Thermographic screening for breast cancer in a gynecologic practice.

In the course of their practice 2 gynecologists have conducted a program of screening for breast cancer in 1538 patients ages 35-49 years and on 1102 patients ages 50 or older. The screening protocol of breast examinations, thermography, and selective mammography is described. Twenty-four (9/1000) breast cancers were found, 12 in each age group. Eight of these (3/1000) were clinically occult (6 in the younger age group, 4/1000) and were detected by abnormal thermograms followed by mammography. Of the 12 cancers in the 35-49-year-old age group, 6 were discovered at the first screening, and the other 6 by thermographic changes at intervals of 6-24 months. Thermographic screening is more accurate than breast examination alone, but less accurate than if mammography is included. However, since routine annual use of the latter in younger women still raises concerns about x-ray dosage, thermography is a valuable adjunct to physical examination alone. When it is abnormal, mammography is indicated. The 3 complementary methods can reveal about 9 of 10 preclinical cancers in young women.


Topical 5-fluorouracil in the treatment of intraepithelial neoplasia of the vagina.

Twelve patients with vaginal intraepithelial neoplasia received topical therapy with 5% 5-fluorouracil cream. Six patients had carcinoma in situ, 5 had moderate dysplasia, and 1 had mild dysplasia. Five patients responded to 1 treatment course. Six patients required 2, and 1 patient required 3 courses of therapy to respond. Three patients developed recurrent vaginal intraepithelial neoplasia 11-16 months after therapy and were retreated with topical 5-fluorouracil. Vaginal irritation occurred in all patients but was limited to the duration of the treatment course.


Ovarian remnant syndrome.

The ovarian remnant syndrome is one of the least recognized and least discussed complications of oophorectomy. The most common presentation is pelvic pain with a pelvic mass. To prevent the condition, the ureters should be mobilized and laterally displaced during oophorectomy, and the pelvic side wall and cul-de-sac peritoneum should be excised when the ovary is adherent to these areas as a result of endometriosis or inflammation.


Minilaparotomy for female sterilization.

Minilaparotomy, as described in this report, is surgical entry into the lower abdominal cavity through a small transverse suprapubic incision, for the purpose of tubal ligation. The 200 operations reported were performed under local anesthesia in a free-standing office surgical unit. For most women requesting sterilization, minilaparotomy is a highly satisfactory approach. For patients with fixed uterine retroversion, enlarged uteri, or suspected adnexal disease, open laparoscopy under local anesthesia is preferable. The standard Pomeroy technique was used in all cases. Analysis of a follow-up minilaparotomy questionnaire indicates a high degree of patient satisfaction. No subsequent pregnancies have been reported by these patients, but since no patient in this series has been followed for more than 2 years, no conclusion as to long-term failure rate may be made.


Luteal deficiency among women with normal menstrual cycles, requesting reversal of tubal sterilization.

Forty women with normal menstrual cycles who had been sterilized by tubal ligation or electrocoagulation requested tubal reconstruction. As part of their preoperative evaluation, progesterone measurements were obtained in the midluteal phase (5-10 days before the next menstrual period). This group of women had a significantly lower (P less than 0.005) mean midluteal progesterone level (9.4 +/- 4.7 ng/ml) than a control group of 24 women with infertile male partners attending the same clinic (17.4 +/- 7.1 ng/ml). In 25 (62%) of the sterilized women, progesterone levels were less than 10 ng/ml, whereas in the control group such low values were found in only 4 (17%) of the women. Thus, reduced midluteal serum progesterone concentration appears more common among women with prior tubal ligation or electrocoagulation than among a control population of apparently normal women.


Cefoxitin: single-agent treatment of mixed aerobic-anaerobic pelvic infections.

Cefoxitin (mefoxin), a new semisynthetic cephamycin antibiotic, resistant to degradation by beta-lactamase enzymes produced by bacteria. In vitro, cefoxitin is active against virtually all clinically important gram-negative facultative bacteria other than Pseudomonas and Enterobacter spp., gram-positive aerobic bacteria other than the enterococcus, and clinically important anaerobic organisms, including Bacteroides fragilis. This broad antibacterial spectrum suggested that cefoxitin might be an effective single antibiotic agent for the treatment of mixed aerobic-anaerobic infections in obstetric and gynecologic patients. In this investigation, the efficacy and safety of cefoxitin was evaluated in 109 patients--68 with salpingitis, 25 with endomyometritis, 9 with pelvic cellulitis, and 7 with pelvic abscesses. An average of 2.5 bacteria were isolated from each patient. Aerobic bacteria alone was isolated in 38% of patients, anaerobic bacteria alone in 25%, and a combination of aerobic and anaerobic bacteria was isolated in 37% of patients. Overall, 100 of 109 (92%) infections responded to treatment with cefoxitin alone. The major cause of treatment failure was the presence of abscesses requiring surgical drainage. In addition to being an effective single agent for the management of pelvic infections, cefoxitin proved to be safe and well tolerated by patients.


Semiquantitative use of Biocept-G radioreceptorassay.

Serum samples (93 total) from 62 different patients were analyzed by quantitative radioimmunoassay (RIA) and by the Biocept-G radioreceptorassay (RRA) for detection of human chorionic gonadotropin (hCG). The ratio of sample counts to reference control counts (S/R) was determined for each RRA. For the 44 serum samples having S/R ratios between 0.295 and 1.20 (corresponding to hCG levels of 4600 and 89 mIU/ml, respectively), there was good correlation between the S/R ratio by RRA and the serum level of hCG by RIA (correlation coefficient = -0.92). When serum samples were analyzed in as many as 4 different Biocept-G kits, the same S/R ratios were obtained. The S/R ratio reliably predicted the trend in serum hCG titer in 7 patients during treatment for gestational trophoblastic disease. The usefulness of the S/R ratio in obtaining semiquantitative results with the Biocept-G RRA is discussed.


Human placental lactogen: a predictor of perinatal outcome?

Serial human placental lactogen (hPL) determinations were performed on 806 women with normal and abnormal pregnancies late in the pregnancy. These results were not reported to the clinicians involved. For the study population as a whole, low hPL levels did not effectively predict those adverse perinatal outcome variables evaluated. Further analysis revealed that this was true both for the normal and abnormal pregnancy groups. Our data do not support the routine use of antepartum hPL screening, as advocated by others, as a means of improving perinatal outcome. In certain at-risk patients, there was an association between low hPL values and the presence of 1 or more of the adverse outcome variables. However, these patients had been recognized clinically as having fetuses in jeopardy.


Patterns of intrauterine growth retardation.

A prospective study of 70 singleton pregnancies at high risk for intrauterine growth retardation (IUGR) was undertaken to determine 1) the differences in intrauterine growth patterns; 2) the diagnostic accuracy of obstetric techniques; and 3) the frequencies of perinatal complications. Thirty infants displayed signs of IUGR. Although only 14 infants had low birth weights, these 14, as well as the remaining 16 infants under study, displayed many other features of growth abnormalities, including a low ponderal index, short stature, and small head circumference. These data demonstrate various patterns of IUGR. Although the perinatal complications occurred primarily in the low-birth-weight group, the major growth abnormalities observed in the non-low-birth-weight group demonstrate the need for additional short- and long-term follow-up studies in both groups.


Predictability of gestational hypertension.

Eighty-five women at 28-36 weeks' gestation were studied prospectively in a clinical research center to assess a "roll over test" (RT) based on the original study by Gant et al. Patients were admitted to the hospital, placed on bed rest, and given a balanced diet. The test started 12 hours after admission. Blood pressure was measured every 10 minutes for an hour with the patient in the left lateral position, and then in the supine position for a second hour. The mean diastolic blood pressure was calculated in each position and the patients were sorted into 6 groups based on the magnitude of change in blood pressure. Seventeen patients developed gestational hypertension (GH). Only 3 of 20 (15%) patients with a positive RT developed GH, while 14 of 65 (22%) patients with a negative RT developed GH. Five of 12 patients who had an actual decrease in mean diastolic blood pressure also developed GH.


The use of amniocentesis in patients with premature rupture of membranes.

A prospective study was conducted to evaluate the usefulness of amniocentesis in patients with premature rupture of membranes (PROM) for the prediction of occult or impending intrauterine infection and the assessment of fetal maturity. Fifty-nine patients with PROM between 28 and 35 weeks' gestation, without apparent infection, were evaluated sonographically for possible amniocentesis. Thirty patients had successful amniocenteses for a success rate of 51%. Fifteen patients had a mature lecithin/sphingomyelin (L/S) ratio and were delivered immediately without respiratory distress syndrome (RDS) or other neonatal complications. All amniotic fluids were evaluated by Gram stains and cultures. Nine of the 30 patients had positive cultures, with a high incidence of subsequent development of amnionitis and other infectious morbidity. In the 21 patients with negative cultures, there were 19 without any infectious morbidity. Amniocentesis appears in this study to be a useful method for selecting the patients who have mature fetuses and/or who are more likely to develop amnionitis.


Early diagnosis of placenta previa.

Ultrasound was used as a diagnostic tool in 859 patients for the localization of the placenta in the second trimester prior to genetic amniocentesis. A greater incidence of total placenta previa was found in the study group (5.6%) than is reported for the general population (0.25-0.5%). Maternal age greater than 35 years was the indication or co-factor in 59% of the patients studied, which might explain this difference. It was possible to predict total placenta previa at term early in the second trimester. It was demonstrated that if a placenta was located centrally over the cervical os and did not change position with variations in the degree of bladder-filling or changes in uterine position, the risk of having a total placenta previa at term increased from 1/143 to 1/8 pregnancies.


Positive rubella titers in pregnancy: a question of validity.

A review of 25 patients with more than 1 rubella titer by hemagglutination-inhibition testing revealed 3 patients with high positive titers that were reported to be negative in subsequent pregnancies. None of the patients had received the rubella vaccine. Because the sensitivity and reliability of hemagglutination-inhibition testing is markedly influenced by multiple variables, it is important for both the clinician and the pathologist to be aware of both the limitations of the testing method and the meaning of an antibody titer on a single isolated specimen.


A Simplified antepartum risk-scoring system.

