Hirsutism.

Many women have some facial hair, and most patients who seek advice will be at the far end of the normal distribution curve for hair. In a second group there is a slight excessive production of androgens with associated hirsutism, either idiopathic or associated with polycystic ovarian disease. An extremely small fraction of patients will have serious disorders of the adrenals or ovaries and significant elevations in androgen levels.


Outpatient surgery and anesthesia.

Outpatient surgery and anesthesia are offered as a means of reducing the costs of health care delivery. Certain principles for outpatient anesthesia are apparent. Inhalational anesthesia is preferred over many intravenous agents. If intravenous agents are used, the doses must be limited. Intravenous agents that are quickly metabolized or redistributed in the body away from the brain are preferred. Inhalational anesthesia inductions that avoid or minimize intravenous agents are preferred. Nerve blocks are useful for outpatient surgery, but may require supplementation with intravenous agents, which in turn may slow recovery.


Sexuality in chronic illness.

Three parameters are involoved in sexual functioning-psychological, organic performance, and organic enjoyment spheres. In evaluating an individual with chronic illness who has sexual complaints one must obtain a normative data base with the general history of the present illness, pertinent past history, a complete sexual history, a psychosocial history with special concern of present factors leading one to pertinent physical findings, and laboratory data (see Table 2). Frequently, it is helpful to interview the sexual partner. Finally, the subjective and objective data must be assessed and a plan with psychiatric or organic treatment, or both, must be made. Often it only can be with prolonged follow-up that we can adequately delineate the exact etiology of the sexual disorder in an individual with chronic medical illness. Even if treatment is difficult, the physician's continued support and interest can mitigate problems in this important aspect of life.


Use of the exercise test in the diagnosis of coronary disease.

The two-step test remains a useful office procedure for the diagnosis of serious coronary disease. The graded exercise test has improved sensitivity. Requiring a good performance and a normal electrocardiographic response as well can exclude prognostically important disease.


Management of depression and anxiety in primary care practice.

Skillful management of depression and anxiety will greatly increase the primary physician's therapeutic impact on his practice. He will, as his skills increase, become a resource person who is able to provide a broader spectrum of medical service to his patients. If family practice is to grow as a legitimate field, its practitioners will need to include the treatment of all of the common disorders in their therapeutic armamentarium, psychiatric as well as organic. The referral of all significant emotional problems to a specialist clearly violates this concept. The primary care physician with proper training can become an effective source of mental health care and in so doing will provide his patients with effective treatment in a familiar, secure, and trusted milieu.


Temporal effects in the estimation of pulmonary diffusing capacity.

Steady state estimates of the pulmonary diffusing capacity for carbon monoxide (DLCO) require measurement of the uptake and the average alveolar partial pressure of carbon monoxide (PACO). The expired alveolar sample obtained by different experimental methods and/or breathing patterns rarely represents the actual PACO. It is widely accepted that nonuniform distribution of ventilation, diffusion and perfusion causes discrepancies in the measurement of diffusing capacity. tan additional source of error in choosing PACO arises in the sampling time chosen by the experimental method. A theoretical study of a ramp-with-pause and a square breathing pattern demonstrates that the sample-time error exists even in the homogeneous lung. The study shows for the homogeneous lung that the correct fractional concentration of alveolar carbon monoxide (FAV) occurs at a time (TAV), one-half of a breathing period after the effective inspiration time (TI) for the two very different breathing patterns. TI is well-defined in relation to any breathing pattern which can be approximated by ramps and pauses. If TAV and the sample time chosen by the experimental method are known, then the measured DLCO can be corrected to the actual diffusing capacity (DL). The theory agrees with experimental results and computer simulations of inhomogeneous lungs from the literature. This agreement suggests that the theory for the homogeneous lung is also relevant to the inhomogeneous lung.


Influence of ruminal and plasma osmotic pressure on salivary secretion in sheep.

The osmotic pressure of the rumen contents and also of the blood was altered by intraruminal administration of water or hypertonic solutions. It was found that alterations in osmotic pressure were accompanied by inverse changes in the flow rate of mixed saliva. Intravenous infusion of hypertonic solutions, causing elevation of the osmotic pressure of the blood without affecting that of the rumen, also caused a reduction of salivary secretion rate. The flow rates of both parotid and residual saliva were affected. When strongly hypertonic solutions of sodium or potassium salts were infused into the rumen, or sodium salts or urea were infused into the blood, the concentration of those substances increased in the saliva. Other treatments had little effect on salivary composition.


Body temperature regulation and thermoneutrality in rats.

Various concepts of thermoneutrality were considered for a proposed study of the role of hypothalamic amines in temperature regulation of rats. The classic definition, the ambient temperature over which metabolic rate is minimum and constant, gave a range of approximately 28 to 32 degrees C. However, within this temperature range rats were inactive, the inactivity apparently representing a behavioural response to heat stress and itself responsible for the reduced metabolic rate; certain thermoregulatory effectors were also activated to increase heat loss. Therefore an alternative range, 18.0 +/- 1.9 (mean +/- S.D.) to 28.1 +/- 1.0 degrees C, was defined in which rats displayed normal activity, behavioural thermoregulations being absent.


A study of chemically induced acute inflammation in the skin of the rat.

Oedema due to application of benzene to the skin was reduced following prior sensory denervation and in animals systemically pre-treated with capsaicine (which is known to confer resistance to chemical irritants) or compound 48/80 (which depletes the body of mast cells). Increased degranulation of mast cells in the benzene-treated skin was unaffected by denervation but did not occur after treatment with capsaicine. Antidromic stimulation of a cutaneous nerve caused oedema and degranulation of mast cells, both of which were less severe than the corresponding effects of topically applied benzene. These effects were completely prevented by prior treatment with capsaicine and the oedema was less severe in 48/80-treated rats. Hence, the presence of mast cells was necessary for full development of the effects of antidromic stimulation. These observations indicate that axon reflexes in sensory fibres contribute to, but are not entirely responsible for, the development of oedema in chemically irritated skin. The prophylactic action of capsaicine may be due to the prevention of degranulation of mast cells rather than to a direct effect on cutaneous nerve endings. These conclusions are embodied in an hypothesis purporting to explain the involvement of axon reflexes, mast cells and various humoral mediators in chemically induced acute inflammation.


The influx of isoleucine into the cerebral hemispheres and cerebellum: carrier-mediated transport and diffusion.

The influx of L-isoleucine from the blood into the cerebral hemispheres, and into the cerebellum, of the living rat was studied. When various raised levels of L-isoleucine were maintained in the circulation, influx did not increase in proportion to the raised blood levels, which showed that a carrier-mediated transport was being saturated. It was found that the values for influx could not be explained precisely by Michaelis-Menten kinetics. The divergence of the observed values for influx, from those which were obtained by the application of Michaelis-Menten kinetics, could be explained if part of the influx was due to a small, non-saturable component. This minor component of influx may be due to diffusion or to a second carrier-mediated transport system that is not readily saturated.


Intestinal lymph flow and lymphatic transport of protein during fat absorption.

A substantial increase in intestinal lymph flow and protein content follows fat ingestion. The effect of intraduodenal feeding of fats was studied in the rat to define the mechanisms responsible. The change appears to be largely independent of the route of fat absorption, that is, whether by the portal venous route or, alternatively, by the lymphatic route. It must be presumed that it is related to events unconnected with the route taken by absorbed fat leaving the intestinal cell.


[Examination of antibiotic sensitivity/resistancy relations of strains of staphylococcus aureus haemolyticus originating from osteomyelitic patients (author's transl)].

On the basis of bacteriology results of osteomyelitic patients of the recent 10 year period the authors examined the changes of antibiotic sensitivity/resistancy relations of strains of coagulase positive Staphylococcus aureus haemolyticus. Examination of 385 strains of Staphylococci showed that Staphylococci originating from osteomyelitic patients are more sensitive, respectively in a lesser degree resistant to antibiotics than those of miscellaneous origin. Concerning 8, in everyday practice most commonly used antibiotics, by means of regression trend line analysis, it has been stated that in the period of 1966-1975 years Staphylococci originating from osteomyelitic patients show a decreasing resistancy to antibiotics examined. The authors are of the opinion that in osteomyelitic patients the no satisfactory results and the high number of recurrent inflammations are not attributable to resistant strains of Staphylococci, but are due to many other biologic factors.


Contacts with a Canadian drug information and crisis centre, 1971-74.

This paper presents data on contacts with a Canadian drug information and crisis centre over a three year span (July, 1971 to June, 1974). The following trends emerged: (1) Although there was only a small change in the total number of contacts, there were substantial decreases in the number of "crisis" and "information" contacts and a substantial increase in the number of "counselling" contacts; (2) The number of "crisis" contacts involving each drug decreased over the time span, particularly those involving "psychedelic hallucinogens" other than L.S.D., solvents, cannabis and opiates. The number of alcohol-involved crisis contacts declined least and alcohol came to account for the second largest proportion of crisis contacts after L.S.D.; (3) There was little change in the age distribution of "crisis" contacts over the period; (4) Crisis contacts in the most recent period (1973-74) were more likely to be rated serious than in the earlier periods; (5) Crisis contacts were less likely to be sent to hospitals in the most recent period.


Drug use among college students--an interim report.

