Apparent validity of alternative survey methods.

A comparison of results using three methods of obtaining the same survey data is reported. The assumption is made that in relation to a question for which there is a socially desirable response, e.g., use of seat restraints for children, those reporting nonuse or infrequent use are giving truthful answers. In an experiment in health education, follow-up assignments were made randomly, one third being interviewed face-to-face, one third by telephone, and the rest by a postal questionnaire. There were no significant differences by method of follow-up in the scores reflecting reported changes in behavior following instruction. Both the telephone and mail methods, however, appear to yield a higher proportion of "truthful", i.e., socially undersirable, responses; 30.4% of those contacted by telephone admitted to not using a restraint on the last trip, compared with 26.3% of those questioned by mail and 17.5% in a household interview. It is recommended that careful consideration be given to these alternative methods of obtaining data, particularly in view of their lower cost and possibly greater validity.


Meperidine surveillance in an outpatient department: the recognition of misuse and its control.

The identification of two patients who were misusing meperidine prescribed in a hospital prompted the establishment of a surveillance system to examine the possible extent of the problem of prescription narcotic abuse. All outpatient prescriptions for meperidine in a six-month period were reviewed and 17 high users were identified who were considered to be at greatest risk of misuse; they received 55% of all meperidine dispensed from the OPD pharmacy. These persons obtained their prescriptions primarily through the emergency room, they rarely saw the same physician twice, and 12 of them carried a diagnosis of sickle cell disease. Among these patients, four cases of definite abuse were identified. Interventions aimed at promoting continuity of care to the high users led to a 66% reduction in meperidine prescribed to this group in the emergency room and to a shift in their care to the clinics. Establishment of a registry for narcotic surveillance is a first toward recognition of outpatient drug abuse. Limiting prescribing privileges to the physician responsible for a patient's long-term care can further decrease this risk.


A community program for the control of cardiovascular risk factors: a preliminary evaluation of the effectiveness of the CHAD program in Jerusalem.

A community program for the control of cardiovascular risk factors, the CHAD program, was instituted in a family practice in western Jerusalem in 1971. The effectiveness of the program was evaluated by comparing the findings of community surveys conducted in 1970 and 1975 and by comparing the changes with those observed in an adjacent control neighborhood. This paper reports the findings among men aged 35 years and above. In the community exposed to the program there was a decrease in mean systolic and disatolic pressures, in the prevalence of hypercholesterolemia, and in the prevalence of cigarette smoking. The changes in blood pressures and smoking habits were significantly greater than those observed in the control population. In the control population (only) there was a small increase in mean body weight and a decrease in reported physical activity. The findings suggest that it is possible for a program that operates and through primary health care to have an appreciable influence upon cardiovascular risk factors in the community.


A review of over-the-counter drug therapy.

The authors review the extent of the use of nonprescription drugs as well as possible variables influencing such consumption. Various studies indicate that age, sex, personality characteristics, perceptions of health status, socioeconomic factors, parental example, and pharmacists all play parts in determining over-the-counter (OTC) drug utilization. Several sources express concern about the inaccessibility of accurate OTC drug information to the consumer. Indeed, even the FDA has occasional difficulty obtaining reliable facts on both the numbers and formulae of such products. Several studies indicate that consumers acquire information about their home remedies through advertising, friends and relatives, physicians, pharmacists, and product labels. By far the most influential of these is advertising, and much concern has been voiced over consumers' unquestioning faith in drug ads. Examples are cited of deceptive, inaccurate, and unfair advertising practices used by some OTC drug manufacturers. The pros and cons of the "drug-oriented society" theory are discussed, including an analysis of its underlying origins. Testing of the safety and efficacy of nonrescription remedies has proved to be controversial, especially when considering the ramifications of the placebo effect. Different surveys report widespread misuse of OTC's by consumers through overuse, taking several drugs concurrently, and using home remedies to treat potentially serious diseases.


Life table analysis of membership in an HMO retention.

The retention patterns of the Kaiser Foundation Health Plan (Oregon Region) were studied over a six-year period using a life table analysis. A 5% random sample, consisting of subscriber units that were enrolled at the initiation of the study of subsequently joined during the six-year period, were followed with respect to enrollment retention. The analysis presented here focuses on the 2,112 subscribers enrolled during the 1967-1970 period. These subscribers were characterized by the year they joined the plan and by their age and sex. The analyses showed that age of the subscriber and length of time on the plan consistently affected the probability of continued enrollment. The sex of the subscriber and the initial year of enrollment showed only a slight differential affect. A general pattern of high attrition in the first year, but rapid slackening thereafter, existed in all subgroup specific analyses. The utility of the analyses and the impact of the effect of differential membership retention on the plan are discussed.


Accessory abducens nucleus and its relationship to the accessory facial and posterior trigeminal nuclei in cat.

Retrograde transport of HRP by the abducens nerve results in the labelling of its principal nucleus and, in addition, a second nucleus about 2.5 mm ventrolateral to the principal nucleus. The presence of this second or accessory nucleus of the abducens in a mammal confirms the observations of several Nineteenth Century anatomists and rebuts the conclusions of more recent investigators who argued that the nucleus was allied instead to the facial or trigeminal nerves. The same HRP technique applied to the facial or trigeminal nerves shows that the accessory nucleus of the abducens is in the same parasagittal plane as the accessory nucleus of the facial nerve and the most caudal cells of the motor trigeminal nucleus. The accessory abducens and accessory facial nuclei fall in a ventrocaudal to dorsorostral line between the principal nucleus of the facial and the motor nucleus of the trigeminal with the accessory abducens just caudal and ventral to the accessory facial.


Cell growth in the monocular segment of the lateral geniculate nucleus following the opening or closing of one eye.

Both eyes were closed in 12 kittens soon after birth, and one eye was reopened at 23 days. From 14 to 26 days later, the cells in the monocular segment of the LGN connected to the open eye became significantly larger than the corresponding cells on the other side of the brain that were connected to the eye that was still closed. Up to 26 days after eye opening, the response of the monocular segment was similar to that of the binocular segment, so the latter may not be dependent on mutual inhibition or competition between sets of cells connected to each eye. From 30 to 60 days after eye opening, however, there were no differences between the monocular segments, but marked differences between the binocular A laminae where mutual inhibition and competition can occur. In seven more kittens both eyes were untouched until 23 days, when one eye was closed. Between 3 and 31 days later the deprived cells in the monocular segment of the LGN were not more than 8% smaller than those on the other side of the brain, and the measurements were not significantly different in any one cat. Within the binocular part of lamina A, cell growth is retarded by eye closure in two phases. Neither the early phase from 4--6 days nor the later phase from 21 days onwards occurred in the monocular segment, so both may be dependent on mutual inhibition of competition between the sets of cells connected to each eye. Two possible explanations of this difference between the effects of eye opening and eye closing are discussed.


The effect of the sequence of contralateral cortical and collicular lesions on the rate of relearning a visual discrimination by cats.

Visual field deficits which follow ablation of the posterior two-thirds of one cerebral hemisphere in the cat have been shown to be ameliorated by ablation of the contralateral superior colliculus. The present study was designed to determine whether the sequence in which contralateral cortical and collicular lesions are made is a significant factor affecting the rate of monocular relearning through the eye ipsilateral to the cortical lesion. Nine adult cats had the optic chiasm sectioned, were trained to criterion monocularly on a dark-light discrimination, and were divided into two groups. Four cats (Group S) had one superior colliculus ablated, followed one month later by ablation of the contralateral two-thirds of the neocortex. Five cats (Group C) had the same lesions in the reverse order. One month after the second brain lesion, each cat was retrained monocularly through each eye on the dark-light discrimination for food reward in a Y-maze. Through the eye ipsilateral to the cortical lesion, all cats in Group S relearned to criterion more rapidly than cats previously reported with only unilateral neocortical lesions. Four of the five cats in Group C were severely retarded in relearning and two of these cats failed to relearn. The results show that when chiasm-sectioned cats are trained monocularly in a Y-maze on a dark-light discrimination, ablation of the superior colliculus prior to ablation of the contralateral neocortex facilitates relearning through the eye ipsilateral to the cortical ablation. When ablation of the superior colliculus follows the neocortical lesion, learning occurs but is not facilitated by the additional lesion.


Connections of the tectum of the rattlesnake Crotalus viridis: an HRP study.

We have studied the connections of the tectum of the rattlesnake by tectal application of horseradish peroxidase. The tectum receives bilateral input from nucleus lentiformis mesencephali, posterolateral tegmental nuclei, anterior tegmental nuclei and periventricular nuclei; ipsilateral input from nucleus geniculatus pretectalis, and lateral geniculate nucleus pars dorsalis; and contralateral input from dorso-lateral posterior tegmental nucleus and the previously undescribed nucleus reticularis caloris (RC). RC is located on the ventro-lateral surface of the medulla and consists of large cells 25--45 micrometer in diameter. Efferent projections from the tectum can be traced to the ipsilateral nucleus lentiformis mesencephali, the ipsilateral lateral geniculate region, anterior tegmental region and a wide bilateral area of the neuropil of the ventral tegmentum and ventral medualla. We have not found any direct tectal projections from the sensory trigeminal nuclei including the nucleus of the lateral descending trigeminal tract (LTTD). We suggest that in the rattlesnake, RC is the intermediate link connecting LTTD to the tectum.


The development of vibrissae representation in subcortical trigeminal centers of the neonatal rat.

