Quantification of thallium-201 scintigrams in acute myocardial infarction.

A method has been developed for measurement of myocardial infarct size from thallium-201 scintigrams that depends on computer measurement of levels of radioactivity in the myocardium. In 16 dogs, thallium-201 scintigrams were obtained in the left lateral and left anterior oblique projections 48 hours after ligation of the left anterior descending coronary artery. Scintigraphic results were obtained by two independent observers and were compared with tissue measurements of infarct volume calculated from thallium autoradiograms and nitro-blue tetrazolium (NBT)-stained tissue slices. Infarct volumes derived from tissue measurements were used to develop criteria for the computer scintigraphic technique. There was no significant difference in the scintigraphic measurements made by the two observers. Scintigraphic infarct size in the left lateral and left anterior oblique projections correlated with tissue infarct size with r values of 0.88 and 0.75, respectively, for thallium autoradiography and 0.71 and 0.70, respectively, for NBT tissue staining. The range of infarct volume was 3.3 to 14.8 percent of the left ventricular mass. Results of this study suggest that scintigraphic quantitation of infarct size is feasible in this dog model.


Critical aortic coarctation: patch aortoplasty in infants less than age 3 months.

Twenty-three infants less than age 3 months (mean age 31 days) underwent patch aortoplasty for relief of coarctation of the aorta. All had intractable congestive heart failure, despite aggressive medical therapy. Each infant had other cardiac anomalies, including patent ductus arteriosus (83 percent) and ventricular septal defect (74 percent). All patients underwent closure of the ductus arteriosus and patch angioplasty of the aorta to produce a luminal diameter of at least 16 mm. In addition, 9 of the 17 patients (53 percent) with a large shunt ventricular septal defect underwent pulmonary arterial banding. There was one hospital death 42 days after operation secondary to bowel perforation and sepsis. Hospitalization beyond 21 days postoperatively was always due to other unrepaired cardiac lesions. The three late deaths at 3, 9 and 18 months after operation were associated with additional major anomalies. Fourteen patients have had postoperative catheterization. No gradient was found across the site of coarctation repair, but one patient had a gradient between the left carotid and left subclavian arteries. Surgical repair of critical coarctation of the aorta in infants can safely be offered despite the presence of other cardiac anomalies.


Blood pressure, heart rate, pressure-rate product and electrocardiographic changes in healthy children during treadmill exercise.

Heart rate, systolic and diastolic blood pressure, rate-pressure product and electrocardiographic changes were measured in 288 healthy children during treadmill exercise. A constant speed (3.5 miles/hour) protocol was used to facilitate the measurements of physiologic data during exercise. Because responses to exercise vary with size, the children were separated into four groups according to body surface area. Comparisons were also made between male and female and between black and white children. The values for heart rate and systolic pressure showed excellent reproducibility in repeated tests. These data establish for clinical use reference values for children during treadmill exercise.


Effects of oral quinidine on left ventricular performance in normal subjects and patients with congestive cardiomyopathy.

To evaluate the effects of oral quinidine therapy on left ventricular performance, 10 normal subjects and 8 patients with cardiomyopathy were studied with echocardiography at rest, after intravenous injection of atropine and during infusion with phenylephrine. The echocardiographic studies were performed during oral quinidine therapy and during placebo administration. In the normal subjects heart rate was significantly faster with quinidine than with placebo (74 +/- 8 (standard deviation) versus 68 +/- 9 beats/min, P less than 0.01), but there was no significant change in blood pressure or left ventricular size and performance. After administration of atropine, heart rate was identical with and without quinidine but the mean normalized velocity of left ventricular dimension shortening was significantly less with quinidine than with placebo (1.28 +/- 0.19 versus 1.44 +/- 0.21, P less than 0.01). During acute pressure loading with phenylephrine there was no difference in left ventricular size or performance during quinidine therapy. In the patients with cardiomyopathy, no significant differences in left ventricular function were detected with this protocol during quinidine therapy. It is concluded that oral quinidine therapy appears to have little adverse effect on left ventricular performance at rest or during acute pressure loading.


Serial echocardiographic appearance of healing bacterial vegetations.

Serial M mode and cross-sectional echocardiograms were obtained from six patients who had been treated with antibiotic drugs for infectious endocarditis. Three to six M mode echocardiograms and one to six cross-sectional echocardiograms were obtained from each patient over a follow-up period averaging 50 weeks (range 10 to 108 weeks). On echocardiography, vegetations were observed to have become smaller and more echo-reflective with healing. A dramatic change was seen in two patients after peripheral embolization. M mode echocardiography was particularly helpful in determining the quality of echo reflection by vegetations; cross-sectional echocardiography was more helpful in judging the size and shape of a vegetation. Echocardiography is ideally suited for the serial visualization of healing vegetations in patients who do not require early valve replacement. It may prove helpful to examine serially valve vegetations with both M mode and cross-sectional echocardiography when following up patients with infectious endocarditis treated with antibiotic agents.


Bilateral cardiac myxomas and peripheral myxomas in a patient with recent myocardial infarction.

Coronary arteriography, performed for recent anterior wall myocardial infarction in a 29 year old man, showed multiple aneurysms of the distal branches of the left coronary artery without evidence of obstructions in the major branches, and two clusters of abnormal vessels, supplying tumors in the right ventricle and the left atrium. At operation and histologic examination both tumors appeared to be myxomas. In addition, two myxomas, located elswhere in the body, could be proven histologically.


Ultrastructural organization of the hamster renal pelvis.

The renal pelvis of the hamster has been studied by light microscopy (epoxy resin sections), transmission electron microscopy, and morphometric analysis of electron micrographs. Three morphologically distinct epithelia line the pelvis, and each covers a different zone of the kidney. A thin epithelium covering the outer medulla (OM) consists of two cell types: (1) granular cells are most numerous and have apically positioned granules which stain intensely with toluidine blue, are membrane-bound, and contain a fine particulate matter that stains light grey to black in electron micrographs. (2) Basal cells do not have granules, are confined to the basal lamina region, and do not reach the mucosal epithelial surface. The inner medulla (IM) is covered by a pelvic epithelium morphologically similar to collecting duct epithelium of IM. Some cells in this portion of the pelvic epithelium (IM) stain intensely dark with toluidine blue, osmium tetroxide, lead, and uranyl acetate. Transitional epithelium, which separates cortex (C) from pelvic urine, has an asymmetric luminal plasma membrane and discoid vesicles, each of which is similar to those previously observed in mammalian ureter and urinary bladder epithelia. Based on morphological comparisons with other epithelia, the IM and OM pelvic epithelia would appear permeable to solutes and/or water, while the transitional epithelium covering the C appears relatively impermeable. It would also appear that the exchange of solutes and water between pelvic urine and OM would involve capillaries, primarily, since morphometric analysis showed that both fenestrated and continuous capillaries of the OM were extremely abundant (greater than 60% of OM pelvic surface area) just under the thin pelvic epithelium.


Cephalic neurulation and optic vesicle formation in the early mouse embryo.

The overall pattern of cephalic neurulation and the concomitant early development of the optic vesicles in mouse embryos were examined by scanning electron microscopy. Paraffin-sectioned specimens were also examined. The overall pattern of closure of the cephalic neural folds accords well with earlier observations of this process. The earliest indication of optic placode formation was seen in histological sections of embryos at the 4-somite stage, while optic pit formation was first observed at the 5- to 6-somite stage. The upper halves of the optic vesicles were formed in 10- to 15-somite embryos by the fusion of the neural folds at the junction between the mesencephalon and prosencephalon, while closure of the lower halves was associated with the closure of the rostral neuropore, and was usually completed by about the 20-somite stage. By the 25- to 30-somite stage, a rapid increase in the volume of the forebrain was observed, so that the optic vesicles were displaced laterally. An overall increase in the volume of the optic vesicles and decrease in the diameter of the optic stalks were also observed at this time. This account of cephalic neurulation and optic organogenesis provides useful baseline data relevant to the study of the normal early development of the mouse. A comparison is made between similar events in the rat, the hamster, and the human embryo.


Observations on closure of the neuropores in the chick embryo.

Neuropore closure was studied in chick embryos by light and electron microscopy. Surface ectoderm reflects over the crests of the neural folds at all craniocaudal levels, merging with the neural ectoderm lining the neural groove. Apices of surface ectodermal cells have an essentially identical morphology prior to approximation of folds, both within the presumptive fusion sites and more laterally. Cells of these areas have slightly convex profiles exhibiting few cellular protrusions. Each neural fold contains a superficial half, composed of neural ectoderm covered by surface ectoderm, and a deep half consisting entirely of neural ectoderm. Initial contact between folds usually occurs near the junction between these halves in cranial regions, but is restricted primarily to surface ectoderm at caudal levels. Subsequent fusion of folds at all levels involves both ectodermal layers. Cellular protrusions and small, morphologically unspecialized intercellular junctions often interconnect cells of apposed folds in areas undergoing fusion. The anterior neuropore closes at stages 10-11, but fusion of folds in this region is not completed until stages 13-14. Fusion occurs dorsoventrally in this area and is more advanced internally than externally. Numerous pleomorphic inclusions and a few apparently necrotic cells are present in areas bordering the anterior neuropore. The posterior neuropore closes at stages 12-13 and fusion is completed in this region during stages 13-14. The caudal end of the posterior neuropore closes dorsal to the developing tail bud. Several morphological features of this closure may at least partially account for the high susceptibility to myeloschisis localized specifically at caudal spinal cord levels.


Lactose intolerance in the Lebanese population and in "Mediterranean lymphoma".

Lactose tolerance tests were performed on 75 healthy Lebanese volunteers, 12 patients with "Mediterranean lymphoma" and 15 American and West European Caucasians. Small intestinal biopsies were done on 10 intolerant and five tolerant subjects for histological evaluation and lactase assay. Lactose malabsorption was present in 78% of the Lebanese subjects, in all patients with Mediterranean lymphoma and in five of the 15 Caucasians. Two of the five intolerant Caucasians had giardiasis. There was no difference in the prevalence rate among the various Lebanese groups nor among males and females. Symptoms occurred in 91% of the 58 intolerant Lebanese subjects: diarrhea in 71%, abdominal distension in 67%, and cramps in 48%. The increased prevalence of lactose intolerance with Mediterranean lymphoma is probably secondary to the pathological changes in the intestinal mucosa and protein depletion.