The effectiveness of a simple antepartum risk-scoring system was evaluated in 2085 consecutive deliveries. Neonatal morbidity was observed in 42.1% of infants of mothers classified as high risk (score greater than or equal to 7) compared to 12.5% of infants of mothers classified as low risk (score less than 7). No neonatal deaths were observed in the low-risk group, compared with 34 in the high-risk group (P less than 0.001). Of all perinatal deaths, 88.6% occurred in the high-risk group. The perinatal mortality rates for low- and high-risk pregnancies were 7.2 and 63.3, respectively, per 1000 live births.


Ileus of the colon with cecal dilatation and perforation.

Segmental dilatation of the colon without obstruction is an unusual but recognizable entity, distinct from mechanical obstruction and paralytic ileus. Cases of ileus of the colon with cecal dilatation following delivery and gynecologic surgery are collected from the literature, and 3 recent cases are presented: 1 following cesarean section and 2 following abdominal hysterectomy. The etiology of this condition is still obscure and the clinical features are deceptive. The occurrence of this entity in obstetric and gynecologic patients is by no means a rarity and warrants a familiarity with and early recognition of this entity on the part of the physician in order to avoid serious sequelae.


Acute pancreatitis and hyperparathyroidism in pregnancy.

A case of acute pancreatitis associated with hyperparathyroidism in the third trimester of pregnancy is summarized, and the clinical findings are discussed. Emphasis is placed on recognition of pancreatitis and its etiology in the third trimester of pregnancy. The surgical approach to the parathyroid pathology is analyzed and its advantages espoused.


Evaluation of fetal monitoring by telemetry.

A radiotelemetry system for the direct monitoring of fetal heart rate and intrauterine pressure during labor has been evaluated at 5 different institutions. A conventional fetal scalp electrode and a special intrauterine pressure sensor are connected to a radio transmitter placed on the patient's thigh. The receiver can be located up to 50 feet away from the transmitter and is either a self-contained monitor or a unit that converts a conventional fetal monitor to a telemetric one. The telemetry recordings are of similar quality to those obtained from conventional monitors. Telemetry allows for greater patient comfort and mobility as well as greater convenience to the clinical staff. Continuous data can be obtained from patients while they are ambulatory or sitting in a chair as well as while they are in bed.


Vaginal vault prolapse with eversion.

The successful treatment of vaginal vault prolapse with eversion continues to be an enigma to surgeons. The many surgical procedures that have been proposed testify to the fact that no single reliable procedure has been developed. The vaginal operation of posterior pelvic shelf colpopexy described in this report represents an evolution of ideas drawn from other surgeons coupled with the author's personal experience. The concept of creating a high, posterior pelvic shelf for vaginal vault fixation is developed, and the surgical technique is discussed in detail.


The Kevorkian curette. An appraisal of its effectiveness in endometrial evaluation.

Office endometrial biopsy with the Kevorkian curette was performed in 400 patients presenting with abnormal uterine bleeding or other endometrial cancer-risk indicators. The use of this instrument has proved to be a safe, simple, inexpensive, and highly reliable outpatient procedure with excellent patient acceptance. It has provided tissue for adequate diagnosis in 91.8% of the cases, and the diagnostic accuracy when controlled by D&C and/or total abdominal hysterectomy (TAH) was 96.2%. As a result, 73.5% of the women required no further surgical procedures for either diagnostic or therapeutic purposes. In the postmenopausal age group, adenocarcinoma was diagnosed in 7 of 177 (3.9%) women. This procedure is highly recommended for early office diagnosis of uterine pathology and, in particular, endometrial adenocarcinoma and its presumed precursor lesion, adenomatous hyperplasia.


Variations in the level of haematogenous antitumour immunity during progressive tumour growth and spontaneous blood-borne metastatic spread.

Inbred DBA2 mice bearing the syngeneic 1699 mammary tumour in the hind limb were challenged intravenously with 125IUdR-labelled single 1699 cell suspensions, and the amount of radioactivity in the lungs compared 20--24 h later with that in the lungs of normal mice or in those of mice bearing the antigenically unrelated syngeneic SaD2 tumour. An immunologically specific decrease in radioactivity was evident at variable periods of time after tumour induction, depending on the number of cells used to induce the leg tumours, but fell below that in normal mice as the leg tumours progressed beyond a weight of approximately 1 g. As assessed by microscopic scanning of serial histological sections of the same lungs the incidence of spontaneous metastases rose to between 80 and 100% immediately the amount of cell loss from the lungs of the tumour-bearing mice reached that of the normal controls. This extremely rapid series of events does not allow a definitive conclusion as to whether immunity failed and led to metastatic spread or vice versa, but does underline the strong association of immunity with the blood-borne dissemination of tumour cells in this tumour system. Following excision of tumours, in no instance was immunity detected 14 days later, and in a single experiment did not reach detectable limits until 25 days after excision, at a time when the lung metastases were observed mostly to have regressed spontaneously.


Comparative study on drug sensitivity of the TA3/Ha and TA3/St tumor sublines.

TA3/Ha and TA3/St sublines differ from each other in some characteristics, like malignancy, survival time and drug sensitivity. TA3/St exhibited a peculiar response to the Vinca derivatives examined.


Bone scintigrams: their clinical usefulness in patients with breast carcinoma.

A comparison of bone scintigrams and roentgenographic skeletal surveys, obtained on 170 patients with breast carcinoma, was made to evaluate the diagnostic efficacy of these techniques in detecting metastatic bone lesions. The bone scans were abnormal in 81 patients, while the roentgenograms were abnormal in only 51. In 34 of the 81 (42%) patients with abnormal bone scans, there was no radiographic evidence of a benign lesion to account for the increased ratiotracer uptake; and the abnormalities noted on the bone scans were proven to be bony metastases on follow-up examinations. In the remaining 47 patients with positive bone scintigrams, both the scans and the roentgenograms were abnormal; however, in 23 patients the bone scan demonstrated significantly more lesions than what the roentgenograms had revealed. This study confirms that bone scan is superior to roentgen surveys in detecting skeletal metastases in patients with breast carcinoma. It was noted that the metastatic lesions can be visualized on the scans earlier than they are apparent on the X-rays by a mean interval of 4 months.


[Cell cycles in the early embryogenesis of the peled].

The dynamics of cell cycles in early embryogenesis of the peled has been studied using various methofs: determination of mitotic and mitotic phase index, of cell doubling time and of coefficient of asynchrony. The desynchronization of divisions begins at the V division after the longitudinal furrow has passed and is completed after the beginning of the cell cycle lengthening. The animal-vegetative gradient in the distribution of mitotic phases is observed at the early stages of desynchronization. The lengthening of cell cycle begins in interphase of the XI-XII cleavage and markedly accelerates from the interphase of the XII-XIII cleavage on. The methods of analysis of the cell cycles in early embryogenesis and possible factors influencing the dynamics of desynchronization are discussed.


[Morphology of the microtubule system in mouse kidney epithelial cells].

The cultured mouse kidney cells forming epithelial sheets were studied using an indirect immunofluorescence microscopy with antibodies against tubulin. These cells, as well as fibroblasts, were found to contain a well developed microtubular system sensitive to colcemid. The assembly of microtubules after washing out of colcemid began from one or two perinuclear centers, associated with the cilium-like structure. There were certain differences between the microtubular systems in epithelial cells and fibroblasts: 1) Microtubules in the fibroblasts penetrated the whole cytoplasm including the peripheral lamella whereas in the epithelial cells the lamellar cytoplasm was often free from microtubules. 2) The orientation of microtubules in the epithelial cells, unlike in the fibroblasts, was not correlated with the stable or active state of the cell margin. A possible role of microtubular system in the epithelial cells and fibroblasts is compared and discussed.


[Nerve fiber interrelationships with the ependyma of the 3d ventricle in rats in the perinatal period].

The localization and ultrastructure of nerve fibers in the wall and lumen of ventral region of III ventricle was studied from the 16th day of prenatal period till the 9th day of postnatal period in the Wistar rats. The nerve fibers were first found in the subependyme zone; between the ependyme cells and in the lumen of ventricle on the 18th day of development. The nerve fibers occur constantly in the lumen of ventricle beginning from the 3rd day of postnatal period. The dilatations of nerve fibers contain granules of 50 to 90 nm in diameter with the electron-dense center (carriers of monoamines and/or releasing hormonnes) granules with moderately osmiophilic contents and light vesicles of the same size. It is suggested that these structures reflect different stages of the release of neurohormones in the cerebrospinal fluid. The synapse-like contacts of nerve fibers with the ependyme cells are observed beginning from the 3rd day of postnatal period. Their role in the regulation of absorption of substances by the ependyme cells functioning is discussed.


[Oxidative phosphorylation in the intact and regenerating liver from a chronobiological viewpoint].

The dynamics of oxidative phosphorylation of the regenerating liver mitochondria on the endogenous and exogenous (glutamate, succinate, ascorbate) substrates in comparison with the normal diurnal and seasonal changes of this process was studied by the polarographical method. With the increase of its activity reflecting the deviation from the state of physiological rest (intact liver in spring, autumn, winter; regenerating liver), the range and synphasing of the oxidative phosphorylation indices were decreased, their bimodal distributions were transformed into the monomodal ones down to the full loss of diurnal periodicity. The degree of the process desynchronization depends, thus, directly on the degree of its activity.


[Cytochemical study of the DNA and histone in the tissues of the lily anther in the course of microsporo- and gametogenesis].

The DNA and histone content in the microsporocytes, microspores, generative and vegetative cells of the pollen grain of Lilium candidum L., as well as in the anther wall tissues, was estimated by double wavelength cytophotometry. The lack of histone, as compared with DNA content, was demonstrated in the microsporocytes at the late premeiotic interphase and early meiotic prophase, as well as in the young microspores and anther wall tissues. The analysis of hydrolysis curves suggests the increase of non-condensed chromatin during endothelial cell differentiation.


[Cortical reaction of the eggs of the mussel, Crenomytilus grayanus].

The extrusion of the contents of cortical granules was found in the places of contact of spermatozoa with the egg surface upon fertilization of the mussel eggs. Not all cortical granules broke down, a great number of them is preserved in the developing embryo cells. The possible mechanism and importance of this phenomenon are discussed.