In every station of the trigeminal system of the young rat, the segmented activity of the mitochondrial enzyme succinic dehydrogenase (SDH) clearly delineates the representation of the mystacial vibrissae. In the trigeminal complex of the medulla, three parallel representation can be seen, two in the spinal trigeminal nucleus and one in the principal trigeminal nucleus. In the next station, the ventrobasal complex of the thalamus, a single representation occurs. Likewise, layer IV of somatosensory cortex contains one representation of the vibrissae. Further, neonatal damage to the mystacial vibrissae results in anomalies within each representation. The present study delineates both the normal development of subcortical trigeminal stations and the aberrant organization seen after vibrisse removal. The results of a similar study on somatosensory cortex (Killackey and Belford, '79) and the present data allow the comparison of the development of each of the five vibrissae representations in the trigeminal system. In the brainstem, each of the three trigeminal complex representations are present at birth, although the pattern becomes more distinct over the first several days of life. Interestingly, vibrissae removal at birth induces an aberrant pattern that is distinct by postnatal Day 3. Although details are not equally discernible in each representation, the abnormalities appear to be similar. The SDH segmentation in the ventrobasal complex develops during postnatal Days 1 through 4. At Day 1, portions of the matrix of high density SDH activity break up into bands. Clusters can be discerned within these bands on Day 2. By Day 4 the pattern is sharply delineated. Vibrissae removal at birth results in anomalies that are a part of the initial development of segmentation, not a later reorganization. Comparison of the present data with that of our previous studies indicates that there is a sequential development of the central somatosensory structures related to the vibrissae, beginning with the most peripheral station. Further, there are many similarities in the development of each station. There are also differences which are particularly important in comparing the trigeminal nuclei with the later stations. The unique features in the abnormal development of the trigeminal nuclei are likely due to their direct connections with the periphery.


Efferent connections of the brainstem trigeminal complex with the facial nucleus of the rat.

The sensory surface of the face of the rat is topographically represented in the brainstem trigeminal complex (Nord, '67), and in parallel with this the underlying facial musculature is also represented in a topographic fashion in the facial nucleus (Papez, '27; Martin and Lodge, '77; Watson and Sakae, '78). It has been recently reported that in the young rat three distinct representations of the vibrissae are present in the sensory portion of the brainstem trigeminal complex (Belford and Killackey, '79). Within this perspective, the specific connectivity between the brainstem trigeminal complex and the facial nucleus was investigated in adult rats by Fink-Heimer technique. The two major sensory nuclei of the brainstem trigeminal complex, the spinal trigeminal nucleus and the principal sensory nucleus, differ in their projection patterns to the facial nucleus. While the principal sensory nucleus sends sparse projections to the ipsilateral lateral and dorsal subdivisions of the facial nucleus, the spinal trigeminal nucleus send differential projections to various subdivisions of the facial nucleus depending on their origin with respect to three cytoarchitectonically different subnuclei that compose the spinal trigeminal nucleus. It is concluded that the magnocellular portion of subnucleus caudalis projects rather heavily to the ipsilateral lateral subdivision of the facial nucleus, while the projections from the subnucleus interpolaris are sparser and distributed more widely to parts of the lateral, dorsal and intermediate subdivisions of the facial nucleus ipsilaterally. In contrast to ipsilateral facial projections from the rest of the brainstem trigeminal complex, the projections from the subnucleus oralis of the spinal trigeminal nucleus are bilateral and confined to the intermediate subdivision of the facial nucleus. However, ipsilateral projections of the subnucleus oralis are denser than the the very sparse contralateral projections. In addition to the facial projections from the brainstem trigeminal complex, projections from the upper portions of the cervical cord to the medial subdivision of the facial nucleus were observed. These projections ar bilateral, and those fibers destined for the contralateral medial subdivision cross over below the level of the pyramidal decussation.


3H-estradiol, 3H-testosterone and 3H-dihydrotestosterone localization in the brain of the lizard Anolis carolinensis: an autoradiographic study.

The presence and the neuroanatomical topography of sex hormone concentrating cells in the brain of the American chameleon, Anolis carolinensis have been demonstrated by these experiments. After 3H-estradiol administration large numbers of hormone concentrating cells were found in the amygdala, septum, medial preoptic area, anterior hypothalamic area, the ventromedial and periventricular nuclei of the hypothalamus, and anterior pituitary. In addition, labelled cells were found in the torus semicircularis, in and around the nucleus isthmus pars parvocellularis. A small number of labelled cells could also be found in the rostral pallium, motor nucleus of the fifth cranial nerve, the raphé nuclei, and the spinal cord. After 3H-testosterone or 3H-dihydrotestosterone administration the neuroanatomical pattern was very similar to that found after 3H-estradiol; however, fewer labelled cells were seen after the androgens were given. Two exceptions to the similarity of pattern were in a caudal part of the pallium and in the mesencephalic tegmental area. Hormone-concentrating cells were found after 3H-testosterone or 3H-dihydrotestosterone administration, while labelled cells in these two areas after 3H-estradiol administration were extremely rare. The pattern of hormone-concentrating cells was the same in male and female brains, for each of the hormones. The preoptic area, hypothalamus, and anterior pituitary have been demonstrated in reptiles to be involved in neuroendocrine regulation and in the control of sex behaviors. The presence and neuroanatomical pattern of sex steroid binding cells in the brains of a wide variety of vertebrates have been documented. Large numbers of hormone-concentrating cells were found in all of these species in the medial preoptic area, tuberal hypothalamus, specific limbic structures, the mesencephalon deep to the tectum, and the anterior pituitary. Most hormone-concentrating cells in the brain of A. carolinensis were found in these same brain regions, thus indicating a vertebrate-wide stable core of hormone-concentrating cells in neuroanatomically defined regions.


The cellular origin of the b-wave in the electroretinogram -- a developmental approach.

Retinal ganglion cells and retinotectal synapses of chick embryos can be activated by electrical stimulation at early stages of development (Rager, '76a,b), whereas light evoked responses occur only towards the end of the incubation period. Thus, photoreceptors seem to be the last cells to mature in the chain of elements necessary to enable transmission of visual information to tectal neurons. In the present study the development of light evoked activity in the retina was investigated and compared with the structural maturation of retinal cells. This ontogenetic approach offers a solution to the problem of the cellular origin of the b-wave called in question by recent records of the potassioretinogram (KRG). Lammellar structures in the developing outer segments of photoreceptors can first be observed on incubation day 17. Late on the same day a corneal electroretinogram (ERG) and a visual evoked response on the optic tectum (VER) can be recorded. The response properties of the developing b-wave and VER were tested using various stimulus parameters. From the latencies of the b-wave and of the VER it is concluded that the b-wave is not generated directly by the activity of neurons involved in intraretinal signal transmission. Thus it is necessary to consider secondary processes triggered by neuronal activity such as depolarization of glial cells. In the chick retina, Müller cells are virtually the only glial cells. They fulfill all structural requirements necessary to explain the current which spreads through the retina during the b-wave. Electronmicroscopic analysis reveals that Müller cells undergo drastic changes during the early phase of b-wave development (incubation day 18). In particular, the number of microtubules per unit volume and the surface area of Müller cell processes in the outer plexiform layer increase considerably. It is, therefore, suggested that the b-wave originates in the depolarization of Müller cells secondary to synaptic activity in the outer plexiform layer.i


Rods and cones in the mouse retina. I. Structural analysis using light and electron microscopy.

Rods and cones of the C57BL/6J mouse retina have been examined by light and electron microscopy to distinguish the structural features of the two photoreceptor types. By light microscopy, cone nuclei are conspicuously different from rod nuclei in 1-2 micrometer plastic sections. Cone nuclei have an irregularly shaped clump of heterochromatin that appears in single sections to be one to three clumps, whereas rod nuclei are more densely stained and have one large, central clump of heterochromatin. Cone nuclei make up approximately 3% of the photoreceptor nuclei in both the central and peripheral retina at all ages examined up to 267 days. Cone nuclei are confined to the outer half of the outer nuclear layer, and more than 50% of the cone nuclei lie adjacent to the outer limiting membrane. By electron microscopy, cones in the mouse retina meet virtually every morphological criterion of mammalian cones. The outer segments are conically shaped. Many, if not all of the outer segment discs are continuous with the outer plasma membrane, whereas almost all of the rod discs are not. Cone outer segments are only about half the length of the rod outer segments, and they are contacted by long, villous pigment epithelial cell processes. The cone inner segment diameter is greater than the outer segment diameter, and the accumulation of mitochondria present at the apical end of the inner segment forms a more conspicuous ellipsoid than in rods. The internal fiber or axon of the cone is larger in diameter than that of the rod, and it terminates in a large synaptic pedicle with multiple ribbon synapses, whereas the rod terminal is a smaller spherule with only a single ribbon synaptic complex.


Rods and cones in the mouse retina. II. Autoradiographic analysis of cell generation using tritiated thymidine.

The period of cell genesis of rod and cone photoreceptor cells has been determined in the retinas of C57BL/6J mice. Embryonic mice were exposed to a single dose of 3H-thymidine at embryonic day (E) 10--18 by injecting pregnant mice intraperitoneally. Animals at postnatal ages were injected subcutaneously once between postnatal day (P) 0--10. The eyes were removed at one to three months of age. After fixation, they were embedded in glycol methacrylate, sectioned at 1.5 micrometers and prepared for autoradiographic analysis. All of the cone cells are generated over a relatively short time interval during the fetal period. In the posterior retina, the peak of cone cell genesis occurs at E13-E14, and no cones are generated after E16. The rods, by contrast, are generated later and over a longer time period. They first begin to be generated in the posterior retina on E13, but the peak of cell genesis is not reached until the day of birth, and some rods are generated as late as P5. For both rods and cones the peaks of cell genesis in the peripheral retina occur two to three days later than in the posterior retina. The findings demonstrate that rods and cones are developmentally distinct cell types in the mouse retina.


Projections from the subiculum to the deep layers of the ipsilateral presubicular and entorhinal cortices in the guinea pig.

Projections from the subiculum to retrohippocampal areas were studied by reduced silver impregnation of anterograde degeneration and by autoradiographic tracing of transported proteins following injections of radioactive amino acids. The subiculum was found to project to the presubiculum and to the medial and lateral parts of the entorhinal area. The projections are exclusively ipsilateral, and arranged in a dorso-ventral topographical order with the terminations confined to the deep cortical layers. The projections form part of multisynaptic chains within the hippocampal region and must also be implicated in output routes for hippocampal activity additional to the fimbria-fornix system.


Retinal projections in the Tasmanian devil, Sarcophilus harrisii.