An examination of factors believed to be associated with infantile obesity.

Forty-two normal (25th to 75th percentiles of weight for age) and 47 "obese" (above the 90th percentile) infants, 4 to 9 months of age, were compared with regard to energy and macronutrient intake, breast-feeding history, age of introduction of solids, and maternal reliance on external feeding cues. The study failed to reveal characteristic group differences. The current stereotype of the obese infant as one who is overfed, is given solids very young, is not breast fed, and whose mother is not responsive to his satiety signals is challenged. As a result, the nature of current group counseling for the prevention of infantile obesity is questioned.


Effects of behavioral and pharmacological weight loss programs on nutrient intake.

Behavior therapy is a widely used method for short-term weight control. Formal nutrition counseling is not included in many behavioral programs. To determine what types of diets were self-selected by patients and to see how they compared with individuals participating in a relaxation group with anorectic medication, the eating diaries compiled by participants in such a program were analyzed for 20 different nutrients. In general, pretreatment intakes were nutritious and typical for Americans. Both the behavioral and a relaxation-medication treatment produced weight loss and reduction in calorie intake. Both treatments were associated with the consumption of a fairly nutritious diet not much different from the pretreatment intake except for a reduction in the amount eaten.


Comparative study of endogenous fecal fatty acids in germ-free and conventional rats.

The effects of gastrointestinal flora on the quantitative and qualitative aspects of "endogenous" fecal fatty acid excretion were studied in the rat using germ-free (GF) and conventional (CVL) animals, lipid-free diet and open-tubular gas-liquid chromatography. Gastrointestinal flora slightly increased endogenous excretion of fatty acids. Analysis of fatty acids from different fecal lipid fractions showed that the presence of a microflora in the gastrointestinal tract extensively modified the qualitative aspects of endogenous fecal fatty acid spectra. In total endogenous fecal lipids, concentrations of mono and polyunsaturated fatty acids (from C16 to C22) were 3.5 times higher in GF rats, while concentrations of even-numbered and saturated fatty acids were 1.5 times higher in CVL rats. Odd-numbered fatty acids (from C11:10 to C2:0) represented 6.5% of total endogenous fecal fatty acids in CVL rats vensus 1.5% in GF rats. Branched-chain fatty acid (even-and-odd-numbered, iso and anteiso) concentrations were 12.9% in CVL rats versus 2.0% in GF rats. Results clearly showed that the gastrointestinal flora was the main source of odd-numbered fatty acids and branched-chain fatty acids in endogenous fecal lipids. However, a secondary source may also exist since these fatty acids represented 3.5% of the total endogenous fatty acids in GF rats.


Clinical results of a cross-over treatment with pyridoxine and placebo of the carpal tunnel syndrome.

Clinical evaluation was made of cross-over treatments by pyridoxine and a placebo of patient 22 having the carpal tunnel syndrome. Extraordinary monitoring of the specific activities of the erythrocyte glutamic oxaloacetic transaminase proved a severe vitamin B6 deficiency, which was partially corrected by the Recommended Dietary Allowance of 2 mg, and completely corrected by 100 mg. The severity of the syndrome diminished on the Recommended Dietary Allowances and the patient was asymptomatic at the higher dosage. On placebo, both the vitamin B6 deficiency and syndrome reappeared. Retreatment with 100 mg again corrected both the deficiency and syndrome. Measurements (total n = 19) of flexion of proximal interphalangeal joints of the index fingers by a goniometer, and of pinch by the Preston gauge revealed objective normalization. Scores of 17 symptoms revealed reductions at both the 2- (P less than 0.01) and 100-mg (P less than 0.001) dosages. Conduction through the carpal tunnels had improved by electromyography. These and previous data on a total of 22 patients showed the concomitant presence of a deficiency of vitamin B6 and the carpal tunnel syndrome; a causal relationship is apparent.


Riboflavin nutritional status and absorption in oral contraceptive users and nonusers.

Riboflavin nutritional status, based on erythrocyte glutathione reductase (EGR) determinations, and the absorption of the vitamin after 10-mg oral doses were assessed in a group of oral contraceptive users (group OC, n = 18) and in a group of nonusers (group NOC, n = 17). Before administration of test doses of riboflavin, mean EGR levels of 4.06 (group OC) and 4.44 (group NOC) mumoles glutathione reduced per minute per gram of hemoglobin were not significantly different. After oral administration of riboflavin, a significant increase in EGR levels was observed within each group although no significant differences were detected between groups. Mean EGR levels continued to be slightly lower for group OC compared to group NOC. Oral absorption of riboflavin based on urinary excretion results was not significantly different between the groups. These findings indicate OC use does not significantly affect riboflavin nutritional status in a subject population having adequate nutrition of moderate to high socioeconomic status. Significant reductions in EGR levels which have been previously reported for OC users appear to be associated with a low socioeconomic status.


Plasma 1,25-(OH)2-vitamin D concentrations and net intestinal calcium, phosphate, and magnesium absorption in humans.

We evaluated the relationship between plasma concentrations of the renal hormone 1,25-(OH)2-vitamin D and net intestinal absorption of Ca, PO4, and Mg in vitamin D-replete patients eating similar diets, who had undetectable, normal or elevated plasma 1,25-(OH)2-D levels, Net intestinal Ca absorption was positively correlated to plasma 1,25-(OH)2-D concentrations: percentage dietary Ca absorbed = 10 + 0.17 x plasma total 1,25-(OH)2-3, pmole/liter, r = + 0.58; P less than 0.001. By contrast, there was no significant correlation between PO4 or Mg absorption and plasma 1,25-(OH)2-D concentrations. Moreover, significant quantities of PO4 and Mg were absorbed in the absence of detectable plasma 1,25-(OH)2-D. We conclude that net intestinal Ca absorption is critically dependent upon the availability of the renal hormone 1,25-(OH)2-D in vitamin D-replete humans when dietary Ca intake is normal. By contrast, other factors must play a dominant role in regulating net intestinal PO4 and Mg absorption.


Serum alpha-tocopherol, lipids, potassium, and creatine phosphokinase in normal and malabsorption patients.

Serum alpha-tocopherol, lipids, potassium, and creatine phosphokinase levels were measured in 20 adult male control patients and eight malabsorption patients. The malabsorption group had significantly lower serum alpha-tocopherol levels than the control group. This change was independent of serum total lipid levels that were not significantly different among the two groups. Serum potassium and creatine phosphokinase levels that are normally used to assess muscle pathology in man did not correlate with serum alpha-tocopherol levels in either the control of the malabsorption groups. Body mass indices that are directly related to adiposity of the individuals were calculated. Among the control patients, there was a significant increase in serum alpha-tocopherol and serum total lipids with increase in body mass index. Similar correlations did not exist in the malabsorption group. In the latter group serum alpha-tocopherol levels may have reached low enough levels to be independent of factors such as adiposity and serum total lipids.


Utilization of swine to study the risk factor of an elevated salt diet on blood pressure.

Two homogeneous groups of castrated swine were fed identical diets except that one contained an increased sodium chloride content. The diets were initiated at weaning age and the blood pressure of the pig was followed for 8 months. Blood pressures were measured with an automatic blood pressure recorder for a 1-week period every 4th week. At the end of 8 months, the group on the high salt diet had blood pressure elevated above that of the group on the low salt diet.


Assessing iron status of a population.

Reliable methods for assessing the iron status of a population are essential for developing effective public health measures to combat iron deficiency. The hemoglobin concentration, transferrin saturation, free erythrocyte protoporphyrin, and serum ferritin are all useful but they vary widely in their specificity and sensitivity for detecting iron deficiency. In applying these laboratory parameters, the usual approach in nutritional surveys is to determine the percentage of values outside the normal range. As an alternative, a model is presented here that uses these measurements to estimate the distribution of iron stores in a population. This approach may be particularly useful for evaluating the effectiveness of iron supplementation and fortification programs.


The association of obesity with socioeconomic factors in Missouri.

The prevalence of obesity and underweight was estimated for residents of Missouri more than 9 years old on the basis of age, sex, household income, educational attainment, and population density from the results of a survey conducted in 1973. The incidence of overweight was greatest among children 10 to 16 years old and the least for adults 17 to 35 years old. Four percent of the girls 10 to 16 were greater than 159% of average weight for height. Among women greater than 59 years old the incidence of overweight and underweight were high. The proportion of adult women who were overweight as defined by average weight for height and body mass index (W/H2) was inversely related to household income and education. The same was true for adult men in relation to income but the reverse results were observed for education. A larger proportion of urban men were overweight as defined by body mass index compared to rural men. The incidence of obesity among males of all ages and females greater than 59 years old appeared to be related to residence in specific types of communities.


Geophagia in rural Mississippi: environmental and cultural contexts and nutritional implications.

We investigated geophagia in the black population of rural Holmes County, Mississippi. Twenty-five sources of geophagical clays were located and most of the sources are associated with rural settlements throughout the county. Clays are taken from subsurface soil horizons, and all but one of the sources come from the upland portion of the county. Geophagia occurs among 57% of women and 16% of children of both sexes, but it is not found among adult males or adolescents. Average daily comsumption of clay is 50 g. Our data indicate geophagia is not correlated with hunger, anemia, or helminthic problems, but it may contribute to the common problem of hypertension. Geophagia has been suggested as one of the factors leading to hyperkalemia, but our data do not support this notion.


An evaluation of upper arm measurements used in nutritional assessment.