[Change in the electrophysiological parameters of human oocytes in the process of maturation outside the body].

The dynamics of electrophysiological parameters (membrane potential--MP and resistance--R) of the human oocytes was studied during their in vitro maturation. The relationship was established between the changes of electrophysiological parameters and meiotic phases. The average value of MP of diplotene oocytes was 22.0 +/- 0.3 mV and that of R 2.0 +/- 0.5 mO. The membrane depolarization was observed upon the meiotic reinitiation. The MP of diakinesis--metaphase I oocytes amounted to 10.0 +/- 0.3 mV and R to 10.0 +/- 0.5 mO. At metaphase II the temporary membrane repolarisation was noted in some cases which, in some oocytes, was replaced by the increasing hyperpolarisation on the 2--3rd day of cultivation. The input membrane resistance increased on the 2--3rd day of cultivation.


[Distribution of acid phosphatase in the chicken blastoderm].

The distribution of acid phosphatase in the chick blastoderm (stages 2--4 by HH) has been studied using cytochemistry. A marked increase of enzymatic activity all over the blastoderm was shown to coincide with the beginning of primitive streak formation. A part of the cells after their immigration are characterized by the fall of acid phosphatase activity. The percentage of such cells increases in the cranio-caudal direction of the definitive primitive streak. The patterns of yolk utilization upon the separation of individual embryonic rudiments are discussed.


Techniques in blepharoplasty.

The technique for upper lid blepharoplasty is presented, which emphasizes the creation of a concave, high supratarsal fold by removal of existing preaponeurotic fat pads, excision of a strip of preseptal orbicularis fibers, and portion of the orbital septum. In additon, the skin edges are fixated to the levator aponeurosis just above the tarsus. With this technique, a pleasing result can be obtained, minimizing the amount of skin that is required to excised and introducing a safety factor in the prevention of postoperative lagophthalmos. A skin technique for lower led blepharoplasty is presented which reduces a tendency for "dog-ear" formation with skin closure and minimizes chances of postoperative ectropion. The technique consists of triangulation of the excision of skin from the lower lid to insure an equal-sided wound edge for precise closure and anchoring the lower lid skin flap to the lateral orbital rim. Although the above techniques introduce a safety factor reducing the problem of lagophthalmos in the upper lid and ectropion in the lower lid, they should be considered an "advanced technique" by the occasional blepharoplasty surgeon.


Intracapsular cataract extraction at the time of vitrectomy.

An alternative surgical technique for cataract extraction using an overlapping scleral flap is described for patients in whom removal of the lens is not possible through the pars plana prior to vitrectomy.


Malignant melanoma of the choroid presenting as choroidal detachment following cataract surgery.

The progression of a monocular nuclear cataract was observed for thirty-two months in an eye which was apparently otherwise normal. Three weeks after uncomplicated cataract surgery the patient presented with an apparent detachment of the choroid which enlarged dramatically within a relatively short time and which was further complicated by a retinal detachment. The subsequent development of rubeosis iridis and increased intraocular pressure suggested some other etiology. Ultrasonography revealed a malignant melanoma which was confirmed following enucleation. Transillumination of all suspected postoperative choroidal detachments is recommended with more definitive examination when indicated.


A fiber-optics cyclodialysis spatula.

A cyclodialysis spatula for glaucoma surgery with a fiber-optics bundle incorporated within its thickness is described. The instrument is used as is commonly done at present with the standard cyclodialysis spatula. In addition, the fiber-optics bundle delivers cold light to the tip of the spatula which is useful in helping the surgeon locate the spatula within the sclera and the anterior chamber.


Vitrectomy in experimental endophthalmitis: Part I-Fungal infection.

In studying the dose-related ocular toxicity of amphotericin B in vitrectomized eyes, up to 5 micrograms/0.1 ml concentration of amphotericin C was nontoxic to the ocular structure when injected in the anterior part of the vitreous cavity. Intravitreal injection of 2.5 micrograms of amphotericin B halted fungal endophthalmitis, which was experimentally induced in rabbit eyes, even after 16 days of infection. Combined treatment of vitrectomy and intravitreal injection of amphotericin B not only cured the fungal endophthalmitis but it also cleared the ocular media from opacities.


Vitrectomy in experimental endophthalmitis: Part II--Bacterial endophthalmitis.

Three methods of treatment for Staphylococcus aureus endophthalmitis were compared: subconjunctival injection with intramuscular gentamicin, intravitreal injection with intramuscular gentamicin, and vitrectomy using infusion solution containing gentamicin along with intramuscular gentamicin. Subconjunctival injection with intramuscular gentamicin was not successful in treating infection. Intravitreal injection with intramuscular gentamicin and vitrectomy with intramuscular gentamicin were equally effective in eradicating infection; however, the combination of vitrectomy and intramuscular gentamicin provided clearer vitreous with greater fundus detail.


PHPV in an adult managed by vitrectomy.

Pars plana vitrectomy requiring a two-instrument technique successfully cleared the pupillary axis of dense persistent hyperplastic primary vitreous in a 29-year-old patient. To find PHPV in an adult eye with vision is so unusual that distinguishing it from the ocular sequelae of traumatic injury can be challenging. Hyperplastic primary vitreous persists with a wide variety of clinical features in both anterior and posterior segments of the eye.


Sickled erythrocytes, hyphema, and secondary glaucoma: I. The diagnosis and treatment of sickled erythrocytes in human hyphemas.

Four patients with sickle cell hemoglobinopathies (one SC, three AS) and hyphemas were found to have more erythrocytes sickled in their anterior chambers than in their circulating venous blood. Intraocular pressure was severely elevated, despite relatively small amounts of intracameral blood. Systemic hypotensive agents were not always successful in reducing IOP, and in patients with sickle cell hemoglobinopathy, are probably contraindicated in high or repeated dose regimens. Moderate elevation of IOP in sickle cell hemoglobinopathy patients may produce rapid deterioration of visual function, perhaps because of a greater than usual effect on vascular perfusion in the central retinal artery and optic nerve. Early anterior chamber paracentesis may be the best treatment for this type of hyphema-induced secondary glaucoma.


Sickled erythrocytes, hyphema, and secondary glaucoma: III. Effects of sicle cell and normal human blood samples in rabbit anterior chambers.

When injected into rabbit anterior chambers, human sickle cell erythrocytes cause more intense and prolonged effects than do nonsickling erythrocytes. The consequences of injected sickle cell trait erythrocytes are not less severe than those of injected SC, SS, and Sthal erythrocytes. Regardless of hemoglobin composition, blood with a higher hematocrit value causes more severe complications than blood with a lower hematocrit value.


Sickled erythrocytes, hyphema, and secondary glaucoma: IV. The rate and percentage of sickling of erythrocytes in rabbit aqueous humor, in vitro and in vivo.

The number of erythrocytes adopting the sickled configuration in rabbit aqueous was determined with a masked counting technique in vitro and in vivo. The percentage of cells that became sickled in aqueous humor was greater than that observed in a control salt solution and in the donor blood itself. Aqueous humor, therefore, can be considered a particularly deleterious medium for erythrocytes having a propensity for sickling. Blood samples from six donors with systemically severe hemoglobinopathies (SC, Sthal, and SS) had relatively high levels of hemoglobin S and, in general, showed faster and more frequent sickling than did blood samples from donors with low levels of hemoglobin S (one SS patient, whose chronic blood transfusion regimen had replaced most of his hemoglobin S with normal hemoglobin, and two AS patients). Even erythrocytes from sickle cell trait cases, however, were capable of sickling when immersed in acqueous humor.


Sickled erythrocytes, hyphema, and secondary glaucoma: V. The effect of vitamin C on erythrocyte sickling in aqueous humor.

In vivo incubations of Hgb SC erythrocytes showed significantly more sickling in anterior chambers characterized by high concentrations of ascorbic acid than in anterior chambers with low concentrations of ascorbic acid (normal guinea pigs compared with scorbutic guinea pigs and normal guinea pigs compared with normal rats). Low concentrations of ascorbic acid, however, did not completely eliminate intracameral sickling. Because acetazolamide raises the concentration of aqueous humor ascorbate, it should be used with considerable discretion when treating hyphema and secondary glaucoma caused by sickle cells. Methazolamide may be more desirable.


Composition and evaluation of the efficacy of Staphylococcus aureus vaccine.

An alum-precipitated Staphylococcus aureus vaccine, composed of a formalin-inactivated whole culture of a strain which produces Smith surface antigen and combined with the whole culture of a highly toxigenic strain, was found to afford a good immunity to staphylococcal skin infection in rabbits. Three injections of the vaccine provided immunity which lasted for at least 6 months against a primarily pyogenic strain of S. aureus and for at least 3 months against a toxigenic strain. From experiments using vaccines prepared from cells or toxoid only, it was deduced that, although there is a measure of strain specific immunity, a good heterologous immunity can be established with a combined product provided that it contains adequate quantities of toxoid. The use of such a vaccine as a potential aid in the control of bovine staphylococcal mastitis is discussed.


Aerospora of an Eragrostis curvula pasture in South Africa.

A qualitative and quantitative survey was made of the aerospora above an Eragrostis curvula (Schrad.) Nees pasture. The pasture, which lay adjacent to a field of Panicum coloratum L. where an outbread of ovine photosensitivity had occurred, was not grazed during the survey. A Burkard volumetric spore trap was used to sample the aerospora continuously for 10 months. Twenty components of the aerospora were recognized: spores of 9 genera of fungi (Cladosporium, Alternaria, Epicoccum, Drechslera, Pithomyces chartarum (Berk. & Curt.) M. B. Ellis, Nigrospora, Sporormia, Curvularia, Spegazzinia); 8 recognizable but unidentified spore types; hyphal fragments and pollen grains. Cladosporium conidia comprised 83,37% of the total aerospora. Conidia of Pithomyces chartarum formed a small (0,29%) but significant component of the aerospora, since this fungus is known to cause hepatogenous photosensitivity.


Parasites of domestic and wild animals in South Africa. XII. Artificial transmission of nematodes from blesbok and impala to sheep, goats and cattle.