Retinal projections were mapped in Tasmanian devils which had one eye injected with 3H-proline. The retinal fibers terminate in seven regions in the brain. These are (1) dorsal lateral geniculate nucleus (LGNd), (2) ventral lateral geniculate nucleus, (3) lateral posterior nucleus, (4) pretectum, (5) superior colliculus, (6) hypothalamus and (7) accessory optic system. The pattern of retinal input to six of these regions is similar to that seen in other marsupials. The pattern of retinal projections to the LGNd, while basically similar to that observed in other polyprotodont marsupials, is much simpler than that seen in the related native cat, Dasyurus viverrinus. The LGNd of Sarcophilus presents the simplest cytoarchitectural organisation of any marsupial examined so far. Each LGNd receives overlapping projections from both eyes. Suggestions of an intermittent lamination are seen in the LGNd contralateral to an eye injection of 3H-proline. On the ipsilateral side there are two patches of label, a large lateral patch and a smaller medial patch, both of which occupy areas receiving contralateral input. The monocular segment, occupying the ventral 40% of the nucleus, is more extensive than has been reported in any other polyprotodont marsupial.


The soap chamber test. A new method for assessing the irritancy of soaps.

The chamber test for assessing the irritancy of soaps entails five weekday exposures to 8% solutions with readings of scaling, redness, and fissuring on the following Monday. Eighteen well-known toilet soaps were evaluated. Great differences were noted. Most had an appreciable irritancy potential. These results contrast with a number of studies which failed to show differences among soaps or which concluded that soaps were innocuous.


Cutaneous irritation induced by crab larvae.

A cutaneous irritation on the exposed surfaces was induced by crab larvae. An abnormal sensation experienced only on exposed skin disappeared when the larval forms were removed. It is to be emphasized that multiple forms of marine animals may produce human cutaneous disorders.


Pigmentary changes in Seckel's syndrome.

Seckel's syndrome consists of multiple congenital anomalies, including bird-headed dwarfism, mental deficiency, and skeletal and ophthalmic defects. We report a patient with this syndrome who demonstrated pigmentary changes, including streaks of brown pigmentation on the neck, groin, and axillae. Histologic examination revealed pigment incontinence.


Alarm reaction of pilosebaceous apparatus.

A series of histologic changes involving the pilosebaceous structures are described under the term "alarm reaction." The follicular manifestation of this phenomenon is characterized by regression of hair matrix, forming a well-defined nest of small basaloid cells found in various parts of the follicular canal. The sebaceous glands either become undifferentiated, forming a solid mass of stratified squamous epithelium, or the sebaceous lobules are taken into the follicular canal and into the surface keratin layer.


"Lumpy-bumpy" elastic fibers in the skin and lungs of a patient with a penicillamine-induced elastosis perforans serpiginosa.

Penicillamine-induced cutaneous elastosis perforans serpiginosa associated with a large air-cyst in the right lung is described in a 29-year-old female patient with Wilson disease. Identical light and electron-microscopic changes were present in both dermal and pulmonary elastic tissue, suggesting a disseminated drug-induced cutaneo-visceral elastosis. Lung cysts have not been previously reported in association with long term penicillamine treatment. The electron-microscopic morphology of the elastic fibers was found to be "specific" enough to allow separation of penicillamine-induced elastosis perforans serpiginosa from other forms of this disease.


Ultrastructural observation of rickettsia-like bodies in erythema cronicum migrans.

Electron microscopic examination of skin biopsies taken from the lesions in two cases of erythema chronicum migrans revealed Rickettsia-like bodies free in the cytoplasm or within phagolysosomes in macrophages. There was also phagocytosis of cellular debris and collagen, and elastic fibers within macrophages.


Dermatofibrosarcoma protuberans. An ultrastructural study of five cases.

An ultrastructural study of five cases of dermatofibrosarcoma protuberans revealed that the basic cell was a spindle shaped fibroblast with a peculiar deeply lobulated nucleus. An origin from perineural and endoneural cells could not be established since basal lamina material was sparsely present in only one case and other differential features were missing. In one case histiocytic cells were found, but also in this case the basic cell was the fibroblast; so evidence of relationship with fibrous histiocytoma was not found.


Disseminated epidermolytic acanthoma.

A 65-year-old Japanese male suffered from numerous brownish papules on his back for 6 months. Clinical appearance resembled seborrheic keratosis, but light microscopic examination revealed epidermolytic hyperkeratosis. Electron findings were the same as those of epidermolytic hyperkeratosis and systemic nevus verrucosus. It may be concluded that this type of skin disease is an acquired epidermolytic hyperkeratosis.


Syringometaplasia: mucinous and squamous variants.

The eccrine sweat ducts are normally lined by cuboidal epithelial cells which may rarely undergo metaplasia, i.e. syringometaplasia. Two lesions were observed in which eccrine sweat ducts displayed the mucinous and squamous variants of syringometaplasia. The first lesion clinically and histologically appeared to be a plantar wart. Microscopically, it consisted of a central invagination surrounded by marked epidermal acanthosis and hyperkeratosis. The invagination was lined by keratinocytes admixed with mucin-filled goblet cells. The mucin was positive by the Alcian blue (pH 2.5) and mucicarmine stains. Numerous eccrine sweat ducts led into the invagination and were focally lined by the mucin-laden cells. Recognition of mucinous syringometaplasia is important since it may be confused with primary or metastatic adenocarcinoma of the skin. The second lesion occurred on the outer ear and was clinically believed to be chondrodermatitis nodularis helicis. Microscopically, there were many islands of atypical squamous cells within the papillary and reticular dermis. These epithelial islands represented squamous syringometaplasia since many contained central lumina with eosinophilic cuticles and blended with normal ductal structures. It is important not to confuse this metaplastic change with invasive squamous cell carcinoma. Squamous syringometaplasia may be analogous to necrotizing sialometaplasia, a recently described phenomenon which occurs in minor salivary glands.


Paracolloid of the skin.

A 51-year-old Caucasian man presented with a yellowish lesion containing multiple protuberances over his right cheek. Light and electron microscopic examination revealed an anhistic substance lacking definite characteristics of either amyloid or collid milium. The term paracolloid degeneration of the skin is introduced to designate this substance which is believed to derive from collagen. A review of the literature showed similar cases previously published under the names of nodular amyloidosis or disseminated colloid.


Proliferating pilar cyst with spindle cell component.

Proliferating pilar cysts are rare tumors which occur most commonly on the scalp of elderly women. The infiltrative areas of these tumors should be differentiated from epidermoid carcinoma because they are usually benign. The intimate association of this entity with a spindle cell component is described here, to our knowledge for the first time.


Dermal duct tumor.

A dermal duct tumor which clinically resembled an intradermal nevus and developed on the lower back of a 59-year-old woman is described. The diagnosis could only be reached by microscopic examination. The dermal duct tumor appears to originate from cells with differentiation towards the intradermal portion of the eccrine sweat duct.


Scanning electron microscopy of dermatofibromas.

The three-dimensional morphology of six dermatofibromas was studied by scanning electron microscopy. Hypertrophic epidermal ridges covered with large keratinized cells overlay each dermal lesion. Small collagenous fibers in the tumors contrasted with the bundles of much larger collagenous fibers in the normal dermis peripheral to the lesions.


Evaluation of the effects of adenosine on hepatic and adipocyte adenylate cyclase under conditions where adenosine is not generated endogenously.

Direct effects of adenosine on adipocyte and hepatic adenylate cyclase have been demonstrated in an assay system where adenosine is not generated. The substrate used, 2'-deoxy ATP may, on metabolism, only give rise to 2'-deoxyadenosine, which does not act at adenosine receptors. With a slight modification of existing assay techniques this assay system has been used to detect a hitherto undiscovered adenosine receptor on liver plasma membranes, which is antagonised by methylxanthines and which stimulates adenylate cyclase activity in a GTP-dependent manner. The potent inhibitory effects of purine-modified adenosine analogs on fat cell adenylate cyclase are reproduced by adenosine in this assay system. An application of this approach to the study of adenylate cyclase not only simplifies detection of the role of adenosine, but also yields insights into the interaction between guanine nucleotides and hormones.


Major elements in milk of the West African dwarf goats as affected by stage of lactation.

Tweove adult West African dwarf (Fouta djallon) does, about 2 years old and weighing from 25 to 28 kg were kept for lactation studies lasting two 19-week periods. During these periods the does were hand-milked twice daily and the daily samples were bulked for each animal for subsequent analysis. The results showed that the colostrum was much richer in its content (g/kg) of Na 1.44 +/- 0.17, K 3.38 +/- 0.22 and Cl 4.83 +/- 0.29 than the mature milk which contained (g/kg) Na 0.65 +/- 0.09, K 1.57 +/- 0.19 and Cl 2.46 +/- 0.58. The corresponding values obtained for Ca (0.65 +/- 0.02) and P (0.36 +/- 0.10) in the colostrum were, however, lower than 2.01 +/- 0.98 and 1.18 +/- 0.28 g/kg obtained for Ca and P respectively in the mature milk. The composition of these elements in the colostrum approached that of the normal goat's milk on the sixth d after parturition. The results showed a rise in Ca, P, Na and Cl levels with stage of lactation and a fall in K content of the milk with advancing lactation with the trends being highly significant (P less than 0.01).


Potential use of 1,25-dihydroxycholecalciferol for prevention of parturient paresis.

Twelve cows, at least third parity, were assigned randomly to either a control or treatment group. Treated cows received .4 mg of the vitamin D metabolite, 1,25-dihydroxycholecalciferol intramusculary in 5 ml corn oil. Intramuscular injections were started 5 days before predicted calving with reinjections every 5 days until calving. Incidence of parturient paresis was 0 and 33% (2 of 6) in the treated and control groups. Response to treatment was rapid with elevated calcium in serum approximately 12 h postinjection. Treatment maintained or elevated calcium and phosphorus concentrations in serum during the critical period, 24 h pre- to 48 h postpartum, when milk fever is most likely to occur. There was, however, no significant difference between treatments at 72 h postpartum. Based on these observations 1,25-dihydroxycholecalciferol holds promise as a preventative of parturient paresis; however, further studies are needed on application and safety.