A survey was conducted at Agra (India) to study the extent and pattern of the non-medical use of dependence producing drugs among the post-graduate students of the local colleges and a number of medical students of other colleges of the state of Uttar Pradesh who were posted for training at the Mental Hospital. The study was confined to the academic year 1975-76 and covered 1,200 students. The present interim report is based on a sample of 564 students covered during 1975 (1st stage). The data on the total sample of 1200 (2nd and the final stage) are still being analysed. The results reveal that 73.88 per cent male, and 25.96 per cent female students had a drug experience at some time or another. Drug use was highest (80.66 per cent) among male medical students. The substances commonly used by males were: alcohol, barbiturates, Mandrax (methaqualone diphenhydramine hydrochloride). Vesparax (hydroxyzine hydrochloride), Equanil (meprobamate). Librium (chlordiazeproxide), pain killers (minor analgesics such as aspirin, and cannabis (bhang, ganja, and charas). The female students mainly used Equanil and pain killers. Among the 23 reasons offered for the use of drugs, the majority of students (50-59 per cent) stated that their main reason for drug use was "to relieve tension and facilitate relaxation". The next motivating factor for indulgence was "for the sake of fun" (30-39 per cent). The student drug users reported a number of effects produced by various substances. The most commonly mentioned effects were: excessive sleepiness, sluggishness, giddiness, inability to concentrate on studies, poor physical co-ordination. They expressed their opinion on various aspects of the drug use problem and favoured stringent measures to curb it.


Use of coca leaf in southern Peru: adaptation or addiction.

Use of coca leaves among the Quechua Indians of the Peruvian altiplano is considered from the biological and social perspectives. Biologically, coca use seems to reduce the loss of body heat in the cold and to enhance working ability to a small degree. It may also have nutritional value. Socially, coca is well integrated into the economic and social systems, providing functions in both spheres. The equation of coca use with cocaine addiction is also considered and a simple equivalence is rejected.


Herbicidal treatments for control of Cannabis sativa L.

In order to test herbicides for the destruction of illicit stands of cannabis (Cannabis sativa L.) a series of commercially available herbicides were sprayed on glasshouse-grown plants having 2 to 6 leaves. The following herbicides caused complete kill or severe injury to cannabis plants: (a) herbicides with root and foliage activity--ametryn, atrazine, metribuzin, prometryn, terbutryne, diuron, fluometuron, linuron, methabenzthiazuron, phenobenzuron, ethofumesate, karbutilate, methazole and oxadiazon; and (b) foliar-acting herbicides with brief or no soil persistence--amitrole, bentazon, 2,4-D, diquat + paraquat, glyphosate and phenmedipham. In field experiments herbicides of the latter group, and ioxynil, metribuzin, and a MSMA-cacodylate mixture, caused death or severe damage to young cannabis plants. Glyphosate, ioxynil and bentazon destroyed developed cannabis plants. In glasshouse and field experiments the following herbicides applied to young cannabis plants caused marked deformations of stems, leaves and/or inflorescences: barban, butralin, dalapon, difenzoquat, dinitramine, diphenamid, IPC, napropamide, penoxalin, triffuralin, and U-27267.


Electrocardiographic abnormalities in acute heroin overdosage.

Twenty-one 25 acutely overdosed heroin addicts had abnormalities noted on their admission electrocardiograms. The most common findings were nonspecific ST-T changes in 17 patients, sinus tachycardia in 11, and left or right atrial enlargement in 8. Five patients had more serious arrhythmias (4 atrial fibrillation and 1 ventricular tachycardia). For the entire group the initial PaO2 was 74.8 +/- 48.2 torr. This degree of oxygenation was only achieved with the use of high dose supplemental oxygen. The 5 patients with the more serious arrhythmias had comparable PaO2s but this was only achieved with higher supplemental oxygen concentrations. We conclude that electrocardiographic alterations (other than arrhythmias) are very common in acute heroin overdosage and may be related to hypoxemia. The abnormal cardiac rhythms may be due to the direct effects of heroin or its metabolites. Heroin addiction is associated with a multitude of medical complications which can affect various organ systmes including the heart (1). Within the last six years several reports have appeared documenting electrocardiographic abnormalities in heroin users (2-5). These studies dealt with either a small series of patients or patients who used methadone or heroin in a chronic fashion. No one, to our knowledge, has extensively studied the electrocardiographic changes which occur in patients with acute heroin overdosage. This retrospective analysis of the electrocardiograms (ECG), arterial blood gases and selected electrolytes in 25 consecutively hospitalized patients acutely overdosed on heroin is an attempt to correct this deficiency.


Cardiac and respiratory monitoring of acute stroke patients.

This study evaluates physiologic monitoring as a tool for improved nursing observation of acute stroke patients. Forty-four patients admitted within 48 hours of onset of stroke were monitored using an automated arrhythmia detection system and impedance pneumography. Cardiac arrhythmias were observed in 25 of 44 patients. Three patients with episodes of atrial fibrillation were digitalized and converted to normal sinus rhythm. Respiratory patterns were intermittently abnormal in 39 of 44 patients. The presence of intermittent Cheyne-Strokes respirations or tachypnea was associated with an increased mortality rate. Cardiac monitoring appears to be a useful tool for prompt detection of potentially serious arrhythmias in stroke patients. Respiratory monitoring is useful for detection of abnormalities of respiratory rate and pattern; these abnormalities may serve as an early indicator of change in neurologic status.


Psychiatric consultation with MICU nurses: the consultation conference as a working group.

A group of MICU nurses responded to a series of acute and chronic clinical and administrative stresses by establishing a consultation conference with a psychoanalyst. The evolution of the consultation conference into an ongoing working group is described. Its value as a modality to help deal with the special stresses of MICU nursing personnel is discussed. The problems of introducing a research focus into the conference are examined.


Acute myocardial infarction following fluorescein angiography.

A 64-year-old woman with diabetes mellitus as well as hypertensive retinopathy developed an acute myocardial infarction and hypertensive crisis following the injection of 5 ml. of 10 per cent sodium fluorescein for fundus angiography. This is the first time this complication has been documented. Possible mechanisms for such an occurrence are discussed. Recommendations for recognizing and dealing with patients at high risk for cardiovascular complications of fluorescein angiography are emphasized.


Micturition angina: a case report.

We report a patient with aortic regurgitation and ischemic heart disease in whom normal, effortless micturition repeatly precipitated angina. To our knowledge, only one other case of micturition angina has been reported in English literature since the first such case was recorded in the 17th century. The mechanism of production of this syndrome remains obscure.


Arterial blood gases in the coronary care unit. Part I.

Blood gas analyses are frequently helpful and at times vital in the management of patients who develop complications during an acute myocardial infarction. This vignette discusses the arterial blood gases when congestive heart failure complicates an acute myocardial infarction. Blood gas measurements are generally obtained for two principle reasons: (1) to determine if the patient is well oxygenated--Po2 and O2 arterial gas measurements, and (2) to determine the patient's acid base status (a) using respiratory component of acid base status--PCO2 measurement, (b) using metabolic component of acid base status--HCO-3 measurement, and (c) using both a and b. Arterial blood gases are preferred over venous blood gases. Venous blood gives information relative to the extremity it drains and may be misleading if the extremity is cold, clammy, or underperfused.


Reasons for health office visits in an urban school district.

A survey of 3,048 school clinic visits (a 5% random sample by school of all visits during one school year) revealed the most frequent complaints or reasons for visits of school children in grades kindergarten through twelve. Minor trauma was the complaint identified in the largest proportion of clinic visits at all levels. Taking prescribed medication was the second most frequent reason for clinic visits at the elementary level. Headache was a frequent complaint presented in high school clinic visits.


Situational hyperactivity: a social system approach.

A sociological approach for viewing hyperactivity has been proposed. Its explanatory power may at this time be limited to differentiating between situational hyperactivity and a medical model for explaining the syndrome. Further research could serve to expand and illuminate this theory. However, even as presently formulated, by focusing on situational hyperactivity we have a perspective that returns meaning to the child's behavior. We can now inquire as to what hyperactive children can tell us about school systems, family structure, and the position of children in our own society. Putting meaning back into explanations of behavior can produce greater insights into our understanding of children and the social systems in which they operate.


Research programs of the National League for Nursing.

National League for Nursing research programs are directed toward collecting useful data for the benefit of nursing and toward examining issues to aid in the formulation of policy. NLN's research program has grown by accretion, influenced by needs for additional data; it is organized to serve the requirements of the profession.


Maternal--child nursing research: review of the past and strategies for the future.

Major subdivisions of research in maternal--child nursing (MCN) include childbearing, childrearing, care of the sick or hospitalized child, and a strong emerging emphasis on the special needs of the child in infancy and in special populations, such as mental retardation and chronic illnesses. An example of MCN research is presented--the Nursing Child Assessment Project, funded by the Division of Nursing, which provides a conceptual basis and methodologies to look at inputs and outputs of expressions of child health and illness. Strategies to assist maternal-child nurse scholars to add to their data base--particularly a focus on infancy, childrearing, and specific populations, including an extension into what now is becoming a major concern of American families, care of their aging members--are defined. Needed are additional mechanisms for providing research training for nurses in MCN, as is a network for collaboration and cooperation in the form of systematic input into literature retrieval systems supportive of concepts and which would further the ability to communicate for the exchange of validation of ideas. Although a knowledge base in MCN is emerging, nurses should move onward in a more systematic manner and develop more successful intraprofessional communication.


Toward a nursing gerontology.

An overview of studies that pertain to the care of the elderly and a review of psychosocial gerontologic nursing research during the past 25 years (1951-1976) is presented. Methodologic problems and conceptual issues of these investigations are discussed; gaps in research are identified: suggestions for further nursing gerontologic studies are proposed: and implications for graduate education, clinical training, and preparation for research are presented.


Anatomy and physiology of the liver in relation to clinical assessment.

As nurses assume  expanded roles in patient care, skills in history-taking and in performing a physical examination are expected. Of the various diagnostic procedures the history and physical examination are the most direct and expeditious methods of obtaining facts about patients' problems. As represented in this article, detailed knowledge of the liver's anatomy and physiology as well as that of other body systems is prerequisite to these skills. To understand and document the complexity of life disturbances occuring in patients with hepatic problems, integration of social-behavioral and mental health concepts is needed.


Research: an international perspective.

This review of nursing research on the international scene highlights historical perspectives, including the status of women and changing social forces, research priorities and directions, current activities, trends, and observations of needs for future development.


The liver: a pharmacologic perspective.