Sheep were successfully infested artificially with the larvae of Haemonchus contortus, Trichostrongylus axei, Trichostrongylus falculatus and Impalaja nudicollis, cultured from the faeces of blesbok naturally infested with these nematodes. Haemonchus placei, Longistrongylus sabie, Trichostrongylus colubrifomis, T. falculatus, Impalaia tuberculata and Cooperia hungi likewise became established in sheep, goats and calves dosed with larvae cultured from the faeces of infested impala. Sheep and goats could also be infested with Cooperioides hamiltoni and Oesophagostomum columbianum of impala origin, but Cooperioides hepaticae could not be transmitted either to these hosts or to calves.


Parasites of domestic and wild animals in South Africa. XIII. The seasonal incidence of adult ticks (Acarina: Ixodidae) on cattle in the Northern Transvaal.

Ticks were collected over a period of 13 months, at approximately fortnightly intervals, from 6 Africaner oxen kept on the farm Nylsvley in the Naboomspruit District. The 8 species of Ixodidae collected were, in order of abundance, Rhipicephalus appendiculatus, R. evertsi evertsi, Hyalomma marginatum rufipes, H. truncatum, Amblyomma hebraeum, R. simus, Boophilus decoloratus and Ixodes cavipalpus. The relative abundance of adult ticks of these species, their predilection feeding sites and seasonal fluctuations in numbers are discussed.


An electron microscopic study of intra-erythrocytic stages of Babesia bovis in the brain capillaries of infected splenectomized calves.

Splenectomized vaccine donor calves undergoing primary reactions to Babesia bovis infections may develop cerebral babesiosis which leads to death if not treated in time. A brain biopsy was performed on an artificially-infected animal showing nervous symptoms and the tissue was immediately processed for electron microscopic examination. Virtually every erythrocyte in the brain capillaries sectioned was infected with B. bovis. Intra-erythrocytic merozoites, trophozoites and dividing trophozoites were indentified. Important features of the piriform merozoites included a reduced apical complex consisting of the anterior polar ring, microtubules, rhoptries and micronemes. Unidentified membrane-bound bodies, mostly spherical in shape, were observed anterior to the nucleus. The trophozoites showed very little structural differentiation and no food vacuoles or micropores could be detected. Each trophozoite produced 2 identical merozoites and the parent cell became totally incorporated in the daughter merozoites in the multiplication process. Projections were seen radiating from the surface of infected erythrocytes which appeared to adhere to other surfaces on contact. This probably resulted in the sludging of infected erythrocytes in the capillaries. The latter observations coincide with those described for Babesia argentina.


A bioassay method for the pheromone(s) of the bont tick Amblyomma hebraeum Koch.

A bioassay was developed which enabled the detection of the pheromones of the bont tick (Amblyomma hebraeum Koch) within 2 hours with a reproducibility of 82 +/- 13%. Dried, solvent-extracted ticks were glued onto the shaved backs of rabbits. Those ticks to which pheromone extract was subsequently applied strongly attracted females of the same species. In a 2-way choice test a cork disc impregnated with pheromone extract was even more attractive to female ticks than a treated dried tick.


The serological relationship of herpesvirus ovis to other herpesviruses and its possible involvement in the aetiology of jaagsiekte.

Cross-neutralization studies showed that 3 different isolates of herpesvirus ovis from cell cultures derived from the lungs of sheep suffering from jaagsiekte were not only identical but were also related to similar isolate made in Scotland. No relationship, however, could be established between herpesvirus ovis and common bovine or equine herpesviruses. Antibodies to herpesvirus ovis were present in roughly 70% of all animals tested and no evidence was obtained for the involvement of the virus in the aetiology of jaagsiekte. On the other hand, the absence of antibodies in sheep sera from Iceland as well as the other data obtained in this study did not exclude involvement of the virus in jaagsiekte.


Lymph node pathology in Trypanosoma brucei-infected sheep.

The temporal sequence of morphological changes occurring in the prefemoral lymph nodes of sheep experimentally infected with Trypanosoma brucei was studied at weekly intervals during the course of infection. Histopathological changes started with lymphoid stimulation which was soon overtaken and masked by intense proliferation of reticulo-endothelial cells. Reticulo-endothelial proliferation resulted in macrophage accumulation, some vascular damage and lymph stasis, varying from insidious to extensive. Reticulo-endothelial activity subsequently decreased and there was an upsurge of proliferative activity in lymphoid tissue. Lymphoid stimulation resulted in increased numbers of primary follicles with active germinal centres and produced cells primarily lymphoblast/plasmablast in type. The response appeared to involve blast cells of the germinal centres rather than thymus-dependent paracortical areas. Both reticulo-endothelial and lymphoid components exhibited marked cellular necrosis which increased throughout the course of infection. Intense lymphopoiesis was not correlated with lymphocytosis but was associated with lymphopaenia.


Correlation of arthroscopy with other diagnostic modalities.

In our experience arthroscopy proved to be the most reliable method of evaluating internal derangement of the knee. Among 96 patients who underwent arthrotomy, the arthroscopic diagnosis was confirmed in 96 per cent. The combined anteromedial, anterolateral, and posteromedial approaches consistently demonstrated all intraarticular disorders. We found the posterolateral approach of little benefit.


Correlations of arthrography with arthroscopy.

Arthrography and arthroscopy were compared on a prospective basis in 100 consecutive and unselected knees, all in patients who underwent arthrography, arthroscopy, and surgery. Arthroscopy was found to be more accurate than arthrography in the diagnosis of medial and lateral meniscus and anterior cruciate ligament lesions. Because of its easy availability and relatively low cost, arthrography continues to be a useful extension of the physical examination of the knee, serving as a further diagnostic screening technique. However, arthroscopy is recommended in all patients prior to surgery because it provides more complete and more accurate delineation of intra-articular lesions.


Arthroscopic visualization of the posteromedial compartment of the knee joint.

Introduction of the arthroscope in the midline through the patellar tendon about 1 cm. below the apex of the patella is described. The posterior compartments of the knee joint can be examined from this single entry. The technique has been used in 1232 patients without any complications. In 127 patients subjected also to arthrotomy the arthroscopic diagnosis proved to be correct in all instances except for one missed rupture of the posterior cruciate liagment. In that case a bucket handle rupture of the medial meniscus prevented the entry into the posteromedial compartment.


Debris observed by arthroscopy of the knee.

In examination of 732 knee joints through the arthroscope since 1961, various types of debris were observed in 47. The debris was classified into four groups: precipitation of fibrin, degeneration and necrosis of villi, desquamation of articular cartilage, and metaplasia of villi. Diseases of the knee joint and their pathogenesis are discussed in the light of these findings.


A method of arthroscopic surgery. Clinical evaluation of synovectomy with the electric resectoscope and removal of loose bodies in the knee joint.

The structure and function of the electric resectoscope have been discussed and the application to synovectomy and removal of loose bodies in the knee joint. Our clinical results have also been reported. The advantages and problems of synovectomy and arthroscopic surgery with the electric resectoscope as used in the knee joint are discussed, especially in comparison with conventional resection of the anterior two-thirds of the synovial membrane. For intra-articular use in the knee joint the electric resectoscope used for transurethral resection in urology was modified to perform synovectomy and arthroscopic surgery. Clinical folow-up observation indicated that synovectomy performed with the electric resectoscope produced results almost comparable with those of conventional synovectomy. Arthroscopic surgery with the electric resectoscope is a new method. It is performed through a small skin incision with fewer untoward effects. The operation is relatively painless and offers more rapid recovery after surgery. A few complications were noted by this method. None were serious. There were two epsiodes of infection during the early use of this technique.


The effect of high tibial osteotomy on osteoarthritis of the knee. An arthroscopic study of 54 knee joints.

1. Arthroscopic findings in repair of articular surfaces and the operation's effect on healthy components made it clear that the ideal correction method is to align the mechanical axis to pass through a point 30 to 40 per cent lateral to the midpoint. 2. If ideal correction was obtained, it was observed by arthroscopy that repair of the ulcerated region was initiated by the surviving cartilage in the affected area and the cartilage bordering the affected area. 3. About one and one-half to two years after osteotomy it was observed that the ulcerated region was thoroughly covered with fibrous and membranous tissue. 4. In some cases in which correction was ideal, repair of the ruptured meniscus was observed arthroscopically.


Arthroscopy in spontaneous osteonecrosis of the knee.

Eight knees with spontaneous osteonecrosis were investigated through arthroscopy, and in seven the intra-articular findings were rechecked at arthrotomy performed one to two weeks later. Anbormalities in the articular cartilage were observed in detail under arthroscopy that could not be seen in roentgenograms. In the early stage of osteonecrosis, flattening and fissures in the articular surfaces, with and without formation of a cartilage flap, were useful findings in choosing intra-articular surgical procedures. In the late stage, free bodies such as cartilage plates in the joint and regeneration with fibro-cartilaginous tissue over the necrotic lesion were also important in selecting surgical treatment. In addition to roentgenographic classification of developmental stages in osteonecrosis, arthroscopy is necessary in differentiating osteoarthroses, in observing the articular surface of the femoral condyles, and in determining the stage of disease when roentgenography provided insufficient information to justify intra-articular procedures such as drilling and bone grafting.


Arthroscopic meniscectomy.

A technique is described for doing arthroscopic meniscectomies using short curved instruments passed through flexible, sealable Teflon sleeves. The goal, with few exceptions, was to achieve en bloc subtotal resection of the posterior two-thirds of the meniscus. The location and character of the lesions found in this series tend to support this pattern of excision. Immediate postoperative morbidity is astonishingly less than that seen with open meniscectomy. Economic losses, including medical costs and time off work, were significantly less, and short term results compare favorably with those of conventional meniscectomy in regard to relief of symptoms and restoration of function.


Meniscus surgery using the Watanabe arthroscope.