Relationship between plasma calcium and QT interval of electrocardiogram in dairy cows.

Relationships between calcium of blood plasma and measurements of the electrocardiogram QT interval corrected for heart rate and interval from Q to the apex of T corrected for heart rate were investigated in six dairy cows. Calcium was varied by infusing 4.7% solution of ethylenediaminetetra-acetic acid disodium salt to induce hypocalcemia, followed by treatment with calcium borogluconate. The within-cow regressions of the intervals on calcium in plasma were significant in all four electrocardiogram leads (leads I, aVF, SIII, and SaVF). These regressions differed between cows in these same leads. Correlation coefficients between calcium and the intervals were consistently larger than --.94 in lead SIII in all cows. When the results from four of the cows similar in age and breed were analyzed separately, regression coefficients between individual cows were not significantly different. However, intervals adjusted for calcium in plasma differed between cows.


Importance of animal products in the human diet.

Increased interest in food, nutrition, and health has led to critical evaluation of the American diet by governmental, scientific, and consumer groups. The exact role of diet in health and disease continues to be debated. Over the years trends in consumption of foods and nutrients have developed. These issues are examined. Historically, animal products have played a key role in the overall health of Americans. The contributions of animal products to human nutrition are emphasized along with an introduction to the use of the concept of nutrient density.


Effect of prepartum selenium-vitamin E injection on time for placenta to pass and on productive functions.

The effect of a single injection of selenium-vitamin E containing 21.9 mg sodium selenite upon time for placenta to pass following calving and on subsequent reproductive and lactational performance was evaluated. Incidence of retained placenta was 11.4%. This amount of selenium-vitamin E did not affect the time for placenta to pass, did not reduce calving difficulty, nor did it increase number of heats prior to first breeding, decrease days open or services per conception, or increase milk the next lactation.


Amylase genetic variation of serum in Holstein cattle.

Three amylase phenotypes, AmIB, AmIC, and AmIBC, were detected by electrophoresis of blood serum from 329 Holstein cattle. These phenotypes appear to be controlled by two alleles AmIB and AmIC at the amylase I locus (AmI). Frequencies were .518 and .482 for alleles B and C. The numbers of phenotypes corresponded closely to expectations of Hardy-Weinberg equilibrium. No evidence of linkage between the AmI locus and other genetic marker loci of blood and milk was detected.


Reproductive hormones associated with normal and abnormal changes in ovarian follicles in postpartum dairy cows.

Concentrations of reproductive hormones and ovarian changes were monitored every 4 days during the postpartum period in 35 dairy cows. The cows were classified as either control (22 cows) or cystic (13 cows) based on per rectum examination of the ovaries. Control cows were detected with a corpus luteum after the first postpartum ovulation while in cystic cows, ovarian follicles of at least 2.5 cm in diameter persisted in the absence of a corpus luteum for at least 14 days. The mean postpartum interval to the first follicle 1.5 to 2.0 cm in diameter was about 16 days for both groups. Ovulation was detected earlier postpartum for cows in the control group (18.4 +/- 1.7 days) than for cows in the cystic group (36.3 +/- 2.7 days). Luteinizing hormone in plasma increased during the early postpartum period (days 1 to 10) for both groups, but mean concentrations of luteinizing hormone, progesterone, and estradiol-17 beta in plasma were not different between groups then or on days -8, -4, or 0 (day of the first postpartum follicle 1.5 to 2.0 cm in diameter). During this period (days -8 to 0), estradiol-17 beta and luteinizing hormone in plasma were correlated positively, but regression coefficients differed between groups. These results suggest a partial hypothalamic and/or pituitary failure in releasing pituitary luteinizing hormone as a cause for postpartum ovarian cysts.


Mastitis history, California Mastitis Test, and somatic cell counts for identifying cows for treatment in a selective dry cow therapy program.

Mastitis history, California Mastitis Test scores, and filter-deoxyribonucleic acid cell counts from 232 cows were used to project the effectiveness of criteria which could be used to determine which cows to treat in a selective dry cow therapy program. Bacteriological analyses of quarter milk samples were used to identify infected cows. Effects of month, lactation parity, stage of lactation, and interaction of stage of lactation with lactation parity on somatic cell numbers in milk were determined. The various criteria singly or in combinations correctly identified from 50 to over 92% of the cows with one or more infected quarters at drying off. However, from 25 to 80% of the cows free of infection would have been treated as well. The most discriminating criteria were two monthly cell counts exceeding 500,000 cells per milliliter where 53% of the cows with infected quarters were identified correctly and only 25% of the uninfected cows would be treated, or the two monthly cell counts exceeding 500,000 cells per milliliter plus a California Mastitis Test score of +2 or +3 at drying off. Here 89% of the cows with infected quarters would be treated, and 56% of the uninfected cows would be treated.


Eosinophilic fasciitis: a problem in differential diagnosis.

Seven clinical criteria and corroborative findings from a properly taken biopsy are necessary for the diagnosis of eosinophilic fasciitis. A properly taken biopsy for eosinophilic fasciitis must be to muscle. The technique of taking a specimen of tissue to muscle depth is described.


Complex radiotherapeutic techniques required in the management of certain cutaneous malignancies.

Complex radiotherapeutic techniques are occasionally required in the management of certain cutaneous malignancies. This report cites two clinical conditions and their circumstances for which techniques were applicable, and illustrates the results obtained.


Vesiculation of focal acantholytic dyskeratosis in acral lentiginous malignant melanoma.

A case of acral lentiginous malignant melanoma is presented in detailed clinical and histologic features because it showed an unusually large vesicle in which there were findings consistent with an exaggerated focal acantholytic dyskeratosis.


Treatment of basal-cell carcinomas with a carbon-dioxide laser.

Treatment of basal-cell carcinomas with a carbon-dioxide laser was studied in 24 lesions for adequacy of treatment, the healing process, and the eventual cosmetic result after twelve months. There was a recurrence rate of 50% at the end of one year; healing occurred with mild degrees of hypopigmentation, erythema, and depression; and the cosmetic result was rated good or better than good in 10 of 11 lesions available for judgment. The high recurrence rate was due, we think, to our cautious use of the laser, which, we think nevertheless, warrants further trial with more aggressive application.


Scalp reduction for alopecia.

A 17-year-old boy had a large, scarred area of alopecia from a thermal burn. Forty square centimeters of scarred scalp skin were excised in six sessions. The cosmetic result was excellent. Neither hypertrophic nor keloidal scarring supervened. The technique of scalp reduction and its procedure as an adjunct to hair transplantation is discussed.


Pancuronium blood level monitoring in patients with tetanus.

Overdosage of muscle relaxant has been given as a possible explanation for the hypotensive episodes occurring during the management of tetanus. The aim of the present work was to study the pharmacokinetics of pancuronium during long term infusion. Pancuronium was administered to eight patients with severe tetanus for a period varying from 8 to 24 days. The concentration of pancuronium was measured daily in plasma and urine using a fluorimetric method. The plasma concentration varied from 0.27 to 0.48 microgram/ml. No tendency to accumulation was observed. The plasma concentration fell rapidly below the level associated with muscle relaxation when pancuronium was discontinued. This absence of accumulation can be explained by a rapid elimination of pancuronium through the kidney according to a process of ultrafiltration.


Comparative haemodynamic effects of dopamine and dobutamine in septic shock.

Septic shock associated with depressed myocardial function generally requires the use of catecholamine. Currently dopamine is often selected. Dobutamine is a newly developed catecholamine which has been shown to be of value in severe cardiomyopathic disease. The aim of this work was to determine the most appropriate drug by comparing haemodynamic responses to dopamine and dobutamine in 19 studies carried out in 11 patients with septic shock and heart failure. Cardiac index increased siliarly with dopamine and dobutamine (33%), as did stroke volume (respectively 26.4 and 25%). Arterial pressure increased by 17% with dopamine whereas it did not significantly change with dobutamine due to reduction in vascular resistance of 19%. Dobutamine decreased filling pressure, either right (14%) of left (28%) whilst they slightly but unsignificantly increased with dopamine. Pulmonary shunting increased more with dopamine (47%) than with dobutamine (16%), but PaO2 remained constant with both. Since septic shock is characterized by lowered arterial pressure and vasodilatation it is concluded that effects of dopamine on capacitance and resistance vessels make this drug more suitable. In addition it selectively increases renal blood flow. Nevertheless dobutamine could be appropriate, in case of very high filling pressures, severe peripheral vasoconstriction, marked pulmonary shunting and in some cases where dopamine becomes ineffective.


Study of right ventricular function in ischaemic heart disease using radionuclide angiocardiography.

A technique for the estimation of LVEF from first passage radionuclide angiocardiography was adapted to provide estimates of RVEF. In 17 subjects with no history of cardiovascular disease mean LVEF was 0.71 +/- 0.08 and mean RVEF 0.65 +/- 0.08. Mean values for 15 subjects with coronary artery disease but no previous history of myocardial infarction were 0.66 +/- 0.10 for LVEF and 0.65 +/- 0.08 for RVEF. Depressed ejection fractions were found after acute myocardial infarction. LVEF was lower after anterior (0.43 +/- 0.06) than inferior (0.51 +/- 0.10) infarction. RVEF was normal in the majority of subjects with anterior infarction (0.58 +/- 0.10) but was depressed after inferior infarction (0.50 +/- 0.05). Similar, although less marked, results were found in a group of subjects with old myocardial infarction.


Circulatory defects during phenformin lactic acidosis.