One of the may vital functions of the liver is the biodegradation of foreign substances. The enzyme systems responsible for this liver function are frequently the site of drug interactions, both therapeutic and detrimental. Various substances can alter these enzymes by inducing, inhibiting, or competing with them, thus affecting drug response. In most instances, the liver detoxifies and deactivates chemicals, protecting the body from their harmful effects. In some biotransformation processes, however, toxic metabolites are produced that may be injurious to liver tissue as well as other body organs and systems. The effect of alcohol on the liver is a prime example. Although significant strides have been made in recent years, much is yet to be learned concerning the effect of the liver on drugs, the effect of drugs on the liver, and the pharmacologic management of various liver diseases.


Chronic problems in rehabilitation of patients with Laennec's cirrhosis.

Hepatic encephalopathy and ascites are two major complications occuring in patients with Laennec's cirrhosis. Both may be intractable to treatment and may have poor prognoses. Many psychosocial problems are present, and counseling should be geared to optimizing maximum adaptation to the alterations that have resulted. Family and significant others are important support systems for the patient and should be included in as much of the nursing and medical care as possible. The nurse is responsible for a myriad of activities in providing care for cirrhotic patients who develop these chronic problems. Background knowledge regarding nursing theory, pharmacology, pathophysiology, psychology, sociology, and principles of teaching is imperative for effective intervention in these patient care situations.


[Brain infarctions during treatment with ovulation inhibitors (author's transl)].

392 cases of cerebrovascular disturbances in women while taking oral contraceptives are reported since 1962. There has been a remarkable change of the distribution of age among these women. Till 1970 were mostly women involved between the age of 30 and 34 years. Today this type of distribution is no more to be seen because of the growing number of reports about complications in other age-groups. Complications were till 1970 mostly reported in the period from ten days till six months after taking oral contraceptives. The publications of the last three years are showing that many women are involved, who had taken oral contraceptives more than two years. New publications and our own results are showing no changes of the clinical syndromes and of the prognosis. Our investigation shows no decrease in the number of young women suffering of thromboembolic cerebral disorders of unknown aetiology in the last years. In this group is the percentage of the women, which had taken ovulation inhibitors, no reduced. The conception, that there is a connection between oral contraceptives and cerebrovascular occlusions seems more possible as before. Especially attention in prescription of oral contraceptives should be given to the fact of a known predisposition. The rareness of these complications leads to the conclusion that one or more predisponating factors of a nature not yet known have to be existent.


[Electroencephalographic examinations in emotionally disturbed children and adolescents (author's transl)].

Electroencephalographic examinations were conducted on 250 emotionally disturbed children and adolescents (175 boys and 75 girls) between the ages of 6 and 18. ll8 (47.2%) of the children and adolescents had an EEG which corresponded with their age group. 88 (35.2%) of the patients showed a HV alteration without any pathological graphologic elements. The electroencephalography in 44 cases (17.6%) clearly showed abnormal and/or pathological alterations. Frequently conspicuous findings were present in children with aggressive behavior, learning problems, anxiety syndromes as well as enuresis and encopresis. The alterations were less pronounced in those children who stuttered and the obsessive neurotics. No statistical significance, however, could be established. A correlation could not be established between a particular psychological symptom and a specific EEG alteration. Our results correspond in this regard with those presented in the literature. The majority of the authors, however, recorded conspicuous EEG findings much more frequently than we did. Basically, an electroencephalographic examination for emotionally disturbed children seems to be necessary for the recognition of somatic factors. For the evaluation, however, the range of variation of the normal encephalogram in children and its special characteristics at various age levels should be taken into consideration.


Interstitial pulmonary edema.

Florid pulmonary edema is frequently preceded by interstitial edema formation. Because of alterations in the balance of oncotic and hydrostatic pressures between the capillary and lung interstitium or changes in capillary permeability, edema fluid forms in the interstitial spaces of the lung. Once the capacitance of the pulmonary lymphatics is exceeded, interstitial and alveolar edemas become more prominent. Bronchoconstriction and increased vascular resistance lead to ventilation-perfusion imbalance, reduced lung compliance, and increasing symptoms. Early detection is possible by noting characteristic changes in gas exchange and chest radiograph. Awareness and early recognition of these changes, together with the predisposing clinical settings, can lead to the institution of appropriate therapy before patients become severely ill with frank alveolar pulmonary edema.


The pneumoconioses.

The pneumoconioses are by and large industrial diseases, although casual contact may be important on occasion, particularly with asbestos. The effect of dust on the lung ranges from only radiographic changes to severe functional impairment. Destruction and fibrosis of lung parenchyma may be the end result in severe disease. Great improvement has been made in recent years in the control of dust in the numerous situations where it may cause disease. We are still faced with evaluating existing standards of particle concentration in air breathed by workers and establishing safe limits and better control of the particles placed into the general environment. Undoubtedly, there are other particulates which potentially can cause lung disease of which we are not aware. Of even more concern is the realization that a latent period of 20 years or so may be necessary for physicians to become aware of the pathologic process. Every physician who sees patients with pulmonary problems must inquire regarding a history of dust exposure and be prepared to interpret that history.


The diagnostic attributes of echocardiography in the patient with chest pain or pulmonary edema.

In the critically ill or clinically unstable patient, echocardiography is particularly useful in that it provides a safe, painless, and yet reliable bedside method for evaluating the anatomy and physiology of the heart. In addition to diagnostic information, serial echocardiograms may be obtained as often as clinically indicated to monitor and detect hemodynamic changes which may be of prognostic value to the clinician. The ultimate role of echocardiography in coronary artery disease is not yet known, and many of the observations and uses we have discussed are still being investigated and substantiated. For the individual patient with coronary artery disease, it is too early to know whether the information available from the echocardiogram will influence the course or outcome of the disease.


Nursing students' experience in critical care: implications for staff development.

The gap between preservice preparation of nurses for critical-care work and employers' expectations is a crucial factor in providing safe care in special-care units. In this study of senior nursing students from 32 Midwestern schools of nursing, it was found that about 75 per cent of the students had had some experience in critical care, with a mean of 46 hours of experience. Most students observed, did selected procedures, or helped a staff nurse. Only 3 per cent planned and carried out care for more than one patient at a time. Fifty-eight per cent considered themselves unprepared to work in areas of critical care and needed more practice and theoretical instruction. There was wide variation in adequacy of instruction in frequently-used assessment and management techniques.


Arterial blood gases in the coronary care unit. Part II.

This vignette discusses the use of blood gas determination in the diagnosis and management of cardiogenic shock complicating an acute MI. Both arterial and venous samplings are used to assess cardiac output. Results of therapy can be followed by noting directional changes in cardiac output, i.e., changes in A-VDO2.


Improving student clinical experiences.

A sound clinical experience provides the nursing student with the framework necessary to transfer classroom learning to actual patient care. Hospitals and related health care facilities, therefore, are vital components of the teaching process in a nursing education program. However, it is up to the faculty to make wise use of these facilities and their learning potential.


Prevention of heart disease in the asymptomatic post infarction patient.

The post infarction patient, though he appears to have recovered completely and suffers no symptoms, is more than four times as likely to suffer a repeat attack as an individual of the same age who is free of evidence of coronary disease. Secondary prevention begins as part of the process of rehabilitation, while the patient is still in the hospital and most receptive to accepting changes in life style.


Prevention of heart disease in the normal subject with a positive exercise test.

The person who has asymptomatic myocardial ischemia is at high risk because he does not have the benefit of the warning signals afforded by the substernal pain that tells most patients with angina to stop what they are doing.


Prevention of heart disease in the young coronary candidate.

Coronary heart disease characteristically attacks with little warning--in more than half the cases, striking before evidence of target organ involvement is seen. Thus a distinct rationale exists for advocating preventive maintenance in young coronary candidates.


Limitations of the oral glucose tolerance test in diagnosis of early diabetes.

It is not generally appreciated that the diagnosis of chemical diabetes by oral glucose tolerance testing has many pitfalls and that many patients with a diagnosis of diabetes based solely on abnormal glucose tolerance testing in fact do not have true diabetes mellitus. Once the clinician sees an abnormal glucose tolerance test his major objective is to exclude all the nondiabetic factors which may have influenced the testing procedure, thus giving a false-positive result. Furthermore, the standards used in the interpretation of the test remain uncertain in older patients thus markedly reducing the usefulness of the procedure in this group. In addition, the test is of limited value and therefore probably should not be performed in hospitalized or chronically (or acutely) ill patients. Finally the detection of glucose intolerance (in presence of fasting normoglycemia) is rarely of benefit to the patient in the absence of obesity and may prove a hardship for psychosocial reasons. Thus the clinician should carefully evaluate the medical indications and the potential benefits derived prior to ordering an oral glucose tolerance test. He should be very conservative in making a diagnosis of diabetes mellitus based on this test.


Clinical evaluation of vertigo.

In attempting to outline the clinical evaluation of these patients with vertigo we have discussed examples which range in order from benign self-limited disease to those requiring emergency surgery or extensive diagnostic evaluation. We sought also to illustrate how the logic of hypothesis testing is generally employed by clinicians in approaching this or other diagnostic problems. The examples were chosen to illustrate the indications for, as well as the limitations of, the various diagnostic modalities--caloric testing, electronystagmography, audiometric testing, roentgenographic and nuclear medicine procedures--which may be employed by the clinician. Most of the skills discussed in our paper, though traditionally accorded to the fields of neurology and otolaryngology, would seem to be fundamental for any general physician, while the problem of vertigo is an example of how common ambulatory problems may require knowledgeable approach to sort self-limited from more serious illnesses as well as to utilize procedures with purpose and efficiency.


The somatic complaint: a ticket of admission for child abusers.

Primary care physicians should be alert to potential or actual child abusers who use somatic complaints as their ticket of admission to the health care delivery system. Five patients who presented in this manner will be discussed along with salient features of child abuse. Suggestions for approaching those abusers who use functional complaints as their ticket of admission will be outlined.