Triceps skinfold thickness and upper arm circumference (parameters used in assessing protein-calorie malnutrition) were measured on both arms of 91 adult volunteers who fulfilled criteria for absence of disease and conditions affecting nutritional status. For the total study group and subgroups of men only and women only, no significant differences were noted between right and left arm measurements of triceps skinfold thickness, arm circumference, or arm muscle circumference. Median values for significant right-left arm measurement differences were + 1.7 mm for the triceps skinfold thickness of left-handed subjects (P less than 0.05) and + 0.3 cm for the arm circumference of volunteers regularly engaged in predominately right-armed activities (P less than 0.05). Criteria of weight within 15% of "ideal" and nine serum and plasma values within a specified range were fulfilled by 77 subjects, and they comprised the "healthy" subgroup. Left arm median values for healthy men and healthy women differed from a currently accepted standard for each of three anthropometric parameters: triceps skinfold thickness (P less than 0.05), arm circumference (P less than 0.05), and arm muscle circumference (P less than 0.01).


Simultaneous determination of alpha-tocopherol and retinol in plasma or red cells by high pressure liquid chromatography.

This paper describes a rapid, microprocedure for the simultaneous determination of alpha-tocopherol (vitamin E) and retinol (vitamin A) in plasma, and of alpha-tocopherol alone in red cells since cells do not contain retinol. A total lipid extract from 0.1 ml plasma or 0.125 ml red cells and containing internal standards of alpha-tocopheryl acetate and retinyl acetates is injected onto a high pressure liquid chromatography with a reverse phase column developed with methanol-water. An ultraviolet detector with 280-nm filter is used. The chromatogram is complete in 8 min and the alpha-tocopherol and retinol are quantitated by the peak height ratio method. Comparison of results with both plasma and red cells gave excellent agreement with conventional methods for these vitamins. The procedure should be particularly useful for clinical studies and nutrition surveys.


Blood levels of selected nutritional status indicators in young men from a rapidly modernizing society in Abu Dhabi, United Arab Emirates.

Some blood levels of selected indicators of nutritional status were assessed in young adult males among the rapidly modernizing bedouin society of Abu Dhabi. Blood specimens from 30 indigenous army recruits were tested for the following: packed cell volume, total serum proteins, albumin, globulins, serum transferrin, serum calcium (total and ionized), serum iron, and total folates in serum and in red blood cells. A control group consisted of 10 male expatriate laboratory personnel of similar age. Except for iron and folates, all parameters were within normal range. Although the average serum iron was normal, 13.3% of the army recruits were serum iron deficient. The mean serum folate in both groups fell within the indeterminate range with two deficient recruits. The mean red blood cell folate was in the low normal value in the local people with one-third of them in the borderline range, and two deficiencies with no pathological effects. The control group was well within the acceptable normal range of red blood cell folate and the difference between the means of both samples was significant. Inappropriate amounts of vegetables in the diet and prolonged cooking may be the cause of such folate inadequacy.


The energy expenditure of Iranian agricultural workers.

The energy cost of agricultural and standard activities and the daily energy expenditure of male agricultural workers were measured during different seasons in Iranian villages to assess the validity of past and present Food and Agricultural Organization recommended energy allowances for that population. Studies included low income farmers in a village representative of those around the central desert where harvesting takes place under conditions of extreme summer heat. Measurements were also made during the Moslem fasting period when no food may be eaten between dawn and dusk. Energy cost of typical activities was measured by indirect calorimetry using the Max-Planck respirometer and daily energy expenditure was assessed using these figures combined with a diary of activities throughout the 24-hr period. Results of individual activity values are compared with other published figures. Comparison of daily energy expenditure of fasting subjects and nonfasting after Ramazan showed no significant difference. No significant difference was found between values of standardized activities at high summer temperatures and moderate temperatures. Mean values of daily energy expenditure during winter when activity is low are around 2600 kcal/day and for the other seasons of high activity 3400 kcal/day. These figures suggest that past and present Food and Agricultural Organization standards are low for this population.


The chemistry of Chinese drugs.

Some herbal drugs commonly used in Chinese medicine have been studied chemically in correlation with their biological activities. In many cases it has been recognized that some characteristic chemical constituents could represent the therapeutical actions of the drugs. It is noted that elucidation of their chemical structures in view of the structure-activity relationship provides scientific evidence for the beneficial uses of traditional drugs in health care and, furthermore, promotes the discovering of new therapeutics from them. The principles of Chinese drugs are distributed widely among almost all the chemical groups of natural products, for example, simple phenolics, lignan, flavonoid, quinonoid, lower terpenes, triterpenoid, steroid, true alkaloid, protoalkaloid or amines and simple and polymolecular carbohydrates. In the present article, the chemical principles of some important Chinese drugs currently used are discussed mainly on the basis of our own investigations, and we refer to other works for a general understanding of the present status on the chemical approach to studies of Chinese drugs and medicine.


Further study of the neurohumoral factor, endorphin, in the mechanism of acupuncture analgesia.

Cross circulation was performed between the femoral arteries and veins of paired rabbits that were entirely conscious. Jaw opening reflex by dental pulp stimulation was used as pain index. When acupuncture was applied to the donor rabbit the pain thresholds of both the donor and recipient were elevated from 30 minutes to one hour after acupuncture stimulation and lasted for another 30 minutes after withdrawal of acupuncture. The analgesic effect in both the donor and recipient was abolished by the pretreatment of naloxone. The increase in the pain threshold of the non-acupunctured recipient was due to an opiate-like, humoral substance generated from the acupuncture donor. The possible role of endorphins in the mechanism of acupuncture analgesia is discussed.


Clinical observations on several meridian loci in chronic hepatitis and liver cirrhosis in comparison with those in female neurovegetative disorder, pregnancy, and the steroid side-effects syndrome.

Patients with chronic hepatitis showed various grades of the pinch-pressure pain (P-p pain) at the right Ch'ü-Ch'üan (Li-8) locus. Sometimes the P-p pain also appeared at the left locus (Li-8) as well, but in such cases the tendency is towards a stronger reactivity at the right side than at the left, and the P-p pain does not appear at the left side alone. These findings offer a noticeable contrast to those seen in pregnant women and in steroid-treated patients affected with an obvious side effect where the stronger reactivity is to be seen at the left rather than at the right. The P-p pain grades were inclined to decrease in severe cases, especially in liver cirrhosis. In general, the variability of the P-p pain of grades correlated well with the process of the findings of the liver function test and of the chief subjective complaints. Therefore, the P-p pain test is useful for the diagnosis of chronic hepatitis. Regarding the grade distribution patterns of P-p pain at the Li-8, LI-4, LI-11, and SI-11 loci, patients with chronic hepatitis showed a pattern of higher grades of P-p pain reactivity at the right Li-8 and SI-11 loci, and at the left LI-4 and LI-11 loci, while patients with the so-called female neurovegetative disorder, pregnant women, and patients affected with steroid side-effects showed a perfectly reversed reactivity pattern. These findings can be useful for the differentiation between chronic hepatitis and those groups of diseases showing subjective signs deceptively similar to those of chronic hepatitis and those groups of diseases showing subjective signs deceptively similar to those of chronic hepatitis. The comparison of the skin temperature between the right and the left loci showed lower levels at the right than at the left, and the comparison of the skin pH between the both sides showed a more elevated level at the right than at the left. The mechanisms of these phenomena are discussed and what seems to be the most appropriate explanation at present is offered.


The neurophysiological mechanism of acupuncture treatment in psychiatric illness: an autonomic-humoral theory.

The author traces acupuncture and its development from antiquity to the present time. Based on knowledge and experience so far gathered, an autonomic-humoral theory is proposed to explain the possible mechanism of acupuncture in the treatment of psychiatric conditions. Essentially, the autonomic nervous system and the neurotransmitters are most likely involved. It is hoped that this proposal will stimulate further research in this area.


Laplace plane analysis of impedance on the H meridian.

The AC impedance of a length of the H meridian not containing any acupuncture points was studied by means of Laplace plane analysis of the time domain response to an input voltage pulse. The ensuing frequency domain data were compared to the results of an identical analysis for two anatomically similar controls on either side of the meridian. The resistance of the meridian was significantly lower than either control.


Reduced ferrochelatase activity in fibroblasts from patients with porphyria variegata.

Ferrochelatase deficiency has been shown in both porphyria variegata (PV) and erythropoietic protoporphyria (EPP). It has been suggested that in PV there is a decrease in the enzyme, whereas in EPP the enzyme is unstable. In the present study ferrochelatase activity was measured in skin fibroblasts from three patients with PV and three normal subjects. The enzymatic activity in the patients with PV (17.5 +/- 4.5 pmoles heme formed per 10(7) fibroblasts per hour) was 50% of that of the control group (31.0 +/- 3.2 pmoles heme formed per 10(7) fibroblasts per hour). This supports the contention that the enzyme is deficient in PV and that an inactive ferrochelatase is the primary deficiency in this type of porphyria.


Acquired hemoglobin H disease in idiopathic myelofibrosis.

A 68-year-old male, diagnosed 1 year previously as having myelofibrosis, developed hemolysis, red cell inclusions, and 37% Hb H. The alpha/beta globin synthetic ratio for circulating reticulocytes, determined by 3H-leucine incorporation and globin chain separation by carboxymethylcellulose chromatography in urea, was 0.049. When total RNA was purified from peripheral blood cells and translated in a wheat germ cell-free translation system, the alpha/beta ratio of the translation products was 0.26, indicating mRNA as a major cause of the globin synthetic imbalance. This study demonstrates that myelofibrosis is one setting in which acquired Hb H disease occurs; that the synthetic imbalance may be extreme; and that it can be associated with an imbalance in the activities of specific globin mRNAs.


A comparison of methods for the rapid quantitation of unsaturated transcobalamin II and the R-binding proteins.

Methods for the rapid quantitation on unsaturated transcobalamin II (TC II) and R-binders in serum following separation of these binders using a) adsorption by uncoated charcoal, b) adsorption by Quso G32, c) precipitation with ammonium sulphate, and d) acidification of serum, have been compared with the standard gel filtration technique. In serum from healthy subjects and patients with elevated R-binders, the serum acidification and Quso methods yielded results in closest agreement with those obtained by gel filtration. When TC II was markedly elevated, the recommended concentration of Quso failed to remove all TC II from serum. Both the serum acidification and Quso methods are suitable for routine use, providing that with the latter method the concentration of Quso is increased when elevated levels of TC II are anticipated, as, eg, in severe jaundice. All the rapid methods tested yielded clinically significant results in patients with myeloproliferative disorders.