Detailed hemodynamic and metabolic studies were performed during the course of phenformin related lactic acidosis in two patients. Arterial blood lactate was increased to 11.5 and 26.1 mM/L and arterial blood pH was reduced to 7.05 and 6.80 units, respectively. A marked reduction in cardiac indices (0.94 and 1.15 L/min/m2), stroke volume, and stroke work were observed, with either normal or increased arterial resistance. Mild increases in pulmonary artery systolic pressure (50/11), 45/25 mmHg) were observed, but necropsy in both cases disclosed no evidence of pulmonary vascular obstruction. In the absence of increases in central venous and pulmonary artery wedge pressure, a cardiac failure was excluded as primary cause of the low output state. Hypovolemia was excluded on the basis of radioisotope dilution measurements of plasma volume and red cell mass and no increase in cardiac output followed volume expansion. Oxygen extraction from blood was not grossly impaired. These observations indicate that phenformin-related lactic acidosis may evolve as a circulatory defect characteristic of shock in which oxygen delivery rather than oxygen utilization is impaired. The hemodynamic defect is best explained by a defect in the intravascular distribution of blood volume.


Metabolic acidosis and coma due to an overdose of nalidixic acid.

A case of severe metabolic acidosis and coma after taking 28 g of nalidixic acid is described. After administration of 600 mEq of sodium bicarbonate the patient developed a respiratory alkalosis with secondary tetany. She recovered her state of consciousness nine hours later and the acid-base disturbance resolved after sixty hours.


Haemodynamics in phaeochromocytoma. A report of 2 cases.

The haemodynamic measurements made in two cases of proved phaeochromocytoma are described. In both the systemic vascular resistance (SVR) was markedly increased and was associated with a decreased preload. In one case, phentolamine infusion, when lowering the SVR, produced a marked decrease in the cardiac index resulting in a state of hypovolemic shock. This was successfully treated by the administration of plasma expanders. The data tend to indicate that haemodynamic measurements in cases of phaeochromocytoma could be both of diagnostic and therapeutic interest.


Characteristics of transcutaneous oxygen tension monitors in normal adults and critically ill patients.

The performance characteristics of two transcutaneous PO2 monitors were detailed in eleven healthy adults and eighteen critically ill patients (twelve following cardiopulmonary bypass). There was no significant difference in their performance when blood was used as the calibrating medium. In critically ill patients they proved to be of value for recording short term trends in arterial PO2 rather than for measuring absolute values.


Auditory discrimination of rise and decay times in tone and noise bursts.

There are indications in the literature on speech perception that differences in rise and decay times of the amplitude envelope are relevant physical correlates in phonemic contrasts. Yet, little is known about the perception of rise and decay times as such. In the present study we have attempted to establish JND's for both rise and decay times of 1000-Hz sine waves as well as white noise bursts by means of an adjustment method. The rise and decay of stimulus amplitude were synthesized to be linear functions of time. Results show that the JND for a change in rise/decay time is generally about 25% of the duration of the rise/decay time. This Weber fraction is a minimum at rise/decay times of about 80 ms and increases significantly for rise/decay times below 20 ms. Of the four signal condition noise bursts were performed with the greatest accuracy (at moderate rise/decay times), while changes in onset time of sine waves were discriminated best at very short rise times (where energy splatter may have contributed an additional cue).


The effect of timing errors on the intelligibility of deaf children's speech.

The purpose of this study was to quantify the effect of timing errors on the intelligibility of deaf children's speech. Deviant timing patterns were corrected in the recorded speech samples of six deaf children using digital speech processing techniques. The speech waveform was modified to correct timing errors only, leaving all other aspects of the speech unchanged. The following six-stage approximation procedure was used to correct the deviant timing patterns: (1) original, unaltered utterances, (2) correction of pauses only, (3) correction of relative timing, (4) correction of absolute syllable duration, (5) correction of relative timing and pauses, and (6) correction of absolute syllable duration and pauses. Measures of speech intelligibility were obtained for the original and the computer-modified utterances. On the average, the highest intelligibility score was obtained when relative timing errors only were corrected. The correction of this type of error improved the intelligibility of both stressed and unstressed words within a phrase. Improvements in word intelligibility, which occurred when relative timing was corrected, appeared to be closely related to the number of phonemic errors present within a word. The second highest intelligibility score was obtained for the original, unaltered sentences. On the average, the intelligibility scores obtained for the other four forms of timing modification were poorer than those obtained for the original sentences. Thus, the data show that intelligibility improved, on the average, when only one type of error, relative timing, was corrected.


Speech synthesis by linear interpolation of spectral parameters between dyad boundaries.

A recent study [Olive and Spickenagel, J. Acoust. Soc. Am. 59, 993-996 (1976)] has shown that area parameters derived from linear prediction analysis can be linearly interpolated between dyad boundaries with very little distortion in the resultant synthesized speech. The success of area parameter interpolation raises a question: can other acoustic parameters, such as the power spectrum of the speech waveform, be similarly interpolated? The spectrum is of special interest because speech can be synthesized in real time from spectral parameters on a programmable digital filter. To study this question a speech analysis-synthesis system using spectral parameters (samples of power spectra at different frequencies) was simulated. These parameters were determined from the speech signal at every dyad boundary, and interpolated for intermediate values. Dyad boundaries (representing the limits of transition regions between phonemes) were determined manually. Informal listening tests comparing synthetic speech with and without linear interpolation showed slight degradation in the interpolated speech. This degradation is significantly reduced by using an additional point within the dyad boundaries for interpolation.


Speech-reception threshold for sentences as a function of age and noise level.

For 140 male subjects (20 per decade between the ages 20 and 89) and 72 female subjects (20 per decade between 60 and 89, and 12 for the age interval 90-96), the monaural speech-reception threshold (SRT) for sentences was investigated in quiet and at four noise levels (22.2, 37.5, 52.5, and 67.5 dBA noise with long-term average speech spectra). The median SRT as well as the quartiles are given as a function of age. The data are described in terms of a model published earlier [J. Acoust. Soc. Am. 63, 533-549 (1978)]. According to this model every hearing loss for speech (SHL) is interpreted as the sum of a loss class A (attenuation), characterized by a reduction of the levels of both speech signal and noise, and a loss class D (distortion), comparable with a decrease in signal-to-noise ratio. Both SHLA+D (hearing loss in quiet) and SHLD (hearing loss at high noise levels) increase progressively above the age of 50 (reaching typical values of 30 and 6 dB, respectively, at age 85). The spread of SHLD as a function of SHLA+D for the individual ears is so large (sigma = 2.7 dB) that subjects with the same hearing loss for speech in quiet may differ considerably in their ability to understand speech in noise. The data confirm that the hearing handicap of many elderly subjects manifests itself primarily in a noisy environment. Acceptable noise levels in rooms used by the aged must be 5 to 10 dB lower than those for normal-hearing subjects.


Binaural critical masking bands.

Current understanding of the relation monaural estimates of the critical bandwidth for masking and those obtained in binaural listening situations is poor. The present study was designed to improve this situation by obtaining estimates of critical bandwich when the signal and masker were presented: (1) monaurally (NmSm), (2) binaurally with both signal and masker in phase at the ears (NoSo), (3) binaurally with masker in phase and signals 180 degrees out of phase (NoSpi). Threshold estimates were obtained in a two-interval forced-choice paradigm as a function of masker bandwidth for signal frequencies of 500 and 2000 Hz for the three conditions mentioned above. Maskers were computer-synthesized and had essentially infinite rejection slopes. For all conditions, as masker bandwidth was narrowed from wide band, threshold remained relatively constant until some critical bandwidth was reached. Further reductions in bandwidth were followed by progressive lowering of threshold, presumably due to removal of masker energy in the critical band. For both signal frequencies, the derived critical bandwidth estimates for the NmSm and NoSo conditions were similar and were smaller than the critical bandwidth estimates obtained in the NoSpi condition.


Signal detection in computer-synthesized noise.

Human observers detected sinusoidal and pulse-train signals in noise derived from two computer-synthesized sources and from a Gaussian noise source. The synthesized noise stimuli were generated from sequences of pulses whose amplitudes were drawn from two divergent types of probability distributions: a centrally peaked distribution and a bimodal distribution. No differences in the detectability of signals in these noise stimuli were evident at pulse rates of 1000, 2000, 4000, or 10 000 Hz. subjects could not discriminate between the two types of computer-generated maskers at any pulse rate. The data support a spectrum-analyzer model of detection in which multiband filtering of the input smooths the masker energy in each spectral region to approximate the Gaussian case.


The range of spectral integration.

The results of two complementary detection tasks using digitally synthesized noise are reported. In one experiment the bandwidth of the synthetic noise was varied to reveal the region most effective in masking a 1-kHz signal. The bandwidth of the internal filter ("critical band") so measured was about 80 Hz. In another experiment, a wideband noise was used as the masker for a synthetic signal whose bandwidth another experiment, a wideband noise was used as the masker for a synthetic signal whose bandwidth was varied to determine the maximum effective width of the internal filter. Although some earlier experiments suggest maximum effective widths as small as 180-200 Hz (around 1 kHz), the data reported here indicate the range of spectral integration extends from the critical band to a maximum width that may exceed 3 kHz. In addition, the good agreement between the two experiments suggests a new method for estimating critical bandwidths based on the determination of two thresholds: that of a tonal signal in a wideband masker and that of a supracritical-width noise signal in a wider-bandwidth masker.


Temporal modulation transfer functions based upon modulation thresholds.

The detectability of amplitude modulation in the absence of spectral cues provides a quantitative description of temporal resolution for steady-state signals with relatively small amplitude changes. Modulation thresholds for sinusoidally amplitude-modulated wideband noise were measured as a function of modulation frequency. The resulting "Temporal Modulation Transfer Function" (TMTF) shows a lowpass characteristic for modulation frequencies below about 800 Hz. The lowpass characteristic is extended up to approximately 2 kHz when the increment in average power produced by modulation is eliminated. The important parametric effects are summarized as follows: (1) TMTFs are independent of overall level, except at very low intensities; (2) the time constant indicated by the TMTF decreases as the center frequency of the band-limited, modulated noise is increased; (3) modulation thresholds generally decrease with increasing duration of modulation, particularly at low modulation frequencies; (4) when the carrier is gated for the duration of modulation, the TMTF shows a highpass segment at low modulation frequencies. Although the TMTFs are not directly consistent with the attenuation characteristic of a simple lowpass filter, a model which incorporates such a filter, with a time constant of 2.5 ms, describes the entire TMTF and also describes the modulation functions obtained with square-wave and pulse modulation. The wide bandwidth of initial filtering indicated by the model raises the important question of the role of peripheral filtering in determining the detectability of high-frequency modulation.