Role of the clinical psychiatrist and psychologist in primary care medicine.

Both the clinical psychiatrist and clinical psychologist can be important adjuncts to the family practitioner in delivery of comprehensive health care services. Some general guidelines are offered for distinguishing between the two disciplines and knowing how and when to utilize their respective services.


Tennis elbow.

Tennis elbow is an inflammation and/or rupture of the extensor aponeurosis at or about the lateral epicondyle. Relief of inflammation, improvement of strength, endurance, and flexibility of the injured extensor muscle unit, and diminution of the force loads in most instances will relieve symptoms.


Antimicrobial susceptibility of Haemophilus parainfluenzae.

Fifty random clinical isolates of Haemophilus parainfluenzae were tested for their susceptibility to 10 antibiotics by a microtiter broth dilution method. Three of the strains tested were resistant to ampicillin, whereas eight were resistant to tetracycline. All strains tested were susceptible to chloramphenicol, kanamycin, gentamicin, cephalothin, and colistin. The ranges of minimal inhibitory concentrations for the three remaining antibiotics were: 0.5 to >/=128 mug of penicillin G per ml, 0.03 to 4 mug of carbenicillin per ml, and 1 to 16 mug of erythromycin per ml. Elevated minimal inhibitory concentrations for penicillin and carbenicillin were noted for the three ampicillin-resistant strains. Tests for beta-lactamase production demonstrated the presence of this enzyme in each of the three ampicillin-resistant strains.


[Erythematodes and nervous system (author's transl)].

Lupus erythematodes is related to the vegetative nervous system in Raynaud's disease, the butterfly distribution in the face, the involvement of the lateral part of the eyebrows (Hertoghe) and in cerebral attacks. Involvement of peripheral and central animal nervous systems is common and produces primary and secondary syndromes. Prominent are polymyositis or lupus-myopathy, in the brain mainly functional psychoses, epileptiform attacks, and a variety of focal, often very massive, signs. There are very clear differences from the neurologic signs of dermatomyositis, less so from arteritis nodosa and even less from progressive sclerodermia. Peripheral neurologic syndromes in lupus erythematosus are less common and more subtle than in arteritis nodosa. Bio-electric parameters of the petitmal-trias have been found. The relative absence of collagenoses from the spinal cord is also noticed in lupus erythematosus. Signs of involvement here appear to be limited and often subacute. Differential diagnosis has to consider many neurologic diseases, a special problem when MS is simulated just as in sclerodermia. Since cerbral attacks appear early in about 5%, the use of anticonvulsive drugs, particularly of the hydantoin group, provides special problems. Signs of myasthenia demand further attention. The neuropathologic changes are known in essential points and can obviously hardly be mistaken for inflammatory processes due to other causes. Certain basic facts appear to apply to other collagenoses. All 4 "grand" or "classic" collagen diseases are very similar and have much in common, but also show more or less definite differences. This is true for their clinical and anatomical appearance and last but not least to their neurologic aspects. The "roof-concept" of Collagenosis" is once more proved to be justified. As far as is known today the autonomic system plays a decisive and obligatory role only is sclerodermia. This syndrome is also the only one which contains the odd phenomenon of atrophy of which the best-known form is facial hemia-atrophy.


[Computerized tomographic diagnosis of the brain: addition of frontal and clivo-parallel cuts to the transverse standard cuts (author's transl)].

The data of now available transverse cut are insufficient for spatial orientation. Using a special technique, frontal and clivo-parallel cuts will provide satisfactory diagnostik detail. The often difficult differentiation between vertically adjoining or commmunicating structures will be facilitated by frontal tomography. Clivo-tangential cuts show the maximum of clivus and dorsum sellae, also the brainstem with axis-parallel transverse cuts. An approximately clivo-parallel cut in the aqueduct the 4th ventricle is longitudinally cut with influx and limited only partially in axis-parallel tomograms because of weak definition in the direction of the Z axis and the variable anatomic and geomtric relations. Pneumo-encephalography and ventriculography cannot be done without. So far in space-occupying lesions clivo parallel cuts are diagnostically valuable near the brainstem, the aqueduct and the 4th ventricle.


[Oral contraceptives--indications and neurological complications (author's transl)].

The influence of oral contraceptive agents on neurologic diseases in not clear. Animal experiments suggest that estrogens lower the seizure threshold whereas gestagens have the opposite effect. In women with epilepsy no change in the pattern of attacks could be observed under oral contraceptives. The inducing effect of hydantions and barbiturates on drug metabolizing enzymes requires the prescription of higher doses of estrogens and gestagens. Otherwise unwanted pregnancy can result, an especially unfavourable event in regard to the teratogenicity of hydantoins and barbiturates and possibly or oral contraceptives, too. An immunosuppressive effect of oral contraceptives - found in animals with EAE--could be favourable in respect to the disturbed immune mechanism of patients with multiple sclerosis and myasthenia. The influence of oral contraceptives on migraine seems to vary. The risk of arterial cerebral thromboembolic disease is increased in women taking oral contraceptives. The correlation to the estrogen content of the drugs remains to be proved.


[Treatment of manic psychosis with clozapine (author's transl)].

Between January 1974 and June 1975 52 in-patients with mania were treated with Clozapine. In one half of the patients this was the only drug throughout. It was so far thought to be indicated mainly for schizophrenics. Its main action mostly was immediate (partly on the first or second day) and was characterised by initial sedation and subsequent improvement of increased motivation and flight of ideas. On the basis of our present experience Clozapine appears to be superior in the treatment of mania in its main and side effects. Patients prefer it often because of the absence of extrapyramidal side-effects. The in-patient treatment was on average much shorter with Clozapine than with other drugs. These first observations demand further tests for this specific indication.


Barker (neonatal respiratory distress) syndrome in the pig: the ultrastructural pathology of the lung.

The ultrastructural pathology of the lung of a naturally occurring, fatal respiratory distress syndrome of the newborn piglet is described. The pulmonary lesions are characterised by immaturity of the distal airways and of alveoli; by severe alveolar epithelial hyperplasia and hypertrophy; by increased width of the blood to air barrier; by alveolar and bronchiolar epithelial degeneration and separation; by the production of alveolar and bronchiolar hyaline membranes and by alveolar haemorrhage and alveolar and peribronchial oedema. Many of the hyperplastic cells of the alveolar epithelium are pyramidal, rest on a basement membrane, have microvilli on their luminal surfaces, form tight junctions with their neighbours and contain reduced numbers of lamellated electron-dense inclusion in the cytoplasm. These cells are dystrophic type 2 pneumocytes. Other hyperplastic alveolar epithelial cells have some of these features and may be type 1 or type 2 pneumocytes. Both types contain large amounts of cytoplasmic carbohydrate material and are deficient in lamellated inclusions associated with type 2 pneumocytes of normal piglets. Increase in the thickness of the blood to air barrier from 0-22 micron to 0-55 micron in normal to 0-50 micron to 2-33 micron in moderately affected piglets, or to a maximum of 12 micron in severely affected piglets, was associated with increasing respiratory distress. Hyaline membranes were composed of epithelial cellular debris from saccular and bronchiolar epithelium. The reduction in size and number of the specific lamellated cytoplasmic inclusions of type 2 pneumocytes in affected lungs was correlated with biochemical findings of increased surface tension and reduced phospholip and lecithin contents of lung washings.


Liquid crystal electromagnetic radiation monitor.

Liquid Crystals having color play centered at different temperatures are arranged on metal coated and nonmetal coated dielectric substrates and used to monitor electromagnetic radiation. While both substrates respond to changes in ambient temperature conditions, the metallized substrate will also have temperature changes due to absorbed radiation. The temperature-dependent light scattering properties of the liquid crystals are used as both the temperature measuring mechanism and the indicating mechanism, with the difference between the temperature indications of the two substrates being a measure of the radiation. An experimental model that measures radiation of 1 to 15 mW/cm2 at 2.45 GHz is described.


Heat-dissipation rate of mice after microwave irradiation.

The heat dissipation rate from individual CF1 male mice was determined by a bio-calorimeter before and after exposure to microwave radiation. The animals were irradiated singly in an environmentally-controlled waveguide apparatus with 2450 MHz CW microwave radiation. The incident power levels were 0 (sham), 0.4, 0.8, 1.7 and 3.3 W, which resulted in corresponding mean average absorbed dose rates of 0 (sham), 7, 12, 27 and 39 mW/g. The environmental conditions were 24 degrees C temperature, and 50% relative humidity. The results indicate an increased heat-dissipation rate of the animals (compared to sham) for average absorbed dose rates above 12 mW/g.


[Determination of penicillinase activity and its genetic location in penicillin resistant Staphylococcus aureus strains].

The penicillinase activity and its genetic location in determined by osmotic shock method in the staph. aureus strains.


A new diabetic with complications: primary nursing care.

Martha, an elderly patient, presented a real challenge to our nursing staff. As a new diabetic, she needed a great deal of education in addition to extensive nursing care for her multiple bleeding leg ulcers, dehydration and malnutrition due to uncontrolled diabetes, and reactive depression. Despite these problems, in approximately one month's time Martha was able to return to her home in control of her diabetes and her emotions and ambulating without pain. Her successful return to normal life was enhanced by holistic nursing management. The nursing staff found that the use of a problem list and a diabetes educational plan assisted them in individualizing their patient care.


Student participation in diabetic patient education.

As described, students who have participated in this innovative curriculum are familiar with individualized instruction. These students are thus experientially equipped to carry out the tasks of individualized patient education in the clinical setting. In the learning module the students study beginning teaching-learning principles and basic concepts of adult education in conjunction with learning to care for patients with endocrine dysfunction who require education for adaptation. Through the experience of assessing, planning, and implementing their own teaching in collaboration with the primary nurse and physician, the students learn to incorporate appropriate teaching behaviors into their concept of nursing. It is hoped that this knowledge and experience will make student nurses more effective nursing practitioners. This achievement is of utmost value to the consumer of nursing care.