Cold agglutinin autoimmune hemolytic anemia in nonhematologic malignancies.

Four patients with nonhematologic malignancies had the simultaneous finding of hemolytic anemia due to high-titer cold agglutinins. In each patient, the cold agglutinin had "anti-I" specificity and was of the IgM kappa immunoglobulin class. Although patients with hematologic malignancies not uncommonly have cold agglutinins, the association between these antibodies and nonhematologic malignancies is unusual.


Hereditary mucoepithelial dysplasia: a disease apparently of desmosome and gap junction formation.

A previously unrecognized autosomal dominant syndrome affecting oral, nasal, vaginal, urethral, anal, bladder, and conjunctival mucosa with cataracts, follicular keratosis, nonscarring alopecia, and terminal lung disease is described in a four-generation kindred of German extraction. Severe photophobia, tearing, and nystagmus in infancy heralds the development of keratitis, corneal vascularization, and lens cataracts. Repeated corneal transplants have failed. Red, periorificial mucosal lesions involving the above structures are noted by 1 year of age and may persist throughout life. Chronic rhinorrhea and repeated upper respiratory infections frequently progress to bilateral pneumonia accompanied by loss of hair, diarrhea, occasional melena, enuresis, pyuria, and hematuria. Spontaneous pneumothorax is frequent, terminating in fibrocystic-type lung disease and cor pulmonale. Women have had repeated abnormal vaginal PAP smears. Histologically the mucosal epithelium shows dyshesion, thinning of the epithelial layer, and dyskeratosis. Mucosal PAP smears show lack of epithelial maturation, cytoplasmic vacuoles and inclusions, and individual cell dyskeratosis. Histochemically there is a lack of cornification and keratinization. Ultrastructural studies show lack of keratohyalin granules, a paucity of desmosomes, intercellular accumulations, cytoplasmic vacuolization, and formation of bands and aggregates of filamentous fibers and structures in the cytoplasm resembling desmosomes and gap junctions. The condition is probably a panepithelial cell defect of desmosomal and gap junction structure most prominently affecting mucosal epithelia associated with an increased susceptibility to a variety of adventitious organisms.


Apparent hexosaminidase B deficiency in two healthy members of a pedigree.

A family is described in which all members have decreased serum and leukocyte hexosaminidase activity. Two individuals, the mother and the younger daughter, have a normal ratio of hexosaminidase B (HEX B) to total hexosaminidase, but their serum enzymes display respectively partial or complete lability to heat. It is proposed that the proband is a double heterozygote for the Sandhoff allele and for an allele producing thermolabile beta subunits.


Argininosuccinic aciduria: prenatal studies in a family at risk.

We have monitored two successive pregnancies in a family which we found to be at risk for argininosuccinic aciduria. We measured argininosuccinic acid (ASA) concentrations in amniotic fluid and utilized an indirect assay of ASA lyase activity in cultured amniotic fluid cells. The assay procedure is based on the uptake of 14C from [14C]citrulline and of [3H]leucine into protein. ASA was easily measured in amniotic fluid from the first fetus at risk, whereas none was detectable in control fluids. Amniotic fluid cells cultured from this fetus had only 5.5% of control ASA lyase activity. The pregnancy was terminated, and hepatic ASA lyase activity in the fetus was shown to be about 1.3% of control values. In addition, eight fetal tissues were analyzed for ASA, and all had significant accumulation. ASA was not detected in amniotic fluid from the second fetus at risk, and ASA lyase activity in cultured cells was 80% of control activity. Enzymatic analysis of erythrocyte lysate confirmed the diagnosis of an unaffected child (ASA lyase = 46% of control) and indicated heterozygosity. Thus, we provide further evidence that argininosuccinic aciduria can be diagnosed successfully in utero by indirect assay of ASA lyase activity in cultured amniotic fluid cells. In addition, high amniotic fluid ASA concentrations provide strong adjunctive evidence for such a prenatal determination, and may prove to be sufficient for diagnosis.


Late replicating X chromosomes in human triploidy.

The status of X-chromosome replication was studied in twenty-seven 69,XXY and nine 69,XXX human triploids in which the parental origin of the additional haploid set was known from the study of chromosome heteromorphisms. Among the 69,XXY triploids, fourteen had no late replicating X, two had one late replicating X in all cells examined, and eleven had two populations of cells, one with late replicating X chromosome, and one without any. Among the 69,XXX triploids, four had a single late replicating X, and five had two populations of cells, one with one late replicating X, and one with two late replicating X chromosomes. There was no correlation between the parental origin of the triploidy and the type of X-chromosome inactivation. However the number of late replicating X chromosomes was significantly lower in cultures grown from fetal tissue when compared with those grown from extra-embryonic tissue. In cultures derived from extra-embryonic tissue there was a significant correlation between the gestational age of the sample and the proportion of late replicating X chromosomes. The older the specimen, the greater the number of late replicating X chromosomes.


Electrophoresis of glucocerebrosidase from normal and Gaucher disease fibroblasts.

A polyacrylamide gel electrophoresis system for glucocerebrosidase has been developed. This method was used to characterize the glucocerebrosidase activity of normal and Gaucher disease fibroblasts; the residual glucocerebrosidase activity in adult Gaucher disease fibroblasts co-migrates with the activity from normal fibroblasts.


Effect of an antacid on gastrointestinal absorption of theophylline.

The effect of a magnesium-aluminum hydroxide antacid (Maalox) on the oral absorption of aminophylline tablets was studied. Twelve healthy adults were administered 200 mg of aminophylline alone or with 30 ml of antacid in a complete crossover study. Blood samples were drawn at 0.33, 0.67, 1, 2, 4, 8, 12, and 24 hours following theophylline (as aminophylline) administration. Theophylline plasma levels were measured by high-performance liquid chromatography. The plasma theophylline concentrations of the group receiving theophylline only were significantly greater than those of the group receiving theophylline plus antacid at the 0.67- and 1-hour sample times only (p less than 0.05). The extent of theophylline absorption and the eliminated rate constant were not significantly affected by the antacid. Antacid significantly decreased theophylline's absorption rate constant (p less than 0.05), indicating a slower absorption of theophylline with antacid. Concurrent administration of the antacid Maalox should not significantly change theophylline's clinical effect.


Aminoglycoside serum assays restricted through a pharmacy program.

A pharmacy program designed to reduce the inappropriate use of aminoglycoside serum assays is described, and the results of an evaluation of the program are reported. If the clinical status of the patient for whom an assay is ordered does not correspond to the indications for the test, a pharmacist calculates predicted aminoglycoside serum levels based on renal function and discourages the physician from having the test performed. If the indications for a test are met, the pharmacist checks for potential interactions. He specifies the exact times serum samples are to be collected, and he prepares a pharmacokinetic report for the physician based on the test results. During the 18-month evaluation, 67 tests were ordered for 53 patients. Three tests were not performed based on pharmacist advice. Five tests could not be evaluated. Of the remaining 59 tests, 56 (95% were used appropriately; 54 of the appropriate decisions made (92%) were a result of the physician following the recommendations of the pharmacist. The program appears to prevent problems that occur when aminoglycoside serum assays are not restricted.


Comparative auditory toxicity of aminoglycoside antibiotics in leukopenic patients.

The incidence of auditory toxicity resulting from therapy with ticarcillin (T) (12 g/sq m/day) in combination with gentamicin (G) (200 mg/sq m/day), amikacin (A) (600 mg/dq m/day), or netilmicin (N) (280 mg/sq m/day) was compared. Before administration of these antibiotic combinations to febrile, granulocytopenic patients, baseline audiograms were determined by a pharmacist using a portable audiometer. The before-therapy audiograms for 32 patients receiving T and G, 29 receiving T and A, and 29 receiving T and N were compared with the audiograms after the completion of therapy. The mean length of therapy was seven days. Two patients (6.2%) receiving T and G, one (3.4%) receiving T and N, and one (3.4%) receiving T and A developed auditory toxicity with bilateral decreases of at least 20 decibels at one or more frequencies. The incidence of auditory toxicity secondary to aminoglycoside exposure was low, and the relative auditory toxicity among the three aminoglycosides appeared to be similar.


Clinical toxicology consultation by pharmacists.

The functions of pharmacists in a clinical toxicology consultation service are described. Pharmacists provided three basic services in conjunction with poisonings treated by the emergency department of a children's hospital: (1) assisted with obtaining the history and assessment of the toxicologic proglems, (2) recommended a plan for rational management, and (3) discussed poison prevention with the parents of the victims. Pharmacists were consulted for 189 poisoning cases over a six-month period; 80% of the cases were attended at the bedside and the remainder were monitored by telephone. Drugs were involved in 58% of the patient exposures. Median time for the pharmacist to reach the emergency room after the patient's arrival was 5 to 10 minutes. Physicians and nurses rated the pharmacists' contributions favorably. These results suggest that pharmacists can play an important role in clinical toxicology.


Comparison of kaolin-pectin and activated charcoal for inhibition of aspirin absorption.

The effects of kaolin-pectin suspension and of activated charcoal on aspirin absorption were compared. Ten fasting volunteers each received on five separate occasions three 325-mg aspirin tablets with: (1) 240 ml of water, (2) 10 g of activated charcoal in a slurry with 240 ml of water, (3) 30 ml of kaolin-pectin suspension with 210 ml of water, (4) 60 ml of kaolin-pectin with 180 ml of water, and (5) 90 ml of kaolin-pectin with 150 ml of water. Aspirin bioavailability was estimated from spectrophotometric assay of total 48-hour urinary salicylate recovery. The mean urine salicylate recovery following administration of activated charcoal (69.5%) was significantly less (p less than 0.01) than that following administration of 30, 60 or 90 ml of kaolin-pectin (90.6, 94.6 and 95.3%, respectively) or of water only (98.6%). The mean percent aspirin recoveries for the 30-ml and 60-ml kaolin-pectin treatments were significantly less than that for water only (p less than 0.05). Neither activated charcoal nor kaolin-pectin delayed the rate of aspirin absorption. Although kaolin-pectin reduces the absorption of aspirin, the effect would be of marginal clinical importance. Kaolin-pectin suspension is not recommended as a treatment for aspirin poisoning.