Representation of steady-state vowels in the temporal aspects of the discharge patterns of populations of auditory-nerve fibers.

This paper is concerned with the representation of the spectra of synthesized steady-state vowels in the temporal aspects of the discharges of auditory-nerve fibers. The results are based on a study of the responses of large numbers of single auditory-nerve fibers in anesthetized cats. By presenting the same set of stimuli to all the fibers encountered in each cat, we can directly estimate the population response to those stimuli. Period histograms of the responses of each unit to the vowels were constructed. The temporal response of a fiber to each harmonic component of the stimulus is taken to be the amplitude of the corresponding component in the Fourier transform of the unit's period histogram. At low sound levels, the temporal response to each stimulus component is maximal among units with CFs near the frequency of the component (i.e., near its place). Responses to formant components are larger than responses to other stimulus components. As sound level is increased, the responses to the formants, particularly the first formant, increase near their places and spread to adjacent regions, particularly toward higher CFs. Responses to nonformant components, exept for harmonics and intermodulation products of the formants (2F1,2F2,F1 + F2, etc), are suppressed; at the highest sound levels used (approximately 80 dB SPL), temporal responses occur almost exclusively at the first two or three formants and their harmonics and intermodulation products. We describe a simple calculation which combines rate, place, and temporal information to provide a good representation of the vowels' spectra, including a clear indication of at least the first two formant frequencies. This representation is stable with changes in sound level at least up to 80 dB SPL; its stability is in sharp contrast to the behavior of the representation of the vowels' spectra in terms of discharge rate which degenerates at stimulus levels within the conversational range.


Optimum threshold crossings and time-window validation in threshold pure-tone computerized audiometry.

Two versions of the "10 dB down-5 dB up" rule were computerized: (1) with a "lax" time-window response validation in which a subject had to press and release a button within the window of 15-3750 ms after onset of a 1-s tone in his earphone (this was designed to stimulate the condition often found in manual audiometry) and (2) with a "strict" condition in which he had to respond within 60-795 ms after onset of the tone and release the button within 15-750 ms following the tone. A threshold-seeking run was continued using 5-dB steps until the threshold had been crossed six times. With 24 subjects it was found that 13 of 288 runs did not yield the "ASHA" criterion (three ascending series ending on the same hearing level (HL), out of any six or fewer consecutive series), but of these 13 runs all but one run did meet the "ANSI" criterion (two ascending series ending on the same HL, out of any three or fewer consecutive series). The ANSI Hearinnd yielded essentially the same means. An ANSI HTL was established within four or fewer ascending series for 95% or more of the runs, while an average of five extra stimuli was needed to pursue the run until an ASHA HTL was achieved (a savings of nearly 5 min per person). It was recommended that the ANSI Criterion for HTL be adopted for many audiometric situations, that a maximum of four ascending series be completed in any single threshold-seeking run, and that rather strict time windows be set within which onset and offset responses may register.


Human values and ethics: professional responsibility.

Following professional codes does not automatically lead to ethical decision-making. Because the health professional makes a commitment to care for human beings and these persons are in a state of need which only expert advice can rectify, a professional decision requires ethical analysis of values. Such analysis engages the whole person in a process of self-reflection and critique of action, something a code of ethics does not provide. For health professionals, including nutritionists and dietitians, the insight is not just philosophical; it stems from the very nature of the profession.


Title VII--Nutrition Program for the Elderly. II. Relationship of socioeconomic factors to one day's nutrient intake.

Food records from 466 participants in the Title VII Nutrition Program for the Elderly were analyzed to determine the relationship of eating at the program site to improvement in dietary intake and to socioeconomic factors. The subjects were divided into three groups: (a) Participants who ate at the meal site on the day of the food record, (b) participants who did not eat there on the day of the food record, and (c) non-participants. Eating at the meal site erased significant differences in dietary intake of nutrients consumed at home related to sex, education, and occupation. Seven nutrients and energy were significantly associated with these factors for both groups of persons not eating at the meal site on the day of the record. However, only sex was related to intake of nutrients (energy, protein, and thiamin) for those eating at the meal site. Women and the socioeconomically disadvantaged benefited the most from the program.


The nutrition program for older Americans. Evaluation and recommendations.

A nutrition program for older Americans, funded under Title VII of the Older Americans Act of 1965, as amended, which served 547 persons over fifty-nine years of age, was evaluated. The results indicate the desirability of: (a) Employing dietitians to administer the program at regional, state, and area levels; (b) serving meals at least five days a week; and (c) including more than one-third of the Recommended Dietary Allowances in the meals served. Women, the socioeconomically disadvantaged, and the oldest senior citizens appeared to be helped the most by these programs. Analysis of blood samples indicated that emphasis on serving vitamin A- and ascorbic acid-rich fruits and vegetables and 3 oz. meat in each meal is warranted.


Mass balance: a quantitative guide to clinical nutritional therapy. I. The predialysis patient with renal disease.

Mass balance principles can be readily applied to the patient with chronic renal failure for the more structured management of his/her nutritional and clinical course. Urine values provide valuable information with respect to rates of protein catabolism and sodium intake; creatinine excretion rates provide a ready check on data accuracy and lean body mass; urea and creatinine clearance can be calculated, if blood levels of these solutes are known. With accurate data on creatinine generation and the ratio of urea to creatinine clearance, creatinine clearance, urea generation, and protein catabolism rates can be estimated from blood levels alone. These techniques then provide quantitative guidance for the nutritional/medical staff in its efforts to control the clinical course of the patient with severly diminished renal function.


Mass balance: a quantitative guide to clinical nutritional therapy. II. The dialyzed patient.

The concepts of mass balance are extended to the nutritional management of the patient with chronic renal failure on dialysis. The use of these concepts permits estimation of protein catabolism from calculated rates of urea generation, using measurement of blood urea levels. Protein catabolic rate will equal intake in the stable patient (zero nitrogen balance), allowing for accurate nutritional screening in a large dialysis population for whom these values are available without individual dietary surveys. This has resulted in a four-fold reduction in routine monitoring of protein nutrition in such patients, freeing the dietitian to concentrate on specific problems. These concepts also comprise a key aspect of the National Cooperative Dialysis Study which seeks to maintain BUN at different levels in four carefully controlled modes of dialysis therapy. With these methods, the monitoring and control of BUN and protein intake has made the dietitian a pivotal member of this study staff.


Buying and food preparation patterns of ghetto blacks and Hispanics in Brooklyn.

Differences in food buying and food preparation practices of blacks and Hispanics in the Bedford-Stuyvesant section of Brooklyn, New York, are analyzed. There were significant variations related to ethnicity, but few differences resulting from the mothers' age and education. The two groups appeared to have many compatible practices which could be improved by the same educational programs, if they were taught in both English and Spanish.


Program evaluation for effective resource management and accountability.

A means of determining the effectiveness of public programs as a basis for justifying resource allocation to these programs is urgently needed. Program evaluation can provide the data base required for program decision-making and modification. A ten-step model for planning and carrying out an evaluation is suggested as a guideline for program personnel who may be assigned to evaluation responsibilities. Nutrition professionals must become aware of the increasing need for evaluation and of the procedures for conducting the evaluation process within programs for which they are responsible. Failure to provide documentation of adequate, on-going evaluation of effectiveness may lead to a loss of resources for the program and, ultimately, to the demise of the nutritional care program.


Cost-based fee-setting for therapeutic consulting services.

A method for developing cost-based dietetic consulting fees is presented which can be applied in hospital in-patient and out-patient departments and in private practice. Limitations and advantages of the method are noted. The advantages outweigh the drawbacks.


Interpretive biomicroscopy.

Slit lamp biomicroscopy provides invaluable diagnostic information as to the nature of ocular abnormalities and disease processes. As such, the emphasis to be presented in this discourse is biomicroscopic interpretation, as opposed to simple observation, with each major ocular structure discussed in turn.


Assessing the Frisby Stereo Test under monocular viewing conditions.

A new random dot stereoscopic test, the Frisby Stereo Test, was evaluated to determine whether monocular information may be used in making correct responses. The performance of 34 optometry students was assessed under both monocular and binocular viewing conditions. Results indicated that one student was able to pass the test upon the initial monocular presentation. Two additional students were able to pass the test monocularly following binocular exposure. It was concluded that the Frisby Stereo test is about as effective as any other commercially available RDS test when used with adults. However, it may have potential deficiencies when used with children.


Comparing stereoscopic performance of children using the Titmus, TNO, and Randot stereo tests.

The stereo acuities of 112 children between 3 and 11 years of age were assessed using the Titmus, TNO, and Randot stereo acuity tests. Results indicated that stereo acuity test scores improved with age and that performance variability decreased with age. Normal adult findings were achieved by age 7. Generally the Randot Stereo test yielded the best stereo acuity performances. It was concluded that the Randot stereo test is a better clinical test for use with children than either the Titmus or TNO stereo tests.


Optometric manpower in Texas--Part I: Demographic characteristics.

The renewed emphasis in health planning within the last few years makes it imperative that optometric manpower be described as comprehensively as possible not only on a national level but also on a state level. This report utilized remittance advice forms completed during the 1978 license renewal cycle of Texas licensed optometrists to complete demographic, educational, and practice characteristics of actively practicing civilian optometrtists in Texas during 1977. Data was examined for the state as a whole and for each Health Service Area (HSA) in the state. A two part paper is presented... Part I, Demographic Characteristics and Part II, Educational and Practice Characteristics (Will appear in August issue).


Diagnostic outcomes of optometric referrals in a VA medical center.

408 conditions affecting the visual system of patients presenting in the optometry clinic of the Birmingham Veterans Administration Medical Center (BVAMC) were referred to other providers within the medical center for care outside the scope of optometric responsibility. Rates of compliance and confirmation are given for nine major categories of eye problems, and the data is analyzed on the basis of age, visual acuity, type of consultation and disposition. Pertinent literature citations are provided.