Diabetes management by the patient and a nurse practitioner.

Patients facing a lifelong disease condition need time and feedback from knowledgeable health professionals to achieve successful treatment compliance. Long-established behavior may need to be changed and the patient and his family need support during the process. Day-to-day problems must be viewed as important and time must be taken to help the patient find acceptable therapeutic solutions. Establishing the diagnosis of diabetes and prescribing diet and medications are only the beginning of a time-consuming, difficult educational process for the patient. Unfortunately, most health care resources are directed to the patient. Unfortunately, most health care resources are directed to the initial diagnosis and treatment or the treatment of complications. Many dollars may be saved and the patient may have a better chance at a more normal life if some time and effort are directed to making him a more knowledgeable therapeutic agent.


The Somogyi phenomenon in insulin-dependent diabetics.

Insulin-dependent diabetics at times of changing stress levels require alterations in their insulin dosage. Determination of the required insulin dosage is not a precise science. At these times, the diabetic may experience insulin overdosage with a resulting rebounding hyperglycemia (Somogyi phenomenon). Adequate data collection and a systematic approach to documentation of the data by either the nurse or the patient will provide both the physician and the nurse with the means to recognize the occurrence of the Somogyi phenomenon. The author recommends a tool that can be used to enhance recognition of the occurrence and provide clinical criteria to evaluate its presence.


An eclectic approach to parent group education.

Many factors contribute to a need for parent education today. Parent education has changed over the past centuries as a result of our changing values, our increasing knowledge base, and changes in family structure. The parent education group attempts to meet the parents' need to validate their concerns and offer them process and skills that promote mental health in children. Two popular models of parent education, the reflective model and the behavioral model, stem from two schools of psychologic thought-the phenomenologic school and the behavioral school. Because of the weaknesses and strengths of each model, an eclectic model of parent education is proposed which facilitates an authoritative patern of parenting correlated with self-reliant, explorative, and self-controlled children. This eclectic model of parent education is perceived as being within the role description of the generalist nurse who has access to back-up specialists in the health care system. Many opportunities exist for the nurse to offer this type of health education.


Mothering.

One can conclude that mothering as an essential component of family life will not be abolished. Attention to the skill and personal dimensions of the mothering role will insure the maintenance and growth of this valuable institution. The time has come for nurses to design strategies that liberate mothers from a restrictive position while promoting effective mothering, personal growth, and societal change.


Pelviperitonitis and bacteremia due to Bacteroides splanchnicus. Report of a case.

A case of pelviperitonitis and bacteremia due to Bacteroides splanchnicus is discussed. It occurred in a 56 year old obese woman who had a history of cholelithiasis and of asymptomatic myomatous uterus. B. splanchnicus was isolated from a blood sample drawn on admission, and from peritoneal pus found at laparotomy on the 11th hospital day. In the latter sample, the strain was associated to Proteus mirabilis. The organism was sensitive to all ten antibiotics tested, including penicillin G. Aminoglycosides were not studied. The patient, who received ampicillin made an uneventful recovery after cholecystectom and peritoneal drainage.


Mediastinal emphysema in mountain climbers: report of two cases and review.

Two cases of mediastinal emphysema occurring in healthy individuals climbing to the summit of Mount Rainier (4,393 m.) are described. In both, the condition was probably attributable to a voluntary, forced pressure breathing technique--a modified Valsalva maneuver. The various circumstances in which mediastinal emphysema may occur are discussed, along with its possible serious complication of cardiorespiratory compromise. The means of diagnosis are presented, emphasizing that cases in which the important finding of subcutaneous emphysema is absent may be those in which the danger is greatest. Therapeutic measures that occasionally may be necessary are outlined, though the condition is usually a benign one that subsides without specific treatment.


Laboratory studies on mecillinam: activity alone and combined with cephradine.

Mecillinam (MC) was found to be inhibitory at low concentrations to a wide range of Gram-negative bacteria; the sensitivity of such strains could be predicted by using a 10 microgram disk. Resistance to MC did not appear to be associated with beta-lactamase-mediated destruction of the antibiotic. Ampicillin-resistant strains tended to be less sensitive to MC. MC and cephradine acted synergistically against Proteus mirabilis, Pr. vulgaris, Prov. stuartii and Serratia marcescens, and the combination was additive against most Klebsiella aerogenes, Enterobacter spp. and Escherichia coli.


Infective endocarditis: a current review.

Infective endocarditis is a dynamic disease for which various infective organisms may be responsible in different patient populations. Antimicrobial therapy should be directed against the specific organism after it has been identified by blood culture. An agent with a spectrum that includes the enterococci should be given in the meantime. Prophylactic use of a bactericidal agent is necessary for patients with valvular or congenital heart disease. Recent advances in microbiologic and cardiac diagnostic procedures offer the clinician various methods of following the activity of the disease, and immunobiology has provided new insights into its pathogenesis.


Viral chemotherapy.

New antiviral compounds are being tested constantly and may be of considerable value with increasing availability. More than 200 analogues of purines and pyrimidines have been found to inhibit DNA and RNA viruses. Adenine arabinoside is most effective against disseminated herpes simplex virus and disseminated herpes zoster. Idoxuridine is useful in treatment of herpetic keratitis. Interferon still is in the experimental stage, and, because of its short half-life and high cost, it probably will not be released in the near future. Amantadine appears to be useful in prevention of A2 influenza, but its value against swine flu has not been established. Methisazone is effective in prevention of smallpox and in the treatment of complications of vaccinia.


Nosocomial infections.

The frequency of nosocomial infection is increasing. The most common sites of such infection are the urinary tract, surgical wounds, the lower part of the respiratory tract, and the skin and subcutaneous tissues. Various techniques are available for prevention of nosocomial infections, but among the most important aspects are understanding and acceptance of responsibility by hospital personnel. The establishment of a surveillance system with a nurse epidemiologist to serve as liaison and educator among professional and ancillary groups within the hospital may be hard to justify on a cost basis to hospital administrators but is important in the control of nosocomial infections.


Granulocyte transfusion therapy: experimental basis and clinical applications.

Granulocyte replacement therapy for the infected patient with severe neutropenia is effective in improving the short-term and possibly the long-term prognosis. The best methods of procuring and administering granulocytes still are under investigation, and no reliable method for predicting compatibility has been developed. At present granulocyte transfusion therapy is indicated for severely neutropenic patients with documented infection as an adjunct to antibiotic therapy. It should be used only at institutions that offer the necessary professional and technical skills to minimize danger and discomfort to both donor and recipient as well as the expense of the treatment.


Rational antimicrobial therapy.

Rational antimicrobial therapy depends on the identity of the causative organisms, the location of the infection, and the condition of the host. Selection of antimicrobial therapy is often started before identification of the causative organism is complete. Certain cultural and staining procedures must be instigated prior to therapy in order to isolate the causative organism. Knowledge of the host's physiologic state is necessary to minimize toxicities and/or failures of therapy. Knowledge of synergistic and antagonistic actions of some antimicrobial agents is necessary for optimal results.


Conceptualization: knowledge and logic guiding empirical research.

This article analyzes functions and processes of research conceptualization. The most prevailing limitation of nursing research, as represented in its published literature, concerns the relevant use of knowledge and logic for the formulation of that which is to be studied. To that end, the components of the conceptual phase of research, as they develop progressively from the initiating question through the stipulation of the specific purpose of a study, are discussed. For each component emphasis is given to the function served by past knowledge toward the generation of new knowledge.


Documented clinical experiences of primary care RN students: a preliminary report.

A student-patient encounter form was developed for documenting patients' visits in the practicums of three primary care courses--obstetric-gynecology, pediatrics, and general adult patients--and from January 1973 to June 1974, 22 registered nurse students completed 1,027 student-patient encounter forms. Health problems were identified, using the Weed system and classified by the International Classification of Disease adapted for use in the United States. The study demonstrated that the encounter form facilitated the documentation of base-line data for student practicums. Preliminary analysis of the data revealed that: 1) health problems of patients classified as "without sickness" were important in the case loads of registered nurse students in obstetric-gynecologic and pediatric practicums; 2) health problems of patients classified as "symptoms of ill-defined conditions" were also important in all three student practicums, particularly with general adult patients: and 3) students encountered a cluster of health problems in dealing with patients in the three practicums. The study suggested a need to develop a classification scheme for health problems encountered in primary care nursing services.


Nurse role conception.

The Corwin (1960) scale measuring role conception and role deprivation was compared with a newly devised instrument that measures bureaucratic, professional, and service-traditional role concepts. Although further work remains to be done on the new scale, role conceptions of nurses in the 1970s are different from those in the 1950s.


Evaluation of developmental health counseling: healthfulness of self-support behavior.

Twenty-two adult patients in a long-term illness clinic who chose not to attend a group counseling project on self support and who were matched on age and education with those who did attend were selected for the purpose of investigating the relationship between their general adjustment and two potentially interrealted types of behavior: self-support behavior and fundamental interpersonal behavior. General adjustment was the sum of scores from Bell's Adjustment Inventory on emotional and home disturbances plus the number of diagnosed problems on the master list in the patient record. Self-support was the amount of use of usual ways of interacting taught in counseling to elicit from others ideas for solution of problems and to elicit from self the incentive to implement solutions. Fundamental interpersonal behavior was individual and combined scores on Schutz's FIRO-B test of self-perceived interpersonal behavior expressed by the self along the dimensions of inclusion, affection, and control. Two-way orthogonal analysis of variance revealed two sets of behavior significantly improved general adjustment: 1) inclusion, affection, and control, and 2) control and self-support.


Adrenergic mechanisms in the hepatic microcirculation in the rat.