Relative drug safety and efficacy: any help for the practitioner?

Approaches are discussed for assuring that the most useful entity is prescribed when a drug is the treatment of choice. Several attributes of pharmaceutical preparations that are likely to influence health status are mentioned. Three models for increasing drug-of-choice prescribing are discussed: the regulatory model, the formulary model, and the drug use review model. Four options regarding formulary preparation are presented: the federal government, a consortium of professional groups, regional expert committees, or local groups. Research is needed to determine which methods hold promise for increasing the frequency of rational prescribing.


A systematic procedure for selection of automated instruments in the clinical laboratory.

A five-step systematic procedure for comparison and selection of automated instruments for the clinical laboratory is presented. Thirteen criteria commonly used for selection of instruments in the clinical laboratory are discussed, and from these an opinion survey form is developed for use in decision making. A procedure for using this opinion survey form, tabulating the survey data, and making the final recommendation is also discussed.


The effect of hematocrit on visual platelet estimation.

Estimation of the number of platelets on Wright's-stained blood smear and from phase platelet counts on more than 1700 patients were analyzed to determine if there were statistical significance in various ranges of hematocrit values. F-test analysis showed no significant difference among these variations in hematocrit determinations.


Safety procedures in clinical laboratories.

Five types of hazards encountered in the clinical laboratory and a list of safety procedures designed to avoid or minimize them are identified. The safety procedures are written in a precise and easy-to-follow manner so that they can be adopted and used in any clinical laboratory. Medical technology educators are encouraged to teach safety procedures and enforce them in the student laboratory.


The association of Waardenburg syndrome and Hirschsprung megacolon.

We describe four patients with Waardenburg syndrome and Hirschsprung aganglionic megacolon. In view of pathophysiologic relationships and animal studies, we conclude that the association of these two uncommon disorders is pathophysiologically significant.


Comparison of noninvasive with hemodynamic data in patients with pulmonary hypertension due to chronic obstructive pulmonary disease.

Twenty-one patients with chronic obstructive pulmonary disease were studied with right heart catheterization. The mean pulmonary artery pressure (PAP) was compared with several noninvasive tests. The pulmonary lobar diameter/thoracic ratio correlated with the PAP, r = 0.677, P less than 0.01. The oxygen saturation and pH were used to derive a calculated value for PAP. The calculated PAP correlated with PAP values measured below 40 mm Hg, r = 0.787, P less than 0.01 but correlated very poorly with PAP values measured above 40 mm Hg. The electrocardiogram revealed at least one criterion for right ventricular abnormality in all 18 patients with pulmonary hypertension, but was too nonspecific to correlate with PAP. The hemoglobin concentration did not correlate with PAP. There was such wide variation between the measured PAP and the various noninvasive tests that these noninvasive tests could not be used to accurately predict the PAP in an individual patient.


The Bowen-Conradi syndrome -- a highly lethal autosomal recessive syndrome of microcephaly, micrognathia, low birth weight, and joint deformities.

This paper describes six Hutterite children from five families who appear to have been affected by the same syndrome that was described in two brothers by Bowen and Conradi [1]. Our additional cases confirm that the major features of the syndrome include porportionate intrauterine growth retardation, microcephaly, micrognathia, a prominent nose, rocker-bottom feet, joint limitation, and failure to thrive, with death within the first year of life. Bowen-Conradi syndrome is an autosomal recessive trait and pedigree records show that all six families now known are related to each other through two couples born in the late 1700s but that there are additional earlier possible sources of the responsible gene. The differential diagnosis of this syndrome is discussed.


Serum immunoglobulins in chronic lymphocytic leukemia.

Serum immunoglobulin levels were periodically determined in 70 CLL patients and the changes were correlated with several clinical and laboratory parameters. It was found that the IgG and IgA levels decreased significantly as the disease progressed. A low IgG concentration was found at the time of diagnosis in 18.7% and after six years in about 50% of the patients. The IgM concentration, although initially low, increased during the follow-up in 43% of the patients and in four of them a monoclonal fraction appeared in the serum. The changes in the immunoglobulins did not correlate with age, sex or initial leukocyte count. Stage O patients as well as untreated patients also had a decrease in their immunoglobulin levels but advanced disease stage and especially continuous chemotherapy seemed to augment the drop in the immunoglobulin levels. Neither the initial immunoglobulin levels nor the subsequent changes, absolute or relative, had a significant prognostic value.


Sporadic case of apparent aprosencephaly.

We report a sporadic case of apparent aprosencephaly, ie, apparent absence of forebrain with the facial anomalies of the (alobar) holoprosencephaly field complex. The infant lived-14 months, manifested temperature variations between 34.5 and 41.7 degrees C, and suffered at least one episode of severe hyponatremia suggesting hypoaldosteronism of brain or adrenal origin. Eye changes were suggestive of Rieger mesodermal dysgenesis.


Are retarded children more distractible? Observational analysis of retarded and nonretarded children's classroom behavior.

Retarded children are frequently characterized as more distractible and/or more outerdirected than are nonretarded children. In this study behavior thought to reflect these processes was described and the relationship of this kind of behavior to task demands was examined. Retarded and nonretarded children were observed while they worked on academic classroom tasks; retarded children were also observed while they worked on nonacademic tasks. Results indicated that retarded children were less attentive than were nonretarded children during academic periods: They spent less time on task, more time out of their seats, and more time "looking busy" but not working. Little support was found for the notion that retarded children are more outerdirected than are nonretarded children. Retarded children responded differently in nonacademic and academic situations, suggesting that behavior reflecting attention is task-related. Results were discussed in terms of previous conceptualizations of retarded persons' attention processes. Implications for future research and for educational practice were also discussed.


What retarded adults believe about sex.

Information was presented from results of administration of the Socio-Knowledge and Attitudes Test to retarded persons aged 18 to 41 (equal sex distribution), most of whom were moderately or severely retarded. One-half of the sample were residents in a state institution, and the other half lived in their own or in group homes in an urban community. Little relationship was found between subjects' ages and response scores, but, on certain subtests, there were significant relationships between sex-knowledge score and subject's IQ, adaptive behavior level, sex, and/or place of residence.


Effects of learning to ski on the self-concept of mentally retarded children.

Changes in the self-concept of TMR children as a function of experience in a physical activity program were evaluated. The self-concept of a group of students was measured before and after participation in a 5-week ski program. A control group received similar pre- and postmeasures of self-concept but did not participate in the ski program. Significant changes in self-concept occurred among students in the experimental but not the control group. Furthermore, the magnitude of success in learning to ski was shown to be positively and significantly correlated with magnitude of change in self-concept.


Cross-organizational job satisfactions of technician-level staff members.

Job satisfactions of technicians were assessed in three medium to large public residential facilities using the Job Descriptive Index. Technicians in a fourth, much smaller facility provided separate reliability and validity data on the Job Descriptive Index. In general, the job satisfactions of technicians as measured by this scale were lower than those of workers in industrial settings, particularly with respect to pay. Correlational analyses revealed no significant relationship between client characteristics and satisfaction scores. Staffing patterns did, however, affect technician satisfactions in several areas.


Age and sex dependency of the Achilles tendon reflex.

Achilles tendon reflex time was measured in normal subjects (1,837 females and 7,937 males). Values of half relaxation time showed a clear dependency on both age and sex. The reflex becomes slower with advancing age and was consistently slower in females. The results redefine the normal range of the Achilles tendon reflex. Regression lines of relaxation time on age were fitted for each sex separately. Lines representing linear regression, log-linear regression or quadratic regression were inferior to those described by linear splines. The gradual increase of Achilles tendon relaxation time with age was not due to unrecognized hypothyroidism or peripheral neuropathy. It is suggested that one cause of the progressive increment is diminution of sympathetic tone with age, and changes in the muscles themselves may also contribute.


Technician losses in public residential facilities.

A cross-organizational longitudinal survey was undertaken of state-operated residential facilities to gauge the extent to which technician-level work forces are affected by turnover and absenteeism. Twelve facilities participated in this study for a period of 9 months. Monthly turnover rates ranged from .6 to 4.9 percent, with a average of 2.4 percent. Turnover rates appeared to be influenced by the size, location, and staffing patterns of the individual institution. With respect to absenteeism, the average "lost time rate" was 6.7 percent. Various standards suggest that absenteeism exceeding 4.5 percent disrupts recommended staffing ratios. One may conclude that employee withdrawal, whether in the form of avoidable turnover or unscheduled absenteeism, represents a serious managerial problem for many institutions.


Iconic-memory processing of unfamiliar stimuli by retarded and nonretarded individuals.

The iconic-memory processing of unfamiliar stimuli was undertaken employing a visually cued partial-report procedure and a visual masking procedure. Subjects viewed stimulus arrays consisting of six Chinese characters arranged in a circular pattern for 100 msec. At variable stimulus-onset asynchronies, a teardrop indicator or an annulus was presented for 100 msec. Immediately upon cue offset, the subject was required to recognize the cued stimulus from a card containing a single character. Retarded subjects' performance was comparable to that of MA- and CA-matched subjects. We suggested that earlier reported iconic-memory differences between retarded and nonretarded individuals may be attributable to processes other than iconic memory.


Lexical usage of retarded children: an examination of informativeness.

Retarded children's lexical usage was examined as a function of informativeness. The children were most likely to both label and imitate when the referent objects were informative in the presentation sequence. The frequency of labeling and imitation was particularly high when the informative element was an object exemplar that had not been seen before. The results were discussed in terms of the presuppositional abilities seemingly demonstrated by the children and the implications these abilities have for intervention programs.


Speed and accuracy in the choice reaction time of mildly retarded adults.

