventricular communication (IVC) in necropsy samples, and made correlations between the size of the failure and the data got from the haemodynamic study, specially the QP/QS, the sistolic pressure of pulmonary arteries (SPPA) and the vascular-pulmonar resistance (VPR). We found no correlation between the size of the orifice and the degree of short-circuit, and the last was no dependant on the SPPA. The SPPA figures were found to be in direct proportion with the failure's area. We found that the short circuit degree is managed by the VPR in inverse relation. We discuss here all the factors involved in the haemodynamic conduct to which we made reference in this paper.


Streptococcus-related acute glomerulonephritis.

Acute poststreptococcal glomerulonephritis (APSGN) is likely the result of immune complex mechanisms. The current theories in search of the  streptococcal antigen responsible for the initiation of the disease are reviewed. The finding of an extracellular protein unique to streptococci isolated from patients with APSGN and its possible role in the pathogenesis of this disease is presented.


Metronidazole therapy of anaerobic bacteremia, meningitis, and brain abscess.

Four patients with Bacteroides fragilis bacteremia, one patient with a brain abscess due to Bacteroides species, Fusobacterium naviforme, and Peptostreptococcus species, and an infant with Bacteroides species ventriculitis and meningitis were treated with metronidazole. In all cases the anaerobic pathogens were eradicated. Five of the six patients recovered. One patient with leukemia in whom B fragilis bacteremia was eradicated by metronidazole treatment subsequently died of Pseudomonas aeruginosa bacteremia. Ventricular fluid and serum concentrations of metronidazole were determined in the case of meningitis and are reported.


Nephrotoxicity of paraquat in man.

Renal function studies were performed in three cases of paraquat poisoning. Acute renal failure was observed in all three cases. Glomerular filtration rate improved for two patients who survived three weeks, illustrating the reversible nature of paraquat-induced acute renal failure. A mild to moderate transient proteinuria was observed during the first and second weeks following paraquat ingestion. Renal glucosuria, marked amino aciduria, and increased fractional excretion of phosphorus, sodium, and uric acid were observed. These findings, which have not been previously described in man, are indicative of proximal tubular dysfunction and parallel observations previously made in experimental animals.


Duration of hepatitis B surface antigenemia (HBs Ag) in hemodialysis patients.

Follow-up studies were done on 231 hemodialysis patients during a period of from one to 48 months to determine the natural history of hepatitis B surface antigenemia (HBs Ag). Of those studied, 113 (49%) exhibited HBs Ag. The probability of remaining HBs Ag positive over the mean follow-up period of 14.4 months was 62%. All of the 38 patients whose HBs Ag reverted to negative did so within ten months. Those patients whose HBs Ag reverted to negative had SGOT levels that were less frequently elevated than the patients with persistent antigenemia. Of hemodialysis patients with HBs Ag, 60% showed e antigen (HBe Ag).


Methyldopa reaction simulating septic shock.

Though drug fever from methyldopa is well known, to my knowledge fever and hypotension simulating septic shock have never been described in this country as a syndrome resulting from methyldopa therapy. Three such cases are presented here, all proved on rechallenge. They erroneously accounted for almost 6% of all cases of septic shock at St Elizabeth Medical Center in the last ten years.


Reactive pituitary abnormalities in patients with Klinefelter's and Turner's syndromes.

Ten unselected patients with gonadal dysgenesis, three with Klinefelter's and seven with Turner's syndromes, were studied. Two of the patients with Klinefelter's and two with Turner's syndromes had enlarged pituitary fossae. The other six patients had normal sized sella, but showed localized change in the sellar contour on polytomography, suggesting hyperplasia or microadenoma formation of the pituitary gland. All ten patients had abnormally high serum follicle-stimulating hormone levels both at basal and after luteinizing hormone-releasing hormone stimulation. These results suggest that hyperplasia or microadenoma of the pituitary gland may occur secondary to gonadal failure, producing enlarged volume or attenuation in the normal contour of the sella turcica. Lack of awareness of reactive pituitary changes secondary to gonadal failure may result in inappropriate surgical management of what may appear to be primary pituitary tumor.