Optometry in the hospital.

The Optometry Section of the Kansas City Veterans Administration Medical Center (KCVAMC) is an example of "optometry in the hospital" that encompasses three distinct areas: the Optometry Patient Care Program, Optometry Residency Program, and VICTORS Program (Visions Impairment Center to Optimize Remaining Sight). This article will explore the relationships between these areas and how they relate to the medical center's structure, patient care services, and ophthalmology.


Public health in optometric education.

This paper describes the rationale for inclusion on community and public health principles and concepts in the optometric curriculum. The discussion includes the effect of external forces upon the optometric profession in the health care delivery system and the type of knowledge the optometrist must have to evaluate certain portions of the health care industry.


Optometric manpower in Texas; Part II -- educational and practice characteristics.

The renewed emphasis in health planning within the last few years makes it imperative that optometric manpower be described as comprehensively as possible not only on a national level but also on a state level. This report utilized remittance advice forms completed during the 1978 license renewal cycle of Texas licensed optometrists to complete demographic, educational, and practice characteristics of actively practicing civilian optometrists in Texas during 1977. Data was examined for the state as a whole and for each Health Service Area (HSA) in the state. This is the second part of a two part article, the first part, Demographic Characteristics, appeared in the July issue.


Vision care for an underserved community.

In 1975, joint efforts of the Southern California College of Optometry, Los Angeles County Department of Health Services, and involved community organizations resulted in development of a unique pilot outreach project, funded primarily by HEW, bringing vision care to a highly underserved area while providing comprehensive, community-oriented clinical training for future doctors of optometry. This training of optometric students, as part of multidisciplinary health care teams in an area whose population might otherwise have no access to vision care services, may prove an influencing factor in future achievement of an equitable opportionment of healthcare specialists to underserved communities.


Industrial vision revisited.

With the Occupational Safety and Health Act of 1970 and other government agencies addressing the protection of employees from occupational hazards at their work place, there has been a reemphasis in the industrial eye care field. Industrial vision programs are reviewed and an overview of the Army's occupational vision program is presented. If optometry is to continue progress in this sphere of public health, optometrists must become more involved in and knowledgeable of the visual requirements of the local industrial community, and the profession should consider the establishment of a certification program for occupational doctors of optometry.


Guidelines for an occupational vision program.

The need for and development of an effective occupational vision program is discussed. The role of the optometrist as an occupational vision consultant is outlined and specific guidelines for the provision of in-plant and in-office vision services are provided. Requirements of the OSHAct are summarized and specific problem areas related to industrial safety eyewear are also discussed.


Low plus lenses and visual performance: a critical review.

This paper reviews the research on which much of the clinical rationale for using low plus lenses is based. An indepth review of this research reveals some serious errors in research methodology and fails to find support for the clinical rationale which supports use of this form of management.


The incidence of visual anomalies in a population of cerebral palsied children.

There is a relatively high incidence of visual anomalies in persons with cerebral palsy. There has been a significant amount of investigative work into what these visual problems are. This paper reviews the literature and explores new areas, not previously reported on, in population of cerebral palsied children.


Do patients really want cheap lenses?

There is a strong possibility that many patients perceive newspaper advertisements as a sign of dependability or prestige rather than the evidence of unethical behavior that professionals traditionally frown upon. "Confidence in the doctor" was the foremost reason given for seeking professional service in a survey by a major commercial optical corporation. Two hundred fifty patients interviewed in a contact lens practice agreed, and the tabulated results would indicate that price alone is not a major factor.


Highway tests of photochromic lenses.

A highway study of clear, tinted and photochromic prescription spectacles was conducted using a 58-mile driving course marked with 130 randomly spaced transverse white stripes. The data of 29 subjects totaling more than 21,000 stripe detection events showed that coated photochromic prescription lenses performed better by day and poorer by night compared to uncoated white crown prescription lenses, and that a multiple-layer coated, tinted lens (Neo Multicoat) performed at least as well, day or night, as did the uncoated white crown lens.


Construction of a Fresnel membrane telemicroscopic system.

The construction of a simple, inexpensive, yet versatile telemicroscopic system is described. The clinical advantages and disadvantages of such a device in rehabilitation of the partially sighted are discussed.


[A new aspect of the anomalies of visual acuity in relation with the four principal directions of the test (author's transl)].

The visual acuity in the four principal directions of the test of Landolt-C is different. This difference increases in the near vision but not in a regular manner, and neither for a certain direction nor in a given period of the experiment. We have proposed a neural interpretation for this phenomenon.


Forearm arterial injuries.

The effects of single forearm arterial injuries with and without associated neurological injuries were studied. Fifty subjects were evaluated: seven patients with isolated arterial lacerations, 15 patients with isolated nerve lacerations, 13 patients with combined nerve and arterial injuries, and 15 control subjects. A series of noninvasive peripheral vascular studies were correlated with the symptoms produced by a controlled cold-environment exposure. The hemodynamic alterations associated with symptoms of hand ischemia, and particularly with cold intolerance, were studied. Unrepaired single arterial injuries caused modest, consistent alterations in hand vascularity, but few signs of ischemia or symptoms of cold intolerance. The remaining intact artery demonstrated a consistent increase in flow velocity. Combined nerve and artery injuries caused the most significant alterations in hand vascularity, and median nerve and associated artery injuries caused the most disabling symptoms. Single arterial lacerations had no effect on the rate or completeness of recovery from associated nerve injuries.


[Preoperative conjunctival bacterial flora and sensitivity to antibiotics (author's transl)].

2 973 preoperative cultures of conjunctiva have placed in a prominent position 834 pathogenic germs. Cultures in an enriched medium and in an atmosphère including ten per cent of carbonic gas (10% of CO2) have widely increased the number of isolated Streptococus. A study of spectra of antibiotics used in ophtalmology has been made for all these germs. The instability of conjunctival flora with time implies a modification in tactics of bacteriological preoperative samples in order to obtain a better operative security.


The "throbbing sign"--an indication of early venous congestion in replantation surgery.

Venous congestion in a replanted or transplanted digit can be detected, even before any obvious color changes, by the "throbbing" elicited by pinching the digit between the thumb and finger of the examiner until the skin blanches. Releasing the pressure slowly, a sensation of throbbing will be felt synchronous with the patient's pulse rate. The sign disappears when venous congestion is relieved or when swelling persists and increases enough to lessen the arterial inflow.


[Ocular metastasis demonstrated a carcinoma of the thyroid gland (author's transl)].

Report of a case of choroidal metastasis. Enucleation was performed because of the clinical aspect of a primitive tumor. Histopathologic stains revealed a vesicular adenocarcinoma, may be of the thyroid gland. Total thyroidectomy was performed and demonstrated a vesicular microcancer (1/10e mm diameter).


[Visual evoked potentials and ophthalmoscopy redfree light in subclinical retrobulbar neuritis of multiple sclerosis (author's transl)].

Combined study using pattern and flash VER as well as fundoscopy with redfree light shows an increased number of axonal degeneration of the retinal fiber layer in patients suffering from multiple sclerosis without ocular symptoms. Discussion of differential diagnosis of other neuropathies (toxical, compressive, etc.).


[Hyalocytes transplantation after pars plana vitrectomy (author's transl)].

The transplantation of cultivated hyalocytes after vitrectomy gave favourable functional results in 64% of the cases and appears to be a method of preventing atrophy of the globe and ocular hypotony after vitrectomy. We have nevertheless still to demonstrate that the results are better than these after injections of physiological saline.


Ring injury with bilateral rupture of the digital arteries without skin damage.

A particular type of trauma of the ring finger, brought about by a ring, resulted in a subadventitial rupture of the radial digital artery and a complete rupture of the ulnar digital artery, despite the skin remaining intact. The radial digital artery was sutured and the ulnar digital artery was repaired by a vein graft. By the eighth month, the result was satisfactory, with a radial digital artery patent, in spite of a thrombosis of the ulnar digital artery.


Sacrifice of the unsatisfactory hand.

A hand which compares unfavorably with a prosthesis in function, comfort, and appearance may be better amputated. This decision must be made conjointly by the surgeon and the patient. Contributory factors are severe tissue loss, pain, appearance, infection, functional requirements, sexual reasons, psychological makeup of the patient, economics, safety, the time elapsed since injury, the patient's body image and his desires, and the surgeon's opinion. Fifteen patients elected hand amputation for various combinations of these factors. Eleven were fitted with a prosthesis at the time of operation and three within 3 weeks. All patients expressed satisfaction with their decision and 12 were successful users of the prosthesis.


[Indentation of large retinal tears (author's transl)].

According to us large retinal tears are between 20 degrees and 70 degrees in their largest dimension, which excludes true giant tears. Study of the data collected on 42 patients has shown us the following facts:--these retinal tears occur in phakic and often highly myopic eyes;--our global success rate is 73,8%;--tears smaller than 2 to 3 papillary diameters radially are on the whole easy to indent and failures are quite often related to a surgical fault;--tears wider than 3 papillary diameters radially are on the whole difficult to indent and failures are not always related to an obvious surgical fault, fishmouth phenomenon plays an important role;--in every case presence of blood in the vitreous seems to be unfavourable to the prognosis;--use of episcleral pockets solves must of times surgical problems related to fishmouth or tear dimension;--post operative intern limiting membrane retraction is frequent (10% vs 5,7% for all the retinal tears and detachments cured in the same period of time).


Dynamic electromyography and decision-making for surgery in the upper extremity of patients with cerebral palsy.

Seventeen children with cerebral palsy were selected for improvement in upper extremity function. Each had normal or nearly normal intelligence; each hand had good or mildly impaired sensibility; each arm had relatively good placement. Electromyograms with wire electrodes were utilized to study the patterns of activity of the planned tendon transfers. Only muscles with isolated activity in grasp were utilized to transfer in hands with weak grasp. Only muscles with isolated activity in release were utilized to transfer in hands with poor release.