Reaction times (RTs) to inside stimuli in an 8-choice task decreased for some retarded subjects when the response ensemble was concealed. Corresponding increases in errors suggested that these subjects made separate visual checks of the response keys in order to respond accurately. Other retarded subjects maintained accurate performance by taking longer to respond. An examination of error data from a number of RT experiments indicated that retarded subjects made more errors than did nonretarded subjects when stimuli and responses were less descriminable. A comparison of RTs for correct and incorrect responses reflected intermittent rather than general tendencies to sacrifice accuracy for speed, a result consistent with the possibility of occasional attentional lapses.


Prevalence of speech and hearing impairment noninstitutionalized mentally retarded adults.

The prevalence of speech and hearing impairment was examinated in a sample of 518 mentally retarded persons currently residing in community residential facilities. The prevalence of speech impairment was found to be approximately 51 percent, while hearing impairment was found in about 15 percent of the sample. Prevalence figures were further delineated by level of mental retardation. Speech impairment showed a moderate correlation with measures of intelligence and personal competence. The results of this study support the need of this population for speech and hearing services.


Extended recency effect extended: blocking, presentation mode, and retention interval.

The effect of blocking of stimulus items on the free recall of EMR adolescents was examined. In Experiment 1 a multitrial free-recall list of 15 pictures was presented either simultaneously in groups of 3, or sequentially, one at a time. Consistent ordering was used in both conditions, so that on each trial, each item in each set of 3 pictures was presented contiguously with the other 2 items from that set. In addition, recall came immediately or after a filled or unfilled delay of 24.5 seconds. Results showed that simultaneous presentation led to higher recall, subjective organization, and clustering than did sequential presentation, but analysis of serial-position curves showed a much reduced extended recency effect in comparison with previous studies. Experiment 2 was designed to determine whether the cause of the reduced extended recency was the use of pictures rather than words as stimuli. Stimuli were presented either as pictures, as pictures with auditory labels, or as words with auditory labels, with both simultaneous and consistent ordering for all conditions. Results indicated a strong extended recency effect for all groups, eliminating presentation mode as a causal factor in the data of Experiment 1. We concluded that blocking leads to increased organization and recall over a variety of presentation modes, rates, and block sizes.


Use of teacher prompts to increase social behavior: generalization effects with severely and profoundly retarded adolescents.

In a single-subject design with replication across subjects, teacher prompts were used in an attempt to increase the rate of social behavior of three severely and profoundly retarded adolescents who were legally blind. Training took place in the classroom on successive school days with the teacher prompting each subject to engage in positive social interaction with each peer. Observations for generalization effects immediately followed each training session. The remaining class members were brought into the room, and social interactions were observed in a free-play setting while the teacher was absent. During both phases, observers recorded the behavior of the three subjects for 5 minutes and recorded all units of social exchange that each subject initiated or responded to. Increased rates of social behavior were obtained for all three subjects during both training and generalization. Major factors that contributed to the generalization effects were discussed.


Reducing inappropriate verbalizations of a retarded adult.

Social feedback was investigated as a treatment strategy for reducing inappropriate verbalizations by a retarded adult in a vocational-training program. Treatment procedures were introduced as a combination of three components: praise for not verbalizing inappropriately, reprimands, and instruction. Additional investigations were made into procedures for withdrawing treatment, while maintaining the corrected verbal behavior. Results of the study indicated that the social-feedback procedures were effective in reducing inappropriate verbalizations. Results of withdrawing all social-feedback components at once suggested that the treatment gains would not be maintained; however, fading social-feedback components sequentially was effective in maintaining low levels of inappropriate verbalizations. Further research into multiple-component training packages for changing and maintaining verbal behavior may provide a means for training more skills leading to job success for mentally retarded adults.


Free recall of nonretarded and EMR children: associative and categorical bases of clustering.

A 12-item stimulus list composed of three conceptual categories, each with two low- and two high-associated word pairs, was presented for free recall. Twenty EMR preadolscents, 20 EMR adolescents, and 20 nonretarded fourth-grade children showed associative clustering in accordance with preexperimental interitem associative strength. The nonretarded children showed significantly greater recall and categorical clustering than did the EMR groups. No groups benefited from instructions to cluster. Nonretarded children do not appear to need outside help to accomplish clustering of categorizable material, whereas retarded persons seem to require stronger interventions to induce organization in recall.


The role of a trial of labor with a positive contraction stress test.

During a 28 month period 812 patients underwent antepartum FHR testing. Twenty-eight patients had a positive CST. There were two antepartum fetal deaths and 11 patients had a cesarean section without a trial of labor. Fifteen patients had a trial of closely monitored labor (continuous FHR and fetal scalp blood sampling when indicated) and 11 of these (73%) were delivered vaginally. The CST records were examined for: per cent late deceleration, baseline FHR, presence of FHR accelerations, duration of the latency period (time from onset of contraction to onset of deceleration), and amplitude of deceleration. The absence of accelerations (nonreactive CST) and a latency period of less than 45 seconds both predicted persistent late deceleration during labor or fetal death in utero but statistical significance was found only for the latter parameter.


Pregnancy in the underweight woman. Course, outcome, and growth patterns of the infant.

The obstetric performance and pregnancy outcome of 354 underweight patients were compared with matched control subjects of normal weight. The growth patterns of their infants were also compared. The underweight women had significantly higher rates of cardiac/respiratory problems, anemia, PROM, and endometritis but were less prone to develop pre-eclampsia. Prematurity and low Apgar scores were significantly more frequent in the infants of underweight women. There was no difference in the frequency of IUGR and in perinatal mortality rates. The mean birth weight of the infants of underweight women was 231 grams less than that of infants of control subjects. Underweight women, particularly if they were anemic, had a higher incidence of low-birth-weight infants despite adequate weight gain. AGA infants of underweight women were more likely to be below the twenty-fifth percentile for weight correlated with length by 12 months of age.


Effect of maternal nutritional status and infant supplementation during lactation on postpartum amenorrhea.

This paper explores the effects of maternal nutritional status and food supplementation ingested by the infant on the duration of postpartum amenorrhea. A significant negative association was found between the nutritional status of the mother during the third trimester of pregnancy and the length of postpartum amenorrhea. A negative association was also found between infant supplementation and duration of postpartum amenorrhea. Each of these associations remained significant after controlling for the other, suggesting that both factors independently affect the length of postpartum amenorrhea.


Studies of colloid osmotic pressure in pregnancy-induced hypertension.

Pulmonary edema, although infrequently encountered, may cause death in severe cases of PIH. The mechanisms that account for edema in these instances are unclear. With a transducer-membrane system to directly measure serum COP, 22 patients with PIH were compared to 23 normal pregnant patients at term. In the PIH group the antepartum and postpartum COP values were significantly lower (17.9 and 13.7 mm Hg, respectively) than comparable values for the control group (22.0 and 17.2 mm Hg, respectively). Two patients in the PIH group in whom the antepartum COP values were 13.1 and 14.7 mm Hg exhibited clinical and radiographic evidence of pulmonary edema. Pulmonary artery wedge pressure (PAW) recorded in one patient with pulmonary edema was only moderately elevated to 18 mm Hg. We believe that serial COP determinations combined with pulmonary artery pressure monitoring may be helpful to guide fluid therapy in critically ill patients with PIH.


Fetal risk in delivery with the Shute parallel forceps: analysis of 1,503 forceps deliveries.

A total of 1,503 vaginal deliveries with the Shute parallel forceps during a 10 year period are analyzed as to the risk of instrumental damage. In this series, 35 infants died intrapartum or neonatally. Eliminating all deaths from unrelated causes, three remain in which the forceps could possibly have been implicated. Investigation of these, however, revealed in each case the presence of other concomitant and potentially lethal factors, none of which could be completely ruled out as the primary cause of fetal death. Each of the three cases is discussed in detail. We conclude from our series that the Shute forceps is useful in the delivery of premature infants, but should be employed for this maneuver only by very experienced operators. In these cases, midforceps should be performed only for critical indications. The risk of damage with parallel forceps deliveries from the pelvic floor is minimal if decision for operation is based on cardiotocographic criteria, and under favorable degrees of oxygenation. In the delivery of the immature infants, the parallel forceps can, in fact, hardly be superseded by any other instrument because of its unique controlled protection of the fragile fetal head from even the pressures of the birth canal. Delivery with the Shute forceps can be performed effectively under pudendal block or local infiltration anesthesia.


Myoendothelial and placental blood flow responses to ritodrine infusion in the guinea pig.

The effect of ritodrine hydrochloride on uterine blood flow was investigated in near-term guinea pigs. The infusion of ritodrine in doses sufficient to inhibit uterine activity provoked tachycardia, and the cardiac output tended to rise. The percentage of cardiac output reaching the gravid uterus did not alter during the infusion of 12 micrograms per minute of ritodrine but decreased from 12% to 10% when the infusion rate was 120 micrograms per minute. There was an increase in the myoendothelial fraction of cardiac output in both instances, whereas the placental fraction decreased at the higher rate of infusion. Perfusion of the myoendothelial tissue improved during the infusion of 12 or 120 micrograms per minute of ritodrine, increasing by 25% and 18% respectively. No significant alteration occurred in the perfusion of the placental tissue.


Absence of human placental lactogen in an otherwise uneventful pregnancy.

Human placental lactogen (hPL) is commonly used in surveying the placental function during normal and pathologic pregnancies. This report describes a pregnancy where hPL could not be found in maternal serum or placental tissue. The pregnancy was in all other respects completely normal, ending with the birth of a normal baby. Some possible reasons and consequences of this unique event are discussed.


Saline-instillation abortion with laminaria and megadose oxytocin.

This study examines the effect of laminaria and oxytocin in 638 saline instillation abortions. Laminaria were inserted into the cervical canal in the physician's office 2 to 3 hours before admission to hospital for instillation. Pitocin was given intravenously at a rate of 417 to 555 mu/min starting 2 hours after instillation. Pitocin was given intravenously at a rate of 417 to 555 mu/min starting 2 hours after instillation. Center for Disease Control (CDC) criteria were used to define complications in the present series. Complication rates compared favorably to those in a national CDC study of traditional saline procedures. Instillation-abortion times averaged 12.5 hours in the present series, about half the time previously reported for saline abortion. If confirmed by other studies, laminaria and oxytocin will be beneficial adjuncts for managing patients aborted by saline instillation.