1. The present uses for arthroscopic meniscus surgery are explained. 2. Postoperative care is facilitated by arthroscopic meniscus surgery. However, improvement in surgical instruments and manipulation is necessary in order to complete the surgery in a short time and to make it easy to perform. 3. Total meniscectomy is especially useful in the Japanese because the discoid meniscus was observed in 16.6 per cent in my arthroscopic study. The incidence is considerably higher than that in foreigners. The procedure for arthroscopic total meniscectomy must be improved. 4. The three puncture method is useful. 5. Partial meniscectomy yields excellent results, but there are pitfalls to watch for. 6. A case of combined surgery with partial meniscectomy and meniscorisis is presented.


Peripheral detachment of the menisci of the knee: a preliminary report.

1. Anterior central detachments do satisfactorily as outlined. 2. However, if synovial meniscal detachments can be subluxed into the tibiofemoral junction, they should be sutured to their synovial ligamentous beds. 3. Both types of peripheral detachment coexist frequently with other intra-articular derangements, which are usually minor except when the anterior cruciate ligament is involved.


Arthroscopy in the evaluation of operative treatment of osteochondrosis dissecans.

In an early stage of postoperative evaluation of intra-articular surgery, as in osteochondrosis dissecans, arthroscopic examination is indispensable. In order to compare the results of different cases, a classification is necessary. The arthroscopic grading system presented is valuable for assessing degeneration of the three knee compartments. Early arthroscopic evaluation for follow-up can be used to classify postoperative complications that are not visable radiologically and are not severe enough to justify re-exploration. After follow-up examination with arthroscopy, advice to the patient may halt the progression of deterioration. Further study of the different treatments can help in formulating a plan of management of osteochondrosis dissecans.


The use of arthroscopy for follow-up in knee joint surgery.

Fifty-three joints in 48 patients were examined arthroscopically after surgery in order to evaluate postoperative results and particularly to reveal the causes of poor results. The chief arthroscopic findings in unsatisfactory cases were the following: recurrence of synovitis or osteoarthritic changes after synovectomy for rheumatoid arthritis, residual meniscal or osteoarthritic changes after meniscectomy, loose ligamentous or meniscal lesions after ligamentous repair or reconstruction, and poor regeneration of cartilage after high tibial osteotomy.


Pain in the knee in children: the medial plica shelf syndrome.

The medial plica shelf syndrome as a clinical entity should be added to the list of differential diagnoses as a possible cause of symptoms of internal derangement of the knee in children. It most frequently mimics chondromalacia of the patella and indeed may lead to it. It can be clinically suspected in the presence of the signs described in this report. The condition can be diagnosed early and accurately by arthroscopy and thereafter treated satisfactorily, with minimal morbidity. The results of such treatment not only have been gratifying over the period of follow-up (five to 32 months), but in all probability have prevented further serious damage to the knee.


Arthroscopy of the wrist and finger joints.

Ninety arthroscopies of the wrist and finger joints in 34 clinical cases and two amputated arms were carried out with the number 24 arthroscope. Eighty-four wrist and finger joints of four cadavers and two amputated arms were also dissected for macroscopic observation. Most portions of the interior structures of the wrist and finger joints can be observed by the dorsal approaches. Color photography and punch biopsy are also possible. Some arthroscopic photographs taken with the number 24 arthroscope are illustrated. From these experiences it is concluded that the number 24 arthroscope is a useful diagnostic tool in arthroscopy of the small joints, even though there are still many problems.


Problems in recording arthroscopy.

Several good combinations of photographic equipment are available today for recording arthroscopies. Some of them are so simple to use that everyone can obtain good still pictures through the arthroscope. It is usually preferable to enlarge the arthroscopic pictures in order to get better slides for presentations during lectures and at scientific meetings. Movie film and video tape offer a more dynamic recording but are both fairly expensive. The use of video tape can cause problems during presentations to larger audiences. Video tape, however, can be transferred to 16 mm. movie film, which is the international standard in the teaching world. Color TV has three different standards in different parts of the world and there are at least four different video casette systems available today.


The initial evaluation of the patient with multiple injuries.

The management of trauma patients requires organization and the cooperation of trained health personnel, beginning at the site of injury and continuing until the patient is discharged from the hospital. Treatment guidelines and priorities must be well outlined in advance to provide optimal care and minimize delay prior to definitive therapy. Resuscitation and treatment must begin immediately and simultaneously following well established principles. These guidelines and the general care of the patient with multiple trauma are discussed in this article.


What constitutes a neurosurgical emergency?

Because of the large numbers of head injuries, physicians are frequently called upon to evaluate and initiate treatment in these acute emergencies. Deterioration of such patients results from direct injury to the brain tissue and a subsequent increase in the intracranial pressure. The pathophysiology of brain injury is manifested in a cycle of detrimental events with increased tissue damage and progressive neurological deficit. Current concepts in management of head injuries aimed at interrupting this cycle of events are discussed in detail.


The initial evaluation in maxillofacial trauma.

Evaluation in maxillofacial trauma is primarily an extension of the art of the physical examination, with inspection, palpation, and evaluation of loss of normal function as the primary requisites. X-ray evaluation is critical, and best results are usually obtained by taking films as soon following the injury as possible, before opacification of the sinus with blood, swelling, or hematoma obscures critical bone landmarks. Primary reduction and surgical management of these fractures can usually be delayed for a reasonable period; however, the most accurate findings on both physical examination and x-ray studies are those obtained as soon as possible after the injury.


The initial evaluation in ophthalmic injury.

The recognition and proper initial handling of the many types of ocular injury will result in increased preservation of eyesight and fewer complications. This presentation has attempted to provide some of the general principles of ocular examination as a guide to the physician in dealing with ocular trauma.


Trauma involving the air and food passages.

The management of trauma to the air and food passages has been reviewed briefly, with emphasis on the management of the acute problems based upon a thorough evaluation.


Management of upper airway obstruction.

The tongue is the most common cause of upper airway obstruction, a situation seen most often in patients who are comatose or who have suffered cardiopulmonary arrest. Other common causes of upper airway obstruction include edema of the oropharynx and larynx, trauma, foreign body, and infection. The management of the patient with upper airway obstruction depends upon the cause of the obstruction, the training and skills of the rescuer, and the availability of adjuncts necessary to perform advanced airway techniques. In most cases, merely positioning the patient or performing one of the three maneuvers designed to elevate the tongue will open the airway of the comatose patient or the victim of cardiac arrest. In patients with suspected foreign body obstruction, abdominal or chest compression should be performed immediately, with digital extraction of the foreign body reserved for those in whom these maneuvers are unsuccessful. Most patients with obstruction secondary to edema, trauma, or infection can be managed initially with orotracheal or nasotracheal intubation. Intubation should be attempted prior to surgical management of the airway in most cases of upper airway obstruction. Occasionally, however, cricothyroidotomy or tracheostomy is necessary to establish an airway. The choice of technique depends primarily on the experience and skills of the rescuing physician or paramedic. In most cases, cricothyroidotomy is technically more simple and more easily performed than tracheotomy, especially for the physician who has not been trained in surgery or otolaryngology and for the nonphysician rescuer. No matter what the method employed in establishing an airway in a patient with upper airway obstruction, it must be performed quickly and a source of ventilation provided for the patient once the airway has been secured.


Acute labyrinthine disorders.

A patient seeking emergency treatment for a labyrinthine disorder is usually complaining of dizziness. The task at hand in the emergency room is, first, to rule out the truly life threatening emergent disorders, and then by means of a rapid but adequate history and physical examination to aid in the differentiation between central and peripheral etiologies. If the problem is central, and especially if there are signs of a true emergency, there should be no hesitation in sharing the responsibility for the care of this patient with a neurologist or neurosurgeon. If one is convinced that the problem is of a peripheral etiology, one most likely is dealing with Meniere's disease, vestibular neuronitis, benign paroxysmal positional vertigo, or true labyrinthitis. An acoustic tumor must always be considered. Appropriate laboratory and x-ray studies may be initiated and therapy begun. Although the emergency room evaluation can be inclusive and accurate, it is necessarily incomplete. There is no substitute for a more thorough history and physical examination under more relaxed conditions, complete audiometry, electronystagmography, polytomography, myelography, angiography, or whatever additional sophisticated studies are deemed necessary. If performed well, however, the emergency room encounter forms an invaluable foundation upon which further diagnostic and treatment decisions are based.


Temporal bone trauma and facial paralysis.

Temporal bone trauma includes a wide range of injuries of greater and lesser severity, most of which require the immediate attention of an otolaryngologist. The most common temporal bone injuries encountered in an emergency room setting include longitudinal and transverse fractures of the temporal bone with and without facial paralysis, labyrinthine concussion, foreign bodies in the external canal, penetrating injuries via the external auditory canal, and pressure injuries, including otitic barotrauma, water skiing accidents, blows or slaps to the ear or side of the head, and severe impact noise. A brief but inclusive examination can be performed within the limitations necessarily imposed by an emergency room setting. Cranial nerve screening, balance testing, hearing, and vestibular evaluation can be accomplished with a considerable degree of accuracy. To a large extent, the long term result reflects the quality of the initial examination.


Management of acute ear infections.

The differential diagnosis between the usual acute otitis externa and acute suppurative otitis media is presented. Other important and sometimes frequently seen entities that present as infections in the ear are also discussed. It is emphasized that a patient complaining of ear pain with normal findings on examination must be more thoroughly investigated because of the possibility of a more ominous condition such as carcinoma of the pharynx.


Sinusitis as an emergency.

The manifestations of diseases of the paranasal sinuses that may present as acute emergency situations and the more common complications of these diseases are briefly reviewed with suggestions for initial evaluation therapy.


Evaluation and treatment of acute bleeding from the head and neck.

Three entities that can cause life threatening bleeding in the head and neck are described: epistaxis, post-tonsillectomy bleeding, and post-tracheostomy bleeding. It behooves all physicians operating in this area and emergency room physicians and personnel to be acquainted with the diagnosis and management of these situations.


[Experiences with autogenic training groups (author's transl)].

According to I. H. Schultz, "Autogenic Training" has helped many children with psychosomatic symptoms. The children's symptoms were obviously influenced by disturbed family-situations and so we invited both children and parents to the "Autogenic Training". The treatment was carried out in two parallel groups, 6 children, 3 parents and 3 mothers. The process and the "outcome" of ten group-sessions are described.