The in vivo hepatic microvascular bed of the rat was observed microscopically in the transilluminated liver and the diameter of the hepatic sinusoids was measured by serial photomicrography. Intraportal infusion of tyramine induced concentration-dependent constriction of the hepatic sinusoids, but also dilatation of the sinusoids when the dose was small. These effects were attributed to the release of endogenous noradrenaline which activated either alpha- or beta-adrenergic receptors and caused constriction, or dilatation, of the sinusoids respectively. Adrenaline and noradrenaline induced similar changes in the hepatic sinusoids as tyramine, while phenoxybenzamine induced dilatation, and propranolol constriction, of the sinusoids. All the above responses were abolished by pretreatment with reserpine. A possible noradrenaline-mediated basal vasomotor tone in the hepatic sinusoids for autonomic control of the blood flow in the sinusoids was postulated.


The absorption of phenformin and its effects on glucose and water absorption in isolated perfused rat small intestine.

The effects of phenformin on glucose and water absorption from isolated perfused rat small intestine were studied. Luminal phenformin inhibited glocose and water absorption progressively as its concentration was increased from 0-1-1-0 mg.ml-1. At 0-5 mg phenformin ml-1, inhibition increased with time of exposure to phenformin up to 15 min and thereafter remained constant. Arterial infusion of phenformin (1-0 mg-ml-1) produced less inhibition of glucose and water absorption. The site of phenformin's action appeared to be intracellular. Phenformin absorption from a luminal perfusate (0-5 mg-ml-1) was measured. Although it was rapidly absorbed (22 microgram.cm intestine-1.h-1) from the lumen, less than 2 microgram.cm-1.h-1 appeared at the serosal surface of the intestine. In subsequent phenformin-free perfusion, only 25% of the absorbed phenformin was recovered in the luminal and serosal effluents.


Synthesis of collagen by smooth muscle in the hyertrophic intestine.

During hypertrophy of the small intestine of the guinea-pig at the oral side of an experimental stenosis, the individual intestinal segments do not increase in length but undergo a remarkable increase in weight (up to 7 times that of control segments). Concomitantly an increase in collagen content is found; this is usually larger than the increase in weight, and the concentration of collagen is therefore also increased. This effect is more noticeable in the muscle coat than in the wall as a whole. It is suggested, on the basis of histological observations, that some of this collagen is synthesized by smooth muscle cells.


The metabolic response to exercise in chronic alcoholics.

The metabolic response to steady exercise was studied in six chronic alcoholics and six normal control subjects. Higher concentrations of lactated and pyruvate were observed in the alcoholics during exercise and they also developed post-exercise ketosis. These changes were probably not due to reduced fitness of the alcoholics as the heart rates of both groups were similar. Alcoholics had lower levels of growth hormone during exercise compared with the controls suggesting that chronic alcohol consumption has a depressor effect on pathways regulating the release of growth hormone.


[Esophageal rupture].

Instrumental injuries of the healthy esophageal wall occur frequently due to esophagoscope are observed in the upper parts of the esophagus, have a lineal form and large sizes. Instrumental, frequently by bougie, injuries of the esophagus altered by scars are of a smaller size, round shape and localize in the thoracic part of the esophagus, frequently between two strictures. Foreign bodies in the esophagus produce defects of small sizes, as a rule, in the upper part of the esophagus, and numerous abrasions and hemorrhages in the mucous membrane. Wall ruptures under the influence of the hydraulic factor are of large sizes, observed in the thoracic or abdominal parts of the esophagus in patients with its pre-existing alterations. Perforating breaks in the esophagus wall favour early development of mediastinitis.


[Pathological anatomy of the post-thrombophlebitic syndrome].

In the post-thrombophlebitis syndrome (PTPS) of the lower extremities pathomorphological changes develop in deep magistral venous trunks, communicating and surface veins, and microcirculation tracts. On the basis of the study on 90 cases of PTPS the following variants of morphological alterations in femoral veins as the most frequently affected segment in deep thrombophlebites were observed: complete restoration of the venous lumen but with the wall sclerosis muscle element atrophy, and loss of the valvular apparatus; partial restoration of the lumen on account of thrombus canalization; complete occlusion of the lumen on account of thrombosis and rethrombosis. Pathomorphological lesions of communicating ans surface veins and microcirculatory bed depend upon the features of lesions in magistral veins and result in the development of chronic venous insufficiency with the syndrome of regional capillary trophic changes leading to edema, dystrophic, necrobiotic, and sclerotic lesions.


[Kidney tubule changes in the terminal stage of chronic glomerulonephritis].

The autopsy material was used for histological and histochemical study of lesions in tubules of the kidneys in chronic glomerulonephritis in comparison with those in acute renal insuffuciency (ARI) of various etiologies. In addition to the phenomena of intracellular regeneration in tubules of the functioning nephrons with formations of nephromas and tubule atrophy in the zone of glomerular sclerosis, some observations showed signs of insufficiency of cortical circulation. They were manifested in dystrophy of the proximal segment epithelium. Dystrophic changes are followed by regeneration which occurs at different times and runs an irregular course. Changes in the tubules are similar to those observed in the oligo-anuria stage of ARI. When cortical circulation is not compensated, paresis and collateral insufficiency develop. Small cortical necroses may be formed. All these changes, when they occur in extracapillary proliferation, may be manifested by the clinical symptocomplex of acute renal insufficiency.


[Free cation protein secreted by gastric epithelium as an ingredient of the alkaline component of gastric juice].

The results of the study suggest that the secrete of the gastric lining epithelium of man and dog contains a free cation protein which is a macromolecular ingredient of the alkaline component of gastric juice. Under conditions of increasing and persisting hypersecretion of the acid, first the surface and then the pit epithelium increasingly secrete cation protein, and in the gastric juice an increased content of the alkaline component is detected. Subsequently, with persisting hypersecretion, the synthesizing capacity of the epithelial cells is exhausted and this is accompanied by a deficiency of the alkaline component in gastric juice.


[Ultrastructure of the bone marrow cells after 85Sr incorporation].

Ultrastructural manifestations of the reaction of the rat bone marrow cells to incorporation of the osteotropic isotope 85Sr in doses of 15 and 150 muCi/100 g of body weight were studied in the electron microscope. It was found that ultrastructures were affected mostly in unidentifiable, blast cells and cells from the reproduction-maturation pool of the myeloid and erythroid series as well as lymphocytes. The lesions consisted in focal cchanges of chromatin and interchromatin structures of the nucleus, nuclear envelope membranes, nucleoli, mitochondrial membranes, endoplasmic reticulum, and plasma membrane. The dynamics of these changes in relation to the time of exposure and irradiation dose were followed.


[Emergency histocytological examination of the internal organs and tumors].

A method for urgent histocytological examination of the internal organs at autopsies and urgent biopsies is offered which is a useful addition to the routine histological examination. The method is based on the preparation of an emulsion from the organ tissue, staining it without preliminary fixation, and examination after pressing with a cover slip or in dried smears after poststaining. This method of specimen treatment is simple, time-saving, needs no freezing microtome. Preparations can be made in 3-5 minutes.


[Method of microphotoexposure].

It is suggested that a photoexposure meter "Photon-1" (TU-4-72) be used for the determination of exposure in microphotography. The photoelement of the apparatus is overlaid on the eyepiece of the photo device. The regulator of the apparatus is set in a position corresponding to the film sensitivity. The exposure meter shows exposure time in seconds.


[Cavernous hemangiomas of the skull. Clinical, radiological and therapeutical aspects].

A series of 26 cases of hemangioma of the skull and review the literature are reported. The frontal localization was most frequent, contrary to the data of the literature suggesting the predominance of the parietal localization. The reported predominance of females has not been confirmed. In the present series the relation of males to females was 17:9. The radiological findings and treatment of hemangiomas are discussed. Direct puncture and injection of contrast medium is the best method for the visualization of the tumor. Treatment should be surgical consisting of total extirpation of the tumor with a margin of the healthy tissues. Direct extirpation is indicated only when soft-tissues are involved and there is no bone lesion. The en-bloque method is the technique of choice.


A congenital myopathy of unknown origin.

Parallel with the clinical and histochemical investigations, an ultrastructural examination of a muscle biopsy specimen was made, in order to detect any slight cellular alterations which cannot possibly be discovered through any other methods, and to identify a muscle disease of unknown origin.


Low-level electrical currents and brain indicators of behavioral activation.

Distinguishing between slow brain potential correlates of arousal and activation on the basis of their functional role and temporal involvement during a reaction-time task, data are presented which suggest that weak electrical polarizing currents applied to the head in human subjects modify predominantly activation indicators rather than arousal ones.


[Mycoses of the central nervous system. Anatomopathological data of cryptococcosis and cerebral aspergillosis].

The pathological findings of the cerebral involvement in deep-seated fungal infections in routine autopsy is reported. In 42 cases of mycotic infections studied among 3.966 autopsies, there were 8 cases of cryptococcosis and 2 of aspergillosis of the brain, showing a very low frequency of central nervous system involvement, occurring in a proportion of 1:400 autopsies. The histopathological findings of the brain in cases of cryptococcosis showed the spectrum of inflammatory reactions already described, although most of the cases presented with mild to severe meningitis with large number of giant cells, and slight degree of involvement of the nervous tissue. The cases of aspergillosis showed a pattern of severe necrotizing meningo-encephalitis with large number of fungi. The paper points out the role of the histological examination in the identification of the fungi in tissues and their morphologic reactions.


[Speech therapy in aphasia].

The speech therapy in fifteen aphasic patients was studied. The group consisted of 8 male and 7 female patients and their ages ranged from less than ten to more than fifty years. In eleven cases the aphasia was due to cerebrovascular disease and in the remaining four cases to traumatic injury to the brain. Predominantly expressive aphasia accounted for five patients while in the others a comparable degree of receptive and expressive deficits existed. Six patients had their therapy programme started within the first three months after the acute phase and the rest of the group started it after more time had elapsed. Eleven patients showed a satisfactory recovery regardless the inicial deficit severity, the patients age, the pathology of the lesion or the period of time which elapsed from the beginning of the disease to the start of the therapy. The speech therapy in aphasic patients is effective although a firm prognosis cannot be established at the beginning of the programme. Useful information concerning prognosis only can be taken from the follow-up and after thoroughly retesting the patients.