Fetal growth and placental function assessed by urinary estriol excretion before the onset of pre-eclampsia.

In a series of 1,316 patients with pre-eclampsia 744 had urinary estriol excretion measured before and 366 after the onset of clinical signs of the disease. Low estriol excretion had a highly significant association with fetal growth retardation and perinatal death both before and after the onset of clinical signs (p less than 0.001). As assessed by the incidences of low estriol excretion, fetal growth retardation, and perinatal wastage, pre-eclampsia of early onset (before 37 weeks) was a malignant disease in comparison with pre-eclampsia of late onset (after 37 weeks). Patients destined to develop early-onset pre-eclampsia had a high incidence of subnormal estriol excretion (25.4%; p less than 0.001). Although further deterioration of placental function occurred after the onset of clinical signs (41.3%; p less than 0.01), fetal growth and prognosis were already determined.


Cigarette smoking as an etiologic factor in cleft lip and palate.

A case-control study has been made on smoking habits in women who, during 1975, gave birth to infants with closure defects of the central nervous system (ASB) or with cleft lip or cleft palate (CLP). For each case, two control subjects with nonmalformed infants were selected and matched for delivery unit, time of delivery, maternal age, and maternal parity. Smoking habits were routinely included in hospital records at first visit to a maternity health clinic during pregnancy. Data were studied for 66 cases of CLP, 66 cases of ASB, and 261 control subjects. Significantly more women who had infants with CLP smoked than did control women, but women with ASB infants showed a normal smoking pattern. Drug use did not explain the findings. It is suggested that maternal smoking is one of many factors of importance in the etiology of cleft lip and cleft palate in humans.


R--pulse wave timing: a technique for continuous cardiovascular monitoring in obstetrics--preliminary report.

A simple, noninvasive technique for continuous cardiovascular monitoring in obstetrics using R--pulse wave timing is described. This preliminary study suggests that different maternal heart rate/R pulse patterns are found in different clinical circumstances. A significant decrease in the R pulse interval occurred in the third trimester in both normal and diabetic women in the left lateral position when compared to the supine position. The R pulse intervals were all prolonged in the standing position in both gravid and nongravid women. During labor R pulse interval usually shortened during uterine contraction. Prolongation of R pulse interval was observed during thiopental injection, hypotension, and excessive bleeding at cesarean section. Exercise testing in healthy male subjects suggested that the change in R pulse interval becomes constant when the oxygen consumption rate reaches a plateau at 100% maximal work load. Further extensive clinical study appears worthwhile since it may add another dimension to cardiovascular monitoring and give an early indication of cardiovascular reserve.


A study of variable decelerations in association with other heart rate patterns during monitored labor.

A review of 1,011 consecutive intrapartum heart rate tracings yielded 37.3% with some degree of variable deceleration pattern. No differences in Apgar score distribution were observed in the presence of uncomplicated variable deceleration pattern when compared to those tracings marked normal. However, the presence of variable decelerations in association with other heart rate patterns resulted in lower mean Apgar scores at 1 and 5 minutes, which were significantly different from those of the fetal heart rate (FHR) normal group. Mean Apgar scores at 1 and 5 minutes were significantly different from normal when variable decelerations were noted in the presence of tachycardia and loss of variability. Mean Apgar scores were lower when bradycardia (prolonged episodes of heart rate less than 120 bpm) was present in the record when compared to normal, but the presence of variable decelerations with bradycardia did not result in different mean scores. The presence of baseline changes with loss of variability and variable decelerations appeared to result in the lowest mean scores. When bradycardia or tachycardia occurred in exclusive association with variable decelerations, the percentage of depressed newborn infants was relatively high.


Labor decreases the lung water content of newborn rabbits.

To test the prevailing concept that drainage of fetal lung liquid begins after birth, we measured extravascular lung water content of 47 fetal rabbits born at term gestation, with or without prior labor. Rabbits born after labor, either vaginally or operatively, had less water in their lungs than those delivered by cesarean section without preceding labor; there was no difference in lung water content between rabbits born vaginally or operatively after labor. These results suggest that reduction in the volume of fetal lung liquid in rabbits normally begins before birth and depends on the experience of labor, not the mode of delivery.


Changes of lipid peroxidation and superoxide dismutase activity in the human placenta.

The oxygen radical may induce peroxidation of unsaturated fatty acids in vivo. We studied changes in superoxide dismutase (SOD) activity and lipid peroxidation using human placental tissue. Lipid peroxidation was marked in early stages (2 to 4 months) of gestation but decreased with growth and was very small by the end of pregnancy. The SOD activity of placental tissue in early gestation was approximately 250 to 500 U per gram of wet weight. The activity increased with growth of the placenta and reached a level of 400 to 1,500 U per gram of wet weight by the end of gestation. These results for SOD activity suggest that the oxygen requirement in the placenta at early stages of gestation is low compared with that at the end of gestation.


Lipid peroxidation in maternal and cord blood and protective mechanism against activated-oxygen toxicity in the blood.

Concentrations of a peroxidation product (malondialdehyde), fluorescent chromophores, lipofuscin-like fluorescent products, superoxide dismutase, catalase, glutathione peroxidase, and vitamin E in the maternal blood and the cord blood were determined and the results obtained were related to the estimation of lipid peroxidation and protective mechanism against uncontrolled oxidative processes in late pregnancy. Serum levels of fluorescent products were higher in the maternal blood than in the cord blood, indicating less frequent lipid peroxidation in the fetus than in the mother. In support of this assumption, the three protective enzymes and vitamin E were present in relatively lower concentrations in the cord blood. Sudden exposure of the newborn infant to a normobaric atmosphere after beginning breathing seems, therefore, to cause oxidation of red blood cell membrane, denaturation of the membrane, inducing hemoglobin breakdown, and consequently hemolysis.


Postirradiation squamous cell carcinoma in situ of the vagina: treatment by topical 20 percent 5-fluorouracil cream.

Eight patients with squamous cell carcinoma in situ of the vagina were treated with monthly 5 day courses of 20% 5-fluorouracil cream applied to the vagina. Seven (87.5%) of the women had an initial complete response; however, three subsequently developed recurrence after the treatment was stopped. They were retreated, and two of these three patients achieved a subsequent complete response. The overall response to therapy was 75% (6/8) with six women off therapy from 1.1 to 6.9 years. Total follow-up of all patients was 3.1 to 6.9 years with no patients having developed invasive carcinoma. Because of the high success rate with no associated serous sequelae, this is believed to be a satisfactory method of therapy for women with squamous cell carcinoma in situ of the vagina occurring after pelvic irradiation.


Computerized tomography applied to gynecologic oncology.

Forty patients on the gynecologic oncology service at the University of North Carolina were evaluated with CT scans. Accuracy and clinical benefit of these scans were compared to those of manual clinical examinations. The CT scans were generally superior and had fewer (9) verified errors in the regions of the pelvic wall and para-aortic area than did the manual examinations (17). Both the CT and bimanual examinations had the same number of verified errors (3) in the central pelvic region. The authors found the CT scans to be beneficial in evaluation of pelvic wall and para-aortic regions for treatment planning of either primary or recurrent cancer.


The influence of acetylsalicylic acid and paracetamol on menstrual blood loss in women with and without an intrauterine contraceptive device.

The influence of ASA and paracetamol on menstural blood loss and on some hematologic parameters was investigated in 23 women without an IUD and 10 women with an IUD. Neither in women with normal nor in women with small defects in the hemostatic mechanism were statistically significant increases in menstrual blood losses observed during treatment with ASA or paracetamol when compared to placebo. There was no linear correlation between bleeding time and basal menstrual blood loss or between the blood losses induced by ASA and paracetamol and the bleeding time.


The intrauterine contraceptive device and acute salpingitis: a multifactor analysis.

From an indigent population hospitalized with acute salpingitis, 163 patients were compared with 222 control patients from the minor trauma section of the emergency room. Four factors were significantly different between cases and controls: race, type of contraception, number of sex partners, and previous history of salpingitis. A discriminate analysis based on a linear logistic equation demonstrated that each risk factor was independent rather than a reflection of another risk factor. Thus factors associated with race, IUD use, multiple sexual partners, and previous salpingitis increase the risk of salpingitis in the population studied.


Pharmacokinetics of norethindrone acetate in women.

The plasma half-life, MCR and plasma metabolite levels at various time intervals have been studied in six women after an intravenous injection of 3H-norethindrone acetate. The disappearance curve due to norethindrone acetate showed an initial rapid disappearance of 3H with an average half-life of 7.5 minutes and a subsequent slow disapperance with a half-life of 51.5 hours. Norethindrone acetate was cleared from the plasma with an average MCR of 495 L/day. Norethindrone acetate is rapidly metabolised after an intravenous injection. Norethindrone, the main metabolite, disappears from the plasma with an average half-life of 34.8 hours. Norethindrone maintains a high level compared with norethindrone acetate at all time intervals up to 24 hours and an equilibrium is reached between the two at 24 to 48 hours.


delta 4-3-Ketosteroid 5 alpha-oxidoreductase in human uterine leiomyoma.

Homogenates of human endometrial, myometrial, and leiomyoma tissues were incubated with (1,2,6,7-3H)-testosterone, and 3H-dihydrotestosterone was subsequently identified, indicating the presence of the enzyme delta 4-3-Ketosteroid 5 alpha-oxidoreductase. The enzyme activity of leiomyoma was higher than that of endometrial and myometrial tissue, while endometrial activity was higher than myometrial activity. The results raise the possibility that 5 alpha-reduced androgens may play a role in the pathophysiology of uterine leiomyoma.


Modern indications for cesarean section.

Total cesarean section rates and rates of various indications for primary cesarean section were reviewed for four yearly periods during the past decade. The time periods studied were chosen to follow the introduction of new obstetric practices and technologic advances in monitoring fetal condition. The total cesarean section rate increased from 6.8% to 17.1% during this time. The most common indication for primary cesarean section was cephalopelvic disproportion, which represented approximately 40% of cases during each study period. Primary cesarean section for fetal distress increased to 28.2% but has decreased over the past 2 years to a present rate of 11.7%. Primary cesarean section for breech presentation increased from 12.3% to 21%. From the perspective of this review a total cesarean section rate of 15% is predicted for the future.


Surgical treatment of stages IB and IIA invasive carcinoma of the cervix by radical abdominal hysterectomy.

From 1963 to 1977, 349 radical abdominal hysterectomies with bilateral pelvic lymphadenectomy were performed for Stage IB (331 patients) and Stage IIA (18 patients) cervical cancer at the New York Medical College, with no operative deaths. Definitive diagnosis was obtained from the biopsy specimen in 281 patients. Twenty-nine patients were pregnant when the diagnosis was established. The average operating time was 4 hours and 48 minutes with an average blood loss of 900 ml. Eleven fistulas were noted: ureterovaginal, 7; vesicovaginal, 3; rectovaginal, 1. Since 1972, there have been no fistulas in 130 radical hysterectomies. Metastatic carcinoma of the regional lymph nodes was discovered in 27 patients for an incidence of 7.7%. Postoperative total pelvic external irradiation was utilized in 40 patients (27 with positive nodes, 10 with microscopic carcinoma in vascular channels, and an additional three patients with an inadequate vaginal extirpation margin). A total of 62% of those patients with poor prognostic criteria receiving postoperative irradiation are alive and well. Two hundred nineteen patients have been followed up for at least 5 years and the survival rate was 90%. Our data support the view that radical abdominal hysterectomy with bilateral pelvic lymphadenectomy is the treatment of choice for patients with Stages IB and IIA cervical cancer in the nonpregnant state, unless there are major medical contraindications.


Therapy of endodermal sinus tumor of the ovary.

Endodermal sinus tumor of the ovary can be differentiated histologically and immunohistochemically from ovarian embryonal cell carcinoma. A case report of a patient with endodermal sinus tumor is presented in which a long-term remission was achieved by unilateral adnexectomy and combination chemotherapy. Review of the current literature indicates that tumor removal followed by combination chemotherapy with vincristine, actinomycin D, and cyclophosphamide is the most effective method of therapy for this highly malignant ovarian neoplasm. The addition of hysterectomy with contralateral ovariectomy or radiation therapy does not appear to significantly improve the survival of patients with this tumor. Serial plasma determinations of alpha fetoprotein provide biochemical monitoring of response to therapy and may be useful in predicting occult tumor recurrence.


Gestational trophoblastic disease within an elective abortion population.

Gestational trophoblastic disease, most commonly hydatidiform mole, is an unusual condition within the United States. The incidence of hydatidiform mole has been reported to vary from 1 in 1,200 to 1 in 2,000 pregnancies. This report described eight cases of hydatidiform mole among 4,829 patients presenting for elective first-trimester abortion. Factors which might account for the frequency of hydatidiform mole of 1 in 600 are discussed. Although the clinical course of patients with hydatidiform mole appears benign- gross examination of tissue obtained at suction curettage and the liberal use of histologic evaluation in questionable cases is required to make the diagnosis.


Anaprox in dysmenorrhea: reduction of pain and intrauterine pressure.

In a double-blind parallel trial, 24 dysmenorrheic women received a single dose of Anaprox (1,100 mg) or placebo. Over the next 2 hours, pain intensity was scored and intrauterine pressure was measured using an immobilized microballoon. At the end of 2 hours, all 11 patients given Anaprox (but only three of the 13 given placebo) experienced complete pain relief (p = 0.0004). The resting intrauterine pressure (IUP) decreased from a mean of 51.4 to 26.8 mm Hg in the Anaprox-treated group, while in the placebo group the mean resting IUP values remained essentially unchanged ( drop from 55.4 to 51.9 mm Hg was observed). This difference between the two treatment groups was statistically significant in favor of Anaprox (p = 0.03). Several patients from each group were given 0.2 mg of ergonovine by intramuscular injection following the 2 hour trial. In both groups, the resting IUP increased within 30 minutes; the corresponding increase in pain intensity was more pronounced, however, in the placebo group. These results support the premise that a decrease in resting IUP is directly linked to the pain-relieving effects of Anaprox.


Systemic lupus erythematosus in pregnancy.

Most literature on pregnancies in patients with systemic lupus erythematosus (SLE) is retrospective and selective. This report is a detailed, prospective analysis of 13 pregnancies in eight women with SLE. Pregnancy was best tolerated by mothers without significant nephropathy or cardiopathy who had been in clinical remission for more than three months prior to conception. Management was aided by serial evaluation of complement (C3 and C4) levels and careful supervision of immunosuppressive therapy when indicated. Although fetal status was closely monitored, premature deliveries and spontaneous abortions occurred frequently. No malformations or adverse sequelae were noted in surviving infants exposed to immunosuppressive agents during gestation.


Obtaining drug exposure histories during pregnancy.

One hundred fifty-three pregnant patients were included in this study to verify the amount of drugs ingested during their pregnancies. The results demonstrate that, unknown to the physician, pregnant patients take a variety of pharmacologic agents. The patient's medical record is considered grossly inadequate in documenting an accurate assessment of a patient's exposure to drugs taken during pregnancy. Drug histories were obtained utilizing the hospital pharmacist drug history interview and home diary. Validity testing of the pharmacist's drug history and of the medical record history was not performed. The patient's compliance for utilizing the home diary for drugs or chemicals taken during their pregnancy was 83% (127 patients). It was shown that the usual methods of drug history documentation will identify only 30% of the actual drug exposure to the fetus.


Outcome of normal and dysfunctional labor in different racial groups.

Spontaneous labor in patients of different racial groups has been studied relating progress and outcome to whether labor was dysfunctional as defined by the partogram and action line. Forty-three percent of primigravidas and 17.6 to 25.8% of multigravidas passed the action line and had a lower admission cervical dilatation and a longer observed first stage than those patients whose labor progress remained to the left of the action line. White and black primigravidas whose labor progressed to the right of the action line had lower 1 and 5 minute Apgar scores and delivered heavier babies than those to the left. The cesarean section rates were 1.6% and 1.4% (left) and 7.6% and 18.2% (right) in white and black primigravidas, respectively. The cesarean section rate was significantly higher in black primigravidas irrespective of the relationship to the action line due to the high incidence of the complications of hypertension such as fetal distress and abruptio placentae in those in normal labor as well as those in dysfunctional labor due to cephalopelvic disproportion in those patients whose cervimetric progress went to the right of the action line.


In vitro effect of dopamine and pimozide on human chorionic gonadotropin secretion.

In human placental explants cultured in vitro, dopamine inhibited human chorionic gonadotropin (hCG) secretion into the culture media. In the control flasks, the level of hCG secretion was 751 +/- 215 mIU/gm of tissue. When 1 mM of dopamine was added, hCG levels decreased to 321 +/- 57.6 mIU/gm of tissue (n = 6, P less than 0.1)--5 and 10 mM of dopamine significantly inhibited hCG secretion. In contrast, 1 mM of pimozide enhanced hCG secretion by 1.8-fold compared to control levels (1,707 +/- 343 versus 3,117 +/- 0.005). This in vitro effect on hCG is similar to the effect of dopamine and pimozide on hCS secretion by placental explants.


Changes in the glycosaminoglycans distribution pattern in the human uterine cervix during pregnancy and labor.

The glycosaminoglycans distribution pattern of uterine cervix samples obtained from 42 women of reproductive age was determined by means of proteolytic digestion and subsequent chromatographic separation. The following glycosaminoglycans were detected: chondroitin 4- and 6-sulfates, dermatan sulfate, hyaluronate, chondroitin, and keratan sulfate. The connective tissue of the uterine cervix shows a characteristic distribution pattern with regard to glycosaminoglycans which does not correspond to that found in any other tissue studied so far. Based on dry weight, the content of keratan sulfate increases during pregnancy while the concentration of chondroitin remains unchanged. The chondroitin sulfates and dermatan sulfate drop simultaneously. During labor chondroitin increases threefold. The hyaluronate content of the postpartum cervix is higher than that of the cervix in nonpregnant women. Both changes in the solubility of collagen as well as in the distribution pattern of the glycosaminoglycans seem to be related to cervical dilatation.


Fetal breathing movements and the nonstress test in high-risk pregnancies.

Three hundred ninety-eight observations of fetal breathing movements (FBM) and the nonstress test (NST) were made in 223 patients. The presence of FBM was noted in a significantly higher proportion of tests with a reactive NST (88%) than a nonreactive NST (67%). Conversely, a significantly higher proportion of tests were reactive when FBM were present (82.6%) than when FBM were absent (49%). A significant relationship existed betweeen either test and the outcome of pregnancy as judged by the five minute Apgar score or the incidence of fetal distress in labor. Combining two normal tests did not improve the accuracy in predicting outcome; but the combination of both tests, when abnormal, produced a significant improvement in predicting fetuses likely to have an abnormal outcome. The combination of the normal with the abnormal test had a predictive accuracy similar to a single normal test in predicting a normal five-minute Apgar. This combination was associated with an incidence of fetal distress in labor intermediate between that seen with either the normal or abnormal test when alone. Neither a single test nor the combination of tests was helpful in identifying the small-for-gestational age (SGA) infants. These data indicate antepartum fetal evaluation may be improved when more than one biophysical variable is used.


The relative significance of human placental lactogen in the diagnosis of retarded fetal growth.

The purpose of this prospective study was to determine whether serial maternal venous hPL determinations could identify pregnancies resulting in growth-retarded infants from a selected population at presumed high risk for IUGR. Our results demonstrated that mean hPL levels in IUGR outcome pregnancies were significantly lower than normal after 33 weeks' gestation. Mean hPL was also lower in some pregnancies resulting in normal-weight neonates with abnormally low PI or short CHL, suggesting that these neonates, despite normal birth weight achievement, may represent previously unsuspected.