Leprosy and thumb reconstruction by opponensplasty or phalangizing the first metacarpal.

Two relatively simple procedures and can improve thumb function in leprosy (Hansen's disease): one provides opposition for the thumb by an indicis proprius transfer; the other provides grasp for the hand lacking digits by phalangizing the first metacarpal.


Distal digital nerve grafts: clinical and anatomical studies.

An anatomical study of the terminal branches of the digital nerves of thumb and finger indicated a constant trifurcation at the level of the distal interphalangeal joint. Twelve microscopic interfascicular nerve grafts were done in 11 patients who had nerve division at this level with insensitive fingertips. All patients exhibited improved sensibility. Eight of 12 or 67% achieved 6 mm of two-point discrimination. Although there were no children in this study, the subjects under 30 years of age enjoyed better final results.


Effect of nerve graft polarity on nerve regeneration and function.

To evaluate the effect of the polarity of nerve grafts, a 1.0 cm segment of sciatic nerve of 40 adult male Sprague-Dawley rats was excised. In 20 animals the nerve was sutured, maintaining the original polarity. In the order 20 the graft was reversed and sutured into place. Four to 6 months later, the nerves were exposed and directed conduction velocity and amplitude studies were done across the graft. No difference was found between the two groups. Comparison with the control side showed return of 70% to 75% of conduction velocity and amplitude. Nerve graft function was independent of nerve graft polarity.


An epidermoid cyst of the tendon.

An epidermoid cyst in the flexor superficialis tendon of the right middle finger of a child limited extension of the finger by preventing the distal gliding of the tendon at the inlet of the flexor tendon sheath. Full extension was regained by excising the tendon.


Reconstruction of pulleys employing extensor retinaculum.

In ten cases, including five rod placements, four tenolyses, and one immediate tendon graft, 15 pulleys have been reconstructed using a strip of extensor retinaculum 6 to 8 cm long and 8 mm in width. Placed around the phalanx, overlapped, and sutured, the 15 mm segment formely over the fourth dorsal compartment has been positioned over the flexor tendod. The reconstruction has been shown to be stronger than the 10 figure-of-eight No. 4-0 sutures employed to perform it and capable of withstanding immediate active motion. No impairment, functional or cosmetic, of the extensor apparatus has been observed.


Pisotriquetral arthritis: a case report.

Degenerative arthritis of the pisotriquetral joint was diagnosed by point tenderness over the pisiform and crepitus elicited by lateral movement of the pisiform on the triquetrum. It was confirmed by a roentgenogram of the wrist (lateral view in 30 degrees supination) and injection of the pisotriquetral joint with local anesthetic. Excision of the pisiform resulted in complete relief of pain.


Compression of the ulnar nerve at the wrist secondary to a rheumatoid synovial cyst: case report and review of the literature.

Compression of the ulnar nerve within or near the canal of Guyon has been ascribed to numerous intrinsic and extrinsic factors. The anatomy of the region is discussed, and a review of the reported causes of ulnar nerve compression is presented. A case of ulnar nerve compression at the wrist secondary to a rheumatoid synovial cyst is reported. Prompt decompression resulted in clinical and electromyographic recovery of sesory and motor function.


Follow-up report on the electrically driven hand splint.

Since the electrically driven hand splint was introduced in 1972, significant improvements have been made in the design and fabrication of the unit which have made it safer, easier to apply, and readily adjustable to the range of motion of a given finger. Over the last 12 months the results of this form of passive exercise were studied by comparing the gain in total active and passive motion in stiff fingers exercised over a 1 month period with similar stiff fingers treated by conventional manual passive joint exercise. There was a significant improvement in the mean gain of both total active and passive motion in those fingers treated with the electrically driven splint.


Capsulectomy of the metacarpophalangeal and proximal interphalangeal joints.

From July 1975, through March, 1978, 105 metacarpophalangeal joint capsulectomies in 37 patients, 47 dorsal proximal interphalangeal (PIP) capsulectomies in 26 patients, and 65 volar PIP capsulectomies in 41 patients were performed. The procedures were done after conservative methods had failed, and the results were tabulated in each area by diagnostic category. In the major group in which stiffness resulted from fracture and crushing injuries, average gains of 13 degrees to 18 degrees of active motion were achieved, with a change in arc of motion, while nerve paralysis patients did substantially better. The study should clarify expectations from the procedure; functional gains may still be significant.


Congenital anomaly of the thumb: absent flexor pollicis longus tendon.

A 6-year-old girl with congenital loss of flexion in the right thumb was found to have no flexor pollicis longus tendon. All other median-nerve-innervated structures were present and normal.


Simultaneous dislocation of the interphalangeal and metacarpophalangeal joints of the thumb: a case report.

A complete dislocation of the proximal phalanx of the thumb is presented. At 6 months after the injury, the patient had a painless right thumb with a full range of motion. No such similar case has been found in the literature.


Some consequences of the new UK 'recommended daily amounts of food energy and nutrients' for evaluating food consumption surveys.

The amounts of energy and nutrients which have been recommended by the Department of Health and Social Security in 1969 and 1979 are compared. For the nation as a whole, the recommendations for energy and protein have decreased by 6 per cent; thus, the adequacy of an otherwise unchanged diet will appear 6 per cent higher than before. The changes for iron, calcium and the three main B-vitamins are smaller, while vitamin C and vitamin A are virtually unaffected. Nevertheless, as the method of calculating retinol equivalents in the diet should now conform to worldwide practice, the amount of vitamin A in the average diet will appear to be about 6 per cent less than before. It will be no longer practical to evaluate dietary intakes of vitamin D, but there are now official recommendations for folic acid.


Rationalisation of therapeutic diets in the Netherlands.

In 1976 a project was started by The Netherlands Education Bureau for Food and Nutrition to rationalise therapeutic diets and reorganise hospital catering departments. The first part of the work--rationalisation of therapeutic diets, including the introduction of a 'national dietetic instruction form'--is reported here.


Assessment of nutritional status: the biochemical approach and its problems in liver disease.

The role of laboratory tests in the assessment of nutritional status is reviewed. Methods commonly used in evaluating adequacy of energy, protein, mineral and vitamin intake are discussed, and a protocol for nutritional assessment and monitoring is presented. The specific nutritional problems found in liver disease, and the effects these have on this protocol are considered.


Alcohol and the liver.

This paper discusses briefly the definition of alcoholism, the extent of the problem in Britain, the roles of ethanol toxicity and malnutrition in causing liver damage, and the types of liver damage seen in alcoholics.


Has cimetidine revolutionised the medical treatment of peptic ulceration?

Cimetidine inhibits gastric-acid secretion, whatever the stimulant. It is superior to placebo for the healing of both duodenal and gastric ulceration, but it does not cure peptic ulceration. When the drug is stopped ulcers often return. Maintenance treatment with cimetidine taken only at bedtime eliminates duodenal ulcer recurrence in most patients.


Getting the message across.

Messages do not simple 'get across'. The author points out the importance (1) of seeing good communication as an effort of understanding between human beings and (2) of dismissing any idea of a single communicator's skill. There are many and different skills to be applied.


Look after yourself: monitoring the effects of a campaign.

A long-term campaign for better health was launched by the Health Education Council in the UK in January 1978. Preliminary findings from surveys evaluating the campaign are presented.


Role of the nurse specialist in stoma care.

The work of the stoma-care nurse is discussed. Emphasis is laid on the need to liaise with other health professionals also concerned with the patient in hospital and in the community. Some specific problems of stoma patients are also discussed.


Modulation of platelet activation by native DNA.

Native DNA (dsDNA) was found to induce the aggregation of isolated human platelets and the release of platelet 5HT; this activation was inhibited by both theophylline and TYA, suggesting a role for cAMP and metabolic products formed from arachidonate. By contrast, nonaggregating amounts of dsDNA inhibited platelet activation induced by collagen or thrombin. This inhibition, which could be overcome by use of greater amounts of the stimulatory agents, was not associated with the loss of platelet viability. Activation of platelets by dsDNA was not observed in plasma or in isolated platelet systems to which small amounts of cell-free plasma were added. However, dsDNA maintained in plasma its ability to inhibit platelet aggregation induced by collagen and thrombin. RNA and single-stranded DNA failed to induce platelet aggregation or release of 5HT and to block the platelet activation stimulated by dsDNA. Further, dsDNA did not significantly inhibit platelet aggregation in platelet-rich plasma stimulated by ADP or epinephrine. These data implicate dsDNA as a selective and potentially important activator and modulator of platelet responsiveness.


Biosynthesis and post-synthetic modification of a precursor (pro-C5) of the fifth component of mouse complement (C5).

Mouse peritoneal macrophages synthesized and secreted a precursor (pro-C5) of the fifth component of serum complement (C5) in short-term tissue culture. Approximately 0.2% of the newly synthesized intracellular protein and 0.8% of secreted protein were precipitable with antiserum to mouse C5. The precursor is similar in size to the native serum protein (210,000 daltons), but consists of a single polypeptide chain. In contrast, serum C5 consists of two polypeptide chains (m.w. 125,000 and 83,000) linked by disulfide bridges. An electrophoretic variant of pro-C5 distinct from intracellular C5 was detected in medium from macrophage cultures.


Prevention of transplantable tumors by adoptive transfer of spleen cells from immunized rats.

Fischer 344 rats were specifically hyperimmunized with allogeneic, nonvirus-producing [Kirsten murine sarcoma virus (KiMSV)] or syngeneic, virus-producing [KiMSV (Rasheed)] rat tumors. Spleen cells taken from these rats adoptively transferred protection against a 100 to 1,000 X rat tumor dose50 cell challenge with several different transplantable rat tumors. Protection was obtained with spleen cells after removal of adherent cells and macrophages but not peritoneal cells. The spleen cells were not directly cytotoxic but required more than 3 days residence in the recipient before protecting the recipient against challenge. No protection against tumor cell challenge was observed when spleen cells were lethally x-ray irradiated before injection into nontreated rats. Spleen cells taken from rats immunized with normal histocompatibility antigens did not protect in this test system.