[Pneumopericardium in newborns during artificial ventilation (author's transl)].

During a period of 4 years 5 cases of pneumopericardium were observed among 571 artificially ventilated early- and newborn babies. 4 patients died as result of cardiac tamponade, 3 of them before the pericardiocentesis could be performed. 1 infant survived by puncture of the pericardial cavity. Frequency, pathological mechanism, and diagnosis of the pneumopericardium including quick terapeutical measurements under which pericardiocentesis could be life saving, are discussed.


[Cervical teratomas. Case report and review (author's transl)].

The finding of a cervical teratoma in a newborn gave rise to a new review of the 131 cases in infancy described in the literature. 13 of the 29 cases reported since 1966 were found in newborns, and a total of 25 cervical teratomas by the end of the first year. The clinical differential diagnosis against other cervical tumors is difficult. With one exception, all teratomas were benign. Because of dangerous respiratory complications and the increasing risk of malign degeneration with age, this tumor has to be removed as early as possible.


[Frequency of Kongenital Adrenal Hyperplasia (author's transl)].

The frequency of homozygous congenital adrenal hyperplasia in Tyrol is found to be 1 : 8991, the gene-frequency for congenital adrenal hyperplasia 1 : 95 and the frequency of heterozygous congenital adrenal hyperplasia 1 : 48. Our data is compared on a numerical and statistical base with that in Zürich and Munich with regard to the frequency of congenital adrenal hyperplasia, to its distribution with and without salt loss and to its sex-distribution. According to our study one may assume a frequency of homozygous congenital adrenal hyperplasia in Tyrol, Zürich and Munich of 1 : 7000--10,000.


Diagnosis of alkaptonuria in children.

Thirty-nine patiens with alkaptonuria diagnosed in childhood were studied with repeated detailed clinical and biochemical examinations. Darkening of the urine, although varying from time to time, was present in all. Pigmentary changes in axillary regions began to appear at 8--10 years with concomitant staining of underwear. Ear cartilage staining occurred in only 1, and none had scleral involvement or anthropathy. Dark brown to black staining of ear cerumen is present even in earliest childhood. This distinctive symptom in a child with no other ochronotic manifestations and even normal urine colour should alert one to possible alkaptonnuria. Other findings are described in detail.


[Growth development of children suffering from chronic insufficiency of digestion under dietary therapy for several years (author's transl)].

83 children suffering from malabsorption and disorders of metabolism were investigated with regard to body growth and weight gain. Though at first the increase of weight in comparison to body height was more rapid, the norm was obtained by the time the children were starting school. The period of retardation depended on the severity of disease and the diet being strictly kept to. It is most important that the circumference of the head was normal, though the other proportions of the body were too small for the age. These findings are parallel with normal intellectual development.


[The effectiveness of the lead covering in roentgen studies of the pelvis].

This is a report on the protective covering of the infant's pelvis. Comparative measurements of two customary lead covers, phantom measurements and comparative measurements on infants were carried out. Results show that a properly applied lead cover with a correct lead value (at least the equivalent of 1 mm of lead) may be considered a very effective protection against irradiation, a method that reduces irradiation to the gonads by a factor of 100. The initial dosis is at the surface and, as a rule is below 1 mR. The dosis attacking the gonads is most likely within the micro-R-range. Thus we state for practical purposes that a lead protective cover is very effective in X-raying the infant pelvis--indeed it should be mandatory for every pelvic X-ray taken in infants.


[Immunosuppressive treatment of endogenous uveitis in childhood (author's transl)].

This report is about a seven year old boy suffering from endogenous uveitis of unknown etiology in both eyes. A local and systemical steroid therapy did not stop the progressive course. Therefore an immunosuppressive treatment with methotrexate was begun. After the second intravenous application of this antifolate an amelioration could be noted and after 6 week a normalisation of the visual acuity on the left eye and an improvement from 0.4 to 0.8 on the right eye was obtained. Immunosuppressive treatment was discontinued after a duration of 14 months; now 2 years later, the inital success has been maintained. The advantages of methotrexate in comparison to other immunosuppressive agents are discussed.


An improved radiant heat algometer and its application to pain threshold measurements in man.

A radiant heat algometer system is described which enables the psychophysical and clinical study of cutaneous pain sensations and reactions by means of a precise, stabilized power source. In this system DC electric power consumption of a bulb is automatically controlled, and no calibration is necessary to be controlled frequently. Moreover, attention is drawn to the significance of using the blackened sticky tape and of the pre-heating procedure. The application of this algometer is also described for a pain threshold determination with the intensity and time methods.


Deafferentation hypersensitivity in the rat after dorsal rhizotomy: a possible animal model of chronic pain.

Unilateral dorsal rhizotomies were done at the cervicothoracic and lumbosacral spinal cord levels in rats. In preliminary experiments dermatome maps were determined for the roots to be sectioned. The behavior of 37 rats was observed for many months after the rhizotomies. The rats with the dorsal roots sectioned in the cervicothoracic spinal cord exhibited the following behavior: at the border of the skin adjacent to the zone of deafferentation, the rat scratched vigorously and progressively denuded the skin; self-mutilation of varying degrees occurred in the deafferented limb. In some animals scratching occurred in the contralateral skin dermatome opposite to the partially deafferented zone. The rats with the dorsal roots sectioned at the lumbosacral level exhibited hypersensitivity to cutaneous stimulation but there was no scratching or self-mutilation. These results are discussed in the light of previous similar research.


On the relation of injury to pain. The John J. Bonica lecture.

Pain is better classified as an awareness of a need-state than as a sensation. It serves more to promote healing than to avoid injury. It has more in common with the phenomena of hunger and thirst than it has with seeing or hearing. The period after injury is divided into the immediate, acute and chronic stages. In each stage it is shown that pain has only a weak connection to injury but a strong connection to the body state.


Responses of spinal cord dorsal horn neurones to non-noxious and noxious cutaneous temperature changes in the spinal rat.

(1) Lumbar dorsal horn units characterized by their mechanical cutaneous sensitivities were tested for their responses to temperature changes of the skin in the decerebrate spinal rats. (a) Class 1 units (i.e. driven by non-noxious mechanical stimuli) were rarely thermally sensitive. (b) Nearly all class 2 units (i.e. driven by both non-noxious and noxious mechanical stimuli) and 4 of the 5 class 3 units (i.e. driven by noxious mechanical stimuli) were sensitive to temperature changes. (2) According to their thermal response threshold and their response range, these units were divided into 3 groups. (a) Warming units whose response threshold and maximum response were below 42.5 degrees C. Such units were rarely encountered. (b) Warming/noxious heat units whose response threshold was below 42.5 degrees C but with a maximum response above this temperature. They represented approximatively one-third of the radiant heat-sensitive units. (c) Noxious heat units whose response threshold was above 42.5 degrees C and maximum discharge several degrees above it. Approximately 50% of units activated by radiant heat belonged to this group. (3) Responses to radiant heat stimulation were frequently affected by a first noxious heat application. It consisted: --in a threshold decrease and/or an increase of their cellular discharge for a same temperature range. Only observed for warming/noxious heat units and noxious heat units, this sensitization phenomenon predminantly affected noxious heat units. --in a decrease of cellular discharge for a same temperature range. This desensitization phenomenon was observed for the 3 groups of units driven by radiant heat but mainly for warming units. (4) Supramaximal transcutaneous electrical stimulation revealed that nearly all the thermally sensitive units received A delta and/or C inputs. These units were largely distributed throughout the dorsal horn (laminae I, IV and V). Ten of the 12 lamina I units responded to noxious thermal stimuli. (5) These data indicate that an increase in skin temperature is coded at the level of the rat spinal cord dorsal horn by both an increase in discharge of low threshold temperature sensitive units and a progressive recruitment of high threshold units.


Diffuse noxious inhibitory controls (DNIC). I. Effects on dorsal horn convergent neurones in the rat.

(1) Sixty-eight convergent dorsal horn neurones have been recorded at the lumbar level in anaesthetized intact rats. All cells received prominent A alpha and C fibre afferents and correspondingly could be activated by high and low threshold stimuli applied to the peripheral excitatory receptive field. (2) The activity of 67/68 of these neurones was powerfully inhibited by noxious stimuli applied to various parts of the body. Since non-noxious stimuli were ineffective in this respect, the term "diffuse noxious inhibitory controls" (DNIC) is proposed. (3) DNIC could be evoked by noxious pinch applied to the tail, the contralateral hind paw, the forepaws, the ears and the muzzle; the most effective areas were the tail and muzzle. Noxious heat applied to and transcutaneous electrical stimulation of the tail were extemely effective in eliciting DNIC as was the intraperitoneal injection of bradykinin. (4) DNIC strongly depressed by 60-100% both the C fibre response following suprathreshold transcutaneous electrical stimulation and the responses to noxious radiant heat. (5) The spontaneous activity and the responses to low threshold afferents induced either by A alpha threshold electrical or natural stimulation were also powerfully inhibited. (6) In the majority of cases, long lasting post-effects directly related to the duration of conditioning painful stimulus were observed.


Diffuse noxious inhibitory controls (DNIC). II. Lack of effect on non-convergent neurones, supraspinal involvement and theoretical implications.

(1) Diffuse noxious inhibitory controls (DNIC) were tested for their effect on noxious only, non-noxious and proprioceptive cells in the dorsal horn of the intact anaesthetized rat. Unlike convergent neurones, as described in the previous paper, there was no effect of DNIC on these neurones. It is concluded that convergent neurones are specifically inhibited by DNIC. (2) The effect of DNIC could not be demonstrated for convergent neurones in the spinal animal. Thus the neuronal substrate for DNIC must involve supraspinal structures. (3) Because of the level of firing in convergent neurones induced by hair and touch receptors, presumably constantly and randomly activated in the freely moving animal, a noxious message arriving at higher centres may be partly masked by this background noise. On the basis of the known role of convergent neurones in nociception, we propose the following mechanism which may interpret this paradoxical convergence: two pools of convergent neurones are influenced by a painful peripheral stimulation, one segmental pool being activated whilst the remaining population of cells is inhibited; the "contrast" between the messages from these two pools may well produce a significant pain signalling output from the convergent dorsal horn cells. (4) These results and their theoretical implications are discussed with regard to the concept of the "analgesic system", certain clinical observations and the paradoxical pain relieving effects of counterirritation and some forms of acupuncture.


Brain evoked potentials are functional correlates of induced pain in man.

Electrical potentials evoked by 5 intensities of painful dental stimulation were recorded at the scalp. During testing, volunteers indicated subjective painfulness by verbal pain ratings and visual analogue scales. Evoked potentials (EPs) to each intensity, observed between 50 and 400 msec, were characterized by 4 waveform components. The peak-to-peak amplitudes, but not the peak latencies, of all 4 EP components systematically increased with increased stimulation. The amplitudes of the two earlier components correlated with stimulus intensity when the effect of subjective painfulness was controlled, but this was not the case for the later components. In contrast, the amplitudes of the two later components were associated with subjective painfulness but not with stimulus intensity. A strong linear relationship was observed between subjective painfulness and peak-to-peak amplitude for the EP component observed between 175 and 260 msec. The data suggest that the earlier EP components may reflect sensory transmission processes while the later components indicate brain activity when pain is perceived.


The submaximal effort tourniquet test: its use in evaluating experimental and chronic pain.

The submaximal effort tourniquet test has been widely used to evaluate experimental and chronic pain; however, there has been great variation in the manner in which the test has been applied. The present study systemitically evaluates how different levels of exercise duration and effort affect subjects' report of pain. The data indicate the following: (1) the manner in which the exercise is performed has an important effect on subjects' rating of pain, and (2) under all conditions studied, the pain ratings do not increase as a linear function of time. Both findings warrant precautions when using the submaximal effort tourniquet test to study experimental and chronic pain.


An improved procedure for accurate assays of factor VIII.

An improved one-stage method for accurate assays of factor VIII combines highly reproducible end points with elimination of temporal drift and of subjective factors involved in graphic analysis. Activated deficient plasma substrate (ADPS) is used as a single reagent for parallel tests. The assays can be performed manually or, with much greater precision, on an 8-channel coagulation meter of new design in which end points are recorded automatically and depend on an abrupt clearing of agitated cloudy suspensions. The coagulation time readings are reproducible to 0.5%. Factor VIII levels are read off a standard table or computed from a general equation which is readily programmable on a pocket calculator and is valid over a wide range of concentrations, including very low plasma levels.


Red cell stroma, a stable standard for assessment of platelet procoagulant release.

Platelet function in vitro may be investigated in various ways. One of the accepted methods involves examination of platelet procoagulant release. Optimal conditions relating to maximal release have not been defined. Red cell stroma phospholipid can substitute for the platelet procoagulant in many in vitro tests (Quick et al., 1954, 1957; Margolis, 1961; Lovric & Margolis, 1964). Using a multiple channel coagulation meter, an assay system was developed for testing both red cell stroma and platelet procoagulants. Maximum procoagulant release was obtained by lysing in alkaline hypotonic solutions or by sonication. The system was tested in a one-stage kaolin-activated platelet-free plasma substrate, obtained from fresh pooled citrated plasma. With this method the amount of available procoagulant could be related to the numbers of red blood cells or platelets. The results indicated that one platelet provided procoagulant equivalent to that derived from 0.7 red cells. Procoagulant release was studied under various conditions and expressed in terms of stable (red cell) standard. Platelets subjected to hypotonic stress or factor 3 release (Hardisty test) were studied quantitatively. The addition of sulphinpyrazone (Anturan) had no observable effect on platelet release in this system.


A rapid method for the quantitation of haemoglobin A2.

A rapid accurate and inexpensive technique for the measurement of haemoglobin A2 has been devised. It uses a small plastic device which embodies a miniature chromatographic column and reservoirs for the eluting buffer and eluates. The device is charged with whole blood, pH 8.25 buffer and centrifuged. The eluate is removed and the centrifugation repeated using pH 7.0 buffer to remove the remaining haemoglobin. The haemoglobin concentration in the 2 volumes of eluates is measured in a spectrophotometer at 414 nm and the percentage of HbA2 calculated. Results are similar to those obtained by standard methods.


The quantitation of haemoglobin A2 and haemoglobin F: a report of the techniques review group of the Thalassaemia Society of Victoria.

A techniques review group was established in 1975 to investigate the reproducibility of tests for HbA2 and HbF for the diagnosis of beta thalassaemia. Over a 3-year period, 22 samples were distributed for analysis by up to 14 laboratories. Of 250 estimations of HbA2, 26 (10.4%) were at variance with the majority result. The largest number of variant results were obtained in samples with a HbA2 close to the upper limit of normal. Of 238 HbF determinations, 29 (12%) were equivocal or at variance with the majority result. It is concluded that the techniques of HbA2 and HbF estimation as currently practised by several laboratories are not sufficiently accurate, and that, therefore, a number of cases of beta thalassaemia are not being diagnosed. It is the opinion of those participating in the study that the survey is of value in providing a continuing review of techniques and a forum for discussion.


Oestrogen receptor protein in breast cancer: a local study.

An assay using charcoal adsorption to separate bound oestradiol from free oestradiol has been set up to study the oestrogen receptor (ER) status of patients with all stages of breast carcinoma. The specificity of the oestradiol uptake was checked by competitive pre-incubation with anti-oestrogens and non radioactive oestradiol. Eighty-three of 137 (61%) primary breast lesions and 42 of 103 (41%) metastatic lesions studied had a (positive) oestradiol binding capacity. Such results are congruous in respect of age groups and receptor status with other published data.


Human malignant melanoma cell lines.

A series of 10 cell lines established from human malignant melanomas is described. The morphology varied but, in general, was epithelioid. Five produced visible melanin in culture but others produced melanin precursors. All lines were aneuploid and each had a distinctive human karyotype. One line appeared not to have the same sex as the patient but its karyotype was distinct from that of other lines.


A systematic study of wound contraction in mammalian skin.

The phenomenon of wound contraction has been studied in the skin of rats, rabbits and guinea pigs with the aim of obtaining a standardized wound system to be used for biological assay of in vivo agonists and antagonists of granulation tissue contraction. The sex of the animal, the time of day of wounding, the size and the shape of the wounds all had no apparent influence on the wound contraction curves expressed as per cent of original area against time. The test animal's age and species did have a significant influence on contraction of skin wounds which by analogy with results obtained with rigid splints attached to the skin could be attributed to variations in the thickness, rigidity and fixation of the skin to deep tissues. The shape of the final scar was influenced by the position of the wound on the body surface. The major factor in this instance was considered to be tensile forces acting within the skin. Wound contraction curves in rats and rabbits showed three distinct phases, namely early closure, stationary and logarithmic closure. Guinea pigs lacked the early closure phase. The exact role of the panniculus carnosus in wound healing is considered to be worthy of detailed study.


The pathology of occipital encephalocoele and a discussion of the pathogenesis.

The midline structures of 5 infant brains with occipital encephalocoeles were studied. Though all cases showed a uniform finding of a midline defect of the occipital bone with a herniated mass, the extent of the bony defect, the amount and nature of the herniated tissues and the degree of distortion of the intracranial structures varied markedly. Two of the cases showed multiple associated systemic malformations and another case had an inverse cerebellum. In spite of such a marked variability in presentation, the common findings of herniation and displacement of the mesencephalon and roof of the diencephalon allowed us to postulate that the primary defect of occipital encephalocoeles is an abnormality of the tissues overlying the mesencephalon of the developing brain. Initial herniation of the mesencephalon and subsequent movement of the rest of the brain as a result of growth determines the tissues present in the hernia sac at birth. Other theories of genesis of occipital encephalocoeles are discussed.


Histology of normal bone--a computerized study in the iliac crest.

The application of an electronic digitizer and a computerized program for the quantitative assessment of bone morphology is reported. The method was used to measure bone surfaces and areas in undecalcified sections of iliac crest in 50 control subjects at necropsy.


Marchiafava-Bignami disease in a non-alcoholic Indian male.

Marchiafava-Bignami disease, a rare affliction of alcoholic males, is described in a severely malnourished Malaysian Indian male who took no alcohol. It is the second report of the disease in an Asian and represents one of the few cases which have occurred in non-alcoholics. Besides the pathognomonic demyelination of the central portion of the corpus callosum, there were striking demyelinative plaques in the subcortical white matter. In addition, neuropathological features of Wernicke's disease were found suggesting that severe malnutrition with thiamine deficiency was probably the cause of his demise.


The pathological assessment of ovarian neoplasms. II: The proliferating 'epithelial' tumours.

All neoplasms of the ovary encountered in a 25-year study period at the King George V Memorial Hospital were classified according to the World Health Organisation Histological Classification of Ovarian Tumours. Of these, one thousand fell into the category designated as 'common epithelial tumours'. In this report a detailed histological assessment of the 144 proliferating epithelial tumours is presented, including the criteria for distinguishing them from their benign and malignant counterparts and for histological typing and grading of these tumours.


Atypical mycobacteria causing non-pulmonary disease in Queensland.

During the period 1971--7, the Tuberculosis Reference Laboratory in Queensland dealt with 52 isolates of atypical mycobacteria made from non-pulmonary sites under circumstances suggesting complicity in disease. Twenty-four isolates belonging to the MAIS complex were associated with lymph node infections in children. Twelve isolates belonged to the M. fortuitum-chelonei complex; most were from superficial abscesses. Five cases of M. marinum infection and 8 of M. ulcerans disease were detected.


Chronic asymptomatic genital tract infection and semen quality.

Chronic asymptomatic genital tract infection has been postulated to cause infertility in man. This study demonstrates the correlation of positive seminal fluid bacteriological cultures with abnormal parameters of seminal fluid analysis in the male partners of 100 uninvestigated couples presenting with infertility. Gram negative bacteria were cultured only in patients with semen abnormalities while Gram positive bacteria were cultured from both normal and abnormal semen specimens.


An improved screening technique for isolation of Pseudomonas pseudomallei from clinical specimens.

A selective medium consisting of trypticase soy agar with 4% glycerol, 5 mg/l crystal violet, 50 mg/l neutral red and 4 mg/l of gentamicin was devised for isolation of Pseudomonas pseudomallei from clinical specimens. Absorption of neutral red was found to be suitable for differentiating this organism from other bacteria, while gentamicin was effective in selecting Ps. pseudomallei from organisms commonly found in clinical material. The medium was more suitable for screening clinical specimens than MacConkey's agar with colistin-S because it was more selective and allowed multiple specimens to be inoculated on a single plate. Eight thousand clinical specimens from an area endemic for melioidosis were screened on the selective medium. This resulted in the recovery of 8 isolates of Ps. pseudomallei that would not have been detected using routine culture media alone.


Hypoglycemia in children.

The factors that sustain postabsorptive glucose concentrations have been analyzed and the adverse effects of various hypoglycemic disorders on these factors examined. The role of alanine has been reviewed and the importance of glycerol as a precursor of glucose and of ketones as a fuel substitute for glucose emphasized. Finally, we have suggested that fasting functional hypoglycemia replace ketotic hypoglycemia as a descriptive term and that we relinquish the concept of leucine-sensitive hypoglycemia as a specific entity.


Depth adjacency and induced motion.

Induced motion was investigated as a function of the stereoscopic separation of the test and inducing object and the instructions to attend to or to ignore the inducing object. It was found that stereoscopically displacing the test object from the inducing object with both kinds of instructions resulted in a decrease in the magnitude of induction particularly with crossed disparity. These results are consistent with the adjacency principle and with the ability of attention as well as adjacency to modify the magnitude of the induced motion.


Perceptual reactance and task performance.

57 female subjects participated in a study in which perceptual reactance was assessed by the kinesthetic figural aftereffects test. Subjects identified as augmenters were quicker than reducers on a disjunctive reaction time task and a significant interactive effect was found on a paired-associate task. Augmenters performed better on a similar list while reducers were more effective on a dissimilar list.


Report on blind subjects' tactile and auditory recognition for environmental stimuli.

In two related experiments on recognition-on touch and audition-accuracy rates were obtained from congenitally blind subjects and compared with those for normally sighted subjects. In Exp. 1, 5 blind subjects inspected, i.e., handled, 150 common objects and were tested after a delay of 7 days. In Exp. 2, 9 blind subjects listened to 194 naturalistic sounds and were  also tested after a 7-day delay. Accuracy of tactile recognition for the blind was 89.4% while it was 87.9% for the normally sighted. Sound recognition by blind subjects was 76.6% and for the normally sighted it was 78.4%. Neither difference was statistically significant.


A diet and exercise regimen: its effect upon mental acuity and personality, a pilot study.

Of the 75 patients in the February 1977 "class" at the Longevity Research Institute, Santa Barbara, California, 11 volunteers were pre- and posttested (21- to 23-day intervals) with the MMPI, 13 with the California Psychological Inventory, and 17 with four subtests of the WAIS (total: 21 males, 10 females). Ten of the (total) 32 scales showed changes in the predicted, favorable direction, statistically significant at the .05 level or better by t test. Further the number of scales changing in the predicted, desirable direction for each of the three tests was statistically significant at the .06, and .001, and .06 levels (sign test), respectively. The pilot results indicate improvement in psychological factors and mental acuity within a month's time concomitant with the diet, activity, and educational program and warrant further investigation.


Skill performance on biorhythm theory's physically critical day.

The hypothesis of a critical day in biorhythm theory predicts that skill performance would be lower than normal on a physically critical day. Participants in an archery league were observed in 346 events. Indoor archery performance provided scores identical to the goal of the task and unaffected by environmental conditions or other competitors. Above-average performances on 34 physically critical days did not differ significantly from the population proportion of above-average performances. No support for the hypothesis was provided by this observation of archery performance.


On the validity of hypotheses derived from the Rorschach: V. The relationship between form level and ego strength.

Although Rorschach interpreted from level as a perceptual and conceptual aspect of intelligence, Beck and the more current meaning assigned to form level relates these functions to ego strength. F+%, therefore, has come to be regarded as a measure of ego strength. The research examining the validity of this assumption was reviewed and Beck's hypothesis was seen to be supported. The research supports the clinical use of F+% as a measure of ego strength, but further research might help clarify what actual psychological processes are involved in the creation of responses of good form.


Handedness of handedness researchers.

This study tested the hypothesis that laterality and handedness researchers are more likely than other researchers to be left-handed. A questionnaire assessing hand preference was sent to authors of articles which either dealt with handedness (N = 50) or other aspects of laterality (N = 100) or did not concern laterality (N = 50). The proportion of left-handers was highest in the handedness group (12.9%) and lowest in the non-laterality group (5.0%), but this difference did not reach significance.


Influence of functional electrical stimulation training on premotor and motor reaction time.

This study was designed to investigate the influence of functional electrical stimulation on the improvement of reaction time and its fractionated components during learning an horizontal arm-sweep task. 62 subjects participated and were divided into control, stimulation, and trail/stimulation groups. Functional electrical stimulation was an effective method of improving total reaction time and its central component, premotor time.


Pupillary attributions of college students to happy and angry faces.

As evidence for an hypothesis that pupil size plays an important role in nonverbal communication, Hess (1975) has reported that adults draw in appropriately sized pupils on his happy and angry faces task. However, he did not report a statistical test of his data. In this study, we replicated Hess' research and found congruent with his hypothesis that college students (n = 223) draw in significantly larger pupils on the happy face.


Electrodermal measures of attention and effort to stimulus onset and offset for intramodal and intermodal tasks.

Two experiments were designed to assess the relationship between task difficulty and arousal. Electrodermal measures of tonic and phasic arousal to four levels of task difficulty at stimulus onset and offset were studied in college students for intramodal and intermodal tasks. The students were presented for 18 trails with visual-auditory or visual-visual stimuli with either 2.0-, 0.2-, or 0.02-sec difference between stimuli onset or offset, and asked to judge which stimulus came on or went off first or merely to observe the stimuli. Both frequency and amplitude of skin conductance responses reliably differentiated the levels of task difficulty for both the intramodal and the intermodal task. None of the measures of tonic level of arousal was reliable. Electrodermal measures of phasic responses accurately reflected the task demands.


Effect of varying picture-sentence congruence on children's free recall.

70 fourth-grade children were shown objects arbitrarily arranged in an integrated scene. Subjects were randomly assigned to conditions which either presented a sentence that correctly labeled and correctly described the physical arrangement of the objects, presented a sentence containing the correct labels of the objects but not the correct physical arrangement, or presented a sentence which did not contain the correct labels and incorrectly described the physical arrangement. Control conditions either provided subjects with correct labels or omitted presentation of verbal prompts. Congruence between the object display and the sentence produced significantly higher recall and clustering than the incongruence or control conditions. The incongruence conditions did not produce significantly higher recall than the control conditions, suggesting that incongruence interferes with formation of stable grouping of items which appears to be an important factor in facilitating free recall.


Practice effects within a multiple-phase Bender administration.

Practice effects within a multiple-phase administration of the Bender Visual-motor Gestalt Test were investigated. The addition of a 5-sec. Flash phase prior to the standard presentation did not significantly influence performance on the standard presentation. Students who attempted both the Flash and standard administration prior to a recall phase remembered significantly more designs than students receiving only the standard administration prior to recall. Those skills possibly measured by the multiple phase Bender format are discussed and the need for research using the three-phase method is suggested.


Role of verbal representations in testing recognition of naturalistic sounds.

This paper reports two experiments concerned with verbal representation in the test stage of recognition memory for naturalistic sounds. In Study I 10 subjects produced verbal description to 50 sounds and after a 7-day delay 5 subjects reviewed self-produced verbal descriptions while 5 did not prior to testing for recognition. Review of descriptions increased recognition to 94.4% compared to 88.5% for those with no review. In Study II 16 subjects produced verbal descripitions to 50 naturalistic sounds. After a 7-day delay all subjects reviewed descriptionss of one-half of the items which were "targets" and 8 subjects reviewed description of 25 "non-targeted" items. The latter condition produced interference, observed as a significant decrement in recognition from 90.3% to 86.5%.


Correlations among perceptual-motor ability, self-concept and reading achievement in early elementary grades.

This study investigated the correlation among measures of perceptual-motor abilities, self-concept, and reading achievement and determined whether perceptual-motor ability and self-concept can predict reading achievement in the early elementary grades. A total of 105 boys and 108 girls from the first, and second and third grades were tested on the stabilometer, a modified Minnesota Manual Dexterity Test, a tapping test, the Primary Self-concept Inventory, and the Science Research Associates Assessment Survey. Intercorrelations across grade levels tended to be low and nonsignificant. The multiple regression procedures yielded no strong predictions of reading achievement. These findings tended to confirm the specificity of perceptual-motor ability, self-concept, and reading achievement.


Restructuring ability and patterns of physics achievement.

For a sample of 24 male and 19 female college students, persons with high visualization (F1,36 = 7.60, P less than .01) and low flexibility of closure (F1,36 = 6.54, P less than .02) attained significantly higher achievement in physics than persons with low visualization or high flexibility of closure. Persons with high restructuring ability and high spatial visualization (M = 88.64, SD = 15.6) attained a significantly higher level of physics achievement than persons with high restructuring ability and low spatial visualization (M = 56.5, SD = 25.1). Flexibility of closure, spatial visualization, and the embedded figures test accounted for 23.8%, 18.4%, and 53% of the variability in physics achievement among the entire sample, among amles, and among females, respectively. The data provided moderate support for the field-dependence--independence model of psychological differentiation and for investigators who reported a possible link between field-dependence--independence, visualization, and extent of neurological lateralization.


Simple auditory reaction time in blind and sighted adolescents.

This study compared simple auditory reaction times of 20 subjects aged between 11 and 15 yr. (M = 13), 10 born-blind from the Louis Braille Institut (Montréal) and 10 normal sighted subjects of the same age and sex. Their task was to press a telegraph key as fast as possible after presentation of an auditory stimulus. Each subject executed five blocks of 10 trials; the blocks were separated by a rest period of 1 min. The results showed no significant difference (p greater than .05) between born-blind and sighted people of the same sex and chronological age in regard to simple auditory reaction time.