[Bacterial meningitis in the newborn. Study of 20 cases].

The cases of 20 patients admitted with purulent meningitis in the neonatal period are reported. The authors analyse the importance in recognizing the minimal signals and symptoms, as weel as the clinical patterns of the manifested disease; Some considerations are draw about the values of the early diagnostic before the high incidence of mortality and the gravity of sequaele that occur besides the high doses and long term antimicrobial therapy.


[Clinico-quatitative evaluation of the action of Ciba 34.647-Ba on spasticity].

Using the clinical quantification of the neurologic symptomatology the authors made observations and avaliated the action of Ciba 34.647-Ba, a GABA derivative, in 12 patients suffering from spasticity and motor incapacity due to spinal cord lesions. The results are reported emphasizing the effects of the drug on the main components of spasticity (hypertonus, hyperactivity of the deep reflexes, clonus and automatisms). Some theories explaining the mechanism of action of the drug are mentioned. References are made about doses, duration of action, tolerance and side-effects.


[Meningitis caused by primary lymphoma of the central nervous system. Report of a case].

The case of a 17 years-old woman, with clinical findings of meningites, without identification of a pathogenic agent is reported. The pacient received treatment for tuberculous and fungi meningitis. In the clinical course were found neoplastic cells in the spinal fluid. Despite the radiologic investigation, the original site of the tumor was not found in life. In the post-mortem examination, a small tumor was discovered in the 4th ventricle. The hystologic examination revealed a primary central nervous system lymphoma, diffuse infiltration of the meninges by tumor cells and proliferation into the central nervous system through the Virchow-Robin space. The clinical course, laboratory investigation and anatomical findings of the tumor are presented. A short revision about the pathogenesis of neoplastic meningites and primary central nervous system lymphoma is made.


Sensorimotor stroke due to thalamocapsular ischemia.

A 61-year-old hypertensive diabetic man awoke with a numb, heavy right arm and leg; symptoms progressed within 30 hours to a dense right hemisensory syndrome involving head, face, trunk, arm, and leg, accompanied by a right hemiparesis, involving tongue, face, arm, and leg with extensor plantar response, leaving him barely able to move the arm and leg against gravity. No impairment in alertness, memory, language, praxic, or visual functions was evident at any time. Improvement in motor function began in 24 hours and progressed to walking status by discharge on day 23. Eight days passed before the sensory deficit showed improvement, and it was still prominent at discharge. Autopsy three months later showed a 4 X 2 X 4-mm lacune in the ventral posterior nucleus of the left thalamus, with a zone of pallor on stained microscopic sections extending into the immediately adjacent posterior limb of the internal capsule. This case appears to be unique in that a sensorimotor stroke has been produced by a confirmed thalamocapsular infarct.


The invasive pituitary adenoma. A prolactin-producing tumor.

Invasive pituitary adenoma was diagnosed by means of a transnasal aspiration biopsy method in 11 patients with extensive destruction of bone in the sellar region. In most cases the initial symptoms were decrease of libido and potency or amenorrhea-galactorrhea. Later, chiasmatic compression developed in six patients, ocular motor signs in two, and epilepsy in two. Most of the patients had symptoms for many years; in two, the tumor was discovered by chance. They all had very high serum-prolactin values. The patients were treated with irradiation, and the prognosis seems to be relatively favorable.


Posttraumatic cerebral hemispheric disconnection syndrome.

Gross and microscopic lesions of the corpus callosum and neighboring structures are common in severe closed head injury. This report is the first, to our knowledge, to confirm neuropathologically the occurrence of extensive traumatic destruction of the corpus callosum in a patient with left-sided apraxia and agraphia. It also demonstrates that large traumatic lesions of the corpus callosum may occur without prolonged posttraumatic coma, vegetative state, or death. In our patient, coexisting extracallosal hemispheric lesions may have modified the effects of callosal pathology. Cases of this type may be more common than generally appreciated, but since symptoms of hemispheric disconnection are not apparent in ordinary behavior, specific tests of callosal function must be employed if disconnection phenomena are to be detected in the posttraumatic period.


Juvenile diabetes mellitus and optic atrophy.

Nine patients with the syndrome of juvenile diabetes mellitus and optic atrophy exemplified the wide range of manifestations of this syndrome. The disease may occur as a recessively inherited or sporadic disorder and tends to have multi-system involvement. Hearing loss, diabetes insipidus, and evidence of cerebellar or central vesitbulo-ocular dysfunction are common.


Crossed aphasia in a Chinese bilingual dextral.

A persistent nonfluent aphasia following a right cerebral infarction developed in a 54-year-old right-handed Chinese man. Computerized axial tomography localized the lesion in the distribution of the right middle cerebral artery. The speech and language dysfunction was greater for performances in Chinese than in English, despite the fact that the patient was born in China, was schooled in Chinese until age 7, and spoke Chinese at home and in his business. It is suggested that early learning of Chinese, an ideographic language based on visual spatial percepts, might have been critical for the establishment and maintenance of language dominance in the right hemisphere.


Cervical spondylotic myelopathy with reversible fasciculations in the lower extremities.

Cervical spondylosis and motor system disease can appear in a similar manner with upper and lower motor neuron signs. Four patients with spasticity and fasciculations in the upper and lower extremities had surgical decompression for cervical spondylosis. Postoperative examinations at 24 to 48 months, including electromyographic studies, disclosed neurological improvement in all patients and loss of fasciculations in the lower extremities in three. Three mechanisms by which cervical spondylosis might cause fasciculations in the lower extremities are vascular insufficiency, cord traction, and denervation.


Intrauterine chronic subdural hematoma.

We discuss a newborn delivered by elective cesarean section who had macrocephaly with severe anemia. The anemia was corrected by exchange transfusion, and the infant, at first, appeared stable but manifested poor feeding and seizures. Transillumination of the skull was negative, although the anterior fontanel was tense. Computerized tomography demonstrated mild hydrocephalus and suggested subdural fluid. Bilateral subdural taps yielded fluid typical for chronic subdural hematoma. To our knowledge, this is the first documented case of intrauterine subdural hematoma developing in the absence of trauma. An analogy is made to the pathogenesis of subdural hematoma after rapid decompression of the ventricular system by shunting procedures for obstructive hydrocephalus.


Muscle-type phosphorylase activity present in muscle cells cultured from three patients with myophosphorylase deficiency.

Skeletal muscle fibers cultured from three patients whose mature fibers are deficient in glycogen myophosphorylase (EC 2.4.1.1) were shown to become rather mature, to have no excessive glycogen accumulation, and to develop signifcant myophosphorylase activity. That activity was characterized electrophoretically and immunologically and shown to be muscle phosphorylase rather than a genetically different type, thereby demonstrating true "rejuvenation" in culture of an enzyme genetically programmed ultimately to be deficient.


Lymphomatoid granulomatosis clinically confined to the CNS. A case report.

A 38-year-old man developed pain and peripheral-type weakness on the right side of his face and was discovered to have decreased hearing bilaterally, as well as optic nerve swelling on the right. The pain and optic nerve swelling subsided over a period of six weeks, but hearing loss and facial weakness persisted. Thirty months later, he developed dysphagia, ataxia, dysarthria, nystagmus, and progressive spastic quadriparesis. He died approximately four years after the onset of the illness. Although no evidence of disease was found other than in the central nervous system during life, two nodules in the right lower lung were found on autopsy. The examination of these nodules, as well as the brain stem, showed an angiocentric and angionecrotic process with lymphoreticular and plasmacytoid invasion.


Syphilitic meningomyelitis. A case report.

A 58-year-old man was admitted with a progressive, subacute asymmetrical paraparesis. The patient denied a previous syphilitic infection, but spinal fluid examination disclosed a lymphocytic pleocytosis, hypoglycorrhachia, and a positive serologic test for syphills. Clinical improvement resulted from a 14-day course of penicillin. Syphilitic involvement of the nervous system appears to be increasing in the United States and should be included in the differential diagnosis of progressive paraparesis.


Radicular compression in multifocal eosinophilic granuloma. Successful treatment with radiotherapy.

A 7-year-old boy with previously diagnosed multifocal eosinophilic granuloma displayed signs and symptoms of a cervical radiculopathy. After myelograpic demonstration of extradural compression, corticosteroid and radiation therapy produced rapid and complete resolution of his symptoms. We suggest that more discrete classification of the "xanthomatoses" of the neurologic literature may provide the basis for choosing nonsurgical intervention in selected cases.


The nerve fiber layer in the diagnosis of glaucoma.

Serial fundus photographs of 14 eyes that eventually developed glaucomatous visual field defects and 110 slides from 76 eyes of race- and age-matched controls were reviewed in randomized masked fashion. Each eye that lost visual field demonstrated consistent abnormalities of the nerve fiber layer, beginning as early as 5 years (mean, 1 1/2 years) before it developed glaucomatous visual field defects on routine Goldmann perimetry. Preliminary estimates, based on regression analysis of this small series, suggest that half of these eyes (median) might demonstrate such reproducible abnormalities between four and six years before onset of their visual field defects. Only 9% of the matched controls showed similar nerve fiber layer changes, and in the one instance where analysis was possible, these were inconsistent and nonreproducible. Nerve fiber layer assessment by means of fundus photographs may be the earliest, surest means of distinguishing ocular hypertension from true glaucoma.


Dipivefrin use in patients with intolerance to topically applied epinephrine.

Twelve patients who had previously demonstrated an intolerance to topically applied epinephrine received dipivefrin 0.1% in one eye and epinephrine 2% in the other eye. An adverse reaction occurred in only one eye (8%) receiving dipivefrin, but in ten (83%) on epinephrine. Topical dipivefrin 0.1% proved useful for lowering intraocular pressure in patients intolerant to topically applied epinephrine.