Arthritis of primary biliary cirrhosis.

We describe the clinical and roentgenographic findings in the hands of 13 patients with primary biliary cirrhosis. A nondeforming, generally asymptomatic erosive arthritis was present in 12 of 13 patients. The erosions were asymmetrically distributed and mainly involved the distal small joints of the hands. Seven patients had osteopenia due to hepatic osteodystrophy. Intraosseous lytic defects were present in three patients, chondrocalcinosis in two patients, and hypertrophic osteoarthropathy in one patient. We discuss the importance of the clinical and roentgenographic features of the arthritis of primary biliary cirrhosis.


Tuberculous pericarditis.

Tuberculous pericarditis is a rare but dangerous disease with a mortality of 20% to 40%. Early diagnosis and institution of appropriate therapy are critical, and open pericardial biopsy appears to be the most reliable diagnostic tool. Corticosteroids, in conjunction with antituberculous medication, are effective in suppressing the early granulomatous inflammatory response. Pericardiectomy should be considered early when the response to a medical regimen is delayed or inadequate.


Abdominal paracentesis for malignant ascites.

Abdominal paracentesis for malignant ascites may be performed safely for several hours by insertion of a plastic tube through an intracatheter needle. The system is closed and sterile for up to 9 liters of drainage.


Nephrotic syndrome associated with methimazole therapy.

Thionamide drugs are widely used in the management of hyperthyroidism and are infrequently associated with adverse reactions. We report the development of the nephrotic syndrome during methimazole (Tapazole) therapy in a young man with Graves' disease. His proteinuria remitted promptly with discontinuance of the drug, and renal histologic features bore a striking resemblance to the toxic nephrosis induced in animals by the aminonucleoside of puromycin. In view of the histologic similarities, we propose that methimazole acted as a direct glomerular toxin, inducing the nephrotic syndrome in this patient.


Leptomeningeal carcinomatosis with normal CSF features.

We report two cases of leptomeningeal carcinomatosis in which CSF-positive cytologic features were present but other CSF measurements were normal--a most unusual combination. In both cases, the results of the cytologic examination led to substantial therapeutic alterations. Cytologic examination of the CSF should be performed in any case with unexplained CNS symptoms or signs, regardless of the character of the CSF.


Muehrcke's lines of the fingernails.

Paired narrow transverse fingernail lines as described by Muehrcke developed in a 64-year-old woman. This patient had lung cancer and was receiving multiple cytostatic agents. Her serum albumin level was normal when this nail finding was quite prominent. There was no history of a markedly reduced serum albumin level. Accordingly, her nail alterations may represent another example of chemotherapy-induced nail changes.


Procainamide-induced agranulocytosis and thrombocytopenia.

Procainamide therapy has frequently been reported as a cause of agranulocytosis, but severe thrombocytopenia associated with the use of this drug has been noted only once. We report a case of simultaneously occurring agranulocytosis and profound thrombocytopenia in a patient receiving procainamide hydrochloride. Different mechanisms appeared to be responsible for the two cytopenias.


Primary empty sella: a histologic and immunocytologic study.

A primary "empty" sella turcica was found incidentally at autopsy, and the anterior lobe of the pituitary gland was studied with the immunoperoxidase technique. All five adenohypophysial cell types, ie, somatotrophs, lactotrophs, corticotrophs, thyrotrophs, and gonadotrophs (containing follicle-stimulating hormone [FSH] and luteinizing hormone [LH], were present in adequate numbers and were well granulated, indicating normal hormone storage.


Assessment of severity of mitral stenosis by echocardiographic leaflet separation.

Mitral valve area (MVA) determined at cardiac catheterization was compared with M mode echocardiographic measurements in 44 patients with mitral stenosis and no substantial mitral regurgitation. Despite statistically significant correlations, measurements of anterior leaflet motion, including rate of diastolic closure (EF slope) were not useful in predicting severity of stenosis. In contrast, maximal diastolic separation of anterior and posterior leaflets (SEP) was more closely correlated with MVA and appears to have some predictive value. Narrow separation was associated with severe mitral stenosis. Wide separation was associated with relatively mild stenosis. Intermediate values in 16 of 44 patients (36%) were not of predictive value. Recognizing this limitation, measurement of maximal diastolic mitral leaflet separation from M mode echocardiograms is proposed as a simple and useful method for assessing severity of mitral stenosis.


Pericarditis: differential diagnostic considerations.

A retrospective analysis of 133 patients was performed to define the factors identifying those individuals at risk for the more serious causes of pericardial disease. In 90% of the cases, the initial assessment from data obtained without pericardiocentesis or pericardiectomy proved correct. Underlying tuberculous or maligant pericarditis were the most common sources of error on initial assessment. Hemodynamic compromise exclusive of anticoagulants, roentgenographic cardiomegaly, pleural effusion, low voltage on ECG, and large pericardial effusion by echocardiography were more common (P less than .05) in tuberculous pericarditis than in acute idiopathic pericarditis. We discuss similar risk factors in patients with chronic idiopathic, rheumatologic, and uremic pericarditis. Anterior pericardiectomy is favored as the diagnostic procedure of choice in patients at risk for the more serious causes of pericarditis because of greater safety, diagnostic sensitivity, and potential therapeutic benefit.


Intravenous antibiotic therapy at home.

Many patients who are hospitalized for intensive intravenous (IV) antibiotic therapy of serious infections are not disabled. Following a short period of treatment in the hospital and after their medical problem has stabilized, these patients can safety receive IV antibiotics at home. Patients who had osteomyelitis or infective endocarditis were selected for this study. Utilizing an IV nurse team, patients were instructed in the administration of the antibiotic. They returned to the hospital every 48 hours to have their IV catheter changed and to receive a new supply of antibiotic. There was a substantial monetary saving with each treatment course (at least $1,600 per patient), and, in addition, the patients were much more comfortable at home and some returned to work or to school.


Thermoregulatory failure secondary to acute illness: complications and treatment.

We report on six patients in whom hypothermia secondary to acute illnesses, including pneumonia, congestive heart failure, renal failure, drug overdose, and hypoglycemia, developed. Complications that occurred were metabolic acidosis in six patients, altered sensorium in five, bradyarrhythmia in three, and hyperamylasemia in two. All patients failed to demonstrate a shivering response and represent cases of acute thermoregulatory failure. Five of the six patients survived. In the course of treatment, the choice of active or passive rewarming should be based on whether or not normal thermoregulatory mechanisms are intact.


Control of refractory cardiac arrhythmias with amiodarone.

Amiodarone hydrochloride was used to treat 19 patients with symptomatic arrhythmias refractory to quinidine sulfate, procainamide hydrochloride, disopyramide phosphate, antazoline hydrochloride, lidocaine hydrochloride, bretylium tosylate, propranolol hydrochloride, phenytoin sodium, and practotol acetanilide given to the limit of tolerance. In 17 patients, attacks were completely controlled. Arrhythmias treated successfully included recurrent supraventricular tachycardias, recurrent supraventricular tachycardias with Wolff-Parkinson-White syndrome, and refractory ventricular arrhythmias including recurrent ventricular tachycardia and ventricular fibrillation complicating acute coronary heart disease. Control was confirmed by continuous ECG monitoring both in the hospital and when ambulatory and was maintained for up to four years. Attacks of supraventricular tachycardia were reduced from 7.9/mo to one attack every 53.5 months on amiodarone. Hospital admissions for arrhythmias were reduced from 34 the year before treatment to none the year after. Therefore, amiodarone is an excellent drug for control of many refractory arrhythmias, but two patients with recurrent atrial fibrillation were refractory to this treatment.


Moderate alcohol dose and chronic obstructive pulmonary disease: not a cause of hypoventilation.

Six patients with chronic obstructive pulmonary disease (COPD) (forced expiratory volume in one second, 1.01 +/- 0.08 L [mean +/- SEM] ) were given either 1 mL of 100% alcohol per kilogram of body weight in an aqueous solution or a similar volume of water in a crossover design on consecutive days. All subjects became intoxicated and the peak alcohol concentration was 137 +/- 11 mg/dL, 40 minutes after ingestion. No significant difference was found in either PaO2 or PaCO2 between the alcohol and control period. A significant decrease in arterial pH occurred following alcohol (P less than .05), and represented a mild metabolic acidosis. Alcohol ingestion resulted in an increase in oxygen consumption (P less than .05) and carbon dioxide production (P less than .05) but no change in respiratory rate. It appears that small to moderate amounts of alcohol will not cause marked changes in oxygen tension or alveolar hypoventilation in patients with severe COPD who do not have marked hypercapnia. Nevertheless, other effects of alcohol on the cardiopulmonary system and the concomitant use of sedatives have to be considered before condoning the use of alcohol.


Acute renal failure in Rocky Mountain spotted fever.

Review of clinical and pathologic data from ten fatal cases of Rocky Mountain spotted fever (RMSF) revealed the importance of acute renal failure in the clinical course and of multifocal perivascular interstitial nephritis as the principal pathologic lesion. In nine cases, Rickettsia rickettsii were demonstrated by immunofluorescence in the areas of vasculitis. Evidence was lacking for the role of disseminated intravascular coagulation, glomerulonephritis, or myoglobinuria in the pathogenesis of acute renal failure in these cases. Rickettsia-induced vascular injury led to acute renal failure by several mechanisms. Hypovolemia early in the course resulted in reversible, prerenal azotemia. Transient hypotension in midcourse produced acute tubular necrosis. In fulminant cases, preterminal circulatory collapse was associated with coma and oliguria. The interstitial nephritis could not be demonstrated conclusively to contribute to the acute renal failure.


Polymyositis complicating pregnancy.

Reports of dermatomyositis and polymyositis during pregnancy are rare, there being only one previously published case that we know of in the literature. We report a case in which severe polymyositis developed during pregnancy and the patient experienced dramatic improvement following delivery. Since there is evidence that polymyositis is an immune-mediated disease, one has to speculate that the fetus and its complement of foreign antigens might have played a role in the patient's disease.


Pseudo atrioventricular block.

Pseudo first- and second-degree atrioventricular (AV) block can occur due to depressive effects of concealed junctional discharges on AV conduction of sinus impulses. Pseudo AV block is not indicative of a primary impairment of AV conduction and is reversible by interventions that suppress ectopy.


Vipoma of the pancreas: observations on the diarhrhea and circulatory disturbances.

A patient with a vipoma of the pancreas and persistently elevated blood levels of vasoactive intestinal polypeptide (VIP) had watery diarrhea, hypokalemia, and achlorhydria (WDHA syndrome). In the untreated state, the diarrhea was never profuse. Fecal volumes ranged from 0.16 to 1.24 L/day. Attempts to correct the dehydration by fluid and electrolyte loading resulted in a massive increase in fecal water and electrolyte loss. Prednisone cured the diarrhea and was associated with a decrease in plasma VIP levels. The patient had a marked circulatory disturbance with systemic arterial hypotension and cutaneous vasodilation that caused a subnormal body temperature. Removal of the tumor led to a dramatic change in the patient's circulation. Generalized vasodilation with systemic venous and arterial hypotension gave away to vasoconstriction with severe venous and arterial hypertension. Central venous pressure rose from -4.4 to +4.0 cm H2O and arterial pressure rose from 80/55 to 195/110 mm Hg. These changes might explain the unexpected and sometimes fatal heart failure that has complicated the removal of these tumors from some patients.


Hypothalamic-hypopituitarism due to temporal arteritis.

Hypothalamic hypopituitarism developed in a 74-year-old woman who was in the active phase of temporal arteritis. Hypopituitarism was established by low basal gonadotrophin, thyroxine, and thyroid-stimulating hormone levels. The failure of growth hormone and prolactin to respond to insulin hypoglycemia and an inadequate prolactin response to the administration of chlorpromazine provided further evidence of hypopituitarism. The hypothalamic origin of the hypopituitarism was suggested by quantitatively normal prolactin and gonadotrophin responses to the administration of gonadorelin (gonadotrophin-releasing hormone) and protirelin (thyrotrophin-releasing hormones). Despite the frequency of other intracranial neurological lesions, injury to the hypothalamus and pituitary gland is rare in temporal arteritis. This apparent protection may be due to the abundant blood supply to the hypothalamic-pituitary region.


Diagnosis of miliary tuberculosis by cerebral computerized tomography.

We report a case of miliary tuberculosis with symptoms and signs of an intracranial mass. These were found to be multiple tuberculomas by computerized axial tomography (CT scan). We review the pathophysiologic features of intracranial tuberculomas. The CT scan allows a rapid and sensitive diagnosis of intracranial tuberculosis without utilizing invasive neurodiagnostic techniques. The value of using CT scans following treatment was confirmed.


Tamoxifen in advanced male breast cancer.

A 47-year-old man with metastatic carcinoma of the breast was found to have positive estrogen and progesterone receptors but refused castration or estrogens. After failing on combination chemotherapy he was started on tamoxifen, which resulted in a partial response lasting seven months. He relapsed in bone and then consented to orchiectomy, which resulted in further clinical improvement. Thus, the tamoxifen did not preclude further hormonal therapy. This case, added to others reported, suggests that tamoxifen may be useful in the treatment of advanced male breast cancer. Further studies are needed to determine the level of activity, when to use the drug, and the predictive value of hormone receptors.


Erythema annulare centrifugum and Hodgkin's disease: association with disease activity.

The skin lesions of erythema annulare centrifugum developed in a 58-year-old woman who had Hodgkin's disease. Response of the neoplasm to vinblastine sulfate was accompanied by disappearance of the skin lesions. When therapy was discontinued, both disorders recurred, and both responded to reinstitution of vinblastine therapy. To our knowledge, this case is the first reported association of erythema annulare centrifugum and Hodgkin's disease. The cutaneous manifestation in this patient were a nonneoplastic concomitant of her neoplastic disorder.


Blindness and reliability in lifetime psychiatric diagnosis.

Confidence in the assignment of lifetime psychiatric diagnosis is of great importance to genetic studies of psychiatric illness. To establish the credibility of a lifetime psychiatric history obtained via a structured interview, two paradigms were constructed to estimate reproducibility of the interview recording process. The first paradigm, simultaneous coding, was used to test comparability of four interviewers independently coding an interview form. Low variance/high reliability was demonstrated. The second paradigm, test-retest, provided for each subject to be interviewed twice, with a mean interim time of 6.7 months (SEM = .39). This paradigm demonstrated high reproducibility of psychiatric diagnosis over time. The overall k value for measurement of diagnostic agreement was .79. Only the diagnostic category of minor depression seemed to evade reliability. It was shown across both paradigms that an interviewer need not be blind (naive to previously held diagnosis) to obtain an unbiased interview. However, it is still recommended that the diagnosis of each interview should be determined by an independent diagnostician.


Extreme MMPI scores and the Research Diagnostic Criteria. Screening college men for psychopathology.

This study compares psychiatric evaluations made with the Minnesota Multiphasic Personality inventory (MMPI) to evaluations with a standard clinical interview and the Research Diagnostic Criteria (RDC). The purpose was to generate a nonhospitalized, previously undiagnosed sample of persons who had psychiatric difficulties or symptoms. Of 385 college male volunteers, 56 with scores at least 3 SD above the mean on at least one MMPI scale were chosen as an index group, and 27, with all MMPI scores within normal limits, as a control group. In the index group, 82% met the RDC for at least one diagnosis, whereas only 22% of the control sample met the RDC for any diagnosis. One index subject met the RDC for schizophrenia; 15 met the RDC for a major affective disorder. Some correspondence between specific MMPI profile code types and RDC diagnoses was evident. Thus, researchers can identify a range of psychopathology meeting the RDC by using MMPI screening in a nonhospital setting. Such a research sample, free from the possible artifacts of hospitalization, drug treatment, and diagnostic labeling, can be useful particularly in testing hypotheses concerning the biological correlates of psychopathology.


Systems of care and treatment outcomes for alcoholic patients.

All admissions to the Singer Mental Health Center, Rockford, Ill, with a diagnosis of alcoholism in a one-year period (N = 466) were randomly assigned to one of two inpatient programs. One program, "intensive incare," had a high staff-patient ratio with the operating assumption that intensive staff-patient interaction is significant in patient outcome. The other, "peer-oriented incare," was of low staff density with the assumption that patient-patient interaction is critical in rehabilitation. In addition, the patients resided in communities with outpatient services classified as either "network" (an organized set of community services) or "no-network" (no special funding or deliberate outreach effort). Thus, each patient could be treated in one of four systems of care. Data on treatment outcomes were collected via semistructured interviews at 3, 6, 12, and 18 months after admission. The "peer-oriented incare" system showed superiority to the "intensive incare" treatment approach in improved drinking behavior. There were no other significant differences among the four systems on the outcome criteria for alcoholic patients. Along with other recent studies, these findings have implications for policy planning, particularly with today's emphasis on cost effectiveness.


Rapid cycling in manic-depressives induced by tricyclic antidepressants.

Maintenance tricyclic antidepressants induced rapid cycling between mania and depression in five female bipolar (manic-depressive) patients. Lithium carbonate did not prevent the tricyclic-induced rapid cycling, although two patients subsequently responded well to lithium carbonate alone. In these patients, the action of tricyclics can be conceptualized as accelerating rather than counteracting the natural, cyclic course of the illness in all of its phases. In this respect, tricyclics are analogous to several other drugs that are capable of modulating the frequency of oscillatory biological processes.


Clomipramine-induced mania in unipolar depression.

Manic behavior during randomly assigned treatment with clomipramine (chlorimipramine) or amitriptyline hydrochloride developed in seven of 50 hospitalized unipolar depressed patients. Six of the 25 clomipramine-treated patients became manic. Only one patient in the amitriptyline-treated group developed manic behavior. The switch into mania occurred at the mean age of 63, much later than the reported age of risk for mania. Significant correlations were observed between the age at onset of mania, the number of days of clomipramine treatment, and the duration of the manic episode. We hypothesize that such a switch into mania in unipolar patients is triggered by the psychopharmacological effect of clomipramine through an alleged change in activity of the central dopamine and serotonin systems.


Human endothelial cells in culture.

Daily changes of cultured endothelial cells were observed by phase contrast microscopy, time-lapse microcinematography and electron microscopy. By light microscopy, the cultured cells are polygonal in shape and form monolayered clusters. However, they become elongated like fibroblasts between 10 and 14 days. Proliferation of the cultured cells by mitotic division could not be recognized by cinematographic observation. On the contrary, many binucleate cells occurred in the periphery of the cluster throughout the proliferation period, suggesting that the cells proliferate here, at least predominantly, by amitotic division. By electron microscopy, specific endothelial granules and two types of filaments (about 120 A and 65 A in diameter) were observed in the cultured endothelial cells. The combined cinematographic and electron microscopic observations suggested that the thiner filaments may be contractile elements involved in the movement of the cultured cells.


Electron microscopic study of macrophages appearing in a stab wound of the brain of rats following intravenous injection of carbon particles.

Colloidal carbon was introduced intravenously into young rats to label circulating monocytes before the stabbing of the brain. The rats were sacrificed 1 to 14 days after the stab wound. In the rats sacrificed between 3 to 7 days after the stabbing, numerous phagocytic cells were present in the needle wound. Electron microscope study showed that some of these phagocytic cells carried intracytoplasmic carbon particles. These carbon-labelled cells showed features either of a monocyte, full-blown macrophages, or typical microglia. It is believed that they are all derived from circulating monocytes which have ingested carbon particles in circulation and thereafter invaded the stab wound.