Scanning microdensitometry of optic disc pallor in glaucoma.

A scanning microdensitometric technique has been developed for measuring the optical density of black and white photographs of the optic disc. From the frequency distribution curve of all the densities of the whole area of the optic disc, a separate peak was identified as corresponding to the area of pallor of the optic disc. Areas of pallor were measured as percentage of areas of the total disc for normal, ocular  hypertensive, open-angle glaucoma patients, and those with suspect discs. Median values of percent area of pallor showed correspondence with the clinical diagnosis, the glaucoma patients having significantly larger areas than the normal subjects. The microdensitometric technique provides an objective means of measuring the amount of optic dis pallor. It has potential usefulness for screening and for following up suspect and confirmed glaucomas to determine progression of the disease.


Specificity of fluorescein angiographic defects of the optic disc in glaucoma.

Fluorescein angiography of the optic disc was performed on normal subjects, patients with nonmyopic open-angle glaucoma dna myopic open-angle glaucoma, normal myopes, patients with optic atrophy due to chiasmal pituitary tumors, and patients with sectorial ischemic optic neuropathy due to vascular hypotension. The normal myopes, those with optic atrophy secondary to pituitary tumor, and the ischemic optic neuropathy group had optic discs similar in appearance to those with open-angle glaucoma. Absolute fluorescein filling defects occurred only in  patients with open-angle glaucoma and sectorial ischemic optic neuropathy. The filling defects in open-angle glaucoma appear to be specific, indicating that the blood supply to the anterior portion of the optic nerve is involved, as in ischemic optic neuropathy. Fluorescein angiography of the optic disc may be useful to differentiate open-angle glaucoma from other entities that have similar optic discs.


Optic nerve compression due to aneurysmal bone cyst.

A 10-year-old boy developed loss of central vision in both eyes due to compression of the optic nerves by a mass arising from the sphenoid and ethmoid sinuses. Histopathologic examination of biopsy specimens showed a fibrous matrix composed of spindle-shaped cells interspersed with small and large channels, characteristic of an aneurysmal bons cyst. One year after partial excision of the intracranial and extracranial portions fo the lesions, vision had returned to nearly normal levels. Aneurysmal bone cysts rarely involve the orbits or other cranial bones to produce ocular signs and symptoms. However, since this lesion probably represents reactive proliferation of bony tissues, rather than neoplasia, the prognosis for vision and life is good.


Suprasellar tumors and incidental optic disc anomalies. Diagnostic problems in two patients with hemianopic temporal scotomas.

Anomalous optic discs may be associated with relative temporal visual field defects that need to be distinguished from bitemporal field defects of chiasmal compression. Two patients with both anomalous discs and suprasellar tumors were hospitalized with temporal hemianopic scotomatous visual field defects. A 19-year-old woman with a chromophobe adenoma had a monocular temporal hemianopic scotoma in the eye exhibiting an inferior-nasal disc crescent. A 22-year-old man with a hypothalamic-chiasmal germinoma causing bitemporal hemianopic scotomas had minor disc colobomas bilaterally. Careful study of the optic discs and posterior fundus, as well as evaluation of the characteristics of the temporal field defects, should distinguish chiasmal compression in the occasional case where suprasellar tumor and anomalous optic discs coincide.


False-positive results with the radioactive phosphorus test.

A chorioretinal granuloma that contained acid-fast bacilli and a choriodal nevus that consisted of benign nevus cells yielded false-positive radioactive phosphorus tests. The beta  emission exceeded that of the control areas by more than 100% in each case. The granuloma had infiltrated the sclera, permitting inflammatory tissue to be in closer proximity to the counting probe than was the normal choroid. The reason for the increased metabolic activity of the nevus cells remains unexplained.


Neurotrophic corneal ulcers in diabetes mellitus.

Three patients with juvenile-onset insulin-dependent diabetes mellitus had neurotrophic keratitis and/or ulceration presumably related to their diabetes. We suggest that significant neurotrophic corneal disease can occur in diabetic patients. The neurotrophic keratitis and corneal ulcers responded to treatment.


Limbal dermoid with ectopic brain tissue. Report of a case and review of the literature.

An 11-year-old Iranian boy had limbal dermoid with ectopic brain tissue as evidenced by histopathologic study. We review the literature dealing with limbal and epibulbar dermoids and discuss the differential diagnosis.


Sebaceous adenocarcinoma of the eyelid. Definition of surgical margins.

Carcinoma of the sebaceous glands of the eyelid carries a serious prognosis. Although uncommon, the diagnosis must be frequently considered owing to the similarity of the early signs of adenocarcinoma to those of chalazion. Three cases with proved sebaceous adenocarcinoma of the eyelid are reviewed to relate subtle evidence of clinical and histopathological malignancy to surgical management.


An improved operating room demagnetizer.

An operating room demagnetizer that utilized a pulsed, smoothly decaying oscillating magnetic field is described. The instrument can demagnetize a number of surgical instruments at one time and can provide instantaneous and complete demagnetization.


Calmette-Guerin bacillus treatment of experimental conjunctival malignant melanoma.

Malignant melanoma of the conjunctival region was induced in the golden Syrian hamster. Inoculation of this lesion with Calmette-Guerin bacillus (BCG), 48 hours after injection of 10(3) tumor cells, either slowed, limited, or completely prevented the growth of the tumor in 56% of the treated eyes. In 98% of the control eyes, malignant melanoma grew rapidly and extensively.


Rabbit endothelial response to ophthalmic preservatives.

The endothelial surface of isolated rabbit corneas were perfused for three hours with varying concentrations of benzalkonium chloride and cetylpyridinium chloride. The threshold for physiological and ultrastructural alteration of corneal endothelium is approximately 0.0001% for benzalkonium chloride and 0.01 mM for cetylpyridinium chloride. The effects of the surfactants can be induced with as little as a 15-minute exposure without subsequent recovery. Use of ophthalmic medications or irrigating solutions containing these agents inside the eye is potentially hazardous to the corneal endothelium. Topical administration of 0.133% benzalkonium chloride to the anterior surface of deepithelialized in vivo corneas (five doses, seven minutes apart) caused no alterations of corneal endothelial cell function or ultrastructure.


Multielectrode intracochlear implants. Nerve survival and stimulation patterns.

A series of neurophysiological and anatomical experiments have been performed on cats implanted on a long-term basis with scala tympani electrodes. Auditory nerve survival was assessed for both neomycin sulfate-deafened and previously normal-hearing cats three weeks to 30 months after electrode implantation. Acute neurophysiological experiments were performed on nearly all of the cats and the spatial response to electrical stimulation was determined. The results of these experiments suggest that the auditory nerve can withstand surgical implantation and the long-term interface with scala tympani electrodes. In addition, restricted portions of the auditory nerve can be discretely excited with bipolar stimulation. Monopolar stimulation produced a very broad excitation pattern. These findings have important implications for the application of multielectrode prosthetic devices to the profoundly deaf.


Diaphoresis and Meniere's disease.

The effect of diaphoresis on patients with Meniere's disease (labyrinthine hydrops) previously has not been reported. With the use of two distinct activities to produce diaphoresis, we were able to document substantial transient improvements in pure-tone threshold, speech-reception threshold, and speech discrimination concurrent with a decrease in tinnitus and fullness in two patients with unilateral Meniere's disease that had been diagnosed previously by the glycerin test. The two diaphoretic activities were (1) strenuous exercise, including periodic visits to the sauna, and (2) passive activity consisting of repetitive visits to the sauna. Glycerin, an osmotic diuretic, produces similar temporary beneficial effects primarily in patients in the fluctuant hearing stage of Meniere's disease. The glycerin test is being used in several clinics as an adjunct for the diagnosis of endolymphatic hydrops.


The submandibular triangle in radical neck dissection.

Various modifications of the standard radical neck dissection operation have been advocated since its original description. An ideal operation would offer maximum cure rates with minimal cosmetic and functional disturbance. The validity of removing the submandibular triangle contents as part of radical neck dissection was studied by analyzing the involvement of this region by metastatic squamous cell carcinomas of the head and neck. Only three of the 51 neck-dissection specimens that were examined contained metastases to submandibular triangle lymph nodes. The primary sites were nose, floor of mouth, and retromolar trigone. None of the 26 laryngeal tumors in this series had spread to the submandibular triangle. In the absence of palpable submandibular or upper, deep cervical lymph nodes, the contents of the submandibular triangle can probably be left undisturbed in radical neck dissections for laryngeal cancer.


Etiology of the retraction pocket in the posterosuperior quadrant of the eardrum.

The tympanic membrane meets the posterosuperior bony canal wall at a wide angle and thus makes the posterosuperior quadrant of the eardrum the most vulnerable part against the thrust effect of the air column in the external auditory canal compared with the rest of the pars tensa. The air column thrust effect becomes active when there is a decrease in the middle ear pressure because of Eustachian tube obstruction. The medial displacement of the eardrum exposes the posterosuperior quadrant of the eardrum to the venturi effect in the isthmus tympanicus posticus and the region below. The retraction pocket is the end result.


Children's use of CROS hearing aids.

Ten children with unilateral hearing loss, aged 7 to 17 years, who were fit with contralateral routing of signal (CROS) hearing aids were followed up for three years to assess the suitability of this type of hearing aid fitting on children. The determination of the success of the fitting was based on follow-up visits, chart review, and response to a questionnaire sent to the parents. The fitting was considered to be successful if the child accepted the aid and if parents and teachers observed substantial improvement in academic performance and/or social behavior. Seven children were considered to be successful users of their CROS aids; one was unavailable for follow-up; one did better with a BICROS aid; and one did not do well with amplification. Our experience suggests that children with unilateral hearing loss can benefit from CROS